October is National Depression and Mental Health Screening Month. Seasonal Affective Disorder (SAD) is a type of depression linked to seasonal changes, typically beginning when fall starts and intensifying during late fall or early winter.

What’s the difference between SAD and the “winter blues”?

Many people feel a little down during colder months because they are stuck inside, and it gets dark early. These feelings, often called the “winter blues,” are temporary. SAD is a clinical form of depression that affects your daily life, including how you feel and think. SAD can last up to five months of the year.

What causes SAD?

About 5% of adults in the U.S. experience SAD. It tends to start in young adulthood. SAD may be caused by reduced serotonin and vitamin D levels, altered melatonin levels, decreased sunlight and shorter days.

What are the symptoms of SAD?

If you have SAD, you may experience mood changes and symptoms of depression, including:

• Persistent sadness
• Increased anxiety
• Food cravings and weight gain
• Extreme fatigue and low energy
• Feelings of hopelessness
• Social withdrawal
• Sleep disturbances

What are treatment options for SAD?

Treatment should be tailored to you and supervised by a healthcare professional. Options include:

• Spending time outdoors—Getting more sunlight can help improve your symptoms.
• Light therapy—Using a light therapy box daily helps regulate circadian rhythms and boost mood.
• Cognitive behavioral therapy—This treatment helps identify and change negative thought patterns.
• Vitamin D—A supplement may help if a deficiency is present.
• Medication—Antidepressants may be prescribed for severe cases.

For more on Seasonal Affective Disorder, visit our website for National Depression and Mental Health Screening Month, MagellanHealthcare.com/Mental-Health, and be sure to check out the suicide prevention tip sheets and awareness campaign toolkit.

Sources

• Cleveland Clinic
• NIMH

Creating inclusive communities where Black, Indigenous and People of Color (BIPOC) feel a sense of belonging and support is important to their wellbeing. Research shows individuals with strong social connections are 50% more likely to live longer and have a better chance of preventing serious illnesses like heart disease, stroke, dementia, anxiety and depression.

Here are five ways you can connect with BIPOC to cultivate culture, community and connection.           

1. Explore the values, beliefs and traditions of diverse cultures: Exploring BIPOC articles, books, documentaries, cultural museums, languages or cuisines can cultivate respect, empathy and inclusivity.
2. Seek authentic connections: Build meaningful BIPOC relationships by finding common ground, personally and professionally. Genuine cultural connections can emerge from supportive neighboring, discussing shared interests or embracing diverse perspectives to achieve common goals.
3. Engage in community activities: Volunteer to support the BIPOC community by assisting at events or with organizations serving BIPOC populations.
4. Promote services and resources that help BIPOC communities: Sharing information about services, resources and job opportunities online or through personal networks can aid BIPOC communities significantly.
5. Support BIPOC organizations: Strengthen community ties and show commitment to BIPOC concerns by supporting BIPOC organizations. This can include buying from local BIPOC businesses, amplifying their voices on social media and advocating for BIPOC needs in civic forums.

Together, we can build a more inclusive and supportive community for all. Every action counts in fostering culture, community, connection and BIPOC wellbeing.

For more information to increase awareness about BIPOC mental health and wellbeing and the importance of recognizing and addressing concerns, visit MagellanHealthcare.com/BIPOC-MH.

SOURCES:

• Human Connection: Why It’s Important I Psych Central
• Social Connection | CDC

The National Football League’s 58^th Annual Super Bowl ended with a winning team and fans who might be recovering from a tough season. Whether you’re an athlete or a fan watching sporting events in person or at home, the competitive nature of sports can be both exhilarating and heart-wrenching. However, what happens when the passion felt for the game triggers emotions such as sadness or depression? In this interview with Magellan Federal’s Performance Coaching Manager Meg Helf, M.S., CMPC®, we explore the concept known as “sports fan depression.”

What is Sports Fan Depression and is it a real diagnosis?

Meg Helf: Although Sports Fan Depression is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), many of us are all too familiar with the emotional rollercoaster that comes along with being a fan. Reactions to any number of life events can linger and develop into diagnosable depression, prolonged grief disorder, or an adjustment disorder with depressed mood. Just as we experience grief with the loss of a relationship or a loved one, a job or an opportunity, we may experience grief at the end of a season or when our favorite team comes up short.

For sports fans, acute grief is that initial intense feeling after a loss takes place. This may manifest in a range of complex feelings such as sadness, anger, frustration, and disappointment, which often isn’t discussed in the context of sport. When this grief is experienced for extended periods of time and starts to impact our daily functioning (e.g., work, eating habits, sleep, relationships), we might be experiencing what many call Sports Fan Depression.

What is it about sports that can trigger this feeling?

Helf: There are several reasons that sports can trigger these feelings. Fans make emotional, psychological, physical, and sometimes financial investments in their teams. There are a plethora of ways that sports can impact our wellbeing: sports can be integral to one’s identity, sports can drive our daily activities, and, sports have the ability to create communities and develop relationships.

