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Anxiety apps offer simple solution for complex condition, but do they work?

2015-12-03

You can do your banking standing in your kitchen, do your grocery shopping at the bus stop, and probably buy a house while you’re on the yoga ball.

The list of industries that haven’t gone online is shrinking daily (if not down to nil already). And given the recent flood of social anxiety apps, at first glance the therapists’ couch seems like it may be on the way to being replaced by a digital version as well.

Anxiety is one of those words that can mean different things to different people. To you, it may be mild unease at the prospect of your annual performance review. To someone else, it can mean crippling fear at the thought of enduring a simple cocktail party.

The numbers vary depending on whom you ask, but the Canadian Mental Health Association says about 12 per cent of Canadians are affected by anxiety disorders. For social anxiety sufferers, the stress of dealing with seemingly innocuous situations can produce a sense of dread that leads to missed opportunities and less enjoyment out of life. In the U.S., the numbers are even higher.

So it’s perhaps not surprising that mental health apps have sprung up like wildfire in the past few years, totaling north of 4,000 on iTunes, many catering to social anxiety sufferers.

Some of them are simple apps that track and give advice on breathing, or play calming music while you sleep.

Others, like the recently-launched Joyable, offer programs that combine online lessons with phone and text interaction with a coach.

While customers may be rushing to embrace the idea of therapy via smartphone, mental health experts are predictably scrambling to keep up with a development that’s turning the traditional treatment model on its head.

“What we know is around 600 million health apps were downloaded in 2013,” says Adam Haim, a PhD and technology lead at the Maryland-based National Institute of Mental Health.

“So there’s a huge marketplace and what we want to put forward is a framework where we’re evaluating best practices, and evaluating the best technology that can be utilized in this forum.”

The trick, of course, is that the Internet moves fast, and traditional research practices are based on observation over a period of time. Meanwhile, in the time it takes to write a research proposal, another 200 apps pop up, many of them charging a monthly fee to essentially treat an illness.

While this could set the scam senses tingling, Haim and others say online therapy has its benefits, not the least of which is overcoming the massive obstacle of getting potential sufferers to seek treatment in the first place.

“The absence of stigma of actually going to see somebody,” says Alan Leschied, a psychologist and professor at Western University in London, Ont. who focuses on children’s mental health. “It can be done in a very personal way that nobody needs to know, so anonymity is huge factor.”

Beyond that, online treatment also breaks down other barriers, such as geography. It can be a lifeline for people who live in remote areas, or don’t have a car, or just don’t want to spend 90 minutes on the bus to then sit in a waiting room before even dealing with the stress of the appointment itself.

Apps make care more approachable, affordable

For someone suffering from anxiety, removing anxiety from the process of seeking help is an obvious positive.

Beyond that, there are costs to consider. Joyable charges $99 a month, and other apps vary. A visit to a therapist could run nearly that per hour, and more if the therapist has a PhD.

So the apps provide a wide menu of cheap and accessible help for a problem that afflicts millions. Efficient, for sure, but the optimism is tempered by a fair amount of caution.

“In university 20 or 30 per cent of every course is an online course… The question is is that really a good idea, is it as good as going to school?” says Leschied.

Deciding to do banking online rather than going to the branch itself is a no-brainer. But is the equation that simple when we’re talking about doing therapy online rather than seeing a specialist?

“One of the big challenges we have with these kinds of apps is the apps are being developed at a very rapid pace so it’s really hard for the research to keep up with the evaluation of the app,” says Matilda Nowakowski, a Postdoctoral Fellow of Psychiatry and Behavioural Neurosciences at McMaster University.

And while some apps offer therapies that are backed by extensive research, the research on whether those therapies work in an online setting is thinner.

This is a problem, as therapists base their practices on established research. It’s why medicine and psychology are slow boats to turn, and why the latter is perhaps not a perfect match with instant-to-market Internet startups.

There’s also the question of what is actually being promised by the app. Is it offering a program that may benefit someone suffering from anxiety, or is it promising improvement without the research to back it up? And without the guidance of a therapist, the decision is left to the person sitting at the computer with their wallet, looking for help.

“For patients it can be very overwhelming because we’re basically putting it into the hands of the patient to determine what is the right program. In a way we’re kind of leading to self diagnosis,” says Nowakowski.

She takes the position, echoed by others, that while online therapy can be effective, it’s certainly more effective when paired with actual contact with a therapist.

“It’s just like a medical problem, you don’t’ just use WebMD to diagnose yourself and then go to the pharmacy to get your own medication,” says Madalina Sucala, a psychologist and research at New York’s Icahn School of Medicine.

“You usually go to a doctor, you get the treatment and then if something is prescribed to you, you do that.”


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