Professional development presentation by Dr Michael Carr-Gregg in Newcastle for the Hunter Institute of Mental Health and Centre for Brain and Mental Health Research, University of Newcastle.
www.michaelcarrgregg.com
12. Around the
world…
31/08/201612
• E-mental health is
being used:
• in mass
delivery
• cost effective
• very effective
• more
accessible
• stay in control
• private
• Engaging
• Stigma
reducing
20. Why technology matters to
young people?
Their real world is both off and online
It is how they communicate
They have never known a world without
computers
It provides them with flexibility and
confidentiality
Removes geographical, attitudinal &
financial barriers
21. The average 18-
25 year old
• Checks their
phone 56 times a
day
• Once every 15
minutes
22. What else do we know?
9 out of 10 teenagers tell us that they are using
their phone while spending ‘quality time’ with
their parents
23. What else do we know?
7 out of 10 teenagers tell us that they
are using their phone while hanging
out with friends
24. What else do we know?
5 out of 10 teenagers tell us that they
are using their phone while eating at
restaurants
25. What else do we know?
3 out of 10 teenagers tell us that they
are using their phone while crossing
the road
26. What else do we know?
1 out of 10 teenagers tell us that they
are using their phone while having sex
27. A device weighing 155 gms
Has infiltrated virtually every
aspects of their lives
28. This gives us an
unprecedented
opportunity to
provide real-time,
standardised health
and wellbeing
information and
treatment directly to
young people in their
natural environment
using their
smartphones
32. Georgie’s Hx
16 years old
Attends local High School
Presents with a long Hx
of anxiety dating back to
primary school when she
was bullied by a group of
girls
Never really recovered
Now smoking cannabis
on weekends
34. Georgie’s Anxiety
She describes her worry as ‘out of
control’ and has started to interfere
with her life.
She often feels fear or worry
She often can’t concentrate because
of worry or fear
She often feels on edge or nervous
She sometimes panics or get upset
easily when nervous
35. Her symptoms can be short lived, or stay for a
long time. It can cause her to:
Become worried or constantly feel
‘something bad’ is going to happen
Often ask unnecessary questions, or
need constant reassurance
Get upset when a mistake is made,
or if there is a change of routine
Be a perfectionist, care too much
about things being ‘just right’
Become irritable or constantly in a
bad mood
36. Common ways anxiety affects her
physically
Having dry mouth or difficulty swallowing
Experiencing nightmares, difficulty
sleeping
Having difficulty concentrating
Experiencing muscle aches and pains
(especially neck, shoulders, back)
Feeling restless, or trembling and shaking
Having a rapid heart and breathing rate,
sweating, dizziness, headache
Feeling sick – nauseous, vomiting, or
having diarrhoea
49. The Centre of Excellence
adapted the American
HEEADSSS assessment
interview.
This included:
changing the language to
suit the Australian context
extending the domains
covered to allow the
detection of more serious
mental disorders.
60. // RESEARCH PROGRAM THREE: USER DRIVEN AND EMPOWERED
RECHARGE
• practical tips to improve her sleep/wake
routine and wellbeing
• Get daily reports to track her mood,
energy, exercise and sleep
• View graphs to help monitor her progress
which can be reviewed in each session
73. diets high in processed foods, soft drinks and
sweets to an increased risk of behaviour and
emotional problems
74. What is a
Mediterranean
diet?
Eating primarily
plant-based foods,
such as fruits and
vegetables, whole
grains, legumes
and nuts.
Replacing butter
with healthy fats,
such as olive oil
Using herbs and
spices instead of
salt to flavour
foods.
93. 8 week mindfulness course - 27
minutes per day
Massachusetts General Hospital
MRI scans documented how
meditation produced massive
changes inside the brain’s gray
matter
A major increase in gray matter
density in the hippocampus
Decreased gray-matter density in the
amygdala
Gets info on mindfulness
108. • an ultra-immersive running
game and audio adventure
• Every run becomes a mission
where you’re the hero, with
our immersive audio drama
putting you at the centre of
your very own zombie
adventure story.
