Cognitive Behavior Therapy On The iPhone
Following up on last week’s entry on Psychology going digital in the form of iPhone apps, as promised, I downloaded several Psychology and Psychotherapy related apps and tried them out. The first batch of apps I looked at were apps for Cognitive Behavior Therapy, and their promising names were iCBT, eCBTmood, and CBTReferee.
To give you some background, the idea in CBT is that our thoughts, feelings, and behaviors mutually influence each other. In other words, what I think (or, simply put, the things I say to myself throughout the day) will influence how I feel, and how I feel will influence what I think. Hence, our interpretation of events in our lives influences our emotional reaction to the events. We all have automatic ways of thinking to ourselves that sometimes are a little biased, or, let’s say, “distorted.” For instance, if I walk down the street and trip, and stranger smiles, I could interpret this as “She is making fun of me and things I am stupid.” Alternatively, I could interpret it as “She smiling at me sympathetically” or “She is having a good day and his smile has nothing to do with me.” Depending on people’s interpretation, their reactions to the exact same event can be quite different.
A large part of the work in CBT is about helping people realize the connection between thoughts, feelings, and behaviors, and helping them identify and challenge their automatic distorted thoughts. One of the way of accomplishing this is by keeping a record of your thoughts (writing them down), and then identifying how the thoughts make you feel. Then, the next step is to see if the thought is biased and distorted, and to see what a balanced, realistic interpretation of the situation would look like, (in other words, to challenge distorted thoughts). Click here for more information on this type of therapy.
Back to the CBT iPhone apps: I looked at each app in terms of content, clinical utility, functionality, and appearance. Of course, I am not going to claim that this is a comprehensive review of all possible apps out there, or that this review reflects anything but my opinion on these apps. For those without an iPhone, iPod touch or iPad, I have not seen any apps on the BlackBerry and only one on the Android platform yet.
At $2.99, this app comes at a comparatively steep price for a simple iPhone app. A quick look at the website reveals that the app is supposed to be based David Burns' CBT self-help classic “Feeling Good”. The website links to a web developer company, but there is no indication that any mental health expert was involved in developing this product. The app comes without much instruction or explanation, so if you’re not familiar with CBT, you’ll have a hard time understanding what this is all about. It asks you to type in an event, pick an emotion off a list, and enter your negative thoughts. Then, you’re supposed to ”rationalize” your thoughts, but the app does not give you tips on how you’re supposed to do that.
CONTENT AND UTILITY: This app would be hard to understand for anyone who does not have a background in CBT. Can serve to replace the pen-and-paper thought record form frequently used in CBT therapy.
FUNCTIONALITY AND APPEARANCE: The home screen does not provide any guidance, but the app does the job if you’re trying to keep a thought record on your pone. Lets you email your entries but is not password protected. The look is very generic, uses stock icons.
The developer team includes a clinical psychologist. The website makes the ambitious claim that effectiveness of eCBTmood is supported by research, and offers links to peer review articles, though I would say it is questionable that the literature can be generalized to directly support effectiveness of any of the eCBT apps. The app offers a well-done explanation of the CBT model, though the online resources button leads to an empty page. Offers the ability to track your level of depression by using a questionnaire that looks an awful lot like the well-established Beck Depression Inventory. Of note, while the app is called eCBTmood, the only mood it addresses is depressed mood – other moods, such as irritable, anxious, or euphoric moods are not addressed in this app.
CONTENT AND UTILITY: Pretty good explanation of the CBT model, focused on depression. Allows to assess and track depressed mood, and to keep a thought record. I don’t really understand the point of their “Identify Your Core Beliefs” function.
FUNCTIONALITY AND APPEARANCE: While, on the plus side, this app allows you to create a graph of your mood and is password protected, it is hard to navigate and does not make good use of the back button. It basically looks like someone converted their PowerPoint presentation into an iPhone app. If you endorse that you've had thoughts of suicide, the next screen offers you a phone number for a crisis hotline. However, you can't click on the number and call the hotline, as you would would with most other apps. Also, I'm not sure why the icon on the bottom of screen has a guy running for the door. Is the app on fire?
Priced at a whopping $4.99, this is the most expensive of the three apps. The website gives no information on who’s behind this app and who developed it. The app does not really give a good explanation of what CBT is, or why you would choose to write down and challenge your thoughts, and there’s not talk about the interaction of thoughts and emotions. You’re asked to write down your thoughts, and pick out the type of automatic thought from a list and challenge the thought. There’s not much help with challenging the thoughts, either, and all-in-all, this app is rather rudimentary.
CONTENT AND UTILITY: You have to be familiar with CBT in order to figure out what to do and why this is supposed to be helpful.
FUNCTIONALITY AND APPEARANCE: This app does not go beyond any basic iPhone OS look and feel. It lacks unique design features, but on the upside, it does offer password protection. Type is very small and could be hard to read for some users.
The bottom line is that if you’re familiar with CBT or if you’re in CBT therapy, and you’re looking to replace the traditional pen-and-paper way of keeping a thought log, any of these apps can do the trick. However, none of them give comprehensive information on CBT skills, and in terms of design, it does not look like much dedication and time has gone into any of them. The home screens are non-inviting, and the designs are pretty generic. None of them are making the greatest use of all the potential great functions of the iPhone platform. Overall, it seems that CBT apps are in their early stages. Looking forward to version 2.0 for their development. Have you come across any good CBT apps?
Mood Kit - - Oct 24th 2014
After reading this post, I did some research on more up-to-date apps. As a clinical psychologist, I must say that I am very impressed with "Mood Kit." For $5, it seems to have addressed a lot of the previous concerns and functional limitations that made other (older) apps less appealing. I will be sure to statrt reccomending this app to my patients.
Information requested - Irismar de Oliveira - Jan 10th 2012
I am a certified cognitive therapist, and I am interested in finding out aout good CBT apps. This comment dates to May 24, 2010. Would you please, let me know if there are other apps that you came across? Thank you so much for this inforation.
iCouch CBT - Brian - Jul 26th 2011
There's a new CBT app now available that is a massive improvement over iCBT. iCouch CBT has comprehensive help screens and great guidance. It also allows users to email their thought records or even submit them for an evaluation by a licensed counselor. It was developed by the clinical psychologist who cofounded the iCouch.me online counseling company. It's an amazing app. The best CBT app available. Search CBT on iTunes and it'll be the top result.
iphone test - Miki - Oct 13th 2010
Tou have to test the "Beck depression inventory" for iphone at this link:
It's a useful and the best application to test your depression.
iCBT - great product! - - May 26th 2010
I recently purchased iCBT for my iPhone. It's a great product!
Still on the way... - Terry McLeod - May 25th 2010
I remember when we developed our first program for tracking addictions patient and medication records...it didn't look like much at first.
It grew with input from the field, getting better and better, and incidentally, more successfull, eventually becoming dominant in that market
The point is that it took a while.
Public acceptance of tools like youre discussing has been a long time coming (the cell phone was invented in 1973), and once a critical mass is reached, they will improve...the market dictates they must.
A friend sent me a link to a snippit from a 60 minutes broadcast interviewing the inventor of the cell phone and his take on healthcare as related to the device. It gives me hope.