The everyday stressors of modern life would take a toll on anyone's mental health, but the past few years, with mounting social unrest, the ever-increasing threat of climate change, a rise in violent crime, intractable political debates over what are seemingly basic human rights, and of course, a deadly pandemic, have exacerbated the matter considerably. These issues don't only plague Americans, either.
“This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health,” said WHO director general Tedros Adhanom Ghebreyesus.
The WHO alarm doesn’t stand alone. A comprehensive review of respondents around the world showed in December 2020 that symptoms of anxiety and stress rose during the pandemic; up to 50 percent of the surveyed population reported anxiety and more than 80 percent reported stress. Both statistics represent jumps from the prior data collected in the group of nations—which includes China, Spain, Italy, Iran, the United States, Turkey, Nepal and Denmark. Yet, while many individuals were able to receive psychological support, there was—and still is—an unmet demand for help.
Although mental health conditions can be successfully treated at a low cost, studies have found a significant gap between individuals needing care and those able to access it. According to the WHO, to close this gap, three things need to happen: better understanding of mental health in order to reduce stigma; more effort placed on increasing access to high-quality treatments; and more research conducted to develop better treatments. Experts say that in addition to efforts by psychologists and psychiatrists, a new resource can be used to tackle all three of these needs—mental health apps on mobile devices.
Such apps have gained traction in recent years. Stephen Schueller, executive director of One Mind PsyberGuide, a nonprofit organization that reviews these apps, estimates that at least 10,000 are out there. The exact numbers are hard to track, given that old apps are constantly being removed and new ones added, he tells Rebecca A. Clay for the American Psychological Association.
“The rate of mental health conditions has skyrocketed, and because of that, there's a real shortage of treatment available, which is unfortunate and a major problem we're going to be contending with for a while,” says Samantha L. Connolly, researcher and clinical psychologist at the VA Boston Healthcare System. “But in that sense, apps can be a really nice avenue to receive some support at the moment if you are finding that there's a very long waitlist to receive care in your community—they're at your fingertips on demand.”
They can help guide users through a meditation practice or display photos of your family or other things that make you happy. “If you're having a rough time, it can feel comforting that there's a resource that you can get some support from whenever and wherever you need it,” Connolly says.
Other than their availability at all times of the day, researchers suggest that apps can also help with the stigma associated with seeking out mental health treatment. “Epidemiological research shows that there are many more people who have an anxiety disorder than who are in therapy for an anxiety disorder,” says Richard E. Zinbarg, a clinical psychologist at Northwestern University. “And believe it or not, the number one reason for people not being in therapy is that they want to solve their problems on their own.” For those with the desire to be more autonomous and independent, using an app could be the perfect resource. “Some people might think that it's a weakness to ask for help and there's this whole stigma around getting a therapist, but maybe an application might be the best way for them to just try to deal with their problems on their own,” he adds.
Though apps might help with some conditions, experts say that they cannot entirely replace professional help—at least for now. “There's even some evidence that apps might be equally as effective as a therapist, —I'm not quite sure that I'm ready to accept that conclusion just yet. But there’s certainly very promising data,” Zinbarg says.
Psychologists also believe that apps could lead more individuals to therapy, instead of replacing it. “Apps might be a gateway to subsequent care,” Schueller tells the American Psychological Association. “Someone might download a CBT [Cognitive Behavioral Therapy] app, realize it’s helpful, and then find a therapist to help more.” CBT focuses on helping individuals learn how to become their own therapists and use problem-solving skills to deal with difficult situations. Eric Kuhn, a clinical psychologist from the Department of Veterans Affairs (VA) Palo Alto Health Care System, says that the VA has developed CBT-inspired mental health apps. “Our apps, such as PTSD Coach, are mostly based on CBT, which is well suited for that channel compared to some other psychotherapies that might require more in-person supportive and reflective insights,” he says.
Yet, with an overwhelming array of apps to choose from, experts note that not all of them are regulated by professionals—let alone lead to positive results. “There are some risks,” says Kuhn, who also teaches at the Stanford University School of Medicine. “Nobody is checking on every app, just like nobody is checking on every self-help book, you know? So, the buyer needs to beware. Some of the apps might have some things in there that we wouldn't want folks doing.”
Many apps ask users to create an account with their name and email address. Some of these apps sell personal data to places like Facebook or Google. “So, I think urging caution before talking about potentially sensitive health information via an app, and really being clear where that data may go, is important,” Connolly adds. For potential users to sort out which apps track their information, Connolly suggests that, if possible, they should ask their healthcare provider or also look at reputable online guides, such as the One Mind PsyberGuide, which rates the privacy policies of apps.
