Smartphone Apps for Mental Health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Most people today are familiar with apps for smartphones.  There are apps for many different purposes including mental health. In fact in 2015, mental health apps made up almost a third of disease specific apps in app marketplaces (1).

Some but not all apps are evidence based, researched, and known to work and some other apps are based on evidence based skills.

A 2017 meta review of studies looked at 190 individual papers researching 147 unique digital health tools and found that there may be some benefit of using apps for depression and anxiety but unclear benefit for other disorders at the time of publication. They also found research and method limitations for many studies (2).

A recent study looked at an app called “Virtual hope box” (VHB) (3).

Who was studied? (3)

  • 118 U.S. service veterans receiving mental health treatment and had a recent history of suicidal ideation.
  • They were divided into two groups.
  • One group received mental health treatment as usual supplemented with the VHB app and another group received treatment as usual supplemented with printed materials about coping with suicidality over a 12-week period.

What was measured? (3)

Using validated scales, the study authors measured coping, suicidal ideation, reasons for living, perceived stress and interpersonal needs at various points of the study.

What were the results? (3)

  • Participants using virtual hope box app showed improvements in their ability to cope with unpleasant emotions and thoughts over time.
  • Users found the app helpful for relaxation and distraction or inspiration when feeling distressed, when emotions were overwhelming, or when they felt like hurting themselves.
  • Participants found it easy to use, helpful in dealing with stress and emotional difficulties, likely to use in the future, and would recommended to others.

What are some caveats?

  • This is a small study and may not be applicable to everyone.
  • There are many apps for mental health but research in this area is limited.
  • Newer apps are being introduced frequently.
  • This is a new field of research, and as we learn more, study designs and outcome measures are being improved upon.
  • Not all the apps are free.
  • Mental health apps do not take place of professional treatment.
  • Your mental health professional may be helpful in considering the right app mental health for you.
  • There are many apps that use evidence based techniques such as apps for cognitive behavior therapy, relaxation skills, prolonged exposure, dialectical behavior therapy, mindfulness based apps, etc.
    • One such example is the OSUCCS app, which can be obtained from the app store.

How much time are you spending on your phone? How are apps in general impacting your mental health? Which app is helping you and which is not?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. IMS Institute for Healthcare Informatics. (2015). Patient adoption of mHealth: Use, evidence and remaining barriers to mainstream acceptance. Parsippany, NJ: IMS Institute for Healthcare Informatics.
  2. Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C. and Davies, E. B. (2017), Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review. J Child Psychol Psychiatr, 58: 474–503. doi:10.1111/jcpp.12663
  3. Nigel E. Bush, Ph.D., Derek J. Smolenski, Ph.D., Lauren M. Denneson, Ph.D., Holly B. Williams, B.A., Elissa K. Thomas, L.P.N., C.C.R.C., Steven K. Dobscha, M.D. A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress.  Psychiatric Services 2017; 68:330–336; doi: 10.1176/appi.ps.201600283.

Study: Caffeine, Stress, and Brain function

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

According to the Food and Drug Administration, caffeine is widely available and upto 80% of adults have caffeine everyday, upto 200mg, which is about 10 ounces of coffee (1).

Sometimes caffeine is used to help stay awake, alert, keep up with academic demands, etc.

While the many benefits of caffeine have been widely documented, problems and side effects caffeine are not as widely known.

One study looked at the impact of caffeine on stress (2).

Who was involved in the study? (2)

  • 25 participants who used caffeine regularly or were light user of caffeine.
  • Subjects received placebo or caffeine (3.5mg per kilogram of body weight, about 238mg for a person weighing 150 pounds)

What was measured? (2)

  • Blood pressure, cortisol (stress hormone), norepinephrine and epinephrine (also involved in stress response and other functions).
  • Measurements were taken at rest, during a stressful laboratory task, and afterwards at rest.

What were the results? (2)

  • Compared to placebo, caffeine caused more than DOUBLE the levels of epinephrine and cortisol, both involved in stress response.
  • Effects were similar in both habitual and light users.
  • Habitual use of caffeine did not development of tolerance to the bodily response.
  • Even at rest, caffeine increased blood pressure and plasma norepinephrine levels.

