Kanesha Simmons, E’leyna Garcia, Mary Katherine Howell, MS,
and Sharlene Leong, MA
Mobile applications, utilized on smartphones, or “apps,” are just one of many behavioral intervention technologies (BITs) that harness the power of information and communication technology to address behavioral and mental health outcomes. Although this article only reviews selected mobile apps for various mental health concerns, BITs may also include videoconferencing and standard telephone technologies to deliver psychotherapy, web-based interventions, social media, virtual reality, and gaming.
In a review of BITs, Mohr and colleagues (2013) explained that the unique contribution of mobile technologies lies in their capacity for “in-the-moment” interventions, using technology that people carry with them nearly continuously, often throughout the day and night.
Smartphone technology has become more interactive and more attuned to real-time events. Increasingly, it is being designed in co-operation with health service researchers and providers. Research has illustrated that smartphone technology has been effective in a wide range of applications, from CPR training (You, Park, Chung, & Park, 2010) to diabetes management (Ciemins, Coon, & Sorli, 2010; Rao, Hou, Golnik, Flaherty, & Vu, 2010). Increasingly, apps are being used in behavioral health settings to deliver treatment directives and monitor compliance in multiple areas including, substance abuse management, anxiety reduction, tobacco cessation, mood management, insomnia, pain management, PTSD, relaxation techniques, severe mental illness, drug abuse, violence prevention, as well as the psychoeducation and management of severe mental illness (Freedman, Lester, McNamara, Milby, & Schumacher, 2006; Obermayer, Riley, Asif, & Jean-Mary, 2004; Brendryn & Kraft, 2008, Depp et al., 2010).
While we will be reporting on some impressive empirically strong outcome studies, it is clear that we need much more research on the factors affecting patient utilization of health oriented applications and how these intervention apps can be integrated into existing treatments as well as establishing the efficacy of specific apps on mental health outcomes. Another significant limitation of smartphone technology is the lack of any comparison research regarding the differential effectiveness of the ever widening assortment of smartphone applications. Still, we have enough evidence, at this time, to present a large number of applications that could confidently be used by a wide range of therapists, using a variety of treatment plans with a variety of patients exhibiting a variety of targeted symptoms.
The range of available applications runs in the hundreds, if not the thousands. Our goal is to present the most validated and rigorous of those applications, which were developed with a variety of goals, including treatment monitoring and adherence, health promotion incentivization, or incentives to providing decision support systems (Chan, Torous, Hinton, and Yellowlees, 2014). While some applications have been designed to work only in conjunction with a treating psychologist, many are highly flexible and can be utilized as a supplement of psychotherapy, as a primary psychosocial intervention under the guidance of a therapist, or on an individual basis without the person being involved in formal therapy or having professional guidance (Chan et. al, 2014).
Mobile applications for mental health are advantageous in that they require minimal resources, are free or low cost, are highly portable, can be utilized with or without a therapist, and can provide instant intervention during a crisis. Additionally, mobile applications have the potential to reduce health disparities in terms of providing easy access, since a majority of patients with mental illness own mobile devices. For example, Chan et al. (2014) reported that of 1,592 individuals with serious mental illness in metropolitan Chicago, 72% owned a mobile device, which included smartphones. Chan and colleagues (2014) also reported that in a university-affiliated outpatient psychiatry clinic, 70 out of 100 patients surveyed owned a smartphone, and over 50% of those owning a smartphone were willing to download a mobile application to monitor their mental health.
Concerns regarding smartphone healthcare technology generally revolve around patient privacy and confidentiality, although some authors have concluded that "telemental" healthcare can be provided safely (e.g., Luxton, Sirotin & Mishkind, 2010). What follows is a list of the most effective apps, available as of 2016, for psychological health service providers to enhance client satisfaction, increase client participation, and improve client outcomes.
Drug abuse is an extremely debilitating disorder as it affects an individual’s family, work life, and daily functioning. Recovering from drug abuse is no easy task. It requires having a strong support system and therapy. Many phone applications have been developed to help support individuals suffering from drug abuse.
Addicaid: designed to help individuals suffering from drug addiction in their process to recovery and sobriety (Addicaid, 2016). The app list numerous 12-step programs and alternative support groups for the user to choose from. In addition, the app lists where groups meetings are being held, provides directions to the group meetings, saves the group meeting dates to the user’s calendar, and allows users to check into meetings. Furthermore, the app allows users to provide feedback on how they thought the meeting went. The app also provides chat/discussion boards, which allow users to chat openly or anonymously about their journey and receive support from others (Addicaid, 2016). This app is currently free for Android, iPhone, iPad, and iPod touch.
