Mobile applications in adolescent psychotherapy - How can they be successfully transferred into practice?
Creators: name: Wüllner, Sarah
Publisher: name: Universität Bielefeld
Year: 2025
Subjects: subject: 150

description: Adolescents are a particularly vulnerable group to psychological stress. They are at high risk for mental disorders. Furthermore, therapy dropouts and rates of non-response are high for adolescents. Additionally, the COVID-19 pandemic resulted in a sharp increase in mental health problems among adolescents. To support young people with their needs, mental health apps can play an important role. They demonstrate several advantages for adolescent psychotherapeutic care, for example, an increase in adolescents’ experience of autonomy and self-efficacy, the possibility to integrate mental health apps flexibly into everyday life, or strengthening the therapeutic alliance. The number of available mental health apps in app stores and the number of evaluation studies of mental health apps increased sharply during the COVID-19 pandemic. However, mental health apps are still rarely used by psychotherapists. So, up to now, the transfer of mental health apps into psychotherapists’ working routines has not been successful. To better understand potential association factors for psychotherapists’ mental health app use, it is necessary to take a closer look at the perspective of psychotherapists. Furthermore, the role of COVID-19 on the development and use of mental health apps should also be considered, as the pandemic led to major changes in our health care system. 
Therefore, the studies conducted as part of this dissertation investigated how the landscape of mobile applications for adolescent psychotherapy looks like after the COVID-19 pandemic and what psychotherapists need to integrate mental health apps into their psychotherapies with adolescents. The first article presented a systematic review about evaluated mental health apps for adolescent psychotherapy and associated evaluation studies published during the COVID-19 pandemic. The aim was to give an updated review of evaluation studies with focus on study methodology and quality in the context of adolescent psychotherapeutic care during COVID-19. Results of the systematic review revealed that the area of application of mental health apps did not change significantly during the COVID-19 pandemic. However, community-network apps emerged as a third app intervention concept next to stand-alone and therapy-accompanying apps. Moreover, there is no change recognizable in the methodology and quality of mental health app evaluation. The methodologies of evaluation studies were diverse, with a predominance of feasibility studies over effectiveness studies, and the study quality was overall low. There was no standardized measurement of the quality features of mental health apps. The results of the effectiveness studies revealed some evidence that mental health apps influenced adolescents’ psychotherapy beneficially. Nevertheless, there is still a lack of evidence-base and high-quality app research. After the first article tool a closer look at the landscape of mental health apps and their evaluation studies, the second article focused on the use of mental health apps. The second article examined preconditions for using e-mental health tools in daily work routines in a sample of German psychotherapists. To this end, we examined the association between psychotherapists’ use of e-mental health tools, especially videoconferencing and mental health apps, and three vital factors: the psychotherapeutic approach, attitudes toward the integration of e-mental health, and the technical equipment available at the workplace. Most of the participating psychotherapists had limited technical equipment available at their workplace. Moreover, the findings demonstrated that the utilization of mental health apps was far from being integrated into daily routines. The psychotherapeutic approach, potential to augment psychotherapy, and technical equipment available at work were significant correlates of e-mental health use. To better understand psychotherapists’ perspective on mental health app use in a more practical manner, in article 3, different feasibility studies were conducted to implement a transdiagnostic and therapy-accompanying app into different psychotherapeutic contexts: inpatient treatment, psychiatric outpatient clinics, and psychotherapy in private practices. The aim of the article was twofold: first, to analyze which app features and characteristics are essential for psychotherapists in order to use a psychotherapeutic mobile application for their psychotherapy with adolescents, and second, to analyze which drivers and barriers determine the integration of such an app from the psychotherapists’ perspective. Results highlighted six core features for a transdiagnostic therapy-accompanying app: (1) customizable mood checks for patients, (2) a template library for psychotherapists, (3) reminders on app usage for patients and psychotherapists, (4) goals &amp; tasks, (5) an emergency kit for self-help in critical situations with skills and emergency contacts, and (6) questionnaires, for example for diagnostics. Furthermore, the integration of mental health apps into daily routines was associated with many drivers and barriers. The most important barriers to integrating mental health apps were technological issues and conditions in daily practice, like the lack of time and resources. The most important driver was the perceived improvement in treatment quality. 
Overall, the results of the conducted studies underlined the importance of several factors determining e-mental health use, which supports the Level of Adoption of e-Mental Health model of Feijt et al. (2018). Furthermore, the results revealed that psychotherapists need more support to start using mental health apps. Although psychotherapists were interested in mental health apps, available mental health apps did not meet the needs of psychotherapists and their working routines. In sum, to start using mental health apps, psychotherapists reported overall the need for an external trigger like reminders or an external commitment to use the app, the right preconditions like the access to technical equipment, being convinced of the benefits, and mental health apps that are not time-consuming to implement. Conclusively, it can be said that we need to combine app development and implementation strategies in a participatory approach, as well as more research on mental health apps and their use in practice to successfully integrate mental health apps into practice. Furthermore, future research should investigate which mechanisms of action differ between apps and face-to-face therapy, and what app features are crucial for effectiveness to better understand the potential benefits of mental health apps.