Stigma stories.

With the popular mood-tracking app Stigma debuting a new Tinder-like interface for matching users to like-minded penpals, is peer counselling the way to go for an ailing mental health system?

By Elizabeth Han


A photo by Aidan Meyer. unsplash.com/photos/Q9GlzfhYgGk

Last year, while finishing up my final semester of medical school, I logged into an app and rated my mood, adding an optional tweet-length blurb, for 100+ straight days. Blurbs were mined to form a set of word clouds, with more frequent words displayed in larger fonts. The candy-coloured ROYGBIV of mood descriptors, supplied by the app, ranged from a brick-red “Angry”, to a seafoam “Calm”, to an obnoxious “Happy” as bright as the skin of a lemon.

I tried to log in as often as possible, setting up automatic diurnal notifications to remind me if I forgot, wanting to supply enough data to render the word cloud and heat map of moods, which at that time I saw as the most compelling features of the app, more accurate. It was to be the first of my two personal forays into the Wild West of emotion-tracking for the digital age. The first, a clumsy search to replace the unwieldy blogs and Livejournals of yore, which had dutifully played host to angsty entries riddled with song lyrics and suicide threats, but had fallen to Facebook once I entered college. And the second stretching for that sense of connection — the friend’s voice, the transference-countertransference dance of the therapist’s office — missing from a lonely post-grad landscape.

In March of 2015, during foray #1, the app, better known as Stigma, a free, stand-alone effort available on iPhone and Android, the invention of Canadian Dan Seider, had yet to introduce its Penpal feature, the simple Tinder-like matching algorithm that mediates a conversation between two semi-anonymous users. But it had already captured my attention. There were many other mood-logging apps populating the tech space by 2015; another that I had recently reviewed, Pacifica, arguably had a more elegant UI and more sophisticated features based on cognitive behavioural therapy. But there was a friendliness to Stigma, in the form of its community feature — a quick swipe showed who else was feeling “overwhelmed” and I could send them a heart — finally, that won me over. I had received a heart. I felt validated.

Getting that kind of peer support right remains one of key challenges of making a mental health mobile app that sticks versus one that gets abandoned after a few weeks. That word, again — validation — underpins the center of it, the idea that your reality is acknowledged by someone else — a sort of “I’m right there with you, buddy” — whether they agree with you or not. I quickly found that, despite the lack of nuance of a heart, I was repeatedly logging in just to check if my mood entry had earned one from one of Stigma’s thousands of other users in pain (and by the same token, I felt reassured that any heart I delivered would make a non-negligible impact).

Getting that kind of peer support right remains one of key challenges of making a mental health mobile app that sticks versus one that gets abandoned after a few weeks.

I stuck with Stigma for nearly four months, a lot longer than I would have if I had been simply rambling into the void. Abandonment rates are notoriously high for apps designed without an easy way for new users to get feedback, not only in mental health, but when you think of our most celebrated social media juggernauts. Imagine Instagram without hearts, Facebook without likes, Reddit without karma, Tumblr without reblogs. The success of Twitter as a whole notwithstanding, I tremble to think of the many orphaned Twitter accounts, their user pictures still set to the default unhatched egg, their tweets unending variations of “eating pot noodles”, “watching Netflix”, and inevitably “i don’t understand Twitter,” because nobody followed and nobody seemed to care.

Still, it’s uncouth to think of reducing a mental health community to a popularity contest, as has come to be the norm in those more general social networks, even if the design insights afforded are helpful. Keeping the hearts anonymous with no standing tally, as Stigma still does now, eleven months since I first used the app, is one way to rein in grandstanding, bullying, and abuse. You get that little hit of dopamine that comes from receiving the notification of a heart, feel validated, and then hopefully move on with your day, which, as a bonus, is consistent with the mindfulness approach that is getting lots of traction in psychiatry.