IMQuit: assists individuals in overcoming their addictions. IMQuit helps users with a variety of addictions ranging from alcohol to smoking. The app traces behaviors and allows users to compare and share their success with friends and physicians (“Best Apps for Addiction Recovery,” n.d.). A unique feature of the app is that it allows users to track more than one addiction at a time. Furthermore, the data the user puts into the app is backed up and can be synchronized on different devices. The app also provides visual charts and diagrams to illustrate the user's progress. An encouraging message is given to users should they relapse to encourage them to keep going (“Best Apps for Addiction Recovery,” n.d.). This app is currently available for Android.
recoveryBox: designed to help users’ recovery from a variety of addictions. The app provides information regarding why habits and addictions form and how to break the cycle, and allows for the user to track their activities using a light system (“RecoveryBox, the iOS App for Addiction Recovery,” n.d.). Activities are categorized into three categories: green light, indicating favorable activities; yellow light, indicating warning activities; and red light, indicating dangerous, acting out activities. Users can send texts and emails directly from the app to their accountability partner or counselor. In addition, the app has daily “devotionals” to help encourage users during their road to recovery. Some unique features of the app are that it allows users to journal their triggers and earn badges when they reach a personal milestone (“RecoveryBox, the iOS App for Addiction Recovery,” n.d.). The app is currently available for iPhone, iPad, and iPod touch for $1.99.
Severe Mental Illness
Within the past decade, researchers have been investigating technological interventions for severe mental illness (Ben-Zeev, D., Davis, K. E., Kaiser, S., Krzsos, I., & Drake, R. E., 2013; Depp et al., 2010; Haas et al., 2010). For example, MONARCA is a system designed to be used by bipolar patients, clinicians, and patients’ relatives. The system is separated into two unique features. The first feature is an Android application that offers discrete services to patients: it allows patients to complete self-assessments, provide assessment feedback, and monitor medication compliance (Bardman et al., 2012). The second feature allows a “second screen” so that the patient’s usage can be shared with clinicians, relatives, and others on the health treatment team. The website provides a historical overview of all activity, which aids clinicians in monitoring patients with bipolar disorder (Bardman et al., 2012). This particular app is still in development as of 2016.
Depp et al. (2010) examined the use of mobile interventions in three preliminary clinical trials utilizing three different mobile applications: Personalized Real-Time Intervention for Stabilizing Mood (PRISM), Mobile Assessment and Therapy for Schizophrenia (MATS), and Skills Training and Empowerment Program (STEP). The goal was to assess the effectiveness of these three apps in reducing the symptomatology of severe mental illnesses including bipolar disease and schizophrenia (Depp et al., 2010). Results indicated that mobile interventions are feasible to use in these populations and can decrease the reported symptomatology of individuals struggling with severe mental illnesses (Depp et al., 2010). These mobile interventions are also still in development as of 2016.
Below are three of the most promising apps designed for severe mental illness that are available as of 2016:
Big White Wall: Big White Wall is a phone application which allows people living with various mental illnesses to chat about their issues. In addition to chatting with other people who have similar mental illnesses, the application allows for individuals to chat and be supported by trained therapists (“Big White Wall – the support community for emotional health,” n.d.). Some specific features of the app include a discussion board, self-assessment, and articles that provide information regarding various mental illnesses. A unique feature of the app is that it allows users to talk with one other anonymously, thus alleviating any stigma, and allows the users to share their problems more candidly. Another unique feature of the app is that it allows users to register for online therapy programs (“Big White Wall – the support community for emotional health”, n.d.). The app also allows users to create “bricks” or picture collages, which serves as a way for the users to express themselves. This app is currently available for Android, iPhone, iPad, and iPod touch for approximately $37, with a free supplemental app available.
eMoods Bipolar Mood Tracker: allows daily monitoring of the user's mood, sleep patterns, medication, and other symptoms of bipolar disorder (“EMoods Mood Charting”, n.d.). A unique feature of the app is that it emails a report to the user’s doctor or caregiver every month, which allows the provider to identify triggers and possibly prevent future episodes. This app is currently free for Android.
DBT Diary Card and Skills Coach: designed by a licensed psychologist and includes the key principles of Dialectical Behavior Therapy (DBT). In addition, the app includes a skills coach and a unique feature that allows for behavior monitoring (“DBT Self Help,” n.d.). These features are designed to help the user slow down and process their thoughts and feelings in that moment and apply the DBT skills (“DBT Self Help,” n.d.). The goal of the app is to improve one’s mood using the DBT key principles. The app is currently available for iPhone, iPad, and iPod touch for $4.99.
