Forget the therapist’s couch – now you can easily and (almost) instantaneously access mental health treatment via a therapy app from your own sofa.
Finding new ways of offering professional support is more crucial than ever. It may come as no surprise that rates of generalised anxiety disorder have markedly increased during the coronavirus pandemic, according to research conducted by Ieso Digital Health. A record number of adults needed emergency referrals for a mental health crisis from April to December 2020 and, in the same period, the number of children and adolescents referred for mental health treatment was up 28 per cent year on year. Therapy apps aren’t designed to be used in a crisis, but they could improve access to early-intervention support.
“Every day, waiting lists for overburdened public health services are increasing; for people looking for support privately, waiting times, lack of knowledge on how to find the right therapist plus costs means it can be inaccessible,” says Dr Sophie Mort, clinical psychologist and author of the upcoming book A Manual For Being Human. “[Apps] rarely have long waiting lists, and usually have a therapist (or someone else qualified to speak to you) available that day. All you need is a phone and internet connection.”
The pandemic has meant “the adoption of digital [treatment] has accelerated dramatically,” Charles Wells, CEO and Founder of HelloSelf, the fastest growing digital psychology platform in the UK, tells me. TalkSpace, a US-based therapy app, reported a 65 per cent rise in clients since the beginning of the pandemic.
Do therapy apps work?
There is no evidence to suggest that therapy is any less effective online than face to face. Teletherapy as a concept has been around for many years; only the app-based format is new. A critical review in the World Journal of Psychiatry in 2015 looked at over 200 controlled trials of online therapy services and found equivalent clinical outcomes between many of the online and face-to-face clients. People receiving therapy online actually reported higher patient satisfaction.
“Many people will indeed find online support, like a video call over a smartphone app with a human therapist, as satisfying and effective as face to face therapy,” says Mort. App-based treatment is more convenient and allows people to seek out therapists with specific expertise or cultural or religious background, even if they don’t live nearby.
The UK-based therapy platform HelloSelf offers an impressive roster of clinical psychologists and CBT therapists available over video call. Users can expect an initial consultation within 24 hours and then to start treatment within seven days. Wells, HelloSelf’s founder, is understandably proud of the additional features the platform offers to engage clients, from the option to record sessions and return to a “highlight reel” of advice from a therapist to an interactive space called SelfLine, which allows users to note what they have learnt and be reminded of it throughout the week. “Some of the benefits of face to face treatment you can replace with digital innovation,” he says.
Online therapy is widely thought of as cheaper than conventional treatment, and in some cases it is, but in the UK quality therapy via an app doesn’t come cheap. HelloSelf’s sessions start at £100, a cost comparable to seeking treatment in person. Mort recommends the app Dr Julian, which offers free assessments and quick access to therapy with accredited counsellors and psychologists, all of whom have a minimum of two years’ clinical experience and have been personally interviewed – but prices start from £60.
There is an important distinction between therapy apps which connect you via video, voice call or text to a trained professional and self-help or mental wellbeing apps. The latter are usually based on the principles of mindfulness, journalling and CBT techniques but are self-guided and don’t offer personal support from a human therapist.
Most self-help-based mental health apps are much cheaper than standard treatment, or even free. The NHS now offers a library of approved mental health apps, including WorryTree, a journalling self-help app, and eQuoo, a game designed by psychologists to increase “emotional fitness”.
Wysa gives users access to an “artificial intelligence (AI) friend,” in the form of Wysa the penguin, who is available 24/7 for anonymous text chats, and offers thoughtful responses designed to help users challenge negative thought patterns. It also offers other self-help resources tackling everything from low self-esteem and sleep to grief and anxiety, some of which are also free. There is the option to speak to a human therapist for £29.99 a session paid weekly, or £12.08 paid quarterly. The app has a remarkable 2.5 million users; it has also been tested in a clinical environment by the North East London NHS Foundation Trust to help children’s mental health.
Other self-help options are entirely AI-based, such as Woebot, a free chatbot app based on CBT techniques. Even though spilling secrets to an AI chatbot won’t be for everyone, evidence suggests that, for some young people, it works. In a randomised, controlled trial at Stanford University, Woebot was shown to significantly decrease anxiety and depressive symptoms in a group of 18-28 year olds. According to Mort, anecdotal evidence suggests that people may actually find it easier to open up in the anonymity of an AI-based app.
Self-help techniques have an important role to play for those who may be struggling with feelings of anxiety or sadness but don’t require professional help, but, as Mort says, they can never replace proper treatment.
“Self-help will never be the same as having a therapist who listens to your personal experiences and helps you make sense of them,” she says. “If you are struggling with a complex or long-standing mental health issue, I would never recommend a [self-help] app over a personal therapist.”
It’s understandable that many people have concerns about the concept of app-based therapy replacing face-to-face treatment, but experts believe the two can coexist. “I don’t think chatbot support will ever fully replace individual therapy with a human therapist who can offer warmth and nuance, and who can safeguard people during times of deep distress,” says Mort. “We will always benefit from a mix of both online and in person therapies as people require different levels and kinds of support.”
The best therapy apps to try
Founded in 2019, this UK-based app has a roster of clinical and counselling psychologists and CBT therapists available over video call. It uses technology to encourage users to engage with their treatment and track outcomes more clearly. The only downside is that their expertise doesn’t come cheap.
From £100, helloself.com
On this UK-based app, sessions with thoroughly vetted counsellors and therapists can be booked on a pay as you go basis (no subscription required) after a free consultation. Therapy can be accessed on a smartphone or tablet and is available to both private and some NHS patients.
From £60, dr-julian.com
This CBT-based app gives users free access to an AI chatbot that is available 24/7 for anonymous messaging support. It also offers a library of self-help resources and the option to access weekly live chat sessions and unlimited messaging with a qualified therapist at an affordable price.
Free, with live therapy from £12.08 per session (billed quarterly), wysa.io