Inside Mental Health Podcast: Are Mental Health Apps Safe?

Episode Description

At last count, there were over 300 mental health-related apps in the app stores. With this many, how do you choose? How do they differ from each other, and do they actually help? Most importantly, how do we know which ones are safe?

On today’s episode, we discuss mental health apps with clinical psychologist, Dr. Nathaan Demers, and digital health marketer, Joe Conrad, who created the mental health app Nod at Grit Digital Health.

Together, they explain what it takes to make an effective mental health app and how consumers can protect themselves. Listen Now.

Guest Bio

Dr. Nathaan Demers is passionate about people. This passion has led him to an enriching career as a clinical psychologist, filled with a number of twists and turns working across a variety of settings. Nathaan is an active traveler and athlete — these aspects of his life have inspired him to think beyond the traditional confines of mental healthcare. He strives to find innovative ways to expand the reach of mental health services to improve the lives of others. While Nathaan is fascinated by all areas of psychology, his passion lies within the positive psychology movement working specifically in preventive behavioral health.

Joe Conrad is a creative entrepreneur and digital health pioneer. Since 1990, Joe has led the charge at Cactus, a purpose-driven branding and creative agency with the mission of creating sharp ideas for brands and causes that help people thrive.

Joe and his team are the creators of Man Therapy, an innovative and award-winning campaign that uses humor to engage working-age men with an immersive, entertaining, digital experience where therapy actually happens.

He’s also the founder and CEO at Grit Digital Health –– a team of specialists in behavioral health, wellness, technology, and marketing. In 2016, Grit Digital Health launched YOU at College, a personal and customized well-being portal that helps students navigate life and campus. And this year the team at Grit is launching Nod, an app that combats loneliness by helping college students build more meaningful relationships. Learn more about Nod at heynod.com.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Inside Mental Health podcast, formerly The Psych Central Podcast. I’m your host, Gabe Howard, and I want to thank our sponsor, Better Help. You can save 10 percent and get a week free by visiting BetterHelp.com/PsychCentral.

And calling into the show today we have Dr. Nathaan Demers and Joseph Conrad, who are here to discuss mental health apps. Now, you might be wondering, how are these two qualified to discuss mental health apps? Well, easy. They created one. Welcome to the show, guys.

Joseph Conrad: Thanks, Gabe, it’s great to be here.

Dr. Nathaan Demers: Happy to be here, Gabe.

Gabe Howard: Now, you two created an app called Nod. Can you give us a brief overview of what that app is?

Dr. Nathaan Demers: Nod is an app that we developed in partnership with Hopelab (sic), the nonprofit foundation based in San Francisco, to combat the issue of loneliness among adolescent and young adult populations.

Gabe Howard: Now I’m thinking about apps, they’re a relatively new thing, they’ve really just popped up in the last decade and I’m, when it comes to mental health apps, it’s really kind of the Wild West, right? I mean, can’t just anybody create an app and be like, boom, use this and suddenly you will be not lonely or not depressed?

Dr. Nathaan Demers: So, mental health professionals, there’s licensing boards, there’s grievances processes, there’s ways to protect consumers. When it comes to apps, there’s none of that as of yet. Right now, there are a bucket of aps that claim to be, quote unquote, mental health apps, but might not have, for example, a clinical psychologist working on that staff, making sure that mental health best practices are being used in that. It’s really important for consumers to be aware of this. Being an informed consumer is incredibly important, and we’re very proud to make sure that we’re bringing best of class mental health tactics.

Gabe Howard: What advice do you have for people when they’re going through their iTunes app or their Google Play store and they’re looking at all these apps so that they can evaluate the difference, how do they know that they’re getting a good app versus one of the cash grabs that are OK going out of business in 90 days?

Joseph Conrad: I think it’s with any consumer product out there, you look to the community to help you decide, is this a good restaurant or a bad restaurant? The review, the ability to see what other people have said about it, how many people are using it, and you can research who’s behind the app. But most people aren’t going to take the time and put the energy into doing that. How do you separate the good ones from the not so good ones unless you’re diligent about doing research? I don’t know that you really can. You can try it and then see what the experiences and decide for yourself. But yeah, it’s a challenge.

