Abstract
The primary objectives of this paper were to (1) review empirical support for existing self-help smartphone applications for depression, anxiety, PTSD, and alcohol use disorders; (2) evaluate whether commercially available self-help applications offer, or were derived from, empirically supported approaches; and (3) provide a framework for evaluating applications for use in the absence of existing empirical support. We performed a systematic review of existing applications via PubMed and performed a content analysis, based on theoretically grounded evidence-based review criteria, on each commercially available application retrieved from Google Play and Apple Store searches. Seventeen academic papers met inclusion criteria and were evaluated; only four empirically supported applications were available commercially. Of the commercial applications, one was found via the PubMed search. While the majority of the smartphone applications evaluated in the content analysis included at least one empirically supported component, there was great variability in how comprehensive the integrated tools were, and a significant proportion included non-evidence-based tools. In this study, we found that evidence-based applications are often not available to the general public and those that are available offer varying degrees of empirically derived tools. These findings unveil a new “research-practice gap” at the intersection of mental health and emergent technology-based interventions. As research attempts to keep pace with emergent intervention technologies, we provide suggestions to consumers and clinicians for reviewing these applications, and for future research in the service of reducing the “research-practice gap.”
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References
American Psychiatric Association (2018). App evaluation model. Retrieved from https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model
Asselbergs, J., Ruwaard, J., Ejdys, M., Schrader, N., Sijbrandij, M., & Riper, H. (2016). Mobile phone-based unobtrusive ecological momentary assessment of day-to-day mood: an explorative study. Journal of Medical Internet Research, 18, e72. https://doi.org/10.2196/jmir.5505.
Bertholet, N., Daeppen, J., McNeely, J., Kushnir, V., & Cunningham, J. A. (2017). Smartphone application for unhealthy alcohol use: a pilot study. Substance Abuse, 38, 285–291. https://doi.org/10.1080/08897077.2017.1281860.
Center for Behavioral Health Statistics and Quality (2016). Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved September 10, 2017, from http://www.samhsa.gov/data/.
Chih, M.-Y. (2014). Exploring the use patterns of a mobile health application for alcohol addiction before the initial lapse after detoxification. AMIA Annual Symposium Proceedings, 2014, 385–394.
Columbus, M. (2014). The nuts and bolts of NIH funding: NIH top 10 [PowerPoint slides]. Retrieved from https://grants.nih.gov/grants/regionalseminars/2014/docs/Presentations2014/NIH_Top_10.pptx.
Donker, T., Petrie, K., Proudfoot, J., Clarke, J., Birch, M. R., & Christensen, H. (2013). Smartphones for smarter delivery of mental health programs: a systematic review. Journal of Medical Internet Research, 15(11), e247. https://doi.org/10.2196/jmir.2791.
Donker, T., Blankers, M., Hedman, E., Ljotsson, B., Petrie, K., & Christensen, H. (2015). Economic evaluations of Internet interventions for mental health: a systematic review. Psychological Medicine, 45(16), 3357–3376. https://doi.org/10.1017/S0033291715001427.
Dragovic, M., Davison, S., Morgan, V. A., Chiu, V. W., Richards, N., Vatskalis, T., Atkinson, A., & Waters, F. (2018). Validated, easy to use and free’: top three requests for mobile device applications (‘apps’) from mental health consumers and clinicians. Advances in Mental Health, online first publication., 1–9. https://doi.org/10.1080/18387357.2018.1557014.
Epstein, E., & McCrady, B. (2009). Overcoming alcohol use problems: therapist guide: a cognitive-behavioural treatment program. New York, NY: Oxford University Press.
Eysenbach, G. (2011). CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions. Journal of Medical Internet Research, 13, e126. https://doi.org/10.2196/jmir.1923.
Fairburn, C. G., & Rothwell, E. R. (2015). Apps and eating disorders: a systematic clinical appraisal. International Journal of Eating Disorders, 48, 1038–1046. https://doi.org/10.1002/eat.22398.
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences: therapist guide. New York, NY: Oxford University Press.
Gee, B. L., Griffiths, K. M., & Gulliver, A. (2016). Effectiveness of mobile technologies delivering ecological momentary interventions for stress and anxiety; a systematic review. Journal of the American Medical Informatics Association, 23, 221–229. https://doi.org/10.1093/jamia/ocv043.
Gilson, M., Freeman, A., Yates, M., & Morgillo Freeman, S. (2009). Overcoming depression: a cognitive therapy approach: therapist guide. New York, NY: Oxford University Press.
