Choosing the Best Digital Mental Health Tools for Patients

Written by Clinical Psychologist Tania McMahon

Digital Mental Health tools and resources are becoming an increasingly important part of our mental health system. They provide effective, evidence-based intervention for patients with mild-to-moderate mental health symptoms, and they can be a fantastic option for patients who experience barriers to accessing face-to-face psychological care (e.g. finances, location, stigma).

However, with a huge selection of digital mental health tools available (e.g. there are an estimated 1400+ mental health apps on the app store), health practitioners face the challenging task of finding and selecting suitable tools for patients on platforms that lack regulation or reliable quality assurance (e.g. the star-rating system on the app store is easily exploited).

A major concern of many practitioners is the quality of the interventions provided by these digital services, as well as concerns about privacy and data security of highly sensitive information. To help address this, the Australian Commission on Safety and Quality in Health Care is undertaking a project to develop national safety and quality standards and a certification framework for digital mental health services. The goal of certification of services is to increase user confidence, increase usage and increase consumer choice in digital mental health services.

With this certification framework still a little while off, the onus is currently on health practitioners and users to individually assess the quality of digital mental health services. While this can feel like an overwhelming task, it doesn’t have to be! Here are a few helpful options, including questions you can ask and steps you can take to help make the right decision:

For Apps – use the Mobile App Rating Scale (MARS)

Researchers at QUT have developed and validated the world’s first known mental health app quality rating tool (the MARS), to provide a multidimensional measure of the quality of each app. The indicators include engagement, functionality, aesthetics, information quality, and app subjective quality.

More information about the MARS (including a free download of the tool) is available here.

For all other services (e.g. websites, online programs)

Is it user-friendly and engaging?
- Is it easy to navigate and use? Is information easy to find?
- Is it engaging and pleasant to use?
- Is the information clearly communicated?
- Will users want to access it enough to get the full benefit?

Is the content clinically safe?
- There should be transparency about who owns the service and what the funding sources are (so that you can identify any conflicts of interest).
- There should be transparency about how the content was developed and by whom (e.g. through university research or a government grant, and what the expertise of the content developers is). Services developed by government-funded bodies and institutions are likely to be the most reliable in terms of content and efficacy. Check out Head to Health for a searchable index of Australian, government-funded digital mental health services.
- There should be some evidence as to the efficacy of the service - ideally a Randomised-Controlled Trial or other evaluative process. However, if not (as RCTs can be difficult to fund), digital adaptations of well-established efficacious treatment interventions (e.g. CBT) can generally be considered effective as long as the treatment is clearly communicated (i.e. something that claims to be online CBT clearly appears to be).
- Are there any treatment elements that could cause harm?
- There should be options for at-risk users to self-identify and seek further help (e.g. a ‘Get Help Now’ button that leads to Crisis Line information).
- If there are health professionals involved in the delivery of the service (e.g. conducting telephone assessments, moderating online forums), do they have appropriate qualifications?

Does it protect privacy and is it secure?
- Is the site secure?
- There should be clear information about how personal data is used and protected.
- The service should have a privacy policy stating that user information is not sold on to third parties.

To get started in your search for helpful digital mental health services, begin here:

Check out the Australian government’s ‘Head to Health’ digital mental health gateway - https://headtohealth.gov.au.
Search for some relevant services and try out one or two for yourself; evaluate them using the questions above (or the MARS, if it is an app).
See if they would be suitable for your clients – if so, great! If not, head back to Head to Health and search for another.

Choosing the Best Digital Mental Health Tools for Patientswebeditor2023-08-21T14:47:38+10:00

Why doesn’t mindfulness work for me?

by Tania McMahon

“Be in the moment.” “Clear your mind.” “Centre yourself.”

I remember feeling rather confused when I first learned about mindfulness as a provisional psychologist. It was so abstract and nebulous – an idea that I just couldn’t grasp as tangibly as behavioural strategies like pleasant […]

Why doesn’t mindfulness work for me?webeditor2023-08-21T14:50:54+10:00

Latest Clinical Practice Guidelines for the Treatment of Anxiety Disorders in Adults

by Sarah Scupham

Anxiety disorders are common, chronic mental disorders, with one in seven adults suffering from an anxiety disorder in any year. Social Anxiety Disorder (SAD) is the most prevalent anxiety disorder, followed by Generalised Anxiety Disorder (GAD) then Panic/Agoraphobia. The Royal Australian and New Zealand College of Psychiatrists […]

Latest Clinical Practice Guidelines for the Treatment of Anxiety Disorders in Adultswebeditor2023-08-21T14:51:29+10:00

Help! My teen has self-harmed. What do I do?

by Karien Hill

Finding out your teen is self-harming can be frightening. You may feel overwhelmed and ill-equipped to handle the situation, fearing you might make it worse. Finding out more about why teens self-harm and how to help them manage their intense emotions can be useful.

