eMoods Bipolar Mood Tracker

EMoods Bipolar Mood Tracker: Android (free/donationware); iOS/Kindle “coming soon”

Developer Website: http://emoodtracker.com/

There is good evidence that various types of therapy, including CBT, are helpful in reducing the impact of Bipolar Disorder on the lives of clients and their families. In most CBT, some sort of thought log is a central piece of the homework that the client is given. When treating a client for Bipolar Disorder, it is also helpful to have “big picture” data on trends in your clients’ mood state. This can help you identify triggers, situations in which your client did not take their medicine, changes in sleep cycle (which are notoriously difficult to self-report without notes), and other data that can help frame treatment. Knowledge about this data, among other things, will in time help your client to identify situations in which manic episodes may be likely to happen. It can also help them plan to head off severe changes in mood when possible. Early identification of a possible change in mood state, combined with rush outpatient treatment for medication and crisis management, can hopefully minimize the risk of hospitalization for your client.

One tool that I have commonly used with Bipolar clients is the BEAM, a mood chart that tracks medication, sleep, weight change, anxiety/irritability, and other notes about a client’s functioning. It has all of the weaknesses of any self-report, but clients can learn to complete it accurately with very little practice.

There are a few such tools in the smartphone app space that attempt to do something similar. One of these is the eMoods tracker, which is designed specifically with Bipolar Disorder in mind. The developer notes that they worked from the list of information that is collected by the mood chart that is utilized by the Massachusetts General Hospital Bipolar Clinic and Research Program. This app has all of the information that you will find on the BEAM, aside from a place for weight (which could go into a daily note anyway). At the top is a place to enter amount of sleep, ranging from zero (red flag, right?) to 24. Clients identify themselves as have No, Mild, Moderate, or Severe symptoms in four areas: Depression, Elevated mood, Irritability, and Anxiety. There is also a checkbox for “psychotic symptoms” and whether or not someone attended a therapy session on that day. Each entry line has a small help screen with descriptive reminders for each category. Toward the bottom is a place for daily notes, which is limited to 300 characters due to the formatting of the output .pdf; the help section states 60, but this is in error. Last comes a place to enter medications. The information can be entered once per day, and can be changed later – although I usually encourage clients to do these tasks at the end of the day.

You can view summaries within the app via the “calendar” and “graph” tabs, which give you either a list of the past 40 days or a monthly graph of mood states (see screenshot). You can also email a report in .pdf format. It is a four-page report that looks similar to the BEAM. There is a setting for daily alarms, but its functionality is severely limited at this point. The app states that improved reminders are “coming soon.” It would be great to be able to manage medications completely within this app, as opposed to using a separate app.

On a side note, the developer’s website has a link to a website with international suicide hotline numbers – something that I frankly had not thought of before.

Regarding data security, this app definitely keeps data that your client would want to keep away from prying eyes. There is no password or other security built into the app, so you should instruct them on how to keep their phone secure if they are not already doing so. (If you can’t discuss and demonstrate this option, I would argue that you are not fulfilling informed consent requirements of treatment. Clients of course are still free to not bother).  This app does email reports. You can leave your name off of the report, which may be helpful to you if these will often be sent to you. While email of course states who it is from, it may still be comforting to have a de-identified report.

The UI is pretty clean and very easy to follow. The reports are also easy to understand. Given the format of the pdf report, it would be nice if daily written entries could be longer. Another drawback is the medication entry. If there are meds that are taken BID or TID, they will need each to be entered individually (and probably labeled as morning/midday/night). It would be helpful to be able to add a medication once and be done with it. There was one notable bug – I think that the app attempts to fill in common medications, but the list can’t be seen under the keyboard.

In general, this is a well-laid out app that covers most of the data that you would probably want to track in a client with Bipolar Disorder. Technically, it could also keep track of unipolar depression or anxiety, but there are other apps that might better fit that niche.

If you or your client use this with regularity, I urge you to purchase the “donate” app in the Google Play store. I’m really a fan of this model of software sales, and from a practical perspective this is the best way to keep this app in active development. I much prefer this model to one where we get free apps which include ads.

Ratings:

Content: 4.5/5 – Covers most data of interest; better medication entry and reminders would be an improvement.

User Interface: 4.5/5 – Easy to navigate, minimal, nonintrusive bugs, good disclaimers and reminders for clients who are filling out the day’s data.

** Disclaimer: While some of these apps may be helpful to you, NOTHING that I review is a replacement for therapy services from a qualified, licensed psychotherapist. If you are reading this because you or someone you care for needs it for mental health reasons, get them live help ASAP. Also, if you haven’t yet, read A Few Words on Security, which contains tips on keeping your and your client’s smartphone data safe from unwanted eyes.

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Depression CBT Self-Help Guide

Depression CBT Self-Help Guide: Android (free)

Developer Website: http://www.excelatlife.com/

While a lot of these reviews are (and will be) of more “general” apps that can easily be applied as therapy or reference tools, there are a number of purpose-built apps that actually make an attempt to utilize psychological science. This app is both a thorough homework tool and resource for CBT of depression and anxiety and an illustration of some of the pitfalls of free apps. I’ll explain more as we go along.

