— Increase seen particularly in western states and in younger adults Pills Fatal overdoses from counterfeit pharmaceuticals, particularly pills found to contain fentanyls, more than doubled in recent years, the CDC reported. Among more than 100,000 recent overdose deaths in the U.S., the percentage caused by pills disguised as legitimate pharmaceutical products increased from 2.0% in the third quarter of 2019 to 4.7% in the last quarter of 2021. The proportion of those deaths involving illicitly manufactured fentanyls jumped to 93.0% from 72.2%, while illicit benzodiazepines also rose to 5.3% from 1.4%. Fake fentanyl was the sole drug involved in 41.4% of counterfeit pill-related deaths, compared with 19.5% of overdose deaths without evidence of counterfeit pill use. Western states drove the increase in deaths with evidence of counterfeit pill use, with a rise from 4.7% to 14.7% across the study period, whereas percentages remained below 4% elsewhere, reported Julie O'Donnell, PhD, of the CDC, and colleagues in Morbidity and Mortality Weekly Reportopens in a new tab or window. "The proliferation of counterfeit pills, which are not manufactured by pharmaceutical companies, but are typically made to look like legitimate pharmaceutical pills (frequently oxycodone or alprazolam [Xanax]), is complicating the illicit drug market and potentially contributing to [overdose] deaths," O'Donnell and colleagues wrote. And it may unintentionally expose new populations to highly potent drugs. "Counterfeit pills often contain illicitly manufactured fentanyls (IMFs), illicit benzodiazepines (e.g., bromazolam, etizolam, and flualprazolam), or other illicit drugs, and can increase overdose risk because the pills might expose persons to drugs they did not intend to use," they added. The findings come against a backdrop of an overall increase in drug overdose death ratesopens in a new tab or window involving fentanyl, methamphetamine, and cocaine from 2016 through 2021, as previously reported by the CDC without respect to counterfeit status. Prevention and education efforts "that are tailored to persons most at risk, and include outreach to those who do not frequent traditional harm reduction services, might be most successful," they wrote. Effective messaging by public health entities might include highlighting the dangers of pills obtained and taken without a prescription, as well as encouraging drug product testing, O'Donnell and colleagues added. Data examined for the study came from jurisdictions participating in CDC's State Unintentional Drug Overdose Reporting System (SUDORS), which included 29 states and the District of Columbia from July 2019 to December 2021, with an additional five states reporting data during 2021. Jurisdictions entered information about unintentional and undetermined intent overdose deaths from death certificates, post-mortem toxicology reports, and medical examiner and coroner reports. As for means of drug use, smoking was the most common non-ingestion route among deaths with evidence of counterfeit pill use (39.5%) and was highest in western jurisdictions (55.1%). More than half of deaths with evidence of counterfeit pill use involved counterfeit oxycodone, either alone (55.2%) or with counterfeit alprazolam (3.9%), researchers reported. Decedents with evidence of counterfeit pill use were younger than those without such evidence (57.1% vs 28.1% under age 35) and more were Hispanic or Latino (18.7% vs 9.4%, respectively). Additionally, a higher percentage of deaths with evidence of counterfeit pill use were in people with a history of prescription drug misuse compared with those without such evidence (27.0% vs 9.4%). Deaths involving oxycodone and alprazolam combined involved people of the youngest average age (26 years). "Counterfeit pills have been marketed toward younger persons, who might have more recently started using drugs and have lower tolerance," O'Donnell and colleagues wrote. "Younger persons might also exhibit more risk-taking behaviors than do older persons, and engage less with harm reduction services." "The higher percentage of Hispanic decedents could reflect the younger age of this population and the demographics of western states where evidence of counterfeit pill use was more common; nonetheless, it might still have implications for access to and use of prevention messaging materials and harm reduction services," they added, such as tailoring these messages and services to address potential engagement, language, or other barriers. Limitations of the study included that analyses might not be generalizable beyond jurisdictions that were included, and that documentation of counterfeit pill use is likely underestimated, the researchers noted. Furthermore, the definition for evidence of counterfeit pill use included pills found or reported to be at the overdose scene, and some overdose deaths might be included as having evidence of such use even if the decedent did not use the pills. Related Article: Substance Use Disorder Two Thirds Say They or Family Affected by Substance Use

Suicidal Behavior Patients with major depressive disorder (MDD) and suicidal behavior during the depressive period have over double the mortality rate of those without a suicide attempt, new research suggests. Investigators studied close to 143,000 patients, encompassing more than 150,000 MDD episodes. Episodes of depression with suicidal behavior (MDD-SB) were compared to MDD episodes without suicidal behavior (MDD-non-SB). Suicidal behavior was associated with a 2.6-fold higher rate of all-cause mortality, as well as considerably higher healthcare resource utilization (HCRU) and work loss, compared to matched controls. Patients with depression who had attempted suicide were younger and more commonly suffering from other psychiatric comorbidities, such as anxiety and addiction. Important risk factors for suicidal acts within a year after the onset of a depressive episode were previous suicide attempts, substance use disorder, anxiety, and sleeping disorders. "The findings tell us that the care provided for this particular group needs to be developed," lead author Johan Lundberg, MD, PhD, adjunct professor in psychiatry and senior physician in psychiatry, Karolinska Institute, Stockholm, Sweden, told Medscape Medical News. "The take-home message is that, when treating patients with increased risk of suicidal behavior, one should offer treatments with this in mind," said Lundberg, also the head of the section of mood disorders, Northern Stockholm Psychiatry Clinic. "One possible option is lithium augmentation.". Identifying Subgroups Depression is associated with increased all-cause mortality, the authors write. Suicidal behavior and previous suicide attempts are known to increase the risk of suicide-associated mortality, with up to 13% of patients with nonfatal suicide attempts dying of suicide at a later time. Previous studies investigating the association between suicidal behavior and mortality have been limited by nonrandom sampling due to "nonuniversal access to healthcare and/or exclusion of primary care data," they state. For this reason, it's not established to what extent these estimates actually represent patients with MDD as a whole, or to what extent suicidal behavior is a risk factor for all-cause mortality. "We think there is a need to identify subgroups within the very large group of individuals with MDD in order to improve treatment outcomes," Lundberg said. To do so, the researchers turned to data from the Stockholm MDD Cohort (SMC), which comprises all patients diagnosed with MDD in any healthcare setting in the regions of Stockholm from 2010 to 2018. They identified 5 years of recorded MDD episodes (n = 158,169) in patients aged 18 years and older (n = 145,577). A single patient could contribute more than 1 episode. At index, MDD-SB patients (n = 2219, mean age 41 years) were matched with MDD-non-SB patients (9574, mean age 41 years) based on age, sex, year of MDD diagnosis, and socioeconomic status. In total, 2219 episodes (63.2% in women, 36.8% in men) were compared to 11,109 episodes (63.4% in women, 36.6% in men), respectively. Enhanced Monitoring, Optimized Treatment The median time from the start of the episode until the first suicidal behavior was 165 days. The all-cause mortality rate in the MDD-SB and MDD-non-SB groups was 2.5 per 100 person-years vs 1 per 100 person-years, respectively (based on 466 deaths), corresponding to a hazard ratio of 2.62 (95% CI, 2.15 - 3.20). Patients in the MDD-SB group were younger, more frequently diagnosed while in specialized care, and had sustained more work loss than their counterparts in the MDD-non-SB group. They also showed a gradual increase in the prevalence of comorbid conditions from about 12 months before index, with this increase being "most pronounced" for anxiety, stress, substance use, and personality disorders. MDD-SB episodes were associated with higher HCRU and more work loss, compared with MDD-non-SB episodes. The researchers calculated a risk score for factors