The DSM is the handbook used by healthcare professionals in the US, and elsewhere in the world, as the leading authority on when and how to diagnose mental disorders. Currently the manual is referred to as “DSM-5” because it is on its 5th edition. The DSM-5 gives professionals information on symptoms and other criteria to help guide diagnoses of mental health conditions. The DSM-5 also defines what conditions do and do not exist, and changes according to the most recent science and practices. For example, DSM-5, which is the latest version, takes cultural differences and gender into account more than previous versions.

The DSM-5 helps clinicians recognize a diagnosable condition by breaking symptoms and experiences down into categories; one of those categories is functional impairment. This refers to whether a condition is “causing significant distress or impairment in social, occupational, or other important areas of functioning.” In other words: is the condition interfering in the individual’s life? An individual may experience some symptoms of major depressive disorder (MDD), but if they are not bothered by the symptoms and the symptoms don’t impair them, they may not be diagnosed with MDD.

Often shortened to GAD, this is the most common anxiety disorder. The DSM-5 begins its definition of GAD with “excessive anxiety and worry… occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance.” It also notes that the person finds it hard to control their worrying, and that the anxiety and worry need to be associated with at least three other symptoms such as restlessness, fatigue, trouble concentrating, or sleep disturbance. The anxiety must be leading to functional impairment (listed above) which means that it’s bothering the patient and getting in the way of everyday life.

Previously referred to as primary insomnia, insomnia disorder is defined in the DSM-5 as a complaint of “dissatisfaction with sleep quantity or quality” and must be associated with symptoms such as difficulty falling or staying asleep, or waking up earlier than desired and not being able to fall back asleep. The sleep troubles need to occur at least three nights per week for at least three months, and, as with GAD (listed above), functional impairment must be present — meaning the symptoms need to be causing the patient distress or otherwise interfering with everyday life.

Most people have heard of depression, but not everyone knows its official name: major depressive disorder (MDD). According to the DSM-5, someone can be diagnosed with depression if they have at least five of these symptoms:  persistently low or depressed mood, decreased interest in or inability to get pleasure from activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor slowing or agitation, sleep disturbances, or suicidal thoughts. Importantly, one of those symptoms must be “depressed mood,” or “decreased interest or pleasure causing social or occupational impairment,” which refers to difficulty or inability to experience pleasure.

Psychopathology is sometimes used to refer to the study of mental disorders. However, this term can also refer to the experience and manifestations of disorders themselves; in other words, the symptoms, behaviors, and cognitions associated with a mental disorder. These can vary according to cultural norms and constructs which change over time. A continued focus on psychopathology is important because as people and cultures change, clinicians and researchers observe new and different conditions. For example, Internet Addiction is a “proposed diagnosis” or condition in the DSM-5. Although it is very relevant to our current times, there’s not yet enough research for this to be considered a discrete condition. This is just one example of psychopathology that requires more research to determine whether it is a condition in and of itself, or better explained as a manifestation of another disorder.
Learn more about how good mental health impacts your employees on and off the job.

Equity is often confused with equality, which refers to the idea of equal treatment. While equality is important, it also often carries the assumption that equal treatment always results in equal outcomes. Because some people start at a disadvantage, giving the same treatment to all people can result in certain groups making progress, but not as much progress as those who benefit from more privilege. When it comes to mental health conditions and mental health care, different populations have different needs and face unique challenges when accessing care. Striving for mental health equity means giving the level of support each person or group needs instead of equal levels across all groups. For example, groups like Therapy for Black Girls provide a targeted level of support specifically to Black women and girls who face unique mental health challenges that white women or non-Black women of color do not face.

