What does wellness mean to you? “It means stability; well enough to hold a job, well enough to enjoy activities, well enough to feel joy and hope,” wrote one person in response to a 2018 survey (Canady etal., Reference Canady2018) by the Milken Institute Center for Strategic Philanthropy and the Depression and Bipolar Support Alliance (DBSA) asking over 4,200 people living with depression and bipolar illness to define wellness. In addition to better treatments and greater understanding of the physiology underlying their condition, two priorities emerged: people wished for the ability to function well and to feel happy. The message was clear: respondents wished for better days.
Traditional psychiatry focuses on deficits, disease, and dysfunction. Innate vulnerabilities, environmental stressors, and traumatic events have received the lion’s share of empirical attention. Therapists tend to concentrate on a patient’s chief complaint and what is going wrong in their life. The goal of health care is to manage illness, minimize symptoms, and prevent relapse. Indeed, mental health has been conceptualized as the absence of mental illness, not the presence of mental health and better days (Duckworth etal., Reference Duckworth, Steen and Seligman2005).
Positive psychiatry strives to expand this model to include factors that contribute to mental health, enhance wellbeing, and enrich the quality of everyday life for people living with and without mental illness (Jeste etal., Reference Jeste, Palmer, Rettew and Boardman2015). For example, positive psychiatry interventions that promote gratitude, foster prosocial behavior, encourage physical activity, and cultivate individual strengths build and support wellbeing. Incorporating these interventions into clinical practice can improve patient behavior, attitude, and outcomes and better engage them in the treatment process.
Smartphone and smart watch app-based treatments such as the one utilized in the study by Cassidy etal. (Reference Cassidy2020) represent a unique opportunity to expand the quality, affordability, and availability of interventions that promote wellbeing. These technologies are especially relevant in the wake of COVID-19 which has taken a significant toll on mental health and also radically transformed the delivery of health care (Holmes etal., Reference Holmes2020). It is equally important to recognize that there are challenges of using mental health apps such as poor regulation of quality and privacy and inconsistencies in engagement.
A key finding in the current study underscores the challenge of engagement (Dixon etal., Reference Dixon, Yael and Nossel2016). The retrospective analysis investigated the differences in outcomes between a clinician-assisted behavioral activation intervention and a self-guided app methodology. Striking differences in completion rates were found between the two methods. Only 10.8% of independent app users completed the intervention compared to 99.2% in the clinician-assisted group. It is noteworthy that method did not affect psychological patient outcomes. Those who did complete the app-based intervention led to the same improvements in health behaviors and attitudes as those who worked with a clinician. I compliment the authors of the study on their valuable contribution to the literature on how health apps can contribute to primary prevention and positive psychiatry.
As mental health apps are increasingly prescribed to supplement in-person treatment and help patients self-manage mental health conditions, it is not only important to know whether and which apps are effective, but it is also critical to understand the factors that make an app appealing. Indeed, even effective apps will have limited impact if they are not highly engaging. As patients typically use apps on their own time, they must be intrinsically motivated to do so.
Evidence from the literature suggests that patient engagement can be enhanced through (1) real-time engagement; (2) usage reminders; and (3) gamified interactions (Chandrashekar, Reference Chandrashekar2018). Translating traditional evidence-based interventions into computer gaming formats and exploiting features of computer games has potential benefits for psychological and behavior change as well as symptom relief. Key motivational orientations that support engagement include achievement, exploration, sociability, domination, and immersion.
Not all patients who have the intention to adopt, maintain, or increase healthy behaviors will subsequently do so. Working with a clinician can help close the intention–action gap (Sheeran and Webb, Reference Sheeran and Webb2016). Mental health apps can also support behavior activation by delivering engaging and interactive strategies to facilitate the practice of healthy behaviors in everyday life (Pramana etal., Reference Pramana2018).
Of course, a possible pitfall of gamifying behavior modification is increasing dependence on smartphones and technology. The success of mental health apps is predicated on engaging features that also prioritize ethical design, empirical validation, and judicial use (Fleming etal., Reference Fleming2017).
Given the global shortage of psychiatrists and lack of access to mental health, apps are a promising tool to help bridge the mental health treatment gap as well as to promote positive behavior, attitudes, and outcomes in all populations. The collaboration of psychiatrists, neuroscientists, and designers has the potential not only to lessen suffering but also to enhance everyday life.
