Apps for teenagers who are self-harming

Recently, two UK-based apps have become available to help with self-harm. Both use techniques of Dialectical Behaviour Therapy, involving a variety of activities individuals can choose to do instead of self-harming.

Calm Harm is developed by Consultant Clinical Psychologist Dr Nihara Krause for the UK-based charity Stem4. Upon opening the app, you are greeted with the metaphor that considers the urge to self-harm as similar surfing a wave: 'it builds…it peaks… but ultimately, it subsides.' As such, you are invited to ride the wave, which takes you to a selection of six categories: Comfort, Distract, Express Yourself, Release, Random and Breathe. Once you've chosen a category, you are given a list of different DBT-based strategies (within the selected category) that you can choose to do. For example, in the Distract category, you could choose to Think of a country for every letter of the alphabet. In the Express Yourself category, you can choose to Write what's upsetting you on a piece of paper and tear it up.

A particularly useful feature is the My Log component of the app. Every time you 'ride the wave' you are asked how strong the experienced urge was, whether your chosen activity helped, and why you got the urge. Your answers, as well as the date and time the distraction activity was taken, will appear in the activity log. You can also see at what time of day on average you appear to be using the tasks and how high your urge to self-harm has been recently. Some cute additional features can be found in the preferences section, where you can change the colour scheme of the app or change the app's mascots (a tough choice between fun cartoon characters or adorable cartoon animals).

Self-Heal was developed by students at the University of Oxford, funded by the Oxford IT Innovation Challenge. Upon opening the app, you can choose to do one of three options: something to help now, something for the longer term, or call Samaritans. When you chose something now or in the long term, you can to flick through a variety of activities, which you can choose to do or favourite for later. Examples of these activities are Make a list of things you're thankful for and Get bubble wrap and burst the bubbles as slowly and then as quickly as you can. Useful additional features include a lengthy list of resources and information for further help, as well as a picture album section where you can flick through inspirational photos and quotes.

I found both apps user-friendly, however Calm Harm was the favourite for me. It allows the individual's experience to be personalised and the tracking feature is useful. That said, Self-Heal is a helpful toolbox of resources and the favouriting feature allows users to collect pictures, quotes and distraction tasks that they believe will be of most benefit to them.

A flaw common to both the apps echoes criticism that is no stranger to the MHealth Apps literature base: lack of scientific evidence of the apps effectiveness. However, Calm Harm and Self-Heal were designed from scientific principles and both provide a disclaimer that they are not a substitute for professional help. An additional limitation is the lack of interaction the apps allow their users to engage in. Recently, research on teenager's experiences of mental health apps suggested that social interaction, including communicating with peers and helping others, are amongst the top most important features of an app (Kenny, Dooley & Fitzgerald, 2016). However, implementing such a feature does come with the added responsibility of protecting privacy on a larger level and monitoring potential cyber-bullying. These apps on their own would work as excellent tools alongside clinical treatment for teenagers experiencing self-harm.

Reference

Kenny, R., Dooley, B., & Fitzgerald, A. (2016). Developing mental health mobile apps: Exploring adolescents' perspectives. Health informatics journal, 22(2), 265-275.