The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

Abstract

Although impressive progress has been made toward developing empirically-supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app-supported smartphone interventions are touted as a possible solution, access to up-to-date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta-analysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=-0.05, n=3), post-traumatic stress symptoms (g=0.18, n=4), and negative affect (g=-0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.

Opportunities From the Coronavirus Disease 2019 Pandemic for Transforming Psychiatric Care With Telehealth

“…6 Likewise, we know that smartphone apps can be useful tools for some patients, but their efficacy more than doubles when used with a clinician. 7 In terms of disaster responses, the actual evidence that can be incorporated into clinical guidance today is minimal, 1 highlighting the need for urgent research. Codifying current evidence in preliminary guidelines and expanding research on real-world implementation and effectiveness will ensure the digital health tools are optimally used.…”

Three Questions to Consider Before Applying Ecological Momentary Interventions (EMI) in Psychiatry

“…Thus, the generalizability of these findings is questionable. A meta-analysis by Linardon et al (4) included more data and a statistical analysis of effect sizes. Based on 66 RCTs of mental health EMI applications in clinical and nonclinical samples, they reported a reduction of stress and depressive and anxiety symptoms with small to medium effects (Hedge's g between 0.28 and 0.58).…”

“…The umbrella term Ecological Momentary Intervention (EMI) labels a group of methods that provide clinical treatment via mobile devices in individuals' daily lives. The development and application of EMI are continuously increasing (1)(2)(3), related to the emergence of smartphone apps and the widespread availability of the internet (4,5). Today, EMI applications are offered as treatment of various different psychological and psychiatric disorders including anxiety disorders, depression, obsessive-compulsive disorders, and posttraumatic stress disorders (2,4,6).…”

“…The development and application of EMI are continuously increasing (1)(2)(3), related to the emergence of smartphone apps and the widespread availability of the internet (4,5). Today, EMI applications are offered as treatment of various different psychological and psychiatric disorders including anxiety disorders, depression, obsessive-compulsive disorders, and posttraumatic stress disorders (2,4,6). EMI are often based on clinically evaluated psychotherapeutic treatments, e.g., cognitive behavioral therapy (CBT) (2), and apply therapeutic activities, assignments, and skills outside the clinical/therapeutic setting, i.e., in individuals' natural environment (7,8).…”

Efficacy of digital cognitive behavioural therapy for symptoms of generalised anxiety disorder: a study protocol for a randomised controlled trial

“…Findings showed that, compared to waitlist control conditions, smartphone interventions significantly reduced symptoms of anxiety, with a medium effect size. A more recent meta-analysis identified 29 RCTs examining the effects of smartphone interventions on generalised anxiety symptoms and found these to be superior to any control condition, with a small effect size [29].…”