Weekly App Review: Be Safe

Screenshot from Be Safe app.

This week, in recognition of Suicide Prevention Awareness Month, I’m reviewing Be Safe. Be Safe is an app that allows users to input a safety plan into their phone or tablet for use in the event of a crisis. A safety plan is a list of possible situations or scenarios which might make a person more vulnerable to suicidal thoughts, signs or symptoms that they are not feeling well and need additional support, coping strategies, and the contact information for friends, family, mental health providers, and crisis hotlines who may be able to help before or during an emergency. The purpose of the plan is help reduce the risk that a person will act on their thoughts/plan about suicide or self-harm by giving them concrete steps to take until their thoughts subside. This is based on the idea that suicide risk can increase and decrease over a relatively short period of time. If a person can recognize that their risk is increasing, they can take steps to help themselves and connect to support before they are in danger of acting on their feelings.

There is more than one way to make a safety plan including the Wellness Recovery Action Plan (WRAP) and Stanley Brown Safety Plan. No app is a substitute for mental health treatment, however, safety planning apps can be a useful tool for people who experience suicidal thoughts, overwhelming emotions, or psychiatric symptoms.

For more information about navigating a mental health crisis, please look through NAMI’s online guide (available in English and Spanish). If you have an immediate crisis please call 988.

Intended Use: The app is intended for developing a Stanley Brown safety plan in the context of mental health treatment.

Target Audience: The app is intended for people who experience suicidal ideation, overwhelming emotions, or psychiatric symptoms. It is listed as being appropriate for ages 4 and up. The interface is entirely text based, however, so children younger than 12 may struggle to use the app independently. Younger users may need a trusted adult (e.g. parent, therapist, guardian, counselor, etc.) to help input the information.

Usability: The interface is easy to use. It provides prompts for users to enter information for each section of the safety plan. This allows users to develop a safety plan with the support of a therapist, counselor, or other mental health professional. People who are already familiar with a safety plan can create or update a safety plan independently or with peer support. Users can access their emergency contacts and crisis hotline numbers directly from the app.

Cost: The app is free to download and there are no ads.

Technical Requirements: Available on iOS.

Pro’s: The app is easy to use and provides prompts for each section of a safety plan. Users can customize their safety plan by writing in their own coping strategies which may be unique to them. Once contacts are added to the app they can be called directly from the app. Crisis hotline numbers are also preprogrammed into the app. Users can also email copies of their plan to members of their support system. It does not cost anything and is add free.

Con’s: The app is text based and requires the user to type their responses. There are no check boxes/suggested items so users who struggle to find appropriate coping strategies may not be able to use the app independently. The app is also only available in English.

Is it worth it? This app is worth your time if you or a loved one experience suicidal ideation, overwhelming emotions, or psychiatric symptoms. It can be a useful tool to support a potentially life-saving intervention. The benefit of having a digital version of the plan in your phone is that you (most likely) will always have it with you in case of emergency.

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Fresh Off the Needles: Socks, Physical Therapy, and Wellness

As my arm is slowing beginning to heal I’ve ben able to resume knitting in my customary hand position. With the cold weather firmly in place I wanted to try making socks. I’ve never been a fan of double pointed needles so I was pleased to a find a pattern that can be worked flat and later sewn together. You can check that out here. The pattern specifically calls for 5mm (size 8) needles and worsted weight yarn. I used a thicker yarn so that I can get more of a slipper sock and am pleased with the first of the pair. The pattern fits a size 9 in women’s but you can adjust the pattern to fit different sizes by adding or subtracting stitches on the sole before the toe and instep after the tow. If my calculations are correct, you should be able to use the size chart I’ve created.

Size 8 needles, Lion Brand Tweed Stripes Bulky (5) yarn in orchid, added 4 rows to the sole and 4 rows to the insole to create a women’s size 10 slipper sock

As I’m regaining mobility in my arm in some ways I feel as though I am living through some of the literature about the therapeutic benefits of knitting. Specifically, I’m reminded of the work of Betsan Corkhill, a physiotherapist and the founder of Stitchlinks, an online community providing support, research, and guidance about knitting. Early on, she observed that her clients often had trouble engaging in physical therapy not because they would be unable to do the exercises but because they felt that had no reason to do it or meaning in their lives. She noticed that her clients often suffered from social isolation, worry, fear, stress, lack of rewarding occupation, low self-esteem, feelings of worthlessness, low confidence, and a changed or lost sense of identity. She speculated that if she took a different approach, specifically introducing knitting, that her clients would have a meaningful hobby which could prompt motivation for physical therapy.

Over time, Corkhill observed that her clients who participated in knitting were less depressed. Later research suggested that frequent knitting (at least three times per week) can help people feel calmer and happier. The reason for this benefit, Corkill suggested, is the complexity of the task of knitting as well as the enjoyment derived from it. She referred to knitting as a “bilateral, rhythmic, psychosocial intervention.” By this she meant that the combination of complex, rhythmic movements of both hands and eyes, simultaneously, across the mid-line of the body is so complex that it leaves little room for negative, ruminative thoughts that are common in anxiety and depression. Additionally, because the repetitive movements of knitting can become part of muscle memory, this allows people who knit in groups to modulate their eye contact (looking up from their work or gazing into their lap) which can create a sense of safety around others which helps people who have experienced trauma.

