Speedy mini-apps are designed to address depression and anxiety
Soon you can seek mental health advice on your smartphone as quickly as finding a good restaurant.
A novel suite of 13 speedy mini-apps called IntelliCare resulted in participants reporting significantly less depression and anxiety by using the apps on their smartphones up to four times a day, reports a new Northwestern Medicine study.
The apps offer exercises to de-stress, reduce self-criticism and worrying, methods to help your life feel more meaningful, mantras to highlight your strengths, strategies for a good night’s sleep and more.
Most apps designed for mental health typically offer a single strategy to feel better or provide too many features that make them difficult to navigate. Users may get bored or overwhelmed and may stop using the apps after a few weeks.
But participants robustly used the IntelliCare interactive apps as many as four times daily — or an average of 195 times — for eight weeks of the study. They spent an average of one minute using each app, with longer times for apps with relaxation videos.
The 96 participants who completed the research study reported that they experienced about a 50 percent decrease in the severity of depressive and anxiety symptoms. The short-term study-related reductions are comparable to results expected in clinical practice using psychotherapy or with that seen using antidepressant medication.
The study was published Jan. 5 in the Journal of Medical Internet Research.
“We designed these apps so they fit easily into people’s lives and could be used as simply as apps to find a restaurant or directions,” said lead study author David Mohr, professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine.
“Some of the participants kept using them after the study because they felt that the apps helped them feel better,” Mohr said. “There were many apps to try during the study, so there was a sense of novelty.”
Participants had access to the 13 IntelliCare apps from Google Play and received eight weeks of coaching for the use of IntelliCare. Coaching included an initial phone call plus two or more text messages per week over the eight weeks. In the study, 105 participants were enrolled and 96 of them completed the study.
The preliminary study did not include a control arm, so it’s possible that some people who enrolled in the trial would have improved anyway, partly because they may have been motivated to try something new, Mohr said. He now has launched a larger trial, recruiting 300 participants, with a control arm.
Some of the IntelliCare apps include:
Daily Feats: designed to motivate you to add worthwhile and rewarding activities into your day to increase your overall satisfaction in life.
Purple Chill: designed to help you unwind with audio recordings that guide you through exercises to de-stress and worry less.
Slumber Time: designed to ease you into a good night’s rest.
My Mantra: designed to help you create motivating mantras to highlight your strengths and values.
“Using digital tools for mental health is emerging as an important part of our future,” Mohr said. “These are designed to help the millions of people who want support but can’t get to a therapist’s office.”
More than 20 percent of Americans have significant symptoms of depression or anxiety each year, but only around 20 percent of people with a mental health problem get adequate treatment.
The IntelliCare algorithm recommends new apps each week to keep the experience fresh, provide new opportunities for learning skills and avoid user boredom. Although the apps are not validated, each one was designed by Northwestern clinicians and based on validated techniques used by therapists.
IntelliCare is a national research study. Individuals can download the apps free with no financial obligation. But Northwestern researchers hope participants will provide confidential feedback, via four weekly questions, that will be used to further develop the system. The data will help the system make even better recommendations and provide more personalized treatment.
People also may enroll in a study in which they will be paid to provide even more feedback. Some also will have access to an IntelliCare coach via text messaging and phone calls, who are available to support them in using the apps.
“We now have evidence these approaches will likely work,” Mohr said. “They are designed to teach many of the same skills therapists teach patients. Different apps are expected to work for different people. The goal is to find what’s right for you.”
In a small double-blind study, Johns Hopkins researchers report that a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.”
The researchers cautioned that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient care setting.
The Johns Hopkins team released its study results, involving 51 adult patients, concurrently with researchers from New York University Langone Medical Center, who conducted a similarly designed study on 29 participants. Both studies are published in the Journal of Psychopharmacology on Dec. 1.
The Johns Hopkins group reported that psilocybin decreased clinician- and patient-rated depressed mood, anxiety and death anxiety, and increased quality of life, life meaning and optimism. Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range. Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events.
