Table – Strategies used in apps to address mental health concerns Approach Strategies Examples Relaxation (30/61 or 49%) Guided audio recordings Hypnosis, meditation, mindfulness, guided breathing Distraction Flash cards ‘Soothing colours’ Music ‘Treatment’ for anxiety Eye Movement Desensitisation Reprocessing (EMDR) Hypnosis Mindfulness Diaphragmatic breathing ‘Overcoming’ negative thoughts and feelings (24/61 or 39%) Exercises CBT, DBT and/or ACT exercises* ‘Brain-training’ Positive psychology exercises Journaling/worry boxes Thought challenges Goal setting Tracking positive experiences Gamification “Take control of a snake as you seek out food” (distraction technique) “Complete Quests, activate PowerUps and battle Bad Guys each day” Track, share and compare (13/61 or 21%) Self-assessment, Diagnostic questionnaires Traffic light system to grade mood Graph of anxiety level over time Log of symptoms Compare To ‘normal’ To ‘population data’ To other anonymous users To self over time Share With social media Support network Clinicians User communities (anonymous) *CBT = Cognitive Behavioural Therapy; DBT = Dialectical Behaviour Therapy; ACT = Acceptance and Commitment Therapy Developer claims to easily and rapidly improve consumer mental health were not supported by evidence, and were undermined by disclaimers. Developers frequently claimed that consumers could easily and rapidly achieve mental health and wellbeing through use of their products. For example, Mark Grant, a psychologist and the developer of Anxiety Release based on EMDR (short for Eye Movement Desensitization & Reprocessing), advertises that consumers can “release anxious thoughts and feelings naturally, by harnessing the power of your brain,” explaining that this is easy:
An individual or entity conducting a commercial activity Go to Question 1.3. A federal public entity You must comply with the Australian Privacy Principles A State or Territory public sector entity Your app is covered by your State or Territory’s privacy legislation and you must comply with their Privacy Principles An individual You are not required by law to comply with privacy legislation unless you are conducting commercial activity. However, you should build privacy into your app’s design. Here’s how: Has your business had an annual turnover of more than $3,000,000 in any financial year since 2002? YES You must comply with the Australian Privacy Principles NO Go to Question 1.4. Does the app do, or claim to do, ANY of the following in ANY way? Assess, maintain or improve a person's physical or mental health, fitness or wellbeing? Manage a person’s condition, disability or disease? Diagnose or treat a person's illness or disability, or injury? Record a person’s health information? YES You must comply with the Australian Privacy Principles NO You are not required by law to comply with privacy legislation. However, you should aim for privacy by design. Here’s how:
Therapeutic Goods Administration (TGA) Regulation of Medical Software and Mobile Medical 'Apps Therapeutic Goods Administration (TGA) Australian Regulatory Guidelines for Medical Devices (under review) Therapeutic Goods Administration (TGA) Therapeutic Goods Advertising Code Therapeutic Goods Administration (TGA) Essential Principles Checklist (Medical Devices) Therapeutic Goods Administration (TGA) Conformity Assessment Certificates Therapeutic Goods Administration (TGA) Australian Register of Therapeutic Goods https://www.tga.gov.au/australian-register-therapeutic-goods Accessibility World Wide Web Consortium (W3C) Mobile Accessibility Guidelines Appendix 2 – Mental health apps included in this study App name (Google Play) App name (iTunes) Developer name (Google Play) Developer name (iTunes) Source ACT Companion ACT Companion: The Happiness Trap App Berrick Psychology Berrick Psychology Top 100 Not available Anorexia Bulimia Binge Eating Test By PocketShrink Not available PocketShrink Top 100 Anxiety Release based on EMDR Anxiety Release based on EMDR Mark Grant trauma and pain management services pty ltd Top 100 Anxiety Test Anxiety Screening Test MoodTools Eddie Liu Top 100 At Ease Anxiety & Worry Relief At Ease: Anxiety & Worry Relief Meditation Oasis Meditation Oasis Top 100 Not available Beat Panic Not available Jane ReachOut toolbox
