Amy Overgaard thought she was going to die. It was December 2014, and the 26-year-old freelance writer from Minnesota was getting ready for a morning meeting when she felt her body betray her.

"It came totally out of the blue, just hit me like a truck and bowled me over," says Overgaard. "I remember getting hot and my mind started racing. I had thoughts flashing in my head that were the worst-case scenario of my life, like I was alone and a burden. It was a horrible reeling of my mind. I started breathing really fast, and my heart was racing."

What had just happened? She wasn't sure, and with her meeting coming up and the need to piece together income from her various jobs, she didn't have time or money to see a therapist.

"In the tradition of my stoic Norwegian upbringing, I just shoved it down and pretended it didn't happen," she recalls. "That was my rapid introduction into the world of anxiety."

With some financial help from a nearby clinic, Amy was able to see a therapist, but they never clicked. So she turned to something she always has with her: her phone.

"It was my doctor who introduced me to Calm," she says. "The moment I click into that app, it's like, relaxation." At $39.99 per year, her subscription is just a fraction of what she would pay to see a therapist. Thanks to the internet, Amy has what she describes as "a resource that's targeting when I'm feeling stressed, or when I can't sleep or when I'm filled with anxiety."

America has a mental health problem. Anxiety is the most common disorder in the country, affecting around 40 million Americans over the age of 18. Add to the mix the 14.8 million Americans with major depression, and you're looking at 17 percent of the total US population who live with those afflictions.​

It's a crisis, but not a unique one. Humanity has been trying to cure mental health disorders since time immemorial — you only need look to Hippocrates on melancholia or the author of 1 Samuel on David. In the grand view of history, therapeutic treatment for mental health is a blip — a helpful, professional, governed blip.

Today, as the rate of depression increases in America, we are increasingly turning to the internet to provide treatment options that are customizable, omnipresent and social. Almost everyone has a phone that's connected to the internet, so it should follow that almost everyone has access to mental health therapy. But what do we lose when we gain increased access? Can the same internet that notoriously breeds contempt also foster personal growth and compassion?

That question has been driving Ricardo Muñoz ever since he began his career in psychology. And the answer might lie in, of all things, a pamphlet.





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Muñoz was ten years old when his family left the small river valley town of Chosicá, Peru, to move to San Francisco's Mission District in 1961. At the time, the Mission was receiving an influx of Latino immigrants due to economic and governmental instability in Central and South America. Initially, Muñoz wanted to be a therapist and provide services to the low-income, Spanish-speaking population in the Mission, but a fateful encounter with a college professor changed all that.

"You sit in your offices and you wait for people to suffer enough to come see you," the professor said in a lecture at the University of Oregon, where Muñoz was a student. "You should go out into your community and teach the skills you have."

Muñoz, an excitable gentleman now in his 60s with a penchant for beginning his sentences with "heck," was sold. And so began his unusual career in psychology that would lead him to be both a professor at the University of California, San Francisco, and a researcher out of San Francisco General Hospital — a vital part of the city's social safety net. Instead of solely focusing on treatment, Muñoz chose to specialize in a little-researched part of psychology: Depression prevention.

Almost everyone has a phone that's connected to the internet, so it should follow that almost everyone has access to mental health therapy.

This is one of Muñoz's greatest passions: Helping people help themselves before they require help from others. "Most mental health services, including health services in general, are consumable," he explains. The hour a patient spends at a therapist's office can never benefit anyone else. Once used, it's over. The non-consumable intervention, however, is the perpetual motion of psychiatry — a single pamphlet, or recently an app, can reach a near-infinite amount of people, seemingly forever.

"That's one of the reasons why our health care system is so expensive," he notes. "We rely almost entirely on consumable interventions that are used up as soon as we administer them to somebody."

Muñoz's first major breakthrough in the non-consumable interventions came in 1997, treating not the mentally ill, but chronic smokers. Muñoz and his colleague Eliseo Perez-Stable mailed brochures to people who had requested information about how to stop smoking. They included a two-page mood-management intervention explaining that "if you can keep your mood healthy you're more likely to remain" a nonsmoker.