For a while — and I did mention this in an IM to Mr. Seider — I imagined that adding the ability to comment on individual statuses would be the next logical step for the Stigma. This is the model we have come to expect from years of reading message boards and Facebook statuses. But I have since come to the conclusion that that would not make me feel more supported. What if the comments devolved into the venomous shouting match that anyone who has scrolled to the comments section below any — and I mean, any — vaguely political video on YouTube is used to? I struggled with that question over my time with the app, thinking of the profound vulnerability and sensitivity of many individuals with mental health issues, without any success. And meanwhile, life events, as they do, caused me to drift away from the effort of mood-tracking in general.

It would be October, almost six months later, before I redownloaded both Pacifica and Stigma to give this thing another go. I found both changed; Pacifica, irritatingly, had corralled most of its best features behind an ironclad paywall, but I still enjoyed its deep-breathing module, so I kept it around. Stigma, on the other hand, remained free. Its biggest alterations were to its UI, now more streamlined, and a new feature called Penpals. The latter, holding enough navigation-bar real-estate to signal its intention as a major feature, stopped me in my tracks; I quickly wrote a little bio, the photo-less, name-less calling-card that would be displayed to other users to accept or pass on, keeping it simple. Canadian girl, likes: sushi, dogs, and tech.

Bringing the conversation from a public forum, as would have been the case with comment threads, to a private conversation between two people, represents a clever and unexpected solution on the part of Stigma’s development team, to several different problems. While a heart is still a heart, with a novelty that eventually wears off, free text unlocks the limitations. The rational concern of whether hearts would be increasingly difficult to come by as the userbase increased is also addressed; the first iteration had two privacy modes for each mood entry — it could stay private or appear to the entire community on the front page, to be displaced by more recent updates. Now each entry can be shown exclusively to one’s penpals. The maximum number of penpals caps off at six — a pop up message informs me that such a policy is intended to foster more meaningful, long-term connections, and ensures that, unlike tinder, your matches won’t be bumped off by the newest, shiniest thing. These are individuals who have ostensibly invested in a mutually supportive relationship.

The maximum number of penpals caps off at six — a pop up message informs me that such a policy is intended to foster more meaningful, long-term connections, and ensures that, unlike tinder, your matches won’t be bumped off by the newest, shiniest thing.

Within an hour I had my first match, and I began chatting. As with Tinder, users cannot speak to each other unless both parties approve the match. The match, as far as I can tell, predicates on how often you’d like to speak, whether you’re more of a talker or a listener, and hashtags you can add to your bio. Anonymity is preserved by assigning random handles based on a combination of a color and a noun: I found out from one of my partners that mine was Nurturing Tiger, an oxymoron perhaps, but more than sufficient for the purposes of the app.

Penpals isn’t the first effort from the Silicon Valley set at tackling the human side of mental health using the age of tech. People seeking a nonjudgemental ear of a stranger have a long history of livejournaling, chatrooming, and hanging out on Reddit. But like most parts of the health care system, in the real world, mental health is a problem that is still being tackled with 1970s era technology, and hour upon hour of waits, that lead to a discharge and maybe a referral to a social worker in a week, essentially, to see if you are “still” in crisis.

I know those who would balk, on principle, at the idea of non-professionals attempting to counsel each other over the internet. But this is a space that is ripe for disruption. Over one million people called into the National Suicide Prevention Hotline in 2013 (Source: TIME), a number expected to increase by 15% each year, many with active suicidal ideation, many who are children and teens. The average wait time for community Dialectical Behavioural Therapy (a leading form of talk therapy, especially effective for suicidality and borderline personality disorder) in a major city like Toronto is at least an entire year. Psychiatric emergency rooms, bare-boned, facing a cataclysm of staffing, serve mostly as great bullshit detectors — to sniff out imminent risk and to send everybody else home to be counselled by their beleaguered families. Make no mistake, an epidemic of mental illness wages war over the population, who might as well be armed with shovels and blunt forks, an aggressive scourge with a need for aggressive tactics in return.

Make no mistake, an epidemic of mental illness wages war over the population, who might as well be armed with shovels and blunt forks, an aggressive scourge with a need for aggressive tactics in return.

