Just to be clear

 Glass, water; clear.  Pic by  [cipher]

Glass, water; clear.

Pic by [cipher]

There's something that needs to be said. Hopefully it comes across, but we need to be clear about this. What we are trying to do is not what most other doctors would do. What I mean is that doctors like Russ and I don't usually put something out there until it has been thoroughly tested. Between coming up with the idea and releasing it there would have normally been years of testing it in the lab with small groups of people. Some of our colleagues will see what we are doing as a bit outlandish.

Why make it so much of an issue?

There is good reason for that; we don't want to claim treatments do anything they are not proven to do. This is most important when developing drugs as they can have side effects. In our case this is not likely to happen; after all our apps are gamified versions of psychological therapies. Nonetheless, even if they are not likely to cause any problems the accepted way of going about this is to see if they are any better than a sham treatment. Sham treatments look and feel like the real thing, but they don't have whatever it is we think makes the treatment work. They are sometimes called placebos. A good example is a sugar pill that looks and tastes exactly like a real tablet.

For instance if we were testing Phobia Free what we would normally do is to get a goup of people with fear of spiders and then randomly get half of them to go through our app the other half to play another similar game; maybe about ants. We would then test them and see if the ones who went through Phobia Free are less afraid of spiders than the ones that played the other game. To make sure there is no bias (i.e. we don't rate differently the people going through Phobia Free to the people playing the ants game) the raters are blinded. That means they are not told whether the person they are rating went through Phobia Free or through the ants game.

This is what we know

Stress Free is more straightforward as it simply trains you and gets you to practice established relaxation techniques, but Phobia Free is trickier. We know that the basic technique we use in Phobia Free is proven; that is systematic desensitisation. We have adapted it into a game and made it fun (well, Richard and the team made it fun), but we believe the basic ingredients are all there. We have some indication that we are right as Russ has spider phobia and the app seems to make him nervous enough to work as a substitute to facing real spiders; this is the key to systematic desensitisation. We also know from research into modified games, virtual reality and augmented reality that these things do the trick when used in therapy instead of putting people in front of the things that they fear (see this chapter by Christiane Eichenberg and Carolin Wolters for a comprehensive look at all the research in this field). The difference is that we do not have a real life therapist to use alongside the games and augmented reality, we have Dr Freeman and Itsy. We don't know whether they will be as good as a person in getting you to face the scarier bits of Phobia Free.

We also know that the better quality self-help books help and we have the same basic material in what we believe to be a far more easy to use format. We are clear that this is probably not going to be as effective as face-to-face therapy. We also know a lot of people don't need face-to-face therapy, or can't access it, or rather not go see someone and would much prefer to do it themselves.

With your help we think we can do it differently

Our plan is to launch the apps and then get all of you to help us figure it out. With your permission we will be able to see how you use the apps, what helps and what doesn't. In Stress Free we will know how your anxiety changes from time to time and what helps reduce it. In Phobia Free we will know if by the end of it you are able to take pictures of real spiders or not, which tells us if you have been successful. We will also need your direct feedback.

While we might not have everything figured out when you first get the app you will eventually have something as effective as possible. We believe mobile technology finally enables us to involve you much more in the development of treatments than ever before.

Beyond self-help

With these tools we can go beyond self-help, we can use what you teach us to improve the treatment not just for you but for others as well. Also we have something that we know is quite helpful: your friends and family who can be more closely involved than before. We also know from real-world experience that having a peer group is very useful. Using the communication and social features of your mobile device you can help others going through the same process and they can help you. You can share with them the things that you find helpful and you can benefit from their suggestions as well. We are not sure whether it will help or not, but no self-help book ever did that.

What the apps are not

Stress Free is not a proven treatment for anxiety disorder. Phobia Free is not a proven treatment for spider phobia. We use techniques that are proven to be effective in both cases but have never been used in this format. Don't use the app if you need a guarantee that the treatment will work. If you need a guarantee visit a therapist.

The apps are not magical cures or 'ten-easy-steps' guides. To overcome stress and phobias is hard work. Success depends on practicing the skills that the app teaches and completing it through to the end. We hopefully made it more fun, more accessible and -- by using game mechanics -- more likely for you to complete it; but you still need to do it and practice on it. If you want a magic wand, this is not it.

Why do it this way?

We think we can get to something that is really effective much quicker this way. Doing this with small groups of people and then changing it bit by bit and repeating the test can take very long and be very costly. Apart from that it normally takes years before it is made available for people to use. This is very important and necessary in the development of drugs, where safety is paramount.

Going through therapy is more like acquiring a new skill than like taking a tablet. What we are trying to do is making sure the learning process is as effective as possible. To do that getting the app in front of as many people as possible as quickly as possible and getting feedback will make improving the app much quicker and easier.

Why should I get the apps, then?

You should get the apps if you love games and, like us, believe they can do more than entertain.

You should get Stress Free if you want to be trained on how to relax and want to have something that reminds you to practice relaxation regularly. We know that relaxation is more effective the more you practice it.

You should get Phobia Free if you have a phobia of spiders and you want to see something like this developed to its fullest potential. You should also get if you know someone with a fear of spiders. We believe children in particular will find this fun and engaging. It may help them reduce their fear on their terms.

Just to be clear.