Is Anxiety Affecting Your Skin?

In a new field called psychodermatology, doctors are exploring the connection between anxiety and the skin.

If you’ve ever had a sudden bout of eczema bloom on your arms or legs while working on a big work presentation or studying for exams, you may already know that anxiety and skin disorders can create a vicious circle. These days, the medical doctors who research topical skin disorders and research the space where psychology and dermatology overlap is called psychodermatology.

Psychodermatology covers a wide range of issues. From “flare-up” issues like psoriasis or acne vulgaris, which are exacerbated by stress, to “self-injury” issues like factitial dermatitis, where people are actually creating lesions on their skin from picking at it, the medical world is just beginning to unravel the connection between skin disorders and anxiety. Is stress causing your skin to flare up? If so, are these flare-ups adding to your anxiety? Here’s what studies show. 

The Body’s Largest Organ

Skin, the body’s largest, fastest-growing, and most visible organ, can signal what’s happening with our nervous systems, our internal bodies. It’s a bit of a revolutionary thought, and it’s not how dermatology, focused solely on the external visible condition, has functioned in the past. For this reason, the field of psychodermatology is a bit controversial.

Patients with skin problems who often drift from one doctor to the next in search of an effective remedy. For the most part this is due to the disparity between treatment approaches and a general misunderstanding of the underlying medical conditions among health professionals.

While cross-collaborations and knowledge of alternative treatment options are gaining traction among psychologists, general practitioners, and dermatologists, this is far from being the norm.

Starting with Diagnosis

Many conditions can be helped with a psychodermatological approach including:

• Psoriasis

• Prurigo

• Urticaria

• Lichen simplex

• Rosacea

• Hyperhidrosis or excessive sweating

• Seborrheic dermatitis

• Eczema

• Aphthosis

• Hives

• Acne

• Skin allergies

• Hair loss

Although criticism of the approach focuses on its lack of corroborating data, anecdotal evidence shows that psychodermatology is proving to be highly beneficial for patients who would otherwise continue to struggle with a seemingly incurable condition, in part because it helps address self-image issues that go hand-in-hand with skin disorders.

Self-Image Issues

The emotional effects of skin disorders are similar to the disorders of self-image spawned from the lack of positive nurturing during childhood. The pervasive nature of skin disorders often produces neurotic symptoms, depression and hostile personality traits in the patient. They can exacerbate pre-existing feelings, like sensitivity to the attitudes of society or anticipation of rejection. Incidentally, there happens to be a higher prevalence of these simultaneous medical conditions among female dermatological patients, widows and widowers.

The psychological stress of low self-steem can be sufficient to upset the permeability of the epidermal barrier, thus disrupting homeostasis, which causes some inflammatory skin disorders. Inflammatory skin diseases caused by psychiatric conditions act on the body’s neuro-immuno-cutaneous system (NICS), which is responsible for interactions between the nervous system, the body’s natural immune system, and the skin. Over a third of dermatology patients are treated through this complex interplay of the neuroendocrine and immune systems.

Chicken and Egg

Which is the trigger, the skin disease or the anxiety? A person dealing with acne is likely to have more emotional stress due to their appearance and thus, the added stress makes the existing acne persist. Studies have shown that young people with acne are at increased risk of depression, anxiety and suicide attempts. It can become a vicious cycle where the psychological response symptoms further exacerbate the skin disorder. Since we can’t always answer the chicken or egg dilemma, it’s important to find relaxation techniques and medications that will help with daily stress management. Here are some places to begin:

• Biofeedback

• Meditation

• Breathing

• Hypnosis-induced relaxation

• Behavioural techniques

• Operant conditioning

• Affirmation

• Guided imagery

• Progressive muscle relaxation

• Symptom-control imagery training

• Antidepressants

 Therapeutic goals in the treatment of psychodermatologic diseases include reducing symptoms, improving sleep, and managing the various psychiatric symptoms like social embarrassment and withdrawal, along with the associated anxiety and anger.

Psychodermatologists see skin from both a biological and a psychosocial perspective. In learning how the mind and body respond to emotional and environmental stressors, practitioners are able to help moderate those responses.

Only with increased understanding will these issues and approaches between primary care physicians, psychiatric practitioners and dermatologists be beneficial.

Hippocrates, the father of medicine, said, "Who has the disease is as important as the disease they have." By delving into the personal history of a person’s aspirations and disappointments, family dynamics and childhood issues, it’s possible to identify the emotional switch or triggers that turn on the symptoms of skin diseases. 

Hayley Sloan is a medical writer for The Breslow Center in Paramus, New Jersey.

When Fame Comes Early and Anxiety Follows

I did not want to be “that child star” for the rest of my life.