There are multiple smartphone applications designed to prevent violent incidents from occurring or to provide immediate help to victims of violence. The majority of these applications center around domestic violence and sexual assault prevention. Intimate partner violence (IPV) is defined as physical, emotional, or psychological harm imposed on an individual by a current or former spouse. Health, Education on safety, and Legal Participant Preferred (HELPP Zone) is a safety application to prevent escalating dating violence designed for Android users. The HELPP Zone application allows users to set up of a list of “trusted contacts,” which are referred to as helpers in the app. Helpers are contacted through text message or phone calls, which provides the user's geographic location, time stamp, and need of the user (Masoumzadeh, 2013). Additional tools available to the user are safety tips that can be used to detect when a situation is escalating and tips on how to de-escalate a violent situation (Masoumzadeh, 2013). For example, the app shows quick tips on the message bar stating “Has your partner yelled at you lately? Watch out! This can only escalate.” As of 2016, this app has not been released as it’s still in the development stage. Below is a list of some of the top emerging applications developed to ensure the safety of women, adolescents, and other potential victims:
Abhaya: a safety application designed to protect women from dating violence and sexual assault. This application includes the installation of four numbers on speed dial, one of which includes the local authorities. In addition, when users are travelling, they are able to leave the application running so that their GPS location is constantly being tracked. Should trouble arise, users are to click the “start” button of the application, which will make an automatic call to the first saved contact number in the registry. It will also send messages to all saved contact numbers of the victims URL location. The message containing the victim’s URL location will be sent continuously every five minutes, until the user/victim presses the “stop” button. This unique feature allows for tracking of the victim, thus enabling authorities to intervene (Yarrabothu, 2015). This app is currently available for Android.
SafeSnapp: designed to act as a safety witness/self-defense tool (“SafeSnapp,” n.d.). It allows users to take a picture of their assailant. Within seconds, the picture is sent to the user’s email address and the email address of a close friend or family member, along with the assailant’s GPS location (“SafeSnapp,” n.d.). Although the app does not necessarily prevent attacks, it does help the user and the police conduct an investigation, providing the police with a good lead to go on (“SafeSnapp,” n.d.). This app is currently available for iPhone, iPad, and iPod touch for $9.99.
circleof6: allows users to connect with six close friends and family members (“Circle of 6,” n.d.). The app has unique features such as sending different notifications to the user’s circle. The notifications range from requesting a safe ride to alerting the user’s circle that he/she is in a strange environment. In addition, the app allows the user to contact the local authorities if needed. The app also has the phone number of hotlines for sexual assault and relationship abuse (“Circle of 6,” n.d.). This app is currently free for Android and iPhone.
Tools to help manage stress and induce relaxation are popular amongst healthcare providers. There are several applications for relaxation techniques. The National Center for Telehealth and Technology (T2) has developed and researched mobile applications that provide relaxation strategies for various circumstances. All can be used on an individual basis; however, they can also be used in conjunction with a therapist. These applications are not intended to replace therapeutic care, but rather to reinforce healthy methods of coping with stress. Most relaxation techniques involve an aspect of controlled breathing, which each app below focuses on in one way or another. Breathing exercises have been documented to decrease stress responses, and to help with mood stabilization, anger control, and anxiety management (“Breathe 2 Relax,” n.d.).
Breathe2Relax: teaches breathing and stress management through diaphragmatic breathing exercises. It can be used as a stand-alone stress reduction tool or it can be used in conjunction with a therapist (“Breathe 2 Relax,” n.d.). Diaphragmatic breathing is a skill that is taught to induce a calming response in various circumstances including treating PTSD, panic attacks, childbirth, and meditation. This app guides a deep breathing practice and can be set to preferred music, video scenery, and breathing intervals. It also offers a pre- and post-exercise stress rating capability. This app is currently free on Android, iPhone, iPad, and iPod touch.
Tactical Breather: teaches the use of breathing to control stress responses. This app can be used to gain control over physiological and psychological responses to stress (“Tactical Breather,” n.d.). Many of the techniques taught in this application were provided from the book “On Combat: The Psychology and Physiology of Deadly Conflict in War and Peace” written by Lt. Col. Dave Grossman (“Tactical Breather”, n.d.). Although this app was primarily developed for soldiers during intense combat situations, anyone can benefit from the techniques in stressful situations. Tactical Breather has been found to be a popular app and received second place in the “General Wellness” category during the Apps4Army competition (“Tactical Breather,” n.d.). Consumers rate the app 3.5 stars out of 5 on iTunes. The app utilizes a male or female voice to guide users through breathing exercises. This app is currently free on Android, iPhone, iPad, and iPod touch.