And it worked. After completing a study linking mood management with smoking cessation, Muñoz came to a realization: "If you can do this through the mail, why not try to do it through the web?"

An internet-based non-consumable intervention is what Muñoz and his colleagues created with the Massive Open Online Intervention, or MOOI. While the best way of doing therapy is face to face, says Muñoz, "There's a part of therapy that involves teaching." And with the internet, teaching can be done across space and time.

In 2012, Muñoz and his colleagues created an online resource for MOOIs, the Institute for International Internet Interventions for Health, or as it's known on the web: i4Health. Anyone with an internet connection can visit i4Health and download manuals on depression prevention, maternal mental health and mood management.

"Heck, I mean, the site is up. If I'm on vacation, if eventually I retire, the site could still be providing the intervention. I mean, if I die, the thing could still be up there," he says. "That's an amazing thing! That's why I'm so captivated by this idea."

Muñoz is especially aware that not everyone can afford face-to-face therapy. For many years, while Muñoz ran the Depression Specialty Clinic at SF General, patients could come and see a psychiatrist for free. "But some of our patients, even those who lived in the Mission, didn't have the money to pay for the Muni bus ride to get them here," says Muñoz. "So the internet takes that place."





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More people are going online to deal with their mental health issues than ever before. According to Google Trends web searches for "anxiety" were at their worldwide peak in April 2016. And with the introduction of the smartphone app, the internet is taking a more active role in mental health treatment. There are some 3,000 mental health apps on Google Play and Apple's App store according to the Wall Street Journal. Our access to online mental health resources is unprecedented with a smartphone in hand.

Though we might consider ourselves an advanced society when it comes to access to and caliber of treatment, there is still a stigma attached to anxiety and depression. But if mental health resources come primarily from the privacy of your own device, rather than a counselor's office or a pill, you might more likely to accept some help.

That was the case for Josh B., a 27-year-old college student and freelance marketer who lives in San Francisco. "Even within my own family there are people who don't believe in mental health as a concept," he says over coffee in San Francisco's Richmond District.

Josh, who asked that we not use his last name so future employers can't find his mental health history, has lived with depression for as long as he can remember. Four years ago, while moving to San Francisco, Josh went through one of the worst bouts he ever experienced. "I couldn't sleep very well and I was bummed out all the time and had no energy… I spent a lot of time in bed," he says. It was during this time he spotted an ad on a bus for a clinical trial at the University of California San Francisco.

The study, called Marigold, sought to "evaluate the safety and effects" of a new medication on people who had tried two or more kinds of antidepressant medications. "I knew some of those studies are paid, so I thought it was worth it to see what the study was about," says Josh. Despite the study's stated nature, the internet was about to play a large role in Josh's recovery from depression.

For four months, Josh, who was in the control group, got a regular check-in on his phone from an app developed by UCSF researchers. Josh and the other participants used the app (and later, after some technical difficulties, a website) to register their experiences with depression on a scale of 1-7. The questions varied. One survey asked Josh to quantify how much he had felt (selecting from six set emotions: scorn, boredom, awe, sadness, stress, and loneliness) in the last week. The study also had participants check in about their levels of activity, sleep and self-perception — asking participants things like: "Do you currently think of yourself as depressed?" These questions are standard things a therapist would ask you to help track your moods, but delivering them through an app meant that people who didn't have to have access to therapy could still treat their depression.

"[The survey] was something I had to do. I was responsible for participating in the study," says Josh. "And if I didn't do the survey at the times I was supposed to then someone would know and send me an email."

Psychologists suggest that accountability is key to successfully treating depression in Internet-based interventions — exactly what the Marigold study did for its participants. "I found the study really helpful," Josh says. "I've had a mixed bag experience with therapy… for the first time in years, I found myself being mindful of how [I was feeling]."

If mental health resources come primarily from the privacy of your own device, rather than a counselor's office or a pill, you might more likely to accept some help.