• While you run to the perfect
mix of heart-pumping audio
drama and pulse-pounding
songs from your own
playlist, you’ll collect
supplies to grow your base
back home.
119. 119
been developed by
mental health nurses
offers alternatives to
deliberate self harm.
Practical easy steps to
distract, displace and
seek help, all at the
touch of a button and
with you at all times
Around the world Governments are really trying to come to terms with the idea of mental health being a much bigger community problem than they previously have recognised.
. If we were only going to use traditional forms of therapy than it would mean that we would all be having to work very, very long hours.
So, governments are looking for ways they can deliver some form mental health support, information and treatment to much larger proportions of the population and this is where e-mental health becomes so important as it can be used in mass delivery
Around the world Governments are really trying to come to terms with the idea of mental health being a much bigger community problem than they previously have recognised. If we were only going to use traditional forms of therapy than it would mean that we would all be having to work very, very long hours. So, governments are looking for ways they can deliver some form mental health support, information and treatment to much larger proportions of the population and this is where e-mental health becomes so important as it can be used in mass delivery, it can be very cost effective and very effective. Also helps people overcome some of the barriers that make it harder for some people to seek help, accessible, helps people stay in charge of their own work that they do, it is private and also can be very engaging. Because the internet is very consumer orientated it can also reduce feelings of shame and stigma about having a mental health problem.
Psychologists can provide some ‘beducation’ by providing Richard with:
This is a personalised six-week program that might help Georgie improve hergeneral health and wellbeing by focusing on four key areas:
Helping her establish a regular wake and sleep time each day, achieved gradually over six weeks;
An alarm clock that triggers fun activities designed to get Georgie up and out of bed;
Increasing her exposure to daylight early in the day, to help reset his body clock; and,
Encouraging her to increase herphysical activity, especially within two hours of waking up.
Recharge starts by asking Richard a few simple questions to set his personalised program goals, which can be done together with the psychologist, once Richard consents to trial it. By simply answering a few questions about his mood, energy, exercise and sleep, he will receive a daily report that will show him which goals you’ve met each day. His progress tracker will help him see the relationship between his mood, energy, exercise and sleep over the six-week program.
Given herinterest in technology, as an adjunct to the ‘beducation’ strategy, a good psychological ploy may be to introduce him to a wearable device, such as Jawbone UP, a slim computer wristband launched in November 2011 by Jawbone, a privately held audio technology company headquartered in San Francisco, California. A Psychologist might start by sending him:
A youtube clip that describes the jawbone UP
A blog on how the Jawbone might be used in therapy
The Jawbone UP is a flexible rubber-coated wristband that can be purchased at major electrical retailers for A$149.95 (at time of writing) and requires Richard to download the free accompanying iPhone or Android app, that allows him to track his sleep, eating habits, and daily activity including steps taken and calories burned
Richard can set the device to wake at a particular time and he will be, woken by a soft vibration on his wrist, timed to start buzzing at the lightest point in his sleep cycle. He presses a button on the bracelet to tell it that he is awake, and immediately plugs it into his iPod, iPhone, or iPad to find out how well he has slept. After a few seconds, a graph pops up to tell him how much deep sleep he has had. He logs how he feels by touching a happy or sad face on his screen.
The wristband is water-resistant and designed to be worn 24/7, with a rechargeable battery that lasts for up to 10 days at a time. It features a vibration motor that can be programmed as an alarm to wake users in the best phase of their natural sleep cycle, or act as a reminder when users have been sedentary too long. Clients report that there is something about seeing their stats written down that prompts them to move more and eat less.
The app allows Richard to add ‘teammates’ much like a Facebook friend stream, and seems to awaken a competitive element within them. He can adjust his settings to Tweet his psychologist, automatically when he reaches a certain goal. There are some organisations outside of private practice that prohibits the use of social media and such behavior would be considered a breach of protocol. This is discussed in greater detail in Module 3.
Logging food using the app is easy – they can scan the barcode and the app works out calories, sodium and saturated fat levels. UP is compatible with other health and fitness apps, including MyFitnessPal, which has a vast database of existing foods and allows people to input ingredients from a recipe to get accurate calories. It also provides a ‘word cloud’ of their most-eaten meals.