Mindfulness Coach: created by the VA's National Center for PTSD in partnership with the Department of Defense's National Center for Telehealth and Technology. Mindfulness has been shown to be helpful for reducing stress and coping with unpleasant thoughts and emotions (“Mindfulness Coach,” n.d.). This app provides education about the benefits of mindfulness, exercises to practice individually or with guidance from a therapist, a log to track progress, and reminders to support the practice of mindfulness (“Mindfulness Coach,” n.d.). Some of the exercises include mindful breathing, mindful walking, and mindful eating. Each exercise can be audio guided or self-guided and the log tracks the total number of minutes of Mindfulness Activity per day. This app is currently available for iPhone, iPad, iPod Touch.
There are mobile applications that address problems with falling asleep, staying asleep, or waking up. They range in cost from free to minimal cost ($5 or less). Some applications are intended to be used in collaboration with a therapist, while others can be used individually without needing to be in therapy. The majority of sleep apps are for tracking total sleep time to better understand general sleep patterns. However, there are a few that are specifically aimed towards clinical sleep disturbances. The sleep apps that are developed for automatically tracking and monitoring sleep may be inaccurate at times, since being very quiet and still registers on the device as “sleep” and movements are registered as “awake.” Thus, when used in nursing homes, sleep times are grossly overestimated since many clients can sit without moving for long periods of time and still be awake. Moreover, children’s sleep times tend to be underestimated since they are more physically mobile during sleep than adults.
Yet, feedback on total sleep time provided by devices such as Fitbit, have been enormously helpful for individuals with sleep state misperception, a condition where individuals feel erroneously that they have been up all night. The feedback gives confirmation that at least their body was sleeping or at least resting “as if” in sleep for X number of hours per night.
The empirical studies on sleep apps is quite extensive. For example, sleep related feedback from breast cancer patients found that the application was useful to help them track their sleep habits during a 90-day longitudinal collection of daily self-reporting (Min et. al 2014). Additionally, applications have been developed to record and monitor the depth of an individual’s sleep (the sleep stages) to help users wake up at appropriate times in the sleep cycle for maximum alertness (Krejcar, Jirka, and Janckulik, 2011).
Mobile applications are effective in reducing the older, obtrusive methods of monitoring sleep (Chen et. al 2013). The willingness, positive outcomes, and the feasibility of mobile applications demonstrate the benefits in recommending mobile applications to address sleep issues that come up in therapy.
For those who suffer with insomnia symptoms, the National Center of Telehealth & Technology recommends an application focused on treating insomnia using Cognitive Behavioral Therapy.
CBT-i Coach: a collaboration between the VA’s National Center for PTSD, Stanford University Medical Center, and the Department of Defense’s National Center for Telehealth & Technology. CBT-i Coach is a mobile application designed to help individuals with insomnia symptoms move towards optimal sleep. The CBT-i Coach application acts as an electronic diary of patients’ sleep combined with cognitive behavioral techniques and education (Wolski, 2011). This app is not intended to be used independently, but rather in conjunction with a clinician who is trained in Cognitive Behavioral Therapy for Insomnia. This app provides three key features that go beyond the traditional care received in a therapeutic session:
1) CBT-i Coach provides instant and time-independent access to the behaviors that should be practiced often for the best outcomes;
2) The app gives continuous feedback on sleep behaviors in order to enable the algorithm-based aspects of the intervention;
3) The app calculates the sleep related data, which the clinician would typically have to do at the beginning of sessions, and allows more time for interaction between the client and the clinician (Wolski, 2011). Babson and colleagues (2015) ran a 2-week intervention for male veterans with sleep problems and cannabis use disorder. The participants who were assigned to use CBT-i Coach found the app to be user-friendly and helpful. They stated they would use it in the future. Additionally, they felt that their sleep efficiency and sleep quality were improved. This app is currently available for Android, iPhone, iPad, and iPod touch.
Dream EZ: developed and researched through the National Center of Telehealth and Technology. It is based on Imagery Rehearsal Therapy (IRT) and can help diffuse nightmares in order to increase optimal sleep. In IRT, a patient must “put effort into confronting the nightmare, visualizing it, rewriting the plot and ending, and reiterating the new dream over and over for the therapy to be effective” (Lange, 2016). The Dream EZ application now allows individuals to do this using their smartphone rather than by hand on paper. Dream EZ enables users to write and log a description of their nightmares, track and monitor when and how often the nightmare occurs, practice visualization techniques to rewrite the dream’s plot and ending, and to record a new version of the dream, which can be repeated before bedtime (Lange, 2016). Dream EZ is considered to be the first mobile application that uses IRT to address nightmares. This application aids patients in remaining engaged in their own healthcare by continuing to practice IRT techniques between appointments (Lange, 2016). Thus, this application is intended for use in conjunction with a therapist, rather than alone. The Dream EZ app also includes sleep tools such as muscle relaxation and diaphragmatic breathing exercises to help individuals reduce stress and anxiety, thus promoting better sleep. Additionally, the app has a dream log with a rating scale to track the intensity of dreams, reminders to practice the new version of their dream before going to sleep, and a summary section that individuals can share with their therapist to demonstrate how their activity between appointments (Lange, 2016). This app is currently available for Android, iPhone, iPad, and iPod touch.
