With increasing expectations and pressure to be at the top of their game, individual sportspeople are hit the hardest when it comes to mental health issues. Is there more support now than before?



By Nick Said



Mental health in sports has become a hot topic after some high-profile incidents in recent years in which competitors at the very top of their game have taken a step back in order to safeguard their own well-being.



It begs the question, are we putting sportspeople under increasing pressure with our demands as fans over their performance, or have these issues always been there and it is simply a case of individuals being more willing to talk about, and confront, their fears?



Rugby players Michael Hooper and Sbu Nkosi, swimmer Michael Phelps, gymnast Simone Biles, and tennis stars Naomi Osaka and Serena Williams, among many others, have all admitted to mental health issues in the last few years.



Their troubles are the tip of the iceberg, but instead of enduring their inner struggles, they have chosen to speak out and take a step back from their sport.



Dr Jannie Botha is a world-renowned psychologist who has worked with a number of sports teams and individuals to help them deal with the scrutiny of being in the public eye and always under pressure to perform.



He has been contracted by South African Rugby and the Blue Bulls, local soccer sides Kaizer Chiefs and Mamelodi Sundowns, as well golfers, and Olympic medal-winning athletes and swimmers.



“People are now more open when it comes to speaking about how they feel,” Botha tells FORBES AFRICA.



“In the past they had to simply survive in their ‘bubble’ and the environment they were in, where they were mentally not well but couldn’t do anything about it.



“They were seen as such heroes that they felt they couldn’t show emotion. A ‘cowboys don’t cry’ kind of thing. But that was the past, it has changed a lot.”



Dr Botha believes individual sportspeople are hit the hardest, often without the support around them to see them through the tough times.



In a team environment there is often a shoulder to cry on.



“There is a difference. In an individual sport, my mental capacity is my own support. In a team environment, my mental capacity is my teammates’ support,” he says.



“You can hide it much longer in a team situation and endure it for much longer with teammates around you.



“You can function much longer in a team sport because your team carries you, but for individuals, there is not that support, so it is more severe.”



Japanese tennis player Naomi Osaka has been one of the most high-profile individuals to speak out in recent times, saying she struggled with constantly being in the media glare.



“I have suffered long bouts of depression since the US Open in 2018 and have had a really hard time coping with that,” she said last year.



“It was important to me to be public because I think it gives me clarity. Just saying out loud that I’ll take a break and I’ll come back when I am truly in love with the sport and I know what I want to do here; it gave me time to reset myself.”



Hooper, one of the leading stars in rugby and long time captain of the Australian national team, quit the side abruptly while on tour in Argentina last year, saying he needed a break from the sport just hours before he was due to play.



“I’ve been playing the game for a long time, had some great changes in my life and there were a lot of things running through my head showing up in Argentina, and Argentina wasn’t the place where I needed to (be to) sort these things out,” Hooper later said.



“I wanted to be around family. I wanted to be in a place where I could put the time in to those things that I needed to put in. As a younger man, I viewed asking for help as, I guess, a bit of a weakness. You want to feel like you have it all worked out and I certainly didn’t.”



Hooper returned to the side months later, but Dr Botha says the player’s feelings are typical.



“The problem is that because in a sense they believe they live in a bubble, which the media creates for them, they struggle to function in normal life. That bubble gives them a bit of security, even if it is false.”



Dr Botha adds that with players expected to perform weekly in what has turned into a 12-month season, both in individual and team sports, that pressure builds.



“The expectations (from fans) have not changed, even though the seasons have got longer,” he says. “They are playing all year round now and the public does not see that, they just want performance week after week. It has changed the dynamics completely.”



South Africa had its own recent case of a player withdrawing from the public eye when Bulls wing Sbu Nkosi went missing for three weeks, leading to such alarm that a missing person case was opened with the police.



He was eventually found at the home of his father in South Africa’s Mpumalanga province and said it had been a build-up of mental pressure over time that saw him take his leave of absence and cut himself off from the world.



“It’s just been a whole lot of mental pressure. It’s been building up for a couple of years now,” he told Sport24. “I was just trying to keep myself calm. That’s been a battle. I’m at a point where I need to prioritize the person before the rugby player.



“I just needed time. I’ve basically been curled up in a ball with my dad, and he’s been managing my mental state daily. 



“I’ve had plenty teammates and I can tell you, not everyone is okay. It’s a tough environment.” But Dr Botha does believe that sportspeople are at least receiving more support than a decade ago. “There is much more awareness, I can see that in the last 10 years,” he says. “Especially in team sports, there is much more focus on helping people in need. Most of the big teams have psychologists working for them now and that is a big positive.”

Shot of a muscular young man wearing headphones while exercising outdoors

Off-Field Battles: How Do African Sports Stars Handle Mental Health Issues

Can technology lead to better brain health? Welcome to the world of digital therapy.



By Tiana Cline 



TECHNOLOGY ISN’T ALL DOOM AND gloom. What it is doing, however, is shifting what it means to be human through how we interact with the world and each other.



This social connectivity has a real impact on our mental wellbeing and that’s not always a bad thing.



According to Dr Jonathan Moch, a psychiatrist and author based in Johannesburg, South Africa, technology is competing with therapy for the better. It’s disrupting the mental health space.



From video conferencing to meditation apps, technology is taking away what Moch calls shadow costs.



“The right technology could help people to reframe situations but there will also be inequality – the sad could get sadder and the happier more so because what they’re doing is using technology wisely.”



