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Mental Health

Behavioral Science, Mental Health, Research, Stanford News

Weekends are happier for those employed or not, Stanford study shows

Weekends are happier for those employed or not, Stanford study shows

campingA freelancing friend calls her state between projects “funemployed” –at least at the start. But unless you’re part of a community of like-scheduled beings, unemployed weekdays may not provide the same sense of joy as do weekends. A new Stanford study reports that weekends feel better for both those employed and not, with reasons including more opportunities for social interactions during shared time off.

From a Stanford News article:

Emotional well-being rises by about 15 percent on weekends, the study shows. This reflects both more positive emotions like happiness and enjoyment, and fewer negative emotions like stress, anger and sadness. The findings are based on a study of 500,000 Americans in the Gallup Daily Poll and eight years of data from the American Time Use Survey.

Understanding the source of weekend well-being is the study’s main focus. “Why are people happier on weekends? The tempting answer is not having to go to work, and not having to deal with your boss. But simply having time off work is not the answer,” [Cristobal Young, PhD, an assistant professor in sociology who co-authored the study with Chaeyoon Lim, PhD, from the University of Wisconsin-Madison,] said.

“Weekends are a break from unemployment,” Young later commented. “Unemployment is psychologically devastating,”

Previously: Study shows happiness and meaning in life may be different goalsGood news: Many studies recommend downtime for increased productivity and Study finds less time worked not always linked to happiness
Photo by Loimere

Medicine and Literature, Mental Health, Podcasts

A conversation with Scott Stossel, author of My Age of Anxiety

A conversation with Scott Stossel, author of My Age of Anxiety

Stossel bookScott Stossel has written a tome on anxiety. The editor of The Atlantic magazine opens his best-selling memoir with a frightening yet comical scene at his wedding. He’s standing at the altar in a Vermont church, and his angst has ripped open his innards reducing him to a puddle of sweat and embarrassment. Anyone who’s suffered from severe anxiety can fully appreciate the yin and the yang of his moment:

The minister is droning on; I have no idea what he is saying… I am praying for him to hurry up so I can escape this torment… Seeing me – the sheen of flop sweat, the panic in my eyes – he is alarmed. “Are you okay?” he mouths silently. Helplessly, I nod that I am… As the minister resumes his sermon, here are three things I am actively fighting: the shaking of my limbs; the urge to vomit; and unconsciousness.

Anxiety disorders have a terrifying grip on nearly 44 million Americans. In the book, psychologist David Barlow, PhD, said of the affliction, “Anxiety kills relatively few people, but many more would welcome death as an alternative to the paralysis and suffering resulting from anxiety in its severe forms.”

I first came across Stossel’s work as a cover story in The Atlantic. Then, I discovered there was buzz about the book, as friends around the country were talking about it. For a few weeks, Stossel was everywhere – Fresh Air with Terry Gross, The Colbert Report, London’s Sunday Times, personal appearances around the U.S., and in laudatory book reviews in the nation’s top papers. I believed his exploration of  “fear, hope, dread, and the search for peace of mind” was something all anxiety sufferers seek, and I knew I wanted to snag him for a 1:2:1 podcast.

When we spoke, I thought I would open with a question I was very curious about. “You’re in the middle of a book tour,” I said to him. “It’s a New York Times best seller. You’re speaking in public. Flying around the county. Doing things that you really hate. So has the book been good for your anxiety, as your doctor posed it might be?”

Well, as you’ll hear, there have been ups and there have been downs. Unfortunately, there’s no Hollywood ending at this particular moment to his psychological puzzle. Yet Stossel does congratulate himself for finishing the book, a task at times he was doubtful he could or would achieve.

When I asked Stossel to read from the book, he said it was my choice what he read. So I chose a passage that was hopeful. It talks about how his anxiety, though often intolerable and miserable, could have an upside. “But it is also, maybe a gift – or at least the other side of a coin I ought to think twice about before trading in,” he writes.

In the end, I’m struck by the tremendous courage that it took for Stossel to lay himself bare – to expose some of his most idiosyncratic fears that have crippled him since childhood. He’s a brave man. It’s for that reason I think My Age of Anxiety has meaning well beyond the words on the page. It will help de-stigmatize this little dark corner of mental disorders. Through peeling back his own layers of psychic skin almost to the quick, I think he’ll change attitudes and  perceptions.

