Cover Story
Apps are Growing in Importance
By Kathleen Greer


Have you ever misplaced your smartphone? Panicking, you realize it’s your lifeline to both your professional and personal lives. The anxiety involved in losing one’s mobile device is intense because of its personalized nature. In addition to serving as one’s calendar, email exchanges, and texts, each user’s collection of multi-purpose apps makes the mobile device uniquely crafted for the individual. This reliance on smartphones is new to Baby Boomers, but younger generations do not know what it’s like to not have one.

Mobile Devices are Dynamic
Each day new apps are introduced that relate to all aspects of life, learning, and connecting. If there is some part of your life not covered by an app, just wait because one will be coming. In the app world, there is never a dull moment or a chance for boredom. The dynamic nature of these devices is particularly important to the Millennials, who now make up the largest generation in the workplace (Pew Research Center, 2015).
Millennials like the convenience of having everything on their phones, which includes their apps. They can make a dinner reservation on Open Table, call for a ride on Uber, and then play games on the way to the restaurant. They exchange money with their friends with Venmo and self-diagnose their ailments on the WebMD app. “I can do it myself if you just hand me my phone,” is the mantra of these independent, convenience-seeking young people.
According to Smart Insights, the overall time spent on apps surpassed the time spent on desktops in 2014. Out of the 5.6 hours per day spent on digital media by American adults, 51% of that total is spent on apps, emphasizing the importance of their accessibility (Smart Insights, 2015). Eighty-five percent of people overall between the ages of 18 and 34 use smartphones or tablets for everything from uploading media content (an overwhelming 96%) to self-diagnosing medical illnesses – just under half of users (48%) do this online (Oracle, 2014).

Mental Health Apps — Clinical vs. Non-Clinical
There are thousands of interesting mental health apps designed to help with an individual’s well-being. However, few are considered “clinical apps,” which are the ones validated through research or clinical trials. That is because clinical apps are often stalled due to the time, money, and the government red tape necessary to validate their effectiveness. Some developers steer away from clinical apps entirely due to regulatory scrutiny (Forbes, 2015). There are exceptions, however, such as Orcas’ well-researched Mood Hacker, which is now gaining popularity among EAPs. And popular Headspace programs are being evaluated for effectiveness through a variety of research partners, including Northeastern University and Stanford Health Care.
But what about “non-clinical apps?” Even with little science behind them, non-clinical apps can be extremely helpful. EAPs can’t afford to wait for apps to be validated when Millennials and others want an app for everything in today’s dynamic environment of personal devices.

Apps as Adjuncts to Counseling
In many instances EAPs have the honor and responsibility of receiving initial calls for help. When such calls are received, there may already be a crisis, so the EA counselor is quickly looking for ways to engage the employee. An appropriate app can be used to enhance or support crisis intervention and short-term counseling. One counselor noted that “An employee’s spouse was experiencing a high level of anxiety. We offered phone support and an app while she waited to have a face-to-face.”

There are other ways in which apps can be helpful alongside EAP counseling:

* They aid in mental health awareness. Apps can be helpful for mental health education. Because of the immediacy of apps, their usefulness far exceeds the standard practice of providing websites, tip sheets, or articles for discussion.  

* They encourage mental health screenings. There is solid data that backs their usefulness, and it won’t be long before validated screening tools are delivered as apps. When used in EAP counseling, even a non-clinical screening app can be effective in helping formulate a treatment plan.

* They offer mood and behavioral assistance. Some apps can be used as a mood or behavioral diary, allowing an employee or family member to record moods, thoughts, or actions in between EAP counseling sessions. With this additional information, the counseling intervention may take on more meaning.

* They help teach relaxation and mindfulness techniques. Other apps teach relaxation and mindfulness skills. This also enhances short-term counseling by encouraging immediate skill development. One counselor said, “In between sessions one and two, an employee learned diaphragmatic breathing directly from an app.” Another counselor commented on the value of sleep aid apps when the employee client finds sleep hard to come by.

