Tag: recovery

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

—

DISCLAIMER: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

The futility of gratitude – and why it’s so important

I had an interesting realization in therapy the other day, and it led to this blog entry. Stay with me for a second.

My therapist and I were talking about trying to change my mindset from both a depression and anxiety perspective. I think a great deal of anxiety comes from a fear of “not being able to handle” any given situation – be that going to school, work, travel, whatever. I’m not quite sure what “not being able to handle” means, save for turning into a blubbering ball of sad and fear, but whatever. Now, by and large, that’s a silly fear. There’s no such thing – not really – as “not being able to handle” something. Sure, there are some life events and experiences that go better than others, but short of dying, you get through life.

This sort of fear in stressful situations can manifest itself in many ways. One of them is that it causes a shift in mindset. You no longer engage in new experiences to enjoy them or learn from them – instead, you do so in order to say “I survived” them. This mindset can be damning for so many reasons. You start an experience not looking to enjoy it, but to get through it. This kind of bunker-mentality can absolutely destroy your ability to get any joy. To try new things. To adventure or gain new experience. Indeed, it makes you afraid, and it makes you far less willing to be adventurous. You live in a constant state of looking over your shoulder, wondering when the anxiety attack will hit. Wondering when you will get cripplingly sad. Wondering what goes wrong next.

This way of thinking, of living – survival versus gratitude – can be absolutely crippling. And it leads me to the point of today’s entry: I don’t want to just survive. I want to thrive. I want to learn and to live. Don’t you?

How do you do that? Hahaha, yeah come on, you know I don’t have an answer. I only have a piece of one. That’s this: Try to change the way you approach new situations. Approach them from a perspective of gratitude and gaining new experience. Instead of entering an anxiety-provoking situation from the perspective of, “Oh, God, how am I gonna get through this?” ask yourself, “Okay, what can I learn from this?” or better yet, “How can I be grateful for this experience?”

Now, I titled this entry, “The futility of gratitude” because I am not an idiot. When you are depressed or anxious and someone tells you to “Be grateful,” you probably want to punch that person in the face. Grateful? For the crippling fear and sadness? That’s madness.

But, that’s exactly why it’s so important.

The only way to break anxiety and depression is to change the way you think. The way you process thoughts and emotions. And the only way to do that is to shift your mindset. So, just try this. Try, every now and then, asking yourself this question: “How am I learning from this new and difficult situation?” or “What can whatever I am experiencing right now teach me so I don’t encounter these problems in the future?” Fear is only crippling is it denies you the chance to grow, to learn. And there’s no such thing as an experience you can’t handle.

So, try to ask yourself that. Try to ask yourself what you can be grateful for. What you can learn. Shift your mind, and maybe you can shift your emotions too.

Redemption – my book – is now available

Today’s the day. A really, really big day, for me. Today, my book, Redemption, is available for order.

First, the logistics: If you pre-ordered it on your Kindle, it should be there! If you want to order it for Kindle or order a print copy on Amazon, go right to the website. To order it in other formats, or to order a printed copy directly from me (which I will sign and ship!), visit my website. Also, if you use Goodreads, you can check out the book’s page here.

Again, here’s what the book is about:

Twenty young people wake aboard the spaceship Redemption with no memory how they got there.

Asher Maddox went to sleep a college dropout with clinical depression and anxiety. He wakes one hundred sixty years in the future to assume the role as captain aboard a spaceship he knows nothing about, with a crew as in the dark as he is.

Yanked from their everyday lives, the crew learns that Earth has been ravaged by the Spades virus – a deadly disease planted by aliens. They are tasked with obtaining the vaccine that will save humanity, while forced to hide from an unidentified, but highly advanced enemy.

Half a galaxy away from Earth, the crew sets out to complete the quest against impossible odds. As the enemy draws closer, they learn to run the ship despite their own flaws and rivalries. But they have another enemy . . . time. And it’s running out.

Okay. Now for the personal stuff.

This book was written during one of the ugliest, most depressed periods of my adult life. I was in a bad funk, my wife was having a hard time at work, and we were both just struggling. I had started seeing my therapist again, I had increased my medication, but I was still in a really bad way. And I made a decision that I needed to do more, and remembered how writing had saved me when I was a teenager. I’d already written a non-fiction book – Tweets and Consequences – and while I’d enjoyed that process, I wanted to do more. I wanted to write something that was truly meaningful to me on a personal level.

