Cited by 328Digital Mental Health InterventionsMobile Health and mHealth ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The DOI matches its Crossref record; 72 of the 74 references it cites were found in a registry or an index; none of the 29 sources its claims cite is checked for support yet.

A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression

Open access

Abstract

Depression is a common mental health condition for which many mobile apps aim to provide support. This review aims to identify self-help apps available exclusively for people with depression and evaluate those that offer cognitive behavioural therapy (CBT) or behavioural activation (BA). One hundred and seventeen apps have been identified after searching both the scientific literature and the commercial market. 10.26% (n = 12) of these apps identified through our search offer support that seems to be consistent with evidence-based principles of CBT or BA. Taking into account the non existence of effectiveness/efficacy studies, and the low level of adherence to the core ingredients of the CBT/BA models, the utility of these CBT/BA apps are questionable. The usability of reviewed apps is highly variable and they rarely are accompanied by explicit privacy or safety policies. Despite the growing public demand, there is a concerning lack of appropiate CBT or BA apps, especially from a clinical and legal point of view. The application of superior scientific, technological, and legal knowledge is needed to improve the development, testing, and accessibility of apps for people with depression.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review identified 117 depression self-help apps, but only 12 (10.26%) appeared consistent with CBT or BA principles. The authors conclude that these CBT/BA apps have no published efficacy/effectiveness evidence, low fidelity to core CBT/BA ingredients, variable usability, and rarely include privacy or safety policies.

Key findings

  • Of 117 apps, 12 (10.26%) were classified as CBT/BA; no studies reported in the scientific literature determined benefits for any of these CBT/BA apps.
  • Median adherence to CBT principles was 15% (range 0–75%) and to BA principles was 18.75% (range 6.25–25%); the best CBT apps were Depression CBT Self-Help Guide (75%) and eCBT Mood (55%).
  • Usability heuristic adherence had a median of 83% (range 42–98%); highest scorers were MoodTools–Depression Aid (98%), Activity Diary (98%), and Depression Cure–The Free 12 Week Course (92%).
  • Only eCBT Mood and Depression CBT Self-Help Guide offered a privacy policy, and 5 of 12 apps (41.66%) provided safety information during crisis; no relationship was found between CBT/BA adherence and usability or popularity indicators.

Methods

  • Systematic review searching scientific databases (IEEE, ACM Digital Library, EMBASE, PubMed/Medline, PsychINFO, Web of Science) in November 2015 and the Canadian Apple App Store and Android Market/Google Play in November 2015 using “depression”; inclusion required native smartphone apps exclusively for depression, publicly available in Canada in December 2015, and in English.
  • Two reviewers screened and categorized apps with Cohen’s kappa reported at 0.69, 0.85, 0.92, and 0.89 across stages; CBT/BA apps were downloaded and evaluated on usefulness (expert-rated fidelity to CBT/BA core ingredients on a 0–2 scale and literature-based effectiveness), usability (Nielsen heuristics rated 1–5), and integration/infrastructure (privacy policy and safety).
  • Analysis used counts and percentages plus Spearman correlations between CBT/BA adherence, usability adherence, and popularity/acceptability indicators.

Limitations

  • Stated: the review was limited to English downloadable apps in Canada and only the two most popular platforms; apps on less prevalent platforms, in other languages/countries, or developed and tested in academic settings were excluded.
  • Stated: CBT/BA app evaluation was based on one expert’s opinion, and an expert panel could have increased credibility; lack of common constructs, outcome measures, definitions, and standards for other app types made cross-case comparison impossible.
  • Evident from the text: the included CBT/BA apps had no published efficacy/effectiveness studies, the CBT/BA sample was only 12 apps, and usability, privacy, and safety assessments each relied on single expert evaluators.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0154248

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

Show all 55 claims

  • Probably not a substantial claim. 23
  • It may state two separate claims as one. 15
35 of 35
  • The paper relies on this without support.

    App store descriptions and manuscript descriptions accurately represent the type of support an app offers.

    “The app description displayed in the stores and any available description provided in the manuscript was the only information used by the reviewers to base their decisions on which category each app fell into.”
  • The paper relies on this without support.

    The development process, usability, feasibility, and efficacy of apps developed in the commercial marketplace are rarely assessed or reported.

    “however the development process, usability, feasibility, and efficacy of these apps developed in the commercial marketplace are rarely assessed or reported.”
  • The paper relies on this without support.