First, the good – the available content in the app is quite thorough. The author identifies herself as a clinical psychologist who has been in practice for 20 years or so, and it shows. The app covers everything that I might want to assign as CBT-based homework for depression, anxiety, and other issues. I give a lot of homework to my patients, and think it’s much easier for some of them to enter information into a smartphone than to keep track of some random sheets of paper. It contains a very thorough thought diary/challenge tool, a reward system, links to relaxation audios, and even a brief depression measure, the PHQ-9, which is designed for primary care settings but is validated and even has guidelines for outcome measurement.

When you run the app for the first time, there is a disclaimer about seeking real treatment if necessary, etc., etc. The home screen includes a nice picture of a butterfly (funny thing about apps with random graphics this week) and has five tabs at the bottom – Info, Audios, Diary, Test, and Points. There are other backgrounds to choose from if the butterfly is just too warm and fuzzy for you.

I’ll start by skipping to the thought diary, which meets my purposes as a therapist wonderfully, but will probably be overwhelming to your clients at first. Part of this is because it’s a lot of information to fit onto a small phone screen. Part of this is the reason that I teach clients to do thought logs in parts rather than all at once – because it’s often too much to master all at once. The logging tool has entries for

  • Event
  • Emotion
  • Intensity
  • Distress rating
  • Thoughts related to the event
  • Irrational beliefs related to the event (with a handy list of definitions)
  • A space for the client to challenge their belief
  • A rating score on their belief of that challenge, and
  • A place to enter a plan or other comments in relation to the event

Like I said, extremely thorough. Emotions and irrational beliefs are picked from checklists that are completely customizeable – wonderful to someone like me who much prefers to use the client’s language whenever possible. Finally, the entry screens have help buttons (the red question marks) which give lists of instructions, irrational beliefs, etc. You can also create a list of standard challenges to help your client get started. Unfortunately, there is no way to do this piecemeal, meaning that you can’t just enter a thought into the diary and save it. I often like to do this because I  think that learning to identify negative thoughts and irrational beliefs are steps that usually require their own homework before the client is able to do the whole A-B-C-D process alone.

The Info tab contains a selection of articles on depression and instructions for use of the app – a good reference for clients, but it’s not like I’m going to tell them to download the app, go home, and figure it out. The articles (as well as the audios) are hosted on the developer’s website.

The audios include a selection of relaxation exercises, a lengthy but informative psychoeducational audio about depression, and another audio that is designed to help clients recognize different emotions – a unique idea that I hadn’t really thought about before.

The Test tab is where you will find the PHQ-9. It will keep results so you can identify improvement over time. Like many depression measures, the PHQ-9 asks about experiences over the past two weeks, so keep this in mind when using it. It will give you a list of past scores as well as graphing them for you.

Finally, the Points tab is where you can apply a behavior plan. As you may have already guessed, it’s called a “points” section because you give yourself points for applying the behavioral part of CBT. This section is a little more limited than the diary. There is a significant list of behavioral items to choose from, but they are keyed to the app and the list is not customizable. I’m not sure I would be able to get very much use out of it.

Regarding data security, this app obviously keeps data that you or a client will not want random people to be able to read. This is a good time to discuss passcodes or the Android pattern lock** with your client (and you should be able to show them how to set this up if you’re sending them home with this app). You can password-protect the app itself in the settings. It requires a six-letter password. If password-protected, the app will run but you will not be able to access any of the tabs (including Diary and the PHQ) without a password. While the setting states “password protect diary,” it actually protects everything within the app. There is a data backup feature in the app, and information can also be sent via email, presumably either to the client or to you. There is also a selection in the settings about disabling the reporting of usage data, and there is no explanation of what this usage data may be. It’s easy enough to opt out, but I don’t like that you have to. Overall, data security is fairly well-protected, but I would never have a client keep an app like this on their phone without password protecting the device. This is especially true for an Android phone, whose file system is pretty easy to access.

The UI is kind of cluttered and is the weak point of this app. I will certainly grant the author the important point that an activity log is difficult to fit onto something the size of a smartphone screen. This is especially true because some of the screen real estate is taken up by ads (more on this later). It’s actually not as cluttered as it could be. Looking at the app reminds me of the many too-flashy websites that we had to suffer through in the mid-to-late 90s.  It’s easy enough for me to read, but I’ve also done most of my book reading on my phone for a few years now, so I’m used to it.

A particular note about the ads. As you may or may not know, ads on many smartphone apps tend to be “targeted” as much as possible. While I get some “harmless” ads for Kindle and other apps down there, at least once I got an ad for “serotonin supplements,” which was kind of worrisome to me. Despite the clear utility of this app, I would never assign it to a client without clear directions to disregard the ads. I would much prefer to have a paid app without ads. I did contact the author about this a few months ago, and she stated that this was a planned update, but wasn’t able to give a timetable.

Overall, I really like the app and would use it given opportunity and the ability to give the client clear directions regarding security and a special warning about the ads. It’s very customizable in most areas, and I like the amount of detail that you are able to get out of it.

Ratings:

Content: 5/5 – Almost everything you might want; would like to customize behavior scoring system.

User Interface: 2/5 – While this is partly for the UI, I really ding it for the ads.

** Android pattern lock, which for a long time stumped experts, now has a reportedly easy hack. If you use pattern lock, disable USB debugging on your Android phones ASAP!

** Disclaimer: While some of these apps may be helpful to you, NOTHING that I review is a replacement for therapy services from a qualified, licensed psychotherapist. If you are reading this because you or someone you care for needs it for mental health reasons, get them live help ASAP. Also, if you haven’t yet, read A Few Words on Security, which contains tips on keeping your and your client’s smartphone data safe from unwanted eyes.