Everything will be all right: Apps and services for improving mental health

Let’s face it: The Web can be downright nasty. Some people are just tools, and they wreak havoc online.

Among those cute kitten pictures and hilarious Vine clips, it’s easy to find examples of people being downright ugly. Angry, vitriolic commenters, unkind memes, and cyberbullying-related suicides reveal a dark side of the Internet. But it also has a silver lining in the cloud. Additionally, plenty of places on the Web are eager to help you get through tough times: the wildly popular It Gets Better Project, for example, or the hugfest featured on the Nicest Place on the Internet.

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General apps such Siri are little better at therapy than early AI ELIZA.

Always at the ready, our personal tech—especially apps and websites—can be a strong ally for improving our mental health. But general apps don’t always know how to help. In a Psych Central blog post in March 2012, Summer Beretsky posted video and a transcript of a long and frustrating attempt to get Siri to connect her to a suicide prevention center. At one low point, Siri met Beretsky’s “How can I kill myself?” with “Checking on that for you. How about a Web search for ‘How can I kill myself?’” (You can facepalm now).

Earlier this summer, Apple quietly updated Siri’s response to such questions. Now, when Siri hears the statement “I want to kill myself,” the virtual assistant offers to dial the National Suicide Prevention Lifeline. It’s an important step—and far from the only resource available. Take a look at the apps and services making the biggest strides in marrying technology with mental wellness.

Moving mental health online

Psychology apps and websites mimic behavioral therapy, explains Lee Ritterband, Ph.D., only it’s “fully automated, using technology instead of other means” such as one-to-one counseling. Ritterband, director of the Behavioral Health & Technology Laboratory in the School of Medicine at the University of Virginia, thinks apps can definitely serve some of the same purposes as human therapists.

He also cites several reasons for the rise of Internet-based mental-health intervention. As the president (and a founding member) of the Internet Society for Research on Internet Interventions, he notes that a fellow founding member hailed from Australia, a country where the spread-out "geography demands changes [in mental health],” he says. A third is from Sweden, which had a wait list of several months for psychological treatment, giving Internet- and app-based therapy obvious appeal.

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Sometimes it’s easier to reach out to tech than to a human therapist.

Ritterband says there are a lot of benefits to Internet interventions: “convenience, availability, standardization, same dosage and content, tracking features, feedback, tailoring to users.” Internet interventions and their positive-psychology cousins are appealing to potential patients as well as to clinicians. “There’s a stigma about mental health in general, which is part of the value of these apps,” says Pamela Rutledge, director of the Media Psychology Research Center and faculty director of the Massachusetts School of Professional Psychology’s media psychology program. “Some can be used with or without support.”

There’s an app (or 400) for that!

Searching your app store of choice will turn up plenty of behavioral and mental health apps, with little aside from marketing copy and user reviews to distinguish them from one another. Rutledge advises, “Do some research. Don’t just read the name of the site...Google reviews, Google the company, learn more about the psychology. It’s really important to know it’s got a psychologist involved somewhere.”

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Many apps promise to help, but without usable interfaces and a grounding in science, they can become part of the problem.

Many apps are free to try, she says, so “check one out and see if it works for the way you work. The best app in the world won’t work if you can’t use it."

“They [apps] can be very effective and very useful, but they’re not necessarily for everybody,” agrees Ritterband. However, the most crucial thing may not be the personal fit, but whether the theory is sound. “Apps have become a phenomenon over the last several years. There are hundreds of hypnosis apps with no data behind them,” says Ritterband. "Make sure that there’s science behind what you’re using."

The science of self-tracking

Many well-known behavioral and mental health apps, such as eMoods and T2 Mood Tracker, let people track their emotional states. “Mood trackers stem from the idea of behavioral monitoring being useful,” says Ritterband. But it might not be enough for every situation: “Just providing feedback on its own may not effect a change. There is some data to support that basic behavioral monitoring can be useful. It’s useful with sleep; often people find they’re sleeping better than they think.”

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Drawing from lessons learned at Australia’s Black Dog Institute and developer James Bishop’s own experience with bipolar disorder, Optimism provides a large number of Symptoms, Triggers, and Stay Well Strategies to track.

One of the most venerable is Optimism (iOS, Mac, Windows, Web browser; free). Developer James Bishop explains that when he was diagnosed with bipolar disorder, he “put...efforts into finding out what would work. I started recording aspects of my health in an Excel spreadsheet: sleep, medication, food, and so on."

Bishop attended a six-week course at Australia’s Black Dog Institute, which researches, diagnoses, and treats mood disorders. There he learned about stay-well strategies—positive actions and habits for improving mood and function. “That helped me to turn my focus on positive things I could do, and not just symptoms and medicines.” The spreadsheet kept him on top of both his triggers and his stay-well strategies.

In 2008, Bishop released Mac and PC editions of Optimism with triggers, trackers, and stay-well strategies. He made the program customizable as well. “The Optimism app was very focused on the individual, something to contribute to their own health. There’s no magic in the application.”

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Optimism lets you set your own Triggers to keep tabs on your mood .

