Use of smartphone apps in psychotherapy

1. The use of smartphone
apps in psychotherapy
Ehab Elbaz , MD , MBA
Consultant psychiatrist , Egyptian Armed Forces
Director of psychiatry hospital , Maadi Military Medical Compound
EPA, 2021

2. OBJECTIVES
 To answer the following questions:
1. What are the barriers to access psychotherapy
?
2. what are the evidence for the efficacy of
smartphone psychotherapy apps?
3. What are the common features for self guided
CBT apps ?
4. What are the characteristics of smartphone
apps offering psychological intervention for
Arab speaking population?

5. INTRODUCTION
 Over the last decade, there has been increasing interest in
using smartphone apps to support mental health disorder
management and well-being , which has been further
intensified since the COVID-19 pandemic .
 Recent reports indicate that nearly 320,000 health apps
are available in major app stores, of which more than
10,000 are mental health apps

6. INTRODUCTION
 However, several shortcomings of mental health apps have
been repeatedly described, including substantial dropout rates
, mishandling of users’ personal health information , poor app
credibility, and lack of content personalization .
 In addition, most health apps available in major app stores
are not evidence based and have not been validated in clinical
trials or approved by regulatory agencies , underlining
concerns about the effectiveness and safety of these apps.

7. O.1 :
What are the barriers to access
psychotherapy ?

8. Barriers to psychotherapy access
 Patient engagement
 High costs of treatment
 Time consumed
 Stigma
 Difficulty accessing specialized care and trained
providers
 Waiting time
 Recently, COVID 19 pandemic

9. O.2:
what are the evidence for the efficacy of
smartphone psychotherapy apps?

11. RESULTS
 66 RCT
 Smartphone interventions significantly outperformed control
conditions in:
1. improving depressive (g=0.28, n=54)
2. generalized anxiety (g=0.30, n=39)
3. stress levels (g=0.35, n=27)
4. quality of life (g=0.35, n=43)
5. general psychiatric distress (g=0.40, n=12)
6. social anxiety symptoms (g=0.58, n=6)
7. positive affect (g=0.44, n=6)

12. RESULTS
 Smartphone interventions conferred no significant
benefit over control conditions on :
1. panic symptoms (g=–0.05, n=3)
2. post-traumatic stress symptoms (g=0.18, n=4)
3. and negative affect (g=–0.08, n=5)

13. RESULTS
 Studies that delivered a (CBT)-based app and offered
professional guidance and reminders to engage
produced larger effects on multiple outcomes.
 Smartphone interventions did not differ significantly
from active interventions (face-to-face, computerized
treatment).
 The efficacy of app-supported smartphone interventions
for common mental health problems was thus
confirmed.

14. O.3:
What are the common features for
self guided CBT apps ?

16. Results
 The initial search yielded 3006 apps ( android and iOS)
 98 apps use CBT techniques
 There were 20 well-being apps
 65 mental health apps, targeting two or more common mental
health disorders
 13 depression apps.
 A total of 28 apps offered at least four evidence-based CBT
techniques, particularly depression apps.
 Cognitive restructuring was the most common technique, offered
by 79% of the apps.
 one-third of the apps offered suicide risk management resources
 17% of the apps offered COVID-19–related information.

17. O.3:
What are the most common theoretical basis
of psychotherapeutic modalities used in
psychotherapy apps?

19.  In a study by lui et al., 2017 to investigate the
effectiveness of mobile applications in the context of
psychotherapy , the main theoretical basis were:
 CBT
 Motivational interviewing
 Mindfulness
 ACT
 DBT

20. O.4:
What are the characteristics of smartphone apps
offering psychological intervention for Arab
speaking population?

22. Results:
 A total of 23 apps are identified with more apps available on the
Google Play Store (n=21) versus only two apps on the iOS App
Store.
 The majority of the apps (n=16) provide general information about
either anxiety, depression, or both.
 (6) apps are of spiritual nature mainly referring to the Islamic faith
and the Holy Quran, with one app referring to the Christian faith.
 (5) apps provide advice on alternative treatments, mainly
concerning herbal medicine recipes. Only two apps provided
utilities for users, specifically about medication reminders.

23. CONCLUSION
 Efficacy of smartphone applications for delivering
psychotherapy for some psychiatric disorders is
confirmed by scientific evidence.
 These apps can be used as an adjunct to traditional
face to face psychotherapy
 May decrease the barriers to access to psychotherapy
 There is a lack of psychotherapy apps for Arabic
speaking population in spite of the widespread of
smartphone usage
 The use of these apps in psychotherapy training is
underutilized