App-Based Social Work: Distance Practice

Technological advances have made tremendous contributions to mental health services in the past few decades. Mental health practitioners have used technology to deliver behavioral interventions and to supplement psychotherapy via phone calls, video games, web cameras, and other computer-based interventions. Mobile devices have also become increasingly valuable in recent years as smartphone apps are being used to deliver treatment interventions and psychoeducation to individuals seeking mental health treatment (Galetsi et al., 2023). Although using smartphone apps as a form of mental health treatment is relatively new, scholarship is on pace to assess the benefits of mobile devices as substitutes and/or supplements in clinical practice.

Benefits of Mental Health Apps

As smartphone ownership continues to increase in the United States, individuals seeking mental health treatment are being introduced to various easily accessible mental health services. Mental health apps give users access to psychoeducation, symptom monitoring, and treatment options at all times (Radovic et al., 2016). There were three critical benefits identified in the use of mental health apps in existing literature. These benefits include (a) positive clinical outcomes, (b) participant feedback, and (c) improvements in access to mental health care.

Positive Clinical Outcomes

The mental health app PRIME-D, designed to deliver mental health services to adults with depression using evidence-based treatments such as cognitive–behavioral therapy (CBT), was tested for effectiveness in one study. This study consisted of 36 adults with depression who participated in a 12-week trial. Depression scores calculated using the Patient Health Questionnaire-9 were noted to have improved by over 50 percent (Schlosser et al., 2017). The mental health app DeStressify was also tested among 163 undergraduate students, with results showing that using the app reduced anxiety and made noticeable improvements to emotional well-being and general health. Students also claimed that using DeStressify resulted in improvements in work and school productivity.

Rizvi and colleagues (2011) conducted another study involving 22 individuals with borderline personality disorder and substance use disorder to test a mental health app using dialectical behavior therapy (DBT) as a treatment option. The DBT Coach app was used by participants for 14 days and had positive clinical outcomes. Emotional intensity ratings for depressive symptoms and psychological distress, along with urges to use substances, decreased over the 14-day trial period. The use of DBT skills such as opposite action increased among participants, who claimed they could now identify and use the skill with more confidence (Rizvi et al., 2011). Last, a suite of depression and anxiety apps known as Intellicare have also been proven, through clinical trials, to reduce symptoms in patients, thus showing that apps that have been tested are effective (Sucala et al., 2017).

Participant Feedback

In the PRIME-D trial, 93 percent of participants claimed the app “helped them achieve their goals,” with 83 percent sharing that they would continue using the app after the trial (Schlosser et al., 2017, p. 553). Service users also expressed interest in being a part of the creation of mental health apps in the future. In a study to develop a mental health app for North Lee Mental Health Services, eight volunteers were interviewed regarding the likelihood of using mental health apps. All eight volunteers expressed interest in such an app, highlighting that the ease of use and access to treatment would result in a higher likelihood of seeking treatment. Furthermore, having specific features on mental health apps, such as those that could personalize their care, was a key component in using mental health apps (Balaskas et al., 2023). Last, in a review of anxiety apps available, the researchers noted that user testimonials gave valuable feedback on the apps available on the market. One review read, “I cannot sleep without this application, and I have tried, believe me” (Radovic et al., 2016, p. 468). Testimonials like this were used to determine app effectiveness based on user reviews.

Improvements in Access to Mental Health Care

One of the benefits of mental health apps is their ability to reach individuals seeking mental health treatment and provide options to those who cannot access traditional face-to-face treatment. Mental health apps are a cost-effective tool to use in delivering mental health services worldwide. Additionally, they tend to be user friendly and are already in use by many (Galetsi et al., 2023). One of the challenges of access to mental health services within traditional professional care settings is that it could take upward of three months to schedule an appointment, whereas mental health apps could provide immediate access to treatment options (Schlosser et al., 2017). The options that are currently available on mental health apps, such as symptom tracking, can be beneficial to patients and clinicians alike. The ability to regularly monitor symptoms and patient progress can be critical (Sucala et al., 2017).