“Barriers to care” refers to obstacles that limit or prevent people from receiving care. Common barriers to care primarily fall into two categories: systemic barriers and cultural barriers. Systemic barriers are policies and procedures that disproportionately impact specific communities. These can include access to health insurance, or financial resources to afford treatment. Systemic barriers can also include experiences of racism in the healthcare system, lack of culturally responsive treatment, and a shortage of culturally informed mental health care providers. Cultural barriers include lack of awareness about mental health conditions and treatments, negative emotions such as fear, stigma, and shame, lower trust in the health care system due to past personal or generational experiences, and a preference for culturally congruent interventions such as community and spiritual leaders or holistic interventions.

The term “stigma” refers to feelings of shame that are perpetuated by widespread misconceptions about mental health. These misconceptions often shape people’s attitudes and behaviors toward those with mental health struggles. Stigma is destructive because it can lead people to dismiss or ignore their symptoms, or someone else’s, which typically leads to the individual in need not getting care. Stigma can come in three forms: public, which includes the societal perception that people with mental health conditions are dangerous, incompetent, unpredictable, and to be blamed for their own struggles; self, which is an individual’s belief that they as an individual may be dangerous, incompetent, or to blame for their own mental health struggles; and institutional stigma which involves stereotypes embodied in laws and institutions that perpetuate inaccurate concepts while also reducing access to mental health care.
Hear from our experts on some of the barriers to mental health care and read how Big Health is prioritizing mental health equity.

Generally speaking, when people say “therapy,” they’re referring to psychotherapy: talk-based treatment provided by a therapist in an office setting. This could be in an individual, family, or group setting, and be administered by a psychologist, licensed therapist, or social worker. Psychotherapy uses various techniques to help an individual overcome challenges, change their behavior, improve their overall wellbeing, or work towards an identified goal. Talk therapy can help with a wide range of concerns and conditions, including but not limited to: depression, stress, grief, substance abuse and addiction, anxiety disorders, insomnia, and trauma.

CBT is an action-oriented type of structured therapy that gives people tangible skills to identify and change unhelpful thoughts and behaviors that harm their mental health. CBT is useful for a variety of conditions, and is particularly helpful with anxiety disorders and insomnia. In CBT, the client learns and practices skills directly related to their individual needs. For example, someone suffering from social anxiety that involves fear in social settings might work on taking small steps towards getting comfortable with small talk. Someone with insomnia might learn how to structure their night time routine to facilitate better sleep.

Digital health is a broad category that covers many ways technology is used to deliver healthcare. Wellness apps qualify as digital health, as do wearables that track things like heart rate and steps.

Digital therapeutics (DTx) are a class within digital health, defined as devices that “deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.” For example, Big Health makes two digital therapeutics — Daylight for GAD and Sleepio for insomnia disorder. Daylight and Sleepio are non-drug, software-based therapies that have been evaluated like a medical device or medication making them clinical-grade treatments. The best digital therapeutics are the ones that are tested and shown to be safe and effective — like Sleepio and Daylight — which have been tested in clinical trials and have been shown to deliver consistent clinical outcomes.

Medication is a drug taken to treat an illness, disease, disorder, or condition. Over-the-counter painkillers are medication to treat the condition of pain; Chemotherapy is medication to treat the disease known as cancer. For mental health, most medications are taken for depression, anxiety, and insomnia. The medications that address those conditions are SSRIs, benzodiazepines, and hypnotics. Some of the brand names these go by are prozac, ativan, and ambien. Medications to treat mental health disorders are usually prescription only. They typically have psychoactive effects, which the American Psychological Association (APA) defines as having “significant effects on psychological processes, such as thinking, perception, and emotion.” Antidepressants, sedatives, antipsychotics, and mood stabilizers are all examples of psychoactive drugs.

We evaluate the effectiveness of medications by weighing the benefits against the risks. Benefits refer to reduced symptoms, or “feeling better.” Risks range from unpleasant side effects to actual risk of physical harm, like accidents or adverse reactions. Using hypnotics as an example, the main benefit is helping people fall or stay asleep. However, there’s also a risk of severe side effects like sleep walking or even driving, moderate ones like having no recollection of doing important things the next morning, and minor ones like daytime grogginess.

