Ian Bolland asked Daniel Mansson, clinical psychologist and co-founder of Flow Neuroscience, and Farina Schurzfeld co-founder of digital mental health player Selfapy for their thoughts on how to keep mentally well during the Coronavirus pandemic, and how technology can be of use.

Ian also highlights an app that is freely available through the NHS, developed with the aim of helping the user manage their mental health.  

What effects can self-isolation have on mental health?

DM: We are all different and some people might even enjoy finally being able to stay at home and read/play video games, or whatever interest you might have. But, in general, self-isolation is difficult for many people, primarily because you cannot meet your co-workers, friends and even family. People that you know and like often have a reassuring and calming effect on you, and in a crisis like this it is not possible to get this other than on the phone or online. Anxiety and stress may rise in some people. 

FS: Self-Isolation can affect our mental health in several ways. Every human needs social interaction to a certain extent. With self-isolation, many people, especially those who are living in a single household, will have little to no opportunities to meet other people in person. This could lead to feelings of loneliness, negative emotions and anxiety. Often feeling “alone” and feeling “lonely” feel the same way and thus are associated with negative emotions.

What would you recommend for people who have to stay indoors during the coronavirus pandemic do in order to stay mentally healthy?

FS: Staying mentally healthy can be a challenge during that pandemic. People should follow three tips in order to avoid examples of feelings of stress and mental burden.

1. Keep your daily routines. Get up before 10am, have a coffee and start the day on time. Make time for lunch, work and whatever else needs to be done.
2. Stay active and build in exercise into those routines. Even a walk around the block (on your own!) or a little yoga session can do its magic and release some endorphins to keep you in check.
3. Be mindful with your news consumption. Don’t spend hours consuming media about COVID-19 but pick one scientifically reliable source and browse it once or twice a day as too much media consumption can fuel feelings of anxiety. 

DM: One effective way to keep anxiety and stress manageable is to give the brain the best possible ability to handle a stress response. We know from several larger studies that you can do this by having a routine of exercise, eating nutritious food and having a stable sleeping pattern.

• Eat nutritiously: Traditional Mediterranean food, sometimes referred to as the ‘anti-depression diet’, for its anti-oxidant and anti-inflammatory properties, includes whole grains, vegetables (particularly green leaves), fruit, berries, nuts (including almonds), seeds and olive oil. The Flow app can offer you a comprehensive understanding on how to eat in order to reduce depression.
• Exercise: With possibly months of the coronavirus pandemic ahead, it is important to keep exercising. Clinical studies show that regular exercise produces chemicals, such as dopamine and serotonin, which are as effective as antidepressant medication or psychotherapy for treating milder depression. Most people will not have access to a gym during the crisis, so it is important to create a daily exercise routine at home. Experts recommend between 30–40 minutes of exercise, three to four times a week to work up a sweat. People with depression often struggle with exercise, so start small with a 10-minute walk, then add a few minutes daily.
• Sleep: 90% of depressed people struggle with sleep, which is likely to increase with fears over coronavirus. Good quality sleep is a form of overnight therapy, and increases the chance of handling strong emotions. Try to wake up and go to bed at the same time every day. Achieving eight hours of sleep, taking a hot bath, setting the bedroom temperature to 18 degrees and having no screen time two hours before bedtime will also help.

Do conventional techniques such as CBT help people during this time?

DM: Yes, it can. CBT is a therapy form used for many sorts of problems and is very good for breaking down the problem into pieces and making sure that you have an adequate response to them. CBT is available through therapists and psychologists, both online and offline. 

Some people might feel that talking about their depression and anxiety requires no additional attention during these unprecedented times. People should be encouraged to talk about their feelings. Various support helplines are available, including the Samaritans, as well as mental health crisis services, details of which can be found via the mental health charity Mind.

FS: Yes, they can be helpful, since CBT is all about changing one’s behaviour in the NOW. There are many techniques one can use in order to work on their (negative) thought patterns and CBT provides a number of resource building techniques to strengthen the mental health during this pandemic. It also helps to keep a daily structure and deal with negative emotions. 

How can technology help?

FS: We can use technology in order to keep in touch with our family and friends despite the current situation. We can make video calls, text each other in order to keep up our social lives. Another way technology works to our advantage is that we can use it as mental support tools to help us keep a strong mind and fight feelings of stress and anxiety.

DM: Our technological progress is a great help in a crisis like this. The advancement in telehealth means that we can contact a doctor or a psychologist online and get advice on what to do without leaving the apartment. One example of a service that psychologists offer online is MyOnlineTherapy or Livi. 

There are also several apps that could help if you are struggling with anxiety or depression such as the Flow - Depression app.  The Flow app, free to download on iOS and Android, can help people to improve their nutrition and reduce the risk of depression at home.

If you are suffering from severe depression you should see a doctor and get appropriate treatment.  

What can your company do for people who are struggling at this time?

DM: Flow Neuroscience has developed an at home treatment for depression that has roughly the same effect as antidepressants but is medication-free and comes with fewer and less severe side effects than the medication. 

The treatment comprises a brain stimulation headset and a therapy app and is the only one in the EU to be medically approved as a home treatment for depression. The headset uses tDCS, a type of brain stimulation which is now listed as a treatment for depression on the NHS website. Clinical studies published in the New England Journal of Medicine and the British Journal of Psychiatry showed that the type of tDCS brain stimulation used in the Flow headset had a similar impact to antidepressants. 

FS: During these times in which social distancing and self-isolation are advised, Selfapy has developed a free online program for all German speaking people who are mentally affected by the Corona Crisis. Our users can learn techniques on how to structure their day, deal with negative emotions and anxiety. We believe it is important during those days to support each other and be there for the people who are in need for mental support.

NHS availability

Aside from Flow and Selfapy, there are other examples of digital health and medtech solutions that are available to the public.

One such solution is a free NHS app called Thrive which has been made available to everyone to use and can be downloaded through the service’s app library. It uses tools to track the user’s mood and teaches methods to take control of stress, anxiety and mental health related conditions.

Dr Andres Fonseca, CEO and co-founder of Thrive, said: “We are committed to supporting as many people as we can and given the current epidemic, we want to remind everyone, from all walks of life, that confidential and effective support is there. Regardless of your occupation you have access to our service to improve your resilience and mental wellbeing. 

“We hope our NHS frontline staff, our teachers, police officers, firefighters, carers and anyone struggling to cope in these uncertain times will find our app useful. Everyone deserves the right to effective mental health support for a healthy mind.”