Smartphone apps help reduce anxiety, depression symptoms

20170112100000, Jairia Dela Cruz
IntelliCare Hub
Screenshot of the IntelliCare Hub. Credit: Northwestern University

A suite of interactive smartphone applications designed to help manage or treat anxiety and depression shows potential for improving symptoms in patients who use the apps for up to four times daily.

Named IntelliCare, the suite consists of 13 apps that provide exercises or activities to reduce stress, self-criticism and worrying; strategies geared towards engaging in positive behaviours or thought restructuring; and mantras highlighting personal strengths to motivate an individual to feel and do better.

It also includes “Hub”—the 14th app that helps manage the other apps from the rest of the IntelliCare collection. Hub consolidates notifications, provides recommendations for new apps the user will most likely find useful, and allows designation of one or two apps as the primary treatment focus for a given week.

Unlike digital mental health tools that use psychoeducational strategies often involving a text/video or a simple recording of symptoms or mood, IntelliCare emphasizes the application of skills through in-app actions (ie, goal setting, checklists, reminders and logging) to promote engagement in the treatment strategy.

“Essentially, IntelliCare operates from the assumption that doing is learning. Understanding will come from doing, and it is not necessary that everyone have the same understanding for the exercise to be useful,” said Dr David D. Mohr, director of the Center for Behavioral Intervention Technologies and professor of preventive medicine at the Northwestern University Feinberg School of Medicine.

“We designed these apps so they fit easily into people’s lives and could be used as simply as apps to find a restaurant or directions,” Mohr added.

The apps require few instructions, containing brief “tips” on the home screen to guide users through their first interaction with a new tool.

The intuitive feature is said to give each app a mean session length of 1 minute, median session rates of 17 seconds, and mean weekly use frequencies of 21 to 29, with no drop-off over time.

Symptoms reduced

In a pilot study evaluating the suite’s use and efficacy, the 96 participants who completed 8 weeks of IntelliCare use showed substantial improvements in depression and anxiety symptoms, as measured by the Patient Health Questionnaire-9 (PHQ-9) for and the Generalized Anxiety Disorder-7 (GAD-7), respectively. [J Med Internet Res 2017;19:e10]

There were significant reductions in both the PHQ-9 and the GAD-7 in the group of participants meeting entry criteria for depression, as well as in the group of those meeting entry criteria for anxiety (p≤0.001 for all).

At week 8, the criteria for full remission or no symptoms of depression (PHQ-9 <5), for recovery or mild symptoms (PHQ-9 5 to 9) and for treatment referral (PHQ-9 ≥10) were met by 35, 38 and 21 participants, respectively. The corresponding number of participants who met the criteria for GAD-7 <5, GAD-7 5 to 9 and GAD-7 ≥10 were 39, 42 and 13.

App use was recorded at 195.4 times over 8 weeks on average, with the length of use being 1.1 minutes and 95 percent of participants downloading 5 or more of the 13 IntelliCare apps.

A total of 105 participants (median age 36 years; 76.2 percent female; 21.9 were on psychotherapy) were recruited for the study, but only 99 initiated treatment. The 96 participants who completed the study received 8 weeks of coaching via text messaging and phone calls with the goal of helping them use the app suite.

“This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety,” said Mohr who was the principal study investigator.

He pointed out that the IntelliCare system was both elemental and eclectic, as it allowed individual apps to be used or not used based on their effectiveness and utility. The treatment strategies could be viewed as elements that could be applied as needed rather than adhering to a singular, overarching, theoretical model.

Highly disseminable, cost-effective treatment

“Each year, around 20 percent of the population will have a diagnosable mood or anxiety disorder. The vast majority never receive treatment, and in fact, there is no way our healthcare system will ever have enough mental health specialists to treat everyone with our current forms of treatment,” Mohr told MIMS.

“IntelliCare, when supported by a small amount of coaching (<1 hour for the entire treatment), can produce substantial improvements in depressive and anxiety symptoms.  This is a treatment that is highly disseminable and cost effective,” he added.

Among the IntelliCare apps included in the suite are Daily Feats (designed to motivate users to add worthwhile and rewarding activities into their day to increase their overall satisfaction in life), Social Force (designed to improve mood by helping users increase positive contact with people who matter most to them), and Purple Chill (designed to help users unwind with audio recordings that guide them through exercises to de-stress and worry less).

The suite is available online and can be downloaded for free. However, users are encouraged to provide confidential feedback through four weekly questions that will be used to further develop the system.

Mohr said the data would help the system make even better recommendations and provide a more personalized treatment.

Meanwhile, he and his team have launched a larger trial including 300 participants with a control arm.