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).

Hidden Consequence E-cigs

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

Electronic cigarettes or E-cigs, have become popular in recent years for a variety of reasons.
Some tout the tobacco free alternative as a way to lower cancer risk.  Others claim it’s less addictive and less risk of lung disease.  These claims have been investigated via long term studies.

There are also risks of much higher nicotine ingestion than traditional (tobacco based) cigarettes leading to nicotine toxicity (1).
A recent small study, by Barrington-Trimis and colleagues, suggest another unexpected consequence of e-cigarette use (2).
Who was studied?
300 students,  in the 11th or 12th grade (2).
What was the study design? (2)
  • Questionnaires were given in the 11th or 12th grade, and again after they turned 18 years old.
  • Some questions included whether they use e-cigarettes, traditional (tobacco) cigarettes, whether they  smoke tobacco based cigarettes now or intend to do so in the future.
What were the results?  (2)
  • 40% of participants who reported e-cigarette use at the beginning of the study ended up using traditional (tobacco) cigarettes by age 18, vs only 11% of students who never used e-cigarettes.
  • After adjusting for different variables,  e-cigarette users were over 5 times as likely to initiate traditional smoking as those who had never used e-cigarettes.
  • The e-cigarette users who reported having no intention of smoking traditional (tobacco) cigarettes at the beginning of the study had a 9.7 x odds ratio of using traditional cigarettes by the end of the study.
What do the results mean?
  • According to this study, smoking e-cigarettes might increase your chances of smoking tobacco based cigarettes.
  • This is concerning because of the variety of negative mental health and physical consequences of tobacco use.
  • Smoking cigarettes can increase depression and anxiety (3,4).
Is e-cigarettes worth the feelings of anxiety, depression, and tiredness? Will you feel better if you exchange it for healthier ways of living?
What are some resources regarding tobacco use?
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. Ordonez J, Forrester MB, Kleinschmidt K. Electronic cigarette exposures reported to poison centers. Clin Toxicology 2013;51:685
2. Barrington-Trimis JL, Urman R, Berhane K, et al. E-Cigarettes and Future Cigarette Use. Pediatrics. 2016; 138(1):e20160379
3. https://u.osu.edu/emotionalfitness/2015/04/15/does-smoking-increase-anxiety-and-depression-if-i-quit-will-i-feel-better/
4. Taylor G, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. OPEN ACCESS. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151 (Published 13 February 2014)