Self-harm - The facts:

Self-harm is defined as intentional harming of one’s body without suicidal intent. It is usually done in places not visible to others.
Approximately 12% of young people have engaged in self-harm previously.

Why do young people self-harm?

To cope with an intense emotion
To punish themselves if they feel guilty
To try and replace emotional pain with physical pain
To feel ‘something’, ‘anything’ if they feel numb, disconnected or alone
To feel in control
To express they need help

Signs someone may be self-harming:

Wearing long sleeved clothing in warm weather
Isolating themselves and withdrawing
Scratches, cuts, bruises, scars with inconsistent explanations

How is self-harm and a suicide attempt different?

Most young people self-harm as a coping mechanism, rather than to attempt to end their life.
However, people who self-harm are also more likely than the general population to feel suicidal and to attempt suicide.

How do I tell the difference?

Just ask - if you notice your teen is engaging in self-harm, ask them if they have thoughts about suicide. If they are, take them to a GP and psychologist for assessment and support.
Experts agree that asking and talking about suicide does not make someone feel worse or ‘put the idea in their head’ – rather it provides relief.

What to say:

Ask – have they been self-harming, what has been going on, how are they feeling about it, what are they thinking, what have they thought about what they could do.
Then listen – you do not need to give advice or fix anything, unless they ask for it.
Acknowledge their feelings - don’t minimise or tell them not to feel a certain way.
Keep your reactions in check – if you feel scared, shocked, angry or blame yourself – breathe slowly and deeply, relax any tense muscles and get back to listening and acknowledging their feelings. If you react they may be less likely to communicate with you in future. Find other parents to connect with and discuss this and get your own support.
Admit you may react or say something unhelpful. Admit you don’t have the answer. Tell them despite this, you care, you are there, you want to help.

What to do:

Help! My teen has self-harmed. What do I do?webeditor2023-08-21T14:53:15+10:00

Burn Out

by Dr Julieta Castellini

We generally don’t wake up, one day to the next, feeling burnt out. Burn out is a gradual, insidious process. We often miss the somewhat vague warning signs, putting these down to feeling tired or just having “one of those weeks”. It’s often not until we’ve fully hit burn out station, or we have it pointed out to us by partners, family, friends or colleagues, that we recognise how depleted we are.

At a societal level, there is increasing pressure to do more and work harder, both at work and at home. We work harder and do more, and in the end lose touch with what happening for us, how we are feeling and our capacity.

I’ve heard of burn out, but what is it?

Burn out is the cumulative reaction to ongoing life stressors. It tends to occur when the resources we have (such as time and energy) are lost or not enough to meet all the demands we have at hand, or when our inputs don’t result in the output we had hoped for. Some factors that lead to a higher risk of burn out are uncertainty, stressful events, heavy workload and pressure.

Signs or indicators of burn out are:

feeling overwhelmed or unappreciated
cynicism or frustration
emotional exhaustion
avoiding or withdrawing
less commitment to activities, i.e. doing the bare minimum
feeling less satisfied
taking more time off
sense of ineffectiveness or failure
changes in attention or concentration
increased use of alcohol, drugs or TV/social media
changes in sleep or appetite

Many of us will experience some of these signs at one point in time or another, which may be completely unrelated to burn out. However if you are finding that these symptoms are ongoing or you are experiencing several of these, you may be burning out.

What can I do to manage burn out?

If you’ve gotten this far and you’re thinking, “help, I’m burnt out!!”, here are some things you can do to not only address burn out, but also take steps towards preventing it.

Good eating, sleeping and exercise routine. If you can, try to aim for 3 to 5 meals per day, about 8 hours sleep a night and a 10 to 20 minute walk per day
Saying “no” if you do not have capacity. If it’s hard to say “no”, try saying “maybe” and give yourself the time to think about whether you have capacity or not
Give yourself breaks between demands or activities, and have some “quarantined time off “ each week, even if just for an hour
Try to find a balance across the different areas of your life, you are not going to be able to give 100% to each area and that is totally ok
Write out the things that are stressing you out. Make a note of the ones that are urgent or important (i.e. will this matter when I’m 85?) and which ones can be postponed or delegated to others
Reconnect with your passions, the enjoyable activities that fulfil you
Socialise with friends
Use mindfulness based apps (such as Smiling Mind or Headspace) to focus more on the present, the right here and now, rather than the future or the past

If you are finding that your symptoms are significantly impacting on your relationships, work or other life areas, or you would like some support with managing burn out, check in with your GP and you may discuss whether seeing a psychologist could be worthwhile. You might also be able to access a psychologist through your workplace under an Employee Assistance Program.