associated with suicidal behavior within 1 year after the start of an MDD episode (outcome). The two most important risk factors for suicidal behavior were a history of suicidal behavior together with age, which had a "U-shaped association" with the outcome, they write, with individuals younger than age 20 and older than age 70 having the highest risks. The final risk score included additional factors that increased the risk of the outcome (in descending order): history of substance use, history of sleep disorders, healthcare level in which MDD was diagnosed, history of antidepressant use, and history of anxiety disorders. These results "indicate that patients at risk for suicidal behavior can be identified at an early stage to allow for enhanced monitoring and optimized treatment with the goal of preventing suicidal behavior and reducing mortality," the authors state. The specific causes of death weren't analyzed in this particular paper, Lundberg noted. A previous study conducted by the same group found the risk of death was doubled in MDD patients, compared to controls. "We don't speculate about which causes other than suicide might explain the difference," and account for the increased mortality risk, he said. "This should be studied in future projects." Complicated Family of Destructive Behaviors Commenting for Medscape Medical News, Russell Copelan, MD, a former emergency department psychiatrist at the University of Colorado Affiliated Hospital and currently an expert consultant to the American Association of Suicidology, said a take-home message of the study is that suicide is "a complex and complicated family of destructive behaviors." The findings "should not suggest a wait-and-see clinical approach," warned Copelan, who wasn't involved with the study. Underrecognized or misdiagnosed anxiety, agitation, and insomnia may be "barriers to remission and treatment response," he noted. Copelan, who is also the founder and CEO of eMed Logic, which offers assessment tools for suicide and violence, encouraged clinicians "not to minimize the proportion of patients who experience anxiety, agitation, and insomnia in response to what some may consider a personal misfortune, such as interpersonal, employment, or financial crisis." Related Articles: Seasonal Patterns Identified for Suicidality in Children, Teenagers Sleep disturbance may predict increased risk of suicidal thoughts

Introduction The term self-sabotage enjoys wide usage in psychological, spiritual, and self-help circles. It is often used to explain a variety of behaviors such as addiction, compulsion, perfectionism, procrastination, and bad financial management. In this article I’ll contend that there are several problems with the notion of self-sabotage: It does not accurately describe what it’s attempting to describe. It carries with it an aura of blame and shame. It provides no explanation for why a person is behaving in a particular way and is therefore essentially useless as a concept. I’ll also lay out what I consider a more helpful way of looking at behaviors that are often described as self-sabotage, using the lens of Internal Family Systems (IFS) as a guide. A Question of Intent The first and most glaring problem with the idea of self-sabotage is that it’s not actually “sabotage.” Sabotage implies conscious intent. The Oxford Dictionary, for example, defines sabotage as follows: “to deliberately destroy, damage, or obstruct” something. Self-sabotage, then, would involve intentionally destroying or obstructing oneself, one’s relationships, one’s career, or what have you. As an example, consider someone who tries to get a new job. They apply for it, get an interview, and then proceed to botch the interview in an explicit way – perhaps by behaving bizarrely or showing up late. The theory of self-sabotage would say that this person initially thought to themselves something along the lines of “I want this job, so I’m going to apply for it and hopefully get an interview”, but then before the interview, they changed their thought to “I’m going to intentionally ruin the interview by behaving in a way that the interviewer finds unacceptable.” Needless to say, this isn’t how things usually happen. Other examples may seem to be more intentional at first glance. For example, a person commits to a diet and then a week later binge-eats ice cream and ruins all of his or her progress. It may be tempting here to conclude that the person intentionally ruined the diet, but this viewpoint conflates the intentionality of the action (eating ice cream) with the intentionality of the effect (ruining the diet). While the eating was intentional – insofar as the physical movements required to do it were under the person’s conscious control – ascribing intentionality to the effect assumes that the person ate the ice cream in order to ruin the diet. One would be hard-pressed to find a situation where this scenario was the case. This matter of intent is extremely important when determining how to treat a given behavioral pattern. Blame & Shame As a result of the fact that it implies intentionality, the term self-sabotage carries with it a connotation of blame, shame, and guilt. If people are intentionally engaging in maladaptive behaviors, it must be their own fault. Can’t he simply stop doing this? Can’t she control herself? What’s the matter with him or her? Whether or not these types of questions are communicated explicitly, they’re inherent in the very name of the diagnosis. Muddying the Waters Much like mental health diagnoses, while the term self-sabotage may appear on the surface to be helpful, it doesn’t actually explain anything. In fact, the logic of it turns out to be completely circular. For example, consider a person who is trying to get a new business off the ground, but keeps herself perpetually distracted by spending inordinate amounts of time on social media. One might say she is self-sabotaging as if this view somehow clarifies the issue, but consider the circular logic of such a claim. “Why does Helen spend hours a day on social media instead of working on her new business?” “Because she is self-sabotaging.” “How do we know she is self-sabotaging?” “Because she spends hours a day on social media instead of working on her new business.” “Why does Helen spend hours a day on social media instead of working on her new business?” What becomes clear is that the term self-sabotage is nothing more than a label that describes behavior (or behaviors). This label offers no insight into why the behaviors are occurring and is therefore unhelpful as any kind of explanation or diagnosis. Getting at Why With any kind of repetitive, maladaptive behavior, it’s critical to get to the root cause – rather than offering a surface-level description – if treatment is to succeed. The behaviors that often fall into the realm of self-sabotage are, in my view, virtually always the result of unconscious emotional processes. As such, a bottom-up therapeutic modality that works with the unconscious – such as Internal Family Systems (IFS) – offers a far more comprehensive approach to healing relative to cognitive (top-down) techniques. IFS recognizes that our minds consist of parts, rather than being a single entity. Each person’s parts interact and function in different ways depending on his or her history. We are particularly susceptible to trauma (both overt and covert) early in life, and this susceptibility causes our parts to take on two basic roles: Burdened Parts carry pain and toxic self-beliefs. Protector Parts take on protective roles aimed at preventing more pain from being inflicted on burdened parts. A practitioner of IFS takes a systems-level view of the parts to understand what the parts are doing, why they’re doing it, and how they’re interacting with each other. Only through the IFS lens can we truly get an understanding of the dynamics underlying one’s behavioral patterns. We then can work with our parts rather than against them – in a compassionate and non-confrontational way – to effect change. As parts largely operate in the unconscious, ascribing intentionality (which implies conscious awareness) to the effects of one’s actions is often inappropriate when parts are in the lead. The parts themselves are acting in intentional ways, but the person’s consciousness has no awareness of this scenario. This type of distinction is a good example of what a parts-aware approach brings to the table: a deeper understanding of the internal dynamics at play, which leads to a more informed and holistic plan of action in therapy. Going back now to the example of the person who did poorly in the job interview: If there are indications that a part (or parts) caused this to happen, in an IFS context we guide the client to form relationships with these parts and find out what their fears were about the prospect of getting the new job. This information-gathering will likely lead to other areas in the person’s life that these parts have been influencing. Once the relevant parts in the system have been identified, the process of unloading the trauma that the burdened ones are carrying can begin, at which point the protective parts won’t need to engage in defensive behaviors anymore. While this post is necessarily a brief overview of how the IFS process works, hopefully, it is helpful in providing a baseline understanding of how the IFS approach can be used to dig deeper into symptoms that might appear as self-sabotaging. Conclusion Thus, the term self-sabotage is inaccurate, unhelpful, and full of negative connotations. A deeper look into the behavioral patterns which typically fall under the self-sabotage label reveals a far more complex and subtle picture, an understanding of which is critical in order for healing to occur. Furthermore, the Internal Family Systems approach provides a far more comprehensive method for healing than cognitive (top-down) techniques.

