Clinical wisdom in the age of computer apps: a systematic review of four functions that may complement clinical treatment

Abstract

Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps. Key learning aims (1) To understand what apps are currently available to treat clinical-level psychiatric problems. (2) To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations. (3) To understand how mental health services can be complemented by utilizing computer processing power within apps.

Advances in digital CBT: where are we now, and where next?

“…However, although high-quality mental health apps exist, with engaging content and strong fidelity to evidence-based treatment principles, the app reviews (Erhardt et al, 2022;Pacheco and Scheeringa, 2022) demonstrate how these may be hard to find given the sheer volume of mental health apps available. Pacheco and Scheeringa (2022) found 722 apps in their initial search for mental health apps, of which only 163 met their criteria for having a substantive clinical element. Erhardt et al (2022) aimed to identify apps implementing cognitive restructuring, but even this more targeted search returned 256 apps, of which only 15 implemented the cognitive restructuring technique.…”

“…Reviews such as Pacheco and Scheeringa (2022) and Erhardt et al (2022) are valuable in that they provide thorough and fine-grained analyses of what specific apps provide. The study of Erhardt et al (2022) highlights that cognitive restructuring apps include most core elements of the technique, although they vary regarding additional elements such as asking for emotion intensity ratings.…”

“…Studies such as Browne et al (2022), Pacheco and Scheeringa (2022) and Patterson et al (2022) reflect advances in how apps and other digital tools can be used as an adjunct to clinician-led interventions. CBT practitioners may be interested in knowing that apps are available to support clients' self-assessment of mental health problems, implementation of treatment techniques, taking fidelity ratings of therapy sessions, and monitoring of clinical outcomes over time (Pacheco and Scheeringa, 2022). Importantly, treatment adjuncts do not always have to occur concurrently with therapy.…”

“…Three articles focus on mental health-related apps. These include an account of the co-design procedures used in the development of a CBT app for adolescents with depression and anxiety ( Li et al ., 2022 ), a review of apps that aim to complement clinical treatment by supporting assessment/diagnosis, treatment planning, treatment fidelity monitoring, or outcome tracking ( Pacheco and Scheeringa, 2022 ), and a review of apps implementing cognitive restructuring techniques ( Erhardt et al ., 2022 ). Three articles focus on remote treatment delivery, including an evaluation of the effectiveness of remote therapy in two Improving Access to Psychological Therapies (IAPT) services in London ( Nguyen et al ., 2022 ), an evaluation of the outcomes of CBT delivered via videoconferencing for young people treated in routine clinical practice ( Porter et al ., 2022 ), and a qualitative investigation of patient and therapist experiences of videoconferencing ( Song and Foster, 2022 ).…”

“…One clear advance reflected in this group of articles is in the development of apps, specifically in what some apps can now do in terms of delivering CBT techniques ( Erhardt et al ., 2022 ; Li et al ., 2022 ), or in their use as an adjunct to therapist-led treatment formats ( Pacheco and Scheeringa, 2022 ). This represents a valuable route towards making CBT more accessible and widely available, particularly for people or groups who may be less likely to access traditional mental health services.…”