Category: therapy

Virtual Reality for Mental Health

This…this absolutely sounds like something out of a science fiction story. But I saw this story in Axios, and now I am absolutely fascinated by its potential. 

So, here’s the basic gist, per the article: Virtual Reality can be used to simulate social settings and help the fifteen million Americans who suffer from social anxiety. It does this by creating facsimiles of social situations, allowing individuals to practice coping skills and learn how to better interact with members of the public. At least one study found that this could help to reduce symptoms of social anxiety.

This has been wondering – where else may virtual reality be able to play a useful role in terms of therapeutic applications?

As it turns out, plenty of spaces.

According to one article in Scientific American, Virtual Reality has been used to treat disorders like PTSD since the 1990s. However, technology and our therapeutic understanding of how the mind works is continuing to advance. As a result, new treatments are being invented to treat things like depression, addiction, and certain phobias. 

Virtual Reality offers many benefits. For therapy that requires exposure therapy, it can be less intimidating and frightening than other forms of therapy, allowing individuals to adjust slowly to real-world ideas. “Safe, controlled environments” can be created, and a therapist can be piped in, allowing for the delivery of therapeutic services. It’s not done yet – and quality control remains a huge issue – but the potential is clearly out there for VR to be effective. 

Much of the effectiveness of Virtual Reality for therapy relies on the design and quality of the technology in question. Is it immersive enough? And have the therapeutic protocols designed been proven to be useful? Remember, this isn’t like a video game – something that seems cool isn’t enough – it has to actually function and help the human mind. 

I can’t lie – I’m absolutely fascinated by this potential. As you may know from reading previous blog entries of mine, I love video games and technology, and I am absolutely fascinated by the potential it may have to be helpful in the mental health space. Of course, none of us would just want to see this be used because it sounds cool – if this is going to be used, it has to be because it has a therapeutic benefit that simply cannot be matched elsewhere. That being said, we know that technology has always been an important part of any treatment plan, and I am absolutely fascinated by the potential that it appears virtual reality may have for mental health.

Any thoughts about this technology? Any experiences you want to share? Let us know in the comments below!

“Noomifying” – and thus “Gamifying” – Depression & Anxiety

A dear friend was telling me about her very positive experience – thus far – with Noom. Just in case you’ve missed the ads (they are all over my YouTube feed, so I must be in their target demographic), here’s the basic gist: Noom is a weight loss website/app/program. There is a charge associated with it (I think it’s $40 a month), but it gives you access to a slew of resources, including weight loss trackers, recipes, fitness goals, articles, and more. The app then gives you “points” for completing tasks, like reading articles or tracking your food.

This buddy of mine is an achievement lover – she’s was laughing as she told me that she has actually done Duolingo for over 1,000 days, even though she doesn’t care that much anymore – simply because she doesn’t want to lose her streak. This fascinated me. Noom apparently gives you little tasks – walk 3,000 steps, for example – and then slowly ups the ante. It thus creates a runway of small, achievable goals. It’s also largely psychology-based, giving users the opportunity to learn more about the mindset behind weight loss and encouraging them to identify flaws in their thinking that lead to more weight gain, or at least less weight loss.

Noom also divides food into three categories – green, yellow, and red. You limit your intake of yellow and red but are free to enjoy green.

This fascinated me. The problem with many of these diets is that you have to stay on them forever or they stop working, like Atkins. But as I understand Noom, it seems to be based on changing the way people think and their lifestyle. This strikes me as having the potential for more success.

Does it work? Yeah, maybe. Noom has an array of research on their website, but it’s unquestionably worth doing a bit of digging on your own. From what I could find, yes. It does seem to work.

All of this being said, I wasn’t trying to write about Noom and weight loss. As my friend was explaining this to me, it made me think: How can we gamify depression the same way?

What would that look like? Hard to say. After all, weight loss isn’t like depression, and depression can often be harder to shake free than weight loss is to lose. However, the lifestyle-centric nature of Noom is what strikes me as having the highest possibility to work, and a lifestyle change with an app – replete with professional resources, access to counselors, tasks you can complete that provide you a sense of accomplishment – that is interesting to me.

Aspects of the Noom app are gamification. You complete certain tasks, you get achievements or rewards. It steers your brain in a certain direction by creating artificial awards that reward desired behavior. Could you do that for depression? Again, hard. But not impossible.

I’m not the only one to come up with this idea, of course, and people smarter than me have written about, researched, and studied this concept. That research has been positive: It appears that a well-design app can actually improve mood and rates of depression.