One thing that scares me the most is talking about myself. How much is too much? And how less is not enough? Will they judge? Will they be shocked? Do they even want to know?

Some important background: As a child, I was an actor on a popular TV series in India. I grew up on the TV. The camera and books were my best friends. Born to extremely humble and “normal — middle class” parents, me being on TV was a big thing. Some people in my family appreciated and acknowledged what I was doing, but most didn’t, so it was just the three of us through it all. I went to a decent school, got good grades but school was just something I did apart from my work.

As a child, I was an actor on a popular TV series in India.

I did not want to be “that child star” for the rest of my life.

Growing up with the world watching you on TV is not easy. They watch your every movie and they follow you everywhere. They want to know what you ate and how much. They want to know where you slept and with whom. While other kids were making friends, pulling pranks on teachers and playing hopscotch during the summer holidays, I was in front of the camera pretending to be a new person everyday and understanding the value of money. No, money was never something my family needed, but an added income always helps right? I bought our first car at 14 and our first own house at 21.

But I did not want to be “that child star” for the rest of my life. I wanted people to know me not just as the characters I played, but for who I am. My relationship with Bollywood was like a mutual break up. I didn’t want to do certain roles, and the industry was more than happy to work with new faces. I went completely awol, not to be seen on social media except for a few pictures from the last photo-shoot, always on the “look how they grew up to be” or “where are these child stars now” lists. I went to college, got an education, started working and doing different things. “Hey, aren’t you that girl from that TV show?” never left me.

Some of the best times I’ve had were on the film sets; some of the most amazing people I’ve met are from the industry. My life was a fairytale, just like my show and it was indeed a dream come true. I still get recognized and it is flattering, but it is also very uncomfortable. Mostly because the image that people have of me is not what I really am. I am in my pajamas all day, messy hair and feeling crappy about myself at all times. I suffer from chronic anxiety and depression and I don’t like to be around people. I suck at society. But that’s not what they want to hear.

What It Feels Like Inside

I am a torrent of anxiety, in the pit of disrepair and illustriously bound to the banks of a raging river of ripped up stories, poems, and legends never told. The Vial I hold is filled with vile putrid secrets unbecoming of my own scornful mind. They are not my secrets, not mine alone they are the hidden fears, phobias, and shames of many lucid souls. I pour into the maelstrom of an eternal mystery, the gods of woe, writing, willpower they are laughing and sobbing in a cacophony of screams never ripped from shattered minds.

The Poetry Within

As I bleed synthetic hollow echoes of hallucination from wounds I have not yet received, scars not yet born nor, are these lacerations to live ever, I learn that my carelessness has cornered me into a vale of memory. A ferocious beast, a lion of decrepit despair, and depression roars at me in with rage and pure vengeful power beyond imagination and comprehension.
I am an injured insignificant rat bound to a fetid corner of this malignant prison. It is with this I nearly succumb to fear and boundless possibilities of hells that could await my shell and soul.
The Valkyrie from Voracious Valhalla she comes, with spear of spiritual courage, and shield of healing hope, and the soul of the wolf and its determination to press onward. I was reborn in that moment, the revelations of Renaissances from past, present, and future and far beyond ripped into my body, mind, and soul. Just as a rat will fight when cornered and a wolf when injured even if beyond all hope, it will fight if it still has “teeth”, and I was ready as battle for creation, curiosity, and tempered true love was begun

The war against the lion still rages on this day, though one wolf cannot do it alone, for they hunt and fight in packs, as friends, family, of all sorts rip at the hateful lion of lovers lost, void, and grief. It is a battle fought by many against demons, lions, and despair, and men, women and, even children fight these battles everyday in their own soul and mind. Let the lovers of life win and the hells of malady of mind be subdued and defeated, for we cannot truly kill our “lions” or “demons” but we can subjugate them. To do much though is an uphill battle for many and we all could use a little help….join in the fight.

I am not going to take all the credit for the acting I did, it was a lifetime ago. All these kids that grew up to be actors, they all came after me. They came in the age of YouTube and Netflix, they know what to say and how to dress. Back in the day my mother packed my clothes for the shoot next day. Times have changed and how! I don’t know if I will act again, I might if something interesting comes my way. As a kid, during interviews, when they asked me what I wanted to do when I grew up, I always said director or writer or camerawoman. It was anything but acting. Well, only time will tell.

Why “I Beat Anxiety” is a Terrible Title

This is not the right approach for anxiety.

Ditto for “Overcame,” “Conquered,” and “Escaped.”