* They promote visibility and utilization of the EAP. EAPs are constantly seeking ways to promote their services in order to reach people in need earlier than is often the case. Apps provide a new avenue for boosting engagement and utilization of the EAP. Lists of Top 10 apps may be promoted at health fairs, lunchtime seminars, or other employee wellness events to improve visibility of EAP services. HR clients might be willing to post the app recommendations on a company intranet or include the app selections in their home mailings.

KGA’s Top 10
KGA released its first top 10 app list in fall 2014. We wanted to demonstrate that we could sift through the multitude of non-clinical free or low-cost apps for mental health, work-life, and general well-being.  To choose the ten best apps that would address the needs and concerns of our clients, KGA looked at the:

* Topics that are aligned with reasons employees call the EAP;
* Appropriateness of the app as an adjunct to counseling;
* History of updates to analyze the upkeep and functionality of the app;
* Price;
* Customer ratings and reviews;
* Popularity; and
* Availability on phone systems.

Top 10 Apps for 2016
It should also be noted that additional methodology that went into KGA’s selection process and promotional campaign is explained in the 2nd Quarter 2015 JEA article, “What are the Leading Behavioral Health Apps?” Along with counselors’ comments, the following are KGA’s top 10 apps for this year:

* Quit That! – Although this app is only available on iOS, it’s incredibly efficient for tracking and helping users kick any bad habit, whether it’s smoking, drinking, coffee, etc. Counselor: “This app can be used for quitting any kind of habit. It has more applicability because you can even track multiple behaviors. I like how it can be used on the Apple Watch – big advantage there.”

* Calm – This app is available on both Android and iOS and allows you to relax any time of the day with 7 guided meditation sessions from 2 to 30 minutes long to fit your needs. Some counselors suggest this app for those suffering from anxiety.

* Headspace – Anyone can learn initial meditation and mindfulness techniques in just 10 minutes a day. Users are offered to continue their education by purchasing the app and gaining access to hundreds of hours of original meditations. Headspace is available for both Android and iOS. Counselor: “I really like Headspace – the voice who leads the meditations has a great soothing, non-judgmental voice, and you feel like he is sitting right in the room with you.”  This app is currently undergoing a clinical trial.

* Pacifica – Available for both Android and iOS, this app uses tools based on Cognitive Behavioral Therapy, relaxation, and wellness to address every day anxiety. Its features include a daily mood tracker, mood history, thought analysis, and private groups and communities to help users manage stress and anxiety at their own pace.  One counselor added a concern that, “Pacifica is not enough for anyone with severe anxiety or depression.” However, that statement is true for ANY app. Apps are a useful adjunct to therapy, but they do not replace therapy.

* My Mood Tracker Lite – This app tracks moods, emotions, and everything that can affect how the user feels. The playful design helps users understand what causes changes in emotions and helps get them on the path to feeling better. This app is available for iOS only. Counselor: “I like My Mood Tracker Lite because it helps differentiate moods by using emoticons, as well as tracking sleep, menstrual cycles, energy levels, and medication.”

* Divorceworks – Available for both Android and iOS, this app strives to help users and their families through a difficult time. It tracks feelings and understanding of the grieving process, serves as a friend/therapist, and even offers tips on how to help children move on as well. Counselor: “The app is really all about emotional awareness and coping during a divorce. I really liked it and would recommend it.”

* Mint – This is a great app to keep track of finances, providing that the user is okay with sharing personal financial information. Not only does it track bills and payments, but it also helps set budgets and plan for future expenses. Designed to help keep anyone’s finances in check, it’s available for both Android and iOS. Counselor: “It’s very easy to use, and I think it could be effective in changing the way you spend money.”

* Relax Melodies – This app is currently the most popular sleep aid app. Users can select sounds and melodies that they like and combine them to make their own mix. Users can also use timers and alarms – ideal for naps and babies! Relax Melodies is available for both Android and iOS. Counselor: “I recommend this app whenever anyone wants to practice relaxation or mindfulness.”