I especially liked what Elizabeth Gilbert, author of Eat, Pray, Love, said about the book:

It could not have been easy for Stossel to dissect his own anxiety so honestly in this memoir. But he was brave as hell to write it, and I’m glad he did, for he brings to this story depth, intelligence, and perspective that could enlighten untold fellow readers for years to come.


Previously: Reframing reactions could reduce symptoms of social anxiety disorder, Stanford study shows and Does more authority translate into a reduction in stress and anxiety?
Image from Random House

Addiction, Health Policy, In the News, Mental Health, Stanford News

A reminder that addiction is a chronic disease

A reminder that addiction is a chronic disease

holding pills - smallerThis morning on KQED’s Forum, guests discussed addiction in the wake of the apparent heroin overdose of actor Philip Seymour Hoffman.

During the show, Stanford’s Keith Humphreys, PhD, a professor of psychiatry and behavioral sciences, noted that addiction is a disease:

Addiction is like other chronic disorders that are not curable – I mean, they can be managed, but we can’t eliminate them. Just like diabetes or low back pain or high blood pressure, you can go through treatment periods and recover your function, but that doesn’t mean that it can’t come back. And people are particularly prone to relapse in times of stress, in times of deprivation. Sometimes in also very good times people haven’t learned to celebrate and be happy without reaching for their drug or alcohol.

Humphreys, who recently served as a senior advisor in the Office of National Drug Control Policy in Washington, outlined two common barriers to receiving treatment: “Not having enough money, and being stigmatized.” But he also shared good news on how addiction is being viewed by the American public – and treated as a medical condition worthy of health insurance coverage.

“Several hundred million Americans, although they might not know it, just got better coverage for addiction treatment in their insurance,” Humphreys said. “The Affordable Care Act defines substance abuse for the first time as an essential health-care benefit. So all new plans must offer benefits, and they must offer them at parity.”

Previously: We just had the best two months in the history of U.S. mental-health policy, Is it damaging to refer to addicts as drug “abusers?”, “Brains are unmentionable:” A father reflects on reactions to daughter’s mental illness, Breaking Good: How to wipe out meth labs, How police officers are tackling drug overdose and Addiction: All in the mind?
Photo (modified from original) by vmiramontes

Complementary Medicine, Mental Health

The remarkable impact of yoga breathing for trauma

The remarkable impact of yoga breathing for trauma

“Military guys doing yoga and meditation?” I’ve been asked in disbelief. It’s true that when they first arrived to participate in my study (a yoga-based breathing program offered by a small non-profit organization), the young, tattoo-covered, hard-drinking, motorcycle-driving all-American Midwestern men didn’t look like your typical yoga devotees. But their words after the study said it all: “Thank you for giving me my life back” and “I feel like I’ve been dead since I returned from Iraq and I feel like I’m alive again.” Our surprisingly positive findings revealed the power that lies in breath for providing relief from even the most deep-seated forms of anxiety.

As many of us know, there is an unspoken epidemic that is taking 22 lives a day in the U.S.

Who is impacted? Those who are willing to make the ultimate sacrifice in protection of others: Veterans.

How? Suicide.

Why? War trauma.

Average age? 25.

After a long deployment of holding their breath in combat, these men and women often return to civilian life no longer knowing how to breathe. Though the military trains service members for war, it doesn’t train them for peace. Ready to give up their life for others, service members embody the values of courage, integrity, selflessness, and a deep commitment to serving. They’ve trained under extreme conditions to do things most civilians don’t encounter: lose parts of their body, kill or injure another human being under orders or by mistake, get right back to work and keep fighting hours after seeing a friend killed, be separated from families and loved ones for months and even years, and live with the horrendous physical and emotional consequences thereof upon their return home.

The National Institutes of Health estimates that 20-30 percent of the over 2 million returning Iraq and Afghanistan war veterans have symptoms of post-traumatic stress disorder (PTSD). This anxiety disorder involves hyper-alertness that prevents sleep and severely interferes with daily life, triggers painful flashbacks during the day and nightmares at night, and causes emotional numbness that leads to social withdrawal and an inability to relate to others. Side effects of PTSD include rage, violence, insomnia, alienation, depression, anxiety, and substance abuse. PTSD symptoms are associated with higher risk of suicide, a fact that may explain the alarming rise in suicidal behavior amongst returning veterans.

While traditional treatments work for some, a large number of veterans are falling through the cracks. Dropout rates for therapy and drug treatments remain as high as 62 percent for veterans with PTSD. Symptoms can persist even for veterans who actually undergo an entire course of psychotherapeutic treatment and drug treatment results are mixed.

