mHealth Apps for Psychological Fitness
The consumer mobile market is quickly being saturated with devices and applications to boost physical fitness and health. But as Siegfried Mortkowitz reports, solutions are now being developed to promote mental health as well.
Mobile apps are increasingly going into areas the technology has not gone before, such as psychology. For example, the UK-based Team Turquoise, which seeks to “create technology that changes how we perceive, feel and behave,” has developed Doppel. It’s a device that enables users to manage their emotions.
The team is currently trying to raise £100,000 on Kickstarter to launch the product. Operation Reach Out is a smartphone app aimed at preventing suicide among military personnel and veterans. The Department of Veterans’ Affairs has helped develop the PTSD Coach, which offers information about Post-Traumatic Stress Disorder and its treatments, provides tools to help screen for symptoms, and offers advice on how to cope with them.
But perhaps the most ambitious maker of psychological apps is Monica Frank, a 57-year-old Saint Louis–based Cognitive Behavioral Theory (CBT) psychologist. She is also the author of numerous books, the holder of a 1st Degree Black Belt in Chinese Kenpo Karate, and the founder and only employee of Excel At Life. The company produces apps and runs a website that publishes her many articles on CBT.
Frank describes CBT as an “evidence-based therapy that uses a lot of tools and training to teach people to cope with certain types of problems. It takes a problem and looks at how it affects you, how it affects your thinking, and what skills you need to cope.” Unlike Freudian therapies, which mine the past to uncover key events that distorted a patient’s personality throughout her life, CBT focuses on the present and only explores past issues “to see how they affect you now, how this affects your thinking. CBT,” she declares, “changes your thinking and your behavior.”
CBT uses a lot of homework, such as the keeping of a daily diary, “so it is easily translated into apps,” Frank explains. Currently, she has 13 self-help apps on the market, all of which deal with a different psychological problem, such as depression or jealousy. She says many of her app users look to solve a specific problem, something that addresses their precise needs.. And, although many of the apps are similar—the Cognitive Diary is a part of many of them—each app has been designed with tools and information specific to the problem.
Her Depression app, for example, includes the Cognitive Diary, an article on how to use the app and relaxation and educational audios that discuss depression and self-esteem. “One difficulty with depression is motivation,” Frank explains. “I tell people to do little things each day, because we know that if people are more actively involved with interests they normally enjoy, it will help lift the depression.”
The app also has a points section where users can check off what they have accomplished, with points awarded for each activity. “Tracking points creates more motivation,” Frank says. And it has a screening for depression test and a graph function that helps the user determine how severe his depression is and track its progress over time.
Frank learned to program and make apps in 2010 from her son, who was producing apps and games. She decided that they would be a big help in therapy because, she says, “patients often forgot to do their homework or keep their diaries. With smartphones, people always have them with them, which makes it very convenient.”
Frank gives the apps away free of charge, earning some income from ads that come on them. “I make a little bit of money from the apps, but far from enough to support myself,” Frank says. “I get satisfaction from helping people.” However, users can purchase one app that removes the ads from all of Excel At Life’s apps.
According to Frank’s figures, which she admits are not precise and come from Google Play, some 175,000 people around the world have downloaded her generic CBT Diary app alone, with more than 31,000 active users over five years. There have been about 2 million downloads of all her apps in that time.
She says she has received emails and comments on Google Play from people all over the world that thank her for making the apps available and saying that they have helped them. “The self-help apps have high ratings, between 4 and 4.3,” she says proudly.
As she has received more feedback from users over the years, Frank has refined them to meet demand. “The apps have improved, they’ve become customized, because of people who contacted me saying they want a certain function.”
Frank admits that her apps will not work for everyone. “When people need more personal accountability and motivation, apps are not helpful,” she explains. “When people have trouble following through, an app could be helpful in combination with office visits.” She says more than a dozen CBT therapists all over the U.S. are using her apps in conjunction with in-person therapy, and they all say they are very helpful.
Scott Woodruff, a post-doctoral fellow at the New York–based American Institute for Cognitive Therapy, is generally enthusiastic about the use of mobile apps for CBT, calling it “a great idea.” He agrees with Frank that they would be problematic with people “who lack motivation, which is especially important for depression.”
In addition, he says, “Therapists provide validation to the patient. They point out, for example, that some thoughts are irrational but that everyone has irrational thoughts, that they are a product of their life experiences, and there’s nothing intrinsically wrong with that.”
And therapists also provide a kind of moral support to their patients. “Therapy can be uncomfortable,” Woodruff says.
Nevertheless, he feels apps can be very valuable psychological tools. “It’s important that clients apply the lessons from the therapy outside of the therapy. Anything that makes it happen is great.”
Woodruff notes that there has not been enough research to determine if apps or internet-based therapy is as effective as in-person therapy. “But early results are promising,” he says. “I’m sure research will find that they are very helpful.”
Currently, the apps are only available for Android platforms, but she plans to make web-based versions that can be used on any phone with internet access. And she is also planning to retire soon from her practice and devote herself entirely to her writing and her apps.
And while Frank’s apps are used in many countries, they are only available in English, with the exception of the Cognitive Diary, which has been translated into Dutch through Crowdin.com, which allows people to volunteer time to help translate. “Hopefully, more will be translated in the future,” Frank says.