Abstract
The purpose of the present study was to review the degree to which current iPhone apps targeting symptoms of worry and anxiety incorporate content consistent with evidence-based cognitive-behavioral therapy interventions for anxiety and worry. Searches for content-relevant iPhone apps for anxiety and worry were conducted in April 2015 and subsequently coded based on evidence-based treatment components for generalized anxiety (N = 361). Most freely available iPhone apps marketed toward decreasing symptoms of anxiety or worry were largely inconsistent with evidence-based treatments. More than half of apps (n = 269) failed to contain any content from cognitive-behavioral therapies. Only 46 (13%) apps were rated as “Consistent”; 87% of apps were rated as “Not Consistent” (n = 280) or “Partially Consistent” (n = 35). Furthermore, the most popular apps for anxiety as indexed by user ratings (n = 25) failed to include any content consistent with evidence-based treatments. Overall, if a user were to select a freely available iPhone app for anxiety management, the odds of selecting an app consistent with evidence-based treatments are very low. Implications and future directions are discussed. A list of CBT-consistent apps is included.
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Abroms, L. C., Lee Westmaas, J., Bontemps-Jones, J., Ramani, R., & Mellerson, J. (2013). A content analysis of popular smartphone apps for smoking cessation. American Journal of Preventive Medicine, 45(6), 732–736. doi:10.1016/j.amepre.2013.07.008.
Anxiety and Depression Association of America (2015). Mobile apps. Retrieved from http://www.adaa.org/finding-help/mobile-apps.
Apple Inc. (2015). iTunes Power Search. Retrieved from http://phobos.apple.com/webobjects/mzsearch.woa/wa/advancedsearch.
Azar, K. M. J., Lesser, L. I., Laing, B. Y., Stephens, J., Aurora, M. S., Burke, L. E., & Palaniappan, L. P. (2013). Mobile applications for weight management: theory-based content analysis. American Journal of Preventive Medicine, 45(5), 583–589. doi:10.1016/j.amepre.2013.07.005.
Bakker, D., Kazantis, N., Rickwood, D., & Rickard, N. (2016). Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Mental Health, 3(1), e7. doi:10.2196/mental.4984.
Berry, R. R., & Lai, B. (2014). The emerging role of technology in cognitive–behavioral therapy for anxious youth: a review. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 32(1), 57–66. doi:10.1007/s10942-014-0184-5.
Bonnington, C. (2014). How to access the iTunes store’s hidden power search. WIRED. Retrieved from http://www.wired.com/2014/04/itunes-store-hidden-search/.
Breton, E. R., Fuemmeler, B. F., & Abroms, L. C. (2011). Weight loss—there is an app for that! But does it adhere to evidence-informed practices? Translational Behavioral Medicine, 1(4), 523–529. doi:10.1007/s13142-011-0076-5.
Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46(5), 423–429. doi:10.1016/0895-4356(93)90018-V.
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20(1), 37–46. doi:10.1177/001316446002000104.
Cohn, A. M., Hunter-Reel, D., Hagman, B. T., & Mitchell, J. (2011). Promoting behavior change from alcohol use through mobile technology: the future of ecological momentary assessment. Alcoholism: Clinical and Experimental Research, 35(12), 2209–2215. doi:10.1111/j.1530-0277.2011.01571.x.
Collins, K. A., Westra, H. A., Dozois, D. J. A., & Burns, D. D. (2004). Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care. Clinical Psychology Review, 24(5), 583–616. doi:10.1016/j.cpr.2004.06.001.
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of genralized anxiety disorder: a meta-analysis. Clinical Psychology Review, 34(2), 130–140. doi:10.1016/j.cpr.2014.01.002.
Davey, G. C. L., & Wells, A. (Eds.). (2006). Worry and its psychological disorders: theory, assessment and treatment. Hoboken, NJ, US: Wiley Publishing.
Deshpande, A., & Jadad, A. R. (2009). Trying to measure the quality of health information on the internet: is it time to move on? The Journal of Rheumatology, 36(1), 1–3. doi:10.3899/jrheum.081101.
eMarketer (2015). Only 33% of US mobile users will pay for apps this year—eMarketer. Retrieved September 12, 2015, from http://www.emarketer.com/article/only-33-of-US-mobile-users-will-pay-apps-this-year/1011965.
Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: an overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8(1), 23.
Hayes, A. F., & Krippendorff, K. (2007). Answering the call for a standard reliability measure for coding data. Communication Methods and Measures, 1(1), 77–89.
