Last week at the Royal Society of Medicine I met Liz Ashall Payne, the CEO of ORCHA, an organisation that reviews health apps. There are a staggering 450,000 of these. I also bought ten books by Freud for £10 and as the two occurred the same afternoon, it made me wonder what he would have made of apps.
ORCHA calculate that every day there are some 5 million clicks on health apps. They often depend on those who use them describing their thoughts and feelings – or to put it technically, to self-report. Freud built psychoanalysis on the basis that his patients often were confused by their thoughts and feelings. Their psyches were well defended and the therapist’s job was to lance through the defences. All psychologists know that self-reports can be very unreliable.
ORCHA has no power to license apps – anyone can put up Beat Your Anxietyand claim it is more effective than any other app. ORCHA’s niche is to review apps and see how well they measure up. The first essential measure is to work out if an app does any harm. Sometimes they are worse than useless. Ashall Payne told me that a number of apps, which claimed to help those with suicidal thoughts, in fact gave detailed advice on how to kill yourself. So they were actually dangerous. They then look at whether it does any good.
Despite such issues, investors seem ready to back apps. There are almost 30,000 dealing with mental health. Astonishingly it costs on average some £450,000 to set up an app – and about a third more to make sure the app updated. If an app is not updated it is useless and about one third of apps are not.
In 1987 Douglas Shelley and I wrote ‘Testing Psychological Tests’ in which we assessed some 40 tests to see how good the evidence was that they assessed states of mind properly and predicted behaviour – at least to some extent. Prediction is never easy with human beings but some tests were hilarious. I particularly liked the test which told you how good a basketball player you were by the answers you gave. The test was a paper and pencil exercise and did not demand anything as athletic as trying to shoot a ball in the basket.
Even though they rely so much on self-reports, there are some positive things about apps. You feel anxious and a good app will get to you to think about your moods, explain what a panic attack is – and then offer a ‘toolbox’ for dealing with that anxiety.
In the U.K there is a strict regime for testing drugs but there’s nothing comparable for testing apps. We need it.
A recent study in the British Medical Journal looked atthe attributes of popular apps for mental health and comorbid medical conditions in America. The researchers at the University of California Davis examined 120 apps that claimed to help six disease states: depression, anxiety, schizophrenia, addiction, diabetes and hypertension.
None of the 120 apps had Food and Drug Administration marketing approval. Nevertheless nearly half made claims that appeared medical. Most apps offer a similar type of service – mainly self-monitoring of health, ‘diagnostic data by a client’ or ‘client look-up of health information’. Clients gave positive ratings to apps that had recently been updated.
The BMJ paper identified the issues that many apps made unsupported claims, and many offered questionable content. It concluded that this ‘warrants a cautious approach by both patients and clinicians in selecting safe and effective ones.’
I do not know of any research on how often therapists have to deal with clients who have sought help from apps. With 5 million clicks a day on health apps, such clients cannot be rare.
ORCHA is trying to provide solid analysis of what particular apps can and can’t do. It would make sense for therapists to keep up with the assessments ORCHA provides. No panacea but a useful part of the therapeutic ‘toolbox’.
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