3 Mental Health Apps Comparable in Benefits

Adam G. Horwitz, PhD

Credit: Michigan Medicine, University of Michigan

A recent study found mental health apps with personalized feedback provide similar benefits to apps incorporating mindfulness-based interventions or cognitive behavioral therapy.¹

“The findings highlight the potential for [digital mental health interventions] to be offered as supplemental or adjunctive tools within health care systems,” wrote investigators, led by Adam G. Horwitz, PhD, from the department of psychiatry at the University of Michigan Medical School.

Mental health services have a wide gap between supply and demand. For people who cannot get an appointment, or have to wait a long time, being able to use an effective mental health app can help individuals get the help they need earlier.

A 2022 meta-analysis supported the potential of using smartphone apps as a mental health intervention to improve depression and anxiety symptoms.² However, little was known about how a mental health app would compare to actual therapies.¹

Investigators sought to compare whether digital mental health interventions based on cognitive behavioral therapy (CBT) or mindfulness would be more beneficial than enhanced personalized feedback.

“Contrary to our hypotheses, randomization to various [digital mental health interventions] did not result in differing outcomes with respect to depression, anxiety, suicidality, and substance use among adults scheduled for outpatient psychiatry services,” investigators wrote.

The team conducted a randomized clinical trial between May 13, 2020, and December 12, 2022, with a follow-up at 6 weeks. They recruited adult patients aged ≥ 18 years who had a scheduled or recent outpatient psychiatry appointment at various clinics within the University of Michigan Health System. Participants were randomized 1:5 to the intervention arms of enhanced personalized feedback, Silvercloud (designed to deliver CBT strategies), Silvercloud plus enhanced personalized feedback, Headspace (designed to deliver mindfulness strategies), and Headspace plus enhanced personalized feedback.

Silvercloud has a global user base of > 500,000 people and consists of psychoeducation and self-guided modules introducing CBT skills, such as mood monitoring, activity scheduling, and cognitive restructuring through text, videos, and journaling exercises. The app has demonstrated the benefits of reducing depression and anxiety symptoms (effect size range, 0.50 – 0.63) compared with controls.

As for Headspace, this app has > 2,000,0000 users and includes many guided mediations and strategies for improving sleep, reducing anxiety, and stress coping mechanisms. This app has also demonstrated benefits in reducing depression and anxiety symptoms (effect size range, 0.24 – 0.26) compared with controls.

The primary outcome was a change in depression symptoms, measured by the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms from baseline to a 6-week follow-up.

The study included 2079 participants with a mean age of 36.8 years and more than half women (68.4%). At baseline, the mean PHQ-9 score was 12.7.

Investigators found for all 6 intervention arms depression symptoms reduced by 2.5 points from baseline to the 6-week follow-up (marginal mean differences in mean change ranged from -2.1 (95% confidence interval [CI], -2.6 to -1.7) to -2.9 (95% CI, -3.4 to -2.4). Ultimately, the difference in depression symptom reduction was not significantly different across 5 arms (P = .31).

Moreover, the arms did not significantly differ in their reduction in anxiety or substance use symptoms. However, compared with the Silvercloud arms, both Headspace groups reported significantly greater improvements on the suicidality measure subscale (mean difference in mean change, 0.63; 95% CI, 0.20 to 1.06; P = .004).

“While the modest magnitude of improvement does not suggest [digital mental health interventions] can replace formal mental health care services, [digital mental health interventions] may serve an important role in supporting patients during waiting list–related delays in care,” investigators concluded.

References

• ^{Horwitz AG, Mills ED, Sen S, Bohnert ASB. Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(7):e2422115. doi:10.1001/jamanetworkopen.2024.22115}
• ^{Goldberg SB, Lam SU, Simonsson O, Torous J, Sun S. Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials. PLOS Digit Health. 2022;1(1):e0000002. doi:10.1371/journal.pdig.0000002}