Online Therapy Online psychotherapy has benefits that are hard to ignore. Clients who lack transportation, or those who live in underserved areas can access treatments that were not previously available. During disasters and public crises, such as the COVID-19 pandemic, treatment can be continued with minimal interruption. There’s more good news: Research seems to show that online therapy works for a broad range of problems and interventions. In many cases, internet-based treatments have outcomes comparable to in-person therapy. Although phone, chat, and email therapy have each found support, we have chosen to focus on video-based online therapy because of its prevalence, and its many similarities to in-person therapy. Because treatment is ultimately the same whether practiced online or in-person, we will focus on what’s different. Laws and Ethics There are many laws that limit how and when online therapy can be practiced. For example, if you live in the United States, you may not be permitted to provide services to a person who is in a different state. You might also find that popular video conferencing services such as Skype and FaceTime are not compliant with medical privacy laws, such as HIPAA. Because laws are location- and situation-specific, it is important to understand how they relate to your own unique situation. If you have any questions about legal or ethical issues related to online counseling, reach out to your local licensure board or an attorney who specializes in the area. During the COVID-19 pandemic, many of the usual legal requirements related to online therapy are being loosened, allowing for care to continue throughout the crisis. See the resources below for more information. Building Relationships Some critics fear that it might be difficult, or even impossible, to create an effective therapeutic relationship through the internet. They argue that limited nonverbal cues, differences in setting such as timezones or weather, and even the loss of other senses, such as smell, could have a negative impact on treatment. Although there are some unique challenges to building a working alliance online, research indicates that these relationships can be just as powerful. This can be especially beneficial for clients who have anxiety about travel, crowds, or in-person meetings, by reducing the barriers to starting a therapeutic relationship. To help build relationships online, some experts recommend having initial sessions in-person, whenever possible. If this isn’t possible, they suggest doing so early in the relationship. However, this is not always necessary to form an effective relationship. When it comes down to it, building a relationship online works much like offline. Many of the standard helping skills in a therapist’s toolbox, such as reflections, empathy, and active listening, are powerful whether or not you are behind a screen. Maintaining Focus and Commitment Getting dressed, driving to an office, and sitting face-to-face with another person helps to create a sense of commitment and convey the importance of each therapy session. It can be difficult to build a similar feeling of commitment through a device that’s more often used for social media, Netflix, and chatting with friends. Many people—clients and clinicians alike—will find that they unintentionally de-prioritize online therapy sessions. While parents might find a babysitter for in-person therapy sessions, it might not feel necessary during online therapy. Pets will beg for attention, laundry machines will rumble in the background, and phone notifications will become more difficult to ignore. To combat the mindset that online therapy requires less commitment, and to minimize distractions, set clear expectations about attention and boundaries during online therapy sessions. First and foremost, this means setting a good example. Ask yourself: Would this behavior be acceptable during in-person therapy? Dress as if you were in the office, silence your phone, place children with a caretaker, and fully commit to the therapy session. Similarly, encourage your clients to close other computer programs, close their door, and commit fully to the session. If there are distractions on your client’s side, again, ask the question: Would this be appropriate during in-person therapy? If not, it might be a good candidate for exploration. Client Privacy During in-person therapy, steps are taken by the therapist to ensure privacy. Typically, therapy offices are far from prying friends and family. During online therapy, while you are responsible for using secure technology to maintain privacy, your clients must take steps to create a sense of privacy in their chosen therapy location. If your clients fear that a family member might hear them through the door, or try to snoop on their session, they might be less likely to self-disclose. Encourage your clients to find a private location for each session. If they live with others, suggest closing the door, and using something to create noise (e.g. white noise audio found online, a loud fan). For clients who live in a smaller home, you may need to get creative. Do they have an outdoor location that’s private? Can sessions be scheduled for times when other family members will be out of the house? Can your client come to an agreement with housemates to be out of the house during the scheduled session time? If the expectation of privacy is regularly violated, it may indicate an issue related to boundaries or assertiveness. These issues can be further explored in therapy. Therapy Office Setup Whether you’re working from home or an office, create a designated therapy area that is neat and uncluttered, with a simple background. Test out the lighting to ensure the area doesn’t get too dark at night or too bright during the day. Make sure the area is quiet, with minimal background noise. To create consistency for your clients, use this same area for every session. Ensure the equipment you’re using is conducive to a good therapeutic experience. This means having a computer, microphone, and camera that allow you and your client to see and hear each other clearly. Built-in laptop webcams and microphones are often low quality, making your image blurry, and your voice distorted. This can greatly affect the ability to read non-verbal cues. Try testing with a friend or colleague to see how your image and sound come out on the other end. Take some time to figure out how you want to appear in front of the camera. How much of your body do you want visible to your clients? By sitting close to the camera, as is typical with a webcam, your face will be visible with great detail. This may allow for better reading of facial expressions. However, by sitting far from the camera, you will allow your clients to see more body language, such as crossed arms or a tapping foot. There is no “right” way to go about this, as both options have different advantages. Crisis Intervention It’s reasonable to have concerns about how to handle a crisis during online therapy. However, if the situation arises, you will take the same general steps, and use the same skills, as you would during a crisis that happens in-person. Conduct an initial assessment with each client before beginning online therapy. Be mindful that clients who are suicidal, or who have other significant risks, may need more intensive treatment than can be provided by online therapy. Before each session, make sure you know the client’s current location (e.g. their home address), along with their local emergency phone numbers. You may want to obtain information about personal emergency contacts, such as friends or family, along with a signed release for these contacts. Make sure your client has access to their local emergency numbers at all times. Technology Backup Plan Inevitably, your internet will go down. Video software will crash. Someone’s computer will break. Something will go wrong. Create a technology backup plan with your client. Have phone numbers, email addresses, or other modes of communication handy. If you and your client are in the middle of a difficult session and the connection goes bad, you’ll both be happy that a plan is in place.