The more someone identifies with their team the stronger they may feel loss about the outcome of the game or result of the season. These events can feel like a blow to our personal identity when we have a sense of pride and belonging. Despite superstitions and lucky shirts, socks, and routines, fans have a lack of influence and impact on the outcome of the game. This may set many up with unrealistic expectations and add a sense of helplessness. A player on the field has the ability to distinguish what went well, identify what they and the team need to develop, and maintain a future focused growth mindset regardless of the outcome. With less control, it is understandable that fans struggle with optimism because they cannot take any action to make the desired change.

For some, being a fan is a part-time (or full-time!) job. Between watching games, competing in fantasy leagues, and researching statistics, our daily lives are filled with something that we are passionate about. Similarly to how some marathon runners experience the “post-race blues,” when a season is over, we may feel a loss for all the time we invested and feel like a large part of our daily excitement and activities are missing. As the season comes to a close, that taste of the adrenaline, tension, energy and anticipation of each game fades and may leave us wanting.

Fans also rarely go it alone. Our favorite team has the ability to connect people, both friends and strangers alike. Fans connect across time zones for draft parties and engage in banter through fantasy leagues, spend hours tailgating before a game, and gather for watch parties. Families strengthen bonds, adorning newborns in gear and creating traditions. Strangers high-five. They hug. They share food, drinks and handwarmers. Even opposing fans engage in playful banter and share stories. Entire cities come together to support their team. We win together. We lose together. And when the season is over, we are losing these opportunities for such a meaningful part of life – connection to others.

How can someone identify if they suffer from this condition?

Helf: A couple of symptoms experienced with depression are diminished interest or pleasure in activities, depressed mood, significant unintentional weight gain or loss, insomnia or sleeping too much, fatigue or loss of energy, feelings of worthlessness or excessive guilt, and diminished ability to think or concentrate, or indecisiveness. Prolonged grief symptoms are intense emotional pain, loss of identity, difficulty moving on with life, emotional numbness, feeling that life is meaningless, and intense loneliness.

Individuals should build self-awareness about the intensity and duration of their symptoms, and the impact they have on their daily lives. Tap into your thoughts. Are they pervasive? Is the loss of the game bleeding over to other areas of your life? Be purposeful with your next steps and be on the alert for destructive or non-productive patterns that may not help you (e.g., alcohol, adrenaline/thrill seeking, substance abuse, risk-taking).

What are steps someone should take if they believe they have Sports Fan Depression?

Helf:

• Make some intentional time to mourn the loss and build self-awareness of when intrusive thoughts creep in so you can shift to more productive, optimistic style thinking.
• Expand your identity – who are you outside of being a loyal, avid fan?
• Develop and maintain healthy habits – make time to move your body, prioritize healthy eating, hydration, and sleep. These habits are always crucial, but especially helpful for individuals who are struggling.
• Cultivate connections with others – reconnect with your fellow fans in a different context and develop new communities. Diversify your portfolio on interests and discover activities that generate positive emotions and engagement.
• Unplug from your fandom. Clear your head and provide an opportunity to get a little emotional distance from the season. Taking time for yourself will sow benefits for you and those around you. If the post-season funk stays around for longer than 2-4 weeks, find a professional to talk to or take a depression screen.

It’s important to understand that it is perfectly natural to have emotional highs and lows when you are so connected and invested with a specific sports team. Just because you experience some grief, sadness, or disappointment does not mean you have depression. It is typical to have reactions when any season changes and normal to reset your compass.

Perhaps consider why you watch sports in the first place. Is it the appreciation of athletic prowess? The comradery and connection with others? Pride in your town? Understanding what is most important to you can help you squeeze every ounce of enjoyment and excitement out of the game, while arming you with strategies to cultivate your wellbeing.

For more information on depression screenings and tips on wellness, please check out: The Journey to Wellness: Do I need a Depression Screening?

And remember…there is always next season!

Resources

Online screens and helplines: 

• Anxiety & Depression Association of America: (1)
• The Reach Institute (2)
• Mental Health America (16)
• Veteran’s Administration (17)
• SAMHSA National Helpline: 1-800-662-4357
• NAMI Helpline: 1-800-950-6264

This article was co-written by David Michael 

Imagine yourself arriving at an airport, getting your ticket, checking your bags, and then heading to security. What if you arrived at the security checkpoint and there was no one there? No screening, no questions or checking your tickets… On the one hand, you might be relieved, and on the other hand, you might be more concerned about your flight! Safety screening has become a regular part of our lives. The screening is brief, systematic, and designed to maintain safety for airline passengers. But what if it was optional?

The Importance of Depression Screenings

There are many optional health screenings that we know to be beneficial and yet we still try to avoid them … everything from annual exams to the blood pressure cuff machine in the pharmacy. Screenings seem to have gotten a “bad rap.” A health screen is designed to be a preliminary tool for providing information at pivotal points when interventions may be crucial.

