Bringing employee mental health into focus — Part 2

This is the second in a three-part series focused on mental health literacy: what it is, why employees need it, and how to achieve it. Read part one now.

In part one, Big Health’s Clinical Lead for Sleep Dr. Jennifer Kanady and Clinical Lead for Anxiety Dr. Michelle Davis explained how to recognize the signs of a mental health disorder and identified some risk factors associated with them. Today they’re focusing on how employees can find and secure quality mental health care.

Key skill: Learning how to identify and obtain quality mental health care

Once an employee is able to recognize symptoms of mental health problems, the next step toward mental health literacy is being able to address symptoms — either through care or learned coping skills — as they arise.

In order for employees to seek effective care, they must first be able to answer: What is quality mental health care?

The spectrum of evidence

Like any kind of health care, mental health treatment should be well researched and evidence based. Dr. Davis says, “Psychology is a science, and treatments are studied in the same way medications are.”

However, it’s important for employers — and their employees — to know that not all evidence is created equal. Dr. Kanady says, “On one end of the spectrum is less-rigorous, anecdotal evidence and testimonials, which while valuable, present with limitations. On the other is the gold standard: randomized controlled trials.”

Interested in learning more about clinical evidence and what to look for? Check out our guide!

Randomized controlled trials (RCTs) are the gold standard in clinical research because they:

• Include a control group that looks the same as the “treatment group” except that the control group does not receive the treatment being studied. This allows researchers to “control for” important variables that aren’t part of treatment, but may influence treatment outcomes, such as progression of time and therapist attention.
• Randomly assign people to either the control group or treatment group, which eliminates noise that can invalidate the study’s results.
• Look at changes in clinically validated measures of symptoms (e.g., PHQ-9, GAD-7 which are question instruments used to screen for the presence and severity of depression and anxiety, respectively.) before and after treatment.
• Involve a peer review process which gathers perspective from researchers who aren’t invested in the results.

Over decades of research, RCTs have shown that cognitive behavioral therapy (CBT) is the gold standard treatment for many mental health conditions such as anxiety disorders and insomnia.

How cognitive behavioral therapy works

CBT works by helping people break the cycle of unhelpful thoughts, emotions, and behaviors that cause them to get stuck. For example, an employee with social anxiety disorder might have a deep fear of public speaking (ahem…). The fear is rooted in their belief that they’ll be negatively evaluated, which can lead to anxious thoughts (e.g., “I’ll make a fool of myself!”) and physical symptoms like sweating and a racing heart. To avoid this unpleasantness, they often procrastinate or avoid public speaking altogether, which keeps them from facing their fear. Dr. Davis says, “It’s a vicious cycle which prevents them from learning that things might actually have gone better than they think.”

By approaching social anxiety with CBT, this employee would learn specific techniques to challenge unhelpful thoughts and behaviors, such as avoidance. After building some skills, they would learn to face their fear of public speaking as an opportunity to test whether their unhelpful thoughts — about being negatively evaluated — are accurate. Over time, and with repeated practice of CBT techniques, the anxiety associated with this fear would start to subside.

Tips for accessing quality care

While in-person CBT is preferred, it is traditionally delivered face-to-face with a therapist, and quality therapists are in short supply. In fact, half the counties in the US don’t have a single licensed mental health professional.

Other barriers to traditional therapy are also problematic. High costs, and the need to miss work and lose wages to attend a mid-day appointment are just a few — and these affect marginalized groups more than other populations.

The good news is that there are other ways to offer cognitive behavioral techniques to employees. Self-help tools like books and evidence-based digital therapeutics like SleepioRx or DaylightRx, can be a good solution. However, if a company does choose to offer a digital solution, Dr. Davis says to be a “good consumer of evidence,” because many solutions may make claims about their efficacy that are supported by insufficient evidence. “Thousands of mental health solutions are available, but not all are based on evidence. Go to the company’s website or contact them directly to see if they’ve done clinical trials supporting their claims.”

We’re two-thirds of the way there

The first two posts in this series focused on helping employees recognize the symptoms of a mental health disorder and cultivate the knowledge to seek and obtain quality mental health care. In the final installment, we highlight the third critical skill: tackling stigma.

SleepioRx is a digital therapeutic intended for the treatment of chronic insomnia/insomnia disorder as an adjunct to usual care in patients aged 18 and older. Sleepio is a prescription device delivering Cognitive Behavioral Therapy for Insomnia (CBT-I) and can be made available on the order of a licensed healthcare provider. Patients should read the indications for use.