Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. OBJECTIVE: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. METHODS: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. RESULTS: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. CONCLUSIONS: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems

Systematic assessment of the quality and integrity of popular mental health smartphone apps using the American Psychiatric Association's app evaluation model

Mobile phones are playing an increasingly important role in supporting mental health, by providing confidential, accessible and scalable support for individuals who may not seek or have means of accessing professional help. There are concerns, however, that many apps claiming to support mental health do not meet professional, ethical or evidence-based standards. App store search algorithms favour popularity (reviews and downloads) and commercial factors (in-app purchases), with what appears to be low prioritisation of safety or effectiveness features. In this paper, the most visible 100 apps for “depression”, “anxiety” and/or “mood” on the Google Play and Apple App stores were selected for assessment using the American Psychiatric Association App Evaluation model. This model systematically assesses apps across five broad steps: accessibility, integrity, clinical and research evidence base, user engagement and interoperability. Assessment is hierarchical, with the most fundamental requirements of apps assessed first, with apps excluded at each step if they do not meet the criteria. The relationship between app quality and app store visibility was first analysed. App quality was also compared across four different app function types: mental health promotion or psychoeducation; monitoring or tracking; assessment or prevention; and intervention or treatment. Of the 92 apps assessed (after eight failed to meet inclusion criteria), half failed to meet the first criterion step of accessibility, and a further 20% of the remaining apps failed to meet the second criterion step of security and privacy. Only three of the 10 apps most visible on app stores met the criteria for research/clinical base and engagement/ease of use, and only one app fulfilled all five criterion steps of the evaluation model. Quality did not differ significantly across app function type. There was no significant correlation between app quality and app store visibility, which presents a potential risk to vulnerable consumers. The findings of this review highlight the need for greater accountability of app developers to meet, and report, at least minimum quality and integrity standards for their apps. Recommendations are also provided to assist users and clinicians to make informed choices in their selection of reputable and effective mental health apps

The role of physiological and subjective measures of emotion regulation in predicting adolescent wellbeing

Emotion regulation (ER) is a key contributor to psychosocial adjustment in adolescence, while ER deficits contribute to psychological distress and dysfunction. To date, research with adolescents has examined a limited subset of ER processes, often in relation to mental ill-health. This study examined associations between multiple ER measures and wellbeing in a normative sample of 119 adolescents (Mage = 15.73). ER was measured using self-report and physiological (RSA) indices. Multiple measures of positive and negative functioning were examined. After controlling for covariates, hierarchical regression analyses revealed that self-reported ER predicted resilience, perseverance, connectedness, and happiness; and fewer depression and anxiety symptoms. Higher tonic RSA predicted resilience and perseverance. Effect sizes were small to moderate. Theoretical and practical implications are discussed

Meaning Making Process and Recovery Journeys Explored Through Songwriting in Early Neurorehabilitation: Exploring the Perspectives of Participants of Their Self-Composed Songs Through the Interpretative Phenomenological Analysis

Objectives: This pilot study examined how 15 participants in early rehabilitation described their self-composed Songs 6- to 12-months following participation in a 6-week identity-focused songwriting program. Specific focus was given to the process of meaning making and identity reconstruction in the participants’ self-composed songs.Methods: Data were collected through individual semi-structured interviews (n = 15) and analyzed using interpretative phenomenological analysis. Findings were developed idiographically as super-ordinate themes unique to each participant, then analyzed across cases to identify recurrent themes and subthemes.Results: Participants described the songwriting process as taking them through one of four distinct recovery journeys described by individuals following acquired neurodisability who underwent a focused therapeutic songwriting program. These included (1) re-conceptualizing values and shifting perspectives about self (my body is broken but my mind has been set free); (2) recognizing acquired inner resources to negotiate discrepancies in self (hope is there); (3) confirming existing values and identifying resources and coping strategies (I have what I need to move forward); (4) confirming previously held values and ongoing process of negotiating discrepancies in self (I don’t yet have the answers).Conclusion: The current study provides insight into the nature and process of meaning making and recovery journeys perceived by individuals with neurodisability. Our findings suggest that songwriting could be a therapeutic tool to facilitate identity reconstruction in neurorehabilitation

A Comparison of the Effects of Short-term Singing, Exercise, and Discussion Group Activities on the Emotional State and Social Connectedness of Older Australians

