Psych-related iPhone apps

http://informahealthcare.com/jmh ISSN: 0963-8237 (print), 1360-0567 (electronic) J Ment Health, 2014; 23(1): 48–50 ! 2014 Informa UK Ltd. DOI: 10.3109/09638237.2013.869575

WEB REVIEW

Psych-related iPhone apps Anthony Mark Harrison1 and Rhianna Goozee2 Division of Health Psychology and 2Psychosis Studies, Institute of Psychiatry, King’s College London, London, United Kingdom

Abstract

Keywords

iPhone apps are a widely utilised technology that have recently been identified as a useful medium for health research, clinical interventions and education. While some researchers have discussed advances in app technology, others promote specific apps that are not free to access. To our knowledge, no study has conducted a review of current, free iPhone apps related to psychology, psychiatry and mental health. Therefore, we conducted a pilot, web-based review exploring free iPhone apps using a replicable search strategy within the iTunes Store search function. A selection of apps were selected and subjectively assessed in terms of their usability, utility, graphics, and associated costs for the consumer. We concluded that the apps reviewed, though novel, are limited in their scope and utility. We also note a significant gap in more scientific, evidence-based app technology, and pose some pertinent ethical questions when developing future psych-related apps.

iPhone, smartphone, apps, technology, psychology, psychiatry, mental health

When divulging his thoughts on romantic relationships the late Apple Inc. co-founder, chairman and CEO, Steve Jobs, is thought to have said, ‘‘if you haven’t found it yet, keep looking. Don’t settle.’’ Perhaps rather fittingly, there is no better time than the present to apply this uncompromising vision of high standards to the constantly proliferating landscape of iPhone app development and, in particular, apps designed specifically for the audiences of psychiatry, psychology and mental health. While a recent ‘‘E-mental health’’ themed issue within Journal of Mental Health has set the scene for current advances in Information and Communication Technologies (ICT) (Schmidt & Wykes, 2012), a more focussed exploration of smart-phone app developments is timely. The respected educationalist, Sir Kenneth Robinson, warns us that most children’s brains today are bombarded by information from the innumerable mediums of electronic wizardry and dizzying array of permeating media now available (http://www.youtube.com/watch?v¼zDZFcDG pL4U). In contrast, contributors to the rapidly expanding field of smart-phone app development emphasise the importance of harnessing this widely utilised technology for the benefit of health research, clinical interventions and education. While Edward-Stewart (2012) suggests there is little empirical support for the effectiveness of current smartphone apps in the mental health arena, the youthful literature on app technology is far-reaching. Research ranges from Correspondence: Anthony Mark Harrison, Division of Health Psychology, Institute of Psychiatry, King’s College London, 5th Floor Bermondsey Wing, Guy’s Campus, London, SE1 9RT, United Kingdom. E-mail: [email protected]

History Received 27 August 2013 Accepted 4 September 2013 Published online 28 January 2014

descriptions of open source software allowing researchers to create their own online and smart-phone-based interventions (e.g. LifeGuide and UBhave, Yardley, 2011); reviews of apps focussing on specific therapeutic techniques (e.g. Positive Activity Jackpot, a pleasant events scheduling app hosting a cunning slot-machine facade, Edward-Stewart, 2012); to philosophical and pragmatic discourse outlining the ethical and technological challenges that beset the progress of app development for the purposes of improving social psychology research (Rachuri & Mascolo, 2011). While Rachuri and Mascolo discuss the exciting developments of Emotionsense and Sociablesence algorithms (i.e. real-time sensory feedback technologies), they also express caution surrounding the cost of expansive data storage and data privacy issues. In a context of recent media coverage highlighting US surveillance programmes, the latter is a poignant issue and researchers are debating the ‘‘big brother’’ implications of these technologies, perhaps with a view to resist an Orwellian dystopia. While the literature tells us something about the arcane, abstract and swiftly changing scenery of smart-phone technologies, a brief foray into the world of current psychrelated iPhone apps may go some way to sate the intrigue of those of us unacquainted with what is available. The remainder of this article will summarise a brief pilot web review exploring free iPhone apps. Replicable search strategy terms were entered within the iTunes Store search function, including ‘‘psychiatry’’, ‘‘psychology’’, ‘‘mental health’’ & ‘‘nursing’’. This resulted in a large list of apps, from which we selected a few upon which we imprint our subjective impressions of usability, utility, graphics, and associated costs for the recipient. Currently, it appears clinical psychology research is awash with vogue debates pertaining to the efficacy of ‘‘third-wave’’

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DOI: 10.3109/09638237.2013.869575

