Wellness apps help a little if you keep using them, and most people don’t

Key takeaways

• In a study of 93 popular mental health apps, a median of just 3.3% of the people who first opened an app were still opening it 30 days later.
• A 2024 analysis of 176 randomized trials found that mood apps ease depression and anxiety by a small amount, with bigger effects for apps built on cognitive behavioral therapy.
• Well-known trials of the Calm and Sleepio programs were run by researchers with ties to those companies, which they disclosed, so independent studies matter.
• Federal law and FDA policy keep most healthy-lifestyle apps outside FDA review, and a company whose apps did pass FDA review still went bankrupt in 2023.
• Before you subscribe, check who makes the app, what method it uses, what trials exist, what it does with your data and what it really costs.

The download is the easy part.

In 2019, a research team writing in the Journal of Medical Internet Research checked how people really used 93 popular Android apps for anxiety, depression and emotional well-being¹. Every app had at least 10,000 installs. The team used anonymous usage data from a commercial panel, covering August 2017 through July 2018¹.

On a typical day, the median app was opened by only 4% of the people who had installed it¹. And of the people who tried an app on day one, a median of 3.3% were still opening it a month later¹.

That gap matters because the evidence for the best apps is real but modest. It helps only the people who keep showing up.

This guide covers which kinds of apps have trials behind them, why most people quit, who pays for the research and how to pick an app that’s worth your time and money.

176 trials say mood apps help, by a small amount

The biggest summary of the evidence came in 2024. An international research team, writing in the journal World Psychiatry, pooled 176 randomized controlled trials of apps for depression and anxiety². In a randomized controlled trial, people are assigned by chance to use the app or to a comparison group.

Apps reduced symptoms of depression and generalized anxiety, but by a small amount². One way to picture it: about 12 people would need to use an app for one extra person to improve².

Some designs did better. Apps built on cognitive behavioral therapy, or CBT, a skills-based talk therapy that targets unhelpful thoughts and habits, had larger effects². So did apps with chatbot features for depression and mood tracking for anxiety². The results held up when the authors removed the smallest and weakest trials².

There are caveats. A critical appraisal published by the Mental Elf, a research-review service, noted that only 6% of the trials met all five standard quality checks³. Apps also looked better when compared with doing nothing, such as a waitlist, than when compared with a placebo or usual care³. The reviewer raised the idea of a “digital placebo effect”: some benefit may come from expecting the app to help.

The analysis relied mainly on scores taken right after the programs ended, so long-term effects are less certain³. The fair summary: a well-built mood app is a helpful tool, not a treatment for serious depression.

Why most people stop opening the app

The 2019 usage study found big differences by type of app¹. Among active users, meditation apps held attention for a median of about 21 minutes a day. Breathing-exercise apps had a median 30-day retention of zero¹.

Peer-support apps kept more people, 8.9% at 30 days, though only two such apps were in the sample¹. Tracking apps kept 6.1%, and meditation apps 4.7%¹.

Even in a research trial, commitment tends to fade. In a 2021 trial of the meditation app Calm, the share of people keeping up with the daily goal fell over the eight weeks of the study⁴.

That’s why download counts and minutes-per-session figures in ads tell you little. The question that matters is whether you’ll still open the app next month. An app that fits a habit you already have, like winding down at bedtime, has a better chance than one that asks you to build a new routine from scratch.

Who ran the trial? Often someone close to the app

Readers of natural-health sources are used to asking who paid for a supplement study. Apply the same question to apps.

The 2021 Calm trial, published in PLOS ONE, enrolled 263 adults with trouble sleeping⁴. One group was asked to meditate with Calm for at least 10 minutes a day for eight weeks. The other was put on a waitlist⁴.

The Calm group had less daytime fatigue, less daytime sleepiness and less mental and physical arousal at bedtime⁴. Those are useful findings. The paper also disclosed that the lead author was a consultant to Calm as its Director of Science, three co-authors sat on Calm’s scientific advisory board, and Calm supplied the usage data⁴. The authors said Calm did not pay for the study⁴.

A landmark 2012 trial of an online insomnia program built with the company Sleepio tells a similar story⁵. It assigned 164 U.K. adults with insomnia to online CBT for insomnia, a placebo program of relaxing imagery or their usual care⁵.

The results were striking. Among people who finished, 76% in the CBT group reached a sleep efficiency above 80%, meaning they were asleep for more than 80% of their time in bed. That compared with 29% on the placebo and 18% with usual care⁵. The lead author was Sleepio’s clinical and scientific director and a shareholder, and a co-author was its CEO⁵.

Company ties don’t make results wrong. Both teams disclosed them, which is what good science requires. But a result means more when independent researchers repeat it, and that’s worth checking before you pay.