Twenty years ago – probably more – I had this idea as a young teenage writer about kids winding up on a spaceship with no idea why. While I was thinking about writing, I remembered this kernel of a plot. I wanted to write about mental illness as well, since that cause has become such a part of my life.

And thus, Redemption.

As for why this is so important to me. Please understand that this isn’t just a book. It’s difficult to explain how meaningful writing this was on a personal level. The best way I can put it is this: When you write, if it is about an issue that you really care about, you’re not just creating words. You’re putting a piece of your heart out for the world to see. This book is a huge piece of who I am and my personal mission of helping people who suffer from mental illness find hope and recovery. I hope this book can do for others what it did for me – help pull me from the darkness. I hope it can help people realize that they can live good lives, even with depression, anxiety and mental illness. And I hope it’s a good read.

Anyway, world, meet Redemption. I hope you enjoy it!

Depression and meditation

Ugh, just writing this article makes me a little depressed. Why? Well, cause I can’t stick with this. No matter how hard I try, I absolutely, positively cannot stick with meditation – and that’s despite the evidence I’m about to write about below.

The studies are clear and I have written about the subject before: Meditation helps with depression. According to one study published in The Lancet, meditation may be as useful as anti-depressants at keeping depression at bay (side note: Damnit! I really need to look at this again!). This study noted the benefit of mindfulness meditation, which is a specific type of meditation.

What is mindfulness meditation? Mindful.org describes it simply: “Take a good seat, pay attention to the breath, and when your attention wanders, return. By following these simple steps, you can get to know yourself up close and personal.”

Want to know more? I found a few interesting resources on the subject. First, there’s this, from Headpsace, a meditation app I’ve used before. The article details the struggles of a very depressed man who tries meditation in a desperate attempt to get some relief and how meditation changes the way he thinks. The Washington Post ran a similar story earlier in the year, in which the author discusses how the Headspace app (this isn’t a sponsored post, I swear) helped them relearn their thinking.

Want more info on the research behind meditation? Check out this article on Mindfulness-Based Cognitive Therapy, which is a specific type of meditation designed to help those with depression.

If you’re interested in more information on how meditation may help people with anxiety and depression, look at this pretty fascinating article from Harvard, which details specifically how depression can physically change your brain.

I will say this: As I’ve bitterly noted repeatedly, there have been many instances where I have actually meditated with some regularity, only to stop after some period of time. But, during those times, I did notice some changes about the way I was thinking. Specifically, I found myself focusing less often on anger, frustration and bitterness. I found myself better able to let things go, and it felt great. Sadly, inevitably, a busy life caught up with me, and I let the practice fall away.

Time to try again!

As always, I conclude with a question: What has been your experience with meditation? Have you practiced it – or do you practice it – on a regular basis? Notice any changes that you want to share with us? Please tell us your story in the comments below!

Why “Redemption”

As I said in an entry the other day, I have a book coming out on June 5. It’s called Redemption, and it’s about depression, anxiety and saving the world. From the blurb:

Twenty young people wake aboard the spaceship Redemption with no memory how they got there.

Asher Maddox went to sleep a college dropout with clinical depression and anxiety. He wakes one hundred sixty years in the future to assume the role as captain aboard a spaceship he knows nothing about, with a crew as in the dark as he is.

Yanked from their everyday lives, the crew learns that Earth has been ravaged by the Spades virus – a deadly disease planted by aliens. They are tasked with obtaining the vaccine that will save humanity, while forced to hide from an unidentified, but highly advanced enemy.

Half a galaxy away from Earth, the crew sets out to complete the quest against impossible odds. As the enemy draws closer, they learn to run the ship despite their own flaws and rivalries. But they have another enemy . . . time. And it’s running out.

Now, here’s the question I keep getting: Why is it called Redemption?

First is the obvious: It’s the name of the ship. But it’s the name of the ship in the book for a reason.