This also relates to the concept of doomscrolling – spending an excessive time on social media absorbing negative news. Instead, they could be using an app that is built to amplify digital wellness.



“The real struggle is the internal reality. On the outside, it may look like you have everything but inside you don’t feel like you have meaningful purpose. Can something from the external environment come in and make you happy? You can go watch good or bad videos, choose to listen to inspiring podcasts or binge series&#8230;” says Moch.



“You need to invest in yourself and that begins with brain health.”



Bloom, for example, is a cognitive-behavioural- therapy (CBT) app created by two Australian influencers-turned entrepreneurs, Chloe Szep and Molly Jane. It combines mindfulness exercises with journaling and interactive videos in an accessible, mobile format. It’s working well for those who cannot afford therapy or prefer a more discreet way of tackling stress and anxiety (so much so that it has now been downloaded by over a million people in 220 countries). But Bloom is far from the only digital therapy option, apps such as Calm, Breathe, Headspace and Insight Timer all offer different forms of meditation and mindfulness, in your pocket. What they also do is present a healthy alternative to the dopamine rush that people get when they use social media.



According to a Harvard study conducted by cognitive neuroscientists, dopamine is a chemical produced by the human brain that gets released when we perform beneficial behavior. While this could easily mean exercising or eating, dopamine also gets released during successful social interactions – every notification activates the same dopaminergic reward pathways.



Brent Davidoff, a manager of network experience and innovation at Harambee Youth Employment Accelerator, used this research to create an online space called Coach Me to reach those who could no longer get to their offices across South Africa due to lockdown.



“We were faced with a situation where there were young people who were more desperate than ever but didn’t have a place like Harambee to go to. We set up a toll-free support line where someone could call and speak to guides,” explains Davidoff, “we started out with around 100 calls a day but as the pandemic went on, we grew to a couple of thousand calls a day. Even with a contact center and 50 guides, we still needed to find a way how we could support young people at scale. This is where the idea of Coach Me came up.”



Coach Me is a web app that takes the best of what Harambee’s guides have to offer and puts it into a virtual space. “It helps people to understand what the challenges they’re facing are and give them some sort of map for their next step,” adds Davidoff. 



For Coach Me, Harambee researched inspiration as a psychological construct, using the app’s dopamine effect to motivate its users.



They also looked into long-term, goal-setting theories, using a practical technique called mental contrasting for the app: “What is your dream? Where do you want to get to? And what is stopping you from getting there? It gets you excited but also creates some kind of cognitive friction which the brain wants to resolve. The result is that you have to start getting rid of those obstacles,” he explains.



By setting up a goal and then working out its obstacles, Harambee has seen that over time, the goals that their users create become more practical. “It goes from someone saying ‘I want to start my own business’ to working on an outcome that is far more realistic and achievable in order to get to that long-term wish, something like going somewhere with free Wi-Fi to research what funding is out there.”



Meeting realistic goals is rewarding; it is what both video games and gamified business applications use to keep those who play them release dopamine and come back. While the amount of dopamine released is similar to that of stimulant drugs, the cognitive, behavioral, and neurochemical impact of gaming isn’t all bad news.



Tetris, for example, may be visually pleasing but a research team in New Mexico found that playing the game leads to a thicker cortex and an increase in brain efficiency.



A British study also discovered that Tetris may prevent post-traumatic stress disorder (PSTD) as it reduces flashbacks experienced later on. The team from Oxford wrote that “recognizing the shapes and moving the colored building blocks around in the computer game competes with the visions of trauma retained in the sensory part of the brain.”



Re-shaping trauma using digital tools is something Moch is particularly interested in, especially when it comes to post- traumatic growth. “There are those whose neurosis are fed by the negative side of technology which means anxiety and stress- related problems are going up. Technology is here to stay. It’s the driving force of innovation and that’s why choosing brain health is so important. Everything comes with a curse or a blessing.”



While there are psychologists already using technology like virtual reality and telehealth, as a sector, it’s growing exponentially, Moch says the Metaverse could be a game-changer going forward.



“There are two realities: your internal subjective and the external environment that you share. Now, for the first time in the history of the world, there could be a third reality,” he says.



“It’s going to be very disruptive to the psychological model of therapy.”

Man having a cognitive behavioral therapy video call with mental health professional

Can Tech Lead To Better Brain Health? What Africa Is Thinking

SOUTH AFRICAN RESEARCHERS ARE NOW developing an innovative, validated online tool to help people recognize and seek treatment for depression and mental health issues. PhD candidate Tasneem Hassem of the University of the Witwatersrand in Johannesburg, along with co-founder Professor Sumaya Laher, have been awarded almost $7,000 in seed funding to further develop and commercialize the tool, aimed at allowing users to more easily recognize and obtain treatment for depression, particularly within the South African context, where low mental health awareness and access to mental health services can still be a challenge.



 “Unfortunately, low awareness of the symptoms of depression means that many people do not know when they are depressed. During our research and through interviews with stakeholders, we determined that an online screening tool would help raise awareness of depression, reduce the stigma and facilitate quality conversations between people and health professionals” says Hassem to FORBES AFRICA. 



According to a recent report in The Lancet which assessed the impact of the Covid-19 pandemic on mental health in 204 countries, anxiety and depressive disorders increased by some 25% across the countries sampled, with South Africa seeing one of the highest rates of increase worldwide.



 “The emergence of the Covid-19 pandemic has created an environment where many determinants of poor mental health are exacerbated,” the study continued. 