Choir membership has been shown to improve emotional states and facilitate social connectedness. It is, however, less clear whether these benefits are unique to group singing or are shared by other social group activities that include some of the characteristics of choirs other than singing, such as music listening and social interaction. This research compares older Australians who are members of either a choir that both produces and listens to music in a social context, an exercise group that incorporates music listening and movement with social interaction, or a current events discussion group with social interaction but no music content. Participants were administered emotional state and cohesion questionnaires at two test times, just prior to and immediately after the session, to determine the short-term (60–90 minutes) effects on emotional state and social cohesion as result of different social activities containing varying levels of music engagement. A two-way Analysis of Variance (ANOVA) revealed significant improvements in positive affect and cohesion scores, and a decrease in negative affect and tiredness scores, over time for all groups. The choir and exercise groups were also observed by two raters who recorded observable behaviors categorized using the circumplex model of emotion. Findings revealed that both groups demonstrated significant increases in Activated Pleasant (high positive affect, high arousal) behaviors over time, but with no differences between the two groups. Taken together, these studies suggest that well-being benefits are shared by self-selected leisure social group activities, and that the effects can be observed within a very short time frame using both self-report and behavioral measures. The authors suggest that future research incorporates suitable control groups into research designs to better articulate any unique benefits that group singing may confer

Facilitatory effects of music on memory: A review of the potential role of emotional arousal

Research reveals background music played during learning can variously enhance or impair memory, although the conditions which determine its effect are not yet understood. Possible explanations for the differing effects of music on memory include characteristics of the music itself, such as tempo and lyrics, induced mood of the listener and personality differences. In this chapter, consideration of the type of music used to manipulate learning and memory will be reviewed, indicating that arousal may play an important moderating role, either as a means of reducing anxiety or increasing arousal to an optimum performance levels. As music is often reported to increase arousal via emotion induction or enjoyment, a well established theory of arousal-modulated memory will be argued to underly the facilitatory effects of music on memory. The methodology used within this research paradigm will be described, and adaptations will be proposed that make it amenable to investigating the effect of music induced arousal on memory. This approach provides a novel method for combining the knowledge gained from music and memory research with arousal and memory literature to further investigate the potential memory enhancing role of music

Emotional Responses to Music: Shifts in Frontal Brain Asymmetry Mark Periods of Musical Change

Recent studies have demonstrated increased activity in brain regions associated with emotion and reward when listening to pleasurable music. Unexpected change in musical features intensity and tempo – and thereby enhanced tension and anticipation – is proposed to be one of the primary mechanisms by which music induces a strong emotional response in listeners. Whether such musical features coincide with central measures of emotional response has not, however, been extensively examined. In this study, subjective and physiological measures of experienced emotion were obtained continuously from 18 participants (12 females, 6 males; 18–38 years) who listened to four stimuli—pleasant music, unpleasant music (dissonant manipulations of their own music), neutral music, and no music, in a counter-balanced order. Each stimulus was presented twice: electroencephalograph (EEG) data were collected during the first, while participants continuously subjectively rated the stimuli during the second presentation. Frontal asymmetry (FA) indices from frontal and temporal sites were calculated, and peak periods of bias toward the left (indicating a shift toward positive affect) were identified across the sample. The music pieces were also examined to define the temporal onset of key musical features. Subjective reports of emotional experience averaged across the condition confirmed participants rated their music selection as very positive, the scrambled music as negative, and the neutral music and silence as neither positive nor negative. Significant effects in FA were observed in the frontal electrode pair FC3–FC4, and the greatest increase in left bias from baseline was observed in response to pleasurable music. These results are consistent with findings from previous research. Peak FA responses at this site were also found to co-occur with key musical events relating to change, for instance, the introduction of a new motif, or an instrument change, or a change in low level acoustic factors such as pitch, dynamics or texture. These findings provide empirical support for the proposal that change in basic musical features is a fundamental trigger of emotional responses in listeners

Emotion Regulation Strategy Mediates Both Positive and Negative Relationships Between Music Uses and Well-being

The mediating effects of emotion regulation (reappraisal and suppression) were examined in the relationship between music engagement and well-being. Emotion regulation strategies (Emotion Regulation Questionnaire; Gross & John, 2003) and styles of music engagement (Music Use questionnaire; Chin & Rickard, 2012) were assessed in a large diverse sample of 637 participants. A battery of hedonic and eudaimonic well-being measures (International Positive and Negative Affect Schedule Short Form; Thompson, 2007; Satisfaction With Life Scale; Diener, Emmons, Larsen, & Griffin, 1985; Mental Health Continuum-Short Form; Keyes et al., 2008) was also administered. Results demonstrated that the path of mediation was dependent on the type of emotion regulation strategy utilized, as well as the way in which one engages with music. Findings provide initial evidence that engaging with music for the purposes of cognitive and emotion regulation may enhance well-being primarily through the habitual use of cognitive reappraisal. In contrast, various other aspects of music engagement (music listening, engaged production, and social connection) if coupled with a tendency to regulate emotions and thoughts by expressive suppression may yield undesirable well-being outcomes. This study highlights the important role emotion regulation plays in the complex relationship between music engagement and well-being. (PsycINFO Database Record (c) 2016 APA, all rights reserved