Accountability is built into most new mental health treatment apps. 7 Cups bills itself as an "on-demand emotional health and well-being service." Koko is "a social network that calms your mind." Calm opens onto a relaxing scene of an Alpine lake, complete with ambient bird noises, where it offers to give you "7 Days of Calming Anxiety" — for a fee.

Many of these apps offer a freemium model, where you can get access to a limited number of resources like guided meditations or chat rooms. Prices vary from $39.99 for an annual subscription to Calm to $25 a week for Talkspace, an app that connects users with licensed therapists for text-based conversations. These are all less expensive than paying out of pocket for an hour with a therapist, which usually runs between $75 and $150.

Premium app services aren't a necessity to receive treatment, however. This was the case for Caitlin David, a 23-year-old editor living in Southern California. Diagnosed with ADD in high school, David found that her medication made her depression "ten times worse." "I usually won't get out of bed… I won't do much of anything," says David. "I've never been suicidal, but there have been points when I've thought, I don't know why I'm here."

Her parents went to counseling throughout their adult lives, so David followed suit and went to see a counselor. That counselor recommended a paid app, something that David, a broke college student, couldn't afford. So she found the free-to-use Pacifica, and has been using it ever since.

"I'm particularly fond of Pacifica because it directly deals with a problem I call 'phase blindness' — the inability to remember that I've ever felt anything other than what I'm feeling right now," says Esmé Weijun Wang, a writer. Wang lives with multiple diagnoses, including schizoaffective disorder, anxiety and PTSD. "With Pacifica, I can look at the mood log and see that I was, in fact, happy five days ago," she says. "Even though I might feel like I've only ever been anxious and panicky."

Founded by entrepreneurs Dale Beermann and Chris Goettel, Pacifica draws from Cognitive Behavioral Therapy, asking users to track their moods and thus escape from cycles of anxiety.

Not having the funds to pay for regular therapy, David depends on Pacifica to see her through some of her worst bouts of depression and anxiety. It may not be as good as regular counseling, she admits, but it's better than nothing.

Nothing in therapy is easy. The point is to pay attention to the most painful parts of your inner life, learn from them and change them. An app can help one understand some of the pieces of the puzzle that is mental health — like mood tracking and self-reflection — but they are limited in their ability to fully address it. A therapist can offer something more personal than the one-size-fits-most solutions offered by apps; medication can address neurochemistry. An app can only help as much as the user will allow it, and those who struggle with anxiety or depression may find it difficult to use an app that requires regular attention and input.

Everyone I spoke with also mentioned this downside of having such easy access to treatment: You have to go through your phone to get there.

Opening Twitter on my phone is a series of almost unconscious swipes and presses; it is contemporary atavism. The same thumb that finds meditations when I need to sleep can also open up the apps that make my thoughts swirl and incite dangerous levels of envy and comparison. The very device that can bring relief can easily, with a single tap, trigger social media-born bouts of anxiety and depression.





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Efficacy aside, apps designed to work with anxiety and depression find themselves in an identity crisis: Are they a technology platform? Or are they mental health care providers?

In their Terms of Service, Talkspace says, in bolded caps, "TALKSPACE DOES NOT OFFER THERAPY DIRECTLY OR SELL THERAPY SERVICES." It's the same caveat that Uber makes — they aren't a transportation company, just a matchmaking service.

Talkspace co-founder Oren Frank and his wife, Roni, found themselves at a crossroads in their marriage several years ago in their native Israel. Separated and ready to file for divorce, they went to counseling as a last resort. "It was a very powerful experience," says Oren Frank. Buoyed by the insights gained from therapy, the couple moved to New York and started to research why therapy hadn't moved online in the same way that things like dating and travel reservations had.

"Most people don't book travel via live agents, most people find their matches and their dating elsewhere," Frank says. "So how come [therapy] didn't migrate to a digital distribution platform? Before you know it you're in a start-up."

The very device that can bring relief can easily, with a single tap, trigger social media-born bouts of anxiety and depression.

