- Mood Tools: http://www.moodtools.org/ Apple Store Play Store
- Fear Tools: http://www.feartools.com/ Apple Store Play Store
- Panic Shield: http://www.panicshield.org/ Apple Store Play Store
The websites for these three apps, and the apps themselves, provide little information about the origins and individuals behind them. I had to dig around a little bit to learn that they were created by Eddie Jiu and Nancy Su, two Duke University psychology and neuroscience students. Both students are pursuing graduate degrees and careers in psychology – Jiu as a psychiatrist, and Su as a psychologist, but they created their flagship Mood Tools app when they were undergraduates.
I’m lumping all of their apps together because they are basically the same structure and theory, just targeting different conditions. Mood Tools is focused on Depression, although there is some content in there for Bipolar Disorder. Fear Tools generally targets anxiety, although I would say it’s most appropriate for phobic anxiety. Panic Shield deals with Panic Disorder. An article I found from 2016 talked about plans to create a PTSD app, but if they’ve done it I haven’t been able to find it.
These apps provide some of the most by-the-book applications of Cognitive Behavioral Therapy for the given conditions that I have ever seen. So the theoretical effectiveness of these apps basically live or die by the theoretical effectiveness of CBT. CBT is still probably the most common form of psychotherapy in the United States, and in many cases it’s still probably among the most effective. CBT seems to be particularly effective for anxiety disorders, making Fear Tools and Panic Shield probably the best match between theory and condition.
In 2015, a big study came out that showed that the effectiveness of CBT for depression has actually gradually decreased since it was first introduced in the 1970s. This really rocked the world of pure CBT practitioners; it was the equivalent of saying “Hey, Penicillin isn’t really working as well anymore these days,” except all the doctors now had to go back to school for anywhere from 2 weekends to a full year again to learn how to use Amoxicillin.
The Penicillin comparison is pretty good, because part of the reason this is happening is overuse.The central concepts of Cognitive Behavioral Therapy – that the way you think and the way you behave can be altered to improve your mood – were much more novel back in the 1970s. I think the best example of this is the idea of self-esteem: a brand new concept when CBT was introduced, and a common feature of junior high health class now.
Mood Tools takes about a 1/2 step beyond basic CBT by incorporating some meditation videos. This isn’t a bad idea – mindfulness is a super-effective tool for treating anxiety and depression, but the meditations feel like much more of an afterthought. They also clash thematically. Where the rest of the app is pretty no-nonsense and scientific, the meditations have titles like “Healing Spirit.”
Each of the apps basically has three types of content: Information, Assessment, and Interventions. Information appears to be synthesized snippets from sources like WebMD and American Psychological Association (APA), and covers a range of topics from basic information about depression, to details about different treatment options. There’s a lot of good information there, it’s well organized, and it’s cut up enough to not feel overwhelming. They made the choice to go broad rather than deep, which again I think is a bit of a mismatch with the overall app. For example, they have a good bit of information about ACT and DBT as treatments for mood disorders, which is nice but doesn’t match well with the rest of the app’s explicit CBT focus. I would rather see more information about how to self-administer cognitive restructuring or behavioral activation.
The rest of the content appears to be adapted right out of some of the current CBT manuals. The assessments are the same assessments that you would see used in a mental health clinic: the PHQ-9 and the GAD-7. These are what many therapists would use to quickly check for the presence of clinical levels of depression or anxiety, and track progress. They also released some companion apps with tests for PTSD and Bipolar Disorder.
The interventions are basically some of the exact same worksheets I would send a client home with, just adapted from pen-and-paper to a smartphone. Each app has a thought record tool that is basically a three column thought record. The Mood Tools app has a behavioral activation worksheet with suggested activities and a safety plan for suicide. Fear Tools has a deep breathing counter and exposure hierarchy. Panic Shield has these as well as interoceptive exposure. If you have no idea what these kinds of tools are, fear not! The app avoids technical jargon, calling interoceptive exposure “internal exposure” and behavioral activation “activity tracking,” along with giving a good amount of explanations of each tool.
If it sounds like I’m knocking the app for a lack of creativity, I’m not. What this app basically does is takes professional-level CBT tools and put them on a smartphone. What it doesn’t do is really take advantage of the other capabilities of a smartphone. There’s no real effort to promote integrating these apps into your lifestyle through notification or sensor-tracking. There’s also no Ecological Momentary Intervention, where an algorithm takes data that is gathered either through user input (like answering questions) or sensors and uses that to make a recommendation for a tool to use. This is advanced stuff, and may be a little bit much to expect from a free tool.
The three apps share a general aesthetic, albeit with different colors. The interface is clean and minimalist. You get a (fairly cursory) introduction the first time you open the app, and after that you go into the home screen with just a few icons to link to the app content. There’s a mix of information that is presented by text and links to other resources, like TED Talks or the meditation videos.
There’s not a lot of guidance on how best to pull the different pieces of the app together. I’m not sure if the developers planned this primarily as a self-help tool or a therapist aid, but I think it works a little bit better as the latter. I like to introduce these tools after I’ve done a little bit of the psychoeducation myself, and I’ll basically introduce them to one tool per week. I use this more for clients that are a little more diligent or organized, because the lack of reminders means that they have to get themselves to sit down and actually use the tool. I don’t take any points off for this, because I think it’s a valid choice to do less hand-holding than some apps like Pacifica.
It wasn’t until I sat down to write this review that I realized there is even a paid version of these apps, and all the paid version does is allow you to password protect the app and change the color scheme. What I’m saying is that these are basically free apps, and what they provide is amazing for a free app. I recommend them particularly to therapists who like to pretty strictly adhere to a CBT framework and just want an easy way for their clients to do the between-session work. They’re also a pretty good self-help app for self-starters or people who really want to set their own self-help agenda.