The greatest limiting factor may well be the lack of mental health providers to match with patients. Ask anyone who has tried their campus mental health service and they will tell you that it is almost impossible to find the appropriate click and rapport between therapist and client. After a long slog of failed encounters, such a match is a luxury for which many cannot dare to hope. Apps like Stigma posit a different approach, that peer supports step in to shore up the fort, not as a stopgap, but as a parallel stream of support in its own right. The idea is to foster an epidemic of empathy, of a kindness contagion. They are finally asking the question: Could Penpals resurrect the space of peer support where others have tried and failed? How should this space be designed? Are we ready for such a thing?

Comparing Antidepressants Using Iodine

Finding an antidepressant is a slog to say the least.

As the famous STAR*D trial discovered, the first antidepressant a patient tries has about a 1 in 3 chance of causing remission of depressed mood. And while the odds of getting better if you try multiple antidepressants are good; overall, with each successive failed drug, the likelihood of the next being the magic pill diminishes.

When you are diagnosed with depression, the starting choice of drug that your doctor makes will be informed by a combination of published guidelines, the type of mood disorder you have, what’s worked for you or a family member in the past, the desired side effect profile, and a host of other factors. For example, in Canada, where I live, some front-line meds for uncomplicated depression are sertraline (Zoloft), venlafaxine (Effexor), and escitalopram (Cipralex). A perfectly reasonable first prescription, therefore, for someone without other limiting factors, might be sertraline 50 mg once daily for a month.

A good doctor will ask you for your input on medications to try because only you know what is most concerning to you — maybe your mother had a horrible time tapering off from venlafaxine (avoid venlafaxine to start!), or you’d like a med that helps with your mood in addition to reducing cigarette cravings (try buproprion).

Your preferences will carry even more importance if the first one or two drugs fail. You may research a possibility that your physician had not initially considered.

But finding a foothold in all the information out there, especially on the internet, is a daunting task.

Iodine is a simple, aesthetic way to view antidepressant information online.

I was pleased to discover, today, a beautiful way to view antidepressant information in the form of a comparisons table, on the emerging website Iodine.

To get a sense of how it worked, I typed “antidepressant” in the search box and navigated to the entry on fluoxetine (Prozac). Clicking on the box labelled “Alternatives” on the horizontal navigation bar led to a wealth of data in the form of side by side comparisons with other popular antidepressants.

I immediately started getting giddy visions of introducing the table to patients to, for example, explain the difference between Prozac, which is often used with kids and adolescents, and duloxetine (Cymbalta), which has a component that treats nerve pain, such as that associated with Shingles, in addition to mood symptoms.

Even though the page overall could possibly do with some paring down — do I really need to know the top 10 most common side effects, as opposed to the top 3? — there is some fantastic stuff here. I love that there is cost information from popular shopping destinations; special blurbs on the effects of the drug on sex, sleep, and weight; and a clear evidence-based grade regarding safety in pregnancy.

The company is founded by Thomas Goetz, the former executive editor of WiRED magazine, who spearheads a team of health professionals and entrepreneurs at Iodine, many of whom worked previously on health apps at Google. Powering the site is survey data collected from real patients (via Google Consumer Surveys) and databases from a number of other health sites around the web.

Iodine uses ratings and reviews from real patients.

The voices of the people who answered those surveys are represented clearly on the site, via the Reviews & Ratings section. Their soundbites appear in tweet-like bubbles down the right-hand column, while a clean and simple graphical representation on the left helps you compare whether patients thought a drug was “worth it” across sex and age groups.

A few years ago, I remember a site called PatientsLikeMe (apparently it’s still around!) that pursued a similar tack of harnessing the power of online patient surveys — I used it to decide that pregabalin (Lyrica) was the next drug I would ask for to treat my fibromyalgia — only for it to lose momentum, and I never really figured out what happened to the data that was collected.