Last year, Talkspace raised $9.5 million in their Series A funding round. According to Frank, Talkspace currently employs over 600 therapists (as contractors) and are onboarding "a couple hundred more." Over 300,000 people have gone through their free consultation. "It's a very big clinic if you look at it in that terms. I would assume it's probably the largest in the world," says Frank.

I press him on the 300,000 — does that mean people who have completed the program? Frank says no. "That is everyone who came in, and many of them just did a free consultation, so they talked to the intake therapist and didn't really go into treatment." And the therapists — are they bound by state licensing laws only to practice in their states? "No one knows," he says. "It's completely unregulated. There's no law, rule, or regulation whatsoever — and we got very extensive legal advice on that."

I asked Danielle Schlosser, an assistant professor of psychology at University of California at San Francisco about this. "This is an area that the Board of Psychology and states haven't touched yet," she says. "The laws have not caught up to the technology." According to the California Board of Psychology, "California residents may only receive treatment from someone who is licensed within California."

When I signed up for a trial, I saw that my Talkspace therapist was from Florida. She sent me an informed consent form before we got started, and a careful read revealed that I was essentially signing up to therapy by Florida rules: It seemed strange to have to agree that our location was Florida when I was sitting at my computer in California, but it was the only way to move forward.

I posed the question of cross-state therapy to Frank. "The licenses are not bound by state," he says. "If you're a therapist you're a therapist." But a moment later, he clarifies, "The boards in the states are the ones issuing the license, and they require that you practice in your state only." Has Talkspace found a loophole to exploit? They are in the business of remote therapy, Frank says.

Schlosser sees things a little differently. "[D]ifferent states have different laws for practicing across state lines," she says. State licensing boards are in place to ensure that mental health professionals are accountable to someone other than their clients, and requirements vary from state to state.

In California, for example, in order to be a licensed professional clinical counselor students must receive training on state-mandated topics such as child abuse, recovery-oriented care and human sexuality, according to Counselor-License, a website that tracks state-by-state licensure requirements.

Out-of-state students have to document that they have been trained on those topics before they are licensed. In an article addressing distance therapy, the American Psychological Association wrote, "[T]here is little consistent guidance across states on how psychologists should use" technology to treat clients across state lines, but, "you may need to be licensed both in your own state and in your clients' state in order to practice." California is one of three states that has passed laws about online therapy, and according to the APA it "requires that providers obtain both written and verbal informed consent before providing telehealth services, including a description of the potential risks, consequences, and benefits of telemedicine."

What's more, there are no standards of treatment when it comes to apps, so the internet ends up being a little like the Wild West of self-help. The FDA will regulate anything that makes a claim about a specific disorder, but it doesn't have any oversight over apps like Calm, which simply offers a way to "meditate and relax with guided mindfulness meditation." In a recent white paper, the FDA said it "intends to apply its regulatory oversight to only those mobile apps that are medical devices and whose functionality could pose a risk to a patient's safety." This means that apps like Calm, which are designed as a stand-in or supplement to therapy, will not be regulated.

The stigma of mental illness and lack of resources are two of the major obstacles people face in addressing mental health, and apps can play a role in overcoming both: They're significantly less expensive than traditional talk therapy, and they can be used in private.

And this isn't just in theory, it's something that therapists are noticing here and now. "I have a lot of male clients [on Talkspace], and I had zero male clients in my private practice," says therapist Shannon McFarlin. "Our culture has shamed men about showing emotion. Men feel more comfortable on this platform because there's no stigma," she says. "They're using technology so it doesn't necessarily feel like therapy, but I have had these incredible conversations and breakthroughs with my male clients."

I signed up for a Talkspace trial and was introduced to Gina. Gina would not be my therapist, but would match me with the person who would be. Gina responded quickly to my in-app text messages, but the communication often felt clumsy and impersonal, like it was pasted from a template.

I am so glad that you have subscribed. We will start the matching process, so that i make sure you get the therapist who is right for you. Everything we have talked about so far gives me a good idea already, but if you don't mind I will leave some more questions for you to answer which will help me even more.

