We Know There’s an App For That (Part III): Home Run–When Research Proves a Mental Health App Is Useful

Posted on June 8, 2012 by

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It was starting to sound like it just couldn’t be done, right?

First I pointed out how so many mental health mobile apps claimed to have reached great heights–and, with no research to back them up, often failed.

And then, like a dog with a bone, I talked about apps with research in progress, that actually sounded great, but had one fatal flaw–due to the slow process, they weren’t exactly on the market. Details, details.

So in short I sounded like a total nay-sayer.

BUT. . .I haven’t taken my third strike yet, and, without that, there’s always a chance for a home run, which is what a few apps have hit, between their clinical trials, research on their efficacy, evidence-based practice–and actually making it to the app store.

My showpiece (but by no means ‘only-piece’) is PTSD Coach, available–for free no less–for both iPhone and Android devices.

Post traumatic stress disorder (PTSD) is a dreadful and dreaded disorder where the mind, when triggered, continually takes the sufferer back to a horrible place in time. Veterans of battle suffer from it in inordinate numbers. Prevalence of PTSD among the total Gulf War veterans is estimated to be 10.1%, and among the Iraq war vets as high as 13.8%.

Julia Hoffman, a clinical psychologist at the Veterans Affairs National Center for Post-Traumatic Stress Disorder, recognized that veterans have such a difficult time seeking help due to perceived stigma, and thus was born the seed of PTSD Coach. Its goal is to provide “Coping skills and assistance for common kinds of post traumatic stress symptoms and problems, including systematic relaxation and self-help techniques.”

As reviewed by Popular Mechanics, the app works in the following way: When someone suffering from PTSD experiences an intrusive thought–or extreme anger–they hit a button entitled ‘manage my stress.’ At that point they input what’s wrong and their distress level on a 1-10 scale.

Using this data, the app responds with what would be most helpful. It might provide a relaxation exercise, play music the user has programmed in his playlist that he finds relieves stress, or begin a camera-roll of comforting images from the user’s phone. At a stress level of 9-10, it might offer the number of a crisis management hotline.

And–aha!–the app is actually based on research.

Nextgov in its article, “Listening to users: How VA developed its PTSD Coach mobile app” comments that Hoffman did her research by going ‘straight to the source,’ asking 80 residential PTSD patients at the Veterans Affairs Department Trauma Recovery Program in Palo Alto, Calif what would be helpful to them.

And it seems that full clinical trials were run, under the auspices of Stanford University [see application ], and headed up by Rachael Lazar from the Stanford University School of Medicine.

In a paper published April 12, 2012, entitled “Current and Future Directions in VHS Mental Health Mobile Applications,” Hoffman writes that they’re still evaluating feasibility and clinical outcomes, and I believe the full trials just closed at the end of May, so the preliminary data has yet to be presented–but it’s comforting knowing it’s there. .

Hoffman will also present further findings on usage of the app–we’ll just have to wait. That should happen in a presentation entitled “Connecting PTSD Coach to A Web-Based Visualization Tool: Systemic Integration Using Open Architecture,” set to be given in September of 2012, at the Medicine 2.0 5th World Congress in Boston.

And, as all research requires, Hoffman didn’t just create her app and send it into atmosphere, up where the air is clear. She’s keeping tabs on its use and usefulness. It’s not a perfect metric, but it’s of no small relevance to know that more than 50,000 people have downloaded the app, in 62 countries.

And a year after its May, 2011 appearance on the market, it won an award for an award for innovation in the advancement of telemedicine from the  American Telemedicine Association.

ATA President Bernard Harris, Jr., said that the ATA Innovation Award is presented for ideas that

save and improve countless lives, whether their patients are young children, soldiers on the battlefield, returning Veterans or the average American health care  consumer,” said .   

Secretary of Veterans Affairs Eric K. Shinseki was impressed, as well. He said,

The health and well-being of our brave men and women who have served this Nation is our highest priority. Using the popularity of mobile devices, we can provide important tools to Veterans wherever they are, whenever they need them, whether or not they receive care through VA or DoD.

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PTSD Coach doesn’t stand alone for strong research, good sense–and great hope.

Live Happy

Screenshot of the Activities homepage

And why not end on a ‘happy’ note? Live Happy certainly has the research to back up its approach–and the research continues into the app’s efficacy even as time goes on.

Live Happy is based on the research of Sonja Lyubomirsky, an expert in a field called positive psychology, which studies how people can become happier and live more fulfilled lives. So rather than a focus on disinfection, it asks what habits and actions contribute to happiness and resilience.

Herself a clinical researcher, Lyubomirsky, professor of psychology at University of California, created her own plan for increasing happiness in daily lives, which she formulated in her book The How of Happiness: A Scientific Approach to Getting the Life You Want.

 Live Happy is the app’s formulation of the strategies in that book.

Lyubomirsky’s ‘happiness graph,’ below, asserts that 40% of happiness is determined by intentional activities, which the app presents and walks you through.

I’ve downloaded it myself–and it’s not a simple-minded app. First you take several tests that assess your happiness level, and then you’re assigned activities to help improve it. The app includes:

  • Personalized Happiness Program Goal Setting/Evaluating/Tracking
  • Formats and Instructions for Expressing Gratitude Directly and Keeping a Gratitude Journal (The Journal can be shared on Twitter’s Gratitude Stream.)
  • Setting you up for Replaying Happy Days and Keeping a Savoring Photo Album
  • Preparing you for Envisioning Your Best Possible Self
  • Encouragement for Nurturing Relationships
  • Help for Remembering Acts of Kindness

The paid version (and I splurged–it was on sale for $.99) has an “Ask Sonja” feature where you can send it questions to Dr. Lyubomirsky.

I’m sure you won’t be surprised that my submitted question was what sort of field testing went into the app before it came to market. I’ll keep you posted.

In July of last year Live Happy was approved to undergo clinical trials for its effectiveness in treating depression. Approved by Fairleigh Dickinson University’s Institutional Review Board, is, therapists began comparing patients using the app daily as an add-on to treatment to those undergoing therapy and medication treatments alone. At that point it was the first time an app was actually tested for clinical efficacy for treating mental health.

Lyubomirsky says of the trials, which were set to end last June,

The findings from this trial will help us gain new insight  into how effective Live Happy is in relieving the symptoms of depression and  helping people achieve greater happiness. The app is designed to improve one’s  happiness by offering people ways to learn and practice the skills it takes to  bolster happiness, and we’re eager to see the results that come from the  clinical trial.

To be frank, I don’t know why there’s no info out about the results of the trials–unless they’ve been extended. But since Live Happy’s still out there going strong, I’m going to assume all’s in order.  If you’d like to check it out for yourself, it’s got a website, twitter account, and facebook page. If that isn’t reaching the big time–well, what is?

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It’s no secret that mobile health apps can change the face of healthcare in this country for the better.

From DiabetesManager, “an all-in-one insulin calculator, carbohydrate database, favorites database, and diary,” to the UCLA-developed system called WANDA (Weight and Activity with Blood Pressure Monitoring) that takes measurements of weight, blood pressure, heart rate, and physical activity, and incorporates the heart failure somatic awareness scale (HFSAS), to the GenerationOne mobile platform for asthmatics, that includes included medical content and protocols developed by the hospital, and the asthmatics’ reception of personalized messages and reminders on their own cell phones, apps for physical illnesses are extremely well-researched, from initial clinical trials to efficacy post-marketing, have paper published on them in peer-reviewed journals, and are both innovative and life-saving. 

Why should the situation be any different for mental health apps?

We should expect–and accept–only the highest standards of smartphone output in the arena of emotional and behavioral health, as well.

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