Could a Smartphone App Provide Successful Treatment for Severe Mental Illness?

Medication might still be the first line of treatment for severe mental illnesses, like depression, bipolar disorder, and schizophrenia, but the future for people managing these conditions could include a digital component. 

For a fully remote randomized controlled trial testing a digital intervention for severe mental illness—the first of its kind—researchers created a smartphone app named CORE with daily game-like exercises to help people with a serious mental illness reassess their beliefs. 

“There are many barriers to treatment for individuals with serious mental illness (e.g., cost, accessibility, availability, stigma),” says co-author Guy Doron, a professor of psychology at Reichman University in Israel and co-founder of GGtude, the company that created the CORE app. 

Doron points out that it can also be difficult to conduct research with people with mental illness, due to the high cost and issues with engaging participants and persuading them to continue with the intervention. This trial attempted to assess a potential way to overcome such barriers—by identifying and engaging with people with severe mental illness, as well as assessing the app intervention itself.   

The researchers say the results of the trial, which are published in the Journal of Medical Internet Research, are encouraging. 

A Closer Look at the Study 

The CORE app was tested on 315 people in 45 states, who were recruited through online ads on Google and Facebook in 2020.

The participants self-reported as having mental illness: 35% with bipolar disorder, 43% with major depression, and 22% with schizophrenia or schizoaffective disorder. The majority were unemployed (67%), female (86%), and white (80%). They were assessed by a clinician for severe mental illness using a variety of screening tools.

Participants were asked to use the smartphone app for three minutes a day for 30 days. On their screen, they saw statements that were either consistent or inconsistent with negative perceptions of themselves, the world, and the future. They could then choose to swipe those statements toward themselves, or get rid of them. If they swiped toward themselves, the app gives them feedback to help them deal with the unhealthy thought, and to encourage healthy ones.

After the study period, the participants reduced symptoms of depression (by an average of seven points on the Beck Depression Inventory) and anxiety (by an average of four points on the Generalized Anxiety Disorder-7 Scale). They also reduced functional impairment by an average of five points on the Sheehan Disability Scale.

Other welcome findings included increased self-esteem and positive perceptions relating to their own recovery (assessed by the Rosenberg Self-Esteem Scale and the Recovery Assessment Scale, respectively).

The changes, which did not apply to the control group, were observed in the test group after 60 days, even after they stopped using the app. 

Aside from the lack of diversity in the test group, a high dropout rate (63%) was a weakness of the study. “This reminds us that although the CORE app may be effective and useful for many patients, it is not suitable for everyone,” Doron says. 

However, he believes the CORE app is usable and acceptable for people with severe mental illness, as well as effective in reducing psychiatric symptoms and disability, and increasing recovery attitudes and self esteem. “The CORE app is low cost, easy-to-use, and can be used on any smartphone,” he adds. 

The Future of Mental Health Treatment 

“An app can’t take the place of prescription antidepressants and therapy, and should only be used as an adjunct treatment,” says Leela R. Magavi, MD, a Hopkins-trained psychiatrist and regional medical director for Mindpath Health. “Individuals with moderate to severe depression usually warrant prescription antidepressants.”

Dr. Magavi says some of her patients have noted improvement in their anxiety and depression symptoms after using apps. But she also warns that some of them have said that using apps has led to more isolating behavior and depressive symptoms. 

"Apps can limit socialization and exposure to anxiety-inducing situations, which can lead to avoidance and increased anxiety in the long term," Dr. Magavi explains. "They can also can increase screen time, which can adversely affect mood, sleep, and overall mental wellness."

While there may be a place for smartphone apps in mental health treatment, Dr. Magavi stresses that there are more pressing issues to be addressed, such as the severe shortage of child and adolescent psychiatrists and adult psychiatrists.

"Due to the pandemic, the rates of psychiatric illnesses have exponentially increased, and many individuals who have endured COVID-19 are waiting for months at a time to see a psychiatrist," Dr. Magavi says. "Many psychiatrists and therapists have full schedules and have no openings for new patients. Physicians are burned out and experiencing depression themselves."

During these difficult times, anything that promotes open, honest conversation about mental health is a positive. "Media has helped increase awareness and normalize psychiatric conditions," says Dr. Magavi. "People of all backgrounds are speaking openly about their feelings on national television. It is pivotal for children to view this and know that it is okay to express emotions openly, and that this does not equate to weakness in any way."