MindShift MindShift Anxiety Disorders Association of British Columbia Anxiety Disorders Association of British Columbia Top 100; ReachOut toolbox Not available MoodKit - Mood Improvement Tools Not available Thriveport, LLC ReachOut toolbox Not available Moodnotes - Thought Journal / Mood Diary Not available Thriveport, LLC Top 100 MoodTools - Depression Aid MoodTools - Depression Aid MoodTools Eddie Liu Top 100 OMG. I Can Meditate! OMG. I Can Meditate! - Meditation and Mindfulness OMG. I Can Meditate! OMG. I Can Meditate! Inc. Top 100 Operation Life Operation Life Australian Government, Dept. of Veterans’ Affairs Australian Government, Department of Veterans’ Affairs Department of Defence Not available Optimism Not available Optimism Apps Pty Ltd ReachOut toolbox Pacifica - Stress & Anxiety Pacifica - Anxiety, Stress, & Depression relief based on CBT & Mindfulness Pacifica Labs Inc. Pacifica Labs Inc. Top 100; University of Sydney Panic Attack Aid Panic Attack Aid MVM Michael Madew Top 100 Panic Attack Aid Lite Panic Attack Aid Lite MVM Michael Madew ReachOut toolbox Panic Relief- stop anxiety now Panic Relief Psychiatrist, MD PhD Marianne Geoffroy, Denmark Geoffroy Aps Top 100 Positivity with Andrew Johnson Positivity with Andrew Johnson HiveBrain Software Michael Schneider Top 100 PTSD Coach Australia PTSD Coach Australia Australian Government, Dept. of Veterans’ Affairs Australian Government, Dept. of Veterans’ Affairs Department of Defence Qi Gong Meditation Relaxation Not available Excel At Life Not available Top 100 Not available ReachOut Breathe Not available ReachOut Australia ReachOut toolbox ReachOut WorryTime ReachOut WorryTime ReachOut Australia ReachOut Australia ReachOut toolbox
Relax with Andrew Johnson Relax with Andrew Johnson HiveBrain Software Michael Schneider Top 100 Relieve Depression Hypnosis Relieve Depression Hypnosis - Mental Health Program for Treatment of Depression & Anxiety Symptoms Surf City Apps Surf City Apps LLC Top 100 Rise Up: Eating Disorder Help Rise Up + Recover: An Eating Disorder Monitoring and Management Tool for Anorexia, Bulimia, Binge Eating, and EDNOS Recovery Warriors Recovery Warriors L.L.C. ReachOut toolbox RR Eating Disorder Management Recovery Record - Eating Disorder Management Recovery Record Recovery Record, Inc ReachOut toolbox Self-help Anxiety Management Self-help Anxiety Management University of the West of England University of the West of England ReachOut toolbox Smiling Mind Smiling Mind Smiling Mind Smiling Mind Pty. Ltd. Top 100; ReachOut toolbox Stop Fears! Hypnosis Stop Fears! Overcome Fear and Anxiety by Hypnosis Kim Fleckenstein Kim Fleckenstein Top 100 Stop Panic & Anxiety Self-Help Not available Excel At Life Not available Top 100; ReachOut toolbox Stop Breathe & Think: Meditate Stop, Breathe & Think: Meditation and Mindfulness Tools for Peace Stop, Breathe & Think, PBC Top 100; ReachOut toolbox SuperBetter SuperBetter SuperBetter, LLC SuperBetter, LLC ReachOut toolbox The Mindfulness App The Mindfulness App: Guided & Silent Meditations to MindApps MindApps Top 100
Application of Self-Regulatory Principles to the Mobile Environment (Digital Advertising Alliance (DAA), 2013) Industry USA Advertising Best Practice Guideline - Responsible Marketing Communications in the Digital Space (Australian Association of National Advertisers (AANA), 2013) Industry Australia Advertising App Store Review Guidelines (Apple Inc., 2015) Industry International Technology Developer Policy Center (Google Play) Industry USA Technology Mobile and Privacy: Privacy Design Guidelines for Mobile Application Development (GSMA, 2012) Industry International Stay Smart Online: Mobile Devices (Attorney-General’s Department, 2017) Government Australia Privacy Doctor’s Guide to Choosing Health Apps that Really Work (Misra, 2015) and related references (Husain & Misra; ‘iPrescribeApps’, 2016) Industry USA Health VicHealth’s Top 10 Tips for Choosing a Healthy Living App; Guidelines for Creating Healthy Living Apps (VicHealth, 2015b) and related references (dialogue consulting, 2015; VicHealth, 2015a, 2016a, 2016b, 2016c, 2016d) Government Australia Health How to Choose a Health App (NZ, 2016) and related references (Health Navigator NZ, 2016) Health System New Zealand Health Choose Wisely: Selecting Mobile Health Apps (Navy and Marine Corps Public Health Center, 2014) Health System USA Health TRUSTed Apps Privacy Certification (TRUSTe, 2016) Industry USA Privacy PsyberGuide (PsyberGuide) Not-for-profit USA Health myhealthapps.net (my health apps, 2014; myhealthapps.net, 2015) Industry UK Health Mobile App Advertising Guidelines: A Framework for Encouraging Innovation While Protecting User Privacy (Lookout, 2012) and related references Industry USA Advertising communications
Safety and Quality Strategy in Mobile Health Apps (Agencia de Calidad Sanitaria de Andalucía, 2012) Government Spain Health A Guide to Apps & In-app Purchases (Australian Communications and Media Authority, 2016) Government Australia Media Mobile App Rating Scale (MARS) (Stoyanov et al., 2015) University Australia Health