As more older adults turn to cannabis to alleviate medical ailments like pain, insomnia, and anxiety, many physicians are hesitant to ask their patients about the topic or advise them about possible health impacts. The lack of questioning is concerning for both doctors and patients: while moderate use of cannabis and cannabidiol (CBD) may be safe on their own when combined with certain medications, the substance can cause serious side effects. Older adults may also be more sensitive to the drug. The problem is magnified by a sharp increase in cannabis consumption among older Americans resulting from its legalization in 38 states across the country. One study found that use of cannabis by adults 65 years and older in the United States jumped sevenfold in the past decade. In states like California, the stark increase has resulted in a 1808% jump in the rate of cannabis-related visits by seniors to the emergency room, according to a study published this past January in the Journal of the American Geriatric Society. As cannabis grows in popularity, doctors need to inform patients about the potential harms and benefits, experts said. Marijuana can have serious interactions with blood-thinning medications like warfarin, resulting in a risk for internal bleeding. Its use may also cause harmful interactions with the anti-epileptic medication clobazam (Sympazan, Onfi). Anesthesia requirements are also greater in those who regularly use cannabis; therefore, if a patient is going into surgery the doctor needs to have an accurate understanding of regular use, said Peter Grinspoon, MD, a primary care physician and instructor at Harvard Medical School in Boston. "If you don't have open communication between a doctor and patient then cannabis use can be dangerous," said Grinspoon, the author of Seeing Through the Smoke: A Cannabis Specialist Untangles the Truth About Marijuana. If doctors are aware of a patient's cannabis use, they can adjust their medications, he said. Many physicians are hesitant to advise their patients on cannabis use because they weren't taught about it in medical school, Grinspoon said. Only about 15% of US medical schools teach about medical marijuana and the endocannabinoid system, through which cannabis works in the body. Cannabinoid receptors are found throughout the body in tissue and organs, and they are most numerous in the brain. When cannabis is in the system it acts on these receptors, which then release brain chemicals that impact appetite, pain, mood, and memory. "We're doing a huge disservice to doctors by not educating them on the basics of how cannabis works," Grinspoon said. Seniors may also turn to cannabis to help with their depression and anxiety, said Thomas Kosten, MD, a professor of psychiatry at Baylor College of Medicine in Houston. The drug also can serve as an appetite stimulant in depressed patients who aren't eating well and are losing weight as a result. An April 2020 study published in the American Journal of Geriatric Psychiatry found that anxiety was among the most common reasons why older patients use cannabis and that patients found it effective for alleviating symptoms. Kosten notes that older patients may sometimes experience anxiety over concerns around aging or loneliness. Although cannabis may reduce symptoms of depression and anxiety, doctors must look below the surface at what's causing the symptoms. "Cannabis may improve your appetite but it won't necessarily make the depression that's causing it any better," Kosten said. "For that, patients may need an antidepressant." Kosten noted that older military veterans may turn to cannabis to help ease "We're doing a huge disservice to doctors by not educating them on the basics of how cannabis works," Grinspoon said. Seniors may also turn to cannabis to help with their depression and anxiety, said Thomas Kosten, MD, a professor of psychiatry at Baylor College of Medicine in Houston. The drug also can serve as an appetite stimulant in depressed patients who aren't eating well and are losing weight as a result. An April 2020 study published in the American Journal of Geriatric Psychiatry found that anxiety was among the most common reasons why older patients use cannabis and that patients found it effective for alleviating symptoms. Kosten notes that older patients may sometimes experience anxiety over concerns around aging or loneliness. Although cannabis may reduce symptoms of depression and anxiety, doctors must look below the surface at what's causing the symptoms. "Cannabis may improve your appetite but it won't necessarily make the depression that's causing it any better," Kosten said. "For that, patients may need an antidepressant." Kosten noted that older military veterans may turn to cannabis to help ease post-traumatic stress disorder (PTSD). Some evidence points to benefits of cannabis for PTSD, including a study published in the journal Psychiatry and Neuroscience in March 2019. Many patients turn to cannabis because the side effects are more tolerable than other medications, Grinspoon said. Even so, doctors need to be aware of these side effects and act accordingly. "There's no free lunch," he said. "All medications have side effects." Sara Novak is a science writer based in South Carolina who has written for a variety of publications, including WebMD, Medscape, Scientific American, and New Scientist.. Some evidence points to benefits of cannabis for PTSD, including a study published in the journal Psychiatry and Neuroscience in March 2019. Many patients turn to cannabis because the side effects are more tolerable than other medications, Grinspoon said. Even so, doctors need to be aware of these side effects and act accordingly. "There's no free lunch," he said. "All medications have side effects." Sara Novak is a science writer based in South Carolina who has written for a variety of publications, including WebMD, Medscape, Scientific American, and New Scientist. Related Article:

In this insightful interview, experts discuss the journey toward a more humanistic approach in psychiatry, the challenges of integrating biological and psychosocial aspects, and the need for comprehensive training for future psychiatrists. CLINICAL CONVERSATIONS Psychiatric Times’ Editor-in-Chief Emeritus Ronald W. Pies, MD, has never shied away from controversial topics and supporting the field of psychiatry and its practitioners. Dr Pies has consistently encouraged the consideration of the ethical, psychosocial, and humanistic aspects of psychiatry, in addition to the biological and pharmacological aspects of the field. His latest book draws from previous commentaries and columns published with Psychiatric Times to reflect on the current status of psychiatry and possible paths for the future. Howard Forman, MD: We have all heard "don't judge a book by its cover," so I want to ask you about the question chosen for the cover of your newest book, Psychiatry at the Crossroads: Can Psychiatry Find the Path to a Truly Humanistic Science? Compared to other eras, how close is our current era to psychiatry achieving this goal? Ronald W. Pies, MD: I think there is both good news and bad news in that regard. Just to put your question in historical context, US psychiatry had its heyday during the 1950s and ’60s when the psychoanalytic era was in full flower, but when biological approaches to mental illness were generally very limited or rudimentary. The 1980s and ’90s saw the great biological turn in psychiatry, which began with a great deal of promise but ended with some disappointment. That’s not to say that our biological treatments were not helpful or that we didn’t learn a great deal about the brain during that period. But despite our best efforts and intentions, the field fell short of integrating basic biological research into clinical practice—so-called translational psychiatry. For example, despite excellent research in the areas of brain