I shared my age, gender and location in the initial chat, but they got lost somehow, and Gina asked me again for my basic biographical details. "Female, age 30, San Francisco, freelancer writer," I wrote. I highlighted the phrase and copied it for future reference, which came in handy when I was finally matched with a therapist. In addition to being a Talkspace therapist, Nicole Amesbury is the head of their clinical development — which may have been part of why, as a reporter, I was matched with her. Her bio read, in part: "It is my experience that my clients know themselves better than anyone… a good therapeutic relationship includes trust, authenticity, freedom and positive outcomes."

Building trust over the internet is something I'm familiar with. As I've written extensively about my own experience with anxiety, I've been invited into other people's experiences with depression, medication, and anxiety disorders. Cultivating a healthy relationship with a therapist I'd never met didn't seem so foreign in a world where most of my long-distance relationships are kept up over text message.

Your online therapist can't hold you accountable to any degree more serious than sending a couple of emails.

The promises of online therapy are lofty, but not entirely unrealistic. In some cases, the technological advances that have enabled online or text-based therapy have been life-saving. "One client I have is a new mom with a little baby and she has post-partum depression," McFarlin says. "She can't leave the house to go to an appointment right now, but we talk every day."

Brooklyn-based journalist Rebecca McCray tried Talkspace when she got a discount code and her former therapist no longer took her insurance. "Talkspace seemed like it could be a decent alternative," says McCray. But she's had mixed results. "I imagine the feeling of anonymity could make it easier [for some people] to divulge painful personal issues," she says. "For me, the most valuable in-person sessions are those in which a conversation pushes me into a really uncomfortable place. But with Talkspace, I can put down my phone and not open the app if I feel even vague discomfort."

That ability to quickly check out of a therapeutic relationship is harder to do in person, where you can't delete an app or ignore your therapist without at least a voicemail or email. Your online therapist can't hold you accountable to any degree more serious than sending a couple of emails, or, in the case of Talkspace, sending a few messages if you disappear for several weeks.

My Talkspace therapist didn't even have my phone number, and no one knew that I was talking to her — I didn't have to explain to any of my friends that I couldn't meet them for happy hour because I was seeing my therapist, something I have had to do in real life. To be held accountable online is an inconvenience easily done away with in the space of a few clicks; a quick cancellation; the act of deleting an app. The ease of access that makes distance therapy so desirable in the first place can also be its downfall.

On the face of it, Talkspace isn't doing anything revolutionary. Phone calls with therapists have existed almost as long as phone calls and therapists — The VA, in particular has been practicing telehealth for almost two decades. The field of telehealth is robust and is still growing, especially in psychiatry. Talkspace is harnessing new technology — smartphones, not phones — in service of an old practice, but this time, it's not just the therapist who is making the money.

We're all independent contractors and we get paid a percentage of the subscription price," McFarlin said. Instead of the client paying the therapist directly, he or she pays Talkspace, who then cuts a check to the therapist. Distance therapy has its advantages for the therapists too. Most Talkspace therapists either maintain an in-person practice or have in the past, but the serve allows them to expand their client base outside of their immediate area. To borrow a tired analogy, it's similar to Uber, but for therapy.

McFarlin wouldn't comment on whether this made Talkspace therapists eager to add more clients to their roster, but she did say that as a mentor to other Talkspace therapists she makes an additional stipend.

The ease of access that makes distance therapy so desirable in the first place can also be its downfall.

While apps like Talkspace repackage traditional therapy methods into an app, others begin with lofty ambitions. Joyable, a platform that connects users with "coaches" to guide them through activities meant to help alleviate social anxiety, states its mission is to "cure the world of anxiety and depression."

I spoke with Dana (not her real name), a former employee at Joyable. When she joined in 2015 Dana was excited about the possibilities Joyable held for working with people with social anxiety. Specifically, she was interested in the model Joyable uses — that it relied heavily on the tools Dana had previously found so useful in her own experience with Cognitive Behavioral Therapy.