This is confirmed in the South African context by the South African Depression and Anxiety Group (SADAG), a mental health services and advocacy organization. 



“We know that the mental health impact during Covid has been immense – we’ve seen that at SADAG,” says Cassey Chambers, SADAG’s operations coordinator, to FORBES AFRICA. 



“Just from January this year, we received over 466,000 calls to our helplines. One in every five calls is a suicide-related issue. And that’s still a conservative figure. Our call volumes from pre-Covid [to this year] has increased by 160%. Covid has definitely impacted mental health, it’s definitely added to more depression, more anxiety, added to people’s mental health issues… Covid has definitely increased the mental health impact.” 



Ensuring mental health tools are relevant to the context and location in which they will be used is a crucial part of ethical and successful interventions, which was a criticalfocus of Hassem’s research and piloting of the app, with the guidance of healthcare professionals. 



The tool’s development funding comes through the University of the Witwatersrand’s Prospector course which aims to foster and develop promising entrepreneurial ideas in research – with Hassem’s proposal securing funding over seven other proposals, with the project being of possibly high value in South Africa, where mental health resources are extremely limited, with some four mental health spaces per 100,000 members of the population, and just 0.97 psychologists for the same number. 



“What is exciting in this instance is that the tool developed by Ms Hassem and Prof Laher has significant potential to support our communities in an illness that is prevalent, yet difficult to diagnose and treat not least because of the unfortunate stigma associated with it. Innovation must meet the real needs of our citizens, and it’s not just about profits,” comments Ela Romanowska, Director of Innovation Support at Wits Enterprise, which supports the initiative. 



“Our tool is specifically adapted to capture the unique depression symptoms experienced by South African individuals. The user receives instant, downloadable feedback that provides resources for seeking treatment or care and can be used in the comfort of one’s home, on any smartphone, tablet, laptop or computer,” explains Hassem.

Directly above shot of mother embracing depressed son on bed at home

Financing Mental Health: NEW TECH TOOL TO TREAT DEPRESSION

The impact of Covid-19 on mental health is also proving deadly, particularly in Africa.



BY PAULA SLIER AND SASHA STAR



PHYSICAL HEALTH HAS BEEN BROUGHT INTO sharp focus over the last year as people watch for any sign of irregular temperature, loss of breath, or a tickle at the back of their throat. Yet, the impact of Covid-19 on mental health is also proving deadly, particularly in Africa where health services were facing a financial struggle long before there was a viral pandemic.



The World Health Organization in 2020 reported that 15 African countries are among the top 30 in the world for suicide per 100,000 people. Mental health is a silent problem when it comes to the continent.



While awareness of such issues may be on the rise globally, cultural and traditional practices in Africa have prevented conditions such as depression and d anxiety receiving the attention they deserve, according to Miyoba Muloongo, a licensed counselor working with Zambia’s Ministry of Health. 



“People relate mental health to witchcraft or superstition because there is less awareness about what the illness really is,” Muloongo says. “There is a stigma related to people who have mental health issues. And sometimes people have mental health issues, but they are not aware; or they may be aware, but are not willing to come forth because of the stigma attached to it.”



Even when those dealing with mental health issues do choose to voice their burden, the disclosure is not always met with encouragement. “I would say the biggest issue is ignorance,” states Kenyan business developer, Andrew Njoroge. “In Africa, people say, ‘How can you be sad? Be happy. Smile!’ That doesn’t solve the issue. You cannot force someone to be happy.”



Njoroge believes that both community members and policy-makers need to get involved to combat the ignorance.



“There needs to be a hybrid solution whereby it’s top-down and bottom-up and they meet in the middle,” he says, while suggesting that the community takes a hands-on approach and the government provides funding and adapts legislature. “Government needs to work on its incentives and community programs, whereas community workers themselves must rally up. You need people on the ground engaging to see who needs help and who is battling mental health. There needs to be a two-pronged approach.”



Community initiatives seem to be the most effective way to assist those afflicted with mental illness, especially in poverty-stricken areas. “We have foundations which are offering appropriate therapy or psychotherapy to people who might be in need but cannot afford to go the private way,” Muloongo says. Volunteers have been trained to listen to adolescents who may not have ventured to clinics but are now able to share their concerns free of charge, while wellness gatherings have been established for men to normalize discussing issues that they would not have spoken about previously. The African concept of an extended family dynamic, where everyone is seen as a relative, is one of the age-old ideologies that is also being adopted to tackle mental health.



“The issue is culture-specific interventions which need to be addressed from the community level because that’s where it all starts from,” believes Muloongo. “That’s where we have the coping mechanisms which we have always used. We would sit around the fire and be told stories on how to cope in general with our grandparents. These methods can still work even this time around.”



Njoroge admits to having anxiety himself and concurs that sharing one’s experience with mental health is the correct way to approach the matter, using the renowned adage ‘a problem shared is a problem halved’. “What I see is more and more people finally speaking out in this day and age of social media and I feel like, in the next five years, there will be more and more people speaking up about their problems,” he says. “I’m speaking my truth so that someone else hears it and it inspires someone else to do so.”

Teenage girl wearing mask sitting in her window

How Mental Health Has Proven To Be The Silent Pandemic

Young adults are the most likely demographic to have signs of negative mental health during the Covid-19 pandemic while older Americans at highest risk of the virus have the least stress and anxiety, a new <a rel="noreferrer noopener" href="https://www.norc.org/PDFs/COVID%20Response%20Tracking%20Study/Rates%20of%20Mental%20Health%20Symptoms%20Unchanged%209Sept2020.pdf" target="_blank">Covid Response Tracking Study</a> poll from the National Opinion Research Center (NORC) finds, as the coronavirus continues to take a large mental health toll on Americans months into the pandemic.



