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What to know before using an app to manage your mental health

Some apps can be genuinely useful. But it's important to go in with a plan — and recognize when you may need more traditional therapy, experts said.

If you're looking for a way to start a mindfulness practice, reduce stress or manage a mental health condition, you may be drawn to one of the many mental health apps out there. And with cost being a major barrier to accessing traditional therapy, cheap or free apps may be an attractive alternative.

But are these apps really effective at keeping mental health issues in check? It depends on the specific app and what you want to use it for, experts told TODAY. And there are some key privacy and health concerns to keep in mind before you start using one.

Do mental health apps actually work?

First, it's important to recognize the wide variety of mental health apps out there. Some apps (like Calm and Headspace) are more generally focused on wellness, mindfulness or reducing stress, while others may be tailored to a specific mental health condition. There are also telehealth services, like Talkspace and BetterHelp, which connect users to therapists and counselors for text, phone or video therapy.

"We don't have a lot of research on (mental health apps you can get in the App Store), in part because there are no overarching regulatory bodies ensuring that they are effective," Vaile Wright, Ph.D., senior director for health care innovation at the American Psychological Association, told TODAY.

Apps like these can't claim to treat a specific mental health condition unless they go through the Food and Drug Administration's regulatory processes, Wright explained. "So they can say things like, 'We treat stress, we teach mindfulness,' but none of the apps on the direct-to-consumer market can claim that they treat anxiety or depression," she said.

And because these apps generally are not regulated like other health products, there’s no one ensuring that the information they provide is accurate, Wright said. The potential for misinformation about treating mental health conditions is one of the field’s biggest concerns about the apps, she added.

But that doesn't mean these apps aren't useful. "Some of the patterns that we've seen is that people who are randomized to use (apps) in the context of a randomized trial do tend to show reductions in depression, anxiety and stress pretty consistently," Simon Goldberg, Ph.D., assistant professor in the department of counseling psychology at the University of Wisconsin — Madison, told TODAY. 

“A lot of the barriers that people have to in-person therapy aren’t there for mobile technology,” said Goldberg, who co-authored a meta-review of research on the usefulness of mental health and mindfulness apps earlier this year. "They're portable. And they're often much less intensive and less expensive."

The study looked at 14 previous meta-analyses of mental health apps, including data for nearly 48,000 participants, and found generally positive results. In particular, the apps seemed to provide small but consistent improvements in feelings of anxiety, depression, stress and general well-being compared to inactive controls (such as being put on a waitlist).

This study also found that text-based interventions could be particularly useful for those who want to quit smoking. And Wright noted that text-based crisis lines for those dealing with suicidal thoughts can also be quite effective.

In general, though, "it's safe to say the evidence is still evolving," Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center, told TODAY. "We see exciting pilot studies that say that, under certain circumstances, for certain people, these could be really helpful," he said. But as the studies progress, the picture becomes more complicated.

For example, he pointed to a new study involving an app designed to help patients with schizophrenia alongside standard treatments. The researchers compared the effects of the app to a placebo app, which was just a simple countdown clock.

The results? "The placebo app did just as good as the real one," Torous said. "It's not that the apps don't help, but how much do they really help? We certainly don't want to have things that are no better than digital watches."

Is it OK to use a mental health app instead of traditional therapy?

All of the experts that TODAY spoke to agreed that not everyone necessarily needs the traditional model of in-person therapy. So it's generally OK to try out a few apps and see if they provide the kind of service you're looking for.

If you are someone who could benefit from more traditional counseling, an app can still be a good first step. But it likely isn't going to cut it as your only form of mental health care.

Generally, if you're feeling like your mental health symptoms are interfering with your work, school or relationships, or you're not able to take care of yourself, those are red flags to consider therapy. But these days, "if you even remotely think you could be helped by a therapist, try to seek out a therapist because there's no reason to wait until there's a crisis," Wright said.

"There's also nothing wrong necessarily with starting with an app," she continued. "Just recognize that it might not solve the problem that actually needs to be solved."

Keep in mind that apps that help you track things like mental health symptoms, emotions and triggers or that prompt you to practice the skills you're learning in counseling can be helpful additions to traditional therapy. You might also find it useful to engage with apps that keep track of or give you prompts to journal about your other healthful behaviors, like physical activity, socializing and sleep, which can also have an impact on mental health.

It can be helpful to use an app in "any way that augments or supplements what you're doing, whether that's bringing new data into a clinical visit or practicing skills that you did in person," Torous said.

He also said that people who are on a waitlist for therapy, taking a break from therapy or have been in therapy before and just want a little guidance may get more out of the apps. That's because they'll be highly motivated and already have some idea of what they want to get out of it.

To find an app that might work for you...

First, think about what you are really trying to get out of an app, Torous said. Are you looking for something to help you manage work stress and get better sleep? Or are you interested in tracking how a new exercise habit might affect your anxiety and depression symptoms? Or maybe you want to practice the cognitive behavioral therapy skills you’re learning from your therapist.

"The good news is that a lot of these apps have trial periods," Golberg said. He recommended doing a little bit of "shopping around" and trying a few different apps to see which ones you like and actually use. "You can download another app in a few seconds," he said. "It’s a lot harder to switch therapists."

Also, check to see if the company has a privacy policy — and actually read the fine print, Wright advised. "These apps take a lot of personal information, and they have no expectation to be HIPAA-compliant," she said. "So they can take your personal health data and sell it in ways that really put people in vulnerable positions."

In fact, a Mozilla Foundation report from earlier this month found that many popular mental health apps "routinely share data, allow weak passwords, target vulnerable users with personalized ads, and feature vague and poorly written privacy policies."

Once you have a general idea of what you want and what kind of privacy policy you're willing to put up with, check out the Mobile Health Index and Navigation Database. This database, put together by Torous and his colleagues, allows you sort through mental health apps based on the types of features you're looking for.

With this tool, the hope is that "you can at least try to make a more informed decision based on more relevant information," Torous said.

If you're not sure where to start, he noted that the apps from the U.S. Department of Veterans Affairs are typically free and have generally good data policies (and you don't have to be a veteran to use them).

Finally, don't discount virtual therapy. While the research is still out on text-based therapy, there is plenty of good evidence now to suggest that virtual therapy via phone or video chat can be just as effective as in-person therapy. And, due to the pandemic, many more therapists are offering these options as part of their services, Wright said.

Some health insurance plans cover virtual therapy services, like Talkspace, so check with your insurance provider to find out what forms of digital mental health services are covered. Your employer might also provide free or low-cost access to a mental health app.

Other ways to access low- and no-fee therapy:

Therapy can be expensive, and many therapists don't accept insurance. But, before you rely on an app (or if you've been using apps and haven't found them to be helpful), know that there are other ways to find less expensive counseling.

Of course, that's not to say a good therapist who works for your budget is necessarily easy to find, but counseling may be more accessible than you think. Here are some ways to find lower-cost therapy:

  • Check for training programs at colleges or universities near you. "They often have graduate students that are in training that offer lower-cost treatment options," Wright said.
  • Don't discount out-of-network options if you have insurance. Sometimes, going out-of-network "gives you more flexibility in choosing a therapist," Wright said. "It often requires a little bit more paperwork on your part," but you might find that your out-of-network reimbursements are worth it.
  • Ask your therapist if they offer a sliding scale, Wright suggested. Even a temporarily reduced fee may be possible.

Consider searching online for community health centers in your area that offer mental health services, Wright said.