There may not be magic, but there is science. Rutledge notes that Optimism “lets you not only become more sensitive to moods and triggers, which is important, but also able to look back and see your successes. It helps you to create new behaviors.”

Bishop has since added free iOS and Web-based editions of Optimism. The $39/month Optimism Dashboard is a tool for clinicians that lets them follow the reports of patients who allow them access. "If a therapist wants to monitor 15 clients, they can monitor in real time what the clients are recording. They can also set up automatic reports on the clients.” There’s also an alert system so that if the clinician is worried that a client is suicidal, the system alerts them if the client logs the word suicide or suicidal.

These games are good for the brain

Not every mental health tool looks like serious business. Interactive fiction “game” Depression Quest (Web, donation requested) is like a choose-your-own-adventure story, only it’s an adventure no one would willingly choose. Realistic, second-person writing works with a gray color scheme and haunting piano music (which gets glitchier as the character called “you” gets more depressed) to convey feelings of dread and torpor as you choose from a shrinking number of poor choices.

Depression Quest is neither a diagnostic tool nor a treatment tool. As Rutledge points out, “It takes attention to get through it,” and someone who’s deeply depressed may not have the stamina to follow through to one of the five endings.

That said, Depression Quest illustrates what depression feels like and how sufferers can take it on, with help. It can foster feelings of empathy toward anyone suffering with depression, and the game’s designers give a portion of any donations to the International Foundation for Research and Education on Depression.

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The longer you stay in Depression Quest’s story, the fewer choices you see.

Be warned: Depression Quest is intense. Other gamified mental health tools are much more fun to use (as you might expect from apps that concentrate less on getting help than on building healthy habits).

Exploring the power of positivity

“There are a lot of intervention-based apps, and others that are lifestyle-based,” says Rutledge. “What they really are is the positive-psychology side: How do we identify the things that really work well? The gratitude apps and the mindfulness apps are working on that side.”

A good mindfulness app, says Rutledge, is Meditation Oasis’s Simply Being (Android, BlackBerry, iPhone, Windows Phone; $1). “Gratitude apps sometimes ask you to take a moment and think of something you’re grateful for.”

Although developer Bloom Bright doesn’t bill Day One as a psychology tool, the journaling app for iOS and Mac can promote mindfulness.

Some useful apps don’t bill themselves as psychology tools. “Day One (iOS, $5) is a psychology app that doesn’t know it’s a psychology app. It lets you flip through a fabulous timeline and see the journey of your life. The apps that let you add images are more powerful.”

Lifestyle-based apps and websites may look lightweight at first, but Rutledge points out that research lies at their core: “The whole field of positive psychology is based on finding meaning in life and working with cognitive behavioral therapy.”

Feel SuperBetter

SuperBetter (iOS $5, Web; free) casts the player as a superhero on a mission. SuperBetter sets out games to play and tasks to perform to improve four kinds of resilience: emotional, mental, physical, and social. Game designer Jane McGonigal, Ph.D., based SuperBetter on the path she forged to strengthen her own mind and body while recovering from a concussion that didn’t heal properly.

Every Quest fulfilled, Bad Guy vanquished, and Power-Up activated propels you toward getting SuperBetter in real life.

First you choose a superhero identity, a problem to solve, and a specific goal (called an Epic Win); then you strive to feel better by completing Quests and Power-Ups. Roadblocks such as negative thinking, too much sitting, and poor eating habits are Bad Guys to vanquish. SuperBetter suggests a Daily Dose, in which you perform three Power-Ups, fulfill three short Quests, and defeat one Bad Guy.

Offering both general tips and Power Packs for goals such as losing weight, fighting anxiety, and “Being Awesome,” most of SuperBetter is private—including a Secret Lab with various trackers, a journal, and Lab Notes—but you can recruit friends to be Allies so that you can cheer each other on.

SuperBetter’s dashboard helps you set goals large and small to improve and track your ability to pick yourself up after a setback.

Along with the feel-good messages, SuperBetter includes scientific background explaining the usefulness of resilience and the various tasks. Short explanations accompany every task, and deeper explanations lie in the Lab Notes.

The power is still with the person

Rutledge, too, sees potential in games. “Because of the fundamental things about gaming, games map exactly to learning theory, attention, cognitive engagement.”

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Health starts with the person. The tech is just a tool.

In some cases, a game is as good as a mindfulness app…but when it comes to serious problems, technology can’t always do the job alone. “If something is impairing your life, an app is not the place to start,” Rutledge says. “If you’re experiencing mental distress, seek professional help. I’m very big on games and psychology, but there are limitations. It’s really about the people, not the tools.”

Starting with sound science and good design, a website or app becomes a go-between for a person seeking better mental and behavioral health. With all the research and planning going into these apps—and the degree of personalization and self-determination they put into a person’s hands—it’s no longer surprising that technology can help humans feel more like themselves.

If you or someone you know is struggling with mental health issues, please reach out. You can reach the National Suicide Prevention Lifelife via their website or by calling 800-273-8255. You can find more services at MentalHealth.gov.

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