Because I’ve been working on Beautiful Voyager for the past three years, nearly every day I receive a new trending anxiety article via text or Facebook messenger from a smart, well-read friend or family member. The piece usually looks like this:

Wall Street Journal, April 28, 2017

These headlines always make me groan. I know they are perceived as what will garner clicks, but they just cause more problems for readers. Whether the writers or editors chose the titles, this is often how anxiety articles are packaged.

The problem is: what gets clicks wends its way into hearts and minds. This framing will not help people who actually have anxiety. In fact, it will exacerbate the problem.

Those of us who have anxiety are always looking for answers. We google until our fingers are numb. We read every book we can find. We covertly study. We slyly interview. We believe that if we work hard enough, we will find a way to beat, escape, or conquer anxiety.

Look ma, more muscles!

Alas, all of this trying and searching is only adding to our anxiety. It is part of the problem, not the solution.

There is no path “out of” anxiety. If you have an anxiety disorder, like Andrea and I do, then like us, anxiety will likely be some part of your entire life.

Does this mean that you can’t be happy? No! You can find many ways to feel safe and comfortable with who you are, anxiety and all. But the false promise these headlines are selling in order to get your click — that you can no longer feel the pressure of anxiety if you just read what someone else did to work on theirs — is a lie. And it needs to stop.

Et tu, Psychology Today?

We all need to stand up to click-bait anxiety titles, but this critique is really aimed at my fellow writers.Ask yourself, “Do I really mean what I’m saying when I write ‘beat anxiety’? Or am I just wanting a dopamine hit from getting a bunch of clicks?”

If it’s the latter, then perhaps you, too, need to ride the wave and adjust your expectations.

Tandem surfing was actually a thing in the 60s.

What I want people with anxiety to know: you’re not alone in feeling confused. You don’t need to Arnold the situation to be OK. There are many tactics to try, but since no two anxieties are the same, what worked for others won’t always work for you. Keep experimenting and you will find calmer, happier shores.

And good luck on that wave!

Originally published in April 2017. Updated in September 2018.

Try A CBD-Enhanced Bath

As you can see, the packaging described that it has 60 MG of CBD in it, in addition to magnesium, menthol, and mint. More info about ingredients here.

Last week, Rebecca Jennings of Vox published a story called Fidget Spinners, Weighted Blankets, and the Rise of Anxiety Consumerism. In it, she talks about the Beautiful Voyager origin story. Since the piece came out, there has been a surge in people visiting Beautiful Voyager, but there has also been a surge in the people sending me products to test. Earlier this morning, I tested one of those products, the Migraine/Anxiety CBD Bath Bomb from Antidote + , $29 for 3.

I shared my experience in real time on Instagram, but figured it would be helpful to lay it out here, too, in story form, including my review. Here’s the step-by-step experience. Results below!

Here’s an insight into setup. The bath bombs come with detailed instructions about when to take the bath, and how.

Why I chose to do the review today.

Make your bath hot, not warm, and know that cannabinoids, menthol, and magnesium are the magical combo.

It’s useful to know that you will be taking a leprechaun bath.

Sorry this is vertical. It’s hard to figure out how to make videos work in all settings.

The instructions say you need to hang out in the bath for at least 20 minutes (though the Antidote website suggests soaking for 30 minutes, so maybe the longer the better?).

That was not a problem for me.

The full list of ingredients to the bath bomb: bicarbonate of soda. citric acid. maize starch. epsom salts. organic coconut oil. organic peppermint essential oil. cannabinoid oil blend. food-grade color pigments. 

Review #1: CBD Bath Bomb From Non-Anxious Person (Meredith’s Husband)

At first, I didn’t think it felt very different than a regular bath, though I feel everyone should take my feedback with a grain of salt since I usually question whether CBD does anything for me. I really liked the smell. Over time, though, I noticed that I was more relaxed than usual. How much would I spend for a relaxing good-smelling bath like this? Probably $3-5.

Final thought: At first, I didn’t think I was feeling much, but 15-20 minutes later, I noticed I was feeling very relaxed. If someone gave me this as a gift, I would definitely be happy about it.

Review #2: CBD Bath Bomb From Migraine Sufferer (Meredith)

I took my CBD bath the morning after a migraine, at a moment when I had a lot of neck tension. As I got into the bath, I immediately noticed the menthol smell was soothing and good for my sensitive nose. I also tuned into the feeling of the coconut oil on my skin. It wasn’t just softening, it encouraged muscle release and neck massage. In terms of the CBD, it definitely adds a new tingly sensation to the bath that is helping my body chill out. I always appreciate this kind of feeling. Since I have very physical symptoms to my anxiety, starting with body relaxation is key for me.