Our research at the University of Wisconsin-Madison and Stanford showed that the week-long Project Welcome Home Troops intervention was successful, with our analyses showing significant decreases in PTSD and anxiety. Improvements remained one month and one year later, suggesting long-term benefit. More telling even than the data are the veterans’ words; with a veteran of the war in Afghanistan writing:

A few weeks ago shooting, cars exploding, screaming, death, that was your world. Now back home, no one knows what it is like over there so no one knows how to help you get back your normalcy. They label you a victim of the war. I AM NOT A VICTIM… but how do I get back my normalcy? For most of us it is booze and Ambien. It works for a brief period then it takes over your life. Until this study, I could not find the right help for me, BREATH’ing like a champ!

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Mental Health, Parenting, Pediatrics

Study finds treatment for anxiety disorders among children and young adults inadequate

Study finds treatment for anxiety disorders among children and young adults inadequate

anxiety_teenNew research shows that less than half of children and young adults who are treated for anxiety disorders will achieve long-term relief from symptoms.

In the study (subscription required), researchers at Johns Hopkins Children’s Center and five other institutions conducted a long-term analysis of nearly 300 patients, ages 11 to 26,  treated with medication, cognitive behavioral therapy or a combination of the two. Individuals received treatment for three months and followed, on average, for six years. Results showed 47 percent were anxiety-free by the end of the follow-up period and nearly 70 percent required some form of occasional mental health treatment.

A story published today in U.S. News and World Report discusses the significance of the findings:

“The study underscores the chronic nature of psychiatric illnesses and illustrates the importance of the pressing need to study and support mental health treatments across the age and demographic spectrum,” said Dr. Aaron Krasner, adolescent transitional living program chief at Silver Hill Hospital in New Canaan, Conn. “Anxiety, a common condition by most epidemiologic estimates, is understudied and undertreated, especially in the pediatric population,” he said.

[Lead investigator Golda Ginsburg, PhD and her] team believe their findings also highlight the importance of close follow-up and monitoring of symptoms among children, teens and young adults who’ve been treated for anxiety, even if they seem to be getting better.

“Our findings are encouraging in that nearly half of these children achieved significant improvement and were disease-free an average of six years after treatment, but at the same time we ought to look at the other half who didn’t fare so well and figure out how we can do better,” Ginsburg, who is also professor of psychiatry at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

“Just because a child responds well to treatment early on, doesn’t mean our work is done and we can lower our guard,” she added.

Previously: Anxious children’s brains are different from those of other kidsNew research tracks “math anxiety” in the brain and Fear leads to creation of new neurons, new emotional memories 

Addiction, Health Policy, In the News, Mental Health, Stanford News

We just had the best two months in the history of U.S. mental-health policy

We just had the best two months in the history of U.S. mental-health policy

For decades, descriptions of the status of U.S. mental health services have included references to service cuts, funding constraints and poor access to care. That makes it only more astonishing and important that the past two months have witnessed the most expansive support for mental-health services in U.S. history. Three critical pieces of federal legislation are responsible for this remarkable turn of events.

Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level

In early November, the Obama Administration released the final regulations for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPEA) of 2008. One of the very last laws passed during the George W. Bush Administration, MHPEA affects the more than 100 million Americans who receive their health insurance through large group employers. It mandates that any insurance plan that offers benefits for the treatment of mental-health disorders must make those benefits comparable to those for other medical disorders. In other words, the higher co-pays, more intensive utilization review requirements and lower benefit caps historically applied to mental health care are now illegal.

Just seven weeks after the final MHPEA regulations were issued, Medicare ended its decades-long practice of reimbursing outpatient mental-health care at a lower rate than care for all other disorders. Historically, Medicare had covered 80 percent of all outpatient care except for mental health care, which was reimbursed at only 50 percent. Due to the final implementation of the Medicare Improvements for Patients and Providers Act of 2008 (.pdf), this disparity was eliminated on January 1, 2014. That’s good news for the approximately 50 million Americans who are covered by Medicare.

Last but not least, as everyone knows the remaining provisions of the Affordable Care Act also came into force over the past month. The ACA had already helped families facing mental illness by allowing parents to keep their children on their insurance policies until the age of 26. That was critical because addictive and psychiatric disorders almost always have onset in adolescence or young adulthood. But an even more influential feature of the law is to define substance use disorder and mental-illness treatment as essential health care benefits, and, to specify that those benefits be at parity with benefits for other disorders, such as is specified in MHPEA. This standard will apply to all plans issued through state and federal health insurance exchanges and the Medicaid expansion, as well as to insurance plans to be issued in the future that are subject to ACA regulations. The HHS Office of the Assistant Secretary for Planning and Evaluation projects the impact of these changes as improving mental-health care coverage for more than 60 million Americans.