imaging and neurochemistry, psychiatry never really developed office-ready biological tests for the major mental illness categories, though we have a few promising contenders. Furthermore, during the so-called Decade of the Brain (ca. 1990-1999), I think psychiatry lost much of its historical connection to psychosocial factors in mental illness and to the rich tradition of psychotherapy. Ever since then, I think the profession has continued to pivot toward mainly biological approaches and treatments, somewhat to the detriment of a full, humanistic understanding of psychiatric illnesses and their treatment. I say this as someone who more or less paid the rent doing psychopharmacology consultation for more than 25 years, and who firmly believes in the benefits of psychiatric medication and somatic treatments. But, during my 40 years in psychiatry, I have always advocated a biopsychosocial approach to psychiatric illness. In fact, my 1994 book Clinical Manual of Psychiatric Diagnosis and Treatment was subtitled, A Biopsychosocial Approach. Psychiatry—to the extent that we can generalize about such a diverse field—now has a golden opportunity to integrate biological with psychosocial knowledge into a single, humanistic science. Now back to your question and to the good and bad news. I think psychiatry—to the extent that we can generalize about such a diverse field—now has a golden opportunity to integrate biological with psychosocial knowledge into a single, humanistic science. We know that a purely biological or purely psychosocial approach to the most serious psychiatric disorders is far from adequate. So, we really must find a way to put it all together. At the same time, market pressures and the general derogation of psychiatric expertise—we are now mere providers—are powerful forces working against us. US psychiatrists are still doing psychotherapy, but substantially less often than in the 1970s and 1980s, and this has played into the hands of third-party payers who want us merely to “write scripts.” I think we, as a profession, need to find the will and the way to resist this kind of pressure. If we do so, we have a shot at becoming a truly humanistic science. Forman: When I attended the 2023 American Psychiatric Association Annual Meeting in San Francisco, I was struck by the contrasting large banners celebrating the success of psychiatry amid a city whose streets are filled with homeless individuals, many of whom are in the throes of active illness. Where has psychiatry failed these individuals? Where has society failed in allowing psychiatry to help? Pies: You are highlighting one of the great tragedies of our American health care system, which is really no system at all! In the US, medical care in general—and psychiatric care in particular—is like a big, tattered patchwork of poorly-integrated, regional fiefdoms. This is especially the case when we look at dual diagnosis treatment, and I would wager that many of the homeless folks you saw on the streets of San Francisco fall into the category of comorbid psychiatric/substance abuse disorders. As our colleague, Allen Frances MD, once commented in Psychiatric Times:1 It is heartbreaking to me that 600,000 of our most severely ill patients are either in jail or homeless and that we have done so little to advocate for the community mental health centers and affordable housing that would have freed them from confinement and ended the shameless neglect. But, I think there is plenty of blame to go around. Society—as represented by our national and state legislatures—never built or financed the kind of community support system needed to deal with the thousands of seriously ill, deinstitutionalized patients with psychiatric disorders who were essentially put out on the streets, during the period of roughly 1955-1980. As a 2007 Kaiser Commission noted:2 Not until 1993 were more state-controlled mental health dollars allocated to community care than to the state institutions… [and] policy in large federal programs was not controlled by those responsible for mental health care… Forman: You have a quote by William Alwyn Lishman, MD, FRCP, FRCPsych (Hon) – PMC: "All psychiatrists should be all types of psychiatrist." Do you see a loss in the movement away from the general psychiatrist to the highly subspecialized psychiatrist? Pies: Yes, indeed I do. I’m glad you cited Dr Lishman’s comment. His classic work, Organic Psychiatry: The Psychological Consequences of Cerebral Disorder (1987) was a very important resource for me over the course of my career. Despite the term organic in the title of his book, the late professor believed that psychiatrists need to take a diversified, pluralistic, biopsychosocial approach to their work, and I certainly agree. I think it’s worth sharing the entire quote you reference:3 You have got to have a finger in every pie in psychiatry, and be ready to turn your hand to whatever is the most important avenue: an EEG one day, a bit of talking about a dream another day. You just follow your nose. All psychiatrists should be all types of psychiatrist. Forman: When I worked for economists, they would joke, "the field of economics advances one funeral at a time." Although I hope psychiatrists will continue to learn and adapt throughout their careers, certainly residency training provides the largest pool of impressionable future psychiatrists. If given the power, what would you change about the training of psychiatrists today? Pies: I doubt this idea will be popular with many residents, but I would like to see psychiatric residency become a 5-year program. After all, surgical residency can last 5 years or more, and we need to know at least as much as surgeons. I would like to see an expansion and deepening of both the neurology and psychotherapy components of residency training, because I see these as being of equal importance. I would like to see our residents become Renaissance clinicians, with a working knowledge of the social, cultural, and spiritual aspects of psychiatric diagnosis and treatment. And, as if I haven’t heaped on enough, I believe our residents need a strong background in the philosophy of psychiatry, as my colleagues Awais Aftab, MD, and Nassir Ghaemi, MD, MPH, have elucidated so well.4 Forman: Where do you see this most recent book fitting into your larger collection of books, which so many of us have enjoyed. Although you indicate it is a sequel of sorts to Psychiatry on the Edge, where do you place it in the larger context of your written works? Pies: Thanks for asking. In a sense, I think Psychiatry at the Crossroads is of a piece with my other writing, in that it contains everything from hard science (for example, articles on serotonin and antidepressants) to psychiatric ethics to philosophical/spiritual pieces,and even to some poetry and fiction. I want to give an appreciative nod to my colleagues who contributed to these features of the book: Cindy Geppert, MD, PhD, MA, MPH, MSBE, DPS, MSJ, Mark S. Komrad, MD, Annette Hanson, MD, Steve Moffic, MD, Alan Blotcky, PhD, James L. Knoll IV, MD, David Osser, MD, Joe Pierre, MD, George Dawson, MD, and Richard Berlin, MD. I also want to tip my hat to Mark L. Ruffalo, MSW, DPsa, for his kind reading of the book. All of which brings to mind the quip by one of my mentors in residency, the late Bob Daly, MD, who used to say, “With psychiatry, you can do biology in the morning and theology in the afternoon!” Indeed, I have found to my deep satisfaction that this is so. Dr Forman is director of the Addiction Consultation Service at Montefiore and assistant professor in the department of psychiatry and behavioral sciences at Albert Einstein College of Medicine. He serves as Psychiatric Times Book Review Editor. Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Professor Emeritus of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books, including, most recently, the novelette, The Unmoved Mover.

