Category #1 - apps that support meditation, focus, relaxation, or mindfulness:
- Headspace (headspace.com, $12.99/month or $69.99/year after a 14-day free trial) is one of the most widely used mental health smartphone apps, with over 70 million members and lots of corporate partnerships. The app mainly offers guided meditation exercises, on varied themes including stress management, mindful eating, mindfulness at work, unlocking creativity, mindfulness with money, sleep meditation, and coping with injustices or challenging times. Meditation videos provide perspectives from a variety of teachers, with vs. without music, with videos of people vs. nature, etc., and they do seem to update their content regularly. Videos are of varied length including some short 3-5 minute meditation exercises. Users can schedule regular check-ins or reminders to meditate in the app. Headspace is supported by a number of published studies showing pre-post reductions in anxiety, depression, and stress.
- Calm (www.calm.com, 7-day free trial then $69.99/year) is another widely used meditation app, featuring regularly updated guided meditation relaxation exercises, sleep aids, movement- or stretching-focused meditations, breathing exercises, and productivity-focused meditations. On-screen nature imagery (either computer-generated or photorealistic), music, and nature sounds are part of the package, along with daily wisdom quotes (similar to the CBT-like Stoic app described below). Some imagery examples are an ocean, mountains, or rain, and they did in fact make me feel calm! This app seems to have a lot of business-to-business partnerships, so you might see if your employer provides subscriptions; the direct-to-consumer fee is on the high end.
- BetterMe (https://betterme.world/product/meditation, 5-day free trial then $19.99/month) is another app that primarily offers meditation exercises. Simple breath meditations are combined with articles, multi-day meditation courses, stories, and sleep sounds. One interesting feature of this app is its "agenda"-like interface, suggesting tools for users to try at different times of day in an integrated program that is customized to some extent based on the user's goals.
- Bloom (https://www.enjoybloom.com/, 7-day free trial then $39.99/year) offers some of the same features as BetterMe for a little lower cost (no monthly option available, though). Users can choose between two virtual "guides" who lead the guided meditation exercises based on selected goals. The features and content are a little thinner on this app, matching its lower price. One note is that this app advertises itself as "CBT" and has a research page that links to studies of online CBT (which aren't specifically about this app); however, it's clearly in the meditation/mindfulness space, not at all comparable to the apps that I put in the CBT category below.
- Centered (centered.app, free version or $10/month for enhanced productivity tools) is a to-do list and productivity tool with "flow music" to help users concentrate. Besides managing tasks, the app can turn off your notifications from other apps to reduce distraction, and provides analytics to help users see patterns in their work productivity. This is an interesting one that mixes behaviorist nudges (described in the next section) with some mindfulness or meditation features as well. It's probably better for work and productivity than for general stress relief. This app is available on the Google Play store or in a web-based/desktop version, not on Apple iOS.
- BCBS Centered (bcbsil.com, free). Note that there is a different app on the Apple store also called "Centered." It is a minimalist meditation app from Blue Cross/Blue Shield of Illinois, but is available to anyone, not just plan members. Two handy features of this app are (a) integration of a mood-tracking feature that can also pop up on an Apple Watch, and (b) the ability to read in your step count from an Apple Watch. Combined with several small scripted audio meditation exercises (only about 10 total), this app lets the user generate graphs that cross-walk their daily mood against their step count and meditation minutes, which facilitates some causal thinking. For a data junkie like me it's a fun tool, although there are no music, no images, and no frills.
- Insight Timer (insighttimer.com, free but with premium features) is one that you might have seen in office meetings. It has a timer that sounds like a gong or a meditation chime, but also includes meditation exercises to support deep breathing or sleep. The premium version of the app includes mood check-in points, a daily quote, multi-day meditation courses, and an "@work" feature focused on maintaining calm in work-related scenarios. Like the Centered app, it seems to have some corporate partnerships and might be sponsored by your employer.
And the winner is: the BCBS Centered app is the best freebie in my view, with Calm as the best bet for general relaxation if you're not bothered by the price tag. Many of these are very similar, however.
Category #2 - behavior-change apps that track and reinforce behavior:
- Virtually all fitness apps now on the market use one or more behaviorist principles to reinforce behavior. Many step-counting apps are tied to a specific sensor device, like the Apple Fitness app for Apple Watch, the Garmin Connect app for Garmin smartwatches, or the Fitbit app which is now part of Google's Android operating system. StepsApp (GmbH, free) is a device-agnostic app with an interface similar to Apple Fitness, available for both iOS and Android devices. All of these tools include features like streak tracking and badges that leverage tools from behaviorism to help users stay consistent with their exercise routines.
