Digital apps and sustaining mental health [PODCAST]

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“Digital mental health apps have increased access to mental health care for people around the world. You can find services that fit your specific needs, often on a 24/7/365 basis, so if you need support in the middle of the night, it’s there. Digital apps can include resource libraries, artificial intelligence-driven chatbots that tailor the treatment they provide to your responses, and digital coaching from credentialed mental health professionals at any hour of the day or night from the privacy of your home. Busy schedules or concerns about stigma no longer need to hold people back from getting the support they need, so if the holidays have you struggling, help is available.”

Zereana Jess-Huff is a counselor and health care executive.

She shares her story and discusses her KevinMD article, “Sustaining mental health during the holidays and starting strong in 2022.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Zereana Jess-Huff. She is a counselor and health care executive. She wrote the KevinMD article “Sustaining mental health during the holidays and starting strong in 2022.” Zereana, welcome to the show.

Zereana Jess-Huff: Thank you so much. I appreciate you having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Zereana Jess-Huff: Yeah, sure, certainly. I am a practitioner. My background is in licensed marriage and family therapy and psychology. I started in the early 2000s as a therapist working with a primarily Medicaid population. In 2009, I unfortunately lost a patient to suicide and decided that I really wanted to affect the Medicaid population from a much larger standpoint, because the issue with this particular person was about access to care.

So I went over to the insurance side of the house, worked with the insurance agencies, and kept running into the same problem over and over again, and that was about access, because we just have a shortage of clinicians in the United States for mental health. So I started to think about the intersection of technology and behavioral health and how that could help with scalability. I started to look at things like telemedicine and digital health applications to see if that would have any sort of impact, which it has. So today, I work as a digital health executive working on behavioral health applications.

Kevin Pho: So you have that dual role as a clinician as well as part of a technology company. Tell me how you manage both roles and how you feel that you can make a bigger impact seeing patients outside of the exam room.

Zereana Jess-Huff: The work that I do every day as a chief clinical officer is really trying to build and bring up a product that can help folks in real time. Digital health applications are awesome because they can be used 24/7. If you think about mental health, it doesn’t present itself at 10 a.m. in the morning; sometimes it presents itself at 2 a.m. in the morning. So these digital health applications really can have an impact on the users whenever they need it most, and that’s my way of trying to impact a larger audience.

In the evenings, I see patients for the express purpose of trying to give back as much as I can to the community, because there is such a shortage of providers. So I do see folks in the evenings, five days a week, and it keeps me sharp. It keeps me on point with the latest trends in treatment, and we’re able to translate that over to the digital health applications that we design.

Kevin Pho: What you’re describing in the behavioral health space is certainly not unique to any specific area. It’s happening all over the country, and it’s especially worsening during the pandemic. So can you tell us a story or a case study of how technology can help with those behavioral health access issues, and perhaps a success story where that intersection really helped?

Zereana Jess-Huff: Yeah. I had a patient who was having pretty extreme anxiety attacks. She was having some difficulty at work; she was placed on an improvement plan. I believe a lot of that was born out of social anxiety that she developed over and through the pandemic, and so she really struggled with interacting with students and interacting with folks that she had to interact with.

So we looked at a digital health application, a specific one, and we had her working on it. The digital health application was grounded and rooted in CBT, cognitive behavioral therapy. She would work through that digital health application in between our sessions; we would assign her a certain thing to do. It was really great because it was digital AI CBT, so it’s CBT based on artificial intelligence. She’s talking to this thing as though it were a real therapist. She’s working through her anxiety, her depression, and tools and techniques to help specifically with the panic attacks. Then we would come back to therapy, review those tools in real time, and talk about instances where she was deploying them in her real life.

I’m happy to say now she’s done a complete 180. She’s able to better maintain and manage her emotions, her feelings, and her thoughts through the cognitive behavioral therapy work that she’s done on the application, and she’s also in a much better place in terms of panic attacks and that sort of thing.

Kevin Pho: So when she interacts with that technology, and you mentioned that she had AI-assisted CBT therapy, cognitive behavioral therapy, tell me what kind of specific interactions she would have with the app. What kind of questions would the app ask her, and what kind of feedback would that app ask for?

