Recently, there’s been some press on the development of smartphone apps for mental health issues. I think this a very worthy area of pursuit. For a few dollars to download, thousands of people could conceivably practice more effective ways to deal with their anxiety—on the bus, subway, or waiting in line. Smartphone apps have potential the offer treatment to people who would not access or do not have access to psychological services.
Key words: “Have Potential”
As much as I support the efforts of researchers in exploring these pursuits, I’d like to acknowledge that we’re at the very early stages of developing apps and testing out their effectiveness. Two things must happen first:
1.) There should be evidence that people who use a particular app show improvements in what the app is designed to address.
2.) The app should be compared against a convincing placebo.
What Do I Mean By” Placebo”?
When judging that a treatment is effective—particularly something like an app—it’s important to compare it against a credible placebo. By placebo, I mean an app that looks like it could be helpful but is not designed to be.
There’s a rich literature that shows that sugar pills (i.e., placebos) relieve a whole host of ailments such as pain, anxiety, and depression. If you gave a group of people a smartphone Scrabble app and told them that it had been specially designed to treat anxiety, about a third of those people would likely show some improvement. Sometimes the simple fact that we belief we’re receiving treatment causes us to feel better.
Some people argue, “If it works, what does it matter why it works?” I sympathize with this position, but what’s important to consider is that if we don’t understand how and why a treatment is effective, then it makes it much harder to make it even better. A sugar pill may make someone’s headache go away, but aspirin is better, and extra-strength aspirin may be even better in some cases.
A February New York Times on smartphone apps for anxiety article suggests that this may be a concern for one of the more prestigious labs studying this technology. A study through a Harvard University lab looking at an anxiety app found that people who used an app that was not designed to decrease anxiety showed as much improvement as those who used the anxiety app. These people did better than a “wait list” comparison group that did not receive an app at all. Moreover, people who heard about the app through a news story in the respected publication The Economist were more likely to show improvement, overall—whether they had the real app or the comparison! These findings hint that there may be a placebo effect. At best, it suggests that the researchers don’t quite understand why their app may or may not work.
However, the great thing about this research is that computer programs such as apps offer ways to compare against convincing placebos to a degree that’s much harder with psychotherapy. Even though this may be a bump in the road, it still offers opportunities for learning. It also demonstrates the integrity of the researchers who attempted to compare their app against a convincing placebo.
Adjust Your Expectations
I think it’s also worth noting that the impact of apps on psychological issues will likely be modest. I doubt there will be a social anxiety app that will turn a wallflower into the life of the party. This isn’t a bad thing: if a $2.99 app can help people manage their lives even a little better, that’s a success in my book.
Some Parting Words
In conclusion, I think the use of smartphone apps for treating problems such as anxiety has great potential to make useful, evidence-based treatments available to a greater number people. At the moment, the research is still in its infancy. I can’t recommend any particular apps just yet, but if you’re interested, you might consider getting involved in a research study and helping to move this process along. At this writing, the Harvard lab conducting this work has a sign-up sheet on their website. Or if you find Angry Birds more soothing, keep launching birds at piggies for now until something with proven effectiveness hits the market.