Integrating mobile apps into your practice
When I first started doing research in technology and mental health people would often ask me if I thought that technology would replace therapists. Digital mental health was seen as an alternative to traditional services that could overcome the challenges to get care to people who need it. Increasingly though, people are starting to appreciate digital mental health is often not an issue of technologies versus therapists but instead is an issue of technologies plus therapists. Here are three ways that technology could improve traditional face-to-face therapy.
Technology can help collect data and bring it into the therapy room. Along with some colleagues, we’ve recently been looking at data from Fitbits which might be useful to improve the treatment of veterans with posttraumatic stress disorder. Having data that can be used in the therapy session can help identify problems, personalize treatments, and monitor progress.
Technology can supplement therapy by training additional skills. For example, cognitive remediation has shown to be useful in psychoses and schizophrenia to improve attention, memory, and other cognitive benefits and can provide overall treatment gains when provided alongside other psychiatric rehabilitation.1 Cognitive remediation is often done through software like websites or apps.
Technology can reinforce therapy by helping practice skills outside of sessions. PE Coach is a good example of an app that helps people receiving prolonged exposure (PE) treatment record sessions, practice homework, and use skills in their daily lives. Having an app can increase the credibility of a treatment, consolidate treatment materials into one place, and increase therapist-patient collaboration.2
Unfortunately, many therapists have not been trained to use technology in their practice. The U.S. Department of Defense’s Connected Health group recently published a Mobile Health Practice Guide 3, that provides useful guidance to therapists interested in doing so. It provides an overview of 5 core competencies that can help clinicians use mobile apps in their practice: evidence base, clinical integration, security and privacy, ethical issues, and cultural considerations. We review issues related to the evidence base and security and privacy in our PsyberGuide App Guide. Clinical integration starts to get at how to use the app in conjunction with one’s practice or in a health system.
Five key steps to clinical integration are proposed: workflow, introduction, prescription, data review, and documentation. Importantly, because many apps do not share information directly back to a therapist and even those that do may not meet regulatory compliance, the safest route for using data from apps is to have clients share their data directly with a therapist in session and for their therapist to document that data in their clinical record. Therapists should be able to walk clients through five steps when introducing an app:
- How much is the client currently using technology? and how will that help or get in the way of using an app with treatment?
- The therapist should be able to describe the apps purpose
- The therapist should be able to describe the apps’ key feature
- The therapist should describe how the app will be used in the context of the client’s treatment plan
- The therapist should describe risks and benefits of using the app and make it clear that its use is voluntary for the client while providing reasonable alternatives.
All of this means therapists need to have a strong working knowledge of the apps their clients are doing, and PsyberGuide can help with that, especially for those apps in which we provide expert reviews which provide a narrative overview of the app.
Apps may not be useful for all clients and as such therapists should review the pros and cons of using such a platform in treatment and make it clear that it is ultimate the client’s choice. Ultimately the client will have to be the one whose use of the app will drive its impact on the treatment and alignment between client and therapist is key. Therapists interested in using apps in their practice should seek additional training and supervision where necessary. The Department of Defense’s Mobile Health Practice Guide is a good place to start and PsyberGuide can help fill in some information for therapists interested in learning more about specific apps.
- Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry, 168(5), 472-485.
- Reger, G. M., Browne, K. C., Campellone, T. R., Simons, C., Kuhn, E., Fortney, J. C., … & Reisinger, H. S. (2017). Barriers and facilitators to mobile application use during PTSD treatment: Clinician adoption of PE coach. Professional Psychology: Research and Practice, 48(6), 510-517.
- Armstrong, C. M., Edwards-Stewart, A., Ciulla, R. P., Bush, N. E., Cooper, D. C., Kinn, J. T., Pruitt, L. D., Skopp, N. A., Blasko, K. A., & Hoyt, T. V. (2017). Department of Defense Mobile Health Practice Guide (3rd ed.). Defense Health Agency Connected Health, U.S. Department of Defense.