Psychiatric interventions have gained an enormous amount of attention from the digital health space this year.In fact, numerous startups and health apps have recently made headlines.
Machine-driven psychotherapy interventions by PsyInnovations’ wayForward has announced it was joining the Startup Health portfolio. Talkspace, psychotherapy by video and text, has gained $13M in funding. Online social anxiety psychotherapy platform Joyable was featured in The Atlantic — and will introduce native apps in the future. And consumer-created apps like Pacifica has landed #1 on BuzzFeed’s list of health apps for anxiety, providing assessments and exercises for anxiety and stress sufferers.
But from a research perspective, do apps that treat anxiety work? The answer: it depends.
Take telemedicine, for instance. An enormous body of literature supports psychotherapy by video for numerous disorders, but most studies have been performed to look at PTSD and depression, not anxiety. Apps that provide ecological momentary interventions (EMI’s) go into greater depth — and take advantage of smartphone functionality — by intervening while persons go about their daily routines in their lives.
A recent quantitative meta-analysis on EMI’s for anxiety in the Journal of the American Medical Informatics Association, “Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: a systematic review,” scoured 1,949 abstracts. The authors found only 15 randomized controlled trials that provided EMI’s for anxiety and related disorders.
EMI’s can include relaxation training, self-monitoring, computerized cognitive behavioral therapy (CBT), and Acceptance & Commitment Therapy (ACT). Some were driven by therapists; some were completely automated with little human support.
They found that, overall, EMI interventions reduced anxiety symptoms in those with generalized anxiety disorder. Studies observing reduction of stress found positive effects as well. However, there were mixed to no results on the studies for panic disorders and social phobia, but the authors note that there were very few studies researching these conditions.
“Currently, there is no convincing evidence that EMIs are effective for other anxiety disorders,” Loo Gee et al. write, but they note that “no new studies targeting social phobia or panic disorder” were found since the last review performed in 2010.
Though there is potential for EMI-driven health apps for anxiety and stress, “it is difficult to draw reliable conclusions on the effects of EMIs reducing anxiety symptoms and stress.” Though the effect size appears lower, it may be because the studies tended to be shorter and less intensive than Internet-delivered CBT, which has shown positive results for anxiety with “comparable effects to treatments delivered by a therapist.”
But does this mean that digital health and mHealth interventions have no place in mental health treatment? Due to the high prevalence of anxiety disorders, there is an overwhelming need for help and support. More research, more funding, and more cost-effective innovative experimentation in models of care — such as those provided by Pacifica, Joyable, and Talkspace — are needed.
Our hope is that as these companies gain traction, they invest in thoughtful studies testing their platforms to prove they are effective and figure out how they can be improved. In an increasingly crowded field, doctors and patients can, and should, demand data showing us that our investments in these platforms can pay off.