This begs the question: What more can we do to gamify depression and anxiety treatment? What controls are needed to ensure that these apps go well and that users don’t experience a crisis – or become worse – while using an app? I don’t have answers, but I do believe that the potential is clearly there.

The Mental Health Benefits of Doggos and Other Animal Friends

According to my Facebook memories, one year ago today, I wrote, “The only true winners of the pandemic are the pets.”

The picture above is the pet, Lexi. We got her in August 2019, and she has been our bestie ever since. She is sweet, lovable, patient, insane, and a wonderful addition to our family. We got her about six months after we lost Molly and a few weeks after we tried – and failed – to foster Mack.

I said it to my wife a thousand times, and it’s true: Lexi made the pandemic so, so much easier. She was a constant companion, a source of amusement, and basically just seemed…pretty glad to have us around. She seemed to just make us happier.

I just wanted to point this out – that’s a very, very real feeling. Doggos help, big time. From a mental health perspective, they:

  • Reduce depression
  • Ease the symptoms of a variety of mental illnesses, including anxiety, depression, and PTSD
  • Lower stress hormones
  • Reduce anxiety felt in children
  • Fill us with love and affection

There are a variety of physical benefits as well, including an increase in exercise, lower cholesterol, and improved heart disease. 

Oh…cats. Fine. I’m a dog person – and, unless I’m mistaken, I’ve found more articles about dogs than cats. However, cats do have real benefits on our physical and mental health, with some studies indicating that they lower blood pressure.

Actually, let me add one more thing. For years, Auron has wanted a fish. I mean, years. We told him – years ago – we’d do it when he was ten. To my disbelief, he actually remembered! Well, Auron turned ten the other day, and his Pappy got him a fish. We were all actually really clear with him: This is yours, buddy. You will be responsible for cleaning and feeding it – yes, we are supervising, I don’t want the damn thing to die.

To be clear, don’t get a dog to cure your depression. That’s not fair to the dog. They are living, breathing things. They are real, intense, and expensive responsibilities. But, if you have the time and the money, they are so, so worth it. If you are on the fence, keep that in mind. They are utter joys. And they can make us feel good.

Go Outside: It’s Good for Your Depression – and a Whole Lot More

Let me start by acknowledging that I’m really lucky that I can actually type this up. I have a nice house with a big backyard. Not everyone is able to do this. However, if you can, if it’s nice enough, you have the means to do so, and you have the space to do so – please go outside.

When I was younger, I went outside more often. That slowed as I got older, and I couldn’t even really tell you why. I was never a backyard kind of guy. Then we spent ten years in a home with a relatively small backyard (albeit a nice porch) and I didn’t see much of a point of going out. That changed as I did more research. One book in particular sticks with me – I’ve written about it before – The Depression Cure by Dr. Stephen Ilardi. The book argues that depression came from the way we have crafted civilization and that more time outdoors is necessary to address depression. I had other issues with the book, but on this point, I think is absolutely right.

The basic crux is that going outside helps make you feel more relaxed, more at peace, and more connected to others – even if there is no one around. And it’s backed up by some research:

  • One analysis of ten studies found that self-esteem and mood could be improved for people who spent more time outside.
  • People who walked in nature showed lower activity in brain centers associated with rumination, as opposed to those who walked in an urban center.
  • Being close to nature or “greenspace” can reduce stress, symptoms of anxiety, and provide children with ADD or ADHD additional cognitive benefits.
  • Nature is also associated with lower stress levels and higher levels of relaxation.

Alright, fine, going outside is good for your mental health. That probably isn’t really much of a surprise to you. It also helps explain why I’ve spent so much dam money on my backyard of late. But, let’s be clear, there are implications here that go a bit beyond the need to get some fresh air. Let’s go back to my disclaimer at the front of this article: What about people who don’t have a backyard? People who live in a heavily urbanized area and don’t have nearby public parks or nice amenities? People who are physically disabled and thus unable to easily access the benefits of nature?

Well…I mean, let’s be honest, they’re not going to get the benefit that the rest of us will. And that’s deeply unfair.

Of course, the benefits of nature, parks, greenways, and waterways are about more than improving your mood. Studies also show that access to nature can improve your physical health and provide a sense of connection with others. It can also improve your memory, your concentration, and help you lose weight. It’s pretty clear that being able to get outside in a high-quality space is about more than just improving your mood. It can do a lot more, and maybe, if Dr. Ilardi’s theory is to be believed, help people reconnect with something deeply biological within them.