Of course, while the above changes all were implemented in the past two months, they each were the product of many years of advocacy by office holders, political activists, grassroots organizations, clinicians and researchers. These laws coming to fruition in such a compressed time window was fortuitous in some respects, but it also reflects a new political reality in Washington: Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level. That augurs well for American families who will face the challenge of mental illness in the coming years.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys

Previously: Managing primary care patients’ risky drinking, Full-length video available for Stanford’s Health Policy Forum on serious mental illness and How states will benefit from Medicaid expansion

Immunology, Mental Health, Microbiology, Public Health

Examining how microbes may affect mental health

Examining how microbes may affect mental health

Over on the NIH Director’s Blog today, there’s an interesting post about research efforts aimed at determining how the colonies of bacteria in our gut could play a role in mental health. As described in the piece, past research has shown there are a number of ways microbes can influence our thoughts, behavior and mood:

First of all, and perhaps most obviously, gut bacteria are engaged in a wide range of biochemical activities, producing metabolites that are absorbed into the human bloodstream. But there are other connections. One species of bacterium, for example, sends messages that are carried via the vagus nerve, which links the intestinal lining to the brain. When this species is present, the mice demonstrate fewer depressive behaviors than when it’s absent. Another bacterium plays an enormous role in shaping the immune system, which goes awry in many neurological diseases. This species of bacterium interacts directly with the immune system’s regulatory T-cells to provide resistance against a mouse version of multiple sclerosis, a progressive disease in which the immune cells damage the central nervous system by stripping away the insulating covers of nerve cells.

As Stanford microbiologist and immunologist Justin Sonnenburg, PhD, commented in a past entry on Scope, “There’s no doubt about it. These microbes are influencing every aspect of our neurobiology. There’s a direct connection between the microbes inside our gut and the central nervous system. They’re influencing our behavior, our moods, even our decisions.”

Previously: Could gut bacteria play a role in mental health?Study shows probiotic foods may alter metabolism, but can they boost your health? and Study shows intestinal microbes may fall into three distinct categories

Mental Health

Six mindfulness tips to combat holiday stress

Six mindfulness tips to combat holiday stress

mindfulnessIs the holiday season stressful or even lonely? Heard about the scientific benefits of mindfulness but just don’t see how you could fit it in? Especially during the holidays? We often mistakenly think meditation requires sitting in lotus posture, preferably on a lotus flower in the middle of a still lake in Thailand with birds chirping in the background. Although that would be nice, it’s clearly not always possible and the good news is that it’s not necessary either! No matter what we are doing – whether it is commuting or traveling, eating or talking, sitting around or doing chores, each of these activities presents an opportunity for mindfulness! Here are six easy ways to integrate mindfulness into your holidays (and any day)!

Most meditation exercises are designed to bring your mind back into the present moment where it is happiest and calmest. About 50 percent of the time, we aren’t in the present moment, according to a study of 5,000 people by Matthew Killingsworth and Daniel Gilbert of Harvard University. Our minds tend to wander and the researchers concluded that “a wandering mind is an unhappy mind.” It is a fascinating fact that, no matter what we’re actually doing, pleasant or unpleasant, we are happiest when our mind is in the present moment. So here are some easy exercises that work, no matter where you are:

1. During the Commute/Travel

Driving mindfully. So often, we regard our commute or cartravel as a stressful annoyance. The worst is when we are stuck in traffic. But hold on, here’s a chance for you to sit back, relax and focus on your breathing. Bring your mind back into the present moment and see if you can become aware of everything around you. Usually our mind is always wandering, especially when we’re in an uncomfortable situation. Being stuck in a commute or in traffic allows us to develop being in the present moment. Have screaming children in the backseat? Practice fully accepting the moment as it is. Chances are they will calm down as you do… The result? You’ll arrive calmer and feel more rested and even restored.

2. During Meals

Eat mindfully. We often stuff our faces while watching TV, between meetings or in front of our computer. During the holidays, we tend to overeat. We are so busy consuming, we sometimes fail to fully pay attention to the flavors that grace our mouths. Try eating a snack with full attention. Notice how it looks and smells, feel the burst of flavors as you place it in your mouth, notice the taste of each bite, the texture. Contemplate the many people it took to bring this food to you (from the farmers to people delivering it to stores to you). You will open your eyes renewed, calmer and more focused.

