Attention-grabbing articles, backed by research.

Let’s face it: first visits with a mental health professional can be intimidating. You are about to share difficulties with emotions with someone you’ve never met. In this post, our CMO Ravi Shah answers some of the most common questions and concerns we hear from people who want to get mental health care but are afraid to take that first step. 

Why do you collect so much information before the visit? 

In short, doing so will save you time and money. A comprehensive mental health initial evaluation requires us to know a lot about you, your current situation, your medical history, and your past. You can provide much of this information yourself in writing prior to the visit. Our mental health professionals will review this information before meeting you. 

Naturally, you as a person are much more than facts about your past. By gathering more information up front, we allow you and the provider to focus the visit on really understanding  your story, your challenges, and your goals. This way the clinician can also take the time to explain your medication and other options for treatment and even answer questions about side effects or other concerns you might have. 

Our mental health experts will start by verifying your identity and asking a few basic questions about your life, where you live, what you do for work or school, etc. Then they will ask you to describe what is bothering you the most and follow up questions that are related. They may ask some questions which you have already provided, but it’s important they understand the context behind your story. They will also ask you important questions about your mental health history like symptoms of bipolar disorder, severe substance use disorders, and other related questions to ensure that Mantra is a good fit for you. 

What’s the best setting for a first visit?

For the telehealth to work optimally, we recommend you be somewhere where you have a strong WiFi connection as cellular data connections may interrupt the flow of the visit or create delays in audio or video transmission. Beyond that, you want to find a place that is private (ie no one else in the room), and where you can speak freely. The best evaluations happen when you can be completely honest with your care team. For people who work in open-floor layouts, sometimes people find a phone booth or lactation room to use for such visits so that they can maintain privacy. 

If the clinician believes a medication may help you, then they will have it delivered to your door in beautiful (and reusable!) packaging. In addition, we’ll have a coach follow-up with you to set goals for your treatment and follow-up on your medications. We are here to help you on your journey by answering questions or concerns as well as making sure the medications are making a meaningful difference in your life. If they're not (or they're causing more harm than good), then we'll help you adjust, change, or stop them as appropriate.

What’s better, telehealth or in-person treatment?

That depends in part on your condition and in part on your preferences. For many, telehealth visits feel less frightening and easier to work into their schedule (in terms of time and money). For patients with more severe mental illness, in-person care may be more appropriate. Ultimately, we believe good care can be delivered in either format, but the key is that if you are suffering, please get help in a way that works for you. At Mantra, we believe everyone deserves world-class mental health care. 

Have more questions about your first visit at Mantra? Ping me at @RaviShahMD

Preparing for your first telehealth visit: Tips from Ravi Shah, MD

Do you struggle with maintaining your focus? Dealing with ADHD as an adult can bring on a whole new set of challenges. For example, if you struggle with focus and concentration, getting through a full workday can be difficult. Research of adults in a simulated work environment shows that adults with ADHD struggle with concentration and hyperactivity when working. However, when they finish their work, they complete tasks just as well as adults without ADHD.  

This may be something you can relate with - you know you can get the job done, but you struggle to stay focused throughout the process. This can cost you both time and money. Here are our tips for improving focus, so you can show your best work (and your best self) on the job. 

Keep your priorities and goals in front of you. Take time to make lists of goals for your life, career, or even simply for the next week or day. Write them out in order of importance. This will help you prioritize and focus on the most important tasks. You should also put your list somewhere where you will see it often. This way you’ll be more likely to finish important pending tasks. Reviewing the list at the beginning and the end of the day to hold yourself accountable. 

Now that you know what you must get done, the next step is to work on when you want to get things done by setting frequent deadlines. Deadlines can help your focus by giving you a little extra pressure that can boost your productivity. If you find yourself struggling to complete tasks, those tasks may be too big or too broadly defined. Try breaking them up into smaller, easier-to-accomplish tasks. An MIT study found that deadlines improved both the time that individuals spent on the task as well as their performance. It also found that evenly spaced deadlines were most helpful.