“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” says Roland Griffiths, Ph.D., professor of behavioral biology in the Departments of Psychiatry and Behavioral Sciences and of Neuroscience at the Johns Hopkins University School of Medicine. He notes that traditional psychotherapy offered to people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, isn’t always effective, and in the case of some drugs, such as benzodiazepines, may have addictive and other troubling side effects.
Griffiths says his team’s new study grew out of a decade of research at Johns Hopkins on the effects of psilocybin in healthy volunteers, which found that psilocybin can consistently produce positive changes in mood, behavior and spirituality when administered to carefully screened and prepared participants. The study was designed to see if psilocybin could produce similar results in psychologically distressed cancer patients.
“A life-threatening cancer diagnosis can be psychologically challenging, with anxiety and depression as very common symptoms,” says Griffiths. “People with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death.”
For the study, the investigators recruited 51 participants diagnosed with life-threatening cancers, most of which were recurrent or metastatic. They were chosen from a total of 566 individuals reached through flyers, web advertisements and physician referrals. Most participants had breast, upper digestive, GI, genitourinary or blood cancer, and each had been given a formal psychiatric diagnosis, including an anxiety or depressive disorder.
Half of the participants were female with an average age of 56. Ninety-two percent were white, 4 percent were African-American and 2 percent were Asian.
Each participant had two treatment sessions scheduled five weeks apart, one with a very low psilocybin dose (1 or3 milligrams per 70 kilograms) taken in a capsule and meant to act as a “control” placebo because the dose was too low to produce effects. In the other session, participants received a capsule with what is considered a moderate or high dose (22 or 30 milligrams per 70 kilograms).
To minimize expectancy effects, the participants and the staff members supervising the sessions were told that the participants would receive psilocybin on both sessions, but they did not know that all participants would receive one high and one low dose. Blood pressure and mood were monitored throughout the sessions. Two monitors aided participants during each session, encouraging them to lie down, wear an eye mask, listen to music through headphones and direct their attention on their inner experience. If anxiety or confusion arose, the monitors provided reassurance to the participants.
In addition to experiencing changes in visual perception, emotions and thinking, most participants reported experiences of psychological insight and often profound, deeply meaningful experiences of the interconnectedness of all people.
The researchers assessed each participant’s mood, attitude about life, behaviors and spirituality with questionnaires and structured interviews before the first session, seven hours after taking the psilocybin, five weeks after each session and six months after the second session. Immediately after the sessions, participants completed questionnaires assessing changes in visual, auditory and body perceptions; feelings of transcendence; changes in mood; and more.
Structured clinical interviews, such as the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, and patient questionnaires, like the Beck Depression Inventory and the State-Trait Anxiety Inventory, assessed depression and anxiety. Other questionnaires assessed quality of life, death acceptance, meaningful existence, optimism and spirituality — generally defined as a search for the meaning of life and a connection to something bigger than one’s self. To measure the changes in attitudes, moods and behavior over time, the researchers administered a questionnaire that assessed negative or positive changes in attitudes about life, mood and behavior.
With regard to adverse effects, Griffiths says 15 percent of participants were nauseated or vomited, and one-third of participants experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose. One-third of the participants had transient increases in blood pressure. A few participants reported headaches following the session.
“Before beginning the study, it wasn’t clear to me that this treatment would be helpful, since cancer patients may experience profound hopelessness in response to their diagnosis, which is often followed by multiple surgeries and prolonged chemotherapy,” says Griffiths. “I could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful. However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.”
Up to 40 percent of people with cancer suffer from a mood disorder, according to the National Comprehensive Cancer Network.
Anticipating wide interest in the psilocybin research from scientists, clinicians and the public, the journal solicited 11 commentaries to be co-published with the study results written by luminaries in psychiatry, palliative care and drug regulation, including two past presidents of the American Psychiatric Association, a past president of the European College of Neuropsychopharmacology, the former deputy director of the U.S. Office of National Drug Control Policy, and the former head of the U.K. Medicines and Healthcare Products Regulatory Authority. In general, the commentaries were supportive of the research and of using these drugs in a clinical setting as tools for psychiatry.
