commentary:-can-mental-health-apps-replace-face-to-face-therapy?
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SINGAPORE: The COVID-19 pandemic has taken a toll on all of us.

Each time a new phase or transition period rolls out, we’ve had to grapple with isolation from our friends and family, hybrid work and school arrangements, and general uncertainties about the future.

The impact on the psychological wellbeing of our nation cannot be understated. A study by the Institute of Mental Health (IMH) between May 2020 and June 2021 indicated 13 per cent of participants reported symptoms of depression or anxiety during the COVID-19 pandemic.

IMH’s helpline also received 50 per cent more callers in 2020, compared to the same period in 2019.

Given the circumstances, it is unsurprising some are looking for more ways to support their mental wellbeing, including the use of mental health apps.

In fact, the use of such resources is getting more popular and the Health Promotion Board (HPB) has rolled out an online portal, MindSG, with mental health resources curated by experts.

THE ATTRACTION OF MENTAL HEALTH APPS

There is a plethora of mental health apps that can be readily accessed or downloaded from app stores or the Internet.

Some focus on empowering individuals to manage their own emotions. These provide various forms of support, ranging from automated bite-sized pieces of information, to guides on how to develop various coping skills.

(Photo: iStock/bymuratdeniz)

For instance, some provide step-by-step audio instructions on how to practise mindfulness meditations or help users pace their breathing when feeling overwhelmed.

Other apps guide users to identify and challenge unhelpful thoughts. These may appeal to those uncomfortable with sharing their emotional vulnerabilities with others or want support readily available at their fingertips. Their anonymity may also destigmatise the process of seeking help.

Some even offer virtual psychotherapy or counselling sessions to those who prefer an individualised approach and real-time interaction with professionals, but have concerns about going out in the pandemic. These may take place over text messaging, phone call or video conferencing.

With a mobile penetration rate of over 100 per cent and relatively higher rates of smartphone usage among millennials in Singapore, it isn’t difficult to imagine such apps appealing to a younger and technologically savvy population.

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CAN APPS REPLACE THERAPY?

The apparent perks of such mental health apps then raise the question: Are they a replacement for face-to-face psychotherapy, which aims to help people manage troubling symptoms of emotional difficulties and support functionality and wellbeing?

Unfortunately, there is currently a lack of empirical evidence on the efficacy or effectiveness for many of these apps.

Whether apps can replace face-to-face psychotherapy depends on what an individual hopes to achieve, the level of support they need, their current life circumstances, and barriers such as fear of stigmatisation, time constraints and costs.

Take for example, Adam*, who initially found some relief using apps from the mental health challenges he was facing. He found comfort in the anonymity and thought using such apps was better than doing nothing at all.

However, his circumstances and stressors changed during the pandemic. He found himself spending more time with quarrelsome parents and faced changes in work demands. But he was unable to engage in usual coping strategies, like going to the gym and meeting friends for meals.

It became increasingly difficult to address his mental health difficulties on his own. Frustrated, he blamed himself for not being able to cope, especially since people claimed to have benefitted from these apps that were highly recommended online.

Adam soon realised he needed individualised support and structure to improve his mental health. While he initially contemplated virtual individual therapy sessions, he decided against this, as his home environment and proximity to his family were not conducive.

This gave him the push he needed to see an in-person therapist.

(Photo: iStock/fizkes)

The initial transition to having to open up to his therapist was daunting, but he slowly found comfort and safety, setting the stage for his continued growth and recovery.

As he gradually returned to work with the economy reopening, he found it increasingly difficult to commit to regular therapy sessions.

Adam and his therapist both agreed to stop sessions as he was coping better and could return to using apps to maintain treatment gains.

DECIDING WHAT’S RIGHT FOR YOU

In deciding which platforms of mental health support to engage, it is important to consider your own needs and wants, and how offline or online resources can meet them.

What suited you in the past may not suit you now or in the future. It is perfectly normal to try something new if current efforts have not been working out.

It isn’t uncommon for individuals to use apps in between face-to-face sessions, especially if a professional assesses this may be helpful in the development or maintenance of coping strategies.

For instance, those beginning to learn relaxation skills may find it less stressful to do so with an audio guide reminding them what to do, rather than memorising instructions. App reminders can also improve adherence to practising the skills outside of scheduled sessions.

That said, more is not always better, as there are many different therapeutic approaches to addressing mental health difficulties. So people may receive different or even conflicting information across various platforms or apps.

For instance, to manage work-related anxiety, some apps may promote finding calm through relaxation exercises while others may encourage exposure to the anxiety to develop emotional tolerance. This difference in approach can be confusing for users.

Ultimately, there is no one-size-fits-all solution. Those unsure which platform best suits them may benefit from professional advice.

In a hyperconnected digital world, it is unsurprising that mental health apps have gained traction among users. If you already use apps and continue to find yourself in persistent or intense emotional distress, seeking out various mental health care providers located in the community or healthcare institutions may be helpful.

As we move towards a “new normal”, expect bumps along the way. It is important to treat yourself with compassion. Your emotional needs are valid, and they are what make you human.

Allow yourself to seek the help you need in whatever way or form that works.

*A pseudonym was used in this commentary.

Denise Lim and Jasmine Chang are clinical psychologists at the Institute of Mental Health (IMH).

Mental health groups have seen a surge in calls since COVID-19 hit. Who are the people tirelessly manning these helplines? Find out on Heart of the Matter.