psychological therapies, which challenge the philosophical assumptions of thought content-focused, realist-oriented approaches like CBT. While Acceptance & Commitment Therapy (Hayes et al., 2012), Mindfulness-Based Cognitive Therapy Segal et al., 2012), and Dialectical Behavioural Therapy (Linehan et al., 1999) claim the greatest glare of publicity in the third-wave literature limelight, our first app, HeadSpace, is not affiliated with any therapeutic ‘‘brand’’. Instead, an ex-Buddhist monk from the UK, Andy Puddicombe, is the sole contributor of this experiential app. Armed with a host of humorously-pitched, animated allegorical videos, Andy features centre stage, explaining the commonly misunderstood practice of mindfulness meditation to a lay audience. His gentle rationale resonates at a level where the user feels persuaded to complete Headspace’s free, 10-day audio-guided meditation programme, forming a useful secular introduction to this ancient practice. Meditation reminder alarms assist those suffering with impaired memory or ‘‘mindlessness’’ and moral support is garnered by gauging how many other people within the meditative community are listening to Andy’s dulcet tones at any one time. Overall, we found this to be a very engaging and interactive app that may have useful clinical applications. Many of us will have attempted to conceal our embarrassment when confusing the principles of p-values and confidence intervals in the company of eminent professors. If this sounds familiar, then you will appreciate the novel AtMyPace Statistics from New Zealand. This simple app hosts a small selection of educational videos, sharing a striking graphical resemblance to Headspace. AtMyPace Statistics does not discuss the complexities of multivariate statistics observed in voluminous textbooks, but the rationale for statistical inference is adequately conveyed in the context of ‘‘Helen’’ and her attempts to address hypotheses surrounding the spurious marketing ploys of a fictitious chocolate bar company, ‘‘Choco-Nutties.’’ As with Headspace, AtMyPace Statistics is a free trial version only, but the full version is available at a small cost to the consumer. Both apps are useful examples of how video and audio media are currently a favoured medium for education in the sphere of app technology. 3D brain is probably the most graphically impressive app identified in our search. This app hosts a colourful illustration of the grey matter, allowing you to grasp the location of the basal ganglia, using simple rotate and zoom-in functions to peer from the parietal region through to the medulla oblongata, viewing 29 distinct brain structures in sum. If you are more interested in the brain when things go wrong you can also read more about the impact of brain damage and brain disorders using the case studies option. While more experienced neuroscientists may view this app as limited in scope, it offers both an interesting introduction for the lay audience (e.g. service users) and is a unique demonstration of how graphical software may be used within future app design. Staying with the theme of video and animation as a medium of education, The Animated Pocket Dictionary of Psychiatry boasts 100-plus neurology, psychiatry and other medical terms that are illustrated by supposedly ‘‘life-like’’ 3D animations. As with AtMyPace Statistics, we experienced only an ephemeral amusement with this particular app.

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One reason is that only some of this dictionary is actually free to use. From the consumer perspective, this raises the question of what apps are truly free, and what increase in quality can we expect when parting with our money? Also, how useful are these apps for professional use? As with 3D brain it may be these apps have some educational utility for health service users as an extension to consultations with their health care professionals. However, a rather tricky problem is that full access to these apps comes at a cost (albeit a small cost in most cases) that might not be acceptable to the service user. This leads us to the question of who would be willing to pay; potentially, in Britain, the NHS? The question also arises as to whether health insurance would cover such services in the US? Given the expansion of apps available, how might access and quality assurance be regulated? A recent Journal of Mental Health article, ‘‘Can’t surf won’t surf: The digital divide in mental health’’ (Ennis et al., 2012) provides support for the idea that technology use in mental health reflects that of the general population, such that BME groups and older adults report less familiarity, access and confidence in using these technologies. Another key access issue is that competing smart-phone companies, like Apple or Samsung, have created apps extending only to their customers, hence our iPhone app-focus within this review. Therefore, it seems we cannot automatically assume that everyone owns a smartphone, has the right one, or knows how to use them. By not offering these technologies, or providing appropriate training, to service users who may not already have one, might we face unwelcome litigation due to limited access? As for regulation, while NHS Choices website actively promotes select smartphone apps (http://www.nhs.uk/Tools/Pages/iphonesmoking. aspx) there is no explicit reference to standardized quality assessment criteria or procedures warranting scientific endorsement. Given the brevity of this article, we can only point in the direction of a few other noteworthy psych-related apps: including the UK Clinical Trials Gateway, which can be referred to when searching for all registered research trials; NICE guidance, which is a useful, shorthand reference for conscientious clinicians; and APA Journals is an easy way to keep abreast of important American developments in psychology. Having subjected a selection of current, questionably ‘‘free’’, iPhone apps to the proverbial microscope, what can we conclude? While all these apps are novel and amusing, most are limited in their scope and utility. We believe we are observing a colossal gap in more scientific, evidence-based app technology. Specifically, our findings corroborate those of Edward-Stewart (2012) as very few apps have any clear theoretical basis for their claims, though some appear to be loosely modelled on empirically supported theories or treatment approaches. However, one obvious challenge is the rapid rate at which technologies become obsolete or culturally passe´, potentially rendering more measured scientific design, evaluation and dissemination fruitless. We highlight how access to such technologies may result in problems related to funding and quality assessment. One question that the literature is yet to pose is how these technologies may change us in the short and long-term? At this stage we have no


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empirical support for them improving learning or clinical outcomes. In light of recent government ‘‘nudge’’ programmes to improve civic behaviour (John et al., 2009), perhaps we also need to consider the potential risks when designing our app technologies. Such as overstating their utility by confusing cost-effectiveness for NHS money-saving political agendas, stigmatizing behaviours, encouraging people to engage in health behaviours that are deemed ‘‘acceptable’’ as defined by health professionals, and potentially creating dependence. For instance, EdwardStewart (2012) suggests the Positive Activity Jackpot helps indecisive users choose an activity, especially when a depressive episode is characteristised by a diminished ability to think or concentrate. It may be that having an app constantly instructing our behaviour may have unexpected consequences for our cognitive faculties and intuitive judgment. In a world captivated by new smart-phone and tablet technologies, perhaps it is time to think more carefully about how apps can best be used both as a valuable clinical resource and a research tool in the world of mental health.

Declaration of interest The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.

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