Generics are now approved for adults in the treatment of BED and for individuals aged 6 years and older in the treatment of ADHD. The US Food & Drug Administration (FDA) announced that it has approved several generics for the treatment of attention-deficit/hyperactivity disorder (ADHD) and binge-eating disorder (BED). The first generics of Vyvanse (lisdexamfetamine dimesylate) capsules and chewable tablets are now approved for the treatment of ADHD in patients aged 6 years and older and for the treatment of moderate to severe BED in adults. These approvals follow the FDA’s announcement of the shortage of an immediate-release formulation of amphetamine mixed salts (Adderall) on October 12, 2022. “The shortages of stimulants (largely generics) have been a nightmare to children, families, and their practitioners,” Timothy Wilens, MD, chief of the Division of Child and Adolescent Psychiatry and codirector of the Center for Addiction Medicine at Massachusetts General Hospital, told Psychiatric Times®. “At a public health level, it is important for policy makers to understand their multifaceted nature and work together to help alleviate such severe, impactful shortages in the future.” With the approval of the lisdexamfetamine dimesylate generic for the treatment of ADHD, more patients with ADHD may have access to treatment. In addition to approving generics, the FDA has announced that it will continue to address the ongoing Adderall shortage by providing assistance to manufacturers, monitoring supply, and sharing updates and other information about the shortage. Related Article:

— News and commentary from the psychiatry world Flotation Therapy The FDA approved the first generic forms of lisdexamfetamine dimesylate (Vyvanse) capsules and chewables to treat attention deficit-hyperactivity disorder (ADHD) in patients 6 years and older, as well as moderate to severe binge-eating disorder in adults. Hopefully this will ease the burden of the ADHD medication shortageopens as children head back to school. (CNBC) Many psychiatrists in clinic are struggling to keep up with their electronic patient messages (STAT) In people with anorexia, twice-weekly, 60-minute flotation therapy sessions for a month helped decrease body dissatisfaction compared with usual care. (eClinicalMedicine) From 2004 to 2019, rates of depressive disorders among kids remained stagnant. (JAMA Pediatrics) Mothers who took selective serotonin reuptake inhibitors after giving birth experienced a benefit not only in their own depression, but also their child's externalizing problems and ADHD symptoms up to 5 years later. (JAMA Network Open) Childless men -- an often forgotten group -- struggle with grief and loneliness (The Guardian) Mental health spending exploded during the pandemic, as telehealth options made care more accessible, a study in JAMA Health Forum found. Clara Hill, PhD, the co-director of a now-closed Maryland psychology clinic connected to 18 retracted papers has retired. (Spectrum) Civilians answering mental health distress calls instead of police officers is becoming the norm in many big U.S. cities. (AP) The national telepsychiatry provider Talkiatry expanded its child and adolescent psychiatry services to another five states. (Fierce Healthcare)

Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions. People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain's structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control. People can develop an addiction to: Alcohol Marijuana PCP, LSD and other hallucinogens Inhalants, such as, paint thinners and glue Opioid pain killers, such as codeine and oxycodone, heroin Sedatives, hypnotics and anxiolytics (medicines for anxiety such as tranquilizers) Cocaine, methamphetamine and other stimulants Tobacco/nicotine Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effects of the substance wears off, or in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sense, and other feelings that are caused by the substance. Intoxication symptoms are different for each substance. When someone has a substance use disorder, they usually build up a tolerance to the substance, meaning they need larger amounts to feel the effects. According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including: To feel good — feeling of pleasure, “high” or "intoxication." To feel better — relieve stress, forget problems, or feel numb. To do better — improve performance or thinking. Curiosity and peer pressure or experimenting. People with substance use and behavioral addictions may be aware of their problem but not be able to stop even if they want and try to. The addiction may cause physical and psychological problems as well as interpersonal problems such as with family members and friends or at work. Alcohol and drug use is one of the leading causes of preventable illnesses and premature death nationwide. Symptoms of substance use disorder are grouped into four categories: Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use. Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use. Risky use: substance is used in risky settings; continued use despite known problems. Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance). Many people experience substance use disorder along with another psychiatric disorder. Oftentimes another psychiatric disorder precedes substance use disorder, or the use of a substance may trigger or worsen another psychiatric disorder. How Is Substance Use Disorder Treated? Effective treatments for substance use disorders are available. The first step is recognition of the problem. The recovery process can be delayed when a person lacks awareness of problematic substance use. Although interventions by concerned friends and family often prompt treatment, self-referrals are always welcome and encouraged. A medical professional should conduct a formal assessment of symptoms to identify if a substance use disorder is present. All patients can benefit from treatment, regardless of whether the disorder is mild, moderate, or severe. Unfortunately, many people who meet criteria for a substance use disorder and could benefit from treatment don’t receive help. Because SUDs affect many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s specific situation and any co-occurring medical, psychiatric, and social problems is optimal for leading to sustained recovery. Medications are used to control drug cravings, relieve symptoms of withdrawal, and to prevent relapses. Psychotherapy can help individuals with SUD better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems. A person's recovery plan is unique to the person's specific needs and may include strategies outside of formal treatment. These may include: Hospitalization for medical withdrawal management (detoxification). Therapeutic communities (highly controlled, drug-free environments) or sober houses. Outpatient medication management and psychotherapy. Intensive outpatient programs. Residential treatment ("rehab"). Many people find mutual-aid groups helpful (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery). Self-help groups that include family members (Al-Anon or Nar-Anon Family Groups). 