Tag Archives: digital therapy

Are there smartphone apps specifically for people who experience eating disorders?

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Q: Are there smartphone apps specifically for people who experience eating disorders?
A: Yes. Three*
1. Rise Up + Recover www.recoverywarriors.com/app
2. Recovery Record – RR www.recoveryrecord.com
3. MindShift www.anxietycanada.com/resources/mindshift-cbt

Q: Is this the shortest blog post in the history of humans?
A: No. Please read on for elaboration, geeky stuff and a disclaimer (look for the red asterisk* below).

Elaboration

Recently I was chatting with someone who experiences an eating disorder and was asked whether there were any apps specific to their circumstances. I was a bit busy at work, and only had time to to check-out Australia’s digital mental health hub Head To Health, and found nothing specific to eating disorders there. A few things pop-up on a google search, but when you’re a health professional you need to be careful about prescribing digital technologies. As articulated in editorials, letters, journal articles and blogs, health professionals have a responsibility to do no harm, and provide credible, evidence-based information if giving advice re apps, websites or other digital technologies.

Geeky Stuff

Fairburn and Rothwell (2015, p. 1038) took a systematic approach to clinical appraisal of eating disorder apps, and concluded, “The enthusiasm for apps outstrips the evidence supporting their use.” Ouch.

But that was way back in 2015, some people are still giving eating-disorder-specific app development a go, and digital therapeutics evolve quickly, so I thought it was worth doing a search of credible sources anyway.

After searching Head To Health, later (in my own time boss) I had a look at the Queensland Eating Disorder Service (QuEDS) resource page, the Butterfly Foundation website, and the Eating Disorders Victoria site and couldn’t find recommendations for apps. I then signed-up for ORCHA (“the world’s leading health app evaluation and advisor organisation“) and did a search there – that yielded poor results. Searching ORCHA for “eating disorder” was too broad and yielded a list of food/diet-related apps. Searching ORCHA for “anorexia nervosa” yielded two apps that had a green rating – one was a NHS/UK-only app, and when I clicked the other one on the App Store the top review spoke about their weight-loss. It might be a good app, but I’m afraid to share it here. That sort of thing would probably be laughed-off with an eye roll by someone who is living with an eating disorder and is in a good head space, but could really throw a spanner in the works for someone who isn’t in a good head space. The mortality rate of eating disorders is a worry, so primum non nocere.

Then I stumbled into the Centre for Eating and Dieting Disorder (CEDD) website and found a resource called “Navigating Your Way to Health” and, lo and behold, found this on page 33:

Using apps can be a handy way of helping you in your journey to recovery. We’ve listed some FREE apps here that might be useful. The following apps have been designed to help people with eating disorders to empower you to be in control of your recovery.
> Rise Up + Recover 
> Recovery Record – RR 
> recoveryBox 
> MindShift 

Disclaimer*

Although it was listed in the resource above, I left the recoveryBox app off my list at the top of the page because as at 09/08/20 (today) their website isn’t working. The app is still available on the App Store, but as the website is out of action, I’m guessing the app isn’t being updated any more. “Navigating Your Way To Health” was published in 2016 and, as noted above, digital therapeutics evolve quickly. It seems they devolve quickly too.

I’m pretty confident this is credible information as of right now, but who knows what reviews are underway or what apps are in development? Not me. For all I know there will be a fantastic Australian app co-produced by consumers/survivors, clinicians and academics tomorrow. I hope so. Just in case, check in on CEDD if you’re reading this after 09/08/20.

As noted in my recent blog post regarding the stepped care model (“One. Step. Beyond.” meta4RN.com/step) the concept of “one size fits all” doesn’t apply in mental health recovery. On the same theme, apps can be a useful addition to other strategies and useful for maintenance/relapse prevention. They should not be relied on alone if someone is experiencing significant symptoms of poor health.

I won’t pretend for a moment to have any special insight into what is a useful app for people who are experiencing an eating disorder, and don’t really have the time, skill-set or funding to undertake an independent review. I do trust the credibility of CEDD though, and if they say these apps are OK, who am I to say otherwise?

As originally noted in September 2012 (see number 13 here: meta4RN.com/about), the views and opinions I express here or on related social media portals do not represent the views of my employer. That really should be taken for granted, but anyway…

One last thing in this section: I don’t have any financial/other ties to any of the organisations or apps named above.

