“Reminder: Eat breakfast.” That’s the notification Jennifer receives on her phone every morning after waking. After eating, she picks up her phone again to record what she ate and how she felt. Throughout the day, the app she uses, Recovery Record, acts as an online diary of sorts, reminding her to eat a snack or log her supper.
“It takes a lot of the anxiety out of eating,” said Jennifer, a 20-year-old Londoner who has had an eating disorder for three years.
Alongside therapy, recording these dietary details on her mobile app is a crucial part of coping with her disorder — as is the privacy of her recovery, so Jennifer is not her real name, and the information she punches in (both food and feelings) is protected.
Hundreds of apps available on iTunes and Android address a spectrum of mental health issues. Some track mood swings, while others deal with anxiety through meditation or breathing techniques. There are apps specific to phobias, depression and eating and bipolar disorders. In the U.K., the National Health Service (NHS) has assembled a library of mental-health-related apps.
But there’s little data on how effective these apps are. And since they are able to collect a great deal of data on users, privacy concerns arise as well.
For Jennifer, the stigma associated with an eating disorder was so powerful that she didn’t even go to her family physician when she first sought help.
Recovery Record stores Jennifer’s data securely on the phone but allows some limited, anonymous sharing with other users. She believes the anonymity leads to support and encouragement. Other apps that are less private and allow more sharing invariably result in what she calls negative competition: a race to the bottom to see who has eaten the least that day.
The app rewards her with a prize — a puzzle piece, for example — for each meal she logs. “I know it’s a bit childish, but I like the idea,” she said of the positive electronic feedback.
The data stored on the app also helped reveal behavioral patterns. Now she eats more in the morning because her mood swings tend to worsen as the day progresses, causing her to skip meals.
Recovery Record, created by 29-year-old clinical psychologist Jenna Tregarthen, has been used by 300,000 people since its launch in 2012. Tregarthen, who said she created the app after watching her best friend’s decade-long struggle with an eating disorder, believes it’s “an easy first step” to getting professional help, adding that about 30 percent of users have not yet confided in anyone about their illness.
“There is so much stigma associated with mental health, and people disclose within the sanctity of the relationship with their clinician,” she said. “Mobile provides a continuation of that relationship,” she said.
The app’s security features include password protection for users as well as for therapists on the receiving end of the data. “We’ve gone to great lengths to make sure this data is secure,” said Tregarthen.
The app delivers cognitive behavioral therapy (CBT) on a mobile platform and solves a specific problem: Although clinicians teach patients a range of skills to help modify their behavior and thought patterns, patients don’t always put these to work when they need to. So the app will remind the user, for example, to practice “thought stopping” and regain control of distorted feelings. Tregarthen said Recovery Record users report feeling more accountable for their behavior because of the app.
“People trust their phones incredibly,” she said. “They’re often able to disclose things they’re not comfortable saying in person.”
Other mental health apps are in the pipeline. Code Blue, which is being tested to help teenagers with depression, will soon be launched by Social Code, a New Zealand–based organization that works to prevent teenage suicide.
The National Alliance on Mental Illness (NAMI), a U.S.-based mental health advocacy group, recently launched an app called AIR (tag line: “Anonymous. Inspiring. Relatable.”) designed for those struggling with mental illness as well as friends and family members in need of support. The app is in a beta stage, with 200 active users who air their feelings by posting anonymously within the network.
Katrina Gay, communications director at NAMI, said that health care still has a long way to go, referring to problems like high out-of-pocket expenses for mental health patients and that mobile apps “could help bridge the gap.”
“People need a variety of tools and avenues,” she added.
Increasingly our personal information — whether medical or financial — is stored online. App designers have to address concerns that this digital information could be hacked or leaked to private health insurance providers.
The AIR app mitigates these risks by collecting only a patient’s user name and email address.
“While we understand that all digital information is at risk for hacking, we do not believe that an insurance provider would find the information revealing about an individual,” said Gay.
Adam Haim, who heads the clinical trials operations and biostatistics branch of the National Institute for Mental Health (NIMH), which funds apps like Recovery Record, admitted there are security challenges.
“This is an evolving field, and in the open marketplace users should be aware there are potential risks to privacy,” he said. “But users should be made fully aware of both the risks and the benefits.”
Despite privacy concerns, Haim expects “a groundswell of new apps” in this area. “Both smartphones and wearables [like the Apple watch] have considerable potential to significantly enhance the diagnosis and treatment of mental illness,” he said.
In order to receive funding from NIMH, mental health app developers must show their product has been tested, researched and peer reviewed. This isn’t the case for many other mental-health-related apps available for download. App developers work fast to get a product on the market, which is not best suited to the exhaustive step-by-step nature of scientific research.
“One of the challenges is that the software development process is not as enmeshed as it might be with traditional research projects,” said Haim.
One app undergoing rigorous testing is Predicting Individual Outcomes for Rapid Intervention (PRIORI), which is being developed for people with bipolar disorder by researchers at the University of Michigan.
PRIORI runs constantly in the background on users’ smartphones, recording their voice and tracking speech patterns. In bipolar patients, a manic episode is often characterized by loud, fast talk, whereas speech slows down during a depressive phase. The app captures and encrypts this speech data and sends it to a central server, where it is analyzed by experts in mathematical modeling.
“I’m not interested in what is said, only how it’s said,” says Melvin McInnis, the lead psychiatrist behind PRIORI.
The idea is that the app works as an early warning system, giving patients and their psychiatrists notice that an episode is on its way. McInnis likens it to an engine light warning on a car.
Reliable, objective data is often hard to come by from patients with extreme mood disorders, but when it’s the app’s job to collect voice data, the patient doesn’t need to do a whole lot. So far, 40 people have tested the app over a year, and McInnis plans to expand the group to thousands more this year.
McInnis and Tregarthen agree that it’s not just the growth in mobile devices that is driving new ways to treat mental illness but also the state of the health care industry in the U.S.
“It’s imperative that we make changes. We can’t continue down this trajectory, because of increasing health care costs,” said McInnis. “The whole mobile device approach will change medicine.”
Tregarthen said feedback from clinicians has been positive. “Therapists are overwhelmed and overworked,” she said. “The therapeutic community is in need of more resources and innovative solutions. There has to be a better way to scale effective care.”
PRIORI has four years’ worth of research behind it, and McInnis said it needs more time in development.
“The app has one goal, to help people with bipolar disorder. The holy grail is to prevent an episode and improve the quality of life,” he said. “If we can’t demonstrate that it can help people live better, then it’s just a cool app.”