When living with ADHD it's easy to get distracted from what you're doing. The more organized you are, the easier it will be to stay focused. Here are a few more tips to help you stay organized:

Live by the rule "a place for everything and everything in its place.” This way you don't waste time having to look for things you need or figuring out where to put them. A classic example is to always put your wallet, keys, and phone in the same place when you get home, and keep them in the same place in the car or office. 

Compile all appointments into one calendar. Keeping everything in one place will help you to stay on top of the tasks you need to be on top of and any appointments/commitments that you have. 

Go paperless and try using an organization app like Evernote. You can create online notebooks and notes for the different areas of your life. Everything is searchable, making it very easy to find what you need. 

How many times do you suddenly realize that you have been mindlessly scrolling on Instagram or Reddit for the last 20 minutes? If something like this happens to you, here are a few tools that may be useful depending on which device you’re using:

“App Limit” on iPhone (Settings > Screen Time)

Setting your phone to “do not disturb” mode

Are your emails pinging on your computer (or phone) non-stop and distracting you constantly? Schedule email downloads for 3 set times a day. Deal with your emails at that time and move on. You’ll find that you’ll be less distracted and more productive.

Work in a loud office? Are your workers gossiping non-stop in the next cubicle over? Buy yourself noise-canceling headphones and wear them without listening to music. This will give you much-needed quiet and make your colleagues less likely to interrupt you (if music works for you, by all means go ahead).

If you are struggling to stay focused and avoid distractions during meetings, conferences, or even conversations, try taking notes on paper, not digitally. A Harvard study found that students that took notes on paper tested better than those that took notes on a laptop. You can always add these notes to your digital note taking app later.

Two of the most important areas of self-care to target that can make a quick impact on your ability to focus are sleep and exercise. 

Insomnia (difficulty sleeping) affects up to a third of the adult population and affects two thirds of people with ADHD. Getting enough sleep and feeling rested is important for you to be able to focus during the day. It’s important to make sure you are going to sleep early enough that you can achieve 7-8 hours of sleep each night. 

You might have heard that exercise is good for helping boost your mood, but did you know that it can help your ability to focus and recall information as well? There have been many studies completed that show that physical exercise can improve cognitive functions including those such as attention and memory. So, whether it's a short run, strength training session, yoga, or a 1-hour walk, get exercise on your schedule. It will help clear your mind and release endorphins that can improve your mood and help keep you focused. Most jobs are fairly sedentary. If this is the case with your job, make sure to get up and move around a little for every 2 hours that you are sitting.  

Making a lot of changes at once can be overwhelming (and even counterproductive). We recommend starting with one change discussed in this article and try that for a week. Once it’s a seamless part of your daily routine, try adding another skill. If you are continuing to struggle after making changes, don't be afraid to reach out for help from a therapist or wellness coach. 

Prescription medications do work for anxiety symptoms, but they aren't the answer for everyone. Some people don’t like the idea of taking medications or want to try more other reasonable alternatives first. Finally, some people have had partial benefit from medications and are looking for other options to keep feeling better. Here we outline some of the best non-medication options for anxiety. 

CBT, or Cognitive Behavioral Therapy, is one of the most effective treatments for anxiety. The basic idea is to identify the thoughts, feelings, and behaviors that result in cycles of anxiety in order to develop skills aimed at interrupting this cycle. CBT teaches you to gain control of anxiety by identifying negative thought patterns. Then, your therapist teaches you to change behavior and develop new coping skills. There is evidence that Computer-Based CBT (cCBT) is effective in treating anxiety, but extensive studies have not yet been done to see if the results are the same as face-to-face therapy. That said, if you don't have access to face-to-face sessions, it may be worth trying. 


CBT isn't the only form of therapy that can help anxiety. Other options include Psychodynamic therapy and Acceptance and Commitment Therapy (ACT). 

Some herbs and supplements have been found to have positive effects on reducing anxiety. These generally come with less risk of serious side effects, but it's important to remember that even natural forms of treatment can have side effects. One study found that Omega-3 Fatty Acids were able to reduce anxiety symptoms by 20 percent. Other supplements and herbs that could be helpful include:

Supplements like Zinc, B6, B12, and Vitamins A, C, E, and D 

Some of the most popular alternative treatments for anxiety are below. 