Dr. Nathaan Demers: Very much agree with you Joe that it’s a challenge, and I also think that there are little ways that people can look to peel the layers of the onion back. So just to draw a parallel, when you’re looking for a therapist, most likely you’re going to go to that therapist’s website. You’re going to look at their degree, the modalities that they use. And similarly, when an individual is looking for an app, go to the team page, see if there’s a full time clinician on staff. Try and see if there’s any research studies that have been undertaken on that topic. And there’s actually a great organization out there called PsyberGuide. I highly recommend that you check it out. That actually has experts review mental health apps and give them a rating based on their credibility. So how much research is there? Their usability? Does it generally work? Is it fun to use? In their transparency in respect to their privacy in terms of use? So that’s another great shortcut that you can use to get a feel before you decide to buy and start using an ap.

Gabe Howard: Thank you so much for that tip. I think that people are leery of the reviews that are left by their peers or consumers in like the Google Play store or the iTunes because they’re kind of all over the place. Right. And you don’t know who is a good reviewer and who is a troll. And I think that’s watered it down. Let’s back up for a second. We’ve talked about how to find a good mental health app, but let’s talk about what a mental health app is and what it is designed to do just at its core.

Dr. Nathaan Demers: Sure, so mental health apps are a really big bucket, so you can’t just pinpoint it, but from my perspective, mental health apps are any digital tool, and that includes in the App Store or websites, for example, that are designed to increase one’s mental health and wellbeing. And this, again, is very big. When we talk about the field of mental health, you can go to therapy for anxiety, depression, OCD. Take your pick. But you can also go there to work on your work-life balance, marital issues and other things. So from our perspective, and the way that we approach mental health apps is anything that helps one’s mental health and overall wellbeing.

Gabe Howard: How common is it for people to use these apps and is there any sort of age range? In my mind I’m thinking, OK, only young people are using these apps. And they’re only common if you’re 18 years old, is that true?

Joseph Conrad: I think there’s a whole range I think the majority of apps that deal with mental health are targeted probably to that 18 to 45-year-old, but I think it runs the gamut. In fact, we were just contacted by an organization that works in care centers that provide care for seniors, and they want to talk to us about taking our Nod app, but recreating that to help seniors build relationships as they get more isolated. And I think if there’s a purpose, a job that needs to be done and somebody who wants to do it, I think apps are being built across the board for not just different age groups, but specific segments or specific issues that you’re dealing with. And they can be very effective.

Dr. Nathaan Demers: So mental health apps are really growing in popularity, so just since the start of COVID, there’s actually been over a half a billion dollars in investment into mental health apps and startups working in this space. One thing that’s very important to remember is that apps are not a replacement for traditional therapy. As a clinician, I feel very strongly about that. But they can augment therapy. They can be that first level of prevention where one can start to explore whether or not they may have a mental health disorder or simply learn some coping techniques to deal with the many stressors that we are living with nowadays.

Gabe Howard: It’s fascinating that you said that they’re not a replacement for clinical therapy, one, I completely agree with that. It’s just another tool in the toolbox. But I’m always surprised that that needs to be said. Let’s take dating apps. I think they’re the most understood. They’re the most popular and the most widely used. Any single person who is on a dating app doesn’t suddenly believe that they’re not allowed to meet people in public. They don’t meet somebody in a bar or a restaurant or, at the roller rink or wherever people meet people and say, oh, I’m sorry, I downloaded an app and in much the same way many people, myself included, back when I was using apps, I had like all the apps I had, OkCupid, I had Plenty of Fish. I just, I had all the apps. What about the idea of using multiple mental health apps? Is that dangerous? Could they butt up against each other and somehow mess up your mental health?

Dr. Nathaan Demers: I think that’s a really great question, and again, it’s a hard one to answer. So from a clinician, we know that generally, you don’t see more than one clinician at the same time for a number of reasons. And I would argue that you wouldn’t want to have multiple apps trying to work on the same issue because you can actually overload yourself. I would really recommend that if you want to give an app a go and you find that it has a good research basis, give that app a go before you download five more because you could actually overstimulate yourself and accidentally pathologize yourself, quite frankly.

