smartphone

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.

Blue Blockers and other ways to reduce electronics-induced sleep disruption, and daytime tiredness

By R. “Ryan” S Patel DO, FAPA-OSU CCS Psychiatristblue_light

Blue spectrum light from electronics suppresses melatonin for several hours after use (1,2) and disrupts your circadian (sleep wake cycle) clock (3). This impacts sleep quality and daytime tiredness (4). Sleep disruption can also impact anxiety, depression, and many other health conditions (5).

So it may be worth avoiding use of electronic devices such as computer, tv, tablets, smartphones, etc. 1-3 hours before bedtime.
Some suggest replacing exposure to bright light bulbs with dim light bulbs around bedtime (6) may also be helpful. There are even light bulbs that do not emit blue light.

What if I need to use electronics at bedtime?
Sometimes it may be necessary to be on the computer, tv, smartphone, etc right before bedtime.
Blue blockers may help prevent sleep disruption from electronics.

How do blue blockers work?
They block blue light emitted by electronic devices, thus melatonin is not disrupted (6).

What are some examples of blue light blockers?
Some examples include blue blocker eye glasses, software programs that prevent your device from emitting blue light, plastic filter screens that are placed on top of the screens to block blue light, and light bulbs that do not emit blue light. You can search for “blue light blockers” “blue light filters”, “bedtime reading software” etc. in a search engine, or in an app store.

Do blue blockers work?
There are small studies that show blue blockers work to prevent melatonin disruption and improve quality of sleep and mood.
For example, 20 subjects were randomized to use either blue blocking glasses, or non blue blocking glasses 3 hours before bedtime over a 2 weeks period (7).

What did the results show?
Those who used blue-blocking glasses reported better sleep quality and mood.

Words of caution:
• You still need to be mindful of getting enough hours of sleep—getting 4 or 5 hours of quality sleep when you need 8 will still leave you tired.
• Blue blocking methods may not help with your sleep if your device usage is overly entertaining or emotionally intense.
• You still need to address other causes such as use of caffeine, nicotine, alcohol use, etc.
• This is still a relatively new terrain and further research is needed.

Are you sleeping poorly? Are you tired during the day? Are electronic devices interfering with your sleep; can you cut down your usage before bedtime? Can blue blockers help you?
What are other ways to improve sleep?
National sleep foundation sleep tips.

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. Brainard GC, Hanifin JP, Greeson JM, Byrne B, Glickman G, Gerner E, et al.
Action spectrum for melatonin regulation in humans: evidence for a novel
circadian photoreceptor. J Neurosci 2001;21(16):6405–12 [August 15, PMID:
11487664].
2. Thapan K, Arendt J, Skene DJ. An action spectrum for melatonin suppression:
evidence for a novel non-rod, non-cone photoreceptor system in humans. J
Physiol 2001;535(Pt 1):261–7 [August 15, PMID: 11507175].
3. Smith MR, Revell VL, Eastman CI. Phase advancing the human circadian clock
with blue-enriched polychromatic light. Sleep Med 2008 [September 18,
PMID: 18805055].
4. Fossum IN, et al. The Association Between Use of Electronic Media in Bed Before Going to Sleep and Insomnia Symptoms, Daytime Sleepiness, Morningness, and Chronotype. Behavioral Sleep Medicine. Volume 12, Issue 5, 2014, pages 343- 357. Published online: 14 Jul 2014. DOI: 10.1080/15402002.2013.819468.
5. http://sleepfoundation.org/sleep-disorders-problems
6. Kayumov L, et al. Blocking Low-Wavelength Light Prevents Nocturnal Melatonin Suppression with No Adverse Effect on Performance during Simulated Shift Work. The Journal of Clinical Endocrinology & Metabolism 90(5):2755–2761.
7. Burkhart K1, Phelps JR. Amber lenses to block blue light and improve sleep: a randomized trial. Chronobiol Int. 2009 Dec;26(8):1602-12. doi: 10.3109/07420520903523719.

Smartphone use before bedtime might impact sleep, and daytime tiredness

Smartphone or cellphones are a useful tool and when used properly can have many benefits.
Many students frequently use cell-phones and often very close to bedtime. Students may not know that cellphone use might impact their ability to sleep at night and this might impact their daytime energy levels.
This study explored the relationship between cellphone use at bedtime and sleep.

Who was studied?
532 students aged 18–39 were recruited from lectures or via e-mail (1).
Mean time of media use per night was 46.6 minutes.

What were the study results?
Mobile phone usage for playing/surfing/texting was positively associated with insomnia.
Computer usage for playing/surfing/reading was positively associated with insomnia.

What do the results mean?
Computer or cellphone use in bed before bedtime may worsen your sleep.

How does screen time impact sleep?
There are various potential causes:
Media use might make it take longer to fall asleep (2).
Media use might mean less time spent sleeping, thus reducing sleep (3).
Bright light emitted by electronic devices might impact sleep quality (4).

Light exposure might be temporarily activating you (5-6).

Are you sleeping poorly? Are you tired during the day? Is screen time before bed impacting your sleep? Will cutting down on screen time improve your sleep? How do you know?

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatrist
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. Fossum IN, et al. The Association Between Use of Electronic Media in Bed Before Going to Sleep and Insomnia Symptoms, Daytime Sleepiness, Morningness, and Chronotype. Behavioral Sleep Medicine. Volume 12, Issue 5, 2014, pages 343- 357. Published online: 14 Jul 2014. DOI: 10.1080/15402002.2013.819468.

2. Higuchi, S., Motohashi, Y., Liu, Y., & Maeda, A. (2005). Effects of playing a computer game using a bright display on presleep physiological variables, sleep latency, slow wave sleep and REM sleep. Journal of Sleep Research, 14, 267–273.
3. Van den Bulck, J. (2004). Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep, 27, 101–104.
4. Cain, N., & Gradisar, M. (2010). Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Medicine, 11, 735–742.
5. Cajochen, C., et al. (2011). Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. Journal of Applied Physiology, 110, 1432–1438.
6. Campbell, S. S., et al. (1995). Light treatment for sleep disorders: Consensus report. III. Alerting and activating effects. Journal of Biological Rhythms, 10, 129–132.