It’s been about an hour since I took the bath. I still feel relaxed and calm and ready to tackle my day in a grounded way. I think the key question is: Is this feeling worth a $10 bath bomb? My answer: It depends on how much you are suffering. If more than one person in your house can use the bath at a given time, that helps bring down the price.

Final thought: I initially thought I wouldn’t buy these CBD bath bombs for myself because I’m bad at that kind of indulgence, but just two weeks later, I found myself reordering these bath bombs and giving them away as gifts. If you’re looking for a great present idea for someone like me, this is the way to go.

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What about you? Have you tried a CBD bath bomb? How did it work for you? Let me know!

The Best Career Advice I Ever Got

It’s 5 AM. I woke up earlier than usual this morning, roused by the sound of my dog throwing up. Not the greatest way to meet the day, but luckily, I love her.

Love makes vomit easier to handle.

Speaking of vomit...

Four years ago, I was moving from startup to startup, confused about my future but leaning into the roles I thought others valued. In the middle of the confusion, I had lunch with a wise friend. An artist and actor, she knows how to read people, and she knew me well. I remember we were eating brunch in San Francisco, near the water, a view of the Bay Bridge before us. I was telling her about my latest job:

“I think it will be good. I am in charge of figuring out how to break engineering work into manageable cycles while working with the operations team to make sure our products are aligned with their expectations.”

My friend got a confused look on her face. Her response was immediate and to the point. In a direct and loving way, she said, “Meredith, don’t you think you might need to be a little more creative in your role? I remember how happy you were working on videos in your past job. You loved that.”

I trust Molly. When it comes to creativity, she knows what she's talking about.

It’s incredible how much a single question can affect the course of your life. I thought long and hard about what she said. Over the next couple of years, I slowly righted the ship. I started by building Beautiful Voyager, an experience that reminded me of my core strengths. These days, I’m happy and secure in a creative role at a larger company I love.

There you have it. The advice that wasn’t advice, but a question. I asked the Beautiful Voyager community to share the best advice they’ve ever received. Here’s what one person said:

The best career advice I was ever given was actually through an NPR interview with the founder of Spanx, Sara Blakely.  She advised “whenever you can afford to do so, delegate the things you aren't good at.”

Though this seems like basic business acumen, it was an eye-opener for me.  As a business owner who is also a perfectionistic overachiever and control seeker, the idea of delegating is scary.  Once I accepted myself and chose to trust others, the process of feeling safe through delegation began.  Of course, finding people who share the passion for our business and services was essential, and now that we have them, my anxiety (and overthinking!) has been relatively put to rest.

I love that it came from the Spanx founder! Trusting others is incredible advice. Thank you for sharing. Here’s another:

The best advice that I ever got was personal rather than professional and it also came in the form of a question.  It was about 10 years ago and I was having lunch with some friends. After mentioning that I was once again returning to counseling because of my depression and issues related to my marriage, one of my friends asked, “If you had to do it over, would you marry your husband?” When I said that I wouldn’t, he asked, “Then why are you still with him?” 

It’s wonderful how direct questions asked by a dear friend can give a girl the kick in the pants that she needs. Because of that question (and the unwavering support of that handful of friends), I found the strength to leave an emotionally-abusive marriage after 17 years, move to another state, and start over.

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Do you have your own story to share? Write it in the comments and share your insights with others! It just feels good to help.

Video Interview with Little Panic Author Amanda Stern

Two Gen Xers Share a Facebook Live Chat and Live to Tell The Tale

Yesterday afternoon I had the pleasure of meeting and talking to Amanda Stern, author of Little Panic: Dispatches from an Anxious Life on in a Beautiful Voyager Facebook live chat. It was such a joy to get to find out from Amanda herself, whose book I loved, about how the book came to be, and what it feels like to talk about her panic disorder publically. It's a long interview (1 hour!) so I wanted to break down different areas so that you can forward to the area that interests you.

2:20 The interview really begins (the first two minutes are warm up).

4:45 How it feels to be talking about panic disorder in real life.

6:30 Anthony Bourdain and Kate Spade's suicides affected this public moment.

8:38 Jenny Slate would play Amanda Stern if there were a movie version of this book.

11:38 How writing is almost like doing EMDR on yourself.

13:49 How the fear of not being educated enough may have held her back.

19:15 Panic disorder wasn't in the vocabulary, therefore people didn't spot it.

14:40 The difference between gut (trust the gut) and the feeling of doom (don't trust it).

28:04 The last panicked experience Amanda had. What happened, and what it felt like.

36:45 Amanda and I both talk about how amazing the book The Worry Cure is.

38:45 My very personal take on why Scott Stossel's book is the result of a stigmatized culture.

45:53 Amanda's next voyage may be: intelligence testing.