So, if you can, go outside. Also – if you can – let’s all do a better job of advocating for high-quality public spaces that can be accessible to all of us, regardless of our income levels, where we live, or our levels of physical functioning.

The Rise of Telehealth

Telehealth wasn’t new to COVID-19. The concept has been around for decades and applies differently to different areas of medicine. That being said, one of its most positive potential uses has been in the area of mental health, and in that regard, COVID-19 may have pushed us towards telehealth in a big way.

First, check out this USA Today article on the subject. This line stuck with me:

Prior to the pandemic, Blue Cross Blue Shield of Massachusetts received about 200 telehealth claims per day. That number reached up to 40,0000 claims per day from April to May 2020, and the insurer is still receiving about 30,000 claims per day almost a year later, according to spokesperson Amy McHugh.

The article also noted that ” mental health appointments made up about 53% of the 7.5 million telehealth claims processed by Blue Cross Blue Shield of Massachusetts since March 2020.”

This isn’t a surprise, and many of us have had experiences with it. I know I had numerous virtual appointments via telehealth over this pandemic, and I found it every bit as effective as an in-person visit. Maybe even more so – the flexibility that came with it was highly beneficial. I remember having a therapy appointment from my office in Harrisburg!

Of course, it’s not for everyone, but there is unquestionably good news in the area of telehealth. According to a 2020 article from the American Psychological Association, telehealth seems to be working so far. There are even some questions as to whether or not telehealth may be more effective for some groups that are typically less willing to visit a psychiatrists office – like men – as it allows them to get therapy without having to leave their house, thus reducing potential barriers and making it easier for them to overcome self-imposed stigma.

The USA Today article also noted that telehealth can make a therapist more efficient. Said one therapist, “I probably spend somewhere between 2 to 5 minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off. There are built-in inefficiencies that isn’t time spending with the person… but some of those inefficiencies are taken care of by the fact that everything is electronic.”

Obviously, COVID pushed us more this way as part of all of our efforts to socially distance. However, major challenges remain in terms of full utilization and effectiveness of telehealth services. First, telehealth is predicated on the idea that someone has the broadband infrastructure and necessary equipment. As this pandemic has shown, that is NOT the case for everyone, particularly among rural Americans or the urban poor. Lacking such equipment means that someone will not be able to get the help they need.

Furthermore, there are insurance barriers. Not all insurance companies cover telehealth, and while states of emergency have knocked down many of these barriers, they haven’t destroyed all. As such, insurance regulations need to be updated in many states. However, this presents a problem in and of itself. For example, in Pennsylvania, the issue has been tripped up due to attempts to limit telehealth services and prevent abortion services from being prescribed or conducted via telehealth. Don’t ask.

The point is this: Telehealth is great, but we’ve got a long way to go.

Let me conclude with this: Did you have a telehealth experience with COVID-19? What was it like? Did you find it to be as effective as an in-person visit? We’d love to hear from you – give us your comments below!

Why is it so hard to find a therapist?

If I hear about one issue related to mental health over and over, it’s this: Why can’t I find someone to see me? Why is it so hard to find a therapist? Why can’t I find a bed to help me with my loved one who needs hospitalization? It is, unquestionably, the most frustrating issue in the mental health world – one that I would argue is more frustrating and problematic than general issues like access, affordability, parity, and stigma. Heck, we could solve all of these issues, but if we can’t get people into a therapist, it doesn’t matter.

The reason, roughly, comes down to this: A shortage of practitioners.

There is a well-documented shortage of mental health practitioners. According to available information, the shortage is growing across all fronts, including marriage and family therapists, psychiatrists, psychologists, and more. This shortage is particularly acute in some areas, like poorer states, or more rural states. It also gets worse as you start getting into specific areas of mental health, like geriatric or pediatrics psychology. In my home – the Lehigh Valley, Pennsylvania – we’re actually comparatively in good shape. This may come as a surprise to many people in our area!

So, why is there such a shortage? As you can imagine, there are many reasons. The biggest one is reimbursement rates. Simply put, psychiatrists and psychologists are not paid as much by insurance companies or Medicare/Medicaid as other doctors, particularly specialists. This, in turn, leads docs to go into more lucrative fields. That’s not it, of course. In fact, one of my legislative colleagues, Rep. Jeanne McNeill, was able to get a resolution passed that studied the mental health care practitioner shortage in Pennsylvania. That study identified numerous reasons, including regulatory barriers, burnout, parity issues, and information sharing.