Learning that depression is more unpredictable and widespread than once thought can produce mixed emotions that reflect on how one conceptualizes depression and its many levels and possible stigma. Depression affects everyone differently; it might surface in the life of someone who has been diagnosed or it may emerge in someone who looks like they have it all together. It is known that most people will face depressed feelings at some point in their life. Life circumstance is bound to “throw a curve ball” and offer the personal support system an opportunity to employ coping skills and reflexive responses to tough situations.

Why get screened for depression?

Here are some ‘Depression Flags’ or Indicators that combined, provide a “road map” recommendation towards further care: (2) (3)

• You have been through a series of tough events or situations and cannot seem to get back to feeling normal again.
• You cannot remember the last time that you felt happy.
• You are irritable and feel down a lot.
• Intrusive negative thinking.
• Change in appetite.
• Change in sleep patterns.
• Change in energy level or motivation.
• Lowered ability to concentrate.
• Change in daily behavior or moods.
• Increased irritability, feelings of helplessness or hopelessness.
• Lowered self-esteem.
• Thoughts about suicide or a desire to have life over with.
• Social withdrawal or isolation.
• Refusals by a child for normal activities such as social gatherings, foods, school attendance.
• For Children: A regression in skills already gained and increased need for reassurances.
• For Teens getting into trouble, concerning behavior changes, or self-harm.
• For Men: irritability, tiredness, anger
• For Women: sadness, worthlessness, guilt.

How to Get a Depression Screening

• Most medical providers or pediatricians will offer a basic depression screen when needed or requested during an office visit.
• Local mental health professionals offer screenings with an office appointment or intake process and can follow up with therapeutic interventions as needed.
• Online screens and helplines:
• Anxiety & Depression Association of America: (1)
• The Reach Institute (2)
• Mental Health America (16)
• Veteran’s Administration (17)
• SAMHSA National Helpline: 1-800-662-4357
• NAMI Helpline: 1-800-950-6264

Tips for Your Wellness Journey

Assemble a Care Team:

• Bring the Guide: A medical professional can provide a depression screening and can also screen for another underlying medical condition exhibiting symptoms of depression, as well as a discussion of the possibility of vitamins and supplement use to balance any deficiencies. A wellness coach, naturopath, chiropractor, or other medical professional can also be consulted. A good first step for support would be to check with the Employee Assistance Program (EAP) provided through your employer for available mental health services.
• Phone a Friend: Talk to a mental health provider, Chaplain, or someone you trust about your inner thoughts and feelings who will offer loving encouragement. Looking for ways to reduce isolation and increase connectedness can be an important step toward wellness.

Bounce Toward Wellness: (13)

• Discover Yourself: Journal your thoughts and feelings to help you get to the bottom of what is bothering you. You may want to discuss this with a trusted professional as old losses or traumas can accumulate and catch up to the one who feels they are well within the rear-view mirror. This can feel overwhelming or like having a lingering ‘emotional cold’ draining your resources.
• Eat Smart: Consuming quality protein and fruits and veggies improves the gut and brain’s ability to provide the neurochemicals needed for feelings of wellness. Junk food and low-nutrient foods increase feelings of depression or low mood in most people. While fast food seems easy, it is the rougher road in the long run. Hydration and taking deep breaths can help your brain have what it needs to perform and calm.
• Pump the Breaks: A daily and weekly break from stress through recreation, creativity, reading, athletics, or other restorative activities can help the body regenerate. Too much stress can produce other physical maladies and drain your emotional and physical batteries. Limiting your schedule can help you regain balance during a stressful time.
• Power Down and Reboot: To drain the body is to drain the mind. Sleep, exercise, and movement increases self-esteem and the immune system almost immediately; the lack of which can produce other urgent issues. While joining a gym might be ideal, even a minimal hour of ping-pong a week or a 10 minute walk a day can have a positive effect on mood and body. Depressed feelings often follow a weary body.
• Screen the Screens: Limit use of devices and time on social media as these influences can contribute to isolation and low self-esteem through comparison, especially at night. Melatonin, which is needed to help one sleep, is depleted with blue light used in devices and the light used can trick the brain into thinking it is time to be awake. Limiting parental screentime and finding ways for family connection through games, conversation, or activities can help kids feel less isolated and more connected providing some protection from depressed moods for all.
• Avoid the Mud: Negative thoughts get one stuck in a negative mind frame. Positive self-talk and optimistic thinking can go a long way to help reduce depressed feelings as evidence of the corresponding relationship between negative thinking and depression. Though it might feel difficult, finding something good in a situation can break up the mire to help one move in the right direction toward wellness. Follow the rule of thumb of thinking and speaking kind thoughts and words to oneself just like a good friend would do. Finding positive and meaningful ways to celebrate wins, whether big or little, can add fuel to the journey.
• Embrace Your Natural State (15): Stimulants and depressants, and other mood-altering substances (even immoderate use of alcohol, sugar, and caffeine) can be addictive, impact the gut, and worsen feelings of unwellness. Alcohol can worsen depressed feelings and interfere with sleep as it turns to sugar in the bloodstream.
• Pack the Jams: Positive or upbeat music and media can go a long way to lighten the mood and lighten thoughts; conversely sad or negative music or media should be used with caution.
• Believe: Research points to many benefits of praying and the belief that there is a purpose to life, a Higher Power and that one is loved. A return to one’s faith and values can help that purpose and meaning to be rediscovered. (13)