Aromatherapy is healing treatments through the use of essential oils. Oils are extracted from natural plants. Then you can use them by inhaling them using diffusers, inhalers, or spritzers. You can also apply them on your skin through oils or creams. 

Studies have found that aromatherapy can help to lower anxiety levels. One study found that the use of aromatherapy decreased anxiety in patients before operations. Some oils found to be effective include bergamot, clary sage, lavender, sweet orange, ylang ylang, and rose.  


Mindfulness is when your mind fully engages with what's happening in the present. When you practice mindfulness, you don't pass judgment on your feelings. Instead, you observe them. 

One study that reviewed 47 trials with over 3,500 participants found that mindfulness medication provided moderate levels of improvement in anxiety. Results persisted beyond 8 weeks, demonstrating some durability in the effect. 

Some forms of therapy, including MBCT (Mindfulness-Based Cognitive Therapy) and ACT, include learning the practice of mindfulness. But you can also learn how to practice mindfulness meditation on your own. If you're interested in learning how, there are plenty of apps. One example is Stop, Breathe & Think. 



Having good self-care habits can improve your mental health and reduce your anxiety. This includes habits like:

All these things can help you to lower your stress and anxiety levels and boost your mood.


Journaling can be an effective addition to your treatment for anxiety. It allows you to track your symptoms and feelings as well as spot patterns in your life. Generating a personal narrative is a key component to many psychotherapies, so it makes sense that journaling might provide benefits in terms of personal growth. Finally, you can also use journals to track your homework and progress from CBT sessions with your therapist. 


Finding the right treatment for anxiety for you

Every situation is unique. The above options may help you improve and manage your anxiety alone, or they may represent a complement to other parts of your treatment. If you're on prescription medicine, these other treatments can still be beneficial. If you’ve tried these methods and remain with persistent, distressing worry or anxiety, it may be time to try medications. Often, medications can help turn the volume of anxiety down so that it becomes easier to practice mindfulness or participate in therapy. 

The most popular non-medication treatments for anxiety

When you think of ADHD, you may you have to take prescription medications to improve your ability to focus and function each day. It’s true that many people find relief from ADHD symptoms that way. But what if you want to avoid medications? There is evidence that alternative ADHD treatments may be beneficial for you. Here we highlight the top 5 supplements with solid evidence to help ADHD. 

When it comes to alternative ADHD treatments through supplements, Omega 3s have the strongest evidence base for showing symptom improvement. Research has found that they can help improve symptoms of, "hyperactivity, impulsivity, attention, visual learning, word reading, and working/short-term memory." 

You can find Omega-3 Fatty Acids naturally in some foods. This includes things like fish, seaweed, chia seeds, hemp seeds, flaxseeds, walnuts, edamame, kidney beans, and soybean oil. 

Most people get the Omega-3s that they need from the food they eat. However, there's a lot of promising research showing that with the correct ratio of Omega-3 and Omega-6 fatty acids, ADHD symptoms can be reduced.

A common symptom of adults with ADHD is difficulty with sleeping, which makes sense because the symptoms don't go away at night. You may struggle with falling asleep, restless sleep, staying asleep through the night, or waking up in the morning. No matter what, we know that poor sleep leads to exhaustion and lower executive functioning the next day. 

Your body naturally produces melatonin from the pineal gland. This helps to control your sleep-wake cycle. If things are working as they should, your body would create higher levels of melatonin at night to help you sleep. However, you can also take melatonin as a supplement to promote positive and natural sleep cycles. 

Melatonin increases naturally around sunset, telling your body that bedtime is coming in the next few hours. Taking 5-6mg of over-the-counter melatonin around 8-9pm (assuming you aim to sleep around 11pm-12am) has been shown to improve sleep quality and duration. Please remember melatonin can cause you to feel a little sleepy, so it’s best to avoid driving after taking it. Research has found that taking melatonin as a supplement can help you to fall asleep faster and stay asleep better overnight. This should also help you to wake up feeling more rested and ready to tackle the day in the morning. 