References

Daya, I., Hamilton, B. and Roper, C. (2020), Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. International Journal of Mental Health Nursing, 29(2): 299-31.
doi: 10.1111/inm.12653

Fairburn, C.G. and Rothwell, E.R. (2015) Apps and eating disorders: A systematic clinical appraisal. International Journal of Eating Disorders, 48: 1038-1046.
doi: 10.1002/eat.22398

Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943

Hunter Institute of Mental Health and the Centre for Eating and Dieting Disorders (2016). Navigating Your Way to Health: A brief guide to approaching the challenges, treatments and pathways to recovery from an eating disorder. NSW Ministry of Health.
via cedd.org.au/begin-recovery 

Neumayr, C, Voderholzer, U, Tregarthen, J, Schlegl, S. (2019) Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist‐guided smartphone app. International Journal of Eating Disorders, 52: 1191– 1201
doi: 10.1002/eat.23152

Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527

Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679

End

That’s it. Thanks for reading down this far 🙂

As always, you’re welcome to leave feedback in the comments section below.

Paul McNamara, 9 August 2020

Short URL meta4RN.com/app

 

Email to a person who experiences persistent pain

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You may have read about nurses as prescribers of digital therapeutics in editorials, letters, journal articles or blogs. This is one of two blog posts demonstrating email as an adjunct to face-to-face support, and as an example of how a nurse can use/prescribe digital therapy. Naturally, it comes with the usual disclaimers about these being examples that may be of use to adapt for you/your practice, not an instruction/template for practice. One of the goals of this blog is to share ideas – that’s what this blog post is about.

Below is a sample email to a person who experiences persistent pain:

From: Paul McNamara
Sent: Friday, 27 December 2019, 11:50 AM
To: paula@emailaddressesarenotcasesensitive.com.au

Subject: Suggestions

Hi Paula

It was good to meet with you today. Here are some of the ideas/suggestions we were talking about:

1. North Queensland Persistent Pain Management Service (NQPPMS)
Sus-out the info on the website: www.health.qld.gov.au/clinical-practice/referrals/statewide-specialist-services/persistent-pain, and if you think it’s something that might be helpful have a chat to your GP about making a referral. There’s usually a bit of a wait to be seen face-to-face: all the more reason to get the ball rolling sooner rather later, I reckon.

2. Free online pain course
This course by MindSpot is considered credible, and would be good “homework” to try for yourself while waiting to hear back from NQPPMS people. I’ve heard good things about it from other nurses and doctors, but haven’t heard back from any patients about it yet. If you do go ahead and give it a go, I’d be keen to hear what you think of it.
Course via mindspot.org.au/pain-course

3. Counselling/psychological support
Like we were talking about today: the brain lives in the body, so of course the body and the brain influence each other. Pain affects-, and is affected by-, both the brain and the body.

For face-to-face support, the easiest way to access that is via a GP Mental Health Plan/Referral – check with the reception staff @ your GP’s rooms if you decide to ahead with this (a lot of GPs prefer a double appointment when doing a Mental Health Plan/Referral).

If getting to see someone face-to-face is going to be a bit tricky,  there is free, confidential 24/7 telephone and online counselling support available via NQConnect: phone 1300 059 625 and/or visit nqconnect.com.au

4. The just-in-case bit
I have no concerns about you being profoundly depressed or suicidal at the moment Paula, but we know that living with pain can be a risk factor for suicidal thoughts. Just in case you get to that dark place again, It would be a good idea if you store the 24 hour number for community mental health’s Acute Care Team in your phone. The number = 1300 64 2255 (1300 MH CALL).

That’s it for me. I hope some of these suggestions are useful Paula – you have a positivity and sense-of-humour that gives me a lot of hope that things will get better. Naturally, I’m happy for you to contact me directly if you’d like clarification or elaboration.

Kind regards,
Paul

.

End Notes

If you’ve seen me in my clinical practice and have received an email similar to the one above, please accept my explanation that this blog post is just to share an idea about integrating digital therapeutics into everyday clinical practice. I’m a bit anxious that seeing the info online rather than as a one-to-one email may call into question the authenticity of the original email. At my end it doesn’t. I do recycle some sentences/paragraphs when I’m emailing a person after meeting them face-to-face, but the email is always tweaked to reflect the uniqueness of each therapeutic engagement. I’d be horrified if the blog post causes offence or dilutes the authenticity of our meeting, and sincerely apologise if it does.