50:19 Amanda's advice for parents who may be dealing with anxiety disorders in their children.

54:30 What Amanda and I are worried about right now.

57:13 Amanda is going to be in San Francisco and we are going to meet up. Come see her read from her book and say hello to me too!

A Beginner's Guide to Generalized Anxiety Disorder

At first, it can be hard to even recognize what forward movement even looks like.

When I was first diagnosed with Generalized Anxiety Disorder, I went searching high and low for a guide that would help me understand what I needed to know about what that meant and what I should do. It was a very confusing time. I googled like crazy, but found nearly nothing online that informed me in a real, useful way. This was way back in 2015, and at the time there was much less than there even is now. Many "guides" used the word worry repeatedly. Worry wasn’t what I did or how I identified. Overthinking, yes. Worry, no.

Then I read a quote from the tennis player Mardy Fish that captured my experience of anxiety in vivid detail. He says: “I wish I had been able to tell myself that I was doing great. But my frame of mind back then couldn't process great. All I could focus on was doing better.”

This short guide is meant to help people who, like me at the time, are just beginning their journey with GAD. If you find yourself googling like crazy and not being able to find answers to your questions: Welcome, kindred soul.

Q. What is Generalized Anxiety Disorder, exactly?

A. If you've already been researching this, you know that GAD is often described as a psychological disorder characterized by excess “worry” particularly about work, finances, and relationships. That's now how it felt to me. I've noticed that often people with GAD don't realize they have it for a long time in part because they don't think of themselves as worriers.

You might hear that GAD means you worry about worry. If you don’t even consider what you're experiencing as worry, that bit of information doesn’t help. And if you are so habituated to pushing away the worry as a coping mechanism, then descriptions like that will lead to a vicious avoidance cycle.

For me, having GAD means that I tended to overthink nearly everything, meticulously trying to figure it all out. When problem arose, I’d write them down and begin my crazed attack in every direction. More noticeably, it also meant crippling shoulder and neck pain and nausea, especially on buses. I used to get dizzy  at times, almost to the point of fainting. The physical symptoms are important: this is what can help you get diagnosed faster. Don't ignore them! 

Q. Can a person have GAD and not know it?

A. It's more common than not that people who have GAD see many doctors before they get properly diagnosed. Gastroenterologists, chiropractors, neurologists, acupuncturists, and gynecologists are some of the people Gaddies might visit on the path to diagnosis.

Q. Is GAD hereditary?

A. Yes, there is a genetic component, but as is often the case, that’s only one part of the equation. Genetic roots and predisposition to anxiety disorders can be triggered by environmental factors. The death of a loved one, divorce, the sudden loss of a job or your house, or a big change in circumstance can bring on episodic fare-up of GAD.

Q: If GAD flares up, does that mean it’s dormant at other times?

A: Even if you're predisposed to GAD, with proper treatment, you can bring your symptoms into check. Since you are predisposed to this condition, when things happen to you, you will be more likely to have bigger anxiety responses than other people. 

Q. How messed up is someone with GAD, exactly? Please be specific.

A. It depends on the person. My GAD makes me aware and worried about silly stuff like taking out the garbage. My family teases me about my absurd fear that if I miss taking out the garbage, our house will be overtaken with garbage. It makes me laugh, but the laughing doesn't stop my anxiety symptoms from coming around every Sunday.

Or this example from years ago, when a few ants were coming through our bathroom window. My response was immediate: "Let's replace the window." It didn't matter that we couldn't afford it. I just wanted the stress to go away. And why was there stress? It was because I didn't see the few ants on the floor. I saw an inevitable 100–200 ants that I imagined would invade and carry off our house.

It’s very hard to be in the here and now when catastrophizing. (Catastrophizing is a cognitive distortion. Learning to recognize cognitive distortions is one important element of cognitive behavioral therapy, the best method for treating GAD.)

A neighbor put it well when he said: “I realized that I did everything in a rush—even simple things like brushing my teeth or making coffee. Eighty percent of what I do on a typical day does not require hurrying and rushing. That rushing creates a lot of stress throughout the day.” I know exactly what he means. I sometimes have the feeling that if I don’t get a certain small household task done at any given moment, the world might end.

Gaddies are not known for their patience.

Q. If I have GAD, how do I make it go away? Does it last forever?

A. Learning to ride the wave is a great place to start. When stressful things happen, you can expect to feel your own particular gremlin poke his head out of the wave’s crest. Knowing what to do with him and that I’ve survived his visits before helps a lot. Here's some more information about whether generalized anxiety goes away.

My own personal trifecta of how to settle the wave is: Meditation. Medication. Communication. Of course, each person has different needs and a different approach. The way to figure out what works is to experiment.