“Worth a shot:” Supplements with moderate evidence for ADHD

These supplements can be helpful in ADHD patients, especially if they naturally have lower levels of these nutrients in their bodies.

It's rare for people living in the United States to be deficient in Zinc. However, it is possible if you have a poor diet or eat a vegetarian diet. Studies in children have found that those that had strong symptoms of ADHD tended to have lower levels of Zinc. Some research has shown there could be a positive connection between taking a Zinc supplement and experiencing a reduction in hyperactivity and impulsivity. 

Similar to Zinc, research has shown that Iron supplements could be beneficial for you if you have naturally lower levels. Based on the research, those with ADHD have a higher likelihood of having low serum iron and ferritin levels. Increasing the levels in the body could help to alleviate your symptoms of hyperactivity, inattention, and impulsivity. That said, there is such a thing as “too much iron.” If you are thinking to take iron supplements, we recommend you get your levels checked by a doctor both before and after so that you can measure the improvement and ensure you’re iron levels don’t become too high. 

Ginseng has also been reported to improve cognitive function in those with ADHD. It's believed that the supplement helps by targeting hyperactivity and inattention. 

Balancing ADHD function improvement with reduction of symptoms

The alternative ADHD treatments discussed above can help you experience improvement in symptoms. You may find that your ability to focus is improved. However, this does not necessarily mean that you'll have an improvement in functioning as well.

This is why it's important to focus on using a combination of treatments. Learning time management skills or putting organizational systems in place can help you improve your executive functioning. and experience results that you won't find with medication or alternative supplements alone. See our blog with ADHD expert Dr. Ramsay to learn more. 

In this new edition of our expert interviews, we are welcoming Dr. John Russell Ramsay, PhD, associate professor of clinical psychology at the Perelman School of Medicine at the University of Pennsylvania, Co-director and Co-founder of Penn’s Adult ADHD Treatment and Research Program, and an advisor to Mantra Health.

I am with Dr. Russell Ramsay,. Dr. Ramsay, you wrote a book on non-medication treatments for Adult ADHD. How do you conceptualize ADHD as a disorder?

It is often not thought of this way, but ADHD itself is not a knowledge problem but rather a performance or implementation problem – recurring difficulties organizing and following through on tasks and goals despite knowing what needs to be done.

It’s my understanding that medications are highly effective for treating the symptoms of ADHD, including for adults. Don’t these medications usually treat these problems? 

Yes. Medications are very effective with symptom reduction, and for many adults these improvements set the stage for improved functioning. However, symptom reduction alone does not necessarily translate into improved time management, organization, or being less prone to procrastination. ADHD coping skills are not in the pills, as the saying goes.

So then, what are the new developments that may address these coping issues?

The psychosocial treatment of adult ADHD, specifically cognitive-behavior therapy or CBT, is well-established as an evidence-based treatment. CBT adapted to adult ADHD is designed to foster the development of coping strategies for managing ADHD that will most definitely improve functioning. There are no trade secrets about what works, but the central focus is on the implementation of these skills.

A recent study examined a course of group-administered CBT that was provided to two groups of adults with ADHD: one group was on a stable regimen of ADHD medications; the other group was not medicated. At the end of the 12-week group treatment, the CBT plus medication group improved at a significantly higher rate than the unmedicated group - no surprise there. But, during the 6-month follow up phase after treatment ended, the CBT + coaching group continued to improve and caught up to the CBT plus medication group in terms of improvements.

What do these results mean for adults with ADHD in their daily lives?

First, medications + CBT from the outset can provide improvements at a faster rate, but the skill-focused CBT for adult ADHD can also lead to improvements over time, which extend beyond treatment, which is important because ADHD requires ongoing efforts to manage. The take home message is that improving concentration with daily medications is great, but making changes to your time management or organizational system can improve your executive functioning over the long-term. 