Knitting is a

Knitting and Pain Poster

What Do Running and Knitting Have in Common?

When you think about running, what image comes to mind? Sweating? Heart pounding? Breathing hard? Moving fast? This probably isn’t the same image you have of knitting. You might not even envision the same person enjoying both activities. Yet, in my experience and as the research suggests, running and knitting may have more in common than you would expect.

Running and knitting are both activities that are based on repetition. Whether it is one foot in the front of the other for miles or one stitch after another hundreds or even thousands of times over, each activity is the repetition of a basic unit over and over. Running a race or knitting a scarf both take perseverance to complete. Practice is essentially repetition and revision to hone a skill. How do you get faster at running? You run sprints, interval train, and hustle up hills. With effort and practice you conquer longer distances at greater speed with more ease. How do you get better at knitting? You practice the knit step over and over again, you learn to purl, you knit in the round, and you try different combinations of stitch patterns. With effort and practice you make more complex projects, sometimes without even looking at your work (shout out to my mother who knits lace patterns, in the dark, while watching Game of Thrones!).

Initially, repetition can be frustrating and challenging. After the basics are mastered, repetition may promote meditative or flow states. Mihaly Csikszentmihalyi described flow as “-a state of concentration so focused that it amounts to absolute absorption in an activity.” During flow states, a sense of time and emotional problems seem to disappear. Colloquially, people describe flow as being “in the zone.” Flow states arise from the enjoyment of using our strengths and skills to rise to challenges. Csikszenmihalyi has interviewed people from many cultures across the world and observed that flow states share the following eight components:

1. We confront tasks we have a chance of completing

2. We must be able to concentrate on what we are doing

3. The task has clear goals

4. The task provides immediate feedback

5. One acts with deep, but effortless involvement, that removes from awareness the worries and frustrations of everyday life

6. One exercises a sense of control over their actions

7. Concern for the self disappears, yet, paradoxically the sense of self emerges stronger after the flow experience is over

8. The sense of duration of time is altered

Flow is related to, but not the same as, peak experiences and peak performance. Maslow describe peak experience as “moments of highest happiness and fulfillment.” They are categorically more meaningful and intense than our usual experiences. Another word for peak experience is ecstasy. The term peak performance refers to performing to our greatest potential and exceeding our typical behavior. When you are performing at your peak you are your most creative, strong, intelligent self. This is not always accompanied by enjoyment, however, as can be observed by the incredible acts of bravery and strength people perform during a crisis situation.

While it might be tempting to create a simple equation for flow, such as peak performance + peak experience= flow, this definition is incomplete. Research about these related concepts suggests that peak performance, peak experience, and flow can be experienced in isolation or in various combinations. Listening to music is a common trigger for peak experience, while sky diving and sex have been cited in the literature as combining elements of both peak experience and flow. Responding to a crisis is a common trigger for peak performance, while artistic achievement or placing well in a running race combine elements of both peak performance and flow. The example of “joyous, superior running or painting” is an example of experiences that are peak experiences, peak performances, and deep flow. From this we can extrapolate that one of the characteristics of peak experience is joy, of peak performance is superior functioning, and flow is fun.

TED talk of Mihaly Csikszentmihalyi discussing flow. Once our basic needs are met, more money or material goods don’t increase our happiness or well-being. We need reasonable challenges to enter optimal, flow states.

Collier’s research described a similar flow state specific to fiber arts which she calls textile rejuvenation. Fiber arts may promote a combination of flow, mood repair, and self-realization of values. This combination often results in a feeling of being “restored, renewed, and ready to start anew” which continues well beyond the immediate participation in textile activity, and it is this emotional state that is captured by the term textile rejuvenation.

Research in the field of athletics suggests that there is a sub-type of flow called clutch performance. While flow may be experienced with open-ended goals such as “I’m going to use good form on my morning run today,” clutch performance occurs with specific, close-ended goals such as “To win the race I need to run the last 500 meters in under 90 seconds.” It remains to be seen whether clutch performance is an independent concept or more closely related to peak performance.

Four tips for promoting flow states at work: focus, freedom, feedback, and the four percent challenge.

Book Review: The Comfort of Knitting

After listening to an interview with Carol Caparosa, founder of project Knit Well (linked below), I knew I had to read the book The Comfort of Knitting: a How-to-Knit Guide for Caregivers and Family. Project Knit Well is a not-for-profit organization that specializes in teaching  patients receiving treatment for severe illness, as well as their families, loved ones, and professional caregivers, how to knit. They recognized the therapeutic benefits of knitting and seek to share instructions and materials with those who can benefit.