Benefits of a Depression Screening

Ultimately, a depression screening is not mandatory like airport security. It is brief, systematized and can be a good measure of your current state so that you can make the best decision for your wellness. At a minimum, it is designed to give you a ‘snapshot’ of your current resources and your ability to find balance. It can offer some perspective for what might be needed to manage feelings and what kind of support would be best suited to help.

The late Jimmy Buffet’s last song, “Bubbles Up” (12) written during a time of great challenge, reminds the one who is under water to follow the air bubbles as they float to the surface to help re-orient oneself and find the exit where life, air, and light reside. It is a metaphor for life when facing a challenge as negative thoughts are intimately tied to negative feelings and increase feelings of overwhelm. Focusing on the positive can be a necessary lifeline for one who feels life is dark and confusing.

A valley of depressed feelings is not the destination. Regardless of which road brought you or a loved one to it, life does not have to be lived there. With some help and support, one may find themselves on a journey to self-discovery, healing, and hope.

References and Resources:

Depression Screens:

1. https://adaa.org/understanding-anxiety/depression?gclid=EAIaIQobChMIzoWE2f3PgQMVEYvCCB2aEACeEAAYASAAEgJUKfD_BwE
2. https://thereachinstitute.org/reach-and-adaa-anxiety-in-children-and-teens/?gclid=EAIaIQobChMIzoWE2f3PgQMVEYvCCB2aEACeEAAYAiAAEgJwYfD_BwE
3. https://www.mhanational.org/national-depression-screening-day
4. https://adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-depression
5. https://www.myhealth.va.gov/mhv-portal-web/depression-screening

Other References and Resources

6. https://adaa.org/
7. https://thereachinstitute.org/
8. https://mhanational.org/
9. https://mentalhealth.va.gov
10. https://www.samhsa.gov
11. https://www.nami.org
12. https://youtu.be/6j3jDTOG7yI?si=eJQ4Qa5YHlLBcVI_
13. https://www.amenclinics.com/
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713100/
15. “The Godfather | Plot, Cast, Oscars, & Facts | Britannica”. www.britannica.com. Retrieved December 31, 2021.
16. Mental Health America. https://mhanational.org/
17. Veteran’s Administration https://www.mentalhealth.va.gov/

Although 21% of U.S. adults have a mental illness, access to behavioral healthcare remains out of reach for most. From 2008 to 2019, the number of adults with any mental illness increased nearly 30%. The pandemic further exacerbated mental health problems for adults and sparked an expanding youth mental health crisis. As the demand for behavioral healthcare continues to grow, Magellan Healthcare recognizes the need to increase access.

Increasing Access to Evidence-based Care

Magellan has collaborated with NeuroFlow, an award-winning behavioral health technology company, to increase access to our evidence-based digital cognitive behavioral therapy (DCBT) programs and enhance engagement. With a history of over 20 years of research and development and an endorsement from the Substance Abuse and Mental Health Services Administration (SAMHSA), Magellan’s DCBT programs are integral components of our Digital Emotional Wellbeing program, including FearFighter® for anxiety, panic and phobia and MoodCalmer for depression. Both programs, as well as RESTORE® for insomnia and other difficulties sleeping, are available online in Spanish, further increasing access to evidence-based programs.

Understanding Digital Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term intervention that behavioral health clinicians use to help individuals overcome negative thoughts and behaviors. CBT is effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. CBT has been demonstrated to be as effective in certain conditions as other forms of therapy or psychiatric medications. Digital CBT (DCBT) is the implementation of CBT on a digital platform with the same core principles, language and exercises used in live practice that include:

• Learning to recognize thought distortions
• Evaluating distortions against reality
• Gaining a better understanding of others’ behavior and motivations
• Using problem-solving skills
• Developing a greater confidence in one’s own abilities
• Changing behavioral patterns
• Developing coping skills

True evidence-based DCBT follows the exact CBT process, differing from evidence-informed digital programs that use some CBT practices but are not built with fidelity to the intervention model. Learn more about evidence-based vs. evidence-informed behavioral health interventions here.

Impact of FearFighter and MoodCalmer on Mental Health

Our collaboration with NeuroFlow has yielded remarkable outcomes that underscore the power of innovative partnerships. In a recent study, members participating in the Digital Emotional Wellbeing program who completed 75% or more of FearFighter and MoodCalmer reported significant reductions in anxiety and depression symptoms within 90 days.

