“This small reinforcement can matter quite a lot” Ly says.
The approach is similar to Nike’s highly popular Nike + running app, Ly claims, which encourages users to set personal running goals, track activities, find new running routes and share the results with friends. Nike’s tagline, “stay motivated, challenged and connected” is in essence what most behaviour-change therapy apps like Viary are all about.
Dr Paul Blenkiron, a consultant psychiatrist in the UK, says that because CBT therapy uses a lot of self-guided ‘homework’, apps like this certainly have a role to play. “They offer portability, choice, flexibility and ease of access to your own self help plan when you need it,” he explains. But, he adds, they are only for “practical coping, not ‘black couch’ therapy.”
In fact, there is still a long way to go to understand if – and how – these apps work at all. Most practicing therapists are unaware of the existence of these apps, and little research has been done confirming their effectiveness. And, even when studies have been done, they tend to have confusing results, says Dr Richard McNally, director of clinical training at Harvard University.
“There’s still a lot of research going on- there’s positive findings and null findings,” he says. “It’s really up in the air.”
At his lab, PhD students have been conducting research on the use of smartphone apps to treat anxiety, through a technique known as attention bias modification.
This is based on lab tests that show people with anxiety – a feeling of fear or dread - tend to have a “bias” towards noticing hostile, or angry faces in a crowd, rather than neutral, happy or relaxed ones. The idea is that by reducing this bias, you can short circuit the feelings that follow, interrupting the feeling of anxiety.
The team tested the idea using a simple game app, which showed people two faces, one with a neutral expression and one looking hostile. The faces appear one above the other on the screen before disappearing, to be replaced by a letter on one half of the screen. The game requires patients to identify this letter.
If all of this sounds very abstract, that is because the true intention of the game is not to identify letters. Rather, the letter appears in a position that encourages the user to shift their gaze from the part of the screen that showed the hostile face. Play the game enough, the logic goes, and a person should train their eyes to look away automatically, providing them with an impulsive control in real life situations that can help control anxiety.
Or at least that is the theory. Hundreds of participants took part in the study, some of which showed a reduction in their anxiety. Yet, other people showed no change and, perhaps more puzzlingly, the control group also showed a reduction in anxiety.
“It totally surprised us,” he says. It appeared that just by playing the game with the belief that it would reduce anxiety, participants actually did reduce their anxiety, something commonly known as the “placebo effect.”
The results have left him with a “cautious optimism”, as he puts it. “We still need to know the variables of when and how these app treatments work. We need to do more proper randomised control trials.”