- Strava (strava.com, free) is a preferred fitness tracker for runners, although it can also track activities like cycling and swimming. It's compatible with multiple sensor devices and operating systems, and has many of the same features as other fitness apps. One particular feature that seems to drive user engagement with Strava is a social-networking aspect: People can follow friends on Strava, track their runs, post maps and stats to other sites, etc. This type of social reinforcement can augment the behavioral effects of other tools like badges and streaks.
- Streaks (Crunchy Bagel, Apple app store, $4.99) is a more generic habit tracker app allows users to record progress on up to 12 daily activities. For exercise goals the app can sync up with a sensor device, but it also allows the tracking of user-specified habits like practicing a musical instrument or completing daily meditation exercises. Unfortunately, everything except the step count involves manual data entry, even if you have other apps tracking those behaviors. The app provides reminder notifications and users can specify different behavioral targets for each type of task. It has an appealing interface and provides a one-stop tracking tool for habits; there are also some nice reporting features. This app is only available for Apple's iOS.
- The MyFitnessPal app (https://www.myfitnesspal.com/, free) deserves special mention here as a platform-neutral tool that tracks not only steps and active minutes, but also food intake. The app has a barcode-scanning feature that allows users to scan the packages of food to automatically import data on calories, nutrients, and other aspects of their meals. Tracking food intake is always a hassle, but this is one of the more user-friendly ways to do it. The app also has a caloric balance feature that tells users how many calories they have burned vs. consumed to that point in the day, which can be a big help for users who are serious about actively losing weight as opposed to just increasing their activity level.
And the winner is: choose among these based on your preferred hardware, because the software is all pretty similar. Apple Fitness works for me, while Strava is best for my wife the marathon runner. I use MyFitnessPal sporadically when I'm trying to lose a few pounds and willing to do the work of tracking my meals, then leave it aside after a few weeks when that becomes too much of a burden.
Category #3 - apps that provide one or more components of cognitive-behavioral therapy:
- Stoic (getstoic.com, $6.99/month or $99.99 one-time fee after a 7-day free trial) includes motivational quotes, guided meditation, journaling prompts, and structured gratitude exercises. The user can schedule check-in reminders up to 3 times per day. The user can also select specific behavior-change goals which results in moderate levels of tailoring or personalization in the suggested exercises, although the full library of tools and quotes is available to all users. Graphics are all black-and-white but elegant, and one nice feature is that the user can select a particular philosophical tradition for inspiration: e.g., Greco-Roman stoic philosophy, Catholic theology, or Buddhist teachings. There are lots of free-text prompts, so it's helpful to have a device with a larger screen when using this application.
- Woebot (woebot.com, free) has a cute robot persona that is an empirically supported feature of the app. That’s because the developers found that humans related better to a robot that embraced its essential robot-ness, rather than an app pretending to be a human. Besides the ability to form a friendly relationship with a robot, the app offers guided exercises that correspond almost exactly to Beck’s Cognitive Therapy, such as recognizing stressors, challenging automatic thoughts, and reframing to avoid cognitive distortions. The app reduced anxiety symptoms among college students in a randomized controlled trial. Woebot has appealing cartoon graphics and makes plenty of stupid dad jokes, which keep things interesting and can help you to feel less depressed despite yourself. The interface is like an SMS chat, so you feel like you are typing messages back and forth with Woebot. The downsides of this app are that it’s on the very cognitive end of the cognitive-behavioral spectrum, so you will hear a lot about dysfunctional thoughts, it’s pretty didactic, and it goes a bit slowly if you’re already familiar with CBT. Still, I kept coming back for a while just because I enjoyed interacting with the robot persona. The user must unlock tools gradually via dialogue, but can refer back to any past conversation later on.
- FreeCBT (https://freecbt.erosson.org/, free) is a simpler alternative that just performs the basic ABC move of Beck’s Cognitive Therapy: activating event (i.e., trigger) / beliefs (i.e., automatic thoughts) / consequences (behaviors and results). As in Woebot, the user is promoted to challenge automatic thoughts by hunting for cognitive distortions based on a standard CBT list of options (similar to David Burns’s Feeling Good self-help book). And similar to Woebot, there is an option to revisit previous dialogues. There’s no cute robot, and the app is a one-trick pony: If you want other CBT suggestions like activity scheduling or systematic desensitization, you’re out of luck. But if what you’re looking for is a handy cognitive restructuring exercise in your pocket, this no-frills option gets the job done.
