Staff Perspective: Seasonal Affective Disorder – Is There an App for That?
If anyone asks, “Is there an app for that?”, tell them “Most likely.” Between Google, Apple, and Microsoft there are over four million apps available for download, generating nearly $500B in revenue (Clement, 2019). Gaming apps make up the largest portion (about one in four), but social networking apps are most often used, accounting for about one-third of screen time (Mindsea, 2019).
As yet, mental health apps do not constitute a tracked category. But if you search the American Psychology Association’s website (APA.Org) you will find reviews for various mental health apps. Under each review is a disclaimer that the opinions are the author’s and not those of APA. In fact APA as an organization does not endorse any app for fear of litigation. The Food and Drug Administration only reviews medical apps (those that diagnose, track, or treat disease), such as reSET-O, a prescription-only app for those in treatment for Opioid Use Disorder (FDA, 2018).
APA did, however, recently sponsor a related webinar, “Using Apps in Clinical Practice.”* The speakers addressed such common concerns as an app’s privacy and supporting evidence. One issue that came up repeatedly during the presentation related to compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. One of the speakers, Marlene Maheu, Ph.D., executive director and current president of the Coalition for Technology in Behavioral Health (CTIBS; CTIBS.Org), an organization that offers training in telebehavioral health, had to reiterate several times that telehealth and the laws governing it are broad. She defined telehealth as the transmission and monitoring of patient data within state lines. In short, she said, if a therapist is using an app to receive and/or review data then they are engaged in telehealth. She added that as such, all the rules and regulations apply, such as the need for HIPAA compliance in the transmission of the data. For example, if the patient is in another state entering the data and the therapist is reviewing or monitoring it, they are violating HIPAA, unless they have a license to practice in both states. She concluded this section by saying that unless an app is HIPAA compliant, email and text exchanges are a violation of HIPAA. As to whose responsibility it is to ensure an app is HIPAA compliant: It’s the therapists.
Regarding evidence, Stephen Schueller, Ph.D, executive director of PsyberGuide.Org (a sort of Yelp for mental health related apps), noted that few if any apps have been used in a randomized clinical trial. As such, they should not be called evidence-based, but they may be evidence-informed. However, he added that in his review, only around 20% of apps that claim to be based on cognitive behavioral theory include related techniques.
After the webinar I was curious whether there are any apps specific to the seasonal variant of recurrent major depressive disorder, commonly referred to as Seasonal Affective Disorder (SAD). I found a couple different types of apps marketed to people with SAD.
Most people know that early morning exposure to full spectrum light has been recommended for SAD. The VA/DoD Clinical Practice Guideline for the Treatment of Depression (2016) suggests that adults with a seasonal pattern be offered light therapy. However, the evidence is graded as weak. The guideline also notes that 6,000 to 10,000-lux (a measure of illumination intensity) for 30 to 60 minutes per day has resulted in favorable short-term outcomes compared to control treatments using dim light (p. 45). The most common app I found ranged from free to $5 and stated they would turn my phone into a light box. But when I finally found the app’s specifications – if they were available – I read that the emitted light’s rating was only between 100-600 lux.
To anyone who understands electricity (I don’t), it should be no surprise that your smart phone is incapable of reproducing the power of medical grade light boxes. The standard smart phone only uses about 1 watt, whereas true light boxes use around 35 watts.
To anyone who understands math (I don’t), if you were going to try and use this type of app to address SAD, even the brightest, most powerful smart phone would probably require 10-20 times the exposure compared to a medical grade light box. The shortest effective exposure timeframe I could find in the research on actual light boxes was 18’ with the average around 30’. So that’s around 5 hours exposed to the light from the smart phone. That would take you well past early morning.
One of the app makers did cite research. But the study (Meesters, Winthorst, Duijzer & Hommes 2016) looked at the effect of low-light on people who did not meet full criteria for MDD.
A related type of app I found took advantage of the common notion that light therapy for SAD has to be blue. This type of app basically had natural scenes with blue in them, such as water and the sky. But the same issues mentioned above apply here: The light just isn’t bright enough to do the job.
A third type of app I found catering to people who thought they had SAD is what’s known as a “dawn simulator”. These apps combine an alarm with the camera light function to gradually intensify over an hour to try and simulate the rising sun. Some were free. Some charged a dollar or more.
Whereas the 2009 VA/DoD CPG recommended dawn simulation, it was removed in the 2016 version. However, you can find numerous anecdotes that using these simulators helps with jet lag, weaning off coffee, and other maladies.
Overall, contrary to the opening line above, there isn’t an app for SAD.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Dave Reynolds, Ph.D., is the Military Internship Behavioral Health Psychogist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Reynolds is currently located at Malcolm Grow Medical Clinics and Surgery Center (MGMCSC), Joint Base Andrews, Maryland.
References
Clement, J. (2019). Mobile app usage – statistics and facts. Retrieved from: https://www.statista.com/topics/1002/mobile-app-usage/
FDA (2018). FDA clears mobile medical app to help those with opioid use disorder stay in recovery programs. News release. Retrieved from: https://www.fda.gov/news-events/press-announcements/fda-clears-mobile-medical-app-help-those-opioid-use-disorder-stay-recovery-programs
Meesters, Y., Winthorst, W. H., Duijzer, W. B. & Hommes, V. (2016). The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in sub-syndromal seasonal affective disorder. BMC Psychiatry, 16, 27. doi: 10.1186/s12888-016-0729-5
Mindsea (2019). 25 Mobile App Usage Statistics To Know In 2019. Retrieved from: https://mindsea.com/app-stats/
VA/DoD (2016). Clinical Practice Guideline for the Treatment of Depression. Retrieved from: https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf
* APA members who would like to watch the webinar mentioned can find it at: https://www.apa.org/members/content/secure/clinical-practice-apps
If anyone asks, “Is there an app for that?”, tell them “Most likely.” Between Google, Apple, and Microsoft there are over four million apps available for download, generating nearly $500B in revenue (Clement, 2019). Gaming apps make up the largest portion (about one in four), but social networking apps are most often used, accounting for about one-third of screen time (Mindsea, 2019).