Q. Can anyone develop GAD? What’s the line between having it and just being a regular stressed out American?

A. The difference between regular anxiety, stress, and GAD comes down to degree. Most people with everyday stress and anxiety aren’t fainting or getting up in the middle of the night. They don’t need neck rubs every day. And they aren’t negatively predicting the outcomes of regular social interactions in a way that adds extra stress to daily life.

A fellow Beautiful Voyager described it this way: “I tend to project into the future all the time. I’m often planning how to deal with some negative turn of events that might happen in the future. Most likely never will. So I’m worrying in the present about something that will never happen in the future.”

If his experience sounds familiar, you might want to keep reading about Generalized Anxiety Disorder.

Q. Is GAD what has been wrong with me?

A. If what you're reading here rings that inner bell of familiarity, you might want to pick up the book The Worry Cure. Don’t think about the title too much. Just investigate your physical symptoms through the lens of your thoughts paying attention to whether what this book has to say relates to you. If it doesn't, then it's likely not GAD that's been bothering you.

Q. Will I ever feel better if I have GAD?

A. I believe that you can feel better if you have GAD. Simply the fact that you're reading this now means that you're on the path.

Q. How do you know?

A. Times are changing. People are talking openly about depression, anxiety, and other forms of mental suffering in a way that they never did when I was younger. The more people speak openly about the spectrum of mental conditions, the more they can be helped earlier on.

Q: What should I do if I’m a friend or family member of a Gaddie?

A: I feel for you. It’s not easy to deal with an anxious person, especially at the high pitch levels that people with GAD specialize in. It’s hard to avoid the role of friend-therapist. You might find yourself talking your friend down and trying to give them a more realistic view of their surroundings. The goal is to help them build those muscles for themselves without exhausting yourself. Bottom line: put the oxygen mask on yourself first.

On the other hand, GAD often presents as perfectionism or invulnerability, so it can be confusing. How do you help someone who doesn’t seem to need help? By tuning in to your instincts. Is the person talking super fast? Are they in a lot of physical pain? If so, they may need to help to learn a new way of thinking about the world around them/

You can gently encourage them to stay grounded in the moment. Send them a link to this piece. Do it with love.

New Mental Health Apps Reviewed: Wysa, Woebot, Joyable, and Talkspace

A few months ago, I was asked by Healthline to review a handful of mental health apps for a story the team was working on. Well, that story is now live on the site. I thought that it might be interesting to share my original reviews for Wysa, Woebot, Joyable, and Talkspace, popular mental health apps on the market now. In addition to paying subscription fees, I was paid $150 to write these reviews (I like transparency around Beautiful Voyager money matters). So take a look at these 4 mental health app reviews and see if you agree with what I found.

Wysa

Cost: Free with In-App Purchases

At first, the differences between Wysa and Woebot were hard to spot. Both are chatbots with a cognitive behavioral focus. Both have daily check-ins. Both offer pre-filled answers to make the check-ins easier (which I appreciated).

I like that the app has small moments of interactivity threaded through the experience.

I also liked some of the interactions. To tell Wysa how you’re feeling every day, you slide the big yellow emoji face up and down. That felt fun and easy.

My interest in Wysa waned pretty quickly though. The app never seemed to know what time of day it was, and the constant presence of the little moon in the upper righthand corner of the screen became a small reminder of how rudimentary the bot really is.

I found Wysa’s requests for more information tiring. It kept pestering me to tell it more about how I was feeling without any examples of what it meant or why that would help me.

Gifs kept popping in at the wrong times and loaded slowly instead of automatically, the way gifs normally do, interrupting  any momentum that I may have been building during the check-in. I found the app’s humor cloying. It wasn’t able to read my signs...or my terse responses, which were a sign of annoyance.

How would you rate the apps user friendliness? Consider a person who is having a bad day (would they be likely to stick with it or are there aspects of it that would be too frustrating?)

I’d find Wysa too frustrating to stick with on a bad day. I’m not a big fan of being asked what I’m feeling constantly, especially without guidance about the scope of response desired. Open-ended questions stress me out. I felt like Wysa didn’t understand the mind of an anxious person. It sometimes created more stress in me to figure out how to chat with it.

How does Wysa compare to in-person therapy? Better? Worse? How and why? Definitely worse. The missteps were clear signs that I was chatting with a very imperfect chatbot. It made me lose interest quickly.

If it needed to learn from me in order to improve, it didn’t make it clear what I needed to provide it to get to that improvement. It felt like I was throwing effort down into a well, and nothing new was coming out.

What the easy toolkit access looks like.

