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Most Mental Health Apps Are Based On Flimsy Science, Says Task Force Chair

Harvard psychiatrist John Torous shares findings from his investigation of dozens of mental health apps.

[Photo: Everett Collection via Shutterstock]

Thousands of mobile apps claim to treat symptoms of anxiety and depression. But are these apps safe and effective for you to use?

Many mental health experts believe that there's no replacement for the human touch. Others see plenty of potential in new smartphone- and computer-based interventions, particularly those that are supported by sound research.

John Torous, a clinical fellow in psychiatry at Harvard Medical School, has spent the past few years evaluating a wide range of mental health apps. He was recently asked to chair the American Psychiatric Association’s task force on the evaluation of commercial smartphone apps and make recommendations to other mental health professionals. I asked Torous to weigh in on the topic, just a few weeks after investors poured $17 million into just one of these apps.

FAST COMPANY: Why are we seeing tech entrepreneurs flock to mental health?

John Torous

TOROUS: "The barriers to entry to building a mental health app are lower than in other medical specialties. Mental health lacks objective biomarkers, so there's more subjectivity. What I mean by that is that it's hard to evaluate and judge how a patient is doing. How do you measure an improvement in mood, for instance? And is that even the kind of metric we should be measuring?"

My Scrabble app momentarily improves my mood, but not my mental health.

"Exactly. These are such subjective measures. The other reason why we're seeing a lot of interest in mental health is that you can offer interventions on the phone, such as virtual coaching or mindfulness meditation. In the tech world, they call it a 'closed-loop platform.'"

Does the research suggest that these apps are helping people with conditions such as depression and bipolar disorder?

"We haven't found any high-quality randomized controlled evidence for that. We've certainly found feasibility evidence that patients are interested, but that doesn't tell us what works and what doesn't work. Most of the research I see is funded by the app makers, so there's a strong bias. And there are typically less than 20 participants."

Why are so many of these apps focused on cognitive behavioral therapy, or CBT? (CBT is a form of therapy that aims to solve current problems and change unhelpful thinking and behavior.)

"CBT has been proven to be very helpful for many symptoms, including for depression. But right now, the evidence for CBT delivered on a smartphone is minimal. For a recent study, researchers recruited 691 depressed subjects from clinics and randomized them to care as usual or one of two computer-based CBT applications. The researchers found no difference in depression outcomes. That study was rare as the researchers were not involved in the development of the [apps]."

Are there any downsides for people who use these apps?

"I think it's hard to know. But it's very possible that people might use apps and they don't seek in-person care. I'm also wary that some of these apps might sell patients' sensitive data—that's certainly been a trend among mobile health companies."

What are the questions we should be asking of these app makers?

"A lot of them have kept a black box around what they're doing. They have trade secrets. But they haven't asked basic questions such as, 'Is this scientific?' 'Does it work?' Researchers identified more than 700 mindfulness apps in the iTunes store but found that only 23 actually provided mindfulness training or education, and only one was supported by empirical evidence.

"I try to read the terms and conditions when researching these apps. Many of these apps use mental health terminology, such as referring to themselves as 'CBT based,' but they hide in their terms and services that they're not actually offering a mental health service. That might even open them up to some liability later down the line."

Are there any apps that you would recommend to patients and/or colleagues?

"I actually think the [U.S. Department of Veterans Affairs] has a very good suite of mobile health apps, which are very good about transparency and privacy."

Have you used a mental health app? Did it help or hinder you? Get in touch: cfarr@fastcompany.com

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