<h5 class="wp-block-heading">KEY FACTS</h5>



The number of Americans reporting psychosomatic symptoms of stress and anxiety like trouble sleeping, feeling nervous and tired, headaches, and crying largely steadily decreases with each age bracket, the poll finds.



The number of Americans reporting psychosomatic symptoms of stress and anxiety like trouble sleeping, feeling nervous and tired, headaches, and crying largely steadily decreases with each age bracket, the poll finds.



Symptoms of stress and anxiety are also highest among women, those with less education and income, those who had been exposed to someone with Covid-19 and those who frequently read, watch or talk about the pandemic.



The percentage of respondents reporting symptoms and who report negative mental health are largely unchanged from previous polls in May and June/July, showing how the mental toll of the coronavirus pandemic has not improved as it stretches on.



51% of Americans read, watch or talk about the pandemic “often” or “most of the time,” and Democrats and those who are more educated are more likely to pay attention to and discuss the pandemic than Republicans, Independents and those with less education.



Though younger Americans are statistically at less risk of serious Covid-19 complications and death than older Americans—and have drawn the most scrutiny for&nbsp;<a href="https://www.forbes.com/sites/carlieporterfield/2020/07/23/as-coronavirus-infections-spike-among-young-new-yorkers-cuomo-warns-against-partying/#33f1ac6e389e">continuing to socialize</a>&nbsp;during the pandemic—they are also among the most likely groups to have been affected by&nbsp;<a href="https://www.pewresearch.org/fact-tank/2020/06/09/hispanic-women-immigrants-young-adults-those-with-less-education-hit-hardest-by-covid-19-job-losses/" target="_blank" rel="noreferrer noopener">job losses</a>&nbsp;during the pandemic.



<h5 class="wp-block-heading">BIG NUMBER</h5>



2 in 10. That’s the number of respondents who say they “frequently suffer from anxiety, depression or irritability,” while five in 10 respondents say they at least sometimes experience those issues. The poll also found that the average person experiences approximately five out of the 15 symptoms associated with stress and anxiety.



<h5 class="wp-block-heading">KEY BACKGROUND</h5>



The negative&nbsp;<a href="https://www.forbes.com/sites/nazbeheshti/2020/05/28/10-eye-opening-statistics-on-the-mental-health-impact-of-the-coronavirus-pandemic/#385af6052df0">mental health toll</a>&nbsp;of the coronavirus has been a serious issue since it began, as lockdown measures, the virus itself and the vast economic fallout has had a negative impact on a broad swath of the population. An&nbsp;<a href="https://www.forbes.com/sites/carlieporterfield/2020/04/02/coronavirus-36-of-americans-say-pandemic-has-made-a-serious-impact-on-their-mental-health/#58c2f2ec6c8e">April poll&nbsp;</a>from the American Psychiatric Association found that 36% of Americans believed the pandemic had taken a “serious toll” on their mental health, while an&nbsp;<a href="https://www.forbes.com/sites/carlieporterfield/2020/08/06/americans-are-more-anxious-and-economically-battered-from-coronavirus-than-citizens-of-other-wealthy-countries/#bdb3ec96a8ca">August survey</a>&nbsp;from the Commonwealth Fund found that approximately one-third of Americans reported negative mental health issues—far more than in the other countries surveyed. A previous NORC Covid Response Tracking Study poll in June also&nbsp;<a href="https://www.forbes.com/sites/carlieporterfield/2020/06/16/in-coronavirus-pandemic-americans-are-unhappier-than-theyve-been-in-50-years/#2b9b09da6255">found</a>&nbsp;that only 14% of those surveyed felt very happy, marking the lowest response recorded in nearly 50 years.



<h5 class="wp-block-heading">FURTHER READING</h5>



<a href="https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx" target="_blank" rel="noreferrer noopener">COVID Response Tracking Study</a>&nbsp;(NORC)



<a href="https://www.forbes.com/sites/carlieporterfield/2020/09/04/more-young-people-living-with-their-parents-than-in-the-great-depression-report-says/#5581b32c51a3">More Young People Living With Their Parents Than In The Great Depression, Report Says</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/carlieporterfield/2020/08/06/americans-are-more-anxious-and-economically-battered-from-coronavirus-than-citizens-of-other-wealthy-countries/#bdb3ec96a8ca">Americans Are More Anxious And Economically Battered From Coronavirus Than Citizens Of Other Wealthy Countries</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/nazbeheshti/2020/05/28/10-eye-opening-statistics-on-the-mental-health-impact-of-the-coronavirus-pandemic/#385af6052df0">10 Eye-Opening Statistics On The Mental Health Impact Of The Coronavirus Pandemic</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/carlieporterfield/2020/04/02/coronavirus-36-of-americans-say-pandemic-has-made-a-serious-impact-on-their-mental-health/#58c2f2ec6c8e">Coronavirus: 36% Of Americans Say Pandemic Has Made A ‘Serious Impact’ On Their Mental Health</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/carlieporterfield/2020/06/16/in-coronavirus-pandemic-americans-are-unhappier-than-theyve-been-in-50-years/#2b9b09da6255">In Coronavirus Pandemic, Americans Are Unhappier Than They’ve Been In 50 Years</a> (Forbes)



-Alison Durkee, Forbes Staff

Re-opening Continues Across Densely Populated New York And New Jersey Areas

Coronavirus Pandemic Affects Young Adults’ Mental Health More Than Older Americans: Poll

As Covid-19 continues to spread ruthlessly across the globe, governments have enforced lockdowns in countries to slow the infection rate. And this has meant restricted movements of people and work from home. As the globe’s population practises self-isolation and social-distancing, the lack of the familiar can lead to further stress and mental health issues. Establishing coping mechanisms to deal with anxiety and depression during these times is crucial. Healthcare practitioner and counselling psychologist, Nkateko Ndala-Magoro, through the South African Depression and Anxiety Group’s Facebook platform, lets us in on five self-help strategies to deal with depression.