Gabe Howard: Along those same lines, mental health is one of those generic terms that means so many things, you know, when we say mental health or are we talking about psychosis or are we talking about schizophrenia or are we talking about anxiety or are we talking about grief? And the reason that I say that is because I know some people, they’re like, well, I have huge mental health concerns. And I was like, OK, well, what’s going on? Well, I have anxiety. And I’m like, well, OK, well, where do you put schizophrenia? And they’re like, well, that’s mental health as well. Well, that’s a wide, wide gap. But again, there’s so much misunderstanding about mental health that doesn’t that misunderstanding just translate right to their understanding of mental health apps and which ones will and will not work for them?

Joseph Conrad: We actually have uncovered a lot about the issue that you’re raising, Gabe, and I think every single one of us should be aware and more concerned about their mental health. All of those things are included in that gamut. We’re all on it somewhere on this continuum of mental health and wellbeing, all the way from mental illness to really thriving and everything in between.

Dr. Nathaan Demers: To draw a quick parallel, think of telehealth medicine, my son had a rash the other day. We felt very comfortable calling, doing a telehealth visit, figuring out what that was. Got a prescription. We’re good to go. If my son fell and was bleeding out, we probably wouldn’t call it telehealth app. We go to the E.R. and I think there’s a lot of parallels that we can think of in terms of mental health. If I’m an individual who is living with schizophrenia, maybe that level of acuity is not perfect or going to be completely mitigated by downloading a quick mental health app. But on the mental wellness side of things, if I am feeling a little bit stressed, I can have a lot of my needs met by downloading an app like Headspace, Calm, exploring ManTherapy.org, for example.

Joseph Conrad: And a lot of our work has uncovered this. Man Therapy was the first campaign because we were trying to combat suicide prevention. The way we did it was go upstream, because if we waited till a guy was in crisis, we were too late. So we really learned about early intervention and connecting the dots with all the other things going on in their life. But it was most crystallized when we started working with college students to also address suicide on college campuses and I think the perfect example that will illustrate what you were talking about. When we did our research, we would talk to students and we would interview them. They would say things like, I’m away from home for the first time. I haven’t met anybody here. I’m really feeling lonely. Everybody seems to have it figured out on campus. I’m not sure what I want to do. I am falling behind in the classroom because it’s harder and creating more stress in my life. So I’m not sleeping and maybe I’m self medicating. But when we talk about mental health, they would be like, oh no, I don’t have any mental health issues. And the aha for us is it’s just life coming at people, in this instance, young people who are in a new environment.

Dr. Nathaan Demers: And what makes these apps successful is bringing folks like myself, a clinical psychologist who knows mental health inside and out, bringing user experience experts, bringing someone who’s great with marketing and branding to have that whole package. And I think that’s one thing that more and more apps need to strive to do, because without that, you could have a great evidence based app. But if the user experience stinks, people aren’t going to use it and it’s just going to sit and hypothetically collect dust in the App Store.

Gabe Howard: I really like how much attention you guys put into research and the process in the beginning, middle and end, it’s clear that this is well thought out and that it’s something that holds water. And that’s all because of the research. Now, I think the average person, they hear research and they’re thinking of rats running through mazes and they’re thinking of, you know, just everything that you can think of and, you know, for a research scientist, the clean room and the beakers. And that’s really making me think like, how do you do a research study to reach the conclusion that this is evidence based when it’s an app? I mean, do you put the app in beakers? Do you make the rats run through the app? I think there’s just this general misunderstanding of how you can research such a thing. How did you research this app?

Dr. Nathaan Demers: Well, I’d love to take phones and put them on a Bunsen burner and see them melt and all, that is not what we do. So very similar to how one researches medical interventions. We do a very similar process with mental health apps. So what we can do is get, let’s say, two hundred people. On day one, we give all two hundred people a bunch of mental health assessments, see how they’re doing in terms of anxiety, depression, social connectedness. You pick your measures. We give half that group the app, we give half the group nothing. So we let the test group use that app. And then at the end of that time period, whether it be four, six, eight, sixteen weeks, we give those same assessments that we did at the beginning. And we can very quickly learn that, wow, the group of individuals who use this app showed significantly reduced stress, anxiety, better social connections, better sleep, whatever those outcomes might be. It’s called a randomized controlled trial.

Gabe Howard: We’ll be back in a minute after we hear from our sponsors.

