mHealth Checkup: Developers Aim to Help Apprehensive Users Relax

Stress levels are rising and app developers are trying to ease anxiety through a variety of virtual and real-world techniques. Siegfried Mortkowitz reports…

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Higher stress levels are creating opportunities in mHealth for app developers looking to help users relax and ease that tension.

Stress affects about three-quarters of the U.S. population, according to an October 2015 study by the Statistic Brain Research Institute. And excessive stress can lead to physical and psychological ailments, such as stroke, heart attacks and depression.  

According to the 2015 study, about three out of four U.S. adults regularly experience physical and psychological symptoms caused by stress. And one in two say that stress has a negative impact on their personal and professional life.

No wonder, then, that applications aimed at reducing stress have proliferated in recent years, as mobile plays an ever-growing role in the digital lifestyle. These apps offer a broad variety of strategies to combat stress and anxiety, including breathing and relaxation exercises, biofeedback (including, notably, one app created by Ariana Huffington and Deepak Chopra), self-awareness based on mood tracking, venting stress on a virtual rubber duck, yoga, meditation and hypnosis.

One widely recommended app uses both meditation and hypnosis as selling points because, as its creator, Darren Marks, hypnotherapist and founder of Harmony Hypnotherapy London, a hypnotherapy practice, says, “We put the two words together because the hypnotic state is very similar to the experience people have when they are meditating. They are relaxed and focused, with a single focus of attention.”

He goes on to say that when you are relaxed you are able to work more efficiently and achieve your goals more efficiently. “You’re going to overcome challenges more effectively,” he adds.

In his program Marks does not actually use the word stress, because he prefers to offer a positive outlook for his patients and clients.

“It’s always better to focus on what you want to achieve, rather than what you don’t want to achieve,” he explains. “So in my [app] recordings, you won’t hear suggestions like, ‘You won’t be stressed.’ Because as soon as you say the word, you’re thinking about stress. So the suggestions in the recordings, like ‘You’re becoming more and more calm, more relaxed, more confident.’ The idea is you’re aiming for something you want as opposed to getting away from something you don’t want.”

Marks says that all the app recordings focusing on relaxation and building confidence actually deal with stress and stress-related problems. The free app has been downloaded more than two million times since it was launched and offers several sessions free of charge, such as “Focus & Concentration” and “Total Relaxation.” The approximately 40 other sessions, which are longer and often target specific fears and goals, require a small payment.

Marks says that the main reason people come to visit him in his London hypnotherapy office is anxiety, which he relates to stress. “People often are anxious because they have stress,” he says. One collateral benefit of the app is that it sometimes brings patients to his practice.

He explains that the app is designed “to replicate what I do in my office. If you work through it methodically, through each category, you’re essentially going through how I work with my clients.”

However, he emphasizes that app users must take more responsibility than his office clients. “The tools are there but you have to work at it. It’s not like it’s just done for you if you use it.”

This means that not everyone who needs treatment for stress can benefit from an app. “Some people will be able to get what they need from an app, and other people will need something a bit more personalized,” he says.

In addition, some of the techniques he uses are “tricky to use on your own,” which may require more personalized support for some people. “But, on occasion, I’ve had people who used the app successfully and then come to me to get a bit more,” he says. “And they discovered that, actually, they preferred the app to me.”

He explains the reason for that is “if you can do something in your home, were you feel totally comfortable, and it’s very low-cost compared to seeing a professional who is very expensive, and you can repeat it over and over—some people will get better results from an app than from a real person.”

Marks also recommends the app to clients he is treating in his office, as a means of reducing the number of sessions. “It’s a way of maintaining whatever they achieved from seeing me on a one-to-one [basis].”

A different, and unique, approach is one taken by Dr. Tracy Dennis-Tiwary, a clinical researcher in psychology and professor of psychology at Hunter College of the City University of New York in New York City. Her free Personal Zen app is based on decades of clinical research and uses a form of gamification to reduce stress and anxiety.

She first became interested in digital and mobile mental health tools because she felt that “we in psychology have failed to provide people with treatments that are accessible, meaning that you can get to them, they are affordable, they are not too time-consuming and burdensome and they are not as stigmatizing as some people feel mental health treatments are.”

Dennis-Tiwary says mobile technology is a “disruptive innovation [because] it exponentially increases people’s ability to access clinically-validated treatments.”

In addition, mobile enables people to react to stress- and anxiety-producing situations as they occur in life. “The notion that you can self-curate your own mental wellness on the go is incredibly important, and it’s really transformative,” Dennis-Tiwary says. “It transforms the way we, as consumers of mental health services, think of mental health.”

Dennis-Tiwary says the fact that her Personal Zen app is evidence-based and backed by several clinical trials distinguishes it from most other mobile solutions. “There are thousands of mental health apps, but fewer than 1 percent have any clinical validation that they actually help people,” she says.

Personal Zen, she explains, is based on research on attention bias modification, which “takes the idea that many mental health problems, like stress-related problems, anxiety and depression, are exacerbated or even caused by certain habits that we have of how we pay attention to and interpret the world.”

That is, we tend to pick out the negative information in our experience of the world, rather than the positive. Dennis-Tiwary gives the example of a public speaker who picks out of his audience the one person who is obviously bored, rather than those who are smiling and engaged.

Her solution is deceptively simple. “Personal Zen takes this habit of paying attention and rewires it,” she explains. “It trains you to automatically disengage from the negative and be more oriented toward the positive information in the environment.” It does this by presenting two cartoon “sprites” on the screen, one that has an angry expression and one that is smiling. After a certain time, they disappear from the screen and a grassy trail appears. The user is then directed to quickly and accurately trace that trail until he or she reaches the smiling “sprite”.

“The healing mechanic is that you’re always following the trail of the happy sprite,” she explains. “Your brain is learning that, if you want to respond quickly and accurately, you have to follow the joy, you have to disengage from the negative.”

She describes the strategy as “sort of like digital worry beads, but more fun. And I’m amazed every time it works. We’ve done four clinical trials with the app that show that this basic technique, used only a few minutes a day, a few days a week, can significantly reduce stress and anxiety.”

In one trial using pregnant women, the app is used 30 to 40 minutes a week. She says it not only reduced anxiety in the group but also lowered levels of the stress hormone cortisol. Dennis-Tiwary’s next app, soon to be launched and using the same solution in a different form, will focus on stress and anxiety in pregnant women.

Dennis-Tiwary says she has been actively working on the app for about six years and launched it publically by accident. “I actually put the app on the App Store just for participants in the lab, as a research tool, because it was easier that way, and it took on a life of its own.” 

Since then, thanks largely to glowing media reviews, it has had more than 160,000 downloads without any marketing. She is now looking for entrepreneurial partners to expand its reach while still keeping it free for users.

Dennis-Tiwary says mobile has great potential, but it must be applied efficiently to be effective. ”We need to figure out which problems and which treatment approaches are most optimal for mobile technology. We need to concentrate more on brief treatments that target specific problems, such as depression, anxiety, stress and addiction, which can be treated in a brief, on-the-go ways.”