Get active: “It is hard I know to stay active while you are confined. The benefits of staying active is the release of feel good hormones that are in contrast with the hormones that exacerbate depression. Being active also helps regulate your heart beat; for people suffering from anxiety, the regulation of breathing might help with the severity of the anxiety/panic attack.”



Take time to sleep: “I know people are already feeling like they do not have any more positions of sleep because of sleeping too much during lockdown. I encourage that people get as much quality sleep as possible in this time. Sleeping has benefits on our health and wellbeing in general, let alone on our mental health on many levels.”



Read: “Keep yourself busy by reading. There is a wealth of information in books. There are many online platforms including Amazon, which have made available e-books for free. Read self-help books and fiction to escape the reality; and any other books that interest you.”



Learn a new skill: “This will also keep you interested as mastering something new takes a lot in terms of focus and energy.”



Connect with loved ones: “Connect with your loved ones via video chats. Journal and work on things you have been meaning to work on to give you a sense of accomplishment.”

Man self isolating at home

5 Ways To Cope With The Self During Isolation

Millions of Americans&nbsp;<a href="https://www.nami.org/learn-more/mental-health-by-the-numbers" target="_blank" rel="noreferrer noopener">deal with mental illness</a>&nbsp;each year, and&nbsp;<a href="https://mhanational.org/sites/default/files/2019-09/2019%20MH%20in%20America%20Final.pdf" target="_blank" rel="noreferrer noopener">more than half of them</a>&nbsp;go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging.&nbsp;



Still a nascent industry, with most startups in the early&nbsp;<a href="https://www.cbinsights.com/reports/CB-Insights_Mental-Health-Briefing.pdf?utm_campaign=Webinars&amp;utm_medium=email&amp;_hsenc=p2ANqtz-9vLgEn6AfsUf_nXfn8UtBBrkhgfEFm7LsQrRFoI68CJsrXrU-zXKTi8M0sgpMW0unONnbLsAVUe6BO0cr2Vj1A0ZPhQiu4178Y2bOAidtpFApBFyw&amp;_hsmi=55818280&amp;utm_content=55818280&amp;utm_source=hs_automation&amp;hsCtaTracking=8133605e-ef8d-41b5-add2-a79fc7aa7322%7Cf61454a1-0ed7-46eb-87c7-40f56ce494c0" target="_blank" rel="noreferrer noopener">seed-stage funding round</a>, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help.&nbsp;



While the <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897664/#__sec1title" target="_blank">efficacy of virtual therapy,</a> compared with traditional in-person therapy, is still being <a rel="noreferrer noopener" href="https://www.thecut.com/2016/12/the-potential-danger-in-therapy-apps-like-talkspace.html" target="_blank">hotly debated</a>, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.



Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to&nbsp;<a href="https://pitchbook.com/news/articles/a-look-at-the-boom-in-vc-funding-for-mental-health-startups" target="_blank" rel="noreferrer noopener">Pitchbook</a>. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.



The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.



Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.



“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”



The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.



Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.



Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can&nbsp;<a href="https://www.northwesternmutual.com/life-and-money/how-much-does-therapy-cost-and-how-do-you-pay-for-it/" target="_blank" rel="noreferrer noopener">go as high as $200</a>&nbsp;or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients.&nbsp;



BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.



But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete.&nbsp;“Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist.&nbsp;



At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”&nbsp;&nbsp;



Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being.&nbsp;



Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app &#8220;isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”



Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.



&#8211; Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

gettyimages-524895492-170667a

How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

One in four South African employees are diagnosed with
depression annually. There are ways you can seek help while your identity is
protected by law.



<hr class="wp-block-separator"/>



You find your life spiralling out of control. There is an
overwhelming feeling of helplessness and the things that used to interest you
do not anymore. If this is what you are going through, you are not alone.



In South Africa, 4.5 million people suffer from depression,
costing the country $16.6 billion of its Gross Domestic Product due to lost
productivity, either due to absence from work or not attending work citing
sickness. 



These are figures by the IDEA study of the London School of
Economics and Political Science in 2016.



According to the South African Depression and Anxiety Group (SADAG), depression is among the prevalent mental disorders in South Africa, resulting in one-in-four South African employees diagnosed with depression annually. 



Meet Mfuneko Mthi, a prison warden from Kokstad, a little
town nestled between South Africa’s KwaZulu-Natal and Eastern Cape provinces.
Today, he sounds upbeat and has a positive outlook on life but this was not the
case two years ago. 



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He suffered from depression. It all started when he and his
childhood friend were shot at by a gang leader in their community. 



Mthi escaped death but the trauma manifested as depression. 



The two years took a toll on his personal and professional
life.&nbsp;&nbsp; 



As a prison warden, he had to work closely with prisoners
and at times, their correctional services uniforms would bring back painful
flashbacks of his offender. 