What do the results mean?

Caffeine may increase your stress level whether you are using caffeine sporadically or regularly.

What are some other effects of too much caffeine?

  • Caffeine had as early as 7am lead to less efficient sleep and reduced total sleep at 9pm (3).
  • Some people have more daytime sleepiness because of caffeine related sleep disruption (4).
  • Caffeine can reduce bloodflow to the brain by up to 27% (5)
  • Too much caffeine can cause (1):
    • Worsening of anxiety
    • Jitteriness
    • Nervousness
    • Sleep disturbance
    • Headaches
    • Make your heart beat faster,  palpitations, high blood pressure, abnormal heart rhythms

What are some caveats?

  • This is a small study and there are many studies showing positive and negative effects of caffeine.
  • Not everyone has the same benefits or side effects caffeine.
  • The AMOUNT of caffeine that has beneficial and harmful effects can be different for different people.
  • Some people can metabolize caffeine much faster or slower than others (6).
  • For some people, it can take days to weeks to see benefits from reducing or eliminating caffeine.
  • Stopping caffeine abruptly can lead to withdrawal headaches, irritability, and other symptoms.

Are you feeling stressed, irritable or anxious? How is your caffeine intake? Could you benefit from less?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.fda.gov/downloads/ucm200805.pdf
  2. Land JD, Adcock RA, Williams RB, Kuhn CM. Caffeine effects on cardiovascular and neuroendocrine responses to acute psychosocial stress and their relationship to level of habitual caffeine consumption.  Psychosom Med. 1990 May-Jun;52(3):320-36.
  3. H.P. Landolt, E. Werth, A.A. Borbely, D.J. Dijk.  Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Research, 675 (1–2) (1995), pp. 67–74.
  4. T. Roehrs, T. Roth. Caffeine: sleep and daytime sleepiness. Sleep Med Rev, 12 (2) (2008), pp. 153–162.
  5. Addicott M.A., Yang L.L., Peiffer A.M., Burnett L.R., Burdette J.H., Chen M.Y.. et al. The effect of daily caffeine use on cerebral blood flow: how much caffeine can we tolerate? Hum. Brain Mapp. 2009;30:3102–3114.
  6. Cornelis, M. C. et al. Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption. Mol. Psychiatry 20, 647–656 (2015).

Healing As A Community

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Unexpected traumatic events can cause a wide range of feelings, thoughts, and physical reactions that can last for days to weeks afterwards. Being proactive can help you with the healing process.

What are some practical ways of healing after such events?

  • Collect yourself:
    • Take a few slow deep breaths.  When feeling scared or upset, doing this can help you feel calmer.
    • Simplify your life:
      • Make a list of things you need to do. Is there anything you can put off for a while? Anything you can let go?
      • Put off making major life decisions, if possible; until you feel better.
    • Take a few minutes each day for “worry time”; write down your concerns or worries.
    • Listen to quiet or relaxing music.
    • Get organized.
    • Tidy up your living space.
    • Re-establish your daily routine if possible.
  • Practice healthy habits:
    • Eat healthy food
    • Exercise regularly
    • Taking a walk.
    • Get enough sleep. For more sleep tips, go here.
    • Avoid using alcohol or drugs because they can delay the healing process.
  • Connect with others:
    • Talk to a close friend or counselor. Processing your feelings can be helpful.
    • Spend time with others if possible.
    • Find ways to help others. Doing so may ease your suffering.
    • Thoughtfully limit your exposure to media.
  • Take a step back and gain perspective:
    • Make a list of things that give you hope.
    • Make a list of things you are grateful for.
    • How does this fit in your bigger picture?

Finally, be kind to yourself. The healing process can be different for each person and you can experience a variety of emotions along the way. Don’t hesitate to seek out professional help.

Where can I learn more?

OSU Office of Student Life’s Counseling and Consultation Services

SAMSHA: Coping with Traumatic Events

What to Expect in Your Personal, Family, Work, and Financial Life: Tips for Survivors of a Disaster or Traumatic Event

Anonymous Mental health screening. Suicide screening prevention.

Adapted from coping after terrorism for survivors and from the links above.

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.