These guides can also be useful when it comes to determining the effectiveness of the app and the accuracy of the information it presents. “Mindfulness and meditation practices have been found to be very helpful for some people with anxiety. So, having an app that has recordings to engage in mindfulness practices could be a good strategy,” Connolly says. “But, if there’s an app trying to give education about a certain disorder, it’s important to make sure that it’s accurate.” Connolly suggests that one must ask these questions before deciding on what app to get: Where is the information coming from? Is it related to a research institute or a federal organization? Can I trust it?
And certain apps may not fit a user’s budget. “Some of these apps, the kind of bigger commercial apps, may have a monthly membership fee. So just be careful about what you're signing up for, and how much it may cost.”
In addition to the One Mind PsyberGuide, MIND Apps also offers a regulated list that can help users find evidence-based apps. Both programs have been reviewed by professionals and allow you to find resources specific to your condition or desired treatment.
Additional options are more targeted, and regulated by professionals. The VA offers research-based apps such as Mindfulness Coach and COVID Coach, which support overall self-care. “You know, try a few different things and see what you resonate to the best,” Zinbarg says. Kuhn agrees. “It's like dating, right? Your first date might not be the person you’re going to marry, but it’s like that—you go around and try different things out.”
Connolly opts for a different metaphor when describing the mental health app marketplace: exercising. “One of the biggest challenges with finding an app is accountability,” says Connolly. “When you get a personal trainer, you have appointments scheduled with an actual person, and you're expected to attend them and somebody's waiting for you.” Yet, with apps, no person works with you on the other end. It's purely self-directed, so it might be hard to motivate and stick with something when you don't have that external support. In the future, Connolly thinks that an important avenue for apps might consist of including a partner or “buddy” for accountability.
To Kuhn, sticking to an app is like sticking to any other kind of habit or behavior you want to improve in some way. “Just reading about it and checking out an app—and not going back to it—is not going to change anything,” he says. “I would encourage folks to try the app out and really give it a good shot before they get rid of it—if it's a reputable app of course.”
Mental health is part of overall health, and it's something individuals should be taking care of just like anything else, Connolly says. “You download apps to count your steps and how far you run, so downloading an app to manage your anxiety could be seen as very similar to those types of things as well. And hopefully, the more that that happens, the less it feels kind of embarrassing or shameful to say that this is part of your health, and it's something that you're maintaining and wanting to keep in good shape.”
The experts interviewed for this story recommend the following apps to deal with anxiety and improve mental health.
Meru Health offers coaching and therapy programs to help attain long-term improvement in mental health. The program consists of 8 to 12 weeks of one-on-one consultations and ongoing chats with a personal coach or licensed therapist, and daily activities including mindfulness and emotional intelligence practices. Kuhn says that the chat feature in the app offers users a hybrid model where they can engage in texting, phone calls, coaching or clinical support. “They actually have a research focus and are working with academics to work on the research angle,” he says. The app is free, but a referral from a healthcare professional—or having Meru Health as part of your employer or insurance benefits—is necessary to enroll in the program.
Insight Timer offers guided meditations, music tracks and talks by leading researchers, neuroscientists, psychologists and mindfulness experts. Zinbarg personally uses Insight Timer to time his own meditations and to guide his patients as well. “It is very useful when it comes to introducing someone to breath meditation,” he says. “I set an interval bell that will tell me when we’re halfway through the time we allotted—to know when to wrap up my guidance and leave them several minutes of them continuing on guiding themselves, so that they might have some confidence when they're at home or circumstances call for them to guide themselves.” Although Insight Timer offers a free version, it also offers more robust benefits with an annual ($59.99) or monthly ($9.99) subscription.
Headspace offers guided meditations, sleep meditations and breathing exercises that help users deal with stress and anxiety. It includes user-friendly content and visually arresting animations that help engage users from all meditation expertise levels. According to Kuhn, Headspace has a robust research program and works with independent researchers to help validate the app. Headspace features a free ten-day introductory program, but it also has two auto-renewing subscription options: $12.99 per month or $69.99 per year.
Calm offers “Sleep Stories” narrated by famous speakers (such as LeBron James), ten-minute Daily Calm sessions as well as a music library, short videos and mindful movement activities. Calm also provides a range of guided meditations with lengths of 3 to 25 minutes to fit the user’s schedule. The platform offers a seven-day trial program at no cost and then has the option of an annual subscription costing $69.99 or a one-time purchase of $399.99.
“Companies like Headspace and Calm are actually validating their product and are not just about the marketing and making it well-designed, visually appealing and engaging—they are showing the app has some benefit through rigorous empirical research,” Kuhn says.