From then, it progressed to the perpetual submission of
medical certificates, one after the other, as he desperately tried all means to
run away from his inner demons.&nbsp; 



“I started reporting sick from work on a regular basis, even
though I was not sick. I could not face the correctional services uniform after
I had seen my offender, during the victim-offender dialogue (VOD),” Mthi
says.&nbsp; 



“The VOD is a voluntary process, where the offender and
victim are able to talk about the effects of the crime. Through the VOD
program, victims of crimes… engage with offenders and communities so that
relationships can be restored and forgiveness sought,” states a report by the
Department of Correctional Services.



During the times that Mthi was present at work, leaving
early also became a regular practice and isolation was his best-kept secret to
maintain sanity, he says. 



<blockquote class="wp-block-quote">I would leave early to go to my place and consume alcohol. I used up all my leave and sick days at work just to avoid being around people.</blockquote>



Mthi needed to go back to the root of the problem in order
to get the help he needed. 



He details how he and his friend were attacked by the same
perpetrator on two separate occasions.



“When I was in my teens, a gang leader who was feared in our
community, used to recruit the youth to commit crimes. When my friend and I
refused, he assaulted us. It is then that our parents opened a case of common
assault with the police,” Mthi says.



The unexpected happened. 



“On the day we got back from his bail hearing, he shot my
friend and I, saying that nobody presses criminal charges against him.”&nbsp; 



Mthi suffered multiple gun-shot wounds but his friend did
not survive the onslaught.



&nbsp;As the wounds healed,
the internal scars continued to bleed; life’s problems rubbed salt into Mthi’s
wounds. 



“A friend of mine committed suicide in 2017 and till this
day, we do not know what led to him doing that. 



“But he did make us aware that he was experiencing a series
of problems, and his job as a prison warden was taking a toll on him due to the
number of traumatizing things that happen in prison,” Mthi says.



&nbsp;He would drown his
sorrows in alcohol when the waves of depression were unrelenting. 



“I would drink a lot to help me sleep most of the time. Even
though I would go out sometimes, I got to a point where I was overdoing it and
that led to me being broke and that created a cycle which would lead to more
depression.”&nbsp; 



Mthi realized he had a problem and he took the first step
towards healing. 



He called SADAG, an organization in South Africa at the
forefront of patient advocacy and educating society on mental illness.



&nbsp;“They told me that I
had depression symptoms and advised that I go see a nearby clinical
psychiatrist,” Mthi says. 



According to Charity Mkone, a clinical psychologist, the
societal stigma associated with depression makes it difficult for it to be
warranted an illness.&nbsp; 



“It is something that is not seen as a real illness…people think that it is something that you can control and that you choose whether to be depressed or not. They also think that because of certain circumstances – such as being a prominent figure – you do not have a right to be depressed,” she says.&nbsp; 



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However, that is not true. Most people, according to Mkone,
have had some form of depression in their life, where they present SIGMECAPS
symptoms (as defined in the box-out).



&nbsp;“To some degree, we
have all expressed these feelings at a point in our lives. But it is usually a
phase. But for someone struggling with depression; that becomes a dominant way
of feeling, as opposed to someone who is feeling like that because of the
circumstances, and once the problem has disappeared, they are fine. A depressed
person would still feel depressed,” she says.



&nbsp;According to SADAG, rural-based
studies have found a prevalent rate of 18% depressive symptomatology and 27%
rate of depression, as opposed to the urban settings where as much as 25.2% of
the population is depressed and in peri-urban settlements where 34.7% of the
people have postpartum depression.



&nbsp;There are 23 known
suicides in South Africa per day, making it approximately 8,000 suicides each
year. Based on research from SADAG, for every person who commits suicide, 10
have attempted it. 



In South Africa, even though women are two times more likely
to suffer from depression, men are more prone to committing suicide. This is
often because men in South Africa battle to come forward with mental health
problems due to the stigma attached to mental health.



“It has a lot more to do with the stigma and that men don’t
actually come out to say that they are depressed. It makes them feel that they
are weak people because one of the symptoms of depression is deep overwhelming
sadness,” Mkone says.



<blockquote class="wp-block-quote">Men are five times more likely to be successful at suicide then women<cite> Charity Mkone </cite></blockquote>







Suicidal thoughts normally manifest when depression goes
untreated for a long time. 



Mkone says that when men commit suicide, they are found to
do it in a more lethal manner.



&nbsp; One of the first
steps that could be used within communities in order to assist people suffering
from depression is to be more aware of the symptoms. 



The more measures are taken to educate people in the
workplace and in communities concerning depression, Mkone believes this would
alleviate the number of suicidal deaths because persons suffering from
depression would get the help they need at an early stage.



&nbsp;It is, however,
important to note that depression may be caused by a number of problems such as
external factors, genetic inheritance, an imbalance of brain chemicals, certain
medical conditions, substance abuse as well as other various medical
conditions. 



This is why mental illness is a treatable condition and, as
a result, 80% to 90% of people have had a good response to medical care. 



Depression in the work place



Depression in the work place is becoming more visible.



“According to the medical ethical code of conduct that all
clinical psychologists sign and are bound to, the sessions that you have with
the client are strictly confidential unless the client gives you written
consent to divulge information about their sessions,” says Mkone. 



“In terms of a patient requiring a written letter for work,
we can provide a medical certificate,” she says. 



One in six employees are willing to disclose their mental
illness, according to a 2017 survey by SADAG.



