By Sandra Basu
WASHINGTON —Helping patients learn to do diaphragmatic breathing as a way to control anxiety and anxious symptoms is much easier, thanks to technology.
A mobile application, Breathe2Relax, has a self-contained tool to teach diaphragmatic breathing, David C. Cooper, PsyD, noted recently, and can be provided to patients even before they come to see him. Before, he had to spend appointment time teaching the technique.
“It is really a nice self-contained tool that goes above and beyond just a handout or training within the clinical session, taking the best of both of those and giving it to the patient on the go,” he explained. “From the moment they contact my office to set up that first appointment I can say, ‘Oh, by the way, sounds like you’re having some issues with anxiety. I want you to go check out this application and use it for a little bit before our first session.’”
Cooper, who serves as a research psychologist with the Mobile Health Program at T2, described the benefits of Breathe2Relax at a recent webinar. He was speaking on behalf of the National Center for Telehealth and Technology (T2) at Joint Base Lewis-McChord, WA, where the application was developed.
“Just like telehealth is taking what we do in our clinics and bringing it to our patients over video, m-health [mobile health] can be considered to do the same thing with mobile apps and websites. So what this means for you is that with m-health, you’ll have access to data that you previously wouldn’t,” he told providers who participated in the webinar.
Cooper pointed out that m-health is increasingly important as people use their mobile phones more and more to access the Internet.
“As of 2012, almost half of all Americans had access to the Internet through a mobile device. Smartphone use is on the rise, and that’s both in the public sector and in military. We’ve done some research here at T2 to look at military technology usage, and what we found is that it pretty well mirrors what you see in the private sector. And what we see there is, increasingly, patients are looking for more tech savvy care,” he explained.
Mobile apps are being developed in both the civilian sector as well as by federal entities like T2. Cooper explained that most every mobile application that T2 develops is for both Android and Apple devices, with a few minor exceptions.
Mood Tracker App
Among the T2 mobile applications Cooper described is the T2 Mood Tracker, which is designed to replace the standard mood-rating sheet clients use to track their moods.
“The nice thing with T2 Mood Tracker is it replaces that paper sheet with an app that will always live on their phone. Again, I can’t tell you how many times I, as a provider, have had patients lose the handout, not take it with them, [and not] fill it out ahead of time,” Cooper said.
Another T2 application featured in the webinar is BioZen, which is designed to assist with bio- and neurofeedback and is only available for the Android phone.
BioZen is the first portable, low-cost method for clinicians and patients to use biofeedback in and out of the clinic, according to T2. The application shows real-time data from multiple body sensors including electroencephalogram, electromyography, galvanic skin response, electrocardiogram, respiratory rate and skin temperature.
Another application, PTSD Coach, was developed in collaboration with the VA’s National Center for PTSD.
“It really straddles the line between something someone can use on their own and use with a provider,” Cooper described. “So either this is something you as a provider can use to augment, give your patient resources to use outside of the session, or if you have a patient who’s maybe more contemplative, not ready to address that they have PTSD, this is a good way to give them just kind of an informational resource to do a little bit of learning on their own about what is PTSD, what are the signs and symptoms.”
Similar to PTSD Coach is CBTi Coach, which supports cognitive behavioral therapy for insomnia.
“So CBTi Coach is like PTSD Coach, a nice application that can either be used by someone who maybe can’t get into a clinic right away or is just considering that they might have sleep issues, as well as in a more active way to help them actually treat their insomnia,” Cooper explained. “You get sleep prescriptions. There are self-assessments, again, information about good sleep hygiene, and, again, a really kind of self-contained tool for using evidence-based cognitive behavioral therapy for insomnia.”
As with any other new tool, Cooper recommended that providers should first gauge how comfortable a patient is in using mobile applications before suggesting their use.
“Do they have a smartphone? Are they comfortable using it? For patients with TBI, getting them engaged in a smartphone and learning how to use their smartphone may actually be very good and beneficial for recovery in terms of building up their long-term strategy,” he suggested.
He also recommended that providers check in regularly with their patients to see how their use of the app is going.
“Would another app maybe work better? Would they be interested in adding other apps to their regimen?” he questioned.
Cooper also said that, while he loves apps, he does not want to sell them as “a one size fits all and a panacea that is going to be everything.”
“Not all apps are going to appropriate for all patients. Some people are going to prefer paper. Some people are not going to be able to use it because of physical limitations,” he said.
Cooper also pointed out that while the private sector has embraced many mobile applications, not all will work on military mobile phones.
“Many of them will only work on servicemembers’ personal devices and not on official military sanctioned mobile phones, or maybe even through your own networks,” he said. “So what that means is, depending on your location policies, you may be unable to access particular websites or download certain apps to your official devices. That’s just, unfortunately, not something that we can help. A lot of this technology is so new the regulations are having trouble keeping pace with is, as we can see from the recent FDA push on mobile applications.”
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.