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Therapy Toolkit

Apps for Mental Health

Don't Worry, Be Appy!
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Mental Health & Wellness Smartphone Apps

Your smartphone can be a powerful tool for improving your overall mental health and wellness! This guide includes some of the BEST and most credible apps available with ratings from One Mind Psyber Guide research center at UC Irvine. Each app is rated on credibility, user experience (U.E.) and transparency, and includes a short description to let you know what to expect from the app. Many of these apps are available on all the leading smartphones and others are available on iPhones and iPads only.

Please feel free to email me with your personal favorites and I’ll add them to the list. (DrKleppe@DrKleppe.com)

Stress, Anxiety, & Depression

Happify: for Stress & Worry 

Happify is a wellness app that offers science-based activities and games to help you reduce stress and anxiety, overcome negative thoughts, and improve your emotional well-being 

Credibility: 5/5

User Experience : 4.59 / 5

Transparency = Acceptable

FREE or by subscription for $14.99/month 

Mood Mission 

MoodMission is an app that offers mood-boosting activities aimed to help users experiencing stress, anxiety, or an overall low mood. "Missions" range from meditations, fitness activities, affirmations, yoga, gratitude, and more! 

Credibility: 4.67/5

User Experience : 3.94 / 5

Transparency = Acceptable

App available for purchase for $4.99 

Sanvello: Anxiety and Depression 

Sanvello is an app designed to help users with symptoms of anxiety, depression, and stress. It tracks users progress over time & provides personalized activities including coaching, coping techniques, meditations, goal and mood tracking & more! 

Credibility: 4.33/5

User Experience : 4.58 / 5

Transparency = Acceptable

FREE or by subscription at $8.99/month 

Meditation/ Mindfulness

Headspace 

Headspace is a popular app that offers guided meditation, sleep meditation, & breathing exercises. There are hundreds of meditations that are broken down by goals including managing anxiety, increasing focus & productivity, relaxation, improved sleep and more! 

Credibility: 5/5

User Experience : 4.97/ 5

Transparency = Acceptable

Available by subscription at $12.99/month 

Calm 

Calm is a mindfulness meditation app for beginners that offers guided meditations, Sleep Stories (for adults and kids!), breathing programs, stretching exercises, and relaxing music. 

Credibility: 4.67/5

User Experience : 4.5/ 5

Transparency = Acceptable

Available by subscription at $14.99/month

Shine 

Shine is a self-care and meditation app designed to calm feelings of stress and anxiety. It was founded by two women of color and offers community support and specialized content to address BIPOC-specific mental health problems. The app includes over 1,000 meditations personalized to your needs on a variety of topics 

Credibility: 2.67/5

User Experience : 3.89 / 5

Transparency = Acceptable

Available by subscription at $14.99/month 

Weight Loss

MyFitnessPal 

MyFitnessPal is a health and fitness app that helps users build healthy habits and reach their weight goals. It has a huge food database available with over 14 million foods, making it easy for users to accurately log everything they eat. Users are able to set customized goals, track their progress, and monitor their calorie and macro intake. 

Available for FREE or by subscription 

Lose It! - Calorie Counter 

Lose It! Is a calorie counting app designed to help you reach your weight loss goals by tracking your nutrient intake and daily activity with ease. You can join in fun challenges by yourself or with friends, personalize the look of your Lose It! App, and keep a database of your own meals and recipes. 

Available for FREE or by subscription

Mental Wellness Brain Games

CogniFit 

CogniFit is an interactive mental game app that helps users improve cognitive function through personalized Brain Training Programs. Users can choose from brain challenges, memory games, puzzles, ingenious games, and more to target memory, attention, concentration, executive functioning, mental agility, and many other cognitive abilities 

Credibility: 4.67/5

User Experience : 4.24 / 5

Transparency = Acceptable

Available by subscription at $19.99/month 

SuperBetter 

SuperBetter is a gamified app designed to help users build resilience, achieve goals, and manage challenges such as anxiety, depression, stress, and chronic pain. 