Nadine Mather, who is a senior associate at law firm,
Bowmans, says: “An employee is not obliged to disclose to their employer that
they suffer from depression or any other mental condition. An employee may,
however, voluntarily choose to do so.”



&nbsp; She added that
should there be a case where the employer is aware that the employee suffers
from depression and it affects their performance at work, then they may address
the matter following the correct procedures, and it would be illegal if they
dismiss the employee without that. 



Depression is regarded as a sub-category of “incapacity” and is recognized as a fair reason to terminate an employee’s employment under the South African law should they no longer be fit to perform their duties.



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“In this regard, our law places an obligation on employers
to investigate the cause, degree and effect of the employee’s depression or
mental condition thoroughly, in order to ascertain the impact that it might have
on the employee’s work,” says Mather.



If the employer can prove without reasonable doubt that the
business or company cannot function without the duties of the employee within a
certain time period, then that could result in the termination of their duties.




“Only when an employer has followed a fair process and can
show that there is no prospect of an employee recovering sufficiently to
justify their continued employment, or improving within a time period during
which an employer could cope without suffering significant loss as a result of
an employee’s absence, would termination of the employee’s employment for
depression or a mental condition become justifiable,” Mather says.



“On the other hand, where the employee is too ill to work
and the employer fails to follow a fair process, the employee may, in certain
circumstances, be awarded compensation up to a maximum of 12 month’s
remuneration,” she says. 



When an employer realizes that their employee is suffering
from depression, they are obligated to support them. 



In Mthi’s case, the employers were supportive. 



They tried to accommodate him by removing him from
traumatizing environments that made him feel uncomfortable.



Mthi is no longer on medication for his depression, but
along the way, he has found the positive aspects of life.&nbsp; 



“I go to the gym during my spare time and I also sell
t-shirts. With the money I make from selling them, I assist the less fortunate
in my community, by buying them school uniforms,” Mthi says.



He is also working with some of his colleagues to build
houses in his community. 



Proving that Mthi is no longer the bleak and lost man he was
two years ago, he initiated a Facebook page last year called Depression is
Real. 



The page provides a platform to those who would like to talk
about depression. 



As depression is on the rise in the country, so are those
that have won the war over the illness, like Mthi. 



The trick is to seek help – before it’s too late.&nbsp;

Really bad news about my home finances. Debica, Poland

Depression in the work place

It’s an act so common you probably did it today or have done it many times before. The problem is, when done excessively, it could ruin your life. We are talking about daydreaming.
“I found out the man I thought was my dad was not my dad when I was seven years old… my mom made it sound like it was a secret and no one was supposed to know. It was a heavy burden for me. Many times I would wonder who else knew and what my real dad was like,” says Bongi Ncwane (name changed to protect identity).
All these questions in her mind set off a world of fantasy and pathological daydreaming.
Ncwane says she would spend a lot of time thinking about what life could have been like with a dad.
“My two older sisters had their dad and my two younger sisters have their dad and then there was me. Although my sisters were great and we could share everything, there was this one thing I couldn’t tell anyone.”
To cope, Ncwane says she created another world in her head.
“I started excessive continuous daydreaming. There is a separate life in my head. This world has a mom, a dad and I am the only child,” she says.
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The continuous daydreaming happened for years before she knew there was a problem. One day, she realized that she was spending hours daydreaming. It was eating into her productivity.
“I daydream and it feels real. If something is happening in my head and it’s emotional, I cry in the real life and when happy I would be happy. I realized I couldn’t control the daydreaming. I knew the difference between real life and what was in my head but there was always a need to do it,” says Ncwane.
She was worried and depressed. She says she spent time researching mental illnesses, like bipolar disorder and schizophrenia, but her symptoms didn’t fit any known conditions.
“I would beat myself up about it because everyone daydreams but I couldn’t control mine. It was taking away from my productivity and although doing very well in my career, I wanted to know why there was another me in my head who was growing, although at a slower rate, as I grew,” says Ncwane.
In Israel, 10,000kms from Cape Town where she is, was her answer.
For the first time, about 17 years ago, Dr Eli Somer, a Clinical Professor of Psychology at Israel’s University of Haifa, noticed an unusual mental activity in his trauma patients. Like Ncwane, they craved extensive fantasizing and often spent hours daydreaming.
“This condition is mostly caused by childhood trauma. In my work with trauma patients, I found that some survivors of childhood maltreatment who possess the intense daydreaming trait, are often intensely tempted to dissociate from their uncontrollable mental pain and absorb themselves in a fantasy world, of which they are in full control,” says Somer.
Somer has been conducting research in the field since. In a seminal paper, published in 2002, he presented this condition, which he termed Maladaptive Daydreaming (MD). Exactly like what Ncwane describes, Somer defined it as extensive fantasy that replaces human interaction and/or interferes with academic, interpersonal or vocational functioning.
“I believe that this type of highly absorptive, fanciful and vivid form of daydreaming requires a special ability. The ability to create an inner world, a mental virtual reality. This trait, often discovered accidentally during childhood, is experienced as highly enjoyable,” says Somer.
It is dangerous. According to Somer in some extreme cases, MD can replace real life.
“People with MD prefer to spend every waking moment of their lives in their inner worlds. In such severe cases, the sufferers display additional mental disorders and are unable to sustain themselves.”
Ncwane and the trauma patients Somer has met are not the only ones talking about this condition. Hundreds of people on social media tell stories of how excessive daydreaming has affected their lives.
“I have lost three jobs in the last 16 months,” says Doreen Wales (name changed to protect identity), who says she can spend up to nine hours a day daydreaming.
“I can’t seem to be able to snap out of it. I have tried to explain to therapists and I have been on various kinds of medication over the past 10 years but nothing seems to work. Unfortunately, this condition seems far-fetched to get the attention it needs. I am happy there is a Facebook community of people going through this and we help each other cope. I have to always try to be active, play music or continue talking to people because once it’s too quiet, I fall into daydreaming,”  says Wales.
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In fact, according to Somer, the rewarding properties of MD also explain why it can develop into a maladaptation. He says people with the condition prefer to daydream whenever they can, and do so at the expense of their daily productivity. It can be triggered by evocative music or repetitive physical movement, such as pacing or rocking.
“To my mind, MD is a dissociative absorption that has evolved into mental addiction,” says Somer.
Unlike schizophrenics, according to Somer, people who suffer from MD, differentiate well between fantasy and reality. In a recent study, on the comorbidity of MD, he found no evidence that schizophrenia is even similar to MD.
The problem is, the clinical field of MD is very young. The condition is not yet well recognized, so people like Ncwane and Wales will continue to pay the price until scientific research yields more answers.
For now, the lives in their heads hold more promise than the real world they open their eyes to.