"CBT is well-studied and well-regarded; it's also short-term, which is great for a program like Joyable," says Dana. Different from psychoanalysis, CBT addresses an acute issue or set of issues and, eventually, helps you make your way off the therapist's couch (or, in this case, the chat room) and back into the real world.

At Joyable, a person signs up for a relationship with a coach who walks them through a series of questionnaires and exercises designed to deal with social anxiety in different settings — at work, at parties, with friends. The client might set goals with their coach, like "Give a presentation at a work meeting."

Their website has a section that defines social anxiety, complete with inspirational quotes in the header. "A happy person is not a person in a certain set of circumstances, but rather a person with a certain set of attitudes," one header reads. On the one hand, this quote reflects classic CBT beliefs: If you work hard enough to change your thoughts, you will overcome your unwanted mental patterns. On the other hand, it could be read as a condemnation of those who aren't happy. If changing your attitude were that easy, wouldn't we all do it?

According to Dana, social anxiety wasn't Joyable's initial target. "Their idea was to do something more broad, [but] the clinical advisor told them that CBT is especially effective for social anxiety," says Dana. "The story was more that, we know anxiety and depression are very prevalent, and we're business folks, and we're going to take this on."

That business-minded approach led to a rapid expansion. Dana was one of the first employees at Joyable when she was hired as a coach in 2015. Now, there are around 30 coaches, many of whom are coming straight from college.

A coach's job at Joyable is to check in with users and remind them to work through the online module. "A client load can be very high," Dana says. "I had as many as 120 clients at once because I started very early. Newer coaches probably hover around the 40-60 client range."

I wondered what their training was like. Dana pauses. "There's no requirement for any sort of mental health credential or background," she says. "Although the hiring criteria changed a bit while I was there." Dana's training consisted of "about a week… not just on CBT and the program, but all coach functioning. The actual amount of training on CBT is pretty minimal. I would say during onboarding there are maybe 2 or 3 hours devoted to CBT."

One of the difficulties with any kind of mental health treatment is that a person who presents with one issue — like social anxiety — might also be dealing with concurrent diagnoses. The difficulty at Joyable was that coaches wouldn't know about a concurrent diagnosis unless their client also knew and reported it. "Sometimes coaches would get messages or calls from people who would be having thoughts of suicide or would be actively using alcohol or drugs in a way that was harmful to them," she says. "So you have coaches who are just out of college and haven't been given any training on what other mental health conditions look like."

Dana also mentioned that users would occasionally make passes at coaches, but since coaches are rated on feedback from their clients, they were reticent to set strong boundaries.

"The philosophy of the leadership of the company was basically, 'We don't need mental health professionals as coaches; the coaches are not doing any sort of mental health service,'" Dana says. Joyable coaches occasionally ended up as crisis counselors, despite not having much training for dealing with people in crisis. This is the danger: young, inadequately prepared people on the phone with clients who are suicidal or having a manic episode or deeply depressed.

This is complicated, and not entirely Joyable's fault. They are clear about what they do, which is address social anxiety. Their homepage, which explains the program, refers to coaches several times but never explicitly says they are not licensed mental health professionals. However, their FAQ does say so, and coaches are trained to state this during initial calls with clients.

This is the danger: young, inadequately prepared people on the phone with clients who are suicidal or having a manic episode or deeply depressed.

Dana found this approach alarming. "Their mission to 'cure the world of anxiety and depression' — you just don't cure those things," she says. From her perspective, the company's leadership paid lip service to the idea of feedback but didn't actually take it. "I was concerned about the potential that Joyable ads were potentially misleading to clients," she says. "We already had enough clients who were experiencing suicidal ideation and coaches weren't trained on that." Dana asked if the company was going to hire an in-house medical advisor and was repeatedly told no. "They have this very, 'move fast-break things' mentality that's very tech-centric," she says. "And it doesn't work well with mental health."

I reached out to Joyable for comment on each of the specific points Dana mentioned. Joyable co-founder and CEO Peter Shalek didn't address the allegations, and instead sent a statement about how he and his co-founder, Steve Marks, "have family members and close friends who've suffered from anxiety and depression. We've seen how hard it is to get help, and we don't want anyone else to suffer that experience."