- MindShift (www.anxietycanada.com, free) offers a mix of meditation and cognitive-behavioral techniques, and was designed with a particular focus on anxiety symptoms. It has a mood-tracking feature, and extensive written information about common anxiety disorders and their symptoms. For each type of anxiety problem, there are details on physical sensations, mental features associated with the problem, and common behaviors -- a comprehensive summary that can help to normalize these symptoms. There are also specific CBT-based tips for each type of anxiety, with links to a toolbox of strategies available in the app. This one is a lot more comprehensive than FreeCBT, taking into account many behavioral strategies as well as the cognitive ones.
- Oberit (https://www.getoberit.com/, free with in-app purchases) is designed specifically for substance use recovery, but it has some unique features that will work for any type of mental health concern. Foremost among these is an emphasis on gratitude practices, which made me think about putting this app in the mindfulness category even though it doesn't contain music or meditation. If you like the "acceptance and commitment therapy" flavor of CBT rather than Beck's automatic-thoughts style, this app might be for you. I found the motivational quotes in this one a little basic (Stoic was better for that, but users can add their own affirmations or inspirational phrases which is a nice feature -- there's no one better qualified to give you a pep talk when you're down than yourself from a time when you were feeling up! There's a points system that can be used for discounted purchases on other wellness-focused products and services, although I didn't use that at all.
- DBTCoach (https://resiliens.com/dbt-coach/, free version but $11.99/month to use all features) is based on Marsha Linehan's Dialectical Behavior Therapy flavor of CBT, which integrates mindfulness and Eastern philosophy with Beck-style CBT techniques. This app has the most comprehensive set of CBT tools that I saw in my survey of apps, and lessons that build on one another over time. Topic categories include mindfulness, emotion regulation, tolerating distress, and building effectiveness in interpersonal relationships. Exercises and tools are available in each of these four categories. There's also a mood-tracking feature, and a way to share progress with a therapist if you are working with one.
And the winner is: Woebot for all-around use, but try MindShift for anxiety or DBTCoach if you're struggling with emotions that feel bigger than a cute little robot can handle. And if the Woebot style of CBT annoys you with its relentless robotic rationalism, try Stoic or Oberit for a more philosophical take on CBT instead.
Category #4 - AI therapists, which use natural language processing to generate an unscripted dialogue with the user. The idea is similar to the old "Eliza" app (still available here: https://web.njit.edu/~ronkowit/eliza.html), but these are a lot more powerful and realistic.
- Wysa (https://www.wysa.com/, free basic version with premium features for $74.99/year) is a chatbot-type app that looks pretty similar to Woebot, with a robot penguin character. Its interface is more flexible and less menu-driven, however: For example when it suggested we talk about productivity and I said I wanted help calming down instead, it followed my lead and made useful suggestions. It is less didactic, and suggests menus of options including the usual arsenal of breathing and cognitive restructuring tools but also some that I haven't typically seen in CBT (e.g., gratitude exercises or Brahmari Pranayam, a practice from India that involves pressing on the eyes and face to produce feelings of calm). There is an option to connect to a live therapist through the app for a fee, with options ranging from a single session to a pre-paid block of conversations -- I didn't try that part because the automated aspect was the focus of this review.
- Elomia (elomia.com, free trial then $98.99 for 12 months) combines results from 4 different text-generation methods to support a free-form dialogue with the user. It is intended specifically to help people with symptoms of anxiety and depression, and it has a library of skill-building recommendations that use empirically based methods like mindfulness and challenging negative thoughts. One published study supports the app’s symptom-reducing effects based on pre-post comparisons. I gave this one a challenging interpersonal scenario from work to chew on, and found that it gave me reasonable recommendations for how to improve a work relationship. I even pushed back on some of the ideas, and the app was able to modulate them to be more acceptable based on the details of my situation. It also includes breathing exercises and daily prompts, although I found the daily messages pretty dull (e.g., "what are you looking forward to tomorrow?"), especially in comparison to Woebot's quirky chatbot persona.
- ChatGPT (https://chat.openai.com/auth/login, currently free as a public demo but might charge a fee at some point) doesn’t currently have an app, but you can use it for free on the OpenAI website. I tried prompting the text generator to “tell me what a therapist might say about …” and then described a similarly challenging situation. ChatGPT also came up with a list of reasonable ideas, although they were a little more simplistic and common-sense. That’s what you might expect from an app that predicts text sequences from patterns discernible online: Some people have characterized its output as “the collective wisdom of the Internet.” In terms of personality, this type of chatbot is really not sentient, but it sure seems like it. There is a little risk because chatbots have also been known to make things up that are patently false. So take its advice with a grain of salt -- but you were going to do that anyway with an automated self-help app, right?
And the winner is: give ChatGPT a try -- as a therapist, I found its advice to be surprisingly on the mark. If you're willing to pay a premium I'd take Wysa over Elomia, but as you saw above I'm drawn to cartoony robot personas.
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