Smartphones offer genuinely new ways for people to interact with mental health interventions. To attend therapy with a clinician, patients have to engage in 50 minute consultations, days or weeks apart. To engage with computerised CBT interventions, users have to work through a series of modules akin to an online course. Both modalities rely on individuals learning skills during the session, then hopefully being able to apply them when they re-enter difficult situations in their life. Mobile apps have the potential to radically alter this paradigm.

 

MoodMission aims to capitalise on the incredible flexibility, portability, and adaptability of mobile apps. When a user feels anxious or low, they simply open the app, report how they feel with three taps, and are immediately offered five different “Missions” they could use to cope. Missions are evidence-based mental health and well-being tools, and MoodMission draws the top five suggested from a database of over 200 different strategies. This includes everything from yoga poses to fitness exercises, to cognitive restructuring, to mindfulness meditations, and more. There is even a machine-learning algorithm, akin to your Netflix recommendations, that helps choose which of those 200 might be a good fit for you.

 

 

Many mental health mobile apps are simple adaptations of workbook resources or online therapy courses. This neglects the strengths of apps; that they can be used in almost any situation, at any time, by anyone with a phone. Mental health problems usually fluctuate across contexts, for example, someone with social anxiety may feel most anxious when surrounded by people at an event. They could then pull out their phone and quickly find a coping strategy for their anxiety.

 

Another drawback of many mental health mobile apps is their lack of supporting research evidence. They may be built on principles of evidence-based therapies, like Cognitive Behavioural Therapy (CBT), but don’t have published research showing the effectiveness of the app itself. MoodMission was developed as part of a doctoral research thesis, so empirical validation was essential from the start.

 

The process started with publication of a literature review, presenting 16 recommendations for mental health apps (Bakker et al., 2016). MoodMission was then designed to fulfil all 16 recommendations, and pilot evaluation found that it was rated significantly higher than other health apps across criteria of Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Bakker et al., 2018a).

 

After MoodMission was released on the public app stores, it collected data on the mental health and wellbeing of users with a small battery of surveys at the start of use and 30 days later. It was found that users who engaged more with MoodMission experienced greater increases in mental well-being (Bakker & Rickard, 2019). It was also found that users who experienced a moderate level of depression or anxiety experienced improvements in coping self-efficacy, which then decreased their levels of depression and anxiety. This effect was not observed for users with mild or severe levels of depression or anxiety, which supports the notion that mental health apps like MoodMission are most effective at moderate levels of mental ill-health. People experiencing severe mental health issues are in need of more intensive interventions.

 

A randomised controlled trial compared MoodMission to two other apps and a waitlist control group and found the same effects on mental wellbeing (Bakker et al., 2018b). It also found that MoodMission users experienced significant reductions in depressive symptoms, and that coping self-efficacy, rather than emotional self-awareness or mental health literacy, acted as a mediator. It appears that apps like MoodMission help users improve their confidence in their ability to cope. This then helps them improve their mental health over time.

 

MoodMission continues to be available on the app stores, and continues to collect deidentified data for ongoing research. For example, Aizenstros et al. (2021) studied the behavioural activation Missions contained within MoodMission. Behavioural activation is a specific type of CBT treatment for depression. Their study found how greater engagement in MoodMission predicted how positively behavioural activation strategies were appraised. The massive variety of strategies contained within MoodMission allows comparison of many different interventions, for example, another researcher is currently investigating whether making a Mission social (e.g. playing a video game with a friend) or not (e.g. playing a video game alone) provides mental health benefits. Another lab group is using advanced statistical models to generate user profiles and determine how MoodMission benefits different sorts of users.

 

As more and more of this research is published, it will help clinicians and developers make their interventions even more tailored. What helps one individual facing a specific problem may not work as well for someone else facing a different problem. The more tailored interventions can become, the more effective they can be.

 

MoodMission is a flexible intervention that can be used preventatively, as a stepped-care support, and as an adjunct to therapy with a clinician. As a psychologist, engaging clients in therapy between sessions can be tricky, with therapy homework often forgotten, misapplied, or not generalised. Homework is often scrawled on a piece of paper, which the client may not have access to when they most need it. Sometimes they try the strategy, but it doesn’t work first time, so it is abandoned and nothing else is tried. MoodMission offsets these limitations by giving clients access to their homework strategies at all times, across most situations, and the app can offer alternative strategies if the first one doesn’t land.

 

We’re very proud of the work that MoodMission has accomplished and we hope the app can continue to make a difference in people’s lives. As a social enterprise, all revenue generated by the app is reinvested in the app’s improvement. We also remain committed to ongoing research so all mental health interventions can benefit from our experiences.

 

To find out more and download MoodMission, visit www.moodmission.com.

 

References:

 

  • Aizenstros, A., Bakker, D., Hofmann, S. G., Curtiss, J., & Kazantzis, N. (2021). Engagement with smartphone-delivered behavioural activation interventions: a study of the MoodMission smartphone application. Behavioural and Cognitive Psychotherapy, 49(5), 569-581.
  • Bakker, D. and Rickard, N. 2019. Engagement with a cognitive behavioural therapy mobile phone app predicts changes in mental health and wellbeing: MoodMission. Australian Psychologist 54, 4: 245–260. https://doi.org/10.1111/ap. 12383
  • Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016). Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR mental health, 3(1), e4984.
  • Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2018a). Development and pilot evaluation of smartphone-delivered cognitive behavior therapy strategies for mood-and anxiety-related problems: MoodMission. Cognitive and Behavioral Practice, 25(4), 496-514.
  • Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2018b). A randomized controlled trial of three smartphone apps for enhancing public mental health. Behaviour Research and Therapy, 109, 75-83.