Credibility: 4.67/5

User Experience : 4.39 / 5

Transparency = Acceptable

Available for FREE 

Other Mental Health Apps

PTSD Coach 

PTSD Coach is an app designed for users experiencing posttraumatic stress disorder (PTSD). It provides educational information about PTSD, tools and skills for managing everyday stress with PTSD, information about professional care, opportunities for support and allows users to track their symptoms over time 

Credibility: 4.67/5

User Experience : 3.9 / 5

Transparency = Acceptable

Available for FREE 

GG OCD 

GG OCD aims to help users reduce symptoms of anxiety and OCD by increasing the users awareness of negative thoughts and training the brain to challenge them. The app is broken down into more than 40 “levels” (15 of which are free) that contain a variety of topics and themes including self-esteem, negative thinking, perfectionism, fear of contamination, social fears, self-criticism, fear of abandonment, emotions, and more. 

Credibility: 4/5

User Experience : 3.7 / 5

Transparency = Acceptable

Available for FREE or by subscription at $11.99 / month 

Sleep Cycle - Sleep Tracker 

Sleep Cycle is a smart alarm clock designed to gently wake you up while you’re in your lightest sleep phase. It also analyzes users sleep patterns, and detects snoring, sleep talking, coughing and other sounds. Premium features include access to relaxing sleep sounds and story library. 

Available for FREE or by subscription at $29.99/year

Mindfulness Meditation

Mindful Meditations for Anxiety

What is Mindfulness?

Mindfulness simply refers to being focused in the present rather than the past or the future. It means thinking, feeling and being only in the moment—not five minutes ago, five hours or even five years ago... and, it also means not worrying about what might happen in the next five minutes, five hours or five years.

Staying focused in the present to reduce anxiety is a very simple concept but it makes sense... much of our stress and anxiety comes from thoughts and feelings about the past or the future. In mindfulness, we meditate or focus on only the present moment and we do so without judgment or criticism.

For example, the simple exercise of concentrating on your breath is considered a type of mindfulness - by relaxing and focusing on only the breath, and the sensations as it enters and leaves your body, you divert attention away from anxious, stressful thoughts. You think only about the present and not the past or future.

Mindfulness Based Practices can be as simple as taking a few moments to concentrate on your breath or it can be a full length meditation with guided imagery. There are many variations and resources to help you get started and I encourage you to find the type of practice that you are most comfortable with.

Does Mindfulness Really Work?

In the last 20 years, there has been an enormous shift in medicine in recognizing mind/body healing approaches for medical and psychological conditions. As a consequence, there is a rapidly expanding scientific literature documenting the effectiveness of mindfulness based practices. Research continues to reflect many significant benefits to both mental and physical health such as improving mood, stress, focus, concentration, sleep, blood pressure, inflammation, cholesterol, and chronic pain.

What the Research Says:

The research exploring mindfulness, although still relatively new, is demonstrating that repeated practice can lead to changes in our lives, with benefits that include:

  • Reducing stress
  • Reducing chronic physical pain
  • Boosting the body’s immune system to fight disease
  • Coping with painful life events, such as the death of a loved one or major illness
  • Dealing with negative emotions like anger, fear, and greed
  • Increasing self-awareness to detect harmful reactive patterns of thought, feeling, and action
  • Improving attention or concentration
  • Enhancing positive emotions, including happiness and compassion
  • Increasing interpersonal skills and relationships
  • Reducing addictive behaviors, such as eating disorders, alcoholism, and smoking
  • Enhancing performance, whether in work, sports, or academics
  • Stimulating and releasing creativity
  • Changing positively the actual structure of our brains

Reprinted from Fully Present, The Science, Art, and Practice of Mindfulnesss by Susan L. Smalley, Ph.D., founder and director of the Mindfulness Awareness Research Center (MARC) at UCLA and Diana Winston, Director of Mindfulness Education at MARC.

How Soon Should I Notice a Change?

When people are new to mindfulness based practices or meditation they often worry that they are not doing it right or they are not sure if it's working. By making it a regular part of your daily routine, you should start to notice positive results within a few weeks.

Mindfulness Resources

There are many resources available to you for practicing mindfulness. I've listed some of them below—including free resources.

Websites

The following websites offer free mediations and deep breathing exercises that you can play, record or download to your own player.

UCLA: Go to www.marc.ucla.edu. Look for the link for “Free Meditation Sessions.”

UC Irvine: Go to www.drrogerwalsh.com. Look for the link for meditations, relaxation, and stress management.

UC San Diego: Go to https://health.ucsd.edu/specialties/mindfulness/programs/mbsr/Pages/audio.aspx. Look for the guided audio files.

