Shrink vs. Anxiety & Depression Test: Measuring progress toward change
Name: Daniel Gaztambide, PsyD
Class: Clinical Psychologist
Available For: Real life.
Round 1: Functionality & Strengths
Depression Test & Anxiety Test are two mental health apps developed by Baris Sarer. They are essentially app-based versions of the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), two questionnaires that are used as screening tools in routine care for major depression and various anxiety disorders (GAD, Panic Disorder, etc). They have also been useful in figuring out if treatment is working and helping you feel better (you can find some research literature on them here and here).
I think using research based tools to evaluate whether you're getting better is really important. It informs you as a consumer on whether the work you are doing, whether in psychotherapy or by trying out healthy behavior on your own, is effective and leading to positive changes. These two apps, with a very similar and easy to use design, allow you to draw on the same tools psychotherapists and other mental health providers use to track changes in functioning.
The user interface for both apps is sleek and easy to use. They will automaticallyload to "The Test" screen, which will display a brief description of the PHQ-9/GAD-7, followed by a short but sweet inspirational quote.
Then there is the test proper, where you will answer 9 items for the PHQ or 7 for the GAD. Each item will ask you to rate how often you've been bothered by certain problems over the past 2 weeks, from "Not at all" to "Nearly everyday."
After answering all the items you'll be transferred to the "Results" screen, where you can see your results by date and time, with a brief interpretation and recommendation. On the next screen, "History," you'll see each time you've taken the test charted over time.
I tested the PHQ-9 out by portraying someone with a moderate amount of depression. True enough, the test picked up on that, and it scored and charted accordingly. This was on January 14th. You'll notice the line rising across time and the data point changing coloring to light orange, indicating worsening symptoms.
Roughly a month later I retook the PHQ-9 and mimicked someone who was now feeling better, and either engaged in some behavior change independently, or with the help of a mental health professional. The PHQ-9 noted the change as well, with a brief feedback recommending periodic monitoring if you know you have either a prior history of depression, or a pronounced family history. On the right you'll see the results charted, noting a change by the line sloping downwards, with the data point now turning green to mark improvement and reduction of symptoms.
Hitting the lower far right button will take you to the "Info" screen, which has some information on the different ranges for the measure (no depression/anxiety, mild, moderate, severe), credits, and additional educational resources. On the GAD-7 version of the app, it also includes a brief disclaimer on the limitations of liability for the app.
Round 2: Very Limited vs Highly Specialized
Both of these apps are incredibly simple and easy to use. But one has to be very aware of their purpose in order to use them effectively. Using these apps is a simple and cost-effective way for you, when engaging in behavior change alone or with a mental health provider, to track your progress. Being able to give yourself and your care provider some form of feedback on how things are going is becoming more and more crucial each day, and these apps provide a straightforward way of doing so, either by completing them on a weekly or monthly basis. That being said, let's look at my final verdict on Baris Sarer's "Test" series.
These are two very straightforward tools designed to do one thing: help you track symptoms of anxiety or depression over time. However, the app requires you to remind yourself to do this periodically. It does not have a system for setting up reminders or push notifications every week/month, etc. Hence, if you are very proactive, or have a therapist who helps remind you to track your progress, this will be shoe in. If you are engaging in behavior change by yourself, and aren't able to keep up with them, the apps may sit on your phone--all lonely and looking for love. 3.5 couches out of 5.
The design for both apps is well streamlined and easy to use and navigate. It gets the job done, and gets it done well. 4 couches out of 5.
OUTCOME MONITORING & FEEDBACK:
These apps were essentially put together with outcome monitoring in mind. They take evidence-based screenings and measures of change, and puts them right on your phone. Importantly, they include a chart that tracks your symptoms scores over time. What might have taken this function to the next level for personal use would have been some "call to action" based on the feedback. For example, if these apps could somehow synchronize with other mental health apps that are based on teaching skills for managing anxiety and depression, then ask the user if they would like to switch to them. Alternatively, a pop up either praising the user for making progress, or recommending getting professional help, could itself be an important form of feedback. These functions, however, are in addition to the specific function these apps were designed to perform. 4 couches out of 5.
Along the same lines, I could use these apps with a client to replace paper forms, and encourage them to them as part of our work to track progress over time. When we chart your progress over time, what do you notice helps? What doesn't? What would take these apps to the next level would be to include an option for the user to either text or e-mail the results to their therapist, using some ID so that no private health information (client's name, cell number, etc) is actually transmitted. That way the clinician could receive real time feedback and prepare for the next session.
SHRINK VS. APP:
As much praise as I can heap on these two apps, they are, like many mental health apps, limited in what they can do to help people safely engage in behavior change. Some mental health apps could be helpful for people with mild, in some rare cases even moderate, depression or anxiety. However, the greater the level of impairment, the more likely actual treatment with a mental health provider is called for. This app series in particular has a very specific function. Outside of that, it does not teach any other skills relevant to treatment anxiety or depression. Nor should they. They do what they are designed to do. Hence, 0 couches out of 5 on this dimension.