Burn Outwebeditor2023-08-21T14:56:49+10:00

Working with: The Existential Crisis

by Tessa Hall

Of the many reasons clients are referred for psychological therapy, anxiety in some form is by far the most common. While treatments like CBT are very effective in helping clients understand and manage their symptoms at a very functional and practical level, sometimes a reflection on the […]

Working with: The Existential Crisiswebeditor2023-08-21T14:58:36+10:00

Freeing Ourselves From Avoidance

By Dr Jasmine Pang

As human beings, we are encoded to survive by avoiding things that are likely to cause us pain, which we have learnt in the past to induce pain or which is stressful or unpleasant: be it that giant spider sitting on the clothing line, that shoulder pain that has been ongoing for a while, or an article that you have promised to write for your upcoming practice newsletter.

In the initial phases, avoidance can work very well. By just using the part of the clothes line that the spider has not occupied, by not thinking about the article I need to write or by working around my sore shoulder, I can pretend that everything is ok and continue on my merry way. We work around it. The problem is that things very seldom remain the same. My resident clothesline spider decides to expand his territory and take up more and more of my clothesline, my shoulder pain worsens to a point that I cannot reach up beyond my shoulder and my practice manager starts sending me “reminder emails” that I cannot avoid anymore. Whilst some avoidance can be a very successful strategy to keep us safe from stressful situations, unpleasant experiences or threats, it can also become counter productive

So what have I learnt about avoidance?

1. Avoidance can be helpful when threats are real. If that spider on the clothesline turns out to really be that gastly dangerous “it’ll kill a grown man within an hour” species that Australia seems prone to having, avoiding it is probably a good idea. We can never totally avoid all the things that we want to avoid. It is seldom that avoidance makes things go away. The spider is still on the line, my shoulder still hurts and the looming newsletter article deadline is still there.

2. Avoidance feeds fear and is an all consuming voracious creature. The more we avoid the greater the problem often becomes. This is particularly so with anxiety. The more anxious I feel, the more I avoid. The more I avoid, the more anxiety I feel. As time goes by, our world becomes smaller and smaller and we feel more and more trapped.

3. Avoidance prevents us from learning that something different can happen or that what we were so fearful of is not as bad as we expected it to be. It prevents us from really experimenting and checking it out, to determine if something is really a threat or not.

What have I learnt to do about it?

1. Acknowledge the problem. We cannot do anything about a problem until we acknowledge it. For me, it was acknowledging that I had a problem in my shoulder (and in all likelihood had torn a ligament), that I was frightened of that spider and that the thought of having to sit down and write an article brought back traumatic memories of writing my thesis.

2. Start small. Be it writing notes on what you’d like to include in the article, finding out about physiotherapists or reading up about whether your resident spider is indeed as dangerous as you imagined it to be. Keep pushing yourself to be at the edge of your comfort zone. Don’t try to aim for the big wins. Small sustainable goals are more likely to get you there. Remember the tortoise and the hare.

3. Get support and help. Having someone to walk you through the journey can be invaluable. It helps give you perspective, keeps you accountable and gives you someone to whine to at the end of the day. This is particularly so if you have been avoiding a situation because of traumatic experiences. Until you stop avoiding, it will continue to intrude in your life and limit you. It might be uncomfortable but keep practicing and trying. Eventually it becomes the new normal.

To quote loosely from Vivian Greene, perhaps life is not about trying to avoid the storms but learning how to dance in the rain. Now excuse me whilst I get a broom to try to relocate my eight-legged friend for the fifth time before I head out for my physiotherapy appointment.

Freeing Ourselves From AvoidanceEllie Raymond2023-08-21T15:05:33+10:00

3 Ways To Tell If Your Child Might Have Social Anxiety

Written by By Dr Cate Hearn

Shy or Self-Conscious

Compared to other children their own age, socially anxious children appear shyer and more self-conscious. They may:

Find it hard to talk to other children

Find it hard to make new friends

Feel left out or awkward, or worry they’ll embarrass themselves

Have less well developed social skills than children their own age

Dislike being the centre of attention

Worry a lot about their appearance

Worry that their friends don’t really like them

Be quiet in large social situations

Speak softly to those they don’t know well

Avoidance

Socially anxious children fear and avoid a range of social situations. They may:

Avoid new social situations

Make excuses not to go, by saying, “I’m just a homebody”, “I don’t feel like going”, “I don’t like parties”

Dread sports days or swimming carnivals

Dislike giving orals or talks in class

Be too anxious to raise their hand/answer questions in class

Play alone often

Tummy pains, headaches

Anxiety and worry can manifest in physical symptoms, and socially anxious children may:

Report pains in the stomach, headaches, nausea or sore/aching arms/legs especially before school or social events

Become withdrawn or irritable before social events or before school

Won't they just grow out of it?

Research shows that a great many children with social anxiety do not just ‘grow out’ of it.

