Promoting Mental Health — 8

Although sensor capture of continuous or high frequency data from individuals in their real world is now feasible for tracking mental health, it has yet to be used in clinical practice at any scale. There are challenges with data analytics, adherence, privacy and security of data, and lack of compelling evidence from randomized trials in diverse populations.

Mindstrong was one of the first companies to pursue digital tracking for mental health, using a person’s interaction with their keyboard for typing speed, typos, and tapping and scrolling patterns to reflect changes in mood. In the rush to market, this digital biomarker was never adequately validated in clinical trials, and there was lack of trust and engagement from clinicians, ultimately leading to the demise of the company in 2023. Perhaps the failure will be instructive for the many other companies who are working on digital tracking for mental health.

The results from 145 randomized trials of mobile phone apps for mental health with nearly forty-eight thousand participants did not provide any strong evidence of benefit, although some of the studies for anxiety, stress, and depression were graded as “providing highly suggestive evidence” of slight effects. Meditation apps like Headspace and Calm, which use soothing audio and breathing exercises, have become popular, but the evidence for reduction of anxiety and stress remains underwhelming. On the other hand, a large randomized controlled trial of self-administered mindfulness interventions, including those directed to breathing and walking, did reduce short-term stress.

The prospects for dCBT apps are somewhat more favorable. A recent review of fifty-six randomized trials found about a 25 percent reduction of depression and anxiety metrics, especially notable in Internet-based dCBT trials with larger effect sizes and longer duration of benefit. The smartphone app Rejoyn, by Otsuka Pharmaceuticals, for people with at least moderate depression, was the first to be FDA cleared for mental health, even though it did not fulfill the clinical trial’s primary endpoint. Used as an adjunct to antidepressant medication treatment, in a randomized trial of 386 participants who received the app compared with sham controls, there was a modest improvement in a depression rating scale. In a randomized trial of a therapist-supported dCBT for reducing anxiety and depression in 194 people with chronic physical conditions, twelve weeks of therapy led to a significant reduction of psychological distress during the COVID-19 pandemic. The benefit was more substantial than all previous trials and in comparison to eighty-three digital interventions for depression in over fifteen thousand participants. Similarly, dCBT significantly reduced postnatal depression and anxiety in a randomized trial of twelve hundred pregnant women. There is no shortage of non-FDA-cleared dCBT apps on the market, including Sanvello, MindDoc, Happify, Evolve, CBT-i Coach, Mindshift CBT, MoodMission, and many others, most of which charge, with a range from $5 to $50 per month. Many of these are indexed at mindapps.org.

Flotation therapy is getting popular in the United States, with an estimated four hundred float centers at which people can float in a tank of warm salt water for about an hour. The limited evidence for helping mental and physical health is based on two randomized trials that provided modest data supporting a salutary effect on sleep, blood pressure, muscle tension, and anxiety symptoms.