Mobile psychology

Just four hours after the PTSD Coach app was released to the public, a distressed veteran called the U.S. Department of Veterans Affairs' crisis line because, he said, "my phone told me to call." The call led to an appointment, and the next day, the vet received mental health care at his local VA.

The app has the potential "to really change the course of someone's day or life," says Julia Hoffman, PsyD, a clinical psychologist and mobile applications lead at the VA's National Center for PTSD, where it was developed in partnership with the U.S. Department of Defense's National Center for Telehealth and Technology.

Hoffman is one of many psychologists developing apps as a way to circumvent barriers to mental health care, and bridge gaps in it, by putting psychology directly into people's palms.

PTSD Coach, for example, targets an important audience because stigma and logistical issues often prevent veterans, service people and civilians dealing with symptoms of post-traumatic stress disorder from receiving care, Hoffman says. The free app was launched in 2011 and as of January, had been downloaded 135,000 times in 78 countries. It also provides educational resources about PTSD, tools to assess symptoms and hundreds of "bite-sized" evidence-based cognitive and behavioral interventions, such as deep-breathing exercises and guidance on positive self-talk, to help users manage their symptoms.

"We don't see apps as a way to replace treatment, but for those who may be reluctant consumers, this may provide a step into care and something in place of nothing," Hoffman says.

Here's a look at five other smartphone applications that can help you and your clients.

CBT*ABC way: Cognitive-behavioral therapy apps in Spanish and English

Available on iTunes, $6.99

San Jose, Calif., clinical psychologist Yvette Tazeau, PhD, designed her app, CBT*ABC way, after noticing parents and children tapping on iPhones and tablets in her waiting room but putting them away as soon as they entered the therapy room.

"I was plugging away using traditional books, workbooks and thought records, and it dawned on me … why don't we put those two things together?" Tazeau says.

So, Tazeau teamed with a computer programmer and a graphic designer to create a series of apps for children and adults dealing with anxiety or depression. Available in English and Spanish, the apps encourage users to record their negative experiences and thoughts, then prompt them to use cognitive-behavioral strategies, such as identifying negative thought patterns and replacing them with positive solutions. For example, a job applicant ruminating about an upcoming interview might replace, "I'll never get the job" with "My experience working abroad will set me apart."

The app is a way for clients to carry around what they learn in therapy — not to substitute for therapy itself. In fact, several users have found their way into a therapist's office after downloading the app, Tazeau says. "[Technology] will never supplant us — it's a way to reach people," she says.

To learn more, go to TikalBayTek.

Insight Notes: Recordkeeping and notes for therapists, evaluators, students and other service professionals

Available on iPad, under $10, plus monthly fee under $20 for secure backup

Adam Alban, PhD, JD, created Insight Notes to give fee-for-service psychologists a note-taking and recordkeeping option that also meets HIPAA requirements for encrypted data. "I wanted to create a simple system that would [allow psychologists] to take notes on a per-client basis, to do it securely and to do it incredibly efficiently," says Alban, who runs psychology and law practices in San Francisco.

The program, which Alban created with a team of attorneys, designers and app developers, allows psychologists to take notes and scan images that are organized by patient and automatically backed up. Providers can then send these files securely in batches, rather than piecemeal. Users can also include their signatures and letterhead on any documents they choose.

While Alban's team plans to add other elements that can facilitate clinical work, he says the program's appeal is in its simplicity. "There's a population of psychologists who don't need really robust practice management solutions — they just want to be able to do things quickly, easily and [digitally]," he says. "We wanted to be able to support them."

To learn more, go to Insight Notes.

ReliefLink: An app for suicide prevention

Available on iTunes, free

When someone who's attempted suicide winds up in the emergency room, the news is mostly good — he or she has failed at the attempt and is receiving care. But once discharged, the patient is at risk again. Seeking to improve the coordination of follow-up care and keep patients closely connected to help is ReliefLink, an app developed by a team led by APA President Nadine J. Kaslow, PhD, at Emory University.

"My idea would be that every time someone comes to a hospital or therapist with suicidal symptoms, they would be encouraged to use the app," she says.

The app includes such features as a mood tracker, a personalized safety plan, coping strategies and an emergency button that connects users to friends, hospitals and other resources. If, for example, a user reports his mood is dipping into a risky zone, a pop-up message offers such suggestions as calling a health-care provider, using deep breathing exercises or following directions to the nearest place to get help.

The app won first prize in a contest sponsored by the federal Substance Abuse and Mental Health Services Administration in September and may soon be used at health-care systems throughout the country, community mental health centers, as well as by suicide prevention organizations in other countries, Kaslow says.

Step Away: Mobile intervention for alcohol addiction

Available on iTunes, $4.99

Far too few people with an alcohol problem receive any sort of treatment, says psychologist Patrick Dulin, PhD, of the University of Alaska, Anchorage. That's why he and colleagues created Step Away, an app that helps curb or eliminate problem drinking in a subtle way that fits seamlessly into people's everyday lives, Dulin says. "We have a great opportunity with smartphones to provide alcohol interventions whenever and wherever people need them."

The app progresses through 10 intervention steps designed to build awareness of the problem, set specific goals and develop skills either to moderate or abstain from drinking. It provides prompts for users to check in daily about progress and upcoming events, and offers weekly feedback based on their goals. For example, if a college athlete aiming to curb her drinking indicates a party on an upcoming Saturday, the app may remind her of her goals on that day — perhaps by showing a photo of her team or by showing a strategy for staying in control while at the party. A father who's worried that his drinking is alienating his children may view a photo of his family when he indicates he's tempted to drink.

The app also links to care, such as the option to call a friend, email a doctor or find a treatment facility, and it allows users to schedule alternative non-drinking-related activities on their calendars. It also records users' progress so that they can share it with friends or health-care providers. "Having this system keeps them aware of various triggers and it helps them to stay on track," Dulin says.

A pilot study of the app's prototype, which Dulin and his colleague Vivian Gonzalez, PhD, created and tested with a grant from the National Institute on Alcohol Abuse and Alcoholism, showed that people who used the app for six weeks spent 60 percent less time drinking heavily and cut their overall number of drinks in half (Substance Abuse, 2012).

For more information, go to Stepaway.

The Therapy Outcome Management System: Instant feedback on therapy outcomes

Available on iTunes, $14.99

Tracking patient progress over the course of treatment is a proven way to improve outcomes, reduce dropout rates and strengthen the therapeutic alliance. But how exactly do you ask, and record, how a patient feels about therapy — or about you?

One new way is through TOMS (Therapy Outcome Management System), an app designed by Nicholas Wiarda, a predoctoral intern at the Spokane VA Medical Center, Mark McMinn, PhD, a professor of psychology at George Fox University in Oregon, and Scott Miller, PhD, founder of the International Center for Clinical Excellence.

Based on Miller's empirically validated session and outcome scales, the app asks clients about their well-being and satisfaction with the therapist's approach before and after each session. Having those data — which the app plots onto a graph — allows therapists to adjust their approach along the way, says McMinn, who uses the app himself. "It is simple, affordable and the results are immediate," one reviewer wrote on the Apple store's website. "This seems like the perfect solution."

To learn more, go to 114 Consulting.