    The quality of available apps for depression had not been the subject of any systematic reviews before this review.

    “The quality of the available apps has not been the subject of any systematic reviews, until now.”
  • The paper relies on this without support.

    The search query 'depression' and the two app stores (Canadian Apple App Store and Android Market) capture the relevant available apps for depression.

    “The search was restricted to apps available through the two most popular mobile phone platforms, The Canadian Apple App Store and Android Market (Google Play). The search was made in November 2015 using ‘depression’ as the search query.”
  • The paper relies on this without support.

    Cross-referencing with apps identified in the scientific literature is sufficient to determine whether any efficacy or effectiveness study exists for the included CBT/BA apps.

    “To evaluate the effectiveness of the apps, we cross-referenced with apps identified in the scientific literature to see whether there was any efficacy or effectiveness study on apps included in the review.”
  • The paper relies on this without support.

    The expert's ratings of adherence to CBT/BA core ingredients are valid.

    “an experienced academic CBT clinician (SR) evaluated the apps for their level of fidelity to theoretical CBT and BA principles by exploring what extent the apps included the core ingredients of these models.”
  • The paper relies on this without support.

    The usability expert's ratings are valid.

    “a user experience designer (MW), who regulary performs expert reviews on mobile apps and websites, where he applies heuristics and professional experience to evaluate user interfaces and suggest design improvements, evaluated the usability of the apps.”
  • The paper relies on this without support.

    The number of downloads, user ratings, and reviews are valid indicators of an app's popularity.

    “Also, no relationship was found between level of adherence of the app to the theoretical models and the indicators of popularity (range = rs = -0.02, p = 0.96 and rs = 0.57, p = 0.18), or between level of adherence of the app with the heuristic usability with the indicators of popularity (range = rs = 0.15, p = 0.68 and rs = 0.59, p = 0.07).”
  • The paper relies on this without support.

    The core ingredients of CBT and BA used in the evaluation are the necessary components for a CBT or BA program to be effective.

    “Of those apps which do use CBT or BA, some apps may provide benefits by partially applying CBT or BA principles, but the majority do not come close to including the core ingredients of a CBT or BA program.”
  • The paper relies on this without support.

    The usability heuristics used are appropriate for evaluating the usability of CBT/BA apps.

    “The usability heuristic evaluation found that the median level of adherence with the heuristics was 83% (range = 42–98%).”
  • The paper relies on this without support.

    The evaluation of CBT/BA content by one expert is a valid measure of the apps' fidelity to CBT/BA models.

    “Second, the evaluation of the CBT and BA apps was based on the opinion of one expert.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Privacy-policy description conflicts with Table 7

    Minor

    The text says the Depression CBT Self-Help Guide policy does not address user control, while Table 7 marks its user-control category as addressed.

1 of 1

Citations

Cites

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Show all 74 references

2 of the 74 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. J.A. Callan, CBT mobilework: A technological solution to improve depression outcomes, Clinical and Translational Science, 4, 120
  2. M Murugan, Mobile phone based supportive patient care, Indian Journal of Psychiatry, 55, S72
  3. 2004, Depression: management of depression in primary and secondary care, Clinical Guideline, 23

Cited by

Sorted by citations

Items 101–200 of 328

Metadata

Authors
Huguet, A., Rao, S., McGrath, P. J., Wozney, L., Wheaton, M., Conrod, J., & Rozario, S.
Affiliations
  • Dalhousie University (CA)
  • Izaak Walton Killam Health Centre (CA)
Corresponding author
Huguet, Anna
Venue
PLOS ONE
Published
2016-05-02
Volume
11
Issue
5
Pages
e0154248
ISSN
1932-6203 (ISSN-L)
OpenAlex
W2346033637
Cited by
328
References
74
Citations by year
2026: 10 · 2025: 16 · 2024: 26 · 2023: 31 · 2022: 38 · 2021: 44 · 2020: 53 · 2019: 40 · 2018: 34 · 2017: 30 · 2016: 6
FWCI
5.96
Type
journal article
Language
en
Open access
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, cognitive behavioral therapy, behavioral activation, mobile health apps, self-help apps, digital mental health, app usability
MeSH terms
Depression, Humans, Cognitive Behavioral Therapy, Cell Phone, Mobile Applications

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