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How Technology Can Help Student Wellbeing
Using technology to support youth mental healthDr Michael Carr-GreggChild and Adolescent Psychologistwww.michaelcarrgregg.com
Been an Apple computer user since 1984
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iPad 3iPadiPad MiniiPad 2
iPad Pro
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For Fathers Day
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. 5
. 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. 6
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
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Can technology be a solution?
More people are using it3 billion people online43% of the worlds population69% of people on earth will be covered by 3G broadband
And its getting faster
Around the world31/08/201612
E-mental health is being used:in mass deliverycost effective very effectivemore accessiblestay in controlprivateEngagingStigma reducing
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.12
Its transforming childhood
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A reconfiguring of Maslowfor young people
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98% of students have a mobile
94.9% have a smart phone
91.89% of students have downloaded an app
ScreenagersBorn early 2000s
MillenialsBorn 1980-1990
Born early 1960s to early 80sPost WW2 born1946-1964
Why technology matters to young people?Their real world is both off and onlineIt is how they communicateThey have never known a world without computersIt provides them with flexibility and confidentialityRemoves geographical, attitudinal & financial barriers
The average 18-25 year old
Checks their phone 56 times a dayOnce every 15 minutes
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
What else do we know?
7 out of 10 teenagers tell us that they are using their phone while hanging out with friends
What else do we know?5 out of 10 teenagers tell us that they are using their phone while eating at restaurants
What else do we know?3 out of 10 teenagers tell us that they are using their phone while crossing the road
What else do we know?1 out of 10 teenagers tell us that they are using their phone while having sex
A device weighing 155 gms
Has infiltrated virtually every aspects of their lives
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
So how might technology help the wellbeing of a young person?
Meet Georgie
Georgies Hx16 years oldAttends local High SchoolPresents with a long Hx of anxiety dating back to primary school when she was bullied by a group of girlsNever really recoveredNow smoking cannabis on weekends
Georgies developmental tasksIdentity FormationPeersEmancipation from adult carersSchool/Vocation
Georgies AnxietyShe describes her worry as out of control and has started to interfere with her life. She often feels fear or worryShe often cant concentrate because of worry or fearShe often feels on edge or nervousShe sometimes panics or get upset easily when nervous
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 happenOften ask unnecessary questions, or need constant reassuranceGet upset when a mistake is made, or if there is a change of routineBe a perfectionist, care too much about things being just rightBecome irritable or constantly in a bad mood
Common ways anxiety affects herphysicallyHaving dry mouth or difficulty swallowingExperiencing nightmares, difficulty sleepingHaving difficulty concentratingExperiencing muscle aches and pains (especially neck, shoulders, back)Feeling restless, or trembling and shakingHaving a rapid heart and breathing rate, sweating, dizziness, headacheFeeling sick nauseous, vomiting, or having diarrhoea
Diagnosis
How Reach Out can help
CBCL and YSR (Achenbach)
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.
Like 98% ofher friends, Georgie has a smartphone
What are Georgies current issues?
Problem 1. Sleep
SleepThe single most important behavioural experience that we have is sleepAverage person spends 36% of their life sleeping
Psychoeducation in Sleep
Inform and educate
She gets guidelines
EXPLAINS THE PSYCHOLOGY OF SLEEP VIA A FACT SHEET FROM ORYGEN57http://oyh.org.au/sites/oyh.org.au/files/factsheets/oyh_sleep_factsheet.pdf
Psychologists can provide some beducation by providing Richard with:57
Offers Georgie a Prof Russell Foster Ted Talk
App Intervention - Recharge (free)
https://itunes.apple.com/au/app/recharge-move-well-sleep-well/id878026126?mt=8
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.
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// RESEARCH program three: user driven and empoweredrecharge
practical tips to improve her sleep/wake routine and wellbeingGet daily reports to track her mood, energy, exercise and sleepView graphs to help monitor her progress which can be reviewed in each session
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 youve met each day. His progress tracker will help him see the relationship between his mood, energy, exercise and sleep over the six-week program.
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Wearable Device/App intervention for her Insomnia: JawboneUP 24 (A$149.95)
https://jawbone.com/up
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SLEEP TRACKING
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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 UPA blog on how the Jawbone might be used in therapyThe 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 burnedRichard 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 isnt 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 Richards 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 werent quite right.
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Georgie has a jawbone tracker
Light sleepREM sleep
Fitbit dashboard
Georgies Mum is worried about her snoring
Problem 2. Georgies Mum is worried about her not eating breakfast
Georgie gets directed to a website on breakfast
Problem 3. Eating too much junk food
diets high in processed foods, soft drinks and sweets to an increased risk of behaviour and emotional problems
What is aMediterranean diet?Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. Replacing butter with healthy fats, such as olive oilUsing herbs and spices instead of salt to flavour foods.
Problem 4. How do we address her Anxiety?
Georgie is offered a fact sheet
Offered a free, evidence based online treatment program to do on her own time
What about psychoeducation for Georgies parents?
Georgie is offered a link to a pamphlet from beyondblue for her parents
How do we deal with Georgies panic attacks?
Georgie is offered an app to help her deal with her panic attacks
Georgie is invited to do someevidence based online treatment
Georgie is offered an app that uses ACT to help deal with her anxiety
Solution: Mindfulness
88Georgie is offered an app that helps with stress
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New website
Georgie can download the app
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.
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Lovely ambassadors
8 week mindfulness course - 27 minutes per dayMassachusetts General HospitalMRI scans documented how meditation produced massive changes inside the brains gray matterA major increase in gray matter density in the hippocampusDecreased gray-matter density in the amygdala
Gets info on mindfulness
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 thePip Apps, which, using biofeedback, helps your mind learn how to manage stress.94
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eSense Skin Response is a small sensor to measure Lucys 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.
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measurement curves, video display
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.
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http://www.thinkmelon.com100
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 themental state of focus. The headband is adjustable in the back to fit most people(ages 10+).100
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Solution Increase Exercise not getting 10,000 steps
Georgie gets a fact sheet on exercise
104Georgie is offered an app that helps with exercise
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 Richards 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.
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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 apps designers provide a fact sheet on stretching called "Stay Loose"
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Georgie gets an encouraging message when she has completed a session or week of 3 sessions
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an ultra-immersive running game and audio adventureEvery run becomes a mission where youre 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, youll collect supplies to grow your base back home.
Problem 7. Georgie is worried about a friend
Georgie is offered an app to help her approach her friend
Problem 8. Georgie wants to cut down her cannabis use
Problem 9. Georgies relationship breaks up
Georgie is offered an app that helps her cope
Problem 10. Georgies mate is self harming
119been developed by mental health nursesoffers 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
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Georgie decides to get some counseling
She is offered a smorgasbord of choices
She is offered a smorgasbord of choices
She is offered a smorgasbord of choices
She is offered a smorgasbord of choices
Visit local General Practitioner
She is offered a smorgasbord of choicesVisit a local headspace centre
School Counseling Service
Georgie has suicidal thoughts
Gets a digital safety plan
Georgie gets some medication
An app to help her remember her medication
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http://www.pillboxie.com
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Questions and Thanks