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Mobile Apps and Mental Health: what's up?

Technology is becoming increasingly more important in our daily lives.

During both work and in free time, everyone holds a computer, a phone, a tablet or a smartwatch in their hands. In light of these changes, science has begun to question to what extent the relationship between man and technology may influence people’s lifestyle. Moreover, this will allow us to understand how to use technology in ways that promote well-being.

In line with the aforementioned statements, psychology and psychiatry are experiencing a real explosion of the use of these technologies to support mental health treatment.

You can have a look yourself: go into your device’s app store, type into the search “mental health”, and you will quickly find a lot of possible applications! You can even find them associated with other communication channels, such as photographic or videos platforms, which can enhance the learning process with a multimedia service.

Normally, the encounter between different disciplines could lead to a new framework of different perspectives and mutual enrichment, but will this also be possible for technology and mental health?

Research has yet to establish to what extent these applications can be utilised to promote the mental well-being of citizens. We need to understand which interventions are effective, for whom they are effective, how we can promote them, who should use them, and what training is required to use them.

People with a good level of mental health are more inclined to download applications related to psychological well-being for several reasons. These may be due to curiosity or to the appeal of the app, from the desire to obtain a higher level of mental health, or perhaps to address a discomfort that they find hard to share, and want to manage by themselves.

These reasons represent why the preventive field have some many applications. A key example is apps for genome sequences, like FACE2GENE and HELIX, which can help find who is at risk of mental health problems, and start promoting early interventions aimed to delay or stop the onset of a number of mental health disorders linked to genetics.

Moreover, apps can be used not only for mental health, but also to monitor other health aspects connected to it. There are lots of apps that promote proper nutrition, physical activity or global health management through the adoption of healthy habits, like MYFITNESSPAL, CAREZONE or CLUE. Primary care physicians are currently considering how to maximise the benefit of the use of these tools in following up patients closely.

Applications can also be useful for the early detection of mental distress. They allow us to overcome some traditional limits of psychiatry, such as the difficulties of reaching people who prefer not making contact with the service due to stigma, to the difficulties in reaching otherwise difficult target populations such as people suffering from social phobias or agoraphobia (fear of public places). Moreover, they can be particularly helpful in the engagement of youth who tend to prefer communicating through technology more than face-to-face.

From a health organisational point of view, these resources can overcome time constraints and other internal needs, allowing people to obtain monitoring by health professionals. From a diagnosis point of view, apps can help in making an in-depth assessment in line with an ecological paradigm of treatment by supporting the physicians in reading the tests and in identifying which are the most useful diagnostic criteria to choose.

Apps can also integrate cognitive-behavioural therapies recognised for the management of different pathologies, such as mood disorders, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder and eating behaviour disorders. They can provide the user with meditation and relaxation exercises, increase personal resources and resilience, and improve cognitive functions. See, for example, MINDFULLNESS APP, HEADSPACE, MOODPATH, MOODNOTES, HAPPIFY.

In times like the ones we are living, where Coronavirus is keeping us apart, can we imagine in how many ways apps could be useful?

First of all, they can guarantee the person the opportunity to play a real, active role in their own care path, promoting real empowerment, supporting self-monitoring and transferring strategies into everyday life context through exercises and homework directed from the apps. Secondly, the users have also the opportunity to get in contact with health professionals, in real-time, through the in-app messaging, mail services and video media. In this sense, the application becomes an additional resource that facilitates the therapeutic relationship.

Furthermore, it is also possible to get into an exchange group with other people who are experiencing the same problem, like TALK LIFE. This fundamental element can potentially allow to extend the person’s support networks in the territory outside the geographical limits of the services. Also, they can also be used by other people, such as family members or caregivers, who can also receive dedicated interventions.

Finally, the apps can also be used by health professionals, who can exchange information while keeping the network of services around the users updated in real-time. Moreover, health professionals can use apps for their continuous professional development and learning, and for keeping up-to-date with the latest research. They can also use these apps to take care of their own mental health and wellbeing, and to prevent phenomena such as burn-out.

All these implementations are in line with what has already been done in psychiatric rehabilitation. Technology has been used for decades in psychiatry, up to the most recent use of computer programs for cognitive remediation, or virtual reality for exposure to anxiety- or paranoia-provoking situations.

At this point, it seems spontaneous to ask whether this relationship between technology and mental health is always so positive, and which are its limits.

The first consideration that is worth making is that these strategies remain tied to the commitment of the person, and dependent on the correct and appropriate use of the app. Therefore, it is necessary to guide the subject by providing training with clear information on its content and purpose, even when the app is chosen by the users independently of the advice of health

professionals, and perhaps selected based on less important criteria, such as design or aesthetics.

Another central problem is the collection of sensitive data that takes place through these tools. The information that you record in the applications requires correct management, which must require the collection of clear information and informed consent, in line with the privacy regulation. These aspects, linked to a strong ethical component, are currently neglected and not properly monitored.

Furthermore, app development needs research in usability and the choice of the best methods and platform to deliver the app, ideally with an interactive process of improvement. Research can also use rigorous methods to generate reliable lists from which the health professional can choose which app is more suitable for which users.

The absence of criteria that guides the choice of certified software constitutes one of the main elements that discourage clinicians from using this technology in their practice. In this sense, it would also be beneficial to check who manufactured the applications, in order to ensure constant communication between manufacturer and health professionals.

There is also a need to improve the personalisation and adaptation to the specific needs of the user, for example, because the app is unable to monitor key processes such as the compliance with medication or other forms of therapy or the correct recording of sleep-wake rhythms.

Moreover, the efficacy of these apps in more complex clinical circumstances, such as addictions, chronic and multimorbid diseases, and critical situations of urgency, remains uncertain.

Finally, let’s not forget the portion of the population that may not have these tools readily available, or may find them difficult to use. These include the elderly, people with severe cognitive impairments, or people from more disadvantaged socioeconomic backgrounds.

In conclusion, it seems clear that technology is now part of the lifestyle of western cultures and beyond, but its role in the management of mental health still needs to be clarified.

The apps can represent an innovative tool for the integration of different therapies and the support of both user and health professional, but we need research in order to validate their effectiveness.

We shall not forget that technology has yet to replace the most important element of a successful therapy: the human relationship.


NOTE FROM THE EDITOR: A massive ‘thank you’ from all of us at the InSPIre the Mind team to the lovely Jessica Zambotti — who works in Psychiatric Rehabilitation and is a master student in Prevention and Early Interventions at the University of Verona in Italy — for this great insight into the ever-evolving relationships between technology, society, and psychiatry. Thanks, Jessica — we look forward to reading more from you soon!


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