Second, a unique feature of this particular CBT approach was that weekly group meetings were augmented with twice weekly, between-session phone contacts with a “coach” for about 10-15 minutes each to review any coping difficulties and help participants stay on track with their goals. This coaching feature was rated by participants as very helpful. If adopted elsewhere, this added step may improve outcomes for adults with ADHD. This is also consistent with the Mantra approach for integrating care and fostering follow through on patients’ behavioral health and overall wellness goals in daily life.

Dr. Ramsay, thank you for sharing this useful update. 

The Latest on ADHD coaching from Mantra Expert John Russell Ramsay, PhD

Today, we have the distinct pleasure of sitting down with Maria Oquendo, MD, PhD. Dr. Oquendo is currently the Chair of the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and a Past President of the American Psychiatric Association. She also serves as a Clinical Advisor to Mantra. In this post, we explore the ways in which psychiatry as a field is changing and what this means for patients in America. 

What is your perspective on collaborative care and how it relates to the future of psychiatry? What makes this model so important?

Collaborative care is the future of mental health (MH) care delivery. There simply will never be enough psychiatrists to provide MH care for everyone who needs it, so we need to be practical.  The system can be set up to be nimble and leverage psychiatrists to oversee care for a greater number of patients. 

How are you employing the principles of collaborative care at Penn? Why?

Here at Penn, we have been devising novel strategies to implement collaborative care.  We call it Penn Integrates Care. Piloting the program in 8 primary care clinics covering 100,000 patients is the first step towards a broader implementation. Not only does collaborative care provide a valuable service to our patients, it also has been embraced by providers including primary care doctors, therapists, and psychiatrists.

How can pre-screening help save time and money for patients without compromising the quality of the experience? How are you using this process? 

Using evidence-based tools and decision support software, we can devise clever ways to triage patients. Most will be well-served by a collaborative care model, and only a minority will need in-person specialty psychiatric care. 

What is the role of a coach (sometimes named care manger or patient navigator)? How are you thinking about this in your department? 

The conditions that we treat affect motivation and volition, so even the most willing patient may have difficulty following directions or adhering to medication regimens and keeping appointments. Coaches can help overcome these problems. As psychiatrists, we’re used to giving medications, but we’re not used to how scary it is for patients to take them. That’s another reason why coaches are so helpful.

Why do we need measurement-based care? Isn’t it enough to ask someone if they feel better or not? Why or why not? 

Measurement-based care is essential because patients will often feel so relieved if they are 30% or 50% better, that they might accept that as a reasonable end-point.  When you track symptoms using validated scales, you ensure that you know exactly how much better the patient is and how far they are from remission or recovery.

Can mental health care really be delivered via technology? 

We are learning more every day about how to leverage technology to deliver MH care. This will be especially true as younger generations who grew up with texting, Instagram and other social media come for MH care.

How can a patient know he or she is getting the best care, especially when using a technology platform? What advice do you have for patients considering getting their mental health treatment from a telehealth-based service?

Patients should use common sense in this decision.  How much support does the person need?  Is there a method for tracking symptom improvement?  Are side-effects taken into account?  Are things explained in a way that is easy to understand?  I would also advise people to trust their “gut feelings.”  If there is discomfort about how things are going, it is crucial to speak up.

The Evolution Of Mental Health Care with Maria Oquendo, MD, PhD

There is a lot of information, resources, and support online about childhood ADHD. While it's most commonly considered a childhood disorder, many people don’t realize that adults are also impacted by ADHD. The scientific community once thought that adult ADHD was simply undiagnosed childhood ADHD, but we now know that adults can develop ADHD even if they never had symptoms of it as a child. This is very important because, even if you did great in school when you were younger or performed well in your career, more recent difficulties with inattention, impulsivity and/or hyperactivity still may be caused by ADHD. In addition, about 60-80% of children with ADHD continue having symptoms as an adult, and one-third of children with ADHD continue to meet criteria for ADHD as an adult.

