Clinically Useful mHealth Apps: Tackling Tough Problems with Technology
I am exceptionally lucky to be supported at PsyberGuide by an outstanding collection of scientists who serve on our Scientific Advisory Board. The Scientific Advisory Board provides feedback and input to help PsyberGuide achieve its mission.These scientists are true innovators, pushing the boundaries of brain health research and treatment. This month, I want to highlight the work of one of these board members, Dr. Dror Ben-Zeev. Based at the University of Washington, Dr. Ben-Zeev is a Professor of Psychiatry and Behavioral Sciences and the Director of the mHealth for Mental Health Program and Co-Director of the Behavioral Research in Technology and Engineering (BRiTE) Center.
Dr. Ben-Zeev has a long history of research in the development and evaluation of technology-based approaches in the study, assessment, treatment, and prevention of serious mental health conditions. In a recent study, published in Psychiatric Services, Dr. Ben-Zeev and colleagues conducted the first head-to-head comparison of a mHealth versus clinic-based intervention for people with serious mental illness.1 In the world of mHealth, where studies tend to be small and methods tend to be loose, this is a large, rigorous, and well-designed trial. Over 150 people, many from racial minority groups experiencing long-term serious mental illness, were recruited. Participants were screened in-person and evaluated by study assessors who had no knowledge of the condition that participants were receiving. Participants in the mHealth group received FOCUS, a smartphone-delivered intervention that had been developed by Dr. Ben-Zeev through a series of research projects. Participants in the clinic-based intervention group received Wellness Recovery Action Planning (WRAP), a group-based recovery-oriented intervention that is led by trained facilitators with lived experience of mental illness and enjoys widespread use. I want to discuss some important takeaways from this study:
Both FOCUS and WRAP were effective, with neither more effective than the other.
On multiple clinical measures, such as general psychopathology and depression, participants who received FOCUS and participants who received WRAP experienced significant decreases. The benefits gained from FOCUS and WRAP were not significantly different at the end of the treatments. These findings support the use of digitally delivered treatments, which can be effective and go toe-to-toe with some of our current front-line treatments. However, to do so other conditions, like engagement and some form of human support, often have to be met.
People were much more likely to engage with FOCUS.
90% of the participants assigned to use FOCUS did so while only 58% of participants assigned to receive WRAP attended any sessions. Furthermore, people remained more engaged with FOCUS overtime with 56% remaining fully engaged for at least eight weeks compared to 40% remaining fully engaged in WRAP. They also used an extremely high bar for full engagement requiring people to log in and use the app at least 5 of 7 days each week. It’s also worth noting that although FOCUS did not have perfect engagement, neither did WRAP. When evaluating technology-based treatments we need to be realistic about how well our current treatments work; although engagement with apps can be a challenge, so can engagement with traditional care.
Although FOCUS is a smartphone-delivered intervention, it included human support.
Participants receiving FOCUS were supported by a trained and supervised “mHealth specialist.” Although this mHealth specialist did not provide extensive long-term support (only 10-15-minute calls per week following the first week), they did help set up and orient people to FOCUS. In an initial in-person session, this specialist helped people learn how to use the phone, the FOCUS intervention, and highlighted content that was relevant to the participants’ needs and goals. The take home here is that to get started with a mHealth resource, often people need some help to get going, and encouragement along the way. People supporting their use of the tool may not need to be licensed professionals, but should be well-versed in the specific mHealth tool.
Participants were representative of the people who need psychiatric care.
Over half of the participants had a high school education or less, 18% had been hospitalized more than 20 times. These were people with real needs and few resources. These also were not extremely tech-savvy folks. Only 65% had actually even previously used a smartphone. This shows that mental health apps are not just relevant for the worried-well or those with moderate mental health issues, they can help those with serious mental health issues who far too often do not receive care.
This study demonstrates some promising directions for mobile mental health apps, illustrating their usefulness for important mental health issues which commonly go undertreated. It’s yet another example where such tools are one piece of the puzzle, which can be effective when combined with other resources such as support from a mHealth specialist. PsyberGuide is one resource that can help raise a person’s awareness of mHealth tools, and can be useful for users who are interested in tools for their own use, but also clinicians and therapists who want to raise their ability to be specialists in using mHealth tools in their work.
- Ben-Zeev, D., Brian, R. M., Jonathan, G., Razzano, L., Pashka, N., Carpenter-Song, E., … & Scherer, E. A. (2018). Mobile Health (mHealth) Versus Clinic-Based Group Intervention for People With Serious Mental Illness: A Randomized Controlled Trial. Psychiatric Services, 69(9), 978-985.