What are the best features of Wysa (3 max)? Why are these features so helpful? Where do you feel it could use improvement (2 max)? Why do you feel this needs improvement?

Best

1. Easy toolkit access to guided meditation and mindfulness activities helps offer a way to guide the chats in useful directions.

2. Ability to “activate coach” (for a price) and chat anonymously with a coach who will guide you to the right tools.

3. Pre-filled responses and fun little interactions to make chatting more fun.  

Worst

1. Constant requests for more information without understanding why or how that helps me.

2. Humor was a little cloying.

Woebot

Cost: Free

Woebot’s a well-written chatbot. With pre-filled answers (see how the word “interesting” is right there for you to hit and keep going?) and guided journeys, it feels more like an interactive quiz or game than a chat.

 Woebot’s daily check-ins start with a question about where you are and what you’re doing, but unlike Wysa, it doesn’t push with open-ended prods. Instead, it asks you to choose a quick emoji that describes what you’re feeling. That’s simple enough.

 Over time, Woebot charts those emoji responses to help visualize trends, then shares that chart with you, allowing you to understand why you should bother checking in daily.

 I often used Woebot on my morning commute, and I found it easy to use in any environment—an advantage of any chatbot. The loud sounds on the train didn’t affect my morning check-in, and I could whip it out between meetings to have something positive to focus on.

How does Woebot compare to in-person therapy? Better? Worse? How and why?

Let’s look at the factors that make therapy difficult for some people: time and price. Both of those issues are removed when it comes to Woebot. Does that make Woebot better? No, but it certainly makes it easier.

On the advice of others,  I went to numerous therapists for varying periods of time over the course of my 20s and 30s. They were caring people, but they weren’t able to diagnose my true problem: Generalized Anxiety Disorder. (I was diagnosed by a neurologist in 2015.) It was the insight that anxiety was causing physical pain that helped me the most of all.

This is where the comparison between a chatbot like Woebot or Wysa and in-person therapy breaks down. If you’ve downloaded an app that describes itself as an: “emotionally intelligent chatbot who reacts to the emotions you express unlock tools to help with anxiety, stress, low mood, anger or sleep issues” (Wysa on the App Store) or a “choose-your-own-adventure mental health manual that gets more specific to your needs over time” (Woebot), you are likely already in the ballpark of knowing what is happening with you. Since that is more than half the battle, the bots can build on that understanding. In-person therapists, however, aren’t necessarily meeting people with that level of awareness, and as a result, they can cause accidental confusing digressions on the road to self awareness.  

A trend chart can help me with a wider perspective on my moods.

In other words: self-knowledge is the most important part of mental health growth, regardless of the format of the treatment. People at different stages of the journey, or with different needs, might find a chatbot more helpful than in-person treatment. I, however, preferred Joyable and Talkspace to Wysa and Woebot.

How would you rate Woebot’s user friendliness? Consider a person who is having a bad day (would they be likely to stick with it or are there aspects of it that would be too frustrating?)

I found Woebot friendlier than Wysa. To kickstart a habit change, chatbots feel more approachable than interacting with human beings: There is more control in starting and stopping a conversation. Ultimately, that same advantage is their downfall since being in control at all times makes truly shifting your mindshift a little harder.  

What are the best features of Woebot (3 max)? Why are these features so helpful? Where do you feel it could use improvement (2 max)? Why do you feel this needs improvement?

Best

1. It shares well-timed information and doesn’t drag.

2. Simple and clear. Woebot is easy to use. It would be easy to get into a morning routine of checking in, then seeing the trends could help me with a wider perspective on my moods.

3. Woebot provides background around why sharing information with it can improve the experience. The why is important.

Worst

1. It’s easy to lose interest when you’re using a chatbot. Just a few missteps in terms of responses, and you lose sight of why this is a good thing to be doing.

2. Hard to remember the correct prompts to take you to the toolbox, etc. I found that I lost track of where my charts, etc were stored, and I forgot which word I was supposed to used to get me back to that home base.

Joyable

Cost: $99/month with a 7-day free trial

Little example stories help illustrate the point at hand.

I’ve been a fan of cognitive behavioral therapy since I found out when I was first diagnosed with generalized anxiety in 2015. I loved the idea of an affordable approach to  CBT and looked forward to giving this structured 2-month course a try (In fact, I ever created a poll for my Facebook followers back in 2016 to see if any of them had ever given it a try).

I liked the clarity of the approach: it’s intended to be just 8 weeks, so there’s no pressure to continue after it ends (The anxious people pleaser in me likes knowing how much time I’m signing up for, and how easy it is to cancel.)  And each week, a new themed course is “unlocked,” allowing me the chance to tackle a new set of cognitive-behavior related challenges.