What the evidence shows, app type by app type

CBT for insomnia, often called CBT-I, is the standout. The National Heart, Lung, and Blood Institute says it is usually the first treatment recommended for long-term insomnia and can be delivered in person, by phone or online⁶.

Most sleep apps don’t offer it, though. In a 2022 review of 106 sleep apps, only about 1 in 4 included CBT-I or a similar sleep therapy¹⁴. Mindfulness was far more common, offered by about 7 in 10¹⁴.

Claim	What studies found	Evidence level
Mood and anxiety apps ease symptoms	176 trials: small benefit, larger with CBT; mostly measured right after the program23	Strong evidence of a small, short-term benefit
CBT-I programs, including online ones, ease insomnia	First-line treatment for long-term insomnia; an online version beat a placebo program56	Strong evidence for CBT-I itself; check that the app really uses it
Meditation apps improve sleep	18 trials: sleep improved compared with waitlists, but the edge over other active programs was not clear; very low certainty7	Promising but early
Fitness and step apps raise daily activity	9 trials: about 477 more steps a day overall, not statistically significant; programs under three months added about 2,0758	Promising but early
Diet apps help people lose weight	11 trials: modest weight loss at four to six months, not significant by nine to 12 months9	Promising but early
Calorie-counting and weight-goal features are safe for young users	No safety trials. In one online survey, about 4 in 10 respondents reported a bad experience, most often obsessive logging, and 21 of 100 top apps allowed underweight goals10	Not enough evidence to call them safe, and early warning signs

The pattern across categories is similar. Benefits show up early and fade over the following months, which fits the usage data¹⁸⁹.

FDA reviews a few apps, but most it never sees

Many people assume a health app has been checked by the Food and Drug Administration. Usually it hasn’t been, and for many apps it doesn’t need to be.

Under the 21st Century Cures Act, software meant only to maintain or encourage a healthy lifestyle, and unrelated to treating or diagnosing disease, isn’t legally a medical device¹¹. FDA’s general wellness guidance, updated in January 2026, says the agency does not intend to examine low-risk products for weight, fitness, stress or sleep tracking to decide whether they are devices¹¹.

FDA does review software that works like a medical device and could cause harm if it fails, such as an app that diagnoses heart rhythm problems¹². For some low-risk apps that help people manage a condition without giving specific treatment advice, FDA uses “enforcement discretion,” meaning it chooses not to require review¹².

A small group of prescription apps did go through FDA review. Pear Therapeutics had three: reSET for substance use disorder, reSET-O for opioid use disorder and Somryst for insomnia¹³.

It didn’t save the company. In April 2023, Pear filed for bankruptcy and let go of about 170 employees, more than 90% of its staff¹³. Its CEO blamed insurers and other payers for refusing to cover the products¹³.

The lesson cuts two ways. FDA review means the evidence was examined, which most wellness apps never face. But no app is guaranteed to stay on the market, so ask what happens to your data if the company is sold or closes.

“Free to download” rarely means free

The same 2022 review looked at 201 apps for headaches, pain and sleep¹⁴. About 90% cost nothing to download. But 81% of the sleep apps weren’t truly free, because key features sat behind in-app purchases or subscriptions¹⁴.

Safety features were thin. None of the 48 headache apps listed crisis or medical contact information, and only 8 of the 106 sleep apps did¹⁴.

Privacy deserves a look, too. The American Psychiatric Association’s App Evaluation Model asks whether you can delete your data and which outside companies receive it¹⁵.

Our health-data privacy guide, listed below, covers what can happen to app data. For trial periods that turn into charges, see our article on wellness subscriptions.

An app is a tool for a practice you already value

Meditation, slow breathing, regular sleep, daily walks and home-cooked food are old practices. Apps didn’t invent them. At their best, apps add structure, reminders and a little company to habits people have valued for generations.

At their worst, they replace listening to your body with chasing a number. In a 2019 study of healthy-eating and fitness apps, about 4 in 10 people who answered an online survey reported a bad experience with one, most often obsessive calorie counting or logging¹⁰. A smaller group described guilt or cutting back on food¹⁰. Among the 100 top free apps, 21 let users set an underweight goal, and 60 rewarded users for continuous use¹⁰.

The survey can’t show that the apps caused these problems, and its authors said as much. But it is a reason to watch how an app makes you feel.

If an app leaves you anxious, guilty or rigid about food or exercise, that’s a signal to step back. Deleting it is a reasonable health decision.

A 10-minute checklist before you download

This checklist draws on the questions in the APA’s model¹⁵. You don’t need a perfect score. An app can meet every point and still be wrong for you¹⁵.