13 principles of effective drug addiction treatment These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives. Addiction is a complex, but treatable, disease that affects brain function and behavior. No single treatment is appropriate for everyone. Treatment needs to be readily available. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. Remaining in treatment for an adequate period of time is critical. Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs. Many drug-addicted individuals also have other mental disorders. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Treatment does not need to be voluntary to be effective. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases. Source: National Institute on Drug Abuse. These principles are detailed in NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide. How to Help a Friend or Family Member Some suggestions to get started: Learn all you can about alcohol and drug misuse and addiction. Speak up and offer your support: talk to the person about your concerns, and offer your help and support, including your willingness to go with them and get help. Like other chronic diseases, the earlier addiction is treated, the better. Express love and concern: don't wait for your loved one to "hit bottom."; You may be met with excuses, denial or anger. Be prepared to respond with specific examples of behavior that has you worried. Don't expect the person to stop without help: you have heard it before - promises to cut down, stop - but, it doesn't work. Treatment, support, and new coping skills are needed to overcome addiction to alcohol and drugs. Support recovery as an ongoing process: once your friend or family member is receiving treatment, or going to meetings, remain involved. Continue to show that you are concerned about his/her successful long-term recovery. Some things you don't want to do: Don't preach: Don't lecture, threaten, bribe, preach or moralize. Don't be a martyr: Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs. Don't cover up, lie or make excuses for his/her behavior. Don't assume their responsibilities: taking over their responsibilities protects them from the consequences of their behavior. Don't argue when using: avoid arguing with the person when they are using alcohol or drugs; at that point he/she can't have a rational conversation. Don't feel guilty or responsible for their behavior; it's not your fault. Don't join them: don't try to keep up with them by drinking or using. Adapted from: National Council on Alcoholism and Drug Dependence Source: American Psychiatric Association Related Article:

Healthy relationships require the right mix of intimacy and independence. Those with insecure attachment struggle to get this balance right. They either worry excessively about their relationships or hold themselves back from fully committing to their partners. Shaped largely by early childhood experiences, insecure attachment can persist throughout the lifespan, affecting the quality and outcome of adult relationships. Thankfully, those with insecure attachment can learn to trust and commit to their relationships by adopting new beliefs and behaviors. Below are some suggestions for how to do this. Key Skills for Secure Attachment Learn about your attachment style Learn about the four main attachment styles as well as the associated thoughts and behaviors. This empowers you to spot trends in your relationship history and make a plan to break unhelpful patterns. Examine your beliefs about relationships Views about relationships tend to get set early in life. If your caregivers were unsafe or neglectful, you’ll likely be distrustful of your adult relationships. For that reason, it’s important to investigate what is actually true about your current relationships and abandon outdated beliefs and interpretations. Next time you hesitate to trust or commit to your partner, try to find evidence that justifies your concern. Consider that you may be projecting experiences from past relationships onto your current relationship. Worksheets for examining your beliefs: Act opposite to your anxious or avoidant style Those with insecure attachment tend to cling to their relationships (anxious style) or hold themselves aloof from them (avoidant style). If you have an anxious style, try taking small steps toward becoming more independent. If you have an avoidant style, try letting down your guard and initiating intimacy. The goal is to find the sweet spot where you have healthy levels of both intimacy and independence. It’s hard work to break a pattern, but remind yourself of the many rewards of improving your relationships. Increase your emotional awareness If you’re unable to manage and work with your emotions, you’ll likely be more reactive in your relationships, which decreases attachment security. Learning to express and tolerate your emotions makes you better able to empathize with those of your partner. Communicate openly and listen empathetically Working toward a secure attachment requires communicating your hopes, fears, and concerns in a respectful, open-hearted way. Non-verbal communication is equally important. Eye contact, nodding, and physical contact can help defuse tension when used skillfully. When conflict does happens, listen empathetically to your partner and determine how you can help each other feel understood and connected, even if you disagree. Seek out others with healthy relationships If you want to run a marathon, it’s helpful to surround yourself with successful runners. In the same way, you can improve your relationships by learning about how people with healthy relationships think and behave. Notice or ask how these individuals set appropriate boundaries in their partnerships. If you don’t have a partner, remember that seeking someone who is securely attached can make it easier in your own journey toward secure attachment. If you’re in a relationship, reflect on areas where improvement is needed. Minimize stressors Stress can worsen attachment issues, even among those with secure attachment. This is particularly true of relationship-related turmoil, such as frequent arguments or the prospect of separation or divorce. Be proactive by committing to self-care, addressing conflict before it escalates, and engaging in calming activities with your partner. An Integrated Approach To summarize, these are the steps you can take to work toward secure attachment and improve your relationship satisfaction: Learn about your attachment style Examine your beliefs about relationships Act opposite to your anxious or avoidant style Increase your emotional awareness Communicate openly and listen empathetically Seek out others with healthy relationships Minimize stressors These actions work with thoughts, emotions, and behaviors, giving you an integrated approach to breaking old patterns and becoming more securely attached. As you work toward secure attachment, keep this principle in mind: Relationship harmony revolves around skillfully expressing your attachment needs and discerning those of your partner. Set aside regular time to reflect on how you and your partner can help each other feel respected, understood, and loved. With consistent effort, this practice can lead to greater intimacy and a more fulfilling relationship.

