Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Results: We identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. This corroborated existing work on apps’ fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. In the first, we analyzed the therapeutic functionality of apps. Methods: We systematically identified apps described as being based on cognitive behavioral therapy for depression. Objective: The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement. Equally, our understanding of what makes apps engaging and valuable to users is limited. However, although many are highly rated by users, few are evidence-based. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. JMIR Bioinformatics and Biotechnology 31 articlesĮmail: Hundreds of mental health apps are available to the general public.
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