What I appreciate about this book is the recognition that caring-giving, while an act of love and kindness,  can take an  emotional toll.  Oftentimes the strain of caring can go unnoticed, particularly in a medical setting where the emphasis is on the identified patient. Caregivers are at greater risk or depression as well as burnout and compassion fatigue. This can manifest as feelings of stress, anxiety, and hopelessness, difficulties sleeping, and loss of interest or enjoyment in activities. 

The book nicely summarizes in plain terms some of the current research about the potential benefits of knitting for emotional and physical health. Cognitive benefits of knitting may include the lower the risk of memory impairment and delayed onset of dementia. Emotional  benefits may include reduced depression,  greater feelings of relaxation, a sense of accomplishment, and feelings of satisfaction. The structured,  purposeful, and repetitive nature of knitting can also impart a sense of control which is particularly important for caregivers who may feel they have lost control over their lives due to their responsibilities and obligations for others.

“Properly practiced, knitting soothes the troubled spirit, and it doesn’t hurt the untroubled spirit either.”

Elizabeth Zimmerman

The Comfort of Knitting also provides step by step knitting tutorials with photographs of each step. There are even seven easy projects for beginners. You are looking for a basic, introductory, brief text about knitting or self care this is a good place to start. If you are interested in the studies cited in this book you can find those in the links below:

The Benefits of Knitting for Personal and Social Wellbeing in Adulthood: Findings from an International Survey
Managing Anxiety in Eating Disorders with Knitting (Free Full-Text)

Engaging in Cognitive Activities, Aging, and Mild Cognitive Impairment: A Population-Based Study (Free Full Text)

The Impact of a Knitting Intervention on Compassion Fatigue in Oncology Nurses (Free Full Text)

Recalculating...

What does your GPS have to do with knitting in the era of COVID-19? Author and designer, Ingrid Fetell Lee, suggested that joy can be found in the world around us. But what about when the world is unsettled, feels unsafe, and upside down? In a recent post on Ideas.TED.com, she recalled the work of Sylvia Boorstein who described neurological “glitches” and how to manage them. A glitch can be understand as a default way of thinking, such as “When in doubt, worry.” While we typically think of a glitch as a mistake, many artists and musicians exploit glitches for their unique, aesthetic qualities. Similarly, a neurological glitch isn’t a problem if you are aware of it and have strategies to work with, rather than against it. Accepting the glitch for what it is allows us to be compassionate with ourselves rather than punitive. She described how our GPS provides a model for gently working with these glitches.

“I was thinking about the GPS in my car. It never gets annoyed at me. If I make a mistake, it says, “Recalculating.” And then it tells me to make the soonest left turn and go back.”

— Sylvia Boorstein

Many of us use a GPS to help navigate when we’re in the car or walking to a new place. The device gives directions based on your current position and what an algorithm suggests is the best route based on the data it has on hand. Almost inevitably, we make a mistake by missing a turn. When this happens, the GPS eventually notes the difference between where it anticipated we would be, and where we actually are now, and we hear the phrase “recalculating.” The GPS gently redirects you back to the path it has suggested. While a live navigator might get annoyed or judge us for our mistakes, the GPS’ only job is to guide you back on track.

The losses, life disruptions, and new realities prompted by the COVID-19 pandemic have meant that, according to Lee “we are all being forced to recalculate.” She added that it is natural and expected to feel “lost in a time like this.” Recalculating in this context means being gentle by avoiding unnecessary, harsh self-criticism, addressing our physical needs, and speaking to ourselves with kind words. Consider how you might speak to a child who needs to be comforted and turn this inward. Accept that things are different, that you feel lost, and make adjustments.

Lee cited research by King and Janiszewki to underscore the importance of nurturing our sense of touch during times of emotional distress. The research suggested that during positive emotional states, we are more attuned to visual stimulation, whereas, during negative emotional states, we are more attuned to tactile stimulation. Warm, fuzzy sweaters, plush slippers, a cozy blanket, or even soft art materials like yarn, fabric, and other fibers provide comforting tactile stimulation. Touch is the first language of attunement and may facilitate access to memories encoded in the body through touch and movement (Sholt & Gavron, 2006).

Finally, Lee suggested that recalculating also means creating a sense of control, regaining equilibrium, and stopping cyclical worrying or rumination. She cites studies by der Vennet and Serice (2012), Yager et al (2018), and Bratman et al (2015) which describe how activities such as coloring in a mandala, playing Tetris, and spending time in nature reduce anxiety, increase a sense of control, and reduce ruminative thoughts. Corkill (2014) has similarly described how knitting is such a complex physical and neurological activity that it leaves little room in the mind for negative, intrusive, and worrisome thoughts. Keeping your hands busy and having moments of control can help to quiet the mind.

How to Recalculate

1. Be gentle with yourself.

2. Reach out and touch something soft, cozy, and soothing

3. Accept that you are lost instead of beating yourself up or protesting against what you cannot change

4. Firm up your foundation by engaging in activities where you have control such as knitting or tidying up your space.

5. Break your worry loops by playing, going outdoors, or making art.

How to Find Your Bearings in a Crisis Ideas.TED.com