The Mind’s Virtual Reality

It was an experience easier to drown in than describe – one of Romi Vidmar’s many hypnotherapy sessions in his small office in Northcliff, an affluent suburb in Johannesburg, South Africa.
As we meet, cars drive past on the busy road. Vidmar asks if I want to experience hypnotherapy.
I sit up straight on the black office chair, my hands on the brown armrest, and Vidmar makes suggestions in a calm voice.
“Visualize your wrist on the right arm. Feel it, imagine it and nod your head when you can. Imagine everything I say is happening because it would actually happen,” he says.
He makes some more suggestions and everything he says happens, until I am in a hypnotic state.
As he speaks, there is a sense of calm, vaguely familiar, akin to the countless times I found myself lost in thought, absorbed in a zone, or simply, daydreaming. The session lasts less than 10 minutes but has the effect of two hours of sleep.
“You are of supreme confidence,” he says as he closes the session.
<a href="http://www.forbesafrica.com/woman/2017/11/15/mental-virtual-reality/" target="_blank" rel="noopener">READ MORE: The Mind&#8217;s Virtual Reality</a>
Even though I had started the session as a sceptic, I feel more relaxed than I have ever been. As I pen this article, I still remember his soothing instructions. Twenty one days later, I feel more confident and have a brighter outlook on life.
“With hypnosis, the human mind goes into an even more relaxed state than meditation. The physical body becomes completely relaxed but the mind remains active,” says Vidmar, a software programmer who has always been interested in understanding how things work. The human mind is one of his major interests.
“I was very interested in hypnotherapy and started doing some research. It wasn’t easy because there wasn’t enough information and most of what was there was confused with entertainment and spiritualism but I discovered, through reading academic work, there is a solid basis for the hypnotic state which you just experienced now,” he says.
<div id="attachment_34398" style="width: 511px" class="wp-caption aligncenter"><img aria-describedby="caption-attachment-34398" decoding="async" loading="lazy" class=" wp-image-34398" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Romi-Vidmar-e1510734243740-300x199.jpg" alt="Romi Vidmar hypnotherapy" width="501" height="332" />Romi Vidmar (Photo supplied)</div>
In 2000, Vidmar trained to be a hypnotherapist and started practising.
“With hypnotherapy, I am able to understand the human mind and help people suffering from depression, anxiety, wanting to lose weight, stop smoking, gain confidence and many other things. For example, with people who have been abused, we help them not to forget but bring some degree of comfort so that they can be able to continue with their lives,” he says.
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According to Vidmar, hypnotherapy is witnessing a big boom in town. He sees eight patients a day at R800 ($60) for a one-hour session. Most of his clients, he says, just want to be happier, deal with depression and other mental issues, stop smoking or lose weight.
“Prescribing medication may be a lot quicker but the medical industry should explore hypnotherapy as a much more sustainable solution. Eighty to 90 percent of my clients see a change after the first session and they come back five or 10 years later but in that time they refer other people.”
Amanda Hoole (name changed to protect identity) is one of the many who claim hypnotherapy helped.
“I had many issues because I was abused as a child and I had a bit of a rebellious energy. I smoked a lot and was an alcoholic. Over the years, I have had hypnotherapy about six times. Now alcohol and cigarettes smell and I can’t stand them. I am even able to keep a job, which is something I couldn’t do for many years,” she affirms.
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According to Vidmar, this effect is possible because hypnotherapy also comes with suggestibility, so much that it was used instead of anaesthesia more than 200 years ago.
“Some medical doctors even train so they can use hypnotherapy when treating patients, for example if a child is afraid of the needle or for women going through childbirth.”
He says hypnotherapy helps by interacting with the subconscious to address the whole mind rather than just treating the symptoms. Through the words used in the session, Vidmar says hypnotherapy replaces trauma with positivity and suggestions create long-term improvement.
“You are even able to deal with unresolved feelings. With hypnotherapy, we can go down to the deepest level of these traumatic experiences, memories and stored emotions to release them from the mind and body,” says Vidmar.
In fast-moving 21st century Africa, hypnotherapy may hold the answer to mental wellbeing, or could at least be one of the options to relieve trauma and stress.

Tag: mental health

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