Can Technology Increase Behavioral Health Wellness?

Originally published in NYAPRS Note: The article below, developed by NYAPRS’ Molly Donahue, delves into the benefits and risks of relying on technology to assist in behavioral health wellness. The resources included are great places to start for consumers, providers, and policy makers to understand this technological capacity.

Can Technology Increase Behavioral Health Wellness?

NYAPRS; Maureen Donahue, 8/20/2014

At some point during a visit with my parents, one or both of them will express a sentiment along the lines of, “I wish there was a way for me to manage x, y, or z more efficiently.” And more often than not, my response is, “Actually, there’s an app for that.” It has become the tagline of the Millennial generation. Cell phones, once a marker of financial stature, are now remarkably cheap and accessible. In a startling study from March of 2013, the United Nations reported that more people on earth have access to cell phones than toilets. In the age of smartphones being a natural extension of our bodies, app developers are constantly finding new and unique ways to integrate our digital connectivity.

Technology is changing the way we experience health care, across the board. Physicians are integrating digital records and applications to streamline treatment and increase accountability. Recently, the coined ‘digital revolution’ intersected with behavior health recovery, and a boom of behavioral health apps hit the marketplace. Managing personal health and recovery goals through technology is not a new concept, but it is gaining momentum. When I was in college, you would have been hard pressed to find a woman who didn’t have a daily alarm set on her Nokia to remind her to take her oral contraceptive – now there are entire apps dedicated to maintaining consistent medication regimens, or easily refilling prescriptions at your favorite pharmacy. Clinical and academic applications allow us to carry unlimited medical resources in our pockets. Mood and feeling diaries are also popular apps for mobile devices.

Along with the increase in apps for behavioral health, criticism of an increasingly ‘app dependent’ generation of patients is on the rise. Attempts to streamline our lives, critics argue, may result in added anxiety or stress. I can understand the position: misplacing my iPhone is a stressful, sometimes panic-riddled monthly event. My entire life is on that phone, I often rationalize – my photos, contacts, calendar of events, etc. Consider then the added anxiety of losing not only your photos, but also a year of your mood diary, or your medication reminders, or your crisis lifeline.

Only you can decide if technology will assist with your overall behavioral health and recovery goals. If you do incorporate apps into your life, just keep in mind that technology, while amazing, is also fickle. Make sure you have backup copies of important information, and keep a hard copy of vital contact numbers or websites so that you can access help in a crisis situation. I think I’ve found a happy medium: I keep a digital mood diary to track potential swings because I have my phone with me at all times, but I also record a hand-written supplement (the physical writing is part of the therapy, for me). I use my phone to refill my prescriptions on the go, but still carry a hard-copy in my wallet just in case.

I’ve collected a list of apps across platforms that are geared toward behavioral health and wellness. Note that this list is not comprehensive and I have not tried/used the majority of these applications. The list is culled from online research, and friend recommendations. It is organized thematically.

Abuse/Violence/Safety

circleof6 – A discreet app for violence prevention in vulnerable populations through the use of mobile technology (iTunes/Android – free)

Guardly – The fastest way to connect to authorities, family & friends, when you need help (iTunes/Android/Blackberry – free)

Just In Case – Set automatic messages to contact friends if in a risky/dangerous situation (Android – free)

LifeLine Response - When the Distress Alert is activated and not disarmed within 20 seconds the Response Verification Center will call the user back and verify there is a real emergency (iTunes/Android - $9.99)

On Watch – A personal safety app developed specifically for college-aged users (iTunes – free)

Addiction recovery

12 Steps Companion (iTunes/Android - $2.99)

ImQuit – Track your progress (Android – free)

iPromises Recovery Companion - Add friends, see shared meetings, track your progress and challenges, and get a daily positive message one day at time (iTunes – free)

Meeting Finder – The most comprehensive 12 step program meeting search tool (iTunes/Android – free)

Recovery Box – A sobriety toolset that facilitates tracking of daily life activities (iTunes - $1.99)

Anxiety

Beat Panic – Interactive resource for before, during, and after a panic attack. (iTunes - $0.99)

Beat Social Phobia – A guided audio program geared toward assisting users with social phobias (iTunes/Android - $2.99)

iCounselor: Anxiety – Learn skills and behaviors to reduce daily anxiety (iTunes – $0.99)

iStress – A stress and anxiety management tool (iTunes - $0.99)

Bipolar/Mood Tracking

Bipol-app – A symptom and trigger monitoring app for users with bipolar disorder (iTunes/Android – free)

eMoods - Charting daily extremes of moods and other symptoms (Android – free)

iMoodJournal - Mood journal, personal diary and charting tool helping you recognize patterns and triggers of your mental state, including bipolar and OCD (iTunes - $1.99)

Mood & Anxiety Diary -  Track changes in mood and anxiety over time (iTunes - $2.99)

Mood Panda – A free and interactive mood tracking application that can also be accessed via browser (iTunes/Android/Web – free)

