When psychologist Charmain F. Jackman, PhD, has trouble sleeping, she reaches for her phone, clicks on the Stop, Breathe & Think app and does a body scan or a breathing exercise until she feels sleepy. She also uses the kids’ version of the mindfulness app with her own children. She has become so gung-ho about the app that she now recommends it to patients in her Boston-area private practice and to the high school students at the Boston Arts Academy, where she is dean of health and wellness.
“The fact that I’ve used it many times for myself is why I feel comfortable recommending it to clients,” says Jackman.
Psychologists are using apps with patients in many ways. Apps can be assigned as a form of homework to help a patient practice new skills and stay motivated between sessions. They can be used to help patients with co-occurring conditions, such as when a therapist recommends an insomnia app for a patient with depression. They can track a patient’s moods or other symptoms. They can even provide an easily accessible alternative to “booster” sessions for patients who have finished therapy.
There are now more than 10,000 mental health apps available to consumers. But if you haven’t used an app yourself, how do you know which ones to recommend to your patients? And how can you incorporate apps into your practice most effectively? Jackman and other psychologists offer this advice:
Get recommendations from reliable sources. When you go to an app store, “it feels like practically every app has four stars,” says Stephen Schueller, PhD, executive director of PsyberGuideopens in new window , A Project of One Mind, a nonprofit initiative that offers accurate, nonbiased information about mental health apps. Resources like PsyberGuide and the APA Services, Inc. “Let’s Get Technical” column can help you narrow your options down. Listen for recommendations at workshops and other trainings. And ask your colleagues what they’re recommending to their patients.
Look for the research base. Try to find apps with some research to back them up, although that may not always be possible. “There is quite a bit of research that shows that these tools can be efficacious as both stand-alone products as well as adjuncts,” says Schueller. But when it comes to a specific app, finding evidence can be a challenge. “Research suggests that somewhere between 3% and 5% have an evidence base behind them,” says Schueller. Check the app store or product website to see if an app cites a specific study or was designed by a psychologist, he suggests.
Protect patient privacy. Look at how any app you recommend saves user data or whether it possibly even sells that data, says C. Vaile Wright, PhD, director of research and special projects at APA. Even when apps might not be imperiling users’ health information, she says, they could still be gathering personally identifying information such as names or email addresses. Psychologists and patients should read the fine print on app privacy policies, Wright emphasizes. And they’ll need to keep at it, as terms of service and privacy policies often change. You’ll need to guide patients through the potential data security risks and explore whether they’re comfortable with those risks. You can also suggest ways of mitigating the risks, such as by telling patients not to post photos or to just use initials or even fake usernames.
Ensure a good fit for your practice. Make sure an app aligns conceptually with your theoretical orientation, for instance. “Just because an app says it uses cognitive-behavioral therapy doesn’t mean it does,” Schueller points out. “App developers know this is a buzzword that makes an app seem more evidence-based.”
Check availability. Make sure the app is offered on both Android and iOS platforms. And try to find apps that are free or low-cost, such as the free options available to all through the U.S. Department of Veterans Affairs at the VA App Storeopens in new window .
Get informed consent. For JoAnna Romero Cartaya, PhD, of the Cartaya Clinic in Humanistic and Behavioral Psychology in Iowa City, that means giving patients a handout that includes the apps she recommends plus general issues to consider when using apps. If the recommended apps will transmit patients’ data to her, she gives them a separate handout that explains what information she’ll have access to and offers tips on how to protect their information.
Teach your patients well. During a session, download the app and walk your patient through how to use it. “Doing it during the session takes away some of the potential barriers, like the patient getting home and forgetting what you said,” says Jackman. She also helps patients come up with app-related goals, such as using a meditation app three times a week for five minutes. “We really make it low stakes,” she says, “while also talking about how it could be helpful.” She also helps patients to solve problems even before they start using an app. “We talk about what might get in the way of using the app and when they see themselves using it,” she says. “I try to prime them by envisioning how they would use it.”
Discuss the app in therapy. Talking about patients’ experiences with an app can provide a jumping-off point for broader discussions. “We talk not only about how they used the apps, but how they begin to apply those skills to daily life,” says Cartaya. For a patient with social anxiety, for example, an app can offer practice in taking small risks—such as engaging in an online community—that can then translate into real-life settings.
Monitor patients’ progress. Jackman periodically checks in with patients about whether they’re finding an app helpful and helps them come up with plans for overcoming any challenges they encounter. For apps that track mood or other symptoms, she invites patients to bring the information to sessions and let her review trends. Other psychologists take advantage of the real-time monitoring and communication tools that some of the pricier apps offer via secure messaging.
Know when to stop. The vast majority of Cartaya’s patients like the apps they’re using and find them motivating, she says. But for those who don’t want to start using apps or who want to stop—whether because of privacy fears or tech concerns or because they just don’t feel a particular app is helping—that’s OK, says Cartaya. “I tell them there are things we can do in therapy that are just like an app, just not as beautiful visually as what an app can do,” she says. “That way, people have a choice and aren’t feeling like this is the only option or their treatment will be limited if they don’t use this technology.”
