Kristen Mulcahy, PhD, psychologist and director, Cape & Islands Cognitive Behavioral Institute, Falmouth, Massachusetts.
Got anxiety? Depression? Obsessive-compulsive disorder? There’s an app for that…and that…and that.
Of course, it’s not that simple. These complex emotional disorders can be very challenging to treat well, and there is no substitute for a good relationship with a talented, experienced therapist.
But apps have a place. Many people have trouble sticking with therapy for a variety of reasons—time, money, transportation and, frankly, motivation. Other people who are in therapy find it really useful to have easy ways to practice what they’ve learned between sessions. And some people who aren’t in therapy still want a convenient, practical way to help manage bad moods, unwelcome thoughts and troublesome behavior patterns.
One category of psychological app is becoming increasingly popular with the public and even with many therapists. These are based on cognitive behavioral therapy (CBT), a kind of therapy that focuses on how our thoughts make us feel, how our feelings affect our thoughts and how both affect our behaviors. CBT helps people understand and identify destructive thinking, evaluate how realistic their thoughts are, learn to restructure negative thought patterns, modify beliefs and change behaviors. Traditional CBT, in person with a therapist, has proven to be effective for depression, anxiety, insomnia, phobias, panic attacks, obsessive-compulsive disorder and many other conditions.
But the CBT approach also lends itself to working well in an app on your smartphone or tablet, either as an activity between therapy sessions or as a stand-alone practice. CBT is based on breaking down therapy into specific practical tasks so that you build skills and learn how to react better to scenarios that may cause you distress. These are the kinds of interactions that can be programmed into an app. Small studies have found that apps can “deliver” CBT effectively, helping people learn skills and reduce symptoms. No wonder CBT-based apps have proliferated on both iTunes (for Apple devices) and Google Play (for Android-based devices).
To discover CBT apps worth exploring, we spoke with psychologist Kristen Mulcahy, PhD, clinical director of the Cape & Islands Cognitive Behavioral Institute in Falmouth, Massachusetts. She’s also an app developer herself. For now, Dr. Mulcahy believes that CBT apps can be helpful for people with mild symptoms of anxiety or depression who are motivated to give them a try. If you’re already in therapy and you’re interested in one of these apps, bring it up in your next session and discuss how it might be incorporated into your program.
Here are cognitive behavioral therapy apps for five different purposes…
Thought Diary Pro allows users to write down their worrisome thoughts, along with the time, significance and consequences of those particular thoughts. The app helps you recognize “cognitive distortions” (thinking errors) and prompts you to change each one to more a more accurate—and productive—thought. An optional feature allows users who are in therapy to send their thought diaries via e-mail to their therapists. The app can also be used by people who are practicing CBT on their own. $4.99. Available on iTunes.
Cognitive Diary CBT Self Help, an app for Android devices, works similarly, allowing users to write down their troublesome thoughts, challenge them and review progress. Free. Available on Google Play.
Moodkit was designed by CBT experts. The activity tool suggests techniques to reduce negative thoughts. The thought checker helps identify situations or thoughts that cause distress, modify such thinking and evaluate the effect of those thoughts. A tracker helps you keep a record of your moods so you can monitor your progress, and a built-in journal lets you save your notes. $4.99. Available on iTunes. It can be used on its own or as an adjunct to professional treatment.
Depression CBT Self-Help Guide includes a screening test to monitor moods, a cognitive thought diary to learn how to challenge stressful thinking, articles on CBT and a tracking feature. Free. Available on Google Play.
CBT works well for insomnia. The CBT-i Coach, developed by experts from Stanford University and the Veterans Administration, helps you develop sleep routines and improve your sleep environment by creating a sleep prescription, maintaining a sleep diary and setting reminders. Such a structured program has been shown to improve sleep and alleviate insomnia. Although the app can be used on its own, it was designed to be used in addition to professional counseling and should not be used to replace therapy for those who need it. Free. Available on iTunes and Google Play.
Mayo Clinic Anxiety Coach, designed by Mayo Clinic anxiety experts, can be used for people with specific phobias, general anxiety, social anxiety, panic disorder or obsessive-compulsive disorder. Users identify their fears and then create a list of tasks that, although anxiety-provoking, will help them overcome their fears. If you’re fearful of meeting new people, for example, the app will suggest activities such as chatting with a store employee that you can add to your To Do list. Before tackling the activity, you’ll rate your anxiety level, then role play the activity on the app—and re-rate your anxiety level. Then you’ll try it in the real world, reporting your anxiety level after each try. Users can track their progress in the checkup section and learn more about anxiety, phobias and CBT. While the app can be used on its own, the developers caution that it does not replace professional therapy. $4.99. Available on iTunes.
Dr. Mulcahy readily admits that she is biased in favor of an app for OCD called Live OCD Free…because she developed it and has a financial interest in it. The app is based on the “exposure and response prevention” treatment method for OCD, an anxiety disorder characterized by obsessive thoughts and compulsive behaviors. “Exposure and response prevention is well-suited for an app because it is a very structured program,” Dr. Mulcahy says. It works to reduce obsessive-compulsive symptoms by helping users to gradually expose themselves to anxiety-provoking situations while resisting any compulsive behavior. For example, users create a hierarchy of anxiety-provoking “exposures,” such as touching a doorknob or purposefully making things messy/uneven. It also helps users practice resisting the urge to engage in compulsive behaviors such as hand washing. With practice, it becomes easier to resist the compulsion and anxiety diminishes. Both the OCD Institute at McLean Hospital and Butler Hospital/Brown University are studying the app in clinical trials. There is a children’s version as well. $79.99. Available on iTunes. The app can be used on its own or with a therapist.
Regardless of which smartphone app you try, if you don’t get the results you need and you aren’t seeing a therapist, start seeing one. Here are some of the reputable organizations that may help you find a qualified therapist trained in CBT…
If insomnia is your primary issue, you can find a sleep professional on the website of the National Sleep Foundation. You may want to ask whether he/she is trained in CBT for insomnia.
If you try one of these apps, let us know your experience!