Mind
| Analysis
24 April 2020
By Jason Arunn Murugesu
Independent Photo Agency Srl/Alamy Live News
The coronavirus pandemic is likely to be bad for our mental health, as many people are now experiencing the effects of social isolation, financial distress and the potential loss of loved ones. Virtual sessions and mental health apps, whether they offer one-on-one therapy or simply mindfulness training, have been touted as a potential solution.
Even before the pandemic, access to therapy could be limited and costly, despite one in four of us being expected to experience issues with our mental health at some point in our lives. As a result, these apps have been on the rise – last year, one called Calm became the first to be valued at over $1 billion.
“Mental health apps seemingly have a lot of advantages: a greater reach of isolated populations, flexible treatment access, increased convenience, fewer visits to specialised clinics, and for some people they can afford greater anonymity and privacy,” says Rebecca Grist at the University of Brighton, UK.
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For those who were already in therapy, virtual therapy has been a lifeline during the pandemic. Anna*, a first-year nurse at King’s College London, has been continuing her university therapy sessions over the phone. “I liked that my therapist didn’t just drop me, and I was able to continue with it,” she says.
In the US, regulations on whether a therapist could prescribe controlled substances remotely have been loosened during the crisis. “Virtual therapy has really exceeded people’s expectations in the last few weeks,” says John Torous at Harvard Medical School. Talking to your therapist from the comfort of your own home has suddenly been normalised, he says.
But there are still challenges to virtual therapy. “Talking over the phone hasn’t been as conversational as talking in person so far,” says Anna. “I feel like it’s easier for you to hide your emotions on the phone, and it might hinder your therapy.”
For those who can’t or don’t want to speak to a real person, apps that provide meditation training and breathing exercises are more popular, but little is known about whether they actually work.
A study published last year looked at those who had downloaded 93 of the most popular mental health apps in Google’s and Apple’s app stores. The researchers found that 94 per cent of people stopped opening these apps just 15 days after downloading them.
“There’s good evidence that people who use these apps often get good results,” says Torous. “But that’s like saying if I can run the London marathon, then I am athletic.”
“One of the issues with these apps is the perceived absence of a strong motivating therapeutic relationship with a therapist,” says Grist. “How people use apps on their phone is very different to how we would sit with a therapist for 60 minutes.”
Several apps also offer a form of cognitive behavioural therapy (CBT), an intervention that aims to challenge a person’s unhelpful thoughts and behaviours. “What does it mean to deliver CBT via an app? How does it actually translate?” asks Torous. “These apps make a lot of serious claims, and yet we’re not demanding the same level of evidence as we do of medication,” he says.
Many apps have been offering their services free to healthcare workers during the pandemic, but Richard Graham at Good Thinking, a mental health service in London, says it isn’t clear if this is sustainable.
“My worry is that when you promote an app to vulnerable people which we cannot provide for free in the long term, how do we help them after?” says Graham. “Digital medicine is not a panacea or a miracle cure. We have to use it like any other potential treatment. The principle of do no harm still matters.”
*Not her real name
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