With more than 4,000 apps out there promising to improve our mental wellbeing, even self-help can feel overwhelming. Vogue looks at the pros and cons of smartphone therapy.
When it comes to self-care, prevailing counsel says put your phone away – but what if technology can actually help? After Alexis (25) was diagnosed with severe depression and PTSD following a traumatic loss, she turned to a source of help that she knew she could always rely on: her smartphone.
But it wasn’t WhatsApp, Facebook or Instagram that Alexis was opening; it was Shine, one of a number of “self-care” apps she’d recently downloaded. As a third-year pharmacy student at a demanding US college, Alexis was already under considerable stress and pressure. “Shine gave me motivation,” she explains. “It helped me feel understood, and focus on positive thoughts. It was lifesaving.”
Using mood trackers, trigger alerts, reminders, self-care suggestions, guided meditations and more, they aim to help users such as Alexis understand and improve their mental wellbeing. The techniques they use are not new – they are essentially very basic and established self-help methods repackaged using sunny visuals. However, the medium is. We hear a lot about the damaging effects of smartphones (and particularly social media apps), yet, given we spend an estimated average of five hours a day using them, it makes sense that some of that time be channelled into fortifying – rather than challenging – our emotional health.
But while apps such as these have many redeeming features – they are free (or certainly affordable), non-judgemental, they have no waiting lists, and they are accessible 24/7 – do they really cure? Or are they part of what Hannah Jane Parkinson refers to in the Guardian as “hashtag healthcare”, a conversation around mental health “dominated by positivity and the memeification of a battle won”?
One thing’s for sure, they’re coming at a vital time. We are told we’re living through a global “mental health epidemic”, with record levels of stress, anxiety and depression. According to the World Health Organisation(WHO), one in four people will experience a mental-health difficulty at some point in their lives and 450 million are currently suffering – making it one of the world’s leading causes of ill health and disability. Distressingly, nearly two-thirds of sufferers never receive any help. “Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders,” says the WHO. Not to mention the all-too-common barriers of time, money and physical access.
These days we might understand mental health better than ever before, but people aren’t receiving the support they (often badly) need. Psychological support services are facing funding cuts and a marked increase in demand worldwide. In the UK, the British Medical Association warned that thousands of patients are waiting more than a year for access to counselling or therapy on the painfully underfunded NHS. A year is a long time, especially if you’re feeling depressed, anxious or worse (one in six people on waiting lists for mental-health services are expected to attempt suicide).
“The systems designed to deliver effective emotional health and wellness resources are broken,” say Happify founders Ofer Leidner and Tomer Ben-Kiki, and they believe that apps can help. In 2013, they took their knowledge from backgrounds in immersive gaming – a field often criticised for its negative impact on health – and combined it with help from leading experts in positive psychology, CBT and mindfulness, to take the kind of support traditionally only offered in therapists’ offices and put it in people’s pockets, allowing them “to access care on their own schedule, in ways that match their personal needs.” With accessibility and being “fun to use” its core priorities, Happify now has more than 3.3 million users worldwide, and is available (in a linguistically and culturally adapted form) in seven languages: English, Spanish, French, Portuguese, German, Chinese and Japanese.
Chen Li, a 27-year-old entrepreneur from Beijing, used Happify last year. “I was struggling with work pressures but didn’t want to tell my family. I took the quiz (Happify asks a number of questions to gauge your emotional health) and it said it seemed like I was having a bad time.” Chen says it was a “relief” to feel “seen and understood”. Happify’s approach in these circumstances is (appropriately) to recommend professional help. After all, it takes between 8 and 12 years to train as a licensed clinical psychologist – longer than any app has been on the market. Li took the advice.
The International Self-Care Foundation (ISF), an independent, non-profit organisation with outposts in the UK and China, defines “self-care” as “the actions that individuals take for themselves, on behalf of and with others, in order to develop, protect, maintain and improve their health, wellbeing or wellness.” Now, while “self-care” is not (yet) a specific app-store category, Apple placed “health and wellbeing” as one of its four biggest breakout trends for 2017. “Never before have we seen such a surge in apps focused specifically on mental health, mindfulness and stress reduction,” the company said. There are close to 4,000 apps dedicated to self-care, and according to app-store intelligence firm Sensor Tower, in the first quarter of 2018 the top 10 highest-grossing self-care apps earned $27 million worldwide.
