The document discusses the use of smartphone apps in psychotherapy. It answers four questions: 1) Barriers to psychotherapy include costs, time, stigma and access issues. 2) Studies show smartphone apps can effectively treat depression, anxiety, and other issues, especially when combined with guidance. 3) Common CBT app features include cognitive restructuring, education on disorders, and suicide risk resources. 4) Few apps are available for Arab populations, most provide general mental health information or alternative treatments like herbal medicine.

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