Psych Scene
@psychscene.bsky.social
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We provide psychiatry education for Psychiatrists, GPs & Mental Health Practitioners.
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Meditation apps won’t replace therapy.

But they’re:

 • Accessible & scalable
 • A gateway to deeper practice
 • Useful tools if clinicians guide use wisely.
💡 Psych Scene Tip:

When patients ask:

 ✔ Recommend trialled apps (e.g., Headspace, Calm)
 ✔ Frame as short-term support, not stand-alone
 ✔ Pair with HRV/sleep data where possible
But 95% quit within 30 days.

Fixes may include:

 ✅ Gamification
 ✅ Micro-rewards
 ✅ Nudges (Duolingo-style)
 ✅ Clinician recommendation
Users pursue different goals:

 • Sleep onset
 • Chronic pain
 • Anxiety relief
 • Mood regulation

AI + data may soon tailor “digital CBT-I” or “breath pacing for pain.”
What’s new: integration with wearables.

→ HRV monitoring
 → Sleep tracking
 → Adaptive content by stress state

Toward personalised, feedback-informed meditation.
Mechanisms:

 → Stronger PFC–amygdala control
 → Default mode network quieting
 → Boosted parasympathetic tone
 → Lower cortisol + CRP

= Better regulation under stress.
Early trials show:

 ✔ Less stress, anxiety, depression
 ✔ Better sleep onset
 ✔ Lower BP + negative thinking
 ✔ Anti-inflammatory gene expression

Even 10–20 min, 3x/week helps.
Meditation apps = the world’s most used mental health tools.

💡 96% of app-based use
💡 300M+ downloads (top 10)

They’ve scaled far beyond therapy access.
Do meditation apps really reduce anxiety, stress, and insomnia?

New data (Creswell, 2025) suggest even brief app-based practice can calm symptoms, aid sleep, and modulate inflammation.

Here’s what clinicians need to know. 👇🧵
Want to go deeper into the neurobiology of ADHD?

Join Dr Sanil Rege for the ADHD Masterclass: From Neurobiology to Clinical Practice on the 29th of November:

https://learn.psychscene.com/adhdmasterclasslive
Psych Scene Takeaway

ADHD is not simply inattention, it’s a breakdown in cortical orchestration.

By understanding the prefrontal network, clinicians can tailor management to restore regulation, not just relieve symptoms.
ADHD is best conceptualised as a dysregulation disorder, where context, arousal state, and neurochemistry dynamically interact.

Psych Scene Tip: Effective treatment integrates pharmacological precision with behavioural interventions that stabilise prefrontal engagement (sleep, rhythm, structure).
Developmental Context

The PFC is the last cortical region to mature, often into the mid-20s.

This explains why ADHD symptoms evolve across the lifespan and why adolescence, stress, and hormonal changes can transiently unmask executive dysfunction.
Pharmacological Implications

Stimulants (methylphenidate, amphetamines) and non-stimulants (atomoxetine, guanfacine) restore optimal catecholamine levels within this “Goldilocks zone,” improving top-down control and emotional regulation.
PFC efficiency depends on dopamine (D1) and noradrenaline (α2A) receptor signalling, both following an inverted-U curve.

Too little catecholamine tone = distractibility and impulsivity.

Too much = cognitive rigidity and anxiety.

(Arnsten AF, Biol Psychiatry, 2009)
Behavioural Inhibition

The right inferior prefrontal cortex inhibits inappropriate motor and verbal responses via projections to the basal ganglia and cerebellum.

Disruption in this loop underlies impulsivity, the failure to pause before acting.
Emotional Regulation and Motivation

The ventromedial prefrontal cortex (vmPFC) projects to the amygdala, hypothalamus, and brainstem arousal/reward systems.

When underactive, emotional impulses become harder to inhibit, explaining frustration intolerance and mood lability in ADHD.
Bottom-Up 'Competition'

Bottom-up circuits respond to salience: movement, novelty, reward.

In ADHD, underactive prefrontal regulation means bottom-up inputs (e.g. phone alerts, noise) more easily capture attention.
The prefrontal cortex (PFC) directs top-down attention, choosing what’s relevant, suppressing distraction, and maintaining goal-oriented focus.

When this system falters, stimulus-driven (“bottom-up”) networks dominate, explaining distractibility and inconsistent attention in ADHD.
ADHD isn’t just an “attention” problem.

It’s impaired prefrontal regulation across distributed circuits that shape attention, inhibition, and emotion.

Here’s how these circuits interact and what clinicians need to know about the neurobiology behind ADHD 🧵👇
Explore our deep dive: “Navigating Female-Specific Complexities in Psychiatry” on Psych Scene Hub 👇

https://psychscene.co/4nIEfTu
Psych Scene Tip

Think hormonal phenotype in women.

Cycle, pregnancy, perimenopause, menopause → all influence outcomes + management.
Takeaway

 Hormones shape:

 ✔️ Onset
 ✔️ Symptoms
 ✔️ Comorbidities
 ✔️ Relapse & treatment response

Stage-specific care is key.
Adjunctive oestrogen

Raloxifene → improves negative symptoms & working memory.

Oestradiol → added benefit, dose & timing matter.