One of the trickiest issues in psychiatry is what’s known as a “drug-drug interaction,” or DDI. A DDI happens when a patient takes multiple medications and the pairing alters the effects of the drug(s) on the body. This could potentially include toxic side effects, the development of new symptoms, or one or more of the drugs not working properly. With nearly 50% of people taking prescription drugs, and half of those on three or more medications at once, DDIs have become very common.

According to the National Institutes for Health (NIH), black box warnings are “the highest safety-related warning that medications can have assigned by the Food and Drug Administration (FDA) in the US.” The purpose of the warnings is to make sure consumers are aware of the major risks associated with taking the drug. For example, some drugs that are commonly prescribed for insomnia — such as Ambien, Lunesta, and Sonata— carry black box warnings. This is because the FDA has determined that they’re likely enough to cause sleepwalking and other sleep behaviors that can lead to injury or even death.

Both psychologists and psychiatrists can provide psychotherapy, or talk therapy, described above. However there are some important distinctions: Psychologists have graduate degrees in psychology (usually a doctorate), and their education focuses on human behavior, research, and scientific methods. A psychologist’s education typically includes four to six years of academics and clinical training, plus one or two years of post-graduate supervised work with patients followed by licensing examinations.

Psychiatrists on the other hand attend medical school and earn a medical degree, then acquire an additional three to four years of training in psychiatry. This training focuses on biological aspects of mental illness. Because psychiatrists have medical degrees, they are able to prescribe medication (however, there are five states — ID, IL, IA, LA, and NM — where psychologists can prescribe as well).

In the medical world, a “first-line treatment” is something that, based on reviews of the science, is the most safe and effective treatment for a condition. And because of that, it should be offered first to people. In medicine, you never want to over-intervene; you don’t want to do surgery if someone just needs a band-aid. So, a first-line treatment is something that enables providers to start with the safest, most effective intervention before moving on to something that might have greater risk associated with it.
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Read more about why CBT is the recommended first-line treatment for most mental health conditions.

Wellness refers to pursuits to improve one’s overall well-being through lifestyle choices regarding physical, emotional, social, mental, spiritual, and environmental aspects of life. Examples of activities one might pursue to increase wellness could include changing diet and exercise, joining a volunteer organization, or practicing mindfulness (discussed below). There are many wellness tools that can come in the form of apps, including popular medication and weight loss programs you may have heard of. There is an important distinction between wellness and the treatment modalities outlined above (talk therapy, medication, etc.). Wellness can be used to prevent illness, and to increase overall well-being. However only treatment is designed to address symptoms of a diagnosed mental health condition and reduce the symptoms of conditions to sub-clinical thresholds.

In short, mindfulness is the practice of becoming more aware of the present moment, our surroundings, and our own emotions. Mindfulness has origins in eastern and Buddhist philosophies and is integrated into many modern types of meditation practice. Mindfulness also has therapeutic applications within psychotherapy — providers might recommend that patients engage in gratitude journals, daily meditation, or other mindfulness activities — but these alone are not sufficient to treat conditions.
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Learn more about the need to prioritize evidence-based platforms over wellness apps for treating clinical conditions.

An RCT is a type of study in which participants (the individuals being observed) are randomly assigned to separate groups. The thing being tested — often a drug, or some kind of medical device — is then administered to one group, while another group has a different experience. Often, they will receive no treatment, or get a placebo. Because the groups are randomly divided, the groups will be similar in terms of characteristics which could affect the outcomes such as gender and age.

This term simply refers to a standard that the scientific community has agreed is the best way to do things. In mental health, the gold standard of evidence is the randomized controlled trial, or RCT, because it has proven to be the most accurate in measuring efficacy and safety.
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Read more about the studies Sleepio and Daylight have been involved in and the impact they’ve had on employees.