• FearFighter users experienced a 41% average reduction in Generalized Anxiety Disorder Assessment (GAD-7) scores, compared to other DCBT users who averaged an 11% reduction in GAD-7 scores.
• MoodCalmer users experienced a 24% average reduction in Patient Health Questionnaire (PHQ-9) scores, compared to an average 13% reduction among those who completed less of the program.

Beyond these impressive results, Magellan has seen a 124% increase in registrations after launching Digital Emotional Wellbeing over previous programs. Members also report high levels of satisfaction with the Digital Emotional Wellbeing program with 85% indicating they would recommend the program to someone else.

Visit Magellanhealthcare.com/digital-bh/ to learn more about the results and how our Digital Emotional Wellbeing program, including our award-winning DCBT programs improve anxiety, depression and more.

Sources:

• Exploring Barriers to Mental Health Care in the U.S. | AAMC
• What is Cognitive Behavioral Therapy? (apa.org)
• Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected Workforce of Psychiatrists in the United States: A Population Analysis. Psychiatr Serv. 2018 Jun 1;69(6):710-713. doi: 10.1176/appi.ps.201700344. Epub 2018 Mar 15. PMID: 29540118.

FearFighter® and MoodCalmer are owned by CCBT Limited Corporation, United Kingdom. CCBT has granted Magellan exclusive rights to FearFighter® and MoodCalmer in the U.S.

If you find yourself grappling with feelings of anxiety, irritability or depression amid scorching and unrelenting heat, you’re not alone. Sweltering heat can destabilize mood, exacerbate existing mental health conditions and complicate psychiatric drug treatment. Elevated temperatures have also been linked to surges in suicide rates. Finding ways to stay cool can be a good starting point to help reduce the impact of periods of intense heat on your mental health.

Tips for Coping with Extreme Heat

Below are simple yet powerful ways to help you and others manage extreme heat and stay mentally well during periods of extreme heat.

• Stay hydrated—Adequate hydration, including restoring electrolytes, is vital for maintaining mental and physical wellbeing during heat waves. Sodium, potassium, calcium and magnesium are key electrolytes, or charged minerals. They help balance fluids, nerve-muscle functioning and hydration. Keeping them balanced is key for your overall health and bodily functions.
• Manage medications—If you take medications, consult with your provider before combining your dose with excessive heat. Some mental health medications, like lithium for bipolar patients, might not be suitable for high temperatures. Since lithium affects the kidneys and sweating can alter its levels, it’s crucial to exercise caution when exposed to heat. Adjusting the dosage or avoiding heat altogether might be necessary to ensure your wellbeing and medication effectiveness.
• Cover your head—Wearing a hat, cap or other head covering can prevent heat-related illnesses like heat exhaustion and heatstroke by helping you maintain a cooler body temperature. It can also reduce sweating which decreases the likelihood of excessive fluid loss and dehydration.
• Wet your head— Pouring water on your head offers immediate relief by absorbing heat and evaporating and cooling your skin. This helps regulate body temperature and prevent overheating. The sudden coolness also improves alertness and cognitive function in hot conditions.
• Seek shade—Exposure to direct sunlight, especially during peak heat hours, also increases the risk of heat-related illnesses. Seeking shade reduces these risks and can help you maintain a comfortable body temperature.
• Stay cool—Embracing cooling strategies like taking cold showers, using fans or placing cold compresses on pulse points helps regulate your body temperature, prevent heat-related issues and promote positive mental health despite challenging weather.
• Exercise inside—If you normally go for walks outside, move them inside a mall or other large space with air conditioning. This change protects you from the heat and offers a controlled space for physical activity, improving your mental wellbeing and keeping you cool and comfortable. If this isn’t possible, change your exercise routine to exercise in the early morning or late evening to avoid the midday heat.
• Practice mindfulness—Engaging in mindfulness exercises like deep breathing and meditation can help you manage heat-related stress and anxiety. These practices not only promote mental clarity and emotional balance but also help in reducing the psychological impact of extreme heat, allowing you to navigate through challenging conditions with a sense of calm and resilience.
• Check-in—Regularly reach out to vulnerable family members, neighbors or friends, offering support and assistance as needed. This act of care can strengthen bonds and provide a sense of purpose and connection, benefiting both your mental wellbeing and the wellbeing of those you care about.
• Visit Heat.gov—With proper planning, education and action, many of the impacts of extreme heat can be prevented or reduced. Heat.gov provides valuable guidance, including information, tools and resources to help you stay safe before, during and after a heat wave and understand the impact of extreme heat on vulnerable populations.

Remember, staying proactive and well-prepared is key to maintaining your mental health during periods of extreme heat.

For more mental health resources, visit MagellanHealthare.com/bh-resources.

