Abstract
BackgroundThe gap between treatment need and treatment availability is particularly wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT. This review examines DBT based apps, with a specific focus on content quality and usability.MethodsAll apps referring to DBT were identified in Google Play and iOS app stores and were systematically reviewed for app content and quality. The Mobile App Rating Scale (MARS) was used to evaluate app usability and engagement.ResultsA total of 21 free to download apps were identified. The majority of apps (71%) included a component of skills training, five apps included a diary card feature. Most (76.19%) apps were designed to function without help from a therapist. The average user “star” rating was 4.39 out of 5. The mean overall MARS score was 3.41, with a range of 2.15 to 4.59, and 71.43% were considered minimally ‘acceptable,’ as defined by a score of 3 or higher. The average star rating was correlated with the total MARS score (r = .51, p = .02). Estimates of app usage differed substantially between popular and unpopular apps, with the three most popular apps accounting for 89.3% of monthly active users.ConclusionsWhile the present study identified many usable and engaging apps in app stores designed based on DBT, there are limited apps for clinicians. DBT based mobile apps should be carefully developed and clinically evaluated.
Highlights
The gap between treatment need and treatment availability is wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT
One way of increasing availability of mental health treatment is through smartphone based mental health apps [10], and a number of consumer-facing mobile applications based on DBT have been developed to date
In addition to reporting summary statistics of the monthly active users (MAUs) data, we report two additional metrics that can facilitate the interpretation of MAU data: the Market Share Index-3 (MSI-3) and the Number Needed to Reach-90 (NNR-90)
Summary
The gap between treatment need and treatment availability is wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT. Ilagan and colleagues (2020) recently published a systematic review and metaanalysis of smartphone applications designed to intervene on symptoms associated with borderline personality disorder (BPD) [11]—a behavioral disorder which is commonly treated using DBT They found that only three studies included indicated the use of apps based on DBT. Rizvi and colleagues [12] found support for good acceptability and usability of a skills training focused app which was associated with reductions in NSSI in a small clinical sample of 16 individuals receiving standard DBT Another app based on DBT was developed and its usability and engagement was evaluated in a series of studies [13, 14]. Among apps that are currently available to consumers, it is unclear which contain essential elements integral to DBT, and even those apps which promote active ingredients of the treatment may vary widely in how usable or engaging they are
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