Sleep Cycle: has the potential to increase optimal sleep for those who suffer from any type of sleep disturbance. Although this mobile application does not have empirical evidence, it has been rated as one of the top five sleep applications in the United States (Henry, 2013). Consumers have rated this app 4.5 out of 5 stars on iTunes. Sleep Cycle watches sleep habits from an individual’s nightstand in order to help them wake up at the best time of the morning. Additionally, the app advises consumers on where they should place their phone while sleeping so that the monitor receives the most accurate data and can also detect awakenings and movement throughout the night. This app presents the data in easy-understand graphs and also functions as an alarm clock. It analyzes sleep patterns and then picks a moment to wake the user within a half-hour window of the set alarm time when the individual is sleeping their lightest. Clinical observations demonstrate that the gentle alarm used for awakening, in addition to the optimal alarm wake time makes it easier for users to get out of bed in the mornings. Sleep Cycle can be used individually or in conjunction with a therapist. However, it is not linked to any specific type of therapeutic treatment. This app is currently free for Android, iPhone, iPad, and iPod touch.
The primary developer and researcher of mobile applications (apps) for posttraumatic stress disorder (PTSD) is the National Center of Telehealth & Technology. Their apps related to PTSD perform one of two functions: 1) provide education on PTSD and opportunities for self-assessment or 2) supplement the psychotherapeutic treatment of PTSD.
PTSD Coach: designed to help individuals with PTSD symptoms better understand and manage their symptoms (Department of Veterans Affairs, 2011; PTSD Coach, 2016). This app provides users with education about PTSD, information about professional care, a self-assessment for PTSD, opportunities to find support, and 29 tools that can help users manage the stress of daily life with PTSD. Tools range from relaxation skills and positive self-talk to anger management, mindfulness, and other common self-help strategies. Users can customize tools based on their preferences and can integrate their own contacts, photos, and music. This app can be used by people who are in treatment as well as those who are not. While the app was created specifically for Veterans, the only Veteran-specific part of the app is the “Find Professional Care” tool, which mostly lists referral resources only relevant to Veterans. This app is currently available for Android, iPhone, iPad, and iPod touch. PTSD Coach is also available for desktop computer use under the name PTSD Coach ONLINE.
A sample of 45 Veterans receiving PTSD treatment using PTSD Coach for several days reported being very satisfied with the app and perceived is as being moderately to very helpful in managing their symptoms (Kuhn et al., 2014). A larger, more recent sample of 156 iPhone and Android users indicated gratitude for the availability of the app in their user review, although only 37% of users accessed one of the app’s primary content areas (Owen et al., 2015).
Two apps have been developed to supplement the two leading evidence-based psychotherapeutic treatments for PTSD, Prolonged Exposure therapy (PE) and Cognitive Processing Therapy (CPT).
PE Coach: designed to provide easy access to the necessary tools for successful PE participation, including audio recording capacity for easy playback after sessions, tools to support patient homework between sessions like a breathing-retraining tool, and visual displays charting symptom reduction over time (Reger et al., 2013; PE Coach, 2016). PE Coach addresses barriers to PE implementation and adherence by integrating with smartphone calendars to encourage patient recall, homework compliance, and session attendance. The app also includes a link to a Clinician’s Guide that integrates the PE Coach app with standard PE. Initial reports indicate that use of PE Coach may improve levels of patient satisfaction during PE compared to treatment as usual (Reger, Skopp, Edwards-Stewart, & Lemus, 2015).
In addition to evaluating the accessibility and utilization of apps for PTSD, clinician perceptions of such apps must also be evaluated, particularly for apps designed to pair with and support evidence-based psychotherapeutic treatments for PTSD. A study investigating 163 mental health clinicians’ perceptions of PE Coach found that certain subgroups of people may be more receptive to using PE Coach. Age (<40 years old), smartphone ownership, and having used apps in therapy previously were related to more favorable perceptions, and smartphone ownership, relative advantages of the app over other known tools, and complexity significantly predicted intention to use PE Coach (Kuhn et al., 2014). This app is currently available for Android, iPhone, iPad, and iPod touch.
