Massive review shows “science” behind most mental-health apps is wildly flawed

The covid-19 pandemic has taken a toll on mental health of countless Americans. To make matters worse, necessary stay-at-home measures make it difficult to access care. In the gap, some people have turned to mental health apps for solace: some of these claim to provide everything from cognitive behavioral therapy to Guided Meditation. But a new study published in PLOS Digital Health finds that these applications are not supported by the rigorous evidence that their claims require; They don’t seem to work that well either.

What’s new – The meta-review examined 145 studies on phone-based mental health interventions. Taken together, the authors say that the methods used to study these applications are flawed. The investigation “failed to find convincing evidence to support any mobile phone-based intervention on any outcomes,” the report states.

“Across the literature, we saw a general pattern of weakening evidence…and decreasing effect size as the comparison condition became more stringent.”

In general, the applications were more effective than no treatment. But their usefulness diminished when compared to other mental health treatments or interventions. This was true regardless of whether the apps targeted anxiety, stress, feelings of depression, tobacco or alcohol addiction, or general well-being.

“If you ask me for my personal opinion, reading the literature, I think there’s pretty strong evidence, actually, that these apps on average offer a small to moderate benefit compared to nothing.” Simon Goldbergassistant professor in the Department of Counseling Psychology at the University of Wisconsin-Madison, tells Reverse.

Why does it matter? mental health apps are a hot market. There are between 10,000 and 20,000 of these apps available to download to your smartphone, according to expert opinion. These include everything from mood diaries to smoking cessation programs to one-on-one text messages with a licensed clinical therapist.

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This is a big deal: Talkspace and BetterHelp ads are unavoidable, especially if you like podcasts; BetterHelp was the biggest advertiser in podcasts in 2021. All over the world, people are expects to spend $500 million about mental health apps in 2022. However, these apps have varying degrees of scientific backing, and there’s little to help you discern which ones are backed by actual data.

Anyone can create a mental health app and start selling it on platforms. A studypublished in the magazine Anxiety and depression in 2017 found that among 52 apps offered for anxiety, two-thirds had no health professional involved in their development. Less than four percent were rigorously tested. For apps that undergo clinical trials, the research is often conducted by researchers employed by the company selling the app.

There are also no robust government regulators to verify these claims. The United States Food and Drug Administration has jurisdiction about health apps, but the risks of using them are so low and the apps so numerous that the agency rarely intervenes unless a particularly heinous app pops up.

A surprising number of mental health apps use chatbots.WANG ZHAO/AFP/Getty Images

What they found – Goldberg’s team finds that researchers trying to measure the effectiveness of mental health apps are also inconsistent in how they go about it. When the researchers compared the apps to other treatments, they rarely compared them to in-person therapy, for example, a rare oversight.

The meta-review found a number of other problems. For example, the included research rarely addressed how people interact with the apps under study. In all the studies examined, the participants used the app for the duration of the study. But when people use mental health apps in the real world, the dropout rate is high.

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“It’s a big deal,” says Goldberg. “Even in a studio, people often don’t stick with these things.”

He points out another problem with the interpretation of meta-analyses in general. When studies show no effect, researchers may not publish the data, leaving an “overly optimistic estimate of effect.”

On a more positive note, mental health apps consistently show evidence of “small magnitude effects” (some relief for many of the users) on mental health issues.

Goldberg says this is not surprising; there has to be a reason behind his popularity, after all.

“I’m sure some of the claims are being exaggerated,” he says, “but I also think that a lot of the products out there are likely to be helpful to people.”

“If you take a look at [the mediation app] Headspace as an example, millions of people are using their products,” he says, “and I think for meditation apps to have millions of people using them, people have to benefit in some way.”

“Meditation isn’t that much fun for most of us,” adds Goldberg.

How they did it – Goldberg and his coauthors conducted a meta-review, which is a kind of meta-analysis of meta-analyses. A meta-analysis systematically combines the findings of several independent research trials to get a bigger picture of what they all studied. A meta-review does the same thing, but for meta-analyses.

They collected 14 meta-analyses, each with at least four studies. In total, they included 145 randomized controlled trials of mental health apps, plus some text-message-based inventions that didn’t use any particular app. In total, the research included 47,940 participants.

Some examined the research on the effectiveness of apps in relieving depression or anxiety. Others studied the apps’ ability to help people quit smoking or improve their overall mental well-being. They also looked at various types of apps: guided meditation, texting with a person, texting with a chatbot, and DIY programs.

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All the apps had one thing in common: you needed a smartphone; Telehealth or face-to-face therapies were left out of this analysis.

LONDON, ENGLAND - JANUARY 11: In this photo illustration, the 'Headspac...

The Headspace meditation app has over two million paying subscribers.Getty Images/Getty Images Entertainment/Getty Images

Whats Next – Goldberg explains that the disparate results for each app may have to do with the newness of the technology itself: they may not have been around long enough or used enough to get a good idea of ​​how well they work. in the lab or in the real world. . But time will tell.

“I think there is fantastic meta-analytic work and there is some [random clinical trials] going on,” he says. “I think literature is just young.”

“If you think about it, we have been studying psychotherapy for a hundred years. We have been studying mobile phone-based interventions for about 20 years,” he adds. That’s a bit of catching up to do.

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