FreeMindfulness.org: Go to www.freeminfulness.org. Look for the “Free Resources” section and download audio files from any of seven different meditation categories.

Public Library

Ask the librarian for CDs or video on mindfulness meditation. If there are none on the shelves, they can order for you at no charge.

Online Resources: CDs

Amazon.com has hundreds of selections available for purchase. Enter “mindfulness meditation” in the search field and you will get over 300 hits including CDs for stress reduction, pain relief, depression and anxiety. I recommend you try several as you will find that different speakers appeal to different people. You can also read the reviews to get an idea of the popularity of different items. Of course, Barnes & Noble is another option.

Retail Stores: CDs

Target shoppers have probably noticed a kiosk with relaxation CDs. Many of these titles are good for mindfulness meditation. Some people prefer soft music or nature sounds to a scripted or guided mediation and the Target selection includes more titles with nature sounds. Barnes & Noble also has a large selection in their music section but ask a sales clerk for advice on your preferred format—music only or guided mediation with a speaker.

Smartphone Applications

There are hundreds of possible Smartphone applications for meditation that can provide you with structure and support as you gain knowledge and confidence in meditative techniques and practices. These apps are just a few of the many available today.

Mindfulness Meditation: $1.99
Narrated by Stephen Bodian, author of Meditation for Dummies. This app offers six meditations ranging from five to 40 minutes with tips on effective mindfulness techniques.

Yoga with Janet Stone: $4.99
This app includes 3.5 hours of video and five hours of audio instruction by yoga teacher, Janet Stone. It has 13 meditations that you can use with or without yoga practice. If you'd like to try the yoga, you can select your fitness level and your fitness goals such as strength or flexibility. The audio and video guides instruct and lead you through all the moves for a complete yoga session whether you are a beginner or more advanced.

Relax and Rest Guided Meditations: $.99 by Meditation Oasis
You can choose from three meditations - a 5 minute, 13 minute or 24 minute program and you can customize them with your own preferences such as the type of background music or the nature sounds that you prefer.

Relax Melodies: FREE by iLBSoft
This free app allows you to customize a sound mix from 46 different nature sounds to help you slip into a state of deep relaxation or sleep. It's advertised as a cure for insomnia and claims to have over 5,000,000 users.

Relax and Sleep Well: FREE by i-mobilize
This free app is a 27-minute hypnosis recording by a bestselling self-help audio author, Glenn Harrold. His recording is designed to help you alleviate stress and anxiety and reduce insomnia.

Meditation 4 Inner Wisdom: FREE by i-mobilize
This is another free app by best-selling author and hypnotist, Glenn Harrold. The 37-minute guided meditation is designed to help you relax and connect with a feeling of inner wisdom and spirituality.

Buddhify: $2.99 by 21awake
This lighthearted, playful app is advertised as the "urban meditation app for modern life" and is designed for use by busy people on the go. You can practice mindfulness meditation whether you are in the gym, on the bus/train, at home, or walking. You can select your location, amount of time, and any other preferences.

Centers for Meditation Groups and Classes

You might find that the structure of group meditation is easier for you and by scheduling it into your busy week, you are more likely to stay disciplined. Here are several Orange County locations that offer group mediation or classes. The first two locations are non-denominational churches that welcome people of all faiths and beliefs.

InSpirit Center for Spiritual Living
Wednesdays, 7:00 pm
(949) 481-4040
25782 Obrero Dr., Mission Viejo, CA 92691

Infinite You Meditation Studio
Offers group and individual classes for meditation and instruction

(949) 873-5134
234 E. 17th St., Suite 113
Costa Mesa, CA 92627
infiniteyoumeditation.com

Unity Church of Tustin*
Call for Schedule
(714) 730-3444
14402 S. Prospect Avenue, Tustin, CA 92780
*site also has Meditation Gardens

Zen Center of Orange County
Call for Schedule
(949) 722-7818
120 East 18th St.
Costa Mesa, CA 92627-3035
Email: zencenter@zcoc.org

Books

There are many excellent book selections available at Amazon or your favorite bookstore. One of the most highly regarded books is Full Catastrophe Living by Jon Kabat-Zinn, Ph.D. This book is a classic in mind-body medicine and is now in its 15th-anniversary edition. Its scientific research using mindfulness was the basis for stress reduction clinics in medical centers across the United States. Another popular title is Buddha’s Brain by Dr. Rick Hanson.