As yet, mental health apps do not constitute a tracked category. But if you search the American Psychology Association’s website (APA.Org) you will find reviews for various mental health apps. Under each review is a disclaimer that the opinions are the author’s and not those of APA. In fact APA as an organization does not endorse any app for fear of litigation. The Food and Drug Administration only reviews medical apps (those that diagnose, track, or treat disease), such as reSET-O, a prescription-only app for those in treatment for Opioid Use Disorder (FDA, 2018).
APA did, however, recently sponsor a related webinar, “Using Apps in Clinical Practice.”* The speakers addressed such common concerns as an app’s privacy and supporting evidence. One issue that came up repeatedly during the presentation related to compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. One of the speakers, Marlene Maheu, Ph.D., executive director and current president of the Coalition for Technology in Behavioral Health (CTIBS; CTIBS.Org), an organization that offers training in telebehavioral health, had to reiterate several times that telehealth and the laws governing it are broad. She defined telehealth as the transmission and monitoring of patient data within state lines. In short, she said, if a therapist is using an app to receive and/or review data then they are engaged in telehealth. She added that as such, all the rules and regulations apply, such as the need for HIPAA compliance in the transmission of the data. For example, if the patient is in another state entering the data and the therapist is reviewing or monitoring it, they are violating HIPAA, unless they have a license to practice in both states. She concluded this section by saying that unless an app is HIPAA compliant, email and text exchanges are a violation of HIPAA. As to whose responsibility it is to ensure an app is HIPAA compliant: It’s the therapists.
Regarding evidence, Stephen Schueller, Ph.D, executive director of PsyberGuide.Org (a sort of Yelp for mental health related apps), noted that few if any apps have been used in a randomized clinical trial. As such, they should not be called evidence-based, but they may be evidence-informed. However, he added that in his review, only around 20% of apps that claim to be based on cognitive behavioral theory include related techniques.
After the webinar I was curious whether there are any apps specific to the seasonal variant of recurrent major depressive disorder, commonly referred to as Seasonal Affective Disorder (SAD). I found a couple different types of apps marketed to people with SAD.
Most people know that early morning exposure to full spectrum light has been recommended for SAD. The VA/DoD Clinical Practice Guideline for the Treatment of Depression (2016) suggests that adults with a seasonal pattern be offered light therapy. However, the evidence is graded as weak. The guideline also notes that 6,000 to 10,000-lux (a measure of illumination intensity) for 30 to 60 minutes per day has resulted in favorable short-term outcomes compared to control treatments using dim light (p. 45). The most common app I found ranged from free to $5 and stated they would turn my phone into a light box. But when I finally found the app’s specifications – if they were available – I read that the emitted light’s rating was only between 100-600 lux.
To anyone who understands electricity (I don’t), it should be no surprise that your smart phone is incapable of reproducing the power of medical grade light boxes. The standard smart phone only uses about 1 watt, whereas true light boxes use around 35 watts.
To anyone who understands math (I don’t), if you were going to try and use this type of app to address SAD, even the brightest, most powerful smart phone would probably require 10-20 times the exposure compared to a medical grade light box. The shortest effective exposure timeframe I could find in the research on actual light boxes was 18’ with the average around 30’. So that’s around 5 hours exposed to the light from the smart phone. That would take you well past early morning.
One of the app makers did cite research. But the study (Meesters, Winthorst, Duijzer & Hommes 2016) looked at the effect of low-light on people who did not meet full criteria for MDD.
A related type of app I found took advantage of the common notion that light therapy for SAD has to be blue. This type of app basically had natural scenes with blue in them, such as water and the sky. But the same issues mentioned above apply here: The light just isn’t bright enough to do the job.
A third type of app I found catering to people who thought they had SAD is what’s known as a “dawn simulator”. These apps combine an alarm with the camera light function to gradually intensify over an hour to try and simulate the rising sun. Some were free. Some charged a dollar or more.
Whereas the 2009 VA/DoD CPG recommended dawn simulation, it was removed in the 2016 version. However, you can find numerous anecdotes that using these simulators helps with jet lag, weaning off coffee, and other maladies.
Overall, contrary to the opening line above, there isn’t an app for SAD.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Dave Reynolds, Ph.D., is the Military Internship Behavioral Health Psychogist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Reynolds is currently located at Malcolm Grow Medical Clinics and Surgery Center (MGMCSC), Joint Base Andrews, Maryland.
References
Clement, J. (2019). Mobile app usage – statistics and facts. Retrieved from: https://www.statista.com/topics/1002/mobile-app-usage/
FDA (2018). FDA clears mobile medical app to help those with opioid use disorder stay in recovery programs. News release. Retrieved from: https://www.fda.gov/news-events/press-announcements/fda-clears-mobile-medical-app-help-those-opioid-use-disorder-stay-recovery-programs
Meesters, Y., Winthorst, W. H., Duijzer, W. B. & Hommes, V. (2016). The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in sub-syndromal seasonal affective disorder. BMC Psychiatry, 16, 27. doi: 10.1186/s12888-016-0729-5
Mindsea (2019). 25 Mobile App Usage Statistics To Know In 2019. Retrieved from: https://mindsea.com/app-stats/
VA/DoD (2016). Clinical Practice Guideline for the Treatment of Depression. Retrieved from: https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf
* APA members who would like to watch the webinar mentioned can find it at: https://www.apa.org/members/content/secure/clinical-practice-apps