So I will be keeping an eye on Iodine’s work with great interest. With so many people on psychotropic medications in the modern world, it makes sense to draw on our collective experiences, both positive and negative, to inform future choices and the development of further generations of medications.

Further reading:

What’s So Bad About Ourselves?: The Creeping Spectre of Mindfulness


“When you don’t feel yourself, time flies by; when you do feel yourself (in the shopping queue, any waiting situation) time drags. That’s why people, even when they have to wait only for two minutes at Starbucks, check their smart phone. They want to get distracted from themselves and time.

Boredom means ‘I am bored by my own existence, therefore I seek distraction from myself.’”

“Entertain Yourself” by Stuart Whatley in L.A. Review of Books

It’s me. I’m the problem.

I have to admit that I have a bad habit: I read when I walk.

My work is a fifteen minute walk on a bad day from my apartment, but I despise making the commute without a book. My partner, who is originally from France, where life moves at a decidedly slower pace, and usually much more focussed on the slow pleasures of food, leisure, and beautiful things, thinks I am crazy. When I live in a picturesque little neighbourhood, on one side bordered by a university, the other abutting sprawling trees and the Northwest Arm only a stone’s throw away, how could I possibly close myself off from it?

Plus the risk of getting run over by a car. Or something. (It’s actually pretty major coming from him; he’s a voracious reader, as well.)

And… Well. It’s because I can’t stand it, only until I read the above quote, I didn’t really know what I couldn’t stand, not having the right word for it.

I don’t like feeling myself.

The difference between “myself” and “like myself”

Let me be clear that that’s “myself” and not “like myself”. I am talking about being conscious of my consciousness, aware of my awareness, feeling my boredom, feeling my body instead of the lake of information it sits in.

If that sounds a lot like mindfulness, it probably explains why mindfulness does not easily gain traction among the very subpopulation who would most benefit from a few body scans.

Nope, I downloaded the Longform app six months ago so that, at the touch of a button, I can now feel any of a universe of information in lieu of myself, including, but not limited to: why Chelsea Clinton will be stuck being first daughter again, analysis after analysis of Brexit, and something about potatoes. In fact the article that the quote was lifted from was digested while on just such a crusade against mindfulness.

It is hard work to be mindful, is what I’m trying to say. I combat it daily.

However, the key, I think, is not to beat one’s self up about these “bad” habits. The inability to practice mindfulness is probably endemic to the human condition; it’s certainly not helped either by the type of world we live in now, permanently crippled by social media’s demand of more, more, more tweets, emails, thoughts that don’t flow.

I remind myself that it’s enough just to try, as a start.

So I try to allow myself a mindful moment each day. The setting is always different. Two days ago, I whipped out the Pacifica app tuned to the famous deep breathing exercise, whilst parked under a tree in the Halifax Public Garden. Yesterday, I took a moment to notice the feeling of water as I squeezed in a workout at the local pool. And today I sunned myself for exactly ten minutes on a patio at work over lunchtime, relishing the dumpling clouds in a rare blue sky.

And yeah, so what if I listened to Last Week Tonight with John Oliver in the shower, every time I shower, because I can’t stand not thinking about anything in the shower, hashtag #noregrets!

What Living Copefully Means.


I actually named this blog Copefully because when registering domain names Copeful.com was taken and general wisdom says even a few extra letters make a difference in the catchiness of a name. But in the style of Massive Attack’s “Teardrop”, which preaches, “love is a doing verb”, I’d posit that living copefully is a smidge better than a copeful life.

It’s living first and foremost, and it’s a doing thing, not a destination.

When I think of people living their lives copefully, I think of all the things that people who are not suffering from mental health issues take for granted. Is there really such thing as a simple quotidian task?

I think about my friends and family and patients who try to show up to their psychiatrist appointments despite soul-crushing malaise, screw up the courage to ask for a switch in medication in case the next one makes a difference. Who push themselves to eat breakfast, who know that wearing a clean shirt can help even if it’s the last thing they want to do, who play Candy Crush or refresh Tumblr for hours to keep anxiety and suicidal thoughts at bay.

