“Dennis,” a composite character whose experiences resemble those of actual veterans, is a 27-year old computer programmer who left the Army two years ago and who has been feeling blue off and on since returning from a deployment to Afghanistan.”He doesn’t sleep great, has trouble getting motivated for work, and has given up many of his favorite hobbies as he no longer gets any joy from doing them. He’s pretty sure that he is depressed, but he has yet to seek treatment for several reasons. First, Dennis lives in a rural part of his home state, where the local medical clinic is has no mental health specialists on staff. Second, like many people with problems of this sort, he doesn’t feel right asking for help from a therapist and he certainly wouldn’t want anyone else to know he was going to see a “shrink.” Finally, his depression, decreased energy and social isolation make it physically difficult for him to make it to the nearest mental health provider. How do mental treatment providers overcome these different barriers to make sure that Dennis is receiving the care that he needs?
Don’t worry, we have an app for that. The widespread use of internet-capable mobile devices has given rise to hundreds, if not thousands of apps that are designed to address mental health problems. These apps offer a variety of functions aimed at improving mental health, from tools for tracking changes in mood to tutorials that teach skills such as how to practice mindfulness. Regardless their underlying commonality is the ability to help someone like Dennis overcome barriers to accessing mental healthcare, whether they be geographical or psychological.
However, while these apps certainly offer greater accessibility, it’s not always clear how effective they are. The pace of app production has tended to outstrip both the scientific rigor of the design process and efforts to gather evidence of their effectiveness. Like many things in life, however, necessity is often what fuels innovation. When it comes to developing apps that are effective in the treatment of mental health problems, that necessity was the multitude of active duty soldiers and newly returning veterans trying to cope with mental health problems such as post-traumatic stress disorder (PTSD), depression, and thoughts of suicide as a result of their experiences during recent conflicts in Iraq and Afghanistan. Many of these soldiers and Veterans faced similar barriers to treatment as the hypothetical Dennis, underscoring the need for tools, such as apps, that were not only effective, but accessible.
Fueled by this necessity, the Department of Defense (DoD) and the Department of Veterans Affairs (VA) worked together to translate the most effective aspects of in-person psychotherapy into mobile tools for military personnel, veterans, and their families. The result of this effort has been the creation of a suite of apps designed to support evidence-based mental health treatments for the most common mental health problems facing soldiers and veterans.
For example, DoD/VA has tested and published evidence for apps designed to address PTSD, insomnia and suicidality. DoD/VA has may other apps that have been designed using the best available science, including apps for depression, traumatic brain injury (TBI), and addiction. Although designed with service members and veterans in mind, these problems are common among non-military civilians as well, and since the apps are available to anyone, free of charge, many are benefiting from using these tools in their everyday lives. So far, there have been more than 540,000 downloads. PTSD Coach and CBT-I Coach (which provides tools for addressing insomnia) have been particularly popular.
Although every app has its own “story” as to how it was created and tested, the process often includes assessments for costs versus benefits, acceptability by veterans and service members and technical feasibility. User testing might include getting reactions to the concept for an app in a focus group. Service members might be shown paper mockups of the screens and asked for their input. Once the software is available, they might be asked to give it a test drive before release.
Finally, there is the task of evaluating the app. The VA and DoD have done a number of surveys of providers to gather their perceptions of the apps as they use them deliver treatment. Research evaluations of some of the apps have also been conducted. Generally, the apps created by the DoD/VA have been favorably received. That said, there is much work yet to be done to better understand how effective these tools are at helping with the problems for which they are designed.
While mobile apps represent only one form of mobile technology, they are arguably the most widespread and easily accessed. As such, they have the potential to impact the lives of many people all over the world. The stunning rate at which mobile technology is being adopted around the word gives rise to interesting questions about the treatments of tomorrow, their effectiveness, and also make one ponder how individuals like Dennis might get help in the decades to come.
The contents of this article do not reflect the policy or position of the U.S Department of Veterans Affairs.