* Lose It – Available for both Android and iOS, this app helps users set a daily calorie intake, track food and exercise, and stay motivated to make smarter choices and achieve goals – thus enhancing the chances of personal success. Counselor: “This app is easy to use and effective when someone is working on weight loss.” This app is currently undergoing a clinical trial.

* Whil – Lastly, this app is also available for both Android and iOS, giving users the ability to practice mindfulness to reduce stress and pay greater attention to the world around them. It helps users manage anxiety, sleep better, sharpen focus, improve performance, and be a happier, more engaged individual. Counselor: “I frequently recommend this app to practice mindfulness; all it takes is 10 minutes a day.”

Summary

There are many reasons why apps can be helpful to people struggling with mental health or other personal problems, and they can provide an excellent adjunct to counseling. EA counselors have the expertise to review an app and decide whether to engage a client who is already using one or to suggest a different, more appropriate app. In addition, a vetted list of apps can provide a strong engagement tool for health promotion activities in order to enhance awareness of EAP services.
Apps are here to stay. For the majority of employees, apps are essential tools, and EAPs need to adapt their practice accordingly. EA counselors are advised to embrace this trend and recognize how an app may make a positive difference in the lives of employees and family members. As apps become more and more popular, EAPs have to do everything they can to remain relevant and connected to their clients, especially Millennials.

Kathleen Greer is founder and chairman of the Framingham, Mass.-based KGA, Inc., which provides EAP services to over 100 organizations. KGA is a member of the National Behavioral Consortium and a recent recipient of the WorldatWork Work-Life 2016 Seal of Distinction. Kathy can be reached at greer@kgreer.com or by visiting http://kgreer.com/articles/top10apps.


References

Millennials surpass GenXers as the largest generation in the U.S. Labor Force, Millennial Pew Research Center Analysis of U.S. Census Bureau Data 1995-2015. Retrieved from http://www.pewresearch.org/fact-tank/2015/05/11/millennials-surpass-gen-xers-as-the-largest-generation-in-u-s-labor-force/.

Oracle. Retrieved from http://www.oracle.com/us/dm/millennials-and-mobility-2508385.pdf.

Smart Insights. Retrieved from http://smartinsights.com/mobile-marketing/mobile-marketing-analytics/mobile-marketing-statistics.

Sukel, Kayt. October 2015. “The Head-scratching Reason There’s No Mental Health Apps”. Forbes magazine.


More Apps are Undergoing Clinical Trials


According to the IMS Institute for Healthcare Informatics, more than 165,000 mobile health apps are currently available to consumers. As a result, EAP counselors can provide much-needed guidance when it comes to selecting and evaluating the appropriate use of non-clinical mental health apps.
However, an article in WIRED magazine revealed that apps are twice as effective when a clinician is involved. In the future we will see many more apps undergoing clinical trials, which will “put more science” behind their validity.
Below is a sampling of mental health apps undergoing clinical trials. To view other trials, visit www.clinicaltrials.gov or www.nhs.uk.

* Anxiety Coach (social anxiety disorder)
* Big White Wall (online community for anxiety/depression)
** Headspace (meditation and mindfulness)
** Lose it (weight loss)
* Mood Hacker (depression)
* Moodscope (mood monitoring with social support)
* Priori (bipolar disorder)
* PTSD Coach (PTSD)
* Sleepio (sleep improvement)
* Wizard (memory and cognitive functions)

** Already on KGA’s top 10 app list

- Kathy Greer

References

ClinicalTrials.com. www.clinicaltrials.com

IMS Institute for Healthcare Informatics (Oct. 12, 2015). Retrieved from http://www.imshealth.com/en/thought-leadership/ims-institute/reports/patient-options-expand-as-mobile-healthcare-apps-address-wellness-and-chronic-disease-treatment-needs.

NHS Choices. www.nhs.uk

Reynolds, E. (Oct. 30, 2015). WIRED magazine. Retrieved from http://www.wired.co.uk/news/archive/2015-10/30/mental-health-apps