The market continues to grow, thanks in part to the technology on which it relies. Earlier this year, Simon Stevens, chief executive of NHS England, said that the UK’s free public health service was “picking up the pieces” of an epidemic of mental illness among children, fuelled principally by social media. “In our society we are almost constantly stimulated [by technology],” says specialist consultant psychotherapist Sara Rourke. “[It’s] a source of stress.” The relationship between our lives and our screens becomes increasingly more blurred by the day, and a strong connection is emerging between obsessive use of the internet/social media and the urgent need for self-care.
Nowhere is this more apparent than among millennials and Gen Z, who, it appears, make up the highest number of users and founders of self-care apps. Frequently referred to as both the most tech-savvy and the most anxious generations in history, they’ve come of age with mobile phones, so it’s little surprise they’re now turning to them for help. And while self-care apps may not be an adequate replacement for traditional mental healthcare (especially when it comes to serious conditions – suicide is currently the second-leading cause of death among 15-29-year-olds), perhaps any help the apps offer is better than none at all.
This was the case for Eliana (22, who prefers to be referred to as they/them) from Chicago, who began using Self Checkout in January to help with their depression and anxiety. “The whole process of identifying my mood triggers was so powerful. It helped me take control of my life, create a more positive reality for myself, and build a groundwork to work on in therapy,” they say. Mel Wells, wellbeing coach and author of The Goddess Revolution and Hungry For More, agrees: “Let’s not be in denial – we are already addicted to our technology. Incorporating these apps can remind us how important it is to take care of our health – much more so than checking Instagram or tracking our steps.”
The two most recent apps to join the market – Aloe Bud and Happy Not Perfect – launched in May. The latter, founded by British entrepreneur Poppy Jamie, came out of her own experiences with anxiety and stress. “[It] left me aware of the horrific impact stress was having on my physical and mental health, and I noticed that everyone around me was feeling the same,” she explains. Both apps employ millennial-friendly visuals that invite users to engage and check in every day. “I want to empower people to look after their minds like they do their bodies – like a gym for mental wellbeing: it requires regular practice,” Jamie says. The “treat your mind like your body” is a tempting comparison, yet they are completely different (as the title of Parkinson’s Guardian feature states: a mental-health condition is “nothing like a broken leg”). The path to wellbeing is much more complicated than that of swimming or jogging a few times a week to get fit.
But can these apps cause harm? “Our phones add to the noise of life, and the incessant din of almost constant notifications can be a source of anxiety and stress,” says Rourke. “Plus, it promotes a reliance on technology.” ISF’s president David Webber agrees: “It’s possible to overuse technology. Measuring your blood pressure a few times a year to check it’s normal is [good practice]. Measuring your blood pressure every day is unnecessary, and bad self-care.” As with everything, excess isn’t healthy. Furthermore, these apps shouldn’t become another area in life in which to feel judged.
“With Shine, I used to feel pressured to complete the motivating/reflection task of the day,” says Alexis. “Sometimes I felt like I wasn’t doing enough for my mental health, or that I was too mentally weak.” It’s crucial to recognise that not only is it sometimes OK to fail at self-care, but also that your needs might exceed what an app can offer. Research published by Evidence Based Mental Health, co-owned by the British Medical Journal Group, concluded that mental-health apps “lack an underlying evidence base, scientific credibility and have limited clinical effectiveness.” The study also highlighted the dangers of over-reliance on apps, equity in access and “increased anxiety resulting from self-diagnosis”. Of the 70 or more health apps on the NHS library, only four were found to be clinically effective, and two of those – Moodscape and Big White Wall, both currently only available in the UK, were in the “self-care” category. Crucially, too, if an app doesn’t work, that might compound feelings of anxiety or helplessness.
No doubt self-care apps can be helpful in the short term, as well as acting as a triage for more mild conditions, but many countries worldwide have free healthcare and offer – if not immediate therapy – telephone support and access to community groups. (There are also charities that provide help – the Samaritans, Mind, Childline, Nami, Sane, and the Centre for Japanese Mental Health, to name a few.)“I believe apps can be used wisely, for tracking medication and moods for example,” concludes Rourke. “But I would encourage an exploration of other ways of connecting to the self. Also, self-care is just one aspect of good mental health – there should also be a focus on reaching out to support networks such as friends and family.” In other words, instead of trying to fix the problem with the problem, try putting the smartphone down altogether. Wells agrees: “Hopefully, these apps ultimately remind us to actually get off our phones and really take care of our mental health.”