Okay. So I wrote this thing not just to tell a science fiction story, but to tell a story of mental illness and give those who suffer hope. That’s sort of been my driving force, as an elected official and advocate for the mentally ill. And to be perfectly honest, that permeates just about every facet of the book. Including the name of the ship.

I named it Redemption because I think the idea of guilt – and seeking Redemption – was and is a big part of my depression. Guilt is a common symptom of depression. It’s something I certainly got to know in a very personal way. And I spent most of my life searching for redemption. I desperately wanted to be redeemed from some unknown sin. And I think that’s something that’s relatively common among those who have suffered.

The entire plot is, at it’s core, a redemption story, but not from a sin: From mental illness, from depression and from anxiety. It’s a redemption that I think we all strive for. In my experience, it’s almost not complete obtainable. Personally, I know I will never be completely free from mental illness. It will always be there, running in the background like an iPhone app. Recovery isn’t an end state, it’s a journey. And that’s a lesson I that I have tried to learn all my life, and a journey I try to highlight in Redemption.

As always, I’d love to have your thoughts. Is this an experience you understand? No? Either way, let us know in the comments!

“So, what are you going to do about it?”

One of the most impactful memories of my life occurred somewhere in the late summer of 2012. At the time I was +220 pounds, and I’m about six feet tall, so this was way up on where I should have been. I had just eaten a ton and had the misfortune of standing on the scale, thus depressing myself more than usual.

Anyway, I was in my living room with my wife, sitting on the couch. My wife had completed her own significant weight loss journey a few years prior, dropping fifty pounds, so I knew she would understand my sadness over my weight and where I was.

So, there I sat, complaining to my wife about my weight. She was silent, nodding, as I listed how upset I felt at what I had allowed myself to do to my body. And then, finally, she asked me this question:

“So, what are you going to do about it?”

That was the question that changed my life. I mean, there I was, complaining about how miserable I was, and I hadn’t done a damn thing to make it better. That wasn’t fair and it wasn’t right. How dare I complain when I hadn’t even tried to improve? So, right then and there, I decided to do something.

In terms of weight loss, I got lucky in that my body was more amenable to losing weight than that of many others. I downloaded a calorie tracker from Livestrong and used that, and exercise, to shift my mindset. Staying in my allocated calories became like a game. And, over time, it worked. I dropped thirty pounds and kept them off. I’m in better shape now than I was in my 20s.

Now, that being said, in writing my blog entry earlier this week, I remembered this question and how it applies to mental health as well. That entry dealt mainly with what I wish every “support person” knew about depression and mental illness, and one of the items mentioned was that none of us really want to be depressed, and we’d all love to get better.

Allow me to propose this question then, support people. It’s the question that you may want to ask when the depressed/anxious person that you love is in pain. You may want to ask it in the most non-judgmental, softest way possible. You also may want to ask it in a tough love sort of style, as my wife did to me:

“So, what are you going to do about it?”

Depression sucks. It does. And it’s taken me years and years to realize that it’s not a weakness and not my fault. Indeed, it’s not the fault of anyone who has it. But there is a big difference between not my fault and not my responsibility. All of us who suffer from some sort of mental illness have an obligation to do something about it. That may mean doing little things on our own time, like exercise or meditation. It may mean seeing a therapist or psychiatrist to discuss medication. But above all else, it means managing our disease.

Support people, here’s where you can come in. Ask us this question. If the depressed person you love truly wants to get better, they’ll need an answer. They’ll need to do something about it in order to get better or get through the rough patch they are in. It is a question I have to ask myself from time to time when things get bad. Sometimes the answer may be, “Wait a week and see if I’m this miserable still – if I am, I’m going to see my therapist.” Sometimes the answer may be, “I’m making a call now!” But above all else, there needs to be a real answer.

And, as always, I’d love to hear your thoughts! How do you ask your loved one or yourself this question. What has your experience with this been like? Let us know in the comments below!

Depressed? Try volunteering

I caught this article on Motherboard and it really, really got me thinking.  The article itself is certainly worth the read, but I’ll try to summarize the points and add my own spin on it.