Zereana Jess-Huff: Yeah. This specific application is highly intelligent. It uses natural language understanding, which is part of NLP, natural language processing, to really understand the tone and the message of what she’s typing. It will review that against a pretty powerful machine, and it will repeat back to her what she’s saying, but also ask her challenging questions around the thoughts that she’s having. Within that conversation that she’s having with the AI CBT companion, they are asking her about her automatic thoughts, and then they’re doing what we call cognitive restructuring and behavioral activation in real time.

That’s allowing her to practice through what her automatic thoughts are, identify cognitive distortions, and then, of course, come up with rational thoughts, which really helps with the thinking patterns that folks go through, especially if they’re the types that are prone to panic attacks. It’s about getting out ahead of the thought before the biophysical response takes over. So she’s able to interact with the app through the digital companion.

This specific app also has 150-plus premium tools, so she’s able to interact with the tools around mindfulness, meditation, those sorts of things. There’s a step-up level of care where she can actually speak with a human coach. She doesn’t actually use that because she has me as a therapist that she’s working with on the side.

Kevin Pho: So as a therapist yourself, you see people who both use and don’t use the app. What kind of difference do you see as a clinician when you see these types of patients?

Zereana Jess-Huff: I see change happening faster with those individuals who use the application. If you think about it, it’s because they’re being asked to practice the skills in real time, and they’re being given feedback through the AI around how they’re doing and how they can better think about things and restructure things, cognitive restructuring, as I said. So I see a lot faster change in their behaviors, thoughts, feelings, and actions, certainly, with those folks who are using the application versus those who aren’t.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Sustaining mental health during the holidays and starting strong in 2022.” It was written back in December. Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Zereana Jess-Huff: Yeah. I really thought it was important because right now in private practice, probably the number one issue I am dealing with is folks who have been tremendously impacted by COVID-19. It’s like we’re isolated; we’re shut off from the world in a lot of regards. It’s getting better, but we were shut off for so long that we forget how to interact with others, and we forget how to attend to our own needs.

So this article was really born out of my desire to help people start off in 2021 pretty strong by doing simple tasks that would really greatly improve how they were living their lives and make sure their lives were certainly much more fulfilled. I really talk about self-care and how it’s important, and how it helps maintain the resilience that’s needed during the navigation of these challenging times. So I gave 10 specific approaches to self-care that I thought folks would certainly benefit from.

Kevin Pho: Now, before I ask you to talk about those specific approaches, when patients come to see you as a therapist, what kind of symptoms are they experiencing that bring them in?

Zereana Jess-Huff: Lately, I’ve been getting a lot around social anxiety. It’s like people have forgotten how to be out in the world, how to talk to others, because they’ve been isolated for so long. So I see a lot of social anxiety. I also see a lot of depression. Folks who have been isolated for so long not only have difficulty connecting with others, but they’re also sad about the time that they’ve lost, and for some folks, it’s critical time. So yeah, that’s primarily what I’m seeing right now.

Kevin Pho: All right, so let’s talk about some of these techniques that you described in the article. What are some ways where patients can invoke some of these self-care techniques to help them out?

Zereana Jess-Huff: There’s mindfulness meditation, which helps improve relaxation and sleep. It can also reduce stress, depression, and anxiety. So doing mindfulness meditation, and there are tons of apps out there where you can get meditation exercises, will really help relieve a lot of the day-to-day stress that you’re dealing with. It will also help keep you present and focused, which is really, really important, because if you’re not in the moment, you’re not present, you’re not focused, you’re typically thinking about the past or worrying about the future, and that’s certainly not what we want you to do.

The other thing is to do something that makes you happy, even if it’s something as simple as watching a 30-minute sitcom. I had a young woman come see me who was dealing with massive panic attacks. She had a recent breakup, and unfortunately, she was very, very unhappy. We did a lot of cognitive behavioral therapy together, and over time, she did sort of a 180. I remember sitting back and saying, “What do you attribute this change in your outlook and in your behaviors to?” She said, “You know what it was? I did something, even if it was something stupid, at least once a day that made me happy.” So that’s one that I definitely think is important.