Please also see this blog post’s companion piece, “Email to a suicide survivor“.

As always, your feedback is welcomed in the comments section below.

Paul McNamara, 27 December 2019

Short URL meta4RN.com/digital01

References/Further Reading

Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943

Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527

Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679

Email to a suicide survivor

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You may have read about nurses as prescribers of digital therapeutics in editorials, letters, journal articles or blogs. This is one of two blog posts demonstrating email as an adjunct to face-to-face support, and as an example of how a nurse can use/prescribe digital therapy. Naturally, it comes with the usual disclaimers about these being examples that may be of use to adapt for you/your practice, not an instruction/template for practice. One of the goals of this blog is to share ideas – that’s what this blog post is about.

Below is a sample email to a person who has survived suicide:

From: Paul McNamara
Sent: Friday, 27 December 2019, 11:50 AM
To: paula@emailaddressesarenotcasesensitive.com.au

Subject: Suggestions

Hi Paula

Thanks for speaking with Molly and I this morning. This email is in follow-up to some of the suggestions we discussed:

1. Safety Plan
In recent years we’ve been thinking more about safety-planning for people who experience suicidal thoughts. Beyondblue have a free App called “BeyondNow” which guides us through the sort of things to include on a safety plan.
Here’s the link: www.beyondblue.org.au/get-support/beyondnow-suicide-safety-planning

Having the safety plan on the phone can be pretty handy, and you can share the plan via email with your GP, trusted friend(s), psychologist etc. If you do decide to use it, and would like the hospital and/or community mental health to have a copy of your safety plan, I’m happy for you to email it to me, and I’ll put it on our system.

2. Mindfulness Strategy
Download the SmilingMind App on your phone from here: www.smilingmind.com.au/smiling-mind-app
As with the BeyondNow App, it’s free, evidence-based and endorsed by beyondblue.
I suggest giving it a try. Mindfulness activities like slow breathing and some of the other stress-management tips on the app can sometimes be more effective than medication when it comes to preventing/managing anxiety.

3. Employee Assistance Program vs GP Referral
Like we talked about today, it would be handy to get plugged-in with a specialist mental health professional (eg: Credentialed Mental Health Nurse, Psychologist, Mental Health Social Worker) in private practice for support. The easiest way to access this for employed people is usually via their Employee Assistance Program – your employer does not get told what you’re discussing in sessions. If you’d rather not go via the Employee Assistance Program, you can book a double appointment with your GP to request a Mental Health Plan/Referral.

4. Short term follow-up via ACT
Community mental health’s Acute Care Team (ACT) will make phone contact with you later today/tomorrow, and will arrange to see you face-to-face within the next week. We think it’s important to offer an avenue to emotional support until we’re sure you’re “back on your feet” and/or engaged with a specialist mental health professional.
You can contact ACT on 1300 64 2255 (1300 MH CALL).

5. Finding your way back
Just in case you lose the booklet I gave you this morning, here’s a an online version:
“Finding your way back” (information for people who have attempted suicide)
www.beyondblue.org.au/the-facts/suicide-prevention/support-and-recovery-strategies/support-after-a-suicide-attempt/finding-your-way-back
You’ll find some good info in that booklet.
Also, the booklet I left for your partner (“Guiding their way back{) is available via the same web page.

It was good to meet you this morning Paula. It’s such a relief that you’re emerging from that dark space you were in a few days ago. I hope this email is helpful to your recovery. Naturally, I’m happy for you to contact me directly if you’d like clarification or elaboration.

Kind regards,
Paul

.

End Notes

If you’ve seen me in my clinical practice and have received an email similar to the one above, please accept my explanation that this blog post is just to share an idea about integrating digital therapeutics into everyday clinical practice. I’m a bit anxious that seeing the info online rather than as a one-to-one email may call into question the authenticity of the original email. At my end it doesn’t. I do recycle some sentences/paragraphs when I’m emailing a person after meeting them face-to-face, but the email is always tweaked to reflect the uniqueness of each therapeutic engagement. I’d be horrified if the blog post causes offence or dilutes the authenticity of our meeting, and sincerely apologise if it does.

Please also see this blog post’s companion piece, “Email to a person who experiences persistent pain“.

As always, your feedback is welcomed in the comments section below.

Paul McNamara, 27 December 2019

Short URL meta4RN.com/digital01

References/Further Reading

Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943

Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527

Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679