MyMoodTracker -  Track your moods and emotions, and everything else that can affect how you feel (iTunes - $4.99)

Crisis Intervention

ASK & Prevent Suicide – Educational and crisis resource (iTunes/Android – free)

HELP Prevent Suicide - easy access to crisis intervention resources, including a list of warning signs, steps on how to talk with someone in crisis, and information on national resources (iTunes – free)

Operation Reach Out - Provides activities to help people who are depressed stay connected to others (iTunes – free)

QPR Suicide Crisis Support - An electronic version of the booklet “The Tender Leaves of Hope, Helping Someone Survive a Suicide Crisis.” (Android – free)

Body/Eating/Health

Body Beautiful – An app to help cultivate positive self-image and health goals. (iTunes - $0.99)

Eating D – A skills and knowledge based application for those living with disordered eating. (Android - $0.99)

Project Toe – An app to facilitate connections between users who are intending to self-harm (iTunes/Android – free)

Recovery Record – Eating disorder management tool for all body image concerns (iTunes/Android – free)

Rise Up + Recover – An eating disorder monitoring and management app (iTunes – free)

Depression

iCounselor: Depression – Learn skills to reduce and manage depression (iTunes - $0.99)

DBT Diary – A DBT skills coach and life diary designed to track, assess and modify behaviors. (iTunes/Android - $4.99)

PTSD

PTSD Coach – Developed for Veterans and military Service Members who have, or may have, Posttraumatic Stress Disorder (Android – free)

Prescribing Exercise before Medication

Depression is the most common mental illness—affecting a staggering 25 percent of Americans—but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.

Percent of patients in each condition six months after treatment. (Psychosomatic Medicine)

Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercise helps the brain grow new neurons.

But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.

After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills? The answer speaks volumes about our mental-health infrastructure and physician reimbursement system, as well as about how difficult it remains to decipher the nature of depression and what patients want from their doctors.

Jogging as medicine

“I am only a doctor, not a dictator,” insists Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. “I don't tell patients what to do.”

Trivedi is one of the forefathers of the movement to combat melancholy with physical exertion. He’s authored multiple studies on the exercise-depression connection, and workouts are now one of the many weapons in his psychiatric arsenal. But whether any given treatment is right for a particular person is entirely up to that patient, he said.

“I talk about the pros and cons about all the treatment options available—exercise, therapy, and pills,” he said. “If a patient says, ‘I'm not really keen on medication and therapy, I want to use exercise,’ then if it's appropriate, they can try it. But I give them caveats about how they should be monitoring it. I don't say, ‘Go exercise and call me if it doesn't work.’”

Here’s how he goes about this unconventional type of prescription: “People will take the disease and treatment lightly if they know Paxil is coming.”

First, Trivedi must gently raise the idea of exercise as a treatment option—patients often don’t know to ask. (There are no televised pharmaceutical ads for running, he notes.) He then tells patients about the studies, the amount of exercise that would be required, and the heart rate they’d need to reach. Based on a recent study by Trivedi and others, he recommends three to five sessions per week. Each one should last 45 to 60 minutes, and patients should reach 50 to 85 percent of their maximum heart rates.

He and the patient then blueprint a weekly workout schedule together. Not doing enough sessions, he warns, would be like a diabetic person “using insulin only occasionally.” He encourages patients to use FitBits or other monitoring gadgets to track their progress—and to guilt them off the couch.
Trivedi says this approach rests on three key elements. “One, you have to be very clear with patients that just because exercise has been shown to be efficacious, it doesn't work for everyone. Two, the dose of the treatment is very important; you can't just go for a stroll in the park. And three, there has to be a constant vigilance about the monitoring of symptoms. If the treatment is not working, you need to do something.”

That “something” could be adding antidepressants back into the mix—but only if the workouts have truly failed. “People will take the disease and treatment lightly,” he said, “if they know Paxil is coming.” For more of this article go to
http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/

Free Community Wellness Fair

You are invited to the

Downtown Newark Community

Wellness Fair

Compeer is a program of Mental Health America of Licking County. Call 740.788.0303 for more information

May 31, 2011 

2 p.m.-6 p.m.

at the Newark Public Library

101 W. Main Street, Newark

Free and open to the public!

National Wellness Action Plan Report Now Available

The Substance Abuse and Mental Health Services Administration announces the availability of its 10 x 10 Wellness Campaign's report, The 10 By 10 Campaign: A National Wellness Action Plan to Improve Life Expectancy by 10 Years in 10 Years for People with Mental Illness. This ground-breaking report from the 2007 National Wellness Summit for People with Mental Illness describes the "shockingly unacceptable" increased mortality and epidemic of health disparities for people with behavioral health problems and recommends essential steps to meet the Campaign's goal to improve their life expectancy by 10 years in 10 years. The National Wellness Action Plan details key elements and barriers to wellness and highlights innovative programs that successfully promoted wellness and reduced early mortality in a variety of populations. You may order the report for free at http://store.samhsa.gov/product/SMA10-4476.