A couple of others: just taking a break. Especially when we’re working from home and we’re on the computer, our days sort of blend together, and we just see ourselves working much longer hours. Taking a break from your desk, taking a break from work, is really important. It helps with concentration, energy, and motivation. It can reduce frustration. So taking a break is really important.

Probably the biggest one, Kevin, that I think a lot about is being kind to yourself: avoiding trying to do too much, and recognizing triggers and how you can avoid them. If crowded stores stress you out, rearranging your schedule to a less busy time is helpful. If the news is stressing you out, quit streaming it 24/7. But finding ways to be kind to yourself, and doing one thing a day that makes you happy, is being kind to yourself. Doing things to take care of yourself is being kind to yourself. So that’s a big one.

Kevin Pho: So on this podcast and on my site, we have a lot of clinicians, physicians, and nurses talk about burnout. The numbers are that even before the pandemic, 50 percent of clinicians experience symptoms of burnout. Now, what are some specific ways that they can implement some of these techniques during their normal workday to perhaps help with their anxiety, depression, and stress during the job?

Zereana Jess-Huff: Yeah. I have a book that I use. It’s called The Next Level Daily Planner; it’s on Amazon.com. This planner is awesome because the very first thing you do at the top of every morning, or, for folks who are on shift work, at the top of every shift, is you write down an affirmation, and you write down one thing that you’re grateful for. That really sets the tone for the day, in my opinion, in terms of your intention and what you know about yourself, and it keeps you focused on the things that make you grateful. So I think having a gratitude journal of some sort is a really, really good tool and technique.

I also think frequent breaks where you’re practicing mindfulness and practicing meditation can help take you out of the intensity of what you’re experiencing, usually on the medical floor. So I think that’s really, really important. Another one is exercising. Exercise gets the endorphins going, gets your heart pumping, and really, really helps relieve a lot of stress. It also can help improve mental health. So I think making sure you make time for exercise is important.

This sort of goes back to what I was talking about earlier around being kind to yourself. When you do these things, like mindfulness meditation or exercising or taking time to do a gratitude journal, these are examples and ways of you being kind to yourself. In a world right now where we’re so fast-paced, where there are so many problems, kindness starts within. So I think that’s really important for folks, particularly medical folks, who are dealing with some unprecedented times.

Kevin Pho: We’re talking to Zereana Jess-Huff. She’s a counselor and health care executive, and she wrote the KevinMD article “Sustaining mental health during the holidays and starting strong in 2022.” Zereana, I’m a primary care physician. We have a lot of primary care clinicians who listen to this podcast. What would be, I guess, your highest-yield tip that we can give patients in terms of how they can manage their behavioral health issues during the pandemic?

Zereana Jess-Huff: Yeah. I think there are two specific apps that I’m absolutely loving right now. One of them is Wysa. It’s a digital health application, and it does a lot around anxiety, depression, and chronic pain. Primary care physicians are often faced with individuals who have fibromyalgia and are sometimes at a loss as to what to do with these folks. I think applications that have proven efficacy and outcomes around management of pain, pain interference, and pain experience are really important. Wysa has done a lot of research around that.

The other one I love is Calm. Calm does a phenomenal job of working with folks on meditation, mindfulness, and relaxation exercises, and really helping people stay in the moment. So that’s a really great tool to relieve stress and anxiety. So as a primary care physician, I think pushing some of these amazing tech tools that we have right on our phone can have a huge impact, especially when the shortage of behavioral health services is so high. There is a place to get help.

Kevin Pho: My final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Zereana Jess-Huff: First of all, thank you to our first care responders for the work that they’ve done during the pandemic. It’s been amazing to see them at work. With that being said, I also understand the level of stress that they’re under. So one of my big messages today, I think, that has reverberated throughout this interview has been about being kind to yourself. So please be kind to yourself. Take care of yourselves. You are what’s keeping our society moving forward, and you’re saving lives every day, and we are proud and grateful and thankful for each of you and the work that you do.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Zereana Jess-Huff: Thank you.

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