The VA’s apps sit in an awkward position among my other mental health app reviews. For one thing, there are 19 apps, rather than just one that I am reviewing. For another, mostly I try to review apps for a general audience, whereas the Department of Veteran’s Affairs is mostly creating apps for (unsurprisingly) veterans.
Now if you had asked me 10 years ago how much crossover I thought there was between military veterans and nerds, I would have said not much. That was before I, an affirmed nerd, tried and failed to join the military. That was also before, or at least the very early stages of, the nerd ascendancy. Now I’m starting to think that an organization that recruits through video games might get a few nerds in it.
Really more to the point, though, the VA is the 2nd largest socialized healthcare system on the continent, so there’s really no better place to look for professional quality apps that are being put onto the marketplace for free. The VA’s been criticized before about their approach to mental health, so they’re trying to get ahead of the curve by focusing on new methodologies, whether that’s new forms of treatment or leveraging new platforms, like mental health apps. As a result, they’ve made a big commitment by producing a wide variety of apps that are available to all. But do they rise to the level of the professionally produced apps, or are they the mental health equivalent of government cheese?
With such a wide variety of apps, you get somewhat of a wide variety of theories as well. Most are based on the principles of Cognitive Behavioral Therapy. Some are focused on Mindfulness. ACT coach is focused, unsurprisingly, on ACT.
The VA, more than almost any other mental health organization, has really focused on training clinicians on “Evidence Based Practices”, which are treatment approaches that have been shown in scientific studies to be effective in treating the diagnosis in question. The thing is, in order to make sure it’s the treatment that’s helping the person, rather than the therapist, evidence based practices tend to be “manualized.” That means that the person delivering the treatment has to follow a pretty strict protocol or script.
There are pros and cons to this approach, with one of the major cons being that it tends to take the therapist out of therapy, which is a real problem considering the therapeutic relationship is one of the most important contributors to recovery. However, when you’re thinking about therapy apps, you take away the biggest criticism of manualized treatments. From that perspective, the VA mental health apps have among the best theoretical grounding of any mental health app.
VA apps tend to fit into two categories: companion apps for professional psychotherapy that you would get in a clinic, and standalone apps for self-help. The companion apps are designed to be the perfect accompaniment to the VA evidence-based practices. They draw from the exact same well of literature, and they basically facilitate all of the take-home practices associated with these treatments. I’ll be super-duper explicit to my therapist readers here: If you’re doing Prolonged Exposure or CBT-I – use these apps. As an example of how convenient they are: for a typical prolonged exposure session, I would need a tape recorder with two tapes (or an audio recorder with two separate tracks), a weekly worksheet, a daily worksheet, and some handouts. The app has all of these in one place, easily accessible, with built in reminders for the person to do them, along with crisis contact and appointment information.
The self-help material is a bit more of a mixed bag. Some apps, like Anger and Irritability Management Skills (AIMS), are more like MOOC style courses, with educational videos that act as lectures along with programs to practice the skills that you learn from the educational part. Other apps, like PTSD coach or Concussion coach, are just collections of tools to use to manage symptoms. Like I said, all of it has a solid research basis, but the VA tended to employ a spaghetti at the wall mentality, throwing every tool they could think of at the veteran to see what sticks.
If you have a clear idea of what’s wrong and are savvy enough to evaluate the offerings, you’re going to find something you like here. If your needs are a little more vague, you’ll probably find yourself lost, and there’s not guidance to be found.
Look, I’m a pretty corny guy. I enjoy the hell out of those badly produced, over-acted safety videos that HR shows you in the first week of a new job. The ones with the Microsoft Word graphics and acting school dropouts pretending to sexually harass each other.
Still, even I think the VA stuff is pretty low quality. The graphics tend to be about clipart level of quality and the general aesthetics and color scheme range from benign to jarring.
Once you get onto the app, which is to say once you’ve gotten through the lack of guidance the main webpage I linked at the top provides, the interface is pretty simple and easy to use. Again, the content goes for quantity over quality, but you can pretty easily understand what each tool or tip is for and where it fits into the approach as a whole.
Regardless, I really have to question the choice to go cute and cheap with the graphics design, especially when you’re dealing with issues like trauma.
With the exception of combat trauma and traumatic brain injury, most veteran mental health issues are the same as general mental health issues. Additionally, there is no one else in the United States putting more money into producing a free mental health product than the VA. This includes the research supporting these practices, much of which is done at VA medical centers, and the apps themselves.
The result is probably the best integration of theory and practice that you’ll see in a free product. Too bad it’s hidden under such an ugly interface.