Other selections can be found by entering mindfulness meditation in the search field on Amazon.

Physician’s Corner

Physician's Corner

Why PCPs Shouldn’t Hesitate to Give a Therapy Referral

If a patient walked into your office saying they were hearing voices or thinking about suicide, you’d likely send them to a psychiatrist. But not every case seems that critical. What if you have a patient who just mentions offhandedly that she’s having trouble concentrating at work? Or a patient complains of headaches… but you find no physical cause? After a deeper assessment, you may think that depression or anxiety is at play.

What you do next, however, is important — especially considering your unique position as a primary health care provider.

“Currently primary care providers are the nation’s de facto mental health system,” said Dr. Geoffrey D.P. Kanter, Monitor on Psychology.1 “And pharmacotherapy is the most widely recommended treatment.”

Indeed, drug therapy has become the most popular course of treatment — but it often ignores the evidence-based options represented by psychotherapy.

Adding a therapy referral to your patient’s care plan can fill in gaps and address issues that you may not have the time, desire, or specialized knowledge to treat. Our team at Orange County Health Psychologists is here to partner with you, starting with some of the most common mental health issues your patients face today.

The Not-So-Hidden Causes of PCP Visits

One out of every four people is depressed2, while up to 7.6 percent of primary care patients in any given year suffer from generalized anxiety disorder.3

Childhood trauma often causes these issues. Plus, when you consider that nearly half of today’s U.S. children have experienced some form of trauma4 — such as emotional or physical abuse — it’s clear that the number of primary care patients needing mental health care will only increase.

What’s more, they likely won’t go directly to a mental health care provider. Instead, they’ll come to you.

PCPs: The First Stop for Mental Health Care

Obviously, primary health care providers are often the required entry point to medical care. But while some patients do have direct access to specialists, they often still consult with their primary care physician or another M.D. first when they have mental health issues. Why?

One survey of 1,647 adults revealed that 49 percent of patients see their primary care provider first for a mental health issue for two main reasons5:

  1. Less stigma. Going to a psychotherapist can be a tough decision for some. Patients may feel hesitant to reach out to a mental health care provider directly due to shame.
  2. Trust. Patients often have an established relationship with their PCP and trust him or her to make recommendations based on their medical history. Some patients report that they don’t have the confidence to evaluate which psychotherapists are good, and would also prefer their PCP to determine the severity of their problem before they seek a therapy referral.

Therapy Referral: The Next Best Step

Some primary care physicians may choose to provide brief in-office counseling themselves rather than give a therapy referral, especially for mild mental health issues.

However, not every PCP believes they have the same nuanced understanding as a mental health care provider would. In fact, in one survey 51 percent of primary care physicians rated their psychiatric knowledge as “average,” while 53 percent “sometimes” made a mental health diagnosis on a previously undiagnosed patient.6

It doesn’t have to be this way. A therapy referral can help round out your patient’s health care plan and be an extension of your patient’s relationship with you. Our experienced team at Orange County Health Psychologists is ready to step in at any time you need us.

—Written by Ekua Hagan for Orange County Health Psychologists.

References:

Clay, Rebecca A. (2015). Going Big: Entrepreneurial Psychologists Explore Alternative Practice Models. Monitor on Psychology, May issue.
National Institute of Mental Health. The Numbers Count: Mental Disorders in America.
3 Kavan, Michael, Ph.D.; Elsasser, Gary, PharmD; Barone, Eugene, M.D. (2009). Generalized Anxiety Disorder: Practical Assessment and Management. American Family Physician, vol. 79, no. 9.
4 Benham, Barbara. (2014). Study: Nearly Half of U.S. Kids Exposed to Traumatic Social or Family Experiences. HUB (Johns Hopkins University).
5 Wun, Yuk San, MBBS, M.D.; Lam, Tai Pong, Ph.D., M.D.; Goldberg, David, DM; Lam, Kwok Fai, Ph.D., Li, Kwok Tung Donald, MBBS; Yip, Ka Chee, MBBS. (2011). Reasons for Preferring a Primary Care Physician If Depressed. Family Medicine, May issue, vol. 43, no. 5.
6 Oyama, Oliver, PA-C, Ph.D.; Burg, Mary Ann, LCSW, Ph.D.; Fraser, Kathryn, Ph.D.; Kosch, Shae Graham, Ph.D. (2012). Mental Health Treatment by Family Physicians: Current Practices and Preferences. Family Medicine, Nov-Dec issue, vol. 44, no. 10.