CPT Coach: designed for persons participating in CPT with a mental health care provider. CPT Coach provides an assessment tool for tracking symptoms and progress, homework assignments and worksheets for each session, reminders for therapy sessions, and educational materials (CPT Coach, 2016). To the knowledge of the author, no peer-reviewed research has been conducted on the efficacy of CPT Coach. CPT Coach is currently available for iPhone, iPad, and iPod touch.
There seem to be more apps currently on the market for anxiety and worry than for any other mental health-related topic. In the following review, we have excluded any apps that may be popular but involve only journaling or self-assessment. Unfortunately, little empirical data exists on anxiety-related mobile apps at this time. However, a review of selected highly rated and frequently downloaded apps from HealthLine’s Best Anxiety Apps of 2016 follows (Schaefer, 2016), accompanied by user observations from the author.
Self-Help Anxiety Management (SAM): offers graduated learning for the management of a wide range of anxiety-related problems with nearly 50 reflection-oriented and action-oriented tools (Johansson, 2016). Users rate the helpfulness of tools and build their own self-help toolbox while they also self-assess their level of distress in different domains of anxiety, including feelings of anxiety and tension, worry, unpleasant physical sensations, and avoidance. SAM also enables users to share experiences with anxiety management in a social cloud. SAM was developed by University of the West of England (Bristol). This app is currently available for Android, iPhone, iPad, and iPod touch.
Stop Panic & Anxiety Self-Help: developed by clinical psychologist Monica A. Frank, PhD, and provides hundreds of tools, articles, and audio files for individuals struggling with panic attacks, including assistance during panic attacks, relaxation techniques, emotion training, and mindfulness training (Frank, 2016). This app also features a cognitive diary and offers instruction on how to identify the precipitating event, ensuing emotions, thoughts, applicable irrational beliefs, a challenge to the irrational beliefs, plans, and comments. This app is currently free for Android.
Panic Relief: another leading app addressing panic. Developed by Danish psychiatrist and cognitive therapy specialist Marianne B. Geoffroy, M.D., PhD, Panic Relief offers educational materials regarding Panic Disorder and several techniques for preventing and managing a panic attack (Geoffroy, 2016). The free version of this app provides the educational materials and instruction on one relaxation technique involving tensing and relaxing the arm. Paying $0.99 unlocks three more relaxation techniques targeted toward other unpleasant panic-related sensations in the body. This app is currently available for Android, iPhone, and iPad.
MindShift: developed by The Anxiety Disorders Association of British Columbia for young adults and teens struggling with anxiety (AnxietyBC, 2016). This app provides users with educational resources about anxiety, a self-assessment tool, relaxation exercises, visualizations, mindfulness strategies, and guided cognitive restructuring for various domains that trigger anxiety. Although some examples and aspects of the app are geared specifically toward youth (examples related to test performance anxiety, etc.), much of the app seems applicable and appropriate to adults of any age. This app is currently free for Android, iPhone, iPad, and iPod touch.
Many individuals that seek psychological care have voiced interest in using supportive technology in their psychological treatment (Sarkar et al., 2016). Particularly when it comes to the treatment of mood disorders, accurately recording common behaviors, thoughts, and moods can be difficult once the client leaves the psychologist’s office. Mood tracking apps provide an easily accessible and systematic means for rating positive or negative moods over time in addition to accounting for environmental influences.
Some mood apps have been developed primarily to share information between the client and the clinician. Since many clinicians encourage using a journal to record thoughts, several apps include journals and have integrated rating scales to help quantify an individual’s mood over a period of time. These rating scales have been adapted from several pen and paper measures that are often used in clinics and healthcare settings to maintain reliability and construct validity (Gaynes et al., 2010). For example, the Beck Depression Inventory can be easily accessed via a smart device to be administered or self-completed (Bahri et al., 2012).
The Mind Mood Monitor (M3): developed by collaborating researchers from the Bipolar Collaborative Network and the Department of Psychiatry at Georgetown University. It is an app to help individuals track mood symptoms via a validated 27-item checklist for elevations in depression, bipolar disorder, anxiety, and PTSD (Gaynes et al., 2010). The app connects to the associated M3 website and provides several visual representations, such as a graph or quadrant plots, so that the consumer can track their moods over a period of time. Additionally, it provides psychoeducational links and a popup for the National Suicide Prevention Lifeline when significant depression indicators are flagged. Importantly, this application was developed for primary care clinicians’ use as they are usually the first providers to discuss a mood problem with the client (Cerimele, Chwastiak, Dodson, & Katon, 2014). Several studies have shown that using the M3-checklist helps organize mood information for initial and ancillary diagnoses in such settings (Cerimele et al., 2014; Culpepper, 2014; Gandotra, Leong, Hipolito, Settles-Reaves, & Lawson, 2015; Gaynes et al., 2010). Clinician accounts are available to track several clients and download available information for needed reports. This app is currently available for Android, iPhone, iPad, and iPod touch.