Hundert, A. S., Huguet, A., McGrath, P. J., Stinson, J. N., & Wheaton, M. (2014). Commercially available mobile phone headache diary apps: a systematic review. JMIR mHealth and uHealth, 2(3), e36. doi:10.2196/mhealth.3452.
Johnson, E. M., & Coles, M. E. (2013). Failure and delay in treatment-seeking across anxiety disorders. Community Mental Health Journal, 49(6), 668–674. doi:10.1007/s10597-012-9543-9.
Juarascio, A. S., Manasse, S. M., Goldstein, S. P., Forman, E. M., & Butryn, M. L. (2015). Review of smartphone applications for the treatment of eating disorders: smartphone apps for eating disorders. European Eating Disorders Review, 23(1), 1–11. doi:10.1002/erv.2327.
Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21–37. doi:10.1177/1745691610393527.
Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychological Medicine, 38, 365–374. doi:10.1017/S0033291707002012.
Kuhn, E., Eftekhari, A., Hoffman, J. E., Crowley, J. J., Ramsey, K. M., Reger, G. M., & Ruzek, J. I. (2014). Clinician perceptions of using a smartphone app with prolonged exposure therapy. Administration and Policy in Mental Health and Mental Health Services Research, 41(6), 800–807. doi:10.1007/s10488-013-0532-2.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159. doi:10.2307/2529310.
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for mental health: integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505–512. doi:10.1037/a0024485.
Mechanic, D. (2007). Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy. The Journal of Clinical Psychiatry, 68(Suppl 2), 20–26.
MedCalc 3000 (2015) Kappa measurement of inter-observer agreement MultiCalc®. Retrieved October 26, 2015, from http://www.hsls.pitt.edu/medcalc/kappa_mc.htm.
Monaghan, C., & Neumayr, T. (2015) App store rings in 2015 with new records. Press Release. Retrieved from https://www.apple.com/pr/library/2015/01/08app-store-rings-in-2015-with-new-records.html.
Mosa, A. S. M., Yoo, I., & Sheets, L. (2012). A systematic review of healthcare applications for smartphones. BMC Medical Informatics and Decision Making, 12(1), 67.
Neumayr, T., & Schopflin, J. (2005). Apple introduces iTunes 5. Retrieved October 15, 2015, from https://www.apple.com/pr/library/2005/09/07apple-introduces-itunes-5.html.
Nicholas, J., Larsen, M., Proudfoot, J., & Christensen, H. (2015). Mobile apps for bipolar disorder: a systematic review of features and content quality. 17(8), e198. doi:10.2196/jmir.4581.
Shen, N., Levitan, M.-J., Johnson, A., Bender, J. L., Hamilton-Page, M., Jadad, A. R., & Wiljer, D. (2015). Finding a depression app: a review and content analysis of the depression app marketplace. JMIR mHealth and uHealth, 3(1). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376135/.
Smith, A. (2015). U.S. smartphone use in 2015. Washington, D.C.: Pew Research Center Retrieved from http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/.
Teachman, B. A. (2013). Generalized Anxiety Disorder | Society of Clinical Psychology. Retrieved October 26, 2015, from http://www.div12.org/psychological-treatments/disorders/generalized-anxiety-disorder/.
Torous, J., Chan, S. R., Yee-Marie Tan, S., Behrens, J., Mathew, I., Conrad, E. J., et al. (2014). Patient smartphone ownership and interest in mobile apps to monitor symptoms of mental health conditions: a survey in four geographically distinct psychiatric clinics. JMIR Mental Health, 1(1), e5. doi:10.2196/mental.4004.
U.S. Food and Drug Administration, Center for Devices and Radiological Health, & Center for Biologics Evaluation and Research (2015) Mobile medical applications: guidance for industry and Food and Drug Administration staff. Silver Spring, MD. Retrieved from http://www.fda.gov/downloads/medicalDevices/.../ucm263366.pdf.
Acknowledgements
We wish to thank Devon Ruhde for her supportive assistance with the project. We would also like to thank Corey Zadik for his assistance collecting app attribute data.
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Kertz, S.J., MacLaren Kelly, J., Stevens, K.T. et al. A Review of Free iPhone Applications Designed to Target Anxiety and Worry. J. technol. behav. sci. 2, 61–70 (2017). https://doi.org/10.1007/s41347-016-0006-y
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DOI: https://doi.org/10.1007/s41347-016-0006-y