 

Making Effective Therapy Referrals

Depression ranks among the top 10 chronic health problems in the United States and up to one in four primary care patients suffers from depression1. Drug therapy has become the most popular course of treatment - often ignoring the evidence-based options represented by psychotherapy. Many physicians are highly skilled and even intuitive in identifying how depression, stress and anxiety are impacting their patient's physical health but they aren't always as comfortable in making referrals to therapy.

Here are a few simple tips for making an effective therapy referral.

  1. Start with the mind-body connection. Examples: I'm wondering if stress could be causing your headaches? or The symptoms of MS can be worse with depression or anxiety about MS. Do you think that could be happeing with you?
  2. Emphasize that the patient does not deserve to have these symptoms. Normalize the symptoms to reduce stigma. Examples: You don't deserve to have this kind of pain every day and it's got to be affecting the quality of your life. or You deserve to have the best possible symptom management with MSIt's normal if you're feeling depressed right now with all you've got going on in your life but you don't deserve to suffer. or Many people who have had a stroke experience symptoms of depression or anxiety afterwardsYou deserve the best recovery possible.
  3. Focus on the symtom and reliefGenerate enthusiasm and hope. Examples: Getting support from a good therapist and learning how to cope with stress might relieve your headaches. or I want to make sure that we're maximizing your chances of recovery from the stroke and we can do that by including a good therapist on our care team.
  4. Provide referral options. Example: I know a few psychologists in the area who can really help with stress. May I give you some referrals?
  5. Get a commitment and follow-up. Example: Does this sound like something you'd be willing to try? Will you let me know how it goes at our next visit?

Put it all together and it might sound something like this:

I'm wondering if you're under more stress lately and if that could be causing some of the headache pain you've been experiencing. You don't deserve to suffer like this and it sounds like the headaches are really impacting your quality of life. Therapy can be a good resource for learning how to cope with stress. I know of some therapists in the area who are really good and easy to talk to and I'd like to give you their names. What do you think? Can we follow-up on this at our next visit? I'd love to know if it was helpful to you.

If the patient is resistant, consider using Motivational Interviewing techniques. The spirit and philosophy of Motivational Interviewing is highly appropriate when discussing therapy as a type of behavioral change. If you are not familiar with Motivational Interviewing, the basic concepts are to 1) identify where your patient is today in his/her willingness to make this change, 2) support and roll with any resistance - do not put the patient on the defensive, 3) ask about pros and cons to making the change, 4) explore any ambivalence and 5) and follow-up next visit.

 

Additional Resources

Insomnia Tips - Download or copy the audio recording Sleep Secrets: 25 Tips to Cure Insomnia by Dr. Kleppe. This resource is made available at no charge to your patients who suffer from insomnia.

References:

1 www.nimh.nih/gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#MajorDepressive

Please check back for frequent updates to Physician's Corner.

If you have any suggestions for mental health or behavioral health online resources, that would be helpful to you and your patients, please contact us.

Book of the Month

The Narcissistic Family

by Stephanie Donaldson-Pressman & Robert M. Pressman

Co-Authored by Stephanie Donaldson-Pressman, therapist, clinical director of New England Center for Pediatric Psychology, and internationally recognized expert on family dynamics, The Narcissistic Family addresses an emotionally-difficult topic with warmth and compassion. Stepping beyond situations where a parent is an actual narcissist, the book approaches the concept of a narcissistic family as one where the needs of a parent significantly override the needs of the children. This can happen not only in overtly abusive families where physical violence or drug/alcohol abuse is present, but also if parents have little time available for their children so the children don't feel heard or don't grow up with a sense that they are worth. Instead they work around their parents' mood and never develop the ability to recognize their own needs or create effective strategies for getting them met.

While written for mental health professionals, The Narcissistic Family is equally suitable for and useful to consumers. The writing is clear and the case studies are helpful in illustrating the concepts - offering ways to acknowledge and value one's feelings as well as specific guidelines for treating individuals raised in a narcissistic or dysfunctional family dynamic.

Dear Reader: Please email me with your psychology book favorites for future Book of the Month articles—my monthly book reviews designed to promote good resources for health and healing.

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