Shalek also says the company "works with leading experts" to deliver mental health care, and that they have "an escalation protocol designed by Dr. Lanny Berman," the former President of the International Association of Suicide Prevention. Shalek says they intend to bring on a full-time Chief Medical Officer and are proud of their "incredibly talented team of coaches and the role they play in supporting our clients as they overcome social anxiety and dramatically change their lives."

Even with her experience at Joyable, Dana doesn't count out the utility of the internet for addressing mental health. "Being able to talk to a licensed mental health professional in a way that is low-cost would be excellent. One thing I'm watching with interest is the expansion of provider networks for mental health care services."

Joyable might embrace the tech industry's outsized ambitions, but Pacifica takes a different approach. "We don't have any intention of replacing therapy," says Chris Goettel, Pacifica's co-founder. Goettel struggled with social anxiety in his teenage years, and his background in consumer apps led to investigate what kinds of online help might be available.

It was October 2014, and he found "meditation apps that had really nice designs, but they didn't use the same clinical tools I had learned from Cognitive Behavioral Therapy," he says. "Then there were CBT apps, but they had a very clinical feel." So Goettel got in touch with Dale Beermann, his former colleague at an educational startup called StudyBlue, and together, they entered the app market. They hired Christine Moberg, then a Stanford postdoc and now a psychologist at the Palo Alto VA Hospital, as an advisor and content consultant.

Like a handful of similar apps, Pacifica aspires to be FDA-approved as an evidence-based tool, and thus covered by insurance. "The long-term vision has always been to get to a place where Pacifica is a reimbursable part of approved treatment plans," says Beermann. There are no official guidelines at the moment as to how an app can be incorporated into an insurance plan, but that isn't stopping apps from trying to be the next best moment in mental health. The therapist's office is still an option, but the avenues to address mental health are manifold.

Pacifica doesn't connect users with coaches or listeners, as some apps do, because "if you think about the end user's mindset, if they're working with an individual to address their mental health, there is an assumption that that individual is qualified to be working with them," Beermann says. "It honestly scares the hell out of me that there are companies like Joyable that are providing mental health services without a licensed medical professional doing it," Beermann says.

The tradeoff is that increased access — to other people, to mental health resources, to less expensive treatment — often come at a cost.

Ambitious as they might be, most of the apps springing up to address mental health aren't suggesting they will replace talk therapy, which is generally considered to be one of the most effective forms of treatment for anxiety and depression. Traditional, in-person therapy will always be a better way to address mental health than clicking through an app to do a ten-minute meditation.

But despite their limitations and caveats, everyone I spoke with saw their own smartphone-led path as one that led to increased empathy, and ultimately, healthier living.

"Anxiety made me feel completely alone and hopeless," Amy Overgaard says. "The only way you can not feel alone in that, is to share your experience and realize how many people in your life around you are dealing with the same things. You see people with more compassion when you know what it feels like to feel broken and hopeless."

Living with depression often saps a person of energy, but a 2002 study found that "People who are depressed are more likely to be highly prone to… an empathetic response to the distress of others." Being aware of and working on your depression or anxiety daily, even through the help of an app, can make a person more tuned in to the depression or anxiety of the people around them.

The tradeoff is that increased access — to other people, to mental health resources, to less expensive treatment — often come at a cost. These can be small and literal, like when a person downloads a $5 app. They can also be unknown, like when a person who has never tried face-to-face therapy opts to see a counselor online. Or they might be enormous, and life-altering. What happens when a suicidal person expects an app to lift themselves out of depression? Is it their fault for having unrealistic expectations, or the app's fault for making outsized promises or something else altogether?

Anyone with a smartphone can seek help with relative ease. The barrier to entry is low, but considering the cost and quality of the treatment — from Pacifica's low-risk meditations to Joyable's questionable ambition — when it comes to mental health, there might not always be an app for that.

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