In Joyable, check-ins are over the phone, lasting anywhere from 15 to 30 minutes once a week with a coach (coaches are not therapists, as you’re reminded numerous times in the app). I was assigned a very nice young female coach who explained the entire process to me—again, this was appreciated—and led me through what was expected of me. Her name, phone number, and email address were all easily accessible from the coach tab. I was even able to look her up on LinkedIn and confirm that she was who she said she was, which helped me quickly get over any misgivings I had about talking with a stranger on the phone.

The basics of cognitive behavioral therapy, packaged in app form.

How does Joyable compare to in-person therapy? Better? Worse? How and why?

I think that in-person cognitive behavioral therapy can be incredibly helpful for someone with generalized anxiety disorder, but it can also be stressful to dedicate the time and money without having a clear sense of progression, a challenge I’ve had with therapy in the past.

In this way, Joyable’s 8-week program is a great compromise for people who want to work on daily challenges without the heavier commitment of in-person therapy. At the same time, a 15-minute phone check-in with a coach won’t likely see the same results that an hour with an experienced cognitive behavioral therapist might.

How would you rate Joyable’s user friendliness? Consider a person who is having a bad day (would they be likely to stick with it or are there aspects of it that would be too frustrating?)

This is an area where Joyable really shines. The program itself feels very easy to navigate, yet polished in a way that puts very little pressure on the person using it. The app isn’t needy, nor are the coaches you check in with. It is straightforward in a soothing way. To me, that is the ideal kind of friendliness.

Clear structure that helps orient you about where you are in the process.

What are the best features of Joyable (3 max)? Why are these features so helpful? Where do you feel it could use improvement (2 max)? Why do you feel this needs improvement?

Best

1. Very clear structure which helps you understand what is expected of you and how to progress.

2. Nice coaches who are also thoughtful people.

3. The courses themselves are well-illustrated, and the design of the app is nice and clean.

Worst

1. If you’re like me, and you already know the basics of CBT,  the app probably won’t help you tackle problems in a new way. It is great for beginners, though.

2. If you don’t like talking on the phone, this app probably isn’t the one for you.



Talkspace

Cost: from $49 to $79 a week, depending on the plan

Talkspace has a longer sign-up process than the other apps I reviewed involving an initial intake process that lasts about a week and involves chatting with an “intake” therapist who asks basics questions about your past and needs.

Once your case has been handed over, you are presented with your therapist matches in the form of photos and bios. It’s up to you to choose a fit — it’s like a dating app, but for therapists.   

I always love to see what types of people I’m paired with in a situation like this. In this case, I was given all women in their 40s in my initial pass. I asked for “more options” just to see what that looked like, and was given a wider array of ages, as well as one man. I chose the man, and received my first voice text within a couple of days.

I liked the asynchronous approach of Talkspace. It allowed me to leave messages at times that worked for me, then check my therapist’s responses at my convenience. There were some technical issues with the app that caused some confusions and delays, but they were short-lived. The biggest issue is that my therapist seemed to have a cold for weeks on end. For one reason or another, I didn’t really get to connect with him much in the two weeks I used the app.

Very clear onboarding is a big plus in my book.

How does Talkspace compare to in-person therapy? Better? Worse? How and why?

Talkspace has a lot of potential. Just like in-person therapy, much of its efficacy comes from the chemistry you have with the person you’re paired with. The asynchronous voice message / texting approach will work better for some people than others: I have enjoyed using other “voice memo” apps like Anchor in the past, so it worked well for me. I didn’t get a strong sense of the kind of impact the therapy might have on my anxiety since my therapist and I didn’t really get a chance to delve into that.

How would you rate the apps user friendliness? Consider a person who is having a bad day (would they be likely to stick with it or are there aspects of it that would be too frustrating?)

Talkspace doesn’t really have much scaffolding around it: It is just you talking to—or leaving messages for— a therapist. So the friendliness comes down to the person you’re paired with. My therapist had a friendly voice, and the control I had over how to engage with his messages felt friendly to me as well.

What are the best features of the app (3 max)? Why are these features so helpful? Where do you feel it could use improvement (2 max)? Why do you feel this needs improvement?

Best

1. Real licensed therapists.

2. The price isn’t bad!

3. I liked hearing human voices, but being able to listen when I wanted to.

Worst

1. As with in-person therapy, it can be hard to find the right therapist fit.

2. Pesky technical difficulties can get in the way of exchanging messages.

All in all, I really appreciated the opportunity (and motivation) to try out these mental health apps and deepen my understanding of the new trends in this space. What about you?

Have you ever tried a mental health app and if so what did you think? Share your thoughts below.