They went to the bathroom to pee instead of holding it in for an hour because of anxiety.

From the dictionary definition coping seems to imply more stemming the bleeding than fighting back, but I don’t think that’s fair at all. Coping is taking a step, any step, even sideways, sometimes two steps back. Coping is telling is someone.

Coping is sometimes waiting because your psychiatrist told you that all feelings are just feelings and all feelings must pass. And you just need to find out if that’s true.

A Month With Stigma: Microjournalling Into Defusion



Cognitive defusion is a technique in Acceptance and Commitment Therapy that works to create distance between ourselves and our thoughts. Unhooking from the stories we tell ourselves about ourselves. Escaping from the quicksand. Once that occurs, we may more easily take action in a valued direction.

Journaling as awareness.

There are hundreds of defusion exercises, but one of the simplest ways to attain distance from thoughts is simply to write them down. You might have kept a traditional journal when you were a kid or teenager. While a great way to keep in touch with your daily activities and develop writing skills, traditional journals can be too detailed, too ruminative, hooking yourself more on the thoughts.

Instead, what if you tried micro-journalling? That is, check in with a Tweet-length entry, something short but including the pertinent details. Then let it float away like a leaf on a stream, the stream itself being your point of focus, the bank or bridge on which you stand providing a platform for your next action.

A month with Stigma.

I’ve been using the app Stigma http://www.getstigma.com/ (App store, $0) for a few months to micro journal and I wanted to share how it works with you all.

Stigma was created by a Canadian, Dan Seider, who, in his second year of university, was diagnosed with bipolar disorder.

The idea is simple: the app will remind you to at various points throughout the day to make a journal entry. Only 140 characters long maximum, the entries are meant to distill only the basics of how you’re feeling.



Who, what, when, where? — the app prompts you. Attached to each entry is a single-word mood descriptor (e.g., calm, overwhelmed, accomplished).

This gets a little closer to what psychiatrist Dr. John Torous and colleagues call “Ecological Momentary Assessment” (EMA), where reports on your mental health are completed at random times of the day to capture a patient’s state in their natural setting.

It’s a step up from filling in long tedious questionnaires at your doctor’s office, or trying to remember how you felt a week ago.

From an acceptance and commitment therapy perspective, micro journaling also provides the opportunity to develop awareness of “the thinking self”, the part of you that makes judgements and fills your head with words and pictures. As opposed to “the observing self”, the part of you that notices those judgements, touches them lightly but is capable of letting them float on by.



Getting the most out of Stigma.

Aside from creating and saving the journal entries, Stigma provides a way to step back and look at the gestalt of your mental health through word clouds. Generated automatically from your microentries, the clouds display the most oft-used words in corresponding font sizes.

Stigma can create a word cloud for negative emotions and positive emotions. You can also click on a particular word and explode a new word cloud based off of that word.

For example, I noticed that in my own negative word cloud, “tired” showed up the most — I wasn’t exactly anxious or worried the majority of the time — it was fatigue that developed into those things.

Stigma features an anonymous, built-in community.

I remember in the heyday of online journalling, a major motivator for checking in was the vibrant communities centered around Livejournal, MySpace, Xanga, and their ilk. You wanted to see that your friends were listening. They were checking in too. In recent years Facebook, Twitter, and Tumblr have become ascendant technologies, and generated their own built-in communities via liking and reblogging.

Similarly, Stigma attempts to make the user feel “heard” by grouping entries based on emotion. When a user finishes making an entry under a certain emotion, say Anger, he or she is shown other recent entries tagged with that emotion. A simple heart beside each entry, analogous to a “like”, permits an acknowledgement.

You never find out who exactly gave your entry a heart, or why, but it can be something as simple as that notification popping up on your phone that brings a smile to you face and allows you to unhook from a thought.

Conclusion.

I like that Stigma keeps it simple. After all, an app isn’t mean to do all the work for you. Defusion is about daily practice tuning into the world with openness, curiosity, awareness. Microjournalling is a tool that I feel can help a lot of people out with that task — so why not give it a try?

