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Published: 20 August 2024
To the Editor: Smartphone applications (apps) have gained public interest in the field of mental health. These interventions help reach underserved populations in need of mental health services. Early apps helped users cope with aversive emotional states such as depression and anxiety.1 The technology was later developed to combat a range of mental health problems, including social robots for autistic people and sex robots like Roxxxy.2 These apps are based on cognitive behavioral therapy (CBT) and can be used alone or with professional support.
A current article3 In The primary care companion for CNS diseases compared traditional cognitive behavioral therapy with application-directed therapy. Six studies were analyzed that examined a variety of patient groups, including those with anxiety, depression, fear of heights, and panic disorders. Young patients in particular benefited more because smartphones play a more central role in their lives than older people. However, in all age groups, treatment adherence was higher when some level of doctor involvement was present.3
In the “real world,” self-directed treatments may not involve doctors at all. While some apps are presented as educational, others are designed to build therapeutic relationships. These relational apps have personable names like Woebot and Wysa and are engaging and empathetic. These “chatbot doctors” are available 24/7 and designed to form an alliance with users.2 They are ready to chat about the “problems of the day,” offer advice, and teach cognitive behavioral therapy strategies. These apps have an engaging screen presence and interact with the patient to help them recognize their symptoms and self-management skills. At the same time, more research is needed to ensure the effectiveness and safety of these virtual platforms.
Although technological advances in this area are promising, the associated risks should not be ignored. Long-term use of artificial intelligence (AI) interventions could result in some patients developing a clinically meaningful attachment to these apps. Humans could humanize chatbots, leading to increased levels of trust that could potentially be abused. Just as in human therapeutic relationships, there is a risk of transference of emotions, thoughts, and feelings to the robot. Can the robot adequately manage the transference aspects of the relationship?
Ethics must be considered when attempting to replace in-person mental health counseling with virtual apps. Although apps are accessible, issues such as security, confidentiality and privacy must be considered. Applications such as Woebot are available through social media platforms and are therefore linked to patients’ real names. When a third-party website is used in conjunction with CBT apps, sensitive information is less protected.4 Conversely, Wysa allows users to remain anonymous without the need to involve third parties. Clear guidelines are needed for handling confidential data collected by assistive robots. In Europe, international standards for clinical testing of AI systems have been developed to promote transparent protocols.5 The unregulated growth raises concerns about the impact of these applications on vulnerable individuals. In terms of charity, the main benefit of apps is their potential to reach populations where mental health services are scarce. After all, it’s hard to turn down therapy when it’s within reach.
About this article
Published online: August 20, 2024. https://doi.org/10.4088/PCC.24lr03754
© 2024 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2024;26(4):24lr03754
Quote: Modesto-Lowe V, Adams S, Rossi A. Smartphone applications: therapy at the touch of a button. Prim Care Companion CNS Disorder. 2024;26(4):24lr03754.
Author affiliations: Hartford Behavioral Health, Hartford, Connecticut (Modesto-Lowe); Department of Psychiatry, University of Connecticut, Farmington, Connecticut (Modesto-Lowe); School of Health Sciences, Quinnipiac University, Hamden, Connecticut (Modesto-Lowe, Adams, Rossi).
Corresponding author: Vania Modesto-Lowe, MD, MPH, Hartford Behavioral Health, 2550 Main St, Hartford, CT 06120 ([email protected]).
Relevant financial relationships: None.
Funding/Support: None.
