As part of the Australian Government’s recommended stepped care model of mental healthcare, ‘e-Mental Health’ services (low-intensity online mental health interventions and resources) are becoming a much more important part of our mental health system.
With 1 in 5 Australians experiencing mental health difficulties, low intensity interventions can provide an ideal option for individuals with mild-moderate mental health symptoms where other options (e.g. psychologist referral, medication) might not be suitable. However, e-Mental Health services need not be an either-or choice when compared with face-to-face treatment. In fact, e-Mental Health services can fill multiple roles in the space between an individual seeking help from their GP and accessing treatment with a Psychologist, from initial psychoeducation and increasing acceptability of face-to-face services for first-time help-seekers, to crisis support between appointments, to providing interim support and brief intervention for busy periods where they may be on a waitlist.
Below is a brief guide to the range of e-Mental Health services available (Table 1), as well as an outline of the various roles e-Mental Health can play, and which services are most appropriate.
All listed programs have been developed by credible sources, such as the Australian Government, universities, and national nongovernment organisations.
Table 1. e-Mental Health Service categoriesHere is an outline of some of the ways e-Mental Health can be used to help our clients:
Head to Health
Previously ‘mindhealthconnect’, this is the Australian Government’s portal to mental health information and e-Mental Health services. It enables consumers to search for information and receive advice about their mental health needs.
|Telephone and Webchat||Telephone and online chat services, most often free and used for crisis support, information-seeking, or brief counselling.||
|Psychoeducation Websites||Freely accessible websites providing mental health information, and often general tips and strategies for wellbeing.|
|Online programs||Online self-guided courses that are either transdiagnostic (i.e. targeting common core mental health symptoms), or address a specific problem (e.g. Social Anxiety, PTSD). Some programs offer limited guidance from a therapist via phone or email. The majority of programs are free, with a few being low-cost.|
|Apps||Easy and convenient to use (as they are mobile- or tablet-based). However, due to the number of apps available on the market and the relative ease in creating them (compared to the more comprehensive online programs), many do not have experimental validation. As such, it is important to thoroughly check the content and credentials of any app before referring to it.||
1. As crisis support:
- Telephone and webchat services are a great option for clients to contact if they need immediate support out of hours or between appointments with their healthcare professional.
- Apps such as the BeyondNow Suicide Safety Planning app can help clients and their healthcare professional create a strong, structured plan for dealing with ongoing crises and distress.
2. Psychoeducation for first-time or hesitant help-seekers:
- Head to Health, the government’s mental health information portal, is a great place to direct clients to in the first instance.
- Psychoeducation websites are fantastic tool for providing information about general stress and wellbeing, specific diagnoses (e.g. generalised anxiety, eating disorders), or specific problem areas (e.g. parenting, relationship issues, work stress) to first time help-seekers.
- Online programs (particularly the transdiagnostic programs that don’t focus on a specific diagnosis, such as myCompass) are a great option for help-seekers who are hesitant or uncertain about face-to-face mental health intervention.
3. Interim support:
- If clients are on a waitlist or aren’t able to access timely support due to situational circumstances, online programs and apps can provide a great option to help them start working on their wellbeing in the meantime (which also means they can hit the ground running when they are able to commence face-to-face intervention).
4. To complement face-to-face treatment:
- Online programs and apps can help build on the skills being taught in therapy, such as CBT strategies, mindfulness and positive psychology. Whilst using these resources as a complementary tool can involve a little extra work on the part of the clinician (i.e. to be able to get to know the programs available and find ones that complement their work), it can really help to strengthen and reinforce the work done in session.
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.
Positive, supportive relationships can help us withstand many of the expected or unexpected challenges life might throw at us. At times of stress, knowing there is at least one special other to turn to, who we can trust to hear and respond to us, strengthens our capacity to cope. Conversely, when that need for support at a critical time is not met, we can feel profoundly hurt by those we rely on for care
and comfort. At these times, instead of pulling together to face life’s difficulties, partners can become disconnected and even hostile with each other.
This is where a trained couples therapist can help. As health professionals, you are likely to be caring for patients who are going through just the kinds of difficult life events that can place strain on relationships. Here are a few tips on how you can encourage your patients to seek help for their relationship.
At Benchmark Psychology, we have psychologists trained in Emotionally Focused Therapy (EFT) for Couples. According to recent studies, 90% of couples who see a well-trained Emotionally Focused Therapist experience improvement, and 70% report full repair of their relationship. Unfortunately, many couples are reluctant to seek therapy because of a range of fears and misconceptions, and
couples therapy is often seen as a last resort before breaking up.
Here are some common concerns couples have about therapy -
1. The therapist will take sides.
We are trained to recognise and understand how both partners contribute to their pattern of disconnection and distress, and to assist partners to understand the painful emotions that underlie their partners’
attempts to reach them.
2. The therapist will tell us we should break up.
The decision about whether to continue in a relationship always belongs to the couple. The role of an EFT therapist is to help couples understand how their relationship has gone wrong, and to guide them, for as long as they are willing to try, in how to repair it.
3. We are too far gone; the situation is hopeless.
Even longstanding problems can be resolved or improved with EFT. The intensity of distress does not indicate the relationship cannot be improved.
4. Talking about our problems will make things worse.
Many couples have experienced that their own attempts to talk about their problems have made things worse, so this concern is understandable! However, an EFT Therapist is trained to create a safe space where problems can be discussed productively. In many cases, the therapist will be able to help partners see each other’s struggles in new ways that open the door to healing and reconciliation.
5. Couples therapy is a waste of time and does not work.
EFT has years of research demonstrating its effectiveness in helping couples improve their relationships, and follow-up studies show these improvements are long lasting. EFT is one of a handful of couple therapies designated as empirically supported by the American Psychological Association (APA).
6. We (or he or she) need individual therapy first.
A growing body of evidence suggests that successful couple therapy can reduce an individual’s symptoms of depression, anxiety, posttraumatic stress and other psychological disorders. At the very least, a stronger, more supportive relationship will reduce the suffering both partners experience when one is struggling with a psychological disorder. Couple therapy may not be the only treatment needed when a partner has significant psychological symptoms can help partners to join hands in working together on the challenges they are facing individually.
Adapted from Ruth Jampol, PhD, Licensed Psychologist Certified EFT Therapist,
Supervisor-in-Training Board of Directors, Philadelphia Center for EFT
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
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.
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.