T2 Mood Tracker: developed by the National Center for Telehealth and Technology and is affiliated with the Department of Defense. It was initially developed for service members in order to monitor their mood after deployment, but has found popularity among civilians (Bush, Ouellette, & Kinn, 2014). The app is programmed to track issues related to service member’s transition to civilian life (anxiety, depression, general well-being, head injury, PTSD, and stress). Clients can also add customized scales on any topic. Sliders without numbers are used to rate these categories and the app graphs daily inputs. It also includes a notes section to describe events that may have affected mood. Consumer ratings for T2 Mood tracker are fairly high (4/5 stars), however clinicians are concerned as extreme ratings (e.g., “severely depressed” or “unsafe”) do not trigger any guidance but rely on the consumer to navigate through local resources to contact help (Singh et al., 2016). However, research shows that sharing T2 Mood Tracker reports with a clinician has enhancing effects for CBT therapy (Aguilera & Muench, 2012; Berry & Lai, 2014). This app is currently available for Android, iPhone, iPad, and iPod touch.
Moodlytics: has been named as one of the best applications for bipolar disorder for the past two years (Legg, 2016). It is an entertaining application that allows the user to track many moods with associated colorful faces. The user is prompted to attach descriptions, relevant photos, and name specific persons (via the user’s contact list) that affected the reported mood. As opposed to monitoring mood severity, which can be done using emotions of associated severity, the user tracks the amount of time that they were experiencing a specific emotion. It also provides future-oriented tasks for general/mood related goals and the ability to set reminders during periods the person knows they will be facing a stressor. Outcomes also include a mood tracking graph, ability to share moods via social media, and it exports reports to providers. The colorful and visual aspects make this interface favorable in adolescent and child settings (van der Velden, Sommervold, & Culén, 2014). Those with bipolar disorder have reported subjective mood improvement with Moodlytics, but some are concerned about the ability of a wide range of clients to navigate the extensive features (Murnane et al., 2016). This app is available for Android, iPhone, iPad, and iPod touch.
Apps have also been developed to track quality of life in patients with various health concerns. With persistent health conditions, such as those related to chronic pain, psychological and cognitive functioning are often hindered (Apkarian et al., 2004). For example, research has found that individuals with chronic pain are more prone to depression and anxiety (Okifuji & Turk, 2016) and use healthcare resources more often, increasing cost of care (Mehra, Hill, Nicholl, & Schadrack, 2012). CBT concepts are effective in challenging the client’s beliefs about their pain and their behaviors related to pain (Roditi & Robinson, 2011). In some cases psychotherapy has been found to be as effective as surgery in the management of chronic pain (APA.org, 2013). The following apps can greatly facilitate treatment for many pain patients.
My Pain Diary: designed for pain tracking for several chronic health conditions, such as lupus erythematosus, fibromyalgia, and arthritis. It was rated as one of the top 10 mobile apps for rheumatoid arthritis by the Journal of Musculoskeletal Medicine (Hackethal, 2013). It provides options to include pictures of pain locations and daily events that may trigger pain. It also provides a detailed interactive image of a skull so that those who suffer from frequent headaches can indicate specific spots that hurt the most, in keeping with research highlighting the importance of pain episode recording, pain data exploration, and pain data sharing when creating pain tracking logs (Chaudhry, 2016). The program is able to explore changes in pain level over time via a graph or a color coded calendar. It also provides the option to mail graphical reports to the user’s psychologist via the associated online interface. This also includes an automatic weather report of the day to assess if reported pain is correlated with weather fluctuations (Macfarlane, McBeth, Jones, Nicholl, & Macfarlane, 2010). Additionally, the program includes mood rating scales for anxiety and depression as such mood disorders frequently co-occur with chronic pain (Arnow et al., 2006; McWilliams, Cox, & Enns, 2003). This app is currently available for Android, iPhone, iPad, and iPod touch for $4.99.
Chronic Pain Tracker: builds upon the pain diary mechanism, adding descriptors for pain intensity, sensation, and speed of onset. There also an interactive map that covers afflicted areas of the body (e.g., the back, joints, or neck). In order to monitor medications for pain and avoid abuse, Chronic Pain Tracker includes a medication log for both prescription and OTC medications. There is also an available option to track alternative therapies that have been successful for the user. This program also creates daily event logs and allows the user to list the activities that they could or could not accomplish due to pain. Research has indicated that this program, as a supportive therapy, can increase awareness and confidence of the user’s ability to engage in a wide range of behaviors despite their chronic condition (Singh et al., 2014; Singh et al., 2016). This app is currently available for iPhone, iPad, and iPod touch for $9.99, with a “lite” version available at no cost.