1. Who makes it, and who pays for it? The owner and funding should be easy to find¹⁵.
2. Is it maintained? Look for an update within the last 180 days¹⁵.
3. What method does it use? Look for a named approach, such as CBT for mood or CBT-I for insomnia, not just “science-backed.”
4. Is there a trial? Search the app’s name with the word “randomized.” Note who ran the study and what the comparison group got³⁴⁵.
5. Can you delete your data? Check which third parties receive it and whether you can opt out¹⁵.
6. What does it really cost? Find the price after the trial ends and how to cancel¹⁴.
7. Does it handle a crisis? A mental health app should show crisis contacts. Many don’t¹⁴.
8. Can you take your data with you? Exporting a sleep or mood log makes it useful to a clinician¹⁵.
9. Will you open it next month? Try it for two weeks, then decide whether it’s helping.

For mental health and brain apps, a free database called MIND, at mindapps.org, can do much of this work. It’s run by the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center in Boston¹⁴.

Its listings cover more than 600 apps, each rated on 105 points drawn from the APA model, and the team refreshes them twice a year or more¹⁴. You won’t find a top-10 list. Instead, you pick the features you care about and see which apps have them¹⁴.

Questions readers ask

The bottom line

A small number of wellness apps, especially those built on CBT for mood or insomnia, have solid trials behind them. Most others have little research, and even good apps help only modestly and mainly while people keep using them.

Choose an app the way you would choose a supplement. Check who makes it, what method it uses, who ran the research, what it does with your data and what it will cost after the trial. Then give it an honest few weeks, and keep a clinician involved for anything serious.

Related reading

• The wellness subscription you meant to cancel
• Health apps share more than you think, and you can lock yours down
• Who paid for the study matters, even when the science is real
• “FDA registered” isn’t “FDA approved”: a buyer’s map to wellness devices
• AI chatbots pass medical exams, yet people using them don’t diagnose better

Sources

1. Baumel A, Muench F, Edan S, Kane JM. “Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis.” Journal of Medical Internet Research, 2019. pubmed.ncbi.nlm.nih.gov
2. Linardon J, Torous J, Firth J, Cuijpers P, Messer M, Fuller-Tyszkiewicz M. “Current evidence on the efficacy of mental health smartphone apps for symptoms of depression and anxiety. A meta-analysis of 176 randomized controlled trials.” World Psychiatry, 2024. research.vu.nl
3. The Mental Elf, National Elf Service. “Apps for depression and anxiety: big new meta-analysis supports effectiveness.” National Elf Service, 2024. nationalelfservice.net
4. Huberty JL, Green J, Puzia ME, et al. “Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial.” PLOS ONE, 2021. journals.plos.org
5. Espie CA, Kyle SD, Williams C, et al. “A Randomized, Placebo-Controlled Trial of Online Cognitive Behavioral Therapy for Chronic Insomnia Disorder Delivered via an Automated Media-Rich Web Application.” Sleep, 2012. pubmed.ncbi.nlm.nih.gov
6. National Heart, Lung, and Blood Institute. “Insomnia: Treatment.” NIH, updated March 2022. nhlbi.nih.gov
7. Lee S-A, Park J-H. “Systematic review and meta-analysis of effects of standalone digital mindfulness-based interventions on sleep in adults.” npj Digital Medicine, 2025. nature.com
8. Romeo A, Edney S, Plotnikoff R, et al. “Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis.” Journal of Medical Internet Research, 2019. pubmed.ncbi.nlm.nih.gov
9. Pujia C, Ferro Y, Mazza E, et al. “The Role of Mobile Apps in Obesity Management: Systematic Review and Meta-Analysis.” Journal of Medical Internet Research, 2025. pubmed.ncbi.nlm.nih.gov
10. Honary M, Bell BT, Clinch S, Wild SE, McNaney R. “Understanding the Role of Healthy Eating and Fitness Mobile Apps in the Formation of Maladaptive Eating and Exercise Behaviors in Young People.” JMIR mHealth and uHealth, 2019. pubmed.ncbi.nlm.nih.gov
11. U.S. Food and Drug Administration. “General Wellness: Policy for Low Risk Devices.” Final guidance, FDA, January 2026. fda.gov
12. U.S. Food and Drug Administration. “Device Software Functions Including Mobile Medical Applications.” FDA, 2026. fda.gov
13. Fierce Biotech. “Cut to the core: Prescription app developer Pear Therapeutics files for bankruptcy, lays off staff.” Fierce Biotech, April 2023. fiercebiotech.com
14. Minen MT, George A, Camacho E, et al. “Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study.” JMIR mHealth and uHealth, 2022. pubmed.ncbi.nlm.nih.gov
15. American Psychiatric Association. “The App Evaluation Model.” American Psychiatric Association. psychiatry.org