Mobile Applications in Clinical Practice
A tremendous number of mobile apps have launched that target treatment of mental health disorders. As a clinical psychologist and trained cognitive behavioral therapist, I often find myself wondering which apps could actually help patients and which apps aren’t worth the time and effort to incorporate into practice.
As my clinical experience with the use of apps has grown, I’ve developed a few tips that have been valuable in practice and can assist clinicians who may be confused by the wide range of mental health apps available.
Tips for Use
Choose apps from trusted sources that are backed by evidence.
Choose apps that function as therapy extenders rather than therapy replacements.
The National Center for Telehealth and Technology (T2) and the Department of Veterans Affairs produce useful apps that are predicated on evidence-based treatments and sound psychological theory. These are my go-to sources for apps for use in clinical practice. When considering apps from other sources, don’t assume that because the app is based on an evidence-based treatment protocol, then it too is effective. Be sure to review the literature supporting the efficacy of the app itself.
Mobile apps generally fall into three categories:
apps that are intended to function independently, without the guidance of a trained clinician
apps that are intended for use within the context of a course of evidence-based therapy with a licensed clinician
apps that could be used without the guidance of a trained clinician but could also be utilized within a course of evidence-based therapy
I’m generally interested in apps that fall into the second and third categories and are used only as therapy extenders, such as ACT Coach and Breathe2Relax. Mobile apps that are therapy extenders are intended to be used in the context of a therapeutic relationship and often simply make available electronic versions of the same tools used in the analogue version of the therapy (e.g., electronic copies of worksheets). These apps help patients by making it more convenient to complete evidence-based therapy work and allowing patients to continue doing that work even when the course of therapy is over.
Download the app before introducing it to a patient and make sure you’re well versed in its use.
Most apps that fall into the therapy extender category are well designed and easy to use. But I often find that I have to spend some time outside of the therapy room playing around with the app, so that I can adequately answer patient questions and foresee any challenges patients may encounter with using it.
Take a few moments during the session to download the app and review its features together.
We often introduce and practice new skills in session with our patients, such as how to complete an A-B-C worksheet. The same should be done with an app. Patients are usually more familiar with the use of mobile technology than I am, but using technology in the context of sometimes emotionally charged events requires prior practice. For example, using the Virtual Hope Box app in a time of distress could be frustrating if the app is new to the patient. T2 offers education and training resources on using mobile health in clinical care including patient handouts describing key features and functionality of the apps.
Review the app’s privacy and security settings and discuss issues of privacy and security with your patient.
Read the privacy and security agreement that comes with the app and be sure to go over this information with your patient. You aren’t assuming responsibility for security breaches by doing this, but you are doing your due diligence to ensure your patient is fully informed before using an app that you’ve recommended. I think of this process in the same way as informed consent before engaging in any therapy protocol. I’ve also found it helpful to recommend patients place a security passcode on the home screen of their phones as an extra layer of security. More information on protecting and securing health information when using mobile devices can be found on the HealthIT.gov website.
The number of mental health-related apps continues to steadily increase and choosing apps that will add value to your practice can be difficult. But the use of apps that are therapy extenders can genuinely make therapy more accessible and approachable for patients, making the search for those apps well worth the effort.