Other components of mental health apps include the possibility of peer contact, which was an important factor among younger users. As young people are identifying more mental health symptoms, it is vital to incorporate access to mental healthcare using resources that they are familiar with and likely to use at times that are suitable to them. The use of a text messaging mental health app can be a preferred alternative to face-to-face meetings, thereby making it a cheaper and more convenient form of treatment for those who cannot access traditional treatment options. This approach could address socioeconomic and geographical barriers to treatment access (Balaskas et al., 2023; Sucala et al., 2017).

The Risks of Mental Health Apps

Currently, clinicians are questioning the validity of these apps, as there has been little empirical research to substantiate claims that these apps are effective in the treatment of mental health conditions (Radovic et al., 2016; Schlosser et al., 2017; Sucala et al., 2017). Multiple studies were analyzed to get an accurate understanding of what is available in the realm of mental health apps and what is known about their effectiveness at this stage. There were three identified risks in the literature: (a) lack of empirical research for mental health apps, (b) patients’ privacy and data security, and (c) validity of the app creators.

Lack of Empirical Research for Mental Health Apps

Prominent throughout the studies was the lack of evidence regarding the effectiveness of mental health apps as well as the lack of evidence-based approaches in this area. In a study that analyzed 208 mental health apps, the apps targeting symptom relief claimed that they could decrease anxiety, relieve stress, and improve moods by using self-help methods; however, these claims were not substantiated by any evidence (Radovic et al., 2016). Furthermore, rarely did any of the apps in this study cite evidence of research to support the approaches used in the app (i.e., audio interventions, relaxation techniques, low-intensity mindfulness). Clinicians should be cautious when using mental health apps that are not proven to be effective, as this can have negative effects on the patient, potentially magnifying their symptoms (Radovic et al., 2016). In another study analyzing 52 anxiety apps, researchers found that 63.5 percent had no information at all about the intervention approaches used, and 26.9 percent stated that they used CBT. The authors also found that 96.2 percent of the anxiety apps in the study did not offer any information about efficacy data to support their approaches. Furthermore, the majority of apps were not using any type of theoretical approaches (Sucala et al., 2017). As research on mental health apps is relatively new, most studies that tested specific apps urged further research in understanding the true effectiveness of the apps, especially in comparison with face-to-face interventions (Lee & Jung, 2018).

Patient’s Privacy and Data Security

In Radovic and colleagues’ (2016) study analyzing 208 mental health apps, only a few apps mentioned anything about privacy settings or legal disclaimers. Confidentiality remains an important factor for individuals with mental health disorders, which could pose an issue in using the apps as a treatment option. When adolescents were asked about their likelihood of using mental health apps, they noted password protection, user control over privacy, and anonymity as key prerequisites (Radovic et al., 2016). Furthermore, health data protection laws such as HIPAA are not universal, and since the app scope is a global one, privacy and confidentiality may not be up to professional standards (Sucala et al., 2017).

Validity of App Creators

One major concern presented by clinicians and mental healthcare professionals was the validity of the app creators. There were only a few apps that provided information about the creator and the creator’s credentials. Under most circumstances, app users will not know if a healthcare professional created that app. When the credentials of app creators were mentioned, few were found to be clinicians or mental health specialists, raising concern about the credibility of modalities and interventions used (Radovic et al., 2016). In Sucala and colleagues’ (2017) study, out of the 52 apps tested, professional acumen of app creators was not listed for most. When details of professional acumen were included, 67.3 percent of the apps were found to lack the employment of professionals in their development (Sucala et al., 2017). Furthermore, few apps clearly indicate that they are not substitutes for traditional professional treatment (Radovic et al., 2016).

Conclusion

Access to mental healthcare without geographic or socioeconomic barriers, daily symptom trackers for clinicians and patients to review, reducing stigma toward seeking mental health treatment, and connecting with peers are just some benefits that were identified in existing literature. On the other hand, the risks such as lack of empirical research, privacy and security concerns, and the validity of app creators should be taken into consideration when clinicians decide to incorporate mental health apps into their treatment intervention. Careful and intensive review on which apps should be used is important for the safety of clients. Existing literature shows a strong preliminary understanding of the benefits and risks associated with mental health apps. With further research and guidelines for clinicians to use when deciding which mental health apps are most effective, there are promising avenues to be explored for the future of mental health. The existing barriers and risks are prevalent but can be worked through as the field of app-based mental health interventions continues to advance.

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