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September, 2016

Reaching for your phone to help with stress and sleep might feel counterintuitive, but there are now hundreds of apps out there to help us find inner peace. With even the NHS on-board, there must something in it

To the smartphone-addled among us, advising the use of apps to fix mental health problems might seem like telling someone who needs to get fit to live on jam and fags. But it’s happening all the same. While gadget and social media addiction are lampooned for increasing teenage depression, and complaints abound that the constant compulsion to check apps and message conduits leaves us frazzled and scatterbrained, purveyors of wearable tech, app designers and even the NHS really want us to use our phones for soul-soothing.

The idea of treating mental health digitally is not new. A PC-based online cognitive behavioural therapy (CBT) treatment for depression has been in clinical use for seven years now – rolling out newer such services via smartphone apps will make this kind of treatment even more accessible. Meanwhile, there are more than 500 mindfulness apps, offering meditation soundtracks, relaxation techniques and pearls of wisdom, not to mention the many fitness/self-optimisation apps making forays into mood tracking. Everyone’s at it, from Apple Watch’s Breathe, to the guy who invented the online monster adoption game, Moshi Monsters, Michael Acton Smith. Scrolling through his mindfulness app, Calm’s, sensory front page options – rain falling on foliage, a mountain lake – is blissful, but can increasing reliance on phones really help us find peace?

There is evidence that mental health apps can work. This summer, it was announced that Sleepio, a digital CBT programme for tackling insomnia, has had a successful NHS “real-world” trial, after being offered via the Manchester service, Self Help (this follows a placebo-group randomised control trial . The app assesses users’ worries, sleep schedules, lifestyle and bedrooms, before teaching them CBT techniques. Through improving their sleep, the 98 participants saw a 68% recovery rate from anxiety and depression symptoms, compared with an NHS average of 45%.

The app was co-created by Peter Hames, an NHS Innovation Fellow, and Colin Espie, who is professor of sleep medicine at Oxford University. It has already been privately administered to more than 750,000 staff members at US companies such as Comcast, LinkedIn, Boston Medical Center and the Henry Ford Health System. And Sleepio’s parent company, Big Health, recently secured $12m funding, to further scale up delivery of drug-free, mental-health treatments.

Meanwhile, the wearable-tech industry is extending its offer into the realm of stress relief. The idea being that devices can track personal biometrics, and then that data can be used to positively influence changes in our behaviour. Fitness brands such as the Misfit Ray and Jawbone Up3 offer rudimentary sleep tracking, and the opportunity to recognise causes for soaring resting heart rates. The upcoming Feel (another wristband) claims to detect mood via electrodermal activity, blood volume pulse and skin temperature. And clip-on devices Bellabeat Leaf, Prana and Spire track breathing.

When Neema Moraveji, chief scientist and co-founder at Spire, and director of the Stanford University Calm Lab, researched the physiological changes that manifest the body according to mood, he says they “found respiration to be a unique and interesting signal because you have direct control over it”. This was followed up by lab studies that, he says, “showed that if you give people feedback about their breathing, they can change it so easily that they don’t even need to stop what they’re doing”.

I started road-testing Spire while coincidentally doing a meditation course. It was encouraging to see all my calm streaks (as Spire calls them) on screen. And realising that a three-minute stress streak coincided with my computer inexplicably not allowing me to copy text from one email to another gave me a calm detachment about inevitable technical issues.

I liked that I could view my breath on screen as a wavy line. One of the app’s guided “boosts” involves following a pace-slowing dot along said line. Another “boost” talked me through alternate nostril breathing, which has a surprisingly settling effect (although I’m not sure I’d do it on the bus).

But my chill honeymoon didn’t last long. First I learned that my dad had had a mild-but-debilitating stroke, and then I accidentally reversed into a parked car while distracted by a screaming child. When I checked Spire to wallow in my dramatic breathing data, the app had detected zero stress.

I ask Moraveji whether this could be because I unknowingly breathe deeply to get through turmoil. “People do learn naturally to slow their breathing when they’re stressed,” he says, “and it might have been that you were so tense that you were holding your breath. That’s something we’re updating in the app.” My relationship with Spire isn’t over, but it no longer takes precedence over Instagram.

Claire Burge is a productivity specialist, brought in by companies (Virgin and Siemens, among others) to liberate staff from mental-energy draining, email-based cultures. She has thought about this question of phones as mental health tools a lot. “I don’t think it’s a conducive environment,” she says. “Phones create neural loops that mindfulness should counter, but that means a break away from the object that creates the neural loop in the first place.”

Even the creator of bestselling mindfulness app Buddhify, is having doubts about his industry. In a recent, widely circulated blog post, Rohan Gunatillake describes the app world as “warring fiefdoms”, battling for market domination, whereas, “community has historically always been part of the mindfulness tradition. Whether it is people practising together or teachers supporting each other with shared codes of ethics, engaging with peers is a central part of the culture”.

He also fears that the way digital mindfulness is monetised, by dangling limited free content up front, with subscriptions then offered if you want all the whistles and bells, risks financially excluding people. “The demographic is English-speaking, middle-class and financially stable,” he writes.

Moreover, mindfulness apps are largely peddling guided meditations, rather than providing the learning and insight you get from experienced teachers. Gunatillake wants to build a bridge between the two strands of mindfulness – traditional and digital – with teachers more involved in app design.

With apps reaching more people than face-to-face teaching can, he says, “nothing will influence how mindfulness is perceived and practised in our culture more in the next 20 years”.


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