New Mental Health Care App for RN Families

Royal Navy families can now access mental health support online.

The Naval Families Federation has launched a 12-month pilot scheme to provide free access to the Headspace app for families of regular and reserve RN personnel.

Working with support from Navy Command and the Royal Navy Family and People Support organisation, 3,000 licences have been bought.

To access the offer, the family member should visit where they will be guided through the verification process.

Can We Use Gamification in Mobile Mental Health Interventions?

Research Paper Title

Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial.


40% of all general practitioner (GP) appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools.

The ubiquity of smartphones offers a delivery platform for such tools. Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions.

This study aimed to explore the effects of a gamified mobile mental health intervention on improvements in resilience, in comparison with active and inactive control conditions. Differences between conditions on changes in personal growth, anxiety and psychological wellbeing, as well as differences in attrition rates, were also assessed.


The eQuoo app was developed and published on all leading mobile platforms.

The app educates users about psychological concepts including emotional bids, generalisation, and reciprocity through psychoeducation, storytelling, and gamification.

In total, 358 participants completed in a 5-week, 3-armed (eQuoo, “treatment as usual” cognitive behavioural therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35.


Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks.

The app also significantly increased personal growth, positive relations with others, and anxiety. With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups.

Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions.


Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition.

Future research should measure eQuoo’s effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.


Litvin, S., Saunders, R., Maier, M.A. & Luttke, S. (2020) Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial. PLoS One. 15(9), pp.e0237220. doi: 10.1371/journal.pone.0237220. eCollection 2020.

Are E-Mental Health Applications for Depression Beneficial?

Research Paper Title

E-mental health applications for depression: an evidence-based ethical analysis.


E-mental health applications (apps) are an increasingly important factor for the treatment of depression.

To assess the risks and benefits for patients, an in-depth ethical analysis is necessary.

The objective of this paper is to determine the ethical implications of app-based treatment for depression.


An evidence-based ethical analysis was conducted.

The material was meta-reviews and randomised control studies (RCTs) on app-based treatment.

Based on the empirical data, an ethical analysis was conducted using the 3-ACES-approach by Thornicroft and Tansella.


Apps may empower autonomy, offer an uninterrupted series of contacts over a period of time, show evidence-based benefits for patients with subclinical and mild-to-moderate-symptoms, are easily accessible, may be used for coordinating information and services within an episode of care, and are on the whole cost-effective.

Their risks are that they are not suitable for the whole range of severity of mental illnesses and patient characteristics, show severe deficits in the data privacy policy, and a big variability in quality standards.


The use of apps in depression treatment can be beneficial for patients as long as:

  • The usefulness of an app-based treatment is assessed for each individual patient;
  • Apps are chosen according to symptom severity as well as characteristics like the patient’s level of self-reliance, their e-literacy, and their openness vis-à-vis apps; and
  • Manufacturers improve their privacy policies and the quality of apps.


Rubeis, G. (2020) E-mental health applications for depression: an evidence-based ethical analysis. European Archives of Psychiatry and Clinical Neuroscience. doi: 10.1007/s00406-019-01093-y. [Epub ahead of print].

E-Therapy & Training Future Psychiatrists

Research Paper Title

Therapy and E-therapy – Preparing Future Psychiatrists in the Era of Apps and Chatbots.


In both Canada and the USA, residency includes learning about psychotherapy.

The Royal College of Physicians and Surgeons of Canada mentions several psychotherapies in its training objectives and states that residents must “demonstrate proficiency in assessing suitability for and prescribing and delivering” such treatments, including cognitive behavioural therapy.

The Accreditation Council for Graduate Medical Education (ACGME) in the USA sets out competency frameworks and assessments for psychotherapy in psychiatry post-graduate education.

Yet on neither side of the 49th parallel is there mention of e-therapies in training requirements.

Read the full article using the link below.


Gratzer, D. & Goldbloom, D. (2020) Therapy and E-therapy – Preparing Future Psychiatrists in the Era of Apps and Chatbots. Academic Psychiatry.

Are Mental Health Apps Worthwhile?

Among the hundreds of thousands of apps available for health and fitness, among many others, millions of us have downloaded mental health apps for everything from breathing exercises to guided meditation.

However, a recent analysis now suggests that almost everyone gives up on such apps in just two weeks.

Amit Baumel (2019), at the University of Haifa in Israel and his colleagues, analysed the use of 93 popular mental health apps.

The data suggests that, after 15 days, more than 94% of users had stopped opening their apps.

Baumel and colleagues only studied apps that are available in English and that have been installed at least 10,000 times via the Google Play store.

App use differed depending on the kind of support provided.

On any given day, just over 4% of individuals who have downloaded mindfulness or meditation apps will use them. However this figure is 17% among those who have installed peer-support apps, which enable individuals to talk to someone who may be experiencing similar issues.

The team did not reveal which apps were included in the analysis, but the findings raise questions over how useful mental health apps are.

It is currently unknown how often an individual needs to use such apps for them to be effective.

Baumel and colleagues study confirms what the clinical community has known for a long time: a lot of individuals abandon these apps.

However, it should be noted that a low engagement rate does not necessarily mean mental health apps do not work – it could be an indication of how curious we are about these apps, and how easy it is to download them.


Baumel, A., Muench, F., Edan, S. & Kane, J.M. (2019) Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis. Journal of Medical Internet Research. 21(9), e14567.

New Scientist. (2019) People Quickly Abandon Mental Health Apps. New Scientist. 16 November 2019, pp.14.