mobile phoneBuddy is a digital tool that is helping to strengthen links between therapists and clients by providing a simple way for users to share their daily thoughts in the periods between appointments.

The growth of apps in mobile telephony has been huge in recent years, and globally it is estimated that more than 70 billion will be downloaded in 2014. Increasingly, mental health services are tapping into this market as a way of engaging with people who use services in new ways.

Several apps have been launched in the past couple of years, such as Buddy, which was developed by a collaboration between South London and Maudsley NHS Trust (SLaM) – the largest provider of mental health services in the UK – and design and innovation company, Sidekick Studios.

Clinicians at SLaM identified a gap in therapeutic services for a tool that could benefit patient engagement and provide an alternative to written mood diaries that can be difficult to maintain, particularly for patients with literacy problems.

The app launched in August 2012 and is now being used across nine NHS trusts for a range of different users. These include young people and adults with depression, anxiety disorders and post-traumatic stress disorder (PTSD). The Buddy app aims to remove the stigma associated with accessing mental health services.

“We wanted to create an app that people could easily engage with as part of their normal routine,” says Syed Abrar, director at Buddy App UK. “Buddy is not an app as we know them today; it is a simple software application that uses SMS text messaging as a vehicle for the user to record their feelings, thoughts and behaviours. Buddy is all about enhancing engagement and improving patient and clinician communication. It offers a rich insight into a client’s thoughts and feelings between therapy sessions.”

How Buddy works
Each day, Buddy sends a text message prompting users to rate their day from one (well below average) to five (well above average). This is usually sent at the end of the working day at 7pm, although the timing of the daily text can be easily amended for those working shifts. In addition to the one to five mood rating request, users are asked to write about what they have been doing, thinking or feeling that day.

The service is discrete, so users can respond even in the company of friends or family. Each text response builds a picture of the person’s moods and feelings over a period of days or weeks. The tool can be used on any type of mobile phone and entries can be viewed online via the secure web-based Buddy system.

Both the patient and their clinician can log in to review recent diary entries. This can help patients to spot patterns of behaviour and habits that positively or negatively affect their moods and thoughts. Therapists usually look back over patient diary entries on the day prior to or the day of their next session. This can help to direct conversation and enable the clinician to reinforce positive behaviours to aid recovery.

Buddy in action
The Military Veterans’ Service is an NHS psychological therapy service that works with British ex-service personnel across the northwest of England, encompassing Cumbria, Lancashire, Merseyside, Greater Manchester and Cheshire. It is provided by Pennine Care NHS Foundation Trust and offers treatment for a range of mental health conditions including stress, anger, depression, anxiety and PTSD. The service began as a pilot in September 2011 and received funding to initially trial the Buddy app. As the service is so geographically dispersed, it hoped Buddy would help to reduce social isolation and promote a greater sense of connection with clients.

Since they have been using the tool, staff at the Military Veterans’ Service feel Buddy adds value to their existing psychological therapy services and the app will now be rolled out on a larger scale to enable all clients to be offered it.

“When we offer the use of Buddy to clients, it is an acknowledgement that they can gain some control over their own recovery,” says Dr Alan Barrett, principal clinical psychologist and clinical lead for the Military Veterans’ Service. “It does not require the therapist to have access to the system, we can set clients up and encourage them to self-monitor.

“Buddy has many flexible clinical uses; we’re also using the app as a waiting list management tool. Once a client is assessed and has been retained for therapy, we will offer Buddy to enable them to start the practice of regularly logging their mood and activity. This has the added benefit of providing the treating clinician with a four to eight-week period of diary entries, prior to the individual’s first session, which can help to illustrate current struggles and difficulties. Some of our clients really like to converse with Buddy and reflect on their personal entries. The typical usage of the app is one to two months and this often aligns with the duration of therapy so the two can match up very nicely.”

Appointment reminders
Additionally, appointment reminders are sent the day before and two hours ahead of scheduled sessions and this can be beneficial for busy clients. The Military Veterans’ Service plans to review the impact Buddy has had on DNA (did not attend) rates and cancellations when the app is more widely used among its client base. Early signs have shown there is a slight increase in the number of cancellations by Buddy users and this is a positive, says Barrett.

“Clients receive a prompt the day before a scheduled appointment and can click ‘I cannot attend’ if the time is no longer convenient for them. This instantly lets us know that the client has cancelled and prevents the treating clinician travelling unnecessarily to an unattended session. We’ve also noticed that people who use Buddy tend to have better attendance rates than those who are not using the tool.”

Goal setting
Another useful function of Buddy is the goal setting option. Goals are typically created jointly by the therapist and patient to help reinforce positive behaviour. This can be beneficial for patients who are affected by low mood and require some motivational help.

Sarah Bramley is a child and adolescent mental health services (CAMHS) therapist at Derbyshire Healthcare NHS Foundation Trust who has been using Buddy with some of her patients for the past six months. The goal setting function provided a great breakthrough in the case of one young person with trichotillomania, a psychological condition where a person feels compelled to pull their hair out.

“I’ve been using the Buddy system to provide goal prompts to a 15-yearold girl who has been affected by trichotillomania since she was 12,” says Bramley. “Prior to trying Buddy, the longest she had been able to go without pulling her hair was just a couple of days. After just a few weeks of using Buddy, she managed to go a whole week without once pulling her hair. The impact of Buddy on that particular young girl has been amazing; she really responded well to the mini goals we set asking her not to pull her hair on specific days of the week.

“It can be a very beneficial tool to enable a gradual shift in the behaviour of a patient. During therapy, young people can feel they are losing control and ownership of their treatment, but receiving a text from Buddy is different. It’s almost like a friend sending a prompt and this helps them to feel more in control about the action they take.”

Bramley has also found Buddy can be useful for improving mood and challenging negative thoughts. “You may see a patient on a day when they feel everything is bad and that the week has been terrible. Buddy can enable you to look through diary entries together and highlight their good days. Young people can struggle to reflect back over their week and Buddy can help to identify the strategies they naturally do on those days when things are going well.”

For more information on the Buddy app visit www.buddyapp.co.uk  

About the author - Julie Penfold is a freelance journalist
This article first appeared in the January/February 2014 issue of Mental Health Today. For more information on the magazine, and subscription options go to www.mentalhealthtoday.co.uk/mental-health-today/