What can we do about it? An in-depth analysis is well beyond my ability to address in a blog entry that I usually try not to break 500 words with, but in a nutshell, I think it comes down to investment. Everything above can be addressed with money. Not eliminated, of course. But absolutely addressed.

And, just like that, we’re back at my favorite topic. Everyone says they care about mental health. Great, neat. Can we do something about it? Can we pretend that it actually matters and invest in things like our workforce? In telehealth laws that will ensure that everyone has good access to mental health care, and broadband services to ensure that rural Americans can actually see a doctor no matter where they live? Can we enforce parity laws and ensure that larger insurance companies are meeting their needs when it comes to mental health coverage? Can we get the federal government to expand what they pay for in terms of mental health?

Gah. I’m on my soapbox again. But what I’m saying is accurate! Until the day comes that we actually treat mental health with the seriousness that it deserves, we’re gonna have practitioner shortages. This will limit the number of people that can get the care they deserve.

A More Preventative Mental Health Model

I caught this article in USA Today and it introduced a fascinating concept – one I hadn’t heard of.

Many of you are likely familiar with the National Suicide Prevention Hotline, which has been used to stave off countless crises and has likely saved thousands of lives. Of course, calling this number is what you do at your worst moment – when you are at the bottom of the barrel and feel as if you might hurt yourself because you have nowhere else to turn.

What if there was a way to reach a person before it hit that crisis point?

Introducing the “warm line” from the Mental Health Association of San Francisco. From the article:

Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis – and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.

In other words – someone can call, get support, talk to someone, and get access to more resources, thus potentially preventing a more expensive and serious crisis.

This is a great idea, and according to article, a wildly popular one. But, does it work? Will it cut down on arrests, suicides or other mental illnesses? According to one analysis, yes.

Here’s the real reason this appeals to me: It’s a paradigm shift. It’s so much more than just a band-aid or a cure for someone in a crisis. Don’t misunderstand – that’s incredibly helpful, and necessary. But what if we can stop someone from getting sick in the first place?

If you stop a physical illness before it gets infected, you save money, time, pain and lives. Hopefully, programs like this can help push in more into that sort of space when it comes to how we discuss, treat and cure mental illness. It’s why we should try to teach mental health in schools. It’s why physicians should conduct mental health screenings on routine exams. It’s why mental health first aid should be taught alongside physical health first aid.

We can stop these problems before they start.

Do you have a puppy folder?

I had a couple of rougher moments over the past weekend. No real reason, just work and stress – the standard stuff, really. I will admit that I was surprised by how intense it was, but these things happen.

Anyway, I was talking with my wife and trying to snap myself out of it, and with a laugh, I pulled up this video.

The background: I was speaking at an event announcing the moving of the Da Vinci Science Center into downtown Allentown (a big deal, locally!). I was surrounded by elected officials, major developers, local residents, the works. And the microphone just went, “Nahh, f&ck you, I ain’t working.” So we have massive feedback, followed by the microphone just straight up falling as I tried to speak. I know it sound stressful, but honestly, it was hilarious for me, and if you watched the clip, you can see I handled it just by laughing at myself. It wound up being really funny (side note: When faced with an embarrassing situation, just lean into it).

Anyway, whenever I watch this clip, I always get a chuckle. And that’s sort of the point of this entry.

On Monday, I spoke about the need to develop specific tactics which can help you fight back against your anxiety. Things that would temporarily distract you from where your head was swirling off to in order to break the cycle of anxiety and get you out of an attack.

This entry is more or less the companion entry for depression. My suggestion: Have a puppy folder. Have a folder (digital or physical) which you watch that features adorable videos which always cheer you up or make you laugh. It can be movie bloopers, cute pictures of puppies, whatever.

By the way, I do mean, literally, have an actual folder. As you probably know, when you go down the rabbit hole of depression, it can be extremely difficult to pull yourself back out, or to do anything which has even the slightest bit of self-care involved. That’s why I say you should have an actual folder, a one-stop shopping sort of place: When it comes to self-care in your darkest moments, you need to make it as easy as possible for yourself.

To be clear, this isn’t a long-term strategy. It’s a tactic, and there’s a difference. If you find yourself having these dark moments more frequently, if they turn to thoughts of self-harm, or if you start to lose productivity and the ability to function, you need to do more than just watch funny videos: You probably need to see a therapist.

That being said, everyone has down moments. The tactic of a puppy folder can help you break the cycle. It can feel good and give you a moment of joy, and that moment can turn into the foundation for getting yourself out of a rougher moment.