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What does wellness mean to you? “It means stability; well enough to hold a job, well enough to enjoy activities, well enough to feel joy and hope,” wrote one person in response to a 2018 survey (Canady etal., Reference Canady2018) by the Milken Institute Center for Strategic Philanthropy and the Depression and Bipolar Support Alliance (DBSA) asking over 4,200 people living with depression and bipolar illness to define wellness. In addition to better treatments and greater understanding of the physiology underlying their condition, two priorities emerged: people wished for the ability to function well and to feel happy. The message was clear: respondents wished for better days.
Traditional psychiatry focuses on deficits, disease, and dysfunction. Innate vulnerabilities, environmental stressors, and traumatic events have received the lion’s share of empirical attention. Therapists tend to concentrate on a patient’s chief complaint and what is going wrong in their life. The goal of health care is to manage illness, minimize symptoms, and prevent relapse. Indeed, mental health has been conceptualized as the absence of mental illness, not the presence of mental health and better days (Duckworth etal., Reference Duckworth, Steen and Seligman2005).
Positive psychiatry strives to expand this model to include factors that contribute to mental health, enhance wellbeing, and enrich the quality of everyday life for people living with and without mental illness (Jeste etal., Reference Jeste, Palmer, Rettew and Boardman2015). For example, positive psychiatry interventions that promote gratitude, foster prosocial behavior, encourage physical activity, and cultivate individual strengths build and support wellbeing. Incorporating these interventions into clinical practice can improve patient behavior, attitude, and outcomes and better engage them in the treatment process.
Smartphone and smart watch app-based treatments such as the one utilized in the study by Cassidy etal. (Reference Cassidy2020) represent a unique opportunity to expand the quality, affordability, and availability of interventions that promote wellbeing. These technologies are especially relevant in the wake of COVID-19 which has taken a significant toll on mental health and also radically transformed the delivery of health care (Holmes etal., Reference Holmes2020). It is equally important to recognize that there are challenges of using mental health apps such as poor regulation of quality and privacy and inconsistencies in engagement.
A key finding in the current study underscores the challenge of engagement (Dixon etal., Reference Dixon, Yael and Nossel2016). The retrospective analysis investigated the differences in outcomes between a clinician-assisted behavioral activation intervention and a self-guided app methodology. Striking differences in completion rates were found between the two methods. Only 10.8% of independent app users completed the intervention compared to 99.2% in the clinician-assisted group. It is noteworthy that method did not affect psychological patient outcomes. Those who did complete the app-based intervention led to the same improvements in health behaviors and attitudes as those who worked with a clinician. I compliment the authors of the study on their valuable contribution to the literature on how health apps can contribute to primary prevention and positive psychiatry.
As mental health apps are increasingly prescribed to supplement in-person treatment and help patients self-manage mental health conditions, it is not only important to know whether and which apps are effective, but it is also critical to understand the factors that make an app appealing. Indeed, even effective apps will have limited impact if they are not highly engaging. As patients typically use apps on their own time, they must be intrinsically motivated to do so.
Evidence from the literature suggests that patient engagement can be enhanced through (1) real-time engagement; (2) usage reminders; and (3) gamified interactions (Chandrashekar, Reference Chandrashekar2018). Translating traditional evidence-based interventions into computer gaming formats and exploiting features of computer games has potential benefits for psychological and behavior change as well as symptom relief. Key motivational orientations that support engagement include achievement, exploration, sociability, domination, and immersion.
Not all patients who have the intention to adopt, maintain, or increase healthy behaviors will subsequently do so. Working with a clinician can help close the intention–action gap (Sheeran and Webb, Reference Sheeran and Webb2016). Mental health apps can also support behavior activation by delivering engaging and interactive strategies to facilitate the practice of healthy behaviors in everyday life (Pramana etal., Reference Pramana2018).
Of course, a possible pitfall of gamifying behavior modification is increasing dependence on smartphones and technology. The success of mental health apps is predicated on engaging features that also prioritize ethical design, empirical validation, and judicial use (Fleming etal., Reference Fleming2017).
Given the global shortage of psychiatrists and lack of access to mental health, apps are a promising tool to help bridge the mental health treatment gap as well as to promote positive behavior, attitudes, and outcomes in all populations. The collaboration of psychiatrists, neuroscientists, and designers has the potential not only to lessen suffering but also to enhance everyday life.