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Gabe Howard: And we’re back discussing mental health apps. Obviously, technology is becoming more and more of a part of our lives, it’s spanning generations. I mean, even my grandmother, who’s 85 years old, is now on Facebook. So clearly apps are here to stay. And as we learned during the pandemic, telehealth is gaining in popularity. And even people like me who hated it a year ago actually thought, oh, wow, well, I was kind of wrong. This is really convenient. I love avoiding rush hour and waiting rooms and getting in quicker. What do you think the future for mental health apps are?

Joseph Conrad: Yeah, I think it’s actually a very ironic situation of what’s taking place right now, because there’s more and more research is being done and released, the technology and specifically social media, which is not an app, but it’s the use of technology and it’s how it’s really taken over how people communicate, get their information and who they associate with. And there are supercomputers out there that are constantly running algorithms to make you stay on that app that you’re on the longest because they know what you like and have liked in the past. And it’s constantly feeding you more and more of that same stuff. There’s a great documentary on Netflix right now called Social Dilemma, and it talks a lot about this. But we’ve been dealing with this for a long time. We’re also now looking can technology and apps and even new ways to use social media, can that be part of the solution? Can we use that connectivity and those apps and those social media platforms for good and to actually learn from our earlier experimentation with it? And so it’s really intriguing to be able to be in this space and try to use technology for good, including those big social media platforms.

Gabe Howard: I have kind of a point-counterpoint question, so I’m asking both of you and Joe, you can go first, but I’m interested to hear the perspective from a market researcher versus a clinical researcher. Do you think that mental health apps are working? Are they making us better?

Joseph Conrad: Generally speaking, I would say, yes, the most popular ones out there are growing through word of mouth and popularity and they have success and they can advertise, seeing Calm come on your feed and give you 15 seconds of quiet. And those little impressions add up. I always like to look at are they doing more evil in the world or more good in the world? And I think that the success and the cream rises to the top, right? The fly by night ones are not going to be around, but the really good ones are well crafted and have evidence that they are successful and the end of the day provide a rewarding, valuable experience to the user. That’s nothing but good. And I think that that in the end wins out.

Dr. Nathaan Demers: Joe, I really agree with all those points and just a few additional ones from a clinical perspective. First, we know that a lot of people very quickly point to technology as the root cause of all the mental health challenges that we’re seeing nowadays. And the research shows that the jury is really out on that point. Less than how much people are using technology, it’s more about how people are using that technology. For example, let’s say I am an international student from Sudan and I identify as gender nonconforming, the likelihood of me finding a great support network on campus is very small. But as soon as I tap into social networks, I can all of a sudden meet a lot of people who match that identity and I can actually build the social support network that can increase my resilience. So I think that’s one thing we really have to remember. And then the second thing, whether we like it or not, technology is here and it is here to stay, especially for younger generations. So if we’re not meeting young people on technology, there’s a good chance that we’re unfortunately not going to meet them. They may not go to the counseling center on a college campus, for example. And a quick analogy. I know I keep going back to medicine, but it works so well. Back in the, let’s say, 70’s, medicine realized, you know what would be a lot better than treating heart attacks over and over again? It’d be a lot more effective to treat high cholesterol. And when it comes to mental health, I think mental health apps specifically are a great scalable intervention that can be delivered to the masses to be able to reduce mild anxiety and depression and help people find work life balance and sleep better, rather than waiting till those small stressors become bigger issues that warrant significant clinical attention.

Joseph Conrad: Great point.

Gabe Howard: I agree that is a great point, and I like what you said about it’s here to stay, it’s if you look throughout history, everything new has been vilified, you know, in my generation, my parents were positive that heavy metal music was going to ruin their child. And you go back to my mom’s generation and they were positive that rock and roll was going to ruin their child. And it seems like everything new is very dangerous. And I’m, you know, I have a granddaughter who watches Disney television about rock bands. I was like, how are parents letting their kids watch that? It was so evil back when I was growing up. I think this is what we have to learn about technology. Now, that said, I’m not saying that there’s absolutely zero problem with heavy metal music or rock. I mean, I’m sure we can find something. But by and large, it was just music. I do think that’s what we’re going to find with technology. Also, we believe in many pathways to recovery. Right? So if this is working for you, it doesn’t automatically mean it’s going to work for somebody else. Is that a point that your app makes? Is there a safeguard in there? Is there something that says, hey, this app isn’t for you? Or, for example, like on PsychCentral.com, we make sure that we have the this does not treat or diagnose anything. And here’s the suicide hotline number. If you’re in crisis, please call 911. Is it smart to build something like that in?