Left untreated, social anxiety can persist and cause significant interference in children’s lives. Child friendly cognitive behaviour therapy for social anxiety can help children overcome social anxiety.

At Benchmark Psychology, we have a number of therapists who can provide child friendly therapy to socially anxious children. Ask for Dr Cate Hearn (who’s PhD thesis was in child and adolescent social anxiety), Dr Alison Bocquee, Dr Kylee Forrest, Dr Jasmine Pang or Dr Leona Chun.

3 Ways To Tell If Your Child Might Have Social AnxietyEllie Raymond2023-08-21T15:11:48+10:00

Five Screen-Time Life Hacks

Written By Dr Tania McMahon

It’s 9pm. You’re exhausted. You’ve just finished dinner, maybe putting the kids to bed, tidying up around the house and vaguely thinking about what you have on tomorrow, and you have approximately one hour before you drag yourself, bleary-eyed, into bed to get some sleep and do it all again tomorrow. It’s time for some ‘you’ time! What about checking social media for a few minutes before figuring out what you could do to relax?

It’s 10:15pm, you realise with a start, as you peel your eyes up from Instagram and check the clock. “A few minutes” has turned into over an hour, and any time that could have been spent tinkering on that craft project, strumming on the guitar, or pulling a new book off the shelf has now been sucked up by the black hole of your digital device. While you have a vague sense of being mildly entertained over the past hour, you can’t remember exactly what it was you were looking at, and your brain is in a strange state between buzzing with alertness and feeling strangely fatigued. As you scramble to get ready for bed, you can’t help but notice a strange feeling of discomfort, a low-level frustration that something hasn’t been tended to, or you didn’t finish something; a feeling of being left unsatisfied.

Sound familiar? You’re not alone. Our devices embody an almost perfect solution to temporary boredom: brief, instant entertainment, on demand. Yet when we find ourselves turning to them at every idle moment, day after day, night after night, we start to realise that they are taking us away from all those things we’d “love to be doing more of”, but that take a little more time and effort to get into. And when we do less and less of those activities we value, we fall more and more into the same trap of turning to our digital devices whenever we have a moment of boredom.

So, how do we hack our way out of this digital ditch? Here are five quick tips to get you started:

1. Categorise screen time into ‘work’ and ‘leisure’.

We all know that some screen time is unavoidable – emails, online banking, checking the bus schedule, and so on. However, this ‘necessary’ screen time need not get mixed in with checking social media, playing games, and browsing the web. By mentally categorising each function, app and activity on your device as ‘work’ or ‘leisure’, you can start to build awareness of your use, and then start to make decisions about how much ‘leisure’ time you really want to spend on it.

2. Track your use

Devices have a funny habit of ‘warping’ time while we’re on them, making it seem like only 10 minutes has passed, when it’s actually been much longer than that. It follows, then, that all of us are rather poor judges of how much time we’re spending on them. By downloading an app that tracks your use (popular options include ‘Quality Time’ for Androids and ‘Moment’ for iPhones), you’ll be able to analyse your use over days, weeks and months, as well as look at patterns of use across the different apps on your device. By knowing when, were and how you use your device the most, you’ll be able to set your own personalised goals for what you’d prefer your use to be like.

3. Set regular screen-free times

While everyone’s screen time rules are ultimately going to be different, a good general rule for everyone to apply is to set at least one regular screen-free time. Some choose a screen-free breakfast, so they can connect meaningfully with their family first thing in the morning; some choose the train or bus trip to work, so they can use it as ‘thinking time’; many choose the hour before bed, because of the strong evidence linking screen use before bed to sleep difficulties. The options are numerous!

4. Change your notification settings

Notifications are designed to catch our attention – a red badge here, a blinking light there. The more we see, the more we feel the compulsion to check them, irrelevant of how important or urgent they actually are (and let’s face it, how many times have those notifications been utter time-wasting distractions??). A simple solution to this is to change your Notification settings so that you only receive Push notifications for things you feel are absolutely necessary. Or, be daring and change them all to Manual!

5. Make your leisure screen time as goal-directed as possible

Get into the habit of asking yourself ‘what am I wanting to achieve by looking at my device right now?’ and ‘is this my preferred use of my time right now’? More often than not, you may find that mindlessly scrolling through social media is not your preferred use of your time. Sure, the answers might be ‘I want some quick entertainment’ and ‘yes, as long as I start making dinner in 10 minutes’, but at least it means that you are consciously making that choice, and that you have defined a meaningful limit to your use. That way, if more than 10 minutes go by and you realise you haven’t started making dinner, you know it's no longer a good use of your time.

Dr Tania McMahon is a clinical psychologist with a particular passion for helping people manage their screen usage. Tania often treats internet and gaming addictions at Benchmark Psychology.

Five Screen-Time Life HacksEllie Raymond2023-08-21T15:12:49+10:00