Daniel Y. Dodek MD CCFP FCFP (biography and disclosures)
What I did before
Mental health problems including anxiety, depression and stress make up a large proportion of a typical day in primary care medicine. They also contribute a huge comorbid burden in specialty care. These conditions all require an intense amount of time to help and manage patients.
Prior to learning about the Mindshift App, I would recommend to patients with moderate to severe mental health issues see a psychologist or registered counselor. Unfortunately many patients are not able to afford this or make the time commitment. Some patients are just plain embarrassed to seek help from allied professionals. Sometimes I would recommend reading material depending on the patient’s condition. I often felt frustrated by these complex cases and was challenged by finding the right resources to offer my patients. In addition, the enormous volume of resources overwhelmed me as I was not sure which information was evidence based.
What changed my practice
The Mindshift App was developed by Anxiety BC (a non-profit organization) and the BC Mental Health and Addiction Services (division of the Provincial Health Services Authority). I started to use it after I received a pamphlet in the mail. I easily downloaded it to my smartphone and quickly realized how useful this would be for many of my patients. The App can be downloaded from iTunes or other App smartphone platforms for free. Look under “Mindshift”. A common feature of many apps is the way developers or third parties silently track data and the user of the app. Tracking does not occur with Mindshift so patient privacy is fully protected.
What I do now
For most of my patients with a mood disorder, insomnia or even chronic disease, I now recommend the Mindshift App. Even though this is specifically for people with anxiety, I recommend patients use the chill out tools section on Mindshift. This is my favourite feature. The chill out tools are a set of relaxation exercises, visualization activities and mindfulness strategies. All of these categories have either a male or female voice that directs the listener through the program.
I specifically direct my patients to the mindfulness strategies. Mindfulness is the awareness that emerges through paying attention on purpose in the present moment and non –judgmentally to things as they are.1 Patients may practice a body scan or mindful breathing. The body scan is a 9-minute meditation that helps patients become aware of body sensations in a curious and non-judgmental manner. The mindful breathing is a 4 minute guided meditation.
Mindfulness has been shown to help in management of hypertension, chronic pain, diabetes, sleep disturbance, anxiety and mood disorders.2
The home page is divided up into 7 sections: The Anxiety 101 section reviews the basics of what anxiety is. My Situations allows the user to track what situations cause anxiety, The Check Yourself section has the user check off on a 10 point scale physical symptoms of anxiety they experience and write down the associated worry. The Thinking Right reviews practical strategies for managing worry, reframing thoughts, dealing with perfectionism and tackling social fears. Finally the Inspiration section has interesting and helpful quotes. Most of these tools utilize a cognitive behavior therapy approach, which has been shown to be very effective in the management of anxiety.3
I have found the Mindshift App is a wonderful resource for my patients. This app was developed initially for youth and young adults, however I have seen how valuable a resource it can be for all patient populations that can navigate a smartphone. I typically spend one minute in a ten-minute office encounter to explain and navigate the Mindshift App to patients. Mindshift allows users to access a resource at any time and anyplace. This really is the ideal patient self-management tool.
I always schedule follow up visits to review the patient’s medical condition and a quick check in to review how a patient is managing the Mindshift App. In the past year that I have been recommending the Mindshift App, some of my patients have reported to me an appreciation for using this tool along with a new sense of optimism.
- The Mindful Way through Depression: Williams, Mark, John Teasdale, Zindel Segal and Jon Kabat-Zinn. New York, NY: The Guildford Press, 2007 (book)
- Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA 2008;300:1350-1352 (View with UBC or CPSBC)
- Katzman et al. Canadian Anxiety Disorders Guidelines Initiative: Clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014, 14(Supp 1):S1 (View with UBC or CPSBC)
- Anxiety BC Mobile App Mindshift http://www.anxietybc.com/mobile-app
- BC Mental Health http://www.bcmhsus.ca/programs-referral-info-at-a-glance
- BC Guidelines Mental Health http://www.bcguidelines.ca/submenu_mental.html