Your smartphone can be a powerful tool for improving your overall mental health and wellness. Here are my picks for some of the best downloads. 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)
Apps for Depression
Most of the apps below help you combat depression using cognitive behavioral therapy (CBT) techniques. They are designed to help you:
Become aware of how your mood changes and what triggers them
Notice your negative or irrational thoughts, and change them to positive or realistic ones
Consider using one or more of these apps in conjunction with weekly therapy to help you make better progress in your treatment program.
$4.99 by Thriveport, LLC
MoodKit was developed by two clinical psychologists and is designed to help you apply effective CBT strategies to your everyday life. It includes over 150 mood improvement activities, a thought checker, mood tracker, guidance to modify distressing thoughts, and a journal for mood ratings and note-taking.
FREE by Jake Greenwood
This app helps you track your mood throughout the day so that you can become more aware of what makes you happy and unhappy. It then plants a seed to help you plan activities that will lift your mood and decrease feelings of depression.
FREE by Defense Health Agency
Based on a behavioral therapy called pleasant event scheduling (PES), this app literally helps you stop and smell the roses. The theory behind PES is that having too few pleasant events can actually trigger depressive mood. On the other hand, activities or exercises that increase feelings of gratitude, optimism, forgiveness, love, zest for life, or even humor can promote a sense of happiness and well-being. Positive Activity Jackpot uses augmented reality technology to tell you when there is something fun to do nearby, as well as invite friends.
FREE by National Center for Telehealth and Technology
Tracking your moods can be hard, but T2 Mood Tracker gives you all the tools you need to monitor your mental state. Use a swipe bar to approximate your moods in different categories and make note of significant events and medication changes. With enough data, it will show you how your moods shift over time and the factors that influence them. It’s a very valuable tool to share with your health care provider when they make decisions about your treatment plan.
Apps for Anxiety
Many of these apps are also based on CBT. If you are struggling with any type of anxiety, phobia, anger management, insomnia, or substance abuse, please also see the list below, as well as the list for meditation and relaxation.
$1.99 by iCouch, Inc.
This app uses CBT to decrease anxiety and depression by training you to be aware of irrational or negative thoughts. It then helps you change those thoughts to more realistic or positive ones. This app will take you through a step-by-step process to examine upsetting thoughts and then challenge them. You'll learn that as you change thoughts, you will also change emotions, feelings, and behavior. The app also gives you the opportunity to track irrational thoughts during the week to discuss with your therapist in your in-person sessions.
FREE by U.S. Department of Veterans Affairs
PTSD Coach is for people with post-traumatic stress disorder (PTSD) and those interested in learning more about PTSD. It offers education about PTSD, self-assessment, opportunities to find support, and tools to help you manage the stressors of daily life. Tools range from relaxation skills to positive self-talk and include many other self-help strategies, including anger management techniques.
FREE by Evolution 2 Media
Anxiety Forum is a web-based support forum with resources for overcoming anxiety, phobias, and panic attacks. It’s free on both mobile and desktop, allowing you to post to discussions, track favorite discussion topics, keep up on research discoveries, read book reviews, access tips on managing anxiety, examine therapy treatment options, and gain peer support.
Apps for Weight Loss
Weight loss applications can be used to support structured commercial programs, such as Weight Watchers, or they can be used on their own. These apps serve to:
Increase your awareness of caloric intake and output
Track calories quickly and efficiently
Improve your nutritional knowledge to support healthy food choices
This app first calculates your daily caloric allowance based on your age, height, weight, exercise levels, and weight loss goals. Throughout the day, you log in meals and snacks to track calories. It includes a comprehensive database of foods so you can look up calories and nutritional information quickly and then save the information to your favorites so you don't have to search again. You can also calculate the benefits of any exercise you do during the day to increase your daily caloric allowance.
This is a fast and easy way to count calories. It has a very large food database with 11 million food entries (including fast foods) as well as a recipe calculator. You can save or memorize favorite meals and use a bar code scanner to look up nutritional information and track all major nutrients. You can also diet with friends by tracking and supporting each other's programs.
Fooducate grades your groceries, explains what’s really inside each product, and offers healthier alternatives. Scan the bar code of any food product with your phone's camera and you’ll get an instant assessment of its nutritional value, such as excessive sugar, tricky trans fats, high fructose corn syrup, additives, preservatives, and food colorings. It will also offer healthier alternatives.
Keeping a food diary is a lot easier with an app like MealSnap. Simply take a photo of each meal with the app, and it will keep them organized by date, time, and your description of what you ate. It’s a great way to log your meals, especially if you’re working with a nutritionist or any other professional on your weight loss journey.
