Using technology to support youth mental health - Dr Michael Carr-Gregg
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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
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Using technology to support youth mental health - Dr Michael Carr-Gregg
- 1. Using technology to support youth mental health Dr Michael Carr-Gregg Child and Adolescent Psychologist www.michaelcarrgregg.com
- 2. Been an Apple computer user since 1984
- 3. iPad 3 iPad iPad Mini iPad 2 iPad Pro
- 8. Can technology be a solution?
- 9. More people are using it • 3 billion people online • 43% of the world’s population • 69% of people on earth will be covered by broadband
- 11. And it’s getting faster
- 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
- 16. A reconfiguring of Maslow for young people `
- 17. • 98% of students have a mobile • 94.9% have a smart phone • 91.89% of students have downloaded an app
- 19. ‘Screenagers’ Born early 2000’s ‘Millenials’ Born 1980-1990 Born early 1960’s to early 80’s Post WW2 born 1946-1964
- 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
- 29. So how might technology help the wellbeing of a young person?
- 31. Meet ‘Georgie’
- 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
- 33. Georgie’s developmental tasks Identity Formation Peers Emancipation from adult carers School/Vocation
- 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
- 37. Diagnosis
- 38. How Reach Out can help
- 45. CBCL and YSR (Achenbach)
- 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.
- 50. Like 98% of her friends, Georgie has a smartphone
- 51. What are Georgie’s current issues?
- 52. Problem 1. Sleep
- 53. Sleep The single most important behavioural experience that we have is sleep Average person spends 36% of their life sleeping
- 57. EXPLAINS THE PSYCHOLOGY OF SLEEP VIA A FACT SHEET FROM ORYGEN 57 http://oyh.org.au/sites/oyh.org.a u/files/factsheets/oyh_sleep_fac tsheet.pdf
- 58. Offers Georgie a Prof Russell Foster Ted Talk
- 59. App Intervention - Recharge (free) https://itunes.apple.com/au/app/recharge-move-well-sleep-well/id878026126?mt=8
- 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
- 61. Wearable Device/App intervention for her Insomnia: JawboneUP 24 (A$149.95) https://jawbone.com/up
- 63. Georgie has a jawbone tracker
- 64. Light sleep REM sleep
- 65. Fitbit dashboard
- 66. Georgie’s Mum is worried about her snoring
- 68. Problem 2. Georgie’s Mum is worried about her not eating breakfast
- 70. Georgie gets directed to a website on breakfast
- 71. Problem 3. Eating too much junk food
- 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.
- 76. Problem 4. How do we address her Anxiety?
- 77. Georgie is offered a fact sheet
- 78. Offered a free, evidence based online treatment program to do on her own time
- 79. What about psychoeducation for Georgie’s parents?
- 80. Georgie is offered a link to a pamphlet from beyondblue for her parents
- 81. How do we deal with Georgie’s panic attacks?
- 82. Georgie is offered an app to help her deal with her panic attacks
- 84. Georgie is invited to do some evidence based online treatment
- 85. Georgie is offered an app that uses ACT to help deal with her anxiety
- 88. 88 Georgie is offered an app that helps with stress
- 89. New website
- 91. Georgie can download the app
- 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
- 95. 95
- 96. 96
- 97. 97
- 101. 101
- 102. Solution Increase Exercise – not getting 10,000 steps
- 103. Georgie gets a fact sheet on exercise
- 104. 104 Georgie is offered an app that helps with exercise
- 106. Georgie gets an encouraging message when she has completed a session or week of 3 sessions…
- 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.
- 109. Problem 7. Georgie is worried about a friend
- 110. Georgie is offered an app to help her approach her friend
- 112. Problem 8. Georgie wants to cut down her cannabis use
- 114. Problem 9. Georgie’s relationship breaks up
- 115. Georgie is offered an app that helps her cope
- 118. Problem 10. Georgie’s mate is self harming
- 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
- 128. Georgie decides to get some counseling
- 129. She is offered a smorgasbord of choices
- 130. She is offered a smorgasbord of choices
- 131. She is offered a smorgasbord of choices
- 132. She is offered a smorgasbord of choices Visit local General Practitioner
- 133. She is offered a smorgasbord of choices Visit a local headspace centre
- 139. An app to help her remember her medication
- 141. Questions and Thanks
Notas del editor
- 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"