Keeping Up with Technology – Using Behavioral Health Apps in Clinical Practice

Azadeh Ghaffari

Azadeh Ghaffari

Azadeh Ghaffari, Ph.D.
Hines VA Hospital, Staff Psychologist in SCI/D Service

According to the IMS Institute for Healthcare Informatics, there are reportedly over 160,000 mobile health apps available to download, and it is estimated that nearly 30% are mental health apps. While there is nothing that can replace the importance of psychotherapy, research, and teaching, mobile app technology has emerged as a potentially powerful tool for health psychologists. With a multitude of apps to choose from, keeping up with the technology can be a challenge.

Using apps in clinical practice can act as a valuable adjunct to psychotherapy, as well as serve as a powerful aid for clinicians. Relaxation and meditation apps can be a positive resource for adaptive coping and promotion of better self-care, while smoking cessation apps can add additional support for attaining challenging therapeutic goals. Many clinicians also find that behavioral health apps are beneficial for helping psychologists maintain a better connection with their patients, and improve tracking of a patient’s mood and symptoms. Additionally, patients can easily track a multitude of health-related activities such as their diet, exercise, and sleep, and help patients better manage symptoms of chronic illness. Apps can also help facilitate psychoeducation, prompt patients to complete homework in between sessions, and are readily available to patients 24/7. Thus, mobile apps can be offered as a supplemental resource to encourage patients to take some control over their behavioral health. Additionally, some clinicians rely on apps to assist in improving patient outcomes and satisfaction. In fact, some apps allow providers to monitor client entries, track progress, and receive alerts to catch health concerns.

While there are many benefits to using mobile apps, there are some limitations to keep in mind. Despite their popularity and ease of use, behavioral health apps are not regulated and many are not evidence-based. However, apps that are affiliated with academic research institutions (e.g. Northwestern University’s Center for Behavioral Intervention Technologies) or government funding agencies (e.g., VA endorsed) are more reputable as they often involve meeting specific standards during the app development and validation process. Patient privacy and security concerns also need to be kept in mind if therapists use apps to communicate between sessions or if these resources are used for data collection/tracking. Thus, clinicians should ensure that communication apps are HIPAA compliant, and that patients are informed when these sources are being used to track data. Finally, low cost can be a benefit or drawback of mobile app technology. While mobile apps will never replace the role of a therapist, some worry that endorsing free or inexpensive mobile technology could potentially add to the problem of undervaluing or under-reimbursing psychologists. Moreover, only recommending free apps may fail to appreciate the time and expenses required for researchers and software engineers to create this type of technology, which in turn, could negatively impact future funding and app development. Discussing the benefits and shortcomings with patients will help them decide if they wish to incorporate the use of apps in treatment.

If you are ready to embrace the use of behavioral health apps in clinical practice, below is a review of some of my favorites.

 

Weight Management

MOVE! Coach: is a weight loss app that offers a 19-week program that guides participants to achieve their weight loss goals through education and use of tools that monitor, track, and provide feedback for progress with weight, diet, and exercise goals. Additionally, the app is endorsed by the VA, and is free to download but only on iOS devices.

 

Pain Management

WebMD Pain Coach: is designed to easily monitor and track various treatments, pain level, and mood for individuals struggling with chronic pain conditions including back pain, neck pain, nerve pain, fibromyalgia, migraines, osteoarthritis, and rheumatoid arthritis. It also assists individuals in helping them to learn what pain triggers to avoid, and to better understand what pain strategies are more effective. The app also helps individuals set goals, share progress with providers, and increase control of lifestyle choices. The app is free to download on both iOS and Android devices, and is endorsed by WebMD.

 

Insomnia/Sleep/Nightmares

CBT-i Coach: While this app was originally developed for Veterans receiving therapeutic treatment for insomnia, the application also offers a variety of helpful tips on sleep hygiene, and provides multiple relaxation techniques including guided imagery. Additionally, the app is endorsed by the VA, and is free to download on both iOS and Android devices.

 

Dream EZ: is designed to help individuals “rewrite” their nightmares in order to decrease their intensity and frequency and improve sleep. The app utilizes principles from Imagery Rehearsal Therapy (IRT) for nightmare reduction, and was designed to be used along with a clinician trained in IRT. Additionally, the app is endorsed by the National Center for Telehealth and Technology, and is free to download on both iOS and Android devices.

 

Smoking/Tobacco Cessation

LIVESTRONG My Quit Coach: is a personalized quitting coaching program that is designed to help individuals quitting cold turkey or those cutting back on nicotine use. It is physician endorsed, and free to download on iOS devices.

 

Stay Quit Coach: is designed to help individuals quit smoking that creates an individualized plan that takes into account an individuals’ personal reasons for pursing smoking cessation. It provides information about smoking cessation, interactive tools to help users cope with urges to smoke, and motivational messages to help users stay smoke-free. This treatment is based on evidence-based clinical practices, and is endorsed by the VA. It is free to download on iOS devices.

 

Relaxation/Meditation

Insight Timer: offers over 5300 guided meditations, and is home to over 2 million meditators worldwide. The app also offers meditation groups, and a community of meditation teachers that can speak in 25 different languages. My recommendation is to incorporate this both in session, and to encourage patients to use this independently outside of therapy. This app is also free to download on iOS and Android devices.

If you are new to using apps with patients, there are great ones to start exploring. If you have already been using apps, consider adding these to your therapeutic toolbox.

 

Resources:

 

References:

Novotney, A. (2016). Should you use an app to help that client? Monitor on Psychology, 47(10), 64.

Sedrati et al. (2016). Mental and physical mobile health apps: Review. Science Direct, 100, 900-906.

 

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