Dr. Nathaan Demers: So going back to what Nod is, it’s an app to help bolster social connections, to combat the issue of loneliness. What’s nice is as a social species, I would argue that just about everyone could use a little extra attention on bolstering our social connections. So while we do acknowledge it’s not designed for everyone, everyone who uses it can benefit. But to get to your question, there are mental health apps that are not designed for everyone. For example, an app that is designed to help people who are coping with symptoms of OCD. That’s not an app that everyone likely needs. And OCD. I’m sorry, is obsessive compulsive disorder. So making sure that the why behind you’re using an app is very important. And most importantly, I know we’ve said this, but I want to hammer it home, making sure that any app you’re using, if it has to do with mental health, was vetted by a mental health clinician, because we have to make sure that in these apps we are using mental health best practices. We have safeguards to make sure that if a user is endorsing any level of acuity, that we are making those appropriate referrals. I think that is the single most danger, quote unquote, if you will, in these apps, is that if we don’t have those safeguards and triggers to a higher level of care when it is indicated.

Gabe Howard: And earlier, you mentioned a website where people could get unbiased information to stay safe with these apps, can you mention that again for our listeners, please?

Dr. Nathaan Demers: Yeah, I’d be happy to. It’s PsyberGuide.org. P S Y B E R Guide.org.

Gabe Howard: It sounds like that what you’re saying for the end user is to make sure that the app is meeting their needs and is allowing for some tailoring to them. For example, if the app is like, well, I don’t care that you don’t like this, you have to do it because the app didn’t consider that and we want you to keep using it. Those are the apps that become, for lack of a better word, dangerous. Is that? Is that a fair statement?

Dr. Nathaan Demers: I agree with that. I think what’s so important when it comes to mental health, just like physical health, one size does not fit all. We can’t just try and put the circle in the square hole and think it’s going to work. I can’t download a sleep app if I’m trying to work on symptoms of depression. Although they’re correlated, it doesn’t mean that app A is going to work for condition B.

Gabe Howard: And of course, just because it works for your friend doesn’t mean it’s going to work for you. The same rules of traditional therapy or traditional psychiatry obviously apply to the apps. I know we see this a lot in weight loss. You know, my friend lost 20 pounds on XYZ, so now I’m using it. But of course, you’re a diabetic and your friend isn’t. So now you’ve put yourself in harm’s way. So I think it’s very important, wouldn’t you agree, to make sure that it addresses all of your needs, not just most of them, and that you have some reason to utilize this based on success, not based on it’s popular at your school, college, in your social peer group, or because your mom gave you a one-year subscription for your birthday and all the other horror stories that we kind of hear about.

Dr. Nathaan Demers: Absolutely. Just to draw another parallel. Not every therapist fits with every client. A lot of times when you’re searching for a therapist, you need to shop around a little bit. And apps aren’t that dissimilar. A lot of therapists offer a free consultation. A lot of apps offer a free trial period. And don’t be afraid to give it a shot. And if it doesn’t work, say this one isn’t for me and keep shopping around.

Gabe Howard: I love that and you guys have been great, thank you so much for being here. Where can our listeners get more information on what you guys are doing?

Joseph Conrad: You can go to GritDigitalHealth.com, and that’ll give you an overview of our company and all of the different projects that we’re working on. Also, our sister company is Cactus. We’re an ad agency based in Denver. And you can go to CactusInc.com to see the innovations that crew’s working on.

Dr. Nathaan Demers: We’re also piloting our You Well-Being platform. So in light of COVID, we know emergency responders have been placed under enormous stress being on the front lines of COVID. So we actually trans created our well-being model for emergency responders. It’s been a huge success thus far and people can check it out at You.ResponderStrong.org, should people be interested.

Gabe Howard: Joe, Nathaan, thank you so much for being here. And to all of our listeners, wherever you downloaded this podcast, please subscribe. And I have like a really big personal favor. Please, please rate, rank and review us. Use your words and tell other people why they should listen. Share us on social media and again, tell people why they should click on that button. I would consider it a personal favor. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole, which is available on Amazon.com. Or you can grab a signed copy for less money at gabehoward.com and I will include show stickers. We’ll see everyone next week.

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