ADHD stands for Attention Deficit Hyperactivity Disorder. It's a brain disorder characterized by a pattern of impaired attention and/or impulsivity. At its most basic level, ADHD is caused by alterations in certain brain circuits, mediated by chemical substances in the brain called neurotransmitters.  While that's a mouthful, the important takeaway is that we have a biological understanding of the causes of the symptoms of ADHD as well as proven treatments that can help patients. If you have ADHD, you most likely find it difficult to concentrate, remain focused on tasks until they're completed, and manage your time efficiently. It's likely that you feel fidgety and restless at times, which leads to a pattern of making impulsive decisions. 

Back in the 1980s and early 1990s ADD was the term that was widely used. It stood for Attention Deficit Disorder, and over the years, the name of the disorder has been updated to reflect the improved scientific understanding of the disorder (namely that for many patients hyperactivity, not attention deficit, may be their main symptom). If you are in the habit of saying ADD, don’t worry, clinicians will still know what you are talking about. The most important thing is to be aware of the possible symptoms of ADHD. 

Scientific studies show that ADHD has a strong genetic component.  Thus, if someone in your family has been diagnosed with ADHD (or has undiagnosed ADHD),you have a higher chance of having it as well. Studies also show that environmental factors (all your experiences and things you have been exposed to since birth) play a limited role in causing ADHD. 

At the most basic level, the symptoms of ADHD are caused by alterations in the brain’s use of neurotransmitters like dopamine, serotonin, and norepinephrine (also called noradrenaline in other countries). This scientific understanding is crucial, because these alterations in neurotransmission are the target of the most common drug treatments like Amphetamines (Adderall®), Methylphenidate (Ritalin®) and Atomoxetine (Strattera®).

If you are living with ADHD there are several different ways that it can impact your personal and professional life. Some of the things that you may experience include:

Decreased productivity. This could mean making less money than you would have otherwise (20% lower, $41K vs $52k; Biederman/Faraone, MedGenMed 2006)

Consequences from missed appointments and meetings

Difficulty with meeting deadlines, managing large projects, and responsiveness at work which makes it hard to get promoted

Compulsive eating, substance use disorders, and screen addiction

Difficulty due to impulsive decisions and emotional outbursts. 

The DSM-5 is a large book published by the American Psychiatric Association that mental health professionals use to classify mental health conditions. For the diagnosis ADHD, it is important that several symptoms of inattention or hyperactivity are present for a period of at least 6 months. These symptoms impair functioning and occur in multiple settings (such as at work and at home). Currently the DSM5 requires that at least some of these symptoms existed were present before the age of 12 (though doesn’t require that you met ADHD criteria in past). For more details on the DSM 5 criteria, click here

Do you identify with the following statements?

People with ADHD tend to identify with several of the following statements:

I struggle when it comes to paying attention to details which leads to careless mistakes. 

There aren't many things that can hold my attention. Even when I try to pay attention when someone is talking, I have a hard time listening

I have difficulty completing work or household tasks because I get side-tracked.

It's hard for me to stay organized. I lose things a lot (keys, wallet, purse, paperwork, glasses, cell phone, etc.)

I struggle with interrupting others. It’s hard for me to wait my turn. 

I tend to blurt out answers to questions before they are asked. 

I am restless and fidget a lot. Even when I’m expected to stay seated, I feel that I must get up. I struggle when participating in quiet leisure activities. 

Even if you identify with the symptoms listed above, ADHD isn't something that you can self-diagnose. Studies show that 70-75% of patients with ADHD also have another psychiatric condition, such as anxiety, depression, or substance abuse. If you think that ADHD is the cause of your struggles, it's important to talk to a mental health specialist. Until then, feel free to take our free evidence-based assessment by clicking here.

Parked Thoughts

Attention-grabbing articles, backed by research.

Preparing for your first telehealth visit: Tips from Ravi Shah, MD

Top 5 Ways to Help You Increase Focus

The most popular non-medication treatments for anxiety

5 Supplements Proven to help ADHD

The Latest on ADHD coaching from Mantra Expert John Russell Ramsay, PhD

The Evolution Of Mental Health Care with Maria Oquendo, MD, PhD

Is Adult ADHD real?