Inside Out.



If you haven’t already, I urge you to watch Pixar’s newest animated film, Inside Out. Centering on an eleven-year-old girl, Riley’s, move from Minnesota to San Francisco with her parents and the subsequent fallout, it’s an ode to childhood and growing up, family, the places we come from, and most of all, the roller coaster of emotions all these things engender.

Most of the action takes place inside Riley’s head, at a starship-like Headquarters, where Inside Out’s star characters, Riley’s emotions — Joy, Sadness, Anger, Disgust, and Fear — burst off the screen with color, personality, verve, and life. Sitting in the theatre watching these anthropomorphic emotions laugh, cry, blaze, dance their way across your view, you get the sense of the title — you’ve been privileged to peek at emotions from the outside-in.

Joy, a waifish pixie-esque character with scary-huge eyes that I think are meant to be comforting, nearly has a breakdown when Sadness, in my opinion the highlight of the movie, her bespectacled, sweater-clad, somewhat-awkward counterpoint, begins to interfere with Riley’s memories. Far from malicious, Sadness’ uncontrollable actions correspond with the challenges Riley faces in the outside world. Disappointment with her new house, crying in class on her first day of school, having an off day at hockey tryouts, and to top it off a blow-the-roof-off pre-teenage-angst argument with her parents. How is a girl supposed to cope?

Joy, in her cloyingly prescriptive way, thinks she has the answer. Stay happy. Pretend to be happy if need be. Poor Sadness doesn’t know why she keeps trying to touch Riley’s memories, only that it seems necessary. Not really caring to figure it out, Joy tries to distract Sadness with busywork and eventually tells her to stay inside a three-foot radius painted on the floor. Of course, the solution is hardly that easy, and when the two are accidentally sucked out of Headquarters, landing in the labyrinthine storage continent of Long-Term Memory, left to scurry back on their own, they have to find a way to work together. And to make room for each other.

The audacity of Inside Out lies in that message: that all emotions, even negative ones, are necessary and important. Each takes up space in our daily living. Some take the forefront at certain times, while others step back. It is very probably real that your sadness is a product of your ability to love, your compassion, your ability to form deep attachment. By allowing herself room to experience the sadness of moving from her childhood home, Riley is able to understand it and move through it, not around it.


Acceptance and Commitment Therapy (ACT) very much espouses the same principles. A fundamental technique in ACT is to identify a felt emotion during a body scan (when you imagine “scanning” your body from head to toe for sensations); then, to explore the contours of that emotion as an observer, not an opponent trying to eradicate the emotion. When we observe our own emotions, we create the chance to let them breathe instead of fiddling with a struggle switch that often makes things worse. The oft-used metaphor is to that of escaping from quicksand — the more you struggle, the more you sink.

The reason why this is a bold proposition is that it is completely counterintuitive to what most people want to do when faced with negative emotions. Naturally, when you get sad, you want to make it go away. You may tell yourself that sadness is silly, start to feel guilty about being sad — only to sink back into the quicksand after some distraction.

Instead, imagine experiencing an attack of anxiety in this way:

Getting up to give a speech to the full house, I can feel the fear grip into my body. It’s electric blue in that moment, flat, four-sided, spiky all over. Like 2D ravioli. It trembles where it sits on my diaphragm. It’s crawling up my back and rooting into my neck. I breathe. I accept this emotion of fear. I can hear the thought that it’s telling me about myself. I am ridiculous. I am inadequate. But they are just words and pictures. They are not me. I take this moment to sit quietly with my fear in an open spirit of knowing.

The idea is that by approaching an emotion in a spirit of curiosity, you will be able to accept it for what it is. Nothing more and nothing less than what it feels like in the moment. After breathing deeply into the emotion, you expand it. And then take an action in a valued direction.