Sources:

• Excessive heat and its impact on mental health | BCM
• Heat Health Awareness: Why it’s Important for Persons with Substance Use Disorders and Mental Health Conditions, Caregivers and Health Care Providers
• Heat Singes the Mind, Not Just the Body
• Psychiatry.org – Extreme Heat Can Take a Toll on Mental Health
• Understanding effects of heat on mental health – Mayo Clinic News Network

Evidence-based or evidence-informed treatment? Confused? You are not alone. Often used interchangeably, the terms “evidence-based” and “evidence-informed” in healthcare are two very different things. So, what do they really mean?

What is evidence-based treatment?

Evidence-based care is considered the gold standard in treating behavioral health conditions. Typically, “evidence-based” refers to an individual intervention that is based on quantitative research studies conducted in controlled, blinded settings and proven to be effective across a wide range of environments and people. Medications and other treatments that receive U.S. Food and Drug Administration (FDA) approval for a certain indication are also considered evidence-based.

What is evidence-informed treatment?  

 Evidence-informed care is an approach that shows promise but lacks enough proof of success to be viewed as a gold standard. Practitioners take bits and pieces from a variety of research, including evidence-based interventions and apply them to a condition. This produces something uniquely tailored to a certain need. Unlike evidence-based treatments, evidence-informed treatments don’t have results from research in controlled settings that demonstrate their effectiveness across a wide range of settings and people. When considering medication and other drug-like treatments, evidence-informed interventions have not received FDA approval for the condition they are treating. This is called “off-label” use.

Examples of evidence-based treatments

• Cognitive behavioral therapy (CBT) is a type of talk therapy that has proved effective in the treatment of anxiety, depression, addictions, phobias and certain physical health conditions. CBT focuses on changing automatic negative thoughts that can contribute to and worsen mental health and substance use symptoms. CBT has more evidence supporting it than any other psychological therapy.
• Acceptance and commitment therapy (ACT) is a type of mindful talk therapy that helps individuals stay focused on the present moment and accept thoughts and feelings without judgment. Over 200 randomized controlled trials have proven ACT is an effective treatment for depression, psychosis, chronic pain, substance use disorder, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder and social phobia.
• Dialectical behavior therapy (DBT) is a type of talk therapy based on CBT and specially adapted for people who experience emotions very intensely. Nine published randomized controlled trials and five controlled trials of DBT have proven its effectiveness for treating borderline personality disorder, including in highly suicidal women.
• Exposure and response prevention (ERP) therapy is a form of CBT that encourages individuals to engage with their obsessive thoughts without carrying out their associated compulsions. Treatment begins with placing individuals in situations which cause a tolerable level of anxiety and gradually build up to settings they find more difficult. ERP has been proven effective for treating obsessive-compulsive disorder in numerous clinical trials.
• Eye movement desensitization and reprocessing (EMDR) therapy is a mental health treatment technique that involves moving your eyes a specific way while you process traumatic memories. The goal of EMDR is to help individuals heal from trauma or other distressing life experiences. Since the first EMDR clinical trial in 1989, dozens of other clinical trials have proven this technique is effective and faster for the treatment of post-traumatic stress disorder.
• Transcranial magnetic stimulation (TMS) is a noninvasive treatment that was first used to treat depression in individuals who were nonresponsive to other treatments. TMS involves using a magnetic coil to influence the brain’s natural electrical activity and has full FDA approval for the treatment of major depressive disorder, obsessive-compulsive disorder, migraines and smoking cessation.
• Esketamine is an FDA-approved nasal spray used to treat severe treatment-resistant depression. Esketamine was found effective in a phase 3, double-blind, active-controlled study conducted at 39 outpatient centers from August 2015 to June 2017. The study involved nearly 200 adults with moderate to severe depression and a history of not responding to at least two antidepressants.
• Fluoextine is an antidepressant medication that is approved by the FDA to treat depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. It belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs) and works by increasing the activity of serotonin in the brain. Data based on a group of 9,087 patients who were included in 87 different randomized clinical trials confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy.

 Examples of evidence-informed treatments   

Response Disequilibrium Therapy (RDx)—Based on the response disequilibrium model, RDx puts patients in charge of implementing their own treatment procedure outside of therapy sessions in the same environments that trigger their symptoms so they can learn new behaviors to replace and control their previous responses to distressing situations.

While preliminary findings from case studies involving 19 participants with OCD suggest RDx may be a promising alternative to traditional OCD treatments, future research is needed to determine its effectiveness across a wide range of settings, people and problems to classify it as an evidence-based intervention.

• Pregabalin (an FDA-approved anticonvulsant medication and fibromyalgia treatment) has been used off-label to treat generalized anxiety disorder, social anxiety disorder, bipolar disorder, insomnia and chronic pain conditions other than fibromyalgia. For pregabalin to be used for these conditions in an evidence-based manner, the FDA would have to approve their use for each specific condition.
• Risperidone (an atypical antipsychotic medication approved by the FDA for the treatment of schizophrenia, bipolar disorder and autism-associated irritability) has been used in a variety of off-label ways, including to treat borderline personality disorder, post-traumatic stress disorder (PTSD) and bipolar disorder. To date, the FDA has not approved risperidone to treat these three conditions.

