A Northwestern Medicine study of a novel suite of 13 speedy mini-apps called IntelliCare found that participants reported significantly less depression and anxiety after using the apps on their smartphones up to four times a day.
The apps offer exercises to de-stress, reduce self-criticism and worrying, methods to help your life feel more meaningful, mantras to highlight your strengths, strategies for a good night's sleep and more.
Most apps designed for mental health typically offer a single strategy to feel better or provide too many features that make them difficult to navigate. Users may get bored or overwhelmed and may stop using the apps after a few weeks.
But participants robustly used the IntelliCare interactive apps as many as four times daily – or an average of 195 times – for eight weeks of the study. They spent an average of one minute using each app, with longer times for apps with relaxation videos.
The 96 participants who completed the research study reported that they experienced about a 50% decrease in the severity of depressive and anxiety symptoms. The short-term study-related reductions are comparable to results expected in clinical practice using psychotherapy or with that seen using antidepressant medication.
"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," said lead study author David Mohr, professor of preventive medicine and director of the Centre for Behavioural Intervention Technologies at Northwestern University Feinberg School of Medicine.
"Some of the participants kept using them after the study because they felt that the apps helped them feel better," Mohr said. "There were many apps to try during the study, so there was a sense of novelty."
Participants had access to the 13 IntelliCare apps from Google Play and received eight weeks of coaching for the use of IntelliCare. Coaching included an initial phone call plus two or more text messages per week over the eight weeks. In the study, 105 participants were enrolled and 96 of them completed the study.
The preliminary study did not include a control arm, so it's possible that some people who enrolled in the trial would have improved anyway, partly because they may have been motivated to try something new, Mohr said. He now has launched a larger trial, recruiting 300 participants, with a control arm.
Some of the IntelliCare apps include:
Daily Feats: designed to motivate you to add worthwhile and rewarding activities into your day to increase your overall satisfaction in life.
Purple Chill: designed to help you unwind with audio recordings that guide you through exercises to de-stress and worry less.
Slumber Time: designed to ease you into a good night's rest.
My Mantra: designed to help you create motivating mantras to highlight your strengths and values.
"Using digital tools for mental health is emerging as an important part of our future," Mohr said. "These are designed to help the millions of people who want support but can't get to a therapist's office."
More than 20% of Americans have significant symptoms of depression or anxiety each year, but only around 20% of people with a mental health problem get adequate treatment.
The IntelliCare algorithm recommends new apps each week to keep the experience fresh, provide new opportunities for learning skills and avoid user boredom. Although the apps are not validated, each one was designed by Northwestern clinicians and based on validated techniques used by therapists.
IntelliCare is a national research study. Individuals can download the apps free with no financial obligation. But Northwestern researchers hope participants will provide confidential feedback, via four weekly questions, that will be used to further develop the system. The data will help the system make even better recommendations and provide more personalised treatment.
People also may enroll in a study in which they will be paid to provide even more feedback. Some also will have access to an IntelliCare coach via text messaging and phone calls, who are available to support them in using the apps.
"We now have evidence these approaches will likely work," Mohr said. "They are designed to teach many of the same skills therapists teach patients. Different apps are expected to work for different people. The goal is to find what's right for you."
Abstract
Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions.
Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety.
Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement.
Results: Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps.
Conclusions: 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. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model.
Authors
David C Mohr, Kathryn Noth Tomasino, Emily G Lattie, Hannah L Palac, Mary J Kwasny, Kenneth Weingardt, Chris J Karr, Susan M Kaiser, Rebecca C Rossom, Leland R Bardsley, Lauren Caccamo, Colleen Stiles-Shields, Stephen M Schueller
[link url="https://www.sciencedaily.com/releases/2017/01/170105123102.htm"]Northwestern University material[/link]
[link url="http://www.jmir.org/2017/1/e10/"]Journal of Medical Internet Research abstract[/link]