The widespread habit of owning and using smart devices affects millions globally. Usually associated with young people, this type of habit affects almost all demographics and can seriously affect mental well-being and daily habits contributing to poor sleep quality, heightened levels of stress, anxiety, and depression. Awareness of the potential problems that may arise with smartphone overuse is essential for mental healthcare providers to help their clients identify, manage, and overcome the difficulties. Phones have evolved from being tools for communication to an all-in-one device where our entire world can now be accessed with just a few taps. Having easy access to the world makes smartphones incredibly useful but also creates a powerful pull that many people find hard to resist. It is important to manage digital literacy in an ever-growing digital world with healthy boundaries, particularly for those with a psychiatric disorder.
Psychiatric disorders have an immense impact on the quality of life, socioeconomic functioning, and life expectancy. Simultaneously, there is a gap between the need for treatment and the number of patients receiving treatment. The shortage of treatment resources leads to delays in treatment, financial issues, and most importantly stigma surrounding mental health issues preventing individuals from seeking help or receiving appropriate treatment.
People with psychiatric disorders have conditions that are associated with socioeconomic disadvantages, limited education, symptoms, and cognitive impairments that may act as a barrier to receiving treatment. Limited income may act as a barrier for patients to acquire a smartphone, some insurance companies in some countries offer phones, including smartphones, to most people with psychiatric disorders at low cost as a tool to aid in the management of patients with psychiatric disorders.
Digital treatment strategies, including smartphone-based interventions, have emerged as promising approaches to address challenges in mental health services. Smartphone-based treatment interventions are easy to use by patients in various geographical locations and provide support between outpatient appointments. Furthermore, smartphone-based treatment interventions can be accessed at the patient’s convenience and offer flexibility in engaging with their treatment allowing them to follow their own pace in comfortable settings. Using smartphone-based treatment interventions allows for personalized approaches tailoring and addressing the treatment to the patient’s specific needs and preferences. The personalization and tailoring to specific needs and preferences may enhance user engagement, motivation, empowerment, and illness insight.
The relationship between social media and mental health has received much attention from not only the academic literature but also the traditional media and the community. Frequently accessed via smartphone apps and connecting people from their own devices to global networks of friends, information, and health resources, social media can represent both a means to quantify mental health and a source of both positive and negative interactions.
Social media can also be used as a therapeutic tool. For example, the PRIME app is designed to help people with schizophrenia through the promotion of functional recovery and the alleviation of negative symptoms (e.g., motivation) through a supportive and personalized network. Specified platforms are another example of an innovation that offers personalized therapy combined with social connections along with other features.
However, social media is not without risk. Disinformation and stigma on social media are forces that cannot be ignored. Stigma on social media is common, although efforts are also underway to challenge and reverse this trend. Using social media for mental health work also remains a catalyst for ethical partiality.
DIGITAL PSYCHIATRY WITHIN SPECIFIC DISORDERS
Symptom monitoring is an important strategy to prevent relapses in patients with bipolar disorder and schizophrenic disorders. Smartphone apps are easy-to-use, low-cost tools that assist with symptom monitoring in daily life. To our knowledge, this is the first method that successfully embedded a smartphone-based monitoring strategy in patients’ daily lives over such a long time frame. With further clinical validation of smartphone data, it may be possible to provide smartphone-based monitoring tools for routine care, which may benefit patients and doctors. Despite expressed concerns that patients with schizophrenia may reject smartphone interventions or that using technology may increase their paranoia, no evidence of serious adverse effects of smartphone use in any of the studies was found. There have been no reports of patients becoming decompensated, more disorganized, delusional, or paranoid because of smartphone use. Rather, patient response was overall positive and they found using a smartphone to be easy and often helpful.
While those outside of the mental health field at times wonder if smartphones and digital technology could induce paranoid delusions in people with schizophrenic spectrum disorders, the reality is quite the opposite. People with psychosis/schizophrenia are interested and eager to use innovative tools to possibly augment their care and ultimate recovery.
Remote monitoring is of interest in psychotic disorders, especially to augment self-reported information when cognition may be overly impaired. Real-time and in-context patient-generated symptom data, obtained through remote-monitoring platform technology, have the potential to timely warn clinicians about the need for intervention, improve treatment decisions by providing a clearer picture of changing patterns of symptoms, and support scheduling of health care contacts based on need. Furthermore, Smartphones may help predict the risk of relapse in people with schizophrenia People with schizophrenia were less likely to send or receive text messages or spend time on outgoing calls in the period that preceded a psychiatric relapse
Depression And Anxiety
Depression and anxiety disorders are among the most common types of mental health conditions globally, and many more individuals experience sub-threshold but disabling symptoms. Due to the high demand for self-management strategies for depression and anxiety, smartphone apps claiming to help with these problems are widely available on app marketplaces.
A recent large-scale meta-analysis of randomized controlled trials explored the efficacy of smartphone apps for mental health problems including depression and anxiety across clinical and non-clinical populations. For depressive symptoms, this meta-analysis found that smartphone apps outperformed control conditions, with larger effect sizes found when waitlists or educational resources (health tips, information) were used compared to attention/placebo controls (e.g., gaming apps). Smartphone apps also outperformed control conditions for generalized anxiety and social anxiety symptoms. App interventions for anxiety did not differ significantly from face-to-face or other computer-based interventions in terms of outcomes, although only a small number of studies were used in these comparisons. For both depression and anxiety, studies that provided professional support alongside the smartphone app (e.g., through supportive phone calls or personalized therapist feedback) produced larger effect sizes compared to studies that did not.
Eating Disorders
The interest in smartphone app technologies for eating disorders is growing, either as a standalone intervention or an adjunct to traditional treatment services.
People with eating disorders are a clinical group that could be well suited to app-based interventions, as the ego-syntonic nature of these conditions usually results in treatment refusal, ambivalence to change, or low motivation to engage in the therapeutic process. The ability for apps to allow an individual to approach treatment at his/her own pace might address these concerns and could help individuals feel more in control of their treatment. Similarly, personalized reminders and motivational messages to practice key therapeutic skills may help increase these patients’ motivation and adherence to the treatment program.
Most importantly, a recent survey shows that a significant proportion of individuals with an eating disorder report a preference for, and willingness to use, smartphone apps and others indicating that their demand is high.
CONCLUSION
The role of the Internet and digital technologies in providing wider access to psychological interventions and mental health care has been long discussed. However, only in recent years have the abilities, affordability, and accessibility of ever-present internet devices (particularly smartphones) advanced to such a point as to allow digital psychiatry to move from a theoretical concept to a realistic option for enhancing traditional mental health care globally. Overall, it now seems inevitable that digital technologies will change the face of mental health research and treatment. The extent to which these changes are genuinely beneficial for those with mental disorders will depend on equitable access, robust research, and ethical, evidence-based implementation of these new technologies within global mental health care along with patients’ development of digital literacy with healthy boundaries.
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