If this sounds like an interesting idea, I urge to read more about ACT. It is not a shortcut out of life’s challenges. Nor is it antithetical to Cognitive Behavioral Therapy (CBT). I believe that they can work together to help you achieve a balance of mental health — CBT when you have access to pen and paper and can work on your daily thought record, and ACT when things are more acute, when you think, “Screw the thought record! I’m so angry I want to rip my hair out!”

ACT, at it’s core is about honouring yourself. If you’re sad, angry, anxious as Riley is for the majority of Inside Out, it’s often for a good reason, because it is authentically how you feel right then. It doesn’t mean that emotion represents your essence, or that you are a bad person. It is just an emotion, thoughts and words and pictures and sensations that are coursing through your body.

Sadness, when Riley finally expresses it, telling her family how she feels about the move, honours the truth of growing up, the truth of change. Her parents then admit that they too feel difficult emotions about the move and are here for her to offer support and love. She is not alone. I will go further, however, to say that even if Riley didn’t have her parents, the skill of honouring her emotions is one of the first steps to feeling better.

Now your turn. The best part is that this skill is something readily available to each and every one of us every day. You already have the tools: your body and your breath. I challenge you to take a magnifying class to your own emotions today. What are you feeling? And for the moment, forget about why and just focus on the sensations. Visualize it. Describe it. Turn it inside out.

Pacifica.

It’s rare that an app comes along that from the very first launch seizes my attention. Even more special that it’s an app for mental health. This is Pacifica, a project by Dale Beermann and Chris Goettel in conjunction with psychologists at Stanford University.

When my patients have struggled with completing hourly and daily mood journals, the reasons are invariably threefold.

  • I can’t remember to do it
  • It’s not simple
  • It’s not guided

Pacifica addresses all of these.

The home screen welcomes you at launch with a gorgeous and minimalist layout. At once, the intuitive UI shows you what’s possible. Would you like to record your mood, record your health, or engage in a self-soothing exercise, gently guided by the app?

(1) Mood.

Simply swipe the mood meter. I like that there are only a few moods, but which can be augmented to your preference by adding a supplementary tag. I added “Accomplished”, “Uncomfortable”, “Grateful” to my list.

Mood can be recorded as frequently as every 15 minutes. A stunning visualization of mood patterns is accessible via a tap in the top-left corner of the home screen.

Can’t remember to record? Set Pacifica to gently remind me every day or several times a day. I loved the way the reminders were phrased — sweet and colloquial. On a slow day, it can be like a friend just checking in to say what’s up.

(2) Health.

Record # hours of sleep, quality of diet, and minutes exercised in much the same way as mood. As you meet healthy thresholds, the heart icon on the home screen fills to show your progress.

While not as comprehensive and analytic as your FitBit, Apple Watch, etc., it’s certainly enough to support a degree of mindfulness of your daily routines.

(3) Exercises.

Who loves a good reflection? I do! But it’s not the easiest thing to do. Who wants to deal with endless CBT worksheets and struggling to “empty your mind” while trying not to fall out of your crossed-leg position? Pacifica breaks it down into three categories of activities.

A. Relax. In the tradition of classic mindfulness meditation, Pacifica provides several exercises focussing on breath, visualization, body scan. Best of all, you can set the breath length and hear someone breathing with you. No more wondering if you need to change your breath now. The best results from mindfulness that I’ve received in practice have, after all, been when I’ve done the exercise with a patient daily.

B. Thoughts. This is where we go full-on CBT. Take two minutes to record your thoughts about an anxious experience you’ve had today. Go freestyle. Then Pacifica prompts you to listen to the recording and mark the moments that were Negative and Positive. Each negative moment is then assigned a cognitive distortion. If you’re not sure which distortion is applicable, you can read a simple description of the distortion. Finally, you are invited to make a second recording focussing on a more balanced view of the situation.

C. Experiments. This section guides you through small tests you can run in your daily life, such as learning to confront situations you used to avoid.


And finally, did I mention this app is BEAUTIFUL?

I am incredibly excited to have stumbled across Pacifica and encourage all of you to try it!