After a month of wearing the UP, Richard may realise that he isn’t sleeping enough – no where near the 8.25 to 9.25 hours a night, that research recommends. The app also delivers daily ‘insights’ based on Richard’s data. At first they are quite generic, but the longer he wears it – the more targeted the suggestions, such as eating pumpkin seeds before bed to improve his quality of sleep and supplying a link to a study that explains why.
One of the greatest features is the ‘trends’ function. It gives two parallel timelines: how much sleep Richard has had, with how many steps he has taken underneath. The day he took 25,000 steps he slept the best, with more hours of deep sleep; when he took only 7,000 steps one day, his sleep was reduced.
Not everyone needs to track how much they move, eat and sleep –indeed for some clients, for instance, those with eating disorders, this device would be contraindicated. But for the young people that have high prevalence disorders, such as anxiety and depression – for whom exercise and sleep is part of the recommended treatment – the UP it is a useful adjunct to their treatment. One of the most useful aspects of the device is that my clients are helped to realise that they need to invest in their sleep, rather than just accept feeling tired all the time. This is what UP does best – it forces them to see the things that they already knew weren’t quite right.
A study at UCLA showed that students who participated in an 8-week mindfulness course showed significantly lower levels of stress in comparison to a control group. This same research group also found that participating in a mindfulness course enhances concentration, cognitive flexibility, attention, empathy and self-awarenessIt boosts levels of happiness and lowers the impact of stress
• It increases your ability to focus your attention and improves your memory
• It makes you less sensitive to pain and boosts your immune system, making you less prone to getting ill.
• It makes it easier for you to fall asleep peacefully.
The Pip is a biosensor. Its breakthrough technology measures stress reactions at the skin level – electrodermal activity – and sends data to your smart device. That data feeds into the Pip Apps, which, using biofeedback, helps your mind learn how to manage stress.
eSense Skin Response is a small sensor to measure Lucy’s skin conductance using the microphone input of her smartphone or tablet (Android or Apple iOS.) The Psychologist explains to Lucy that skin conductance depends directly on her state of relaxation or stress, making it a commonly used and very precise stress indicator. With the eSense Skin Response, Lucy can precisely identify her stress level and reduce it with biofeedback training.
The eSense app provides Lucy with feedback about her momentary stress levels, e.g. with measurement curves, video display and audio feedback features. For the audio biofeedback, the eSense has a headphone jack, so she can listen to meditation music or a guided mindfulness exercise while training her stress level down! The app for eSense is free, and allows exporting the measured data via e-mail. With the aid of a computer, physiological processes which are otherwise difficult or impossible to perceive, are registered and thus made manifest and visible.
An activity monitor for your brain that teaches you about cognitive performance.
Turn the invisible activity of your mind visible! Melon's brainwave monitoring (EEG) headband listens to the electrical activity naturally given off by your brain. Using Bluetooth 4.0LE, Melon wirelessly connects to your phone to help you track and train the mental state of focus. The headband is adjustable in the back to fit most people (ages 10+).
Couch to 5K – Running App ($1.99), is a program that's been designed to help Richard progress from minimal exercise to running 5 kilometers or 30 minutes in just 9 weeks. Given Richard’s interest in technology and a stated desire to get fit, this app may be very useful for him. It is a gentle introduction to getting his body moving, starting off alternating between walking and running small distances, and slowly building up until after 8 weeks, when Richard will be ready to run 5 kilometers or 30 minutes non stop. Once fit he can set himself goals and track progress on walking, running, swimming, cycling. The key to success is to encourage Richard to ease into his 5K training plan gradually. In fact, the beginners' program is less of a running regimen than a walking and jogging program.
Each session should take Richard about 20 or 30 minutes, three times a week. That just happens to be the same amount of moderate exercise recommended by numerous studies for optimum fitness. Richard needs to space out these three days throughout the week to give him a chance to rest and recover between efforts. Richard needs to precede each training session with a five-minute warm up walk or jog. Being sure to stretch both before and after the sessions. The app’s designers provide a fact sheet on stretching called "Stay Loose"