A single dose of psilocybin, the major hallucinogenic component in magic mushrooms, induces long-lasting decreases in anxiety and depression in patients diagnosed with life-threatening cancer according to a new study presented today at the annual meeting of the American College of Neuropsychopharmacology.
Patients who receive a cancer diagnosis often develop debilitating symptoms of anxiety and depression. Reports from the 1960s and 1970s suggest that hallucinogenic drugs such as LSD may alleviate such symptoms in cancer patients, but the clinical value of hallucinogenic drugs for the treatment of mood disturbances in cancer patients remains unclear. In this new study, Roland Griffiths and colleagues from the Johns Hopkins University School of Medicine investigated the effects of psilocybin on symptoms of anxiety and depression in individuals diagnosed with life-threatening cancer. Five weeks after receiving a dose of psilocybin sufficiently high to induce changes in perception and mystical-type experiences, patients reported significantly lower levels of anxiety and depression compared with patients that received a low dose of the drug. The positive effects on mood persisted in the patients at 6 month follow-up.
The authors suggest that a single dose of psilocybin may be sufficient to produce enduring decreases in negative mood in patients with a life-threatening cancer.
“Gamifying psychological interventions successfully could revolutionize how we treat mental illness and how we view our own mental health.”
Playing a science-based mobile gaming app for 25 minutes can reduce anxiety in stressed individuals, according to research published in Clinical Psychological Science, a journal of the Association for Psychological Science.
The study suggests that “gamifying” a scientifically-supported intervention could offer measurable mental health and behavioral benefits for people with relatively high levels of anxiety.
“Millions of people suffering from psychological distress fail to seek or receive mental health services. A key factor here is that many evidence-based treatments are burdensome — time consuming, expensive, difficult to access, and perceived as stigmatizing,” says lead researcher Tracy Dennis of Hunter College.
“Given this concerning disparity between need and accessibility of services, it is crucial for psychological researchers to develop alternative treatment delivery systems that are more affordable, accessible, and engaging.”
That’s where the mobile app comes in.
The game is based on an emerging cognitive treatment for anxiety called attention-bias modification training (ABMT). Essentially, this treatment involves training patients to ignore a threatening stimulus (such as an angry face) and to focus instead on a non-threatening stimulus (such as a neutral or happy face). This type of training has been shown to reduce anxiety and stress among people suffering from high anxiety.
In the study, about 75 participants — who all scored relatively high on an anxiety survey — were required to follow two characters around on the screen, tracing their paths as quickly and accurately as possible.
After playing the game for either 25 or 45 minutes, the participants were asked to give a short speech to the researchers while being recorded on video — an especially stressful situation for these participants.
The videos revealed that participants who played the ABMT-based version of the game showed less nervous behavior and speech during their talk and reported less negative feelings afterward than those in the placebo group.
“Even the ‘short dosage’ of the app — about 25 minutes — had potent effects on anxiety and stress measured in the lab,” explains Dennis, who co-authored the study with Laura O’Toole of The City University of New York. “This is good news in terms of the potential to translate these technologies into mobile app format because use of apps tends to be brief and ‘on the go.’”
The researchers are currently investigating whether even shorter stints of play – similar to how we normally play other smartphone games — would have the same anxiety-reducing effect.
“We’re examining whether use of the app in brief 10-minute sessions over the course of a month successfully reduces stress and promotes positive birth outcomes in moderately anxious pregnant women,” Dennis says.
While it’s unclear whether this app would produce mental health benefits in those with clinically-diagnosed anxiety, it does present a compelling case for gamified ABMT acting as a “cognitive vaccine” against anxiety and stress. The researchers believe that apps could eventually be developed to assist in the treatment for other mental health disorders, such as depression or addiction.
“Gamifying psychological interventions successfully could revolutionize how we treat mental illness and how we view our own mental health. Our hope is to develop highly accessible and engaging evidence-based mobile intervention strategies that can be used in conjunction with traditional therapy or that can be ‘self-curated’ by the individual as personal tools to promote mental wellness,” Dennis concludes.