3. During Conversation

Listen mindfully. Every interaction we have, whether it is at work or at home is an opportunity for mindfulness. Usually we are bursting with the impulse to talk about ourselves, to interrupt, or, oftentimes our mind is wandering – i.e. we are not really listening. See if, even for 5 minutes, you can fully dedicate your attention and awareness to the people who are speaking to you. Not only will you feel more peaceful and calm, but you will notice that you can understand them better and they will in turn feel deeply grateful and valued as they notice your full attention on them. As Simone Weil writes, “attention is the rarest and purest form of generosity.”

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Addiction, Mental Health

Is it damaging to refer to addicts as drug “abusers?”

I’ve written quite a bit about mental-health issues over the years, and I’ve never thought twice when typing the words “substance abuse.” But then I read this excellent piece on CommonHealth – a Q&A with Harvard psychiatrist John Kelly, PhD, – and it got me thinking. In it, Kelly, a former Stanford/VA Palo Alto Health Care System scientist, addresses the stigma surrounding addiction and discusses why we shouldn’t refer to those with drug problems as “abusers.” From the piece:

It seems clear that addiction is not a good thing. It can cause people many problems, even kill them. But you’re saying that the trouble with addiction stigma is that it goes beyond seeing addiction as bad, to actually blaming the addict?

Yes. The degree of stigma is influenced by two main factors: cause — ‘Did they cause it?’ — and controllability — ‘Can they control it?’ We now know that about half the risk of addiction is conferred by genetics – what you’re born with. On controllability, neuroscience has also taught us that alcohol and other drugs cause profound changes in the structure and function of the brain that radically impair individuals’ ability to stop, despite often severe consequences.

The language we use to describe these problems may perpetuate stigma, and that can potentially harm patients and continue the suffering among families.

You pointed out at the drug reform summit that other mental health fields don’t use the term ‘abuse.’

Right. Individuals with ‘eating-related problems’, are uniformly described as ‘having an eating disorder,’ not as ‘food abusers.’ We need to do the same in the addiction field.

Because the term ‘abuse’ gives rise to the ‘abuser’ term, it is better to use the term ‘misuse.’ Furthermore, given the lack of scientific specificity associated with the ‘abuse’ and ‘abuser’ terms, its nonuse would not result in any loss of scientific accuracy.

Kelly spoke last week at a White House summit on drug policy reform. The rest of his thoughts are worth a read.

Previously: “Brains are unmentionable:” A father reflects on reactions to daughter’s mental illness and Addiction: All in the mind?

Behavioral Science, Mental Health, Stanford News

Study: Bulimics may have difficulty perceiving their own heartbeat

Study: Bulimics may have difficulty perceiving their own heartbeat

3408225331_ce15c66c6b_zNew research published in the December issue of Eating Behaviors shows a possible link between bulimia and the ability to detect one’s own heartbeat. The study found that women who suffered from the eating disorder were less likely to accurately detect their own heartbeat, and thus, may have difficulty detecting other internal cues such as hunger or fullness. From an Inside Stanford Medicine story:

A growing body of literature shows that heightened or suppressed interoception [which is the ability to sense internal body cues] is either a contributor to or a product of many psychiatric disorders. For example, anxiety patients tend to be particularly sensitive to their own heartbeat. They are more likely to accurately detect their own heartbeat than those without anxiety.

This is the first study to use the heartbeat detection task to assess interoception in recovered bulimia nervosa patients, [Megan Klabunde, PhD, a postdoctoral scholar at the Stanford Center for Interdisciplinary Brain Sciences Research], said. Previous studies have asked participants to rate their own ability to detect hunger and satiety.

Klabunde said it is unclear whether diminished interoception is a contributing factor to the development of the bulimia, or a consequence of repeated binging and purging.

However, she feels that bulimia and other eating disorders are not purely driven by a vain desire for thinness. “I come from a philosophy that, in terms of psychiatric disorders, symptoms are there for a reason. And if we don’t understand the symptom, it means we need to research it better,” Klabunde said.

Klabunde plans to continue to study interoception in the context of eating disorders and says this work could lead to potential new therapies for eating disorders. “The body is clearly involved in emotional processing,” Klabunde said. “We might have to be more creative in terms of how we address the body in treating psychiatric disorders.”

Previously: Possible predictors of longer-term recovery from eating disorders and Exploring the connection between food and brain function
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