Kanesha Simmons is a third year Clinical Psychology PhD student with an emphasis in Neuropsychology at Howard University. She joined Dr. Denee’ T. Mwendwa’s lab, Health Promotion, Risk Reduction Research Center (Health PARC) which seeks to understand the role that psychological, social, spiritual, and biological factors play in the development, prevention, and treatment of cardiovascular disease in minority populations across the lifespan. Currently, Kanesha’s research interests include cardiovascular disease and its impact on executive functioning. After completing her PhD, she intends to be practicing clinician and researcher investigating cerebrovascular disease and neurocognitive processing. She currently receives clinical training at St. Elizabeth’s psychiatric hospital and Howard University Family Health Services.
E’leyna Garcia is a graduate student in the Clinical Psychology PhD program at Howard University. Her research interests are in investigating the relationships between trauma exposure and sleep disturbances in urban adolescents. After obtaining her BA in Psychology from Guilford College, E’leyna began her training as a clinical scientist, joining Dr. Hall Brown’s lab, Adolescent Sleep and Stress, in 2014.
As a graduate student in the Clinical Psychology PhD Program at Howard University, Mary Katherine Howell’s primary research interests are in pathways of subjective distress and autonomic arousal and habituation that optimize treatment response in exposure-based treatments for PTSD. She also has an interest in posttraumatic distress presentation in various cultural contexts, such as urban-residing African American populations, Veteran populations, and Arab populations. She is a member of Dr. Thomas Mellman’s lab, the Sleep and Stress Research Program. She was recently awarded the NIH TL1 grant, which will fund her dissertation research, and is currently receiving clinical training at the DC VA Medical Center in the Trauma Services Program.
Sharlene Leong is currently pursuing her PhD in Clinical Psychology at Howard University where she is studying the effects of mood disorders on cognitive and memory performance in older populations at risk for age related dementias, primarily Alzheimer’s Disease. Her interest is in developing technological and behavioral interventions in cognitive rehabilitation for various cultural contexts and age groups. She contributes her clinical and assessment skills to various clinical trials related to Alzheimer’s Disease in the Department of Geriatrics at Howard University Hospital, overseen by Dr. Thomas Obisesan. Sharlene earned her MA in General Psychology with a concentration in mental health and substance abuse counseling from the New School for Social Research, her BA in Psychology from New York University, and currently serves as the copyeditor for the Journal of the National Medical Association.
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Table of Apps
Google Play: https://play.google.com/store/apps/details?id=com.addicaid.app&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.piapox.android.imquit&hl=en
Severe Mental Illness
Big White Wall
Google Play: https://play.google.com/store/apps/details?id=com.bigwhitewall&hl=en
eMoods Bipolar Mood Tracker
Google Play : https://play.google.com/store/apps/details?id=my.tracker&hl=en
DBT Diary Card and Skills Coach
Google Play: https://play.google.com/store/apps/details?id=com.shainfotech.abhaya&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.circleof6.v2
Google Play: https://play.google.com/store/apps/details?id=org.t2health.breathe2relax&hl=en
Google Play: https://play.google.com/store/apps/details?id=t2.tacticalBreather&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.t2.cbti&hl=en
Google Play: https://play.google.com/store/apps/details?id=org.t2health.dreamez&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.northcube.sleepcycle&hl=en
Google Play: https://play.google.com/store/apps/details?id=is.vertical.ptsdcoach&hl=en
Google Play: https://play.google.com/store/apps/details?id=org.t2health.pe
Self-Help Anxiety Management (SAM)
Google Play: https://play.google.com/store/apps/details?id=com.uwe.myoxygen&hl=en
Stop Panic and Anxiety Self-Help
Google Play: https://play.google.com/store/apps/details?id=com.excelatlife.panic&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.indention.panicrelief&hl=en
Google Play: https://play.google.com/store/apps/details?id=com.bstro.MindShift&hl=en
The Mind Mood Monitor (M3)
Google Play: https://play.google.com/store/apps/details?id=com.mymoodmonitor.whatsmym3&feature=search_result&rdid=com.mymoodmonitor.whatsmym3&rdot=1#?purchaseButton=lNQAL11AFrVftwkHbvhAgzonrZ0%3D
T2 Mood Tracker
Google Play: https://play.google.com/store/apps/details?id=com.t2.vas&hl=en
Google Play: https://play.google.com/store/apps/details?id=AnantApps.Moodlytics&hl=en
My Pain Diary
Google Play: https://play.google.com/store/apps/details?id=com.damonlynn.mypaindiary&hl=en
Chronic Pain Tracker