Any videos, pictures or websites which you use on a regular basis to get yourself out of that darkness? Let us know in the comments below!

 

4 Quick Tips to Break You Out Of Your Funk

My wife and I spent a lot of time this summer at the our local parks. We’re lucky – we live in Allentown, and we have this ridiculous park system. One of the closest to our house – and the largest – is Trexler Park, a gorgeous park with a lake, ample green space and a few paths. Every night last week, we’ve grabbed the kids and hopped down to Trexler. It’s been wonderful.

And I always feel better when we get back.

Look, one of the many problems with depression is that it totally locks you in. You do the same things because you simply do not have the time or mental energy to do anything else. That, of course, can only lead to more depression issues, and that’s something which you have to try and break if you’re ever going to make a recovery.

There are ways, however. The next time you feel stuck, consider doing any of these 5 activities.

Go to the park

Forget your troubles, try to forget everything. Go for a nice walk and lose yourself in nature.

Yes, this does help – and there’s research to prove it. It’s 8am on Sunday as I am writing this, and I just took the dog for a walk around my nearly deserted block. It felt so nice. The best way I can describe how I feel is more centered.

Volunteer at a nearby animal shelter

Our family just adopted a pupper again, and it’s been very nice so far. We took our time making the selection from the Lehigh County Humane Society, and one of the things which struck me when we were there was that they had a slew of volunteers walking in and out of that place, caring for the animals, taking them for walks, etc.

Look, puppies and kitties are more than just adorable: They help you fight depression. Combine that with the general mental health benefits of volunteering, and this one is well worth it. If you’re an animal person, go check out your local shelter and see what volunteer options there are.

Exercise

I’ve written about this one before so I am repeating myself, but exercise when you are depressed can be very beneficial, and again, there’s research to prove it. Depression is fundamentally biological, and exercise can change your biology and physiology, making you feel better.

Take care of yourself

When I think of myself in my most depressed state, it’s this: Covered in a hoodie, unshowered, hair uncombed and unshaven. Sound familiar? When you’re depressed, you lack the energy or mental strength to do even the most basic things, like take care of general hygiene. That, of course, is largely a mental trick, but it works both ways. Doing something small – even if it’s just brushing your teeth -can signal to your body that this is not where you want to be right now. So, to that end, when you’re down, make sure you take care of your body. Do the basics – shave and comb your hair. If you don’t think you have strength for that, try something small – take a warm shower. Try to fool your body into thinking you are okay – and then look the part.

These are four things which work for me and others, but they may not for you. What does work for you? Let us know in the comments!

 

The biggest reason it’s so hard to find a mental health practitioner

We don’t have enough of them.

As I run around in my real job discussing mental health, I consistently come back to this one central truth: The biggest issue in the area of mental health is that we simply do not have enough people to provide care, or who take Medicare or Medicaid. This means that, when you call a psychologist or psychiatrist, the most likely response is, “I’m sorry, but the Doctor is not accepting patients at this time.”

Consider this: According to a 2016 study, the supply of mental health practitioners by 2025 is expected to be 250,000 short. This disturbing trend is occurring despite the fact that rates of mental illness and suicide continue to increase, and increase alarmingly among the youngest members of our society.

Interestingly, the above article notes that a big part for the rise in demand of mental health practitioners has been a lessening of the stigma which surrounds mental health. As more people become more comfortable with seeking treatment, they put a greater strain on the need for mental health providers.

The problem is particularly bad in rural areas, where, according to this 2018 CNN article, “a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.” This shortage contributes to higher rates of mental illness, addiction, and suicide in rural communities. Indeed, it helps explain why rural areas typically have higher suicide rates than their urban counterparts.

So, what can we do about this?

I’d argue the biggest challenge is the need to increase mental health reimbursement rates, which are historically lower for mental health services. These low rates typically steer prospective doctors away from mental health specialties and into more lucrative practice areas like cardiology and oncology. Increasing these rates would help recruit more practitioners.

Additional funding is also needed for recruitment and loan forgiveness programs. Many states – including Pennsylvania – have begun enacting these programs in an effort to increase access.

Private practitioners and hospital systems also need to step up their game when it comes to this area, but according to the article above, the good news is that they are doing just that. I know that both of the major health networks in my area have said they are looking to expand capacity and recruitment when it comes to psychologists and psychiatrists, and they aren’t the only ones

If you are interested in the interaction between mental health and public policy, you really should pay attention to this space. There will be a lot more in this area in teh next few years.