Are mental health and wellness apps evidence-based or evidence-informed?

These days, you can’t browse the web or use most apps on your phone without seeing an ad for a wellbeing or therapy program or app. Used alone or to supplement traditional treatment and promote wellbeing, not all mental health, substance use and wellbeing apps use evidence-based practices, nor have they been extensively researched in treating specific conditions. Wellbeing and therapy apps are typically considered:

• Evidence-based when evidence-based interventions are fully implemented on the platform and followed by users in the same manner they would be if they were being delivered during face-to-face treatment. For example, the original evidence-based model below is used in a wellbeing app that delivers CBT digitally and all steps are followed as listed.
  1. Identify troubling situations or conditions in your life.
  2. Become aware of your thoughts, emotions and beliefs about these problems.
  3. Identify negative or inaccurate thinking.
  4. Reshape negative or inaccurate thinking.
• Evidence-informed when only certain components of evidence-based interventions are implemented on the platform, and/or the app only fully implements or uses components of evidence-informed interventions. For instance, if a wellbeing app provides CBT and only asks users to identify troubling thoughts and become aware of their thoughts, emotions and beliefs about these problems, it is evidence-informed because it does not ask users to identify and reshape negative or inaccurate thinking.

When considering using an app for yourself, your patients, your employees or your members, ask yourself these questions:

• Are the treatments used in the app based on quantitative research?
  • Were the studies conducted in controlled, blinded settings?
  • Are the treatments proven to be effective across a wide range of environments and people?
• Are all treatment steps included in the process, or has the process been watered down?
• Have the treatments used in the app received FDA approval for a certain indication, if FDA approval is possible?

Magellan’s approach to evidence-based versus evidence-informed treatments and mental health, wellbeing and substance use apps

The American Psychiatric Association and the American Psychological Association both consider evidence-based interventions preferred approaches for the treatment of psychological conditions.

At Magellan, we are leading the way in providing innovative, impactful behavioral healthcare solutions. When developing new and enhancing existing offerings , like our digital cognitive behavioral therapy (DCBT) programs, we always start with evidence-based treatments and adhere fully to all tenets. Magellan Healthcare’s DCBTs have been heavily researched in the studies below:

• FearFighter® for anxiety, panic and phobia (now available online in Spanish)
  • Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directions. L. Gega, I. Marks, D. Mataix-Cols. Journal of Clinical Psychology: In Session (2004), Vol. 60 (2), 147-157.
  • Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: Randomized controlled trial with pre-registration nursing students. L. Gega, I.J. Norman and I.M. Marks. International Journal of Nursing Studies 44 (2007) 397-405.
  • The feasibility and effectiveness of computer-guided (CBT) (FearFighter) in a rural area. L. Hayward, A.D. MacGregor, D.F. Peck, P. Wilkes. Behavioural and Cognitive Psychotherapy (2007) 35, 409-419.
• MoodCalmer for depression (now available online in Spanish)
  • Saving clinician’s time by delegating routine aspects of therapy to a computer: A randomized controlled trial in phobia/panic. I.M. Marks, M. Kenwright, M. McDonough, M. Whitaker and D. Mataix-Cols (2004).
  • Technology-based advances in the management of depression: Focus on the COPE program. Disease Management and Health Outcomes. J.H. Greist, D.J. Osgood-Hynes, L. Baer and I.M. Marks (2000) 7, 4.
• RESTORE® for insomnia and other sleep difficulties (now available online in Spanish)
  • Implementing computer-based psychotherapy among veterans in outpatient treatment for substance use disorders. E.D.A. Hermes and R.A. Rosenheck. Psychiatric Services 67:2, February 2016, 176-183.
  • Cognitive behavioral therapy for insomnia enhances depression outcomes in patients with comorbid major depressive disorder and insomnia. R. Manber, J.D. Edinger, J.L. Gress, M.G. San Pedro-Salcedo, T.F. Kuo, T. Kalista. SLEEP, Vol. 31, No. 4, 2008, 489-495.
  • Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. N. Vincent and S. Lewycky. SLEEP, Vol. 32, No. 6, 2009, 807-815.
  • Sleep locus of control and computerized cognitive-behavioral therapy (cCBT). N. Vincent, K. Walsh, and S. Lewycky. Behaviour Research and Therapy, 48 (2010), 779-783.
• SHADE for substance use disorder
  • Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: Short-term outcome. A.L. Baker, D.J. Kavanagh, F.J. Kay-Lambkin, S.A. Hunt, T.J. Lewin, V.J. Carr and J. Connolly. Addiction, 105, (2009) 87-99.
  • Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: A randomised controlled trial. F.J. Kay-Lambkin, A.L. Baker, B. Kelly and T.J. Lewin. Medical Journal Australia, 195, 3, 1 August 2011.
  • Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. F.J. Kay-Lambkin, A.L. Baker, T.J. Lewin and V.J. Carr. Addiction, 104, 278-388 (2009).
• ComfortAble® for chronic pain
  • Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. D.M. Ehde, T.M. Dillworth and J.A. Turner. American Psychologist (2014), Vol. 69, No. 2, 153-166.

