Dossier: Digital life

Mental health apps: what you need to know

Whether as support against depression and eating disorders or as a coach for meditation and mindfulness, mental health apps are booming. So it’s important to be able to distinguish good offers from bad ones.

Text: Stefan Schweiger; photo: iStock

Almost 39% of women in Switzerland felt constantly or occasionally despondent or depressed over a period of four weeks in 2021. This figure is much lower for men – at just under 27% – as recent surveys by the Swiss Health Observatory show, but the figures clearly demonstrate that mental health is an increasingly urgent issue.

If the sheer explosion in mental health apps is anything to go by, people certainly appear to be taking the matter seriously, with looking after yourself seeming to be a widespread concern today. These digital aids are supposed to be able to recognise and interpret the users’ behavioural patterns, help them take a deep breath, let off steam and listen to their emotions. At least, that’s what they promise.

When distinguishing good offerings from bad ones, a first indication can be the ranking in the download charts. However, it is even better to rely on scientific efforts that give users tangible criteria. As part of a major literature study commissioned by the Federal Office of Public Health, researchers put together three factors that indicate quality. According to the study, well-made apps that are regularly used by users and contribute to behavioural changes typically ...

  • … set individual goals that take personal needs into account.
  • … observe behaviour and ask questions about it interactively.
  • … provide immediate motivational feedback.

Such criteria provide a useful point of reference. Depending on your individual goal, however, it’s worth delving deeper.

Apps against depression

What’s a realistic goal – and what’s not? Programmes based on cognitive behavioural therapy can help to identify negative thought patterns and practice new behaviours. However, depression apps are only suitable for mild depression – and have been shown to work better when integrated into psychotherapy with a human counterpart.

Typical feature: A mood diary tracks your state of mind each day and gives feedback on how you can best improve your mood. Based on dialogue, the app devises individually tailored exercises to help you change your thought patterns.

What to look out for: In many apps, the dialogue you are led through can seem impersonal – only  a few apps actually include contact with a human psychotherapist.

Well-known apps: Deprexis, Moodpath, Moodgym, Selfapy, Novego, Cara Care, Hello Better

Apps against eating disorders

What’s a realistic goal – and what’s not? Patients with an eating disorder receive permanent support through apps to change their behaviour. However, they are not recommended as the sole component of therapy, but rather to supplement it. Or to encourage the user to keep going after a successful course of therapy.

Typical feature: The diary collects nutrition logs and motivates the user by providing direct visualisation of the progress made. When it is anticipated that a situation will be difficult for the user, the app sends personal messages of support.

What to look out for: Some apps offer to share the data collected with your therapist. This kind of monitoring is effective – but it can also feel patronising.

Well-known apps: MindDoc, Recovery Record, Selfapy

Apps for meditation and mindfulness

What’s a realistic goal – and what’s not? Focusing the mind to calm it: those who manage to do this are in the moment and experience relaxation through mindfulness. The goal of many meditations is to observe thoughts and feelings without evaluating them. But this is precisely where many people fail without the guidance of a human professional – especially at the beginning.

Typical feature: Guided meditations and mindfulness exercises to listen to on your smartphone. Ideally, the exercises build on each other and provide feedback on your progress. They range from breathing exercises to sleep training and dream journeys.

What to look out for: The voice must be pleasant to listen to so that you can follow it for a long time during meditations. Also, many apps are only offered in English.

Well-known apps: Headspace, 7Mind, Calm, Breathing Zone, Balloon

Good to know

You can find further support and tips for mental health, in our free mental health guide in the Sanitas Portal app. 

To the guide

Ask the expert: How good are mental health apps really?

Mr Berger, how motivated do I need to be for an app to have any chance of helping me?

An app only helps if it is actually used. In our research, we’ve found that people who have reached a certain level of suffering are more motivated to actually change and be supported by an app. If the level of suffering isn’t high enough, for example because you don’t really feel depressed, you won’t use an app. There’s just no reason to do so.

The level of suffering is quite a negative motivational factor. Is there a more positive way of thinking about it that might aid prevention?

The chance that an app will work well increases if a person has a positive association with it – in other words, if they believe that it can help them. And that they themselves can contribute to achieving this goal. But the desire to change has to be there. Basically, it’s a good thing that we can also use these less intrusive digital services to reach those who would never even consider consulting room therapy.

This is also what digital app manufacturers claim – but they often promise a lot.

If the range of indications is limited – that is, if it’s clearly spelled out in which specific area the app can help – then that’s a sign of quality. And are there contra-indications that even warn against the use of the app? For example, that the app is not suitable for acute suicidal crises. If the app promises to do everything, then it’s not worth taking seriously.

Is it at all possible to define general quality criteria for mental health apps?

Many apps try to scientifically prove that they have a benefit. However, the majority listed in the app stores do not. The Federation of Swiss Psychologists has developed quality standards for online interventions that can be used as a reference. In addition to clearly stated limits on what the app is suitable for, it is above all a question of transparency: Who is behind an app? What expertise? What costs will I incur? And then, of course, confidentiality and data protection: only data that is necessary to use the app should be requested – and of course it must not be passed on.

When would you advise against using an app?

If your condition deteriorates as a result of using it and you’re not supported by a professional. This can happen, for example, in the treatment of anxiety disorders or also occasionally in psychotherapy. Then it’s important that a professional is at your side.

The interviewee

Professor Thomas Berger is Head of the Department of Clinical Psychology and Psychotherapy at the University of Berne. He is considered a pioneer for online psychotherapy in Switzerland.