Not only will this app help you track your daily diet and exercise on your weight loss journey, but it also comes with self-management guides to help you overcome barriers.
Apps for Meditation
Research continues to reflect many significant benefits of meditation, such as improving mood, stress, focus, concentration, sleep, blood pressure, inflammation, cholesterol, and chronic pain.
When people are new to meditation, they often worry that they are not doing it right or they are not sure if it’s working. These apps can help by offering instruction, structure, and support. By making meditation a regular part of your daily routine, you should start to notice positive results within a few weeks.
$3.99 with Janet Stone
This app includes 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.
$1.99 by Meditation Oasis
You can choose from three meditations—a five-minute, 13-minute, or 24-minute program. Then, you can customize them with your own preferences such as the type of background music or the nature sounds that you prefer.
FREE by Diviniti Publishing, Ltd.
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, as well as reduce insomnia.
$2.99 by Mindfulness Everywhere, Ltd.
This lighthearted, playful app is advertised as “meditation done differently” and is designed for busy people on the go. You can practice a different mindfulness meditation depending on what you’re doing and/or how you’re feeling. Meditations are broken up into categories such as Walking, Stress & Difficult Emotion, Work Break, Going to Sleep, and more.
Available by subscription ($12.99/month) by Headspace, Inc.
Headspace is a very popular app that teaches you how to meditate. It includes free guided meditations that are broken down by your goals— whether that be productivity, managing anxiety, improving your sleep, etc.
Available by subscription ($14.99/month) by Calm
Calm is a mindfulness app for beginners that includes guided meditations, breathing programs, stretching exercises, relaxing music, and even bedtime stories (for adults and kids!). Rated one of the Best of 2018 by Apple, it’s one of the most popular apps in its category.
FREE by Insight Network, Inc.
Talk about a robust library — this app provides over 35,000 guided meditations. It’s also a great resource to help you get started with meditation if you’re new to it (check out their free 7-day course).
Apps for Sleep
Research has found that sleep disruption and mood disorders are strongly linked. If you have insomnia, you’re 10 times more likely to develop clinical depression and 17 times more likely to develop clinical anxiety. The reverse is also true: Both anxiety and depression can lead to sleep problems.
Addressing your sleep issues can be an important part of your mental health treatment plan. Below are some apps that can help you both track your sleep and get better rest.
FREE by National Center for Telehealth & Technology
This app helps you rewrite your nightmares based on the principles of imagery rehearsal therapy (IRT). Designed to be used with a therapist who’s trained in IRT, this tool helps you track the intensity of your dreams and their disturbing elements. It also has relaxation exercises and reminders to practice re-scripted dreams before going to sleep.
FREE with an optional premium subscription ($29.99/year) by Sleep Cycle
Sleep Cycle is a smart alarm that wakes you up every morning while you’re in your lightest sleep phase. This is the most natural way to wake up for optimal energy throughout the day. It will also analyze your sleep trends. More features for premium subscribers include longer-term sleep analysis and a heart monitor.
FREE by U.S. Department of Veterans Affairs
Whether you’re using cognitive behavioral therapy (CBT) with your therapist or you just need new strategies to improve your sleep, CBT-i Coach can help. It allows you to track your sleep habits and provides relaxation exercises you can use when you’re unable to sleep, all while walking you through a structured program that’s proven to alleviate insomnia. —Compiled by Ekua Hagan for Orange County Health Psychologists
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 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
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.
There are many resources available to you for practicing mindfulness. I've listed some of them below—including free resources.
The following websites offer free mediations and deep breathing exercises that you can play, record or download to your own player.
FreeMindfulness.org: Go to www.freeminfulness.org. Look for the “Free Resources” section and download audio files from any of seven different meditation categories.
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.
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
25782 Obrero Dr., Mission Viejo, CA 92691
Infinite You Meditation Studio Offers group and individual classes for meditation and instruction
Unity Church of Tustin*
Call for Schedule
14402 S. Prospect Avenue, Tustin, CA 92780
*site also has Meditation Gardens
Zen Center of Orange County
Call for Schedule
120 East 18th St.
Costa Mesa, CA 92627-3035
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.
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:
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.
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.
1 Clay, Rebecca A. (2015). Going Big: Entrepreneurial Psychologists Explore Alternative Practice Models. Monitor on Psychology, May issue. 2 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.
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?
Emphasize that the patientdoes 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 MS. It'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 afterwards. You deserve the best recovery possible.
Focus on the symtom and relief. Generate 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.
Provide referral options. Example: I know a few psychologists in the area who can really help with stress. May I give you some referrals?
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.
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.
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.