We further validate this research with outcomes from practical application of our solutions. By doing this, we ensure our clients and members receive only high-quality products and services that work in the real world—where it really matters.

SOURCES:

• ACT is an Empirically-Supported Therapy: Background and Clinical Evidence
• Act Theory: Acceptance and Commitment Therapy Explained
• CBT Explained: An Overview & Summary of CBT
• Dialectical Behavior Therapy
• EDMR Therapy
• Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives – PMC
• The Evidence for Cognitive Behavioural Therapy in any Condition, Population or Context: A Meta-review of Systematic Reviews and Panoramic Meta-analysis
• Fluoxetine: a review on evidence-based medicine
• National Library of Medicine: Pregabalin
• National Library of Medicine: Risperidone
• New Therapy Shows Promise for Swift Treatment of Obsessive Compulsive Disorder – Association for Psychological Science – APS
• Psychiatry.org – Study Supports Effectiveness of New Fast-Acting Antidepressant, Esketamine Nasal Spray
• Transcranial Magnetic Stimulation
• VR therapy for OCD Can Enhance the Delivery of Exposure Response Prevention
• What is Evidence-Based Therapy: 3 EBT Interventions

Discussions about mental health in the Black community shouldn’t be limited to Black History Month in February and BIPOC Mental Health Awareness Month in July. The conversations and action steps geared toward providing education, support, and resources require a year-round effort.

A recent article published by the Kaiser Family Foundation, shares that although Black people have made great contributions and achievements in the United States, “they continue to face many health disparities that adversely impact their overall health and well-being,” which have been “exacerbated by impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people.”

What impact do these factors have on the mental health of individuals in the BIPOC community? Magellan’s medical director Rakel Beall-Wilkins, M.D., MPH shares her perspectives on depression and suggestions on ways to be supportive.

What is depression and what are some signs or symptoms?

Dr. Beall-Wilkins: Depression is a clinical illness characterized by:

• Prolonged periods of low or sad mood.
• Loss of interest or pleasure in activities.
• Changes in appetite, sleep or energy levels.
• Feelings of worthlessness or hopelessness.
• Thoughts of death or suicide.

Depression can be caused by medical illness, substance abuse, and stressful social, academic, or occupational situations, but it can also develop more readily in individuals who have a family history of depression or other mental health conditions.

Other signs of depression may include:

• Withdrawing from social activities, relationships, or hobbies.
• Escalating drug or alcohol use.
• Declining self-care in the form of poor personal hygiene and grooming.
• Expressing feelings of hopelessness, worthlessness, and/or helplessness.
• Neglecting to attend to chronic medical conditions or maintain follow-up with healthcare providers.

How does depression impact individuals in the Black community?

Dr. Beall-Wilkins: As of 2020, the National Survey on Drug Use and Health found that 6% of Black American adults and 12.9% of Black American adolescents experienced a major depressive episode within the last year. Despite increasing levels of depression within the Black community, studies also show that Black Americans are less likely than their White counterparts to receive psychotherapy or medications for their depressive symptoms. This disparity is largely attributed to limited access to healthcare coverage and culturally competent behavioral health providers, as well as pervasive cultural stigma.

Is it possible for someone to experience depression that is triggered by external factors and societal issues, such as violence, police brutality, political unrest, and racism? If so, how?

Dr. Beall-Wilkins: Yes, it is possible for depression to develop as a result of exposure to sociopolitical strife. In fact, during the week following the highly publicized death of George Floyd in May 2020, rates of depression and anxiety spiked from 36 to 41% among Black American respondents to the Census Bureau’s 2020 Household Pulse Survey.

Likewise, a 2018 study published in The Lancet found that police killings of unarmed Black Americans resulted in an increase in poor mental health days among Black American respondents. Though they may not know the victims of these circumstances personally, it is very common for Black Americans to collectively internalize the trauma of these events and feel despair over the possibility that a similar fate could befall them or their close family members and friends. Moreover, the repeated nature of these events can elicit sadness, hopelessness, and fear that things will never change.

What are tips for an individual that recognizes they are showing signs of depression?

Dr. Beall-Wilkins:

• Visit your doctor and seek treatment: Regularly follow up with a primary care provider to ensure there are no untreated or undertreated medical conditions that may contribute to the development or worsening of depressive symptoms.
• Stay connected: Stay connected to close friends, family, and spiritual community for support.
• Diet and exercise play a role: Eat a balanced diet and engage in physical activity for at least 30 minutes a day, three times per week.

Resources:

• National Alliance on Mental Illness’s (NAMI) cultural dimensions website for BIPOC/AAPI communities.
• DSM-5 (American Psychiatric Publishing, Copyright 2013 (American Psychiatric Association) 
• Stanford University 
• Anxiety and Depression Association of America