Giroux, D., Bacon, S., King, D. K., Dulin, P., & Gonzalez, V. (2014). Examining perceptions of a smartphone-based intervention system for alcohol use disorders. Telemedicine Journal and E-Health, 20(10), 923–929. https://doi.org/10.1089/tmj.2013.0222.
Glass, J. E., McKay, J. R., Gustafson, D. H., Kornfield, R., Rathouz, P. J., McTavish, F. M., Atwood, A. K., Isham, A., Quanbeck, A., & Shah, D. (2017). Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders. Journal of Substance Abuse Treatment, 77, 57–66. https://doi.org/10.1016/j.jsat.2017.03.011.
Gustafson, D. H., McTavish, F. M., Chih, M.-Y., Atwood, A. K., Johnson, R., A., M., G. B., et al. (2014). A smartphone application to support recovery from alcoholism: a randomized controlled trial. JAMA Psychiatry, 71, 566–572. https://doi.org/10.1001/jamapsychiatry.2013.4642.
Hung, G. C.-L., Li, M. S., Chen, Y. L., & Chiang, J. H. (2016). Capturing depression with your smartphone: validity and utilization of iHOPE for depressed patients in Taiwan. European Psychiatry, 33, S283. https://doi.org/10.1016/j.eurpsy.2016.01.758.
Ivanova, E., Lindner, P., Ly, K. H., Dahlin, M., Vernmark, K., Andersson, G., & Carlbring, P. (2016). Guided and unguided acceptance and commitment therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: a randomized controlled trial. Journal of Anxiety Disorders, 44, 27–35. https://doi.org/10.1016/j.janxdis.2016.09.012.
Jang, S. H., Woo, Y. S., Hong, J. W., Yoon, B. H., Hwang, T. Y., Kim, M. D., Lee, S. Y., & Bahk, W. M. (2017). Use of a smartphone application to screen for depression and suicide in South Korea. General Hospital Psychiatry, 46, 62–67. https://doi.org/10.1016/j.genhosppsych.2017.03.006.
Kazdin, A. E. (2017). Addressing the treatment gap: a key challenge for extending evidence-based psychosocial interventions. Behavior Research and Therapy, 88, 7–18. https://doi.org/10.1016/j.brat.2016.06.004.
Kertz, S. J., Kelly, J. M., Stevens, K. T., Schrock, M., & Danitz, S. B. (2017). A review of free iPhone applications designed to target anxiety and worry. Journal of Technology in Behavioral Science, 2, 61–70. https://doi.org/10.1007/s41347-016-0006-y.
Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45, 184–198. https://doi.org/10.1016/j.jbi.2011.08.017.
Krebs, P., & Duncan, D. T. (2015). Health app use among US mobile phone users: a National Survey. JMIR mHealth and uHealth, 3(4), e101. https://doi.org/10.2196/mhealth.4924.
Kuhn, E., Greene, C., Hoffman, J., Nguyen, T., Wald, L., Schmidt, J., Ramsey, K. M., & Ruzek, J. (2014). Preliminary evaluation of PTSD coach, a smartphone app for post-traumatic stress symptoms. Military Medicine, 179(1), 12–18. https://doi.org/10.7205/MILMED-D-13-00271.
Larsen, M. E., Nicholas, J., & Christensen, H. (2016). Quantifying app store dynamics: longitudinal tracking of mental health apps. JMIR mHealth and uHealth, 4, e96. https://doi.org/10.2196/mhealth.6020.
Lattie, E. G., Schueller, S. M., Sargent, E., Stiles-Shields, C., Tomasino, K. N., Corden, M. E., Begale, M., Karr, C. J., & Mohr, D. C. (2016). Uptake and usage of IntelliCare: a publicly available suite of mental health and well-being apps. Internet Interventions, 4, 152–158. https://doi.org/10.1016/j.invent.2016.06.003.
Lieberman, M. (2014, February 20). 10 stats about inbound marketing that will make your jaw drop. Retrieved from https://blog.hubspot.com/insiders/inbound-marketing-stats.
Ly, K. H., Dahl, J., Calbring, P., & Andersson, G. (2012). Development and initial evaluation of a smartphone application based on acceptance and commitment therapy. SpringerPlus, 1, 1. https://doi.org/10.1186/2193-1801-1-11.
Martinez-Perez, B., de la Torre-Diaz, I., & Coronado-Lopez, M. (2013). Mobile health applications for the most prevalent conditions by the world health organization: review and analysis. Journal of Medical Internet Research, 16, e20. https://doi.org/10.2196/jmir.2600.
McTavish, F. M., Chih, M.-Y., Shah, D., & Gustafson, D. H. (2012). How patients recovering from alcoholism use a smartphone intervention. Journal of Dual Diagnosis, 8, 294–304. https://doi.org/10.1080/15504263.2012.723312.
Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., et al. (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 41, 1751–1761. https://doi.org/10.1017/S0033291710002291.
Moore, T. (n.d.). What’s the cost to maintain an App? - App Press. Retrieved from https://www.app-press.com/blog/whats-the-cost-to-maintain-an-app
Muroff, J., Robinson, W., Chassler, D., Lopez, L. M., Gaitan, E., Lundgren, L., et al. (2017). Use of a smartphone recovery tool for Latinos with co-occurring alcohol and other drug disorders and mental disorders. Journal of Dual Diagnosis, 13, 280–290. https://doi.org/10.1080/15504263.2017.1348649.
Penzenstadler, L., Chatton, A., Van Singer, M., & Khazaal, Y. (2016). Quality of smartphone apps related to alcohol use disorder. European Addiction Research, 22, 329–338. https://doi.org/10.1159/000449097.
Possemato, K., Kuhn, E., Johnson, E., Hoffman, J. E., Owen, J. E., Kanuri, N., et al. (2016). Using PTSD coach in primary care with and without clinician support: a pilot randomized controlled trial. General Hospital Psychiatry, 38, 94–98. https://doi.org/10.1016/j.genhosppsych.2015.09.005.
Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014). mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical Psychology & Psychotherapy, 21, 427–436. https://doi.org/10.1002/cpp.1855.
Radovic, A., Vona, P. L., Santostefano, A. M., Ciaravino, S., Miller, E., & Stein, B. D. (2016). Smartphone applications for mental health. Cyberpsychology, Behavior and Social Networking, 19, 465–470. https://doi.org/10.1089/cyber.2015.0619.
Rubanovich, C. K., Mohr, D. C., & Schueller, S. M. (2017). Health app use among individuals with symptoms of depression and anxiety: a survey study with thematic coding. JMIR, Mental Health, 4(2), e22. https://doi.org/10.2196/mental.7603:10.2196/mental.7603.
Schueller, S. M., Neary, M., O’Loughlin, & Adkins, E. C. (2018). Discovery of and interest in health apps among those with mental health needs: survey and focus group study. JMIR, Mental Health, 20(6), e10141. https://doi.org/10.2196/10141:10.2196/10141.
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., Freeston, M., Garety, P. A., Hollon, S. D., Ost, L. G., Salkovskis, P. M., Williams, J. M. G., & Wilson, G. T. (2009). Mind the gap: improving the dissemination of CBT. Behavior Research and Therapy, 47(11), 902–909. https://doi.org/10.1016/j.brat.2009.07.003.
Smith, A. (2017). Record shares of Americans now own smartphones, have home broadband. Retrieved from http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology/
Society of Clinical Psychology. (2016). Psychological treatments. Retrieved from https://www.div12.org/treatments/.
Torous, J., Friedman, R., & Keshavan, M. (2014). Smartphone ownership and interest in mobile applications to monitor symptoms of mental health conditions. JMIR mHealth and uHealth, 2, e2. https://doi.org/10.2196/mhealth.2994.
Torous, J., Levin, M. E., Ahern, D. K., & Oser, M. L. (2017). Cognitive behavioral mobile applications: clinical studies, marketplace overview, and research agenda. Cognitive and Behavioral Practice, 24, 215–225. https://doi.org/10.1016/j.cbpta.2016.05.007.
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629.
You, C. W., Chen, Y. C., Chen, C. H., Lee, C. H., Kuo, P. H., Huang, & Chu, H. H. (2017). Smartphone-based support system (SoberDiary) coupled with a Bluetooth breathalyzer for treatment-seeking alcohol-dependent patients. Addictive Behaviors, 65, 174–178. doi:https://doi.org/10.1016/j.addbeh.2016.10.017.
Zhang, M. W., Fang, P., & Ho, R. C. (2016). Global outreach and user preferences of a smartphone application developed for drinkers. Technology and Health Care, 24(4), 495–501. https://doi.org/10.3233/THC-161143.
Zinbarg, R., Craske, M., & Barlow, D. (2006). Mastery of your anxiety and worry: therapist guide. New York, NY: Oxford University Press.
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Livingston, N.A., Shingleton, R., Heilman, M.E. et al. Self-help Smartphone Applications for Alcohol Use, PTSD, Anxiety, and Depression: Addressing the New Research-Practice Gap. J. technol. behav. sci. 4, 139–151 (2019). https://doi.org/10.1007/s41347-019-00099-6
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DOI: https://doi.org/10.1007/s41347-019-00099-6