The article notes that volunteering helps with depression.  This happens a few different ways:

  • First, there are mental and physical benefits to volunteering.  Volunteering can lower blood pressure, reduce the risk of hypertension and make you physically feel better.  This happens, in part, by noting that oxytocin (feel good brain chemical) gets released when you regularly volunteer.
  • Volunteering helps you keep things in perspective.  It gets much harder to be depressed when you are working with someone much less fortunate than you.  I’ve always found this to be a helpful strategy, to be honest: On moments when you are depressed, compare yourself to someone who has it worse than you.
  • Volunteering gives you social connections and social interaction, a challenge for people who are depressed.

It’s actually the second point that I want to talk about more than anything else, because that’s something I’ve always found to be powerful: Volunteering gets you out of your own head.  Let me point back to a blog entry I made some time ago about depression and rumination: Thinking obsessively about yourself, and your own problems, can be tied very strongly to depression.

That’s where volunteering can come in.  Not only are you exposed to people in legitimately worse situations than you, but it can help you out of your own head, as it is much harder to think about yourself when you are trying to help others.  Sometimes, your brain needs that extra kick in the butt to stop the thoughts of yourself.  And that’s where volunteering can come in.  According to the article, there is no volunteering that is better than others – doing good means feeling good.

I do want to add one clarification here, however: I’ve made volunteering sound like a selfish exercise designed to the volunteer feel better. That’s not the attitude that you should have when you go to do good. Don’t get me wrong, there is nothing wrong with volunteering because you want to feel better and are hoping to build some social connections and make a difference.  But I would remind you that the only way to truly reap the benefits of volunteering is to do so by approaching it from an ultimately selfless perspective.  Go somewhere with the hope of doing good, and the rest of it will fall into place.

As always, I am curious to hear your perspective.  What good experiences have you had with volunteering in the hopes that it will help control depression?  How about negative ones?  I know I’ve felt both ways when volunteering, and I’m curious to hear other perspectives.  Let us know your thoughts in the comments!

Why talking about mental illness helps

I’d almost make the argument that the thing that makes the most sense about depression is that it doesn’t make any sense at all.

Like, none.

Understand that this is just my perspective, but hear me out on this one.  Depression, anxiety, mental illness, the works, they make no damn sense.  I mean, isn’t one of the things that makes us human the ability to control our own thoughts and act independently?  “I think, therefore, I am?” and all that?

Which is why having a mind that works against you so darn frustrating.

Call me crazy here…okay, don’t, I do that enough on my own…but I think that one of the reasons that depression is so frustrating, confusing and mystifying is that it goes against the very thing that makes us human: Our ability to think.  Humans are fundamentally logical and emotional creatures, right?  I firmly believe that there is a piece of our own minds will always believe that it is in control.

Of course, that isn’t the case.

Even now, even as someone who has been living with depression for years and doing so in a very public forum – it still makes no sense to me.  How is it that people who are so successful, loved and popular can still suffer so?  And I ask myself this question despite the fact that I am someone who has depression.

So, that brings me back to the crux of this blog entry: Why I think that talking about depression/mental illness in an open, honest and public manner helps, and why I always encourage others to do the same.

I think it helps us make sense.

I firmly believe that the idea that we aren’t in complete control of our emotions and thoughts is a truly alien one, something that most of us struggle with on some base level.  To that extent, I think that talking about mental illness helps.  It helps us process what’s going on in our brain and make sense of the thoughts and feelings that we are experiencing.

I obviously don’t have all the answers to mental illness – if I did, I’d be a lot richer, and at least a little bit happier.  But I would suggest this: If you are one of the people suffering in silence, do what you can to change that perspective.  Talk about it.  You may not have access to a supportive network of family or friends, but I think you’d be surprised at the amount of online support groups that you can participate in – anonymously or not.  Even the act of sitting there, and formulating your feelings, can help process your emotions and make a positive difference in your life.

And, on a personal note: I’ve found that this blog has helped my advocacy tremendously, and not just because it gives someone else a chance to read my thoughts.  By putting “pen to paper,” so to speak, it gives me a chance to organize my thoughts, examine my feelings and reevaluate the way I handle my own recovery.  It’s also helped me to rethink some of my public advocacy, in particular the portions related to stigma – it’s not just stigma that matters, but self-stigma.  

As always, I’d love to hear your thoughts.  Am I onto something here?  Let us know in the comments, and have a wonderful day!

What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!