Freud vs Jung The Ultimate Clash of the Unconscious: Freud vs Jung The key idea of the video is that both Freud and Jung recognized the power of the unconscious mind in shaping our thoughts and actions, with Freud emphasizing the influence of the unconscious and Jung emphasizing the need for conscious understanding to uncover deeper truths. The Ultimate Clash of the Unconscious How did Carl Jung's theory of the unconscious differ than Freud's? Like Freud, Carl Jung divided the human personality into three parts, but he looked at it from a different perspective. Unlike Freud, who stated that human mind centers upon the id, the ego, and the super ego, Jung divided the human psyche into the ego, the personal unconscious, and the collective unconscious. Freudian and Jungian Theories of the Unconscious Mind Introduction The theories that were put forward by Sigmund Freud and Carl Jung had a substantial influence on the development of the field of psychology. Both scholars took innovative approaches to study and understand the mind and their ideas keep causing controversy even in our time. Both scholars emphasized the importance of the unconscious in explaining human behavior, but their visions on the subject defer in many ways. The purpose of this paper is to discuss and compare Freudian and Jungian theories of the role of the unconscious mind in human behavior. Main body The concept of the unconscious mind is central to the work of Sigmund Freud. The psychoanalytic school of thought that was created by the scholar is based upon the idea that human behavior is primarily determined by the unconscious processes, of which people are not aware. Freud outlined the importance of early experience and relationships with parents in human development and saw suppressed childhood memories as the primary source of psychological problems among adults (Harris, 2009). The founder of psychoanalysis also suggested that trying to bring the unconscious drives into awareness causes anxiety and triggers defense mechanisms that serve to avoid and repress disturbing thoughts and memories. At the same time, the scholar believed that the unconscious could be understood by studying dreams, errors in speech, and unintentional acts. Like Freud, Carl Jung divided the human personality into three parts, but he looked at it from a different perspective. Unlike Freud, who stated that human mind centers upon the id, the ego, and the super ego, Jung divided the human psyche into the ego, the personal unconscious, and the collective unconscious. The Jungian notion of the personal unconscious is similar to Freudian underspending of the subject. Also, Jung’s idea of the collective unconscious is close to Freud’s ideas of the id. It is worth mentioning that Jung and Freud believed that the unconscious plays a vital role in people’s lives by significantly affecting their conscious behavior. However, unlike Freud, Jung held the view that the collective unconscious lies much deeper in the human psyche, modifying it at a fundamental level. The scholar thought that this type of unconscious is shaped by inherited patterns of thought and structures of behavior that he called archetypes (Lecci, 2015). Like French anthropologist Claude Lévi‐Strauss, Jung also believed that explanation for human actions could be found by studying myths that contain the archetypal stories (Iurato, 2015). Thus, according to this idea, mythology can be seen as a manifestation of the collective unconscious through language. Both Freud and Jung considered that dreams might reveal much about human behavior by making the unconscious visible to conscious. However, the visions the two thinkers had on the role of dreams and human sexuality are very distinct. Freud considered suppressed sexual desire to be the main cause of the psychological problems among humans and saw dreams as a manifestation of these unconscious thoughts (Kirsch, 2019). Jung, on the other hand, suggested that events and symbols that appear in dreams might have different explanation depending on their context. In his vision, the source of the content of dreams can be found not only in personal experience but also in archetypal stories. The scholar believed that they could be used as a tool to help a person solve his or her psychological problem. Conclusion Sigmund Freud and Carl Jung are among the most influential figures in the history of psychology. The ways the two scholars looked at the subconscious and personality had a big impact on each other and were partly similar, but at the same time, differed in many impotent ways. The thinkers took different approaches to the subject and put emphasis on different aspects of the subconscious, yet both of them had significant findings. I think that each theory provides a useful framework for studying personality, and the two schools of thought can complement each other.

Mindfulness has been defined as "a moment-to-moment awareness of one's experience without judgment" (1). This means having conscious awareness of one's own thoughts, feelings, sensations, and behaviors, without evaluation, or the formation of an opinion. You're acting mindfully when you listen to a song you love, and notice every tiny detail in the sound. Or maybe you've felt anxiety before a big event like a wedding or a job interview, you acknowledged that feeling, and chose to simply accept it. The opposite of mindfulness would be those times when your body works on "autopilot". Maybe you've eaten a meal and realized you didn't taste a thing, just because you weren't paying attention. Or maybe you've said something cruel out of anger, without realizing that your emotions were driving your actions, until it was too late. Over the past decade, mindfulness has emerged as a popular component to many types of psychotherapy such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT). But what does mindfulness actually do for us, and for our clients? Does it really help? We decided to dig through the research to find some answers. Mindfulness and Mental Illness In psychotherapy, mindfulness training is regularly used as a tool to treat depression, anxiety, and stress. The good news is that it works, and it works well. Multiple meta-analyses suggest that mindfulness reduces clients' anxiety, stress, and symptoms of mood disorder, and the positive effects are maintained long-term (2, 3). One study even found that mindfulness training was as effective as anti-depressants at preventing the relapse of depressive symptoms, 16 weeks after treatment (4). Mindfulness-based treatments seem to work, but how? The most studied form of mindfulness training is called Mindfulness-Based Stress Reduction (MBSR). In MBSR, clients attend an 8-week course where they practice a variety of mindfulness exercises such as meditation, discuss their stressors, and complete regular homework which encourages further practice of mindfulness skills. Other treatments, such as DBT, use mindfulness as a single part of a larger approach to therapy. In DBT mindfulness training is used to help clients learn to accept problems that they do not have control over, or cannot change. In each of these interventions, various mindfulness exercises are used with the idea that practicing will lead to a higher level of trait mindfulness. Trait mindfulness refers to a person's frequent experience of mindfulness (as if it is a personality trait), as opposed to only experiencing mindfulness during the course of an exercise. The verdict on increasing trait mindfulness seems to be positive. Some studies have found that those who regularly practice mindfulness develop changes in how their brain functions that contribute to emotional regulation, concentration, and cognitive processing speed (1). These changes may account for the long-term positive effects associated with mindfulness training. Mindfulness may also help in the treatment of mental illness by facilitating the use of other coping skills. For example, a client dealing with anger will be more likely to use a relaxation skill if they are mindful of their emotions, and identify their anger early. Mindfulness for Therapists Some researchers are beginning to look at the benefits of mindfulness not only for clients, but also for therapists. Because this area has been studied less thoroughly, many questions are still unanswered, but what we do know is interesting. Several traits of therapists that are associated with positive treatment outcomes are thought to be improved by mindfulness training. A few of these traits include empathy and compassion for clients, attentiveness during sessions, and increased comfort with silence (1). Therapists-in-training who were taught to use mindfulness meditation reported higher levels of self-awareness, improvements in their basic counseling skills, and overall wellness. The effects of mindfulness on symptoms of mental illness, such as anxiety and mood symptoms, hold true for clinicians as well. Mindfulness training might result in better stress-management and reduced levels of burnout among therapists. Unfortunately, treatment outcomes and their relationship with therapists' levels of mindfulness are still unclear. Initial studies indicate that there is no connection between a therapist's self-reported level of mindfulness and the treatment outcomes of their clients (1). However, when a therapist undergoes formal mindfulness training, their treatment outcomes tend to improve. This might just tell us that self-report is a poor measure of mindfulness, but further research will be required before making any assertions. Other Benefits of Mindfulness Mindfulness can clearly play a role in the treatment of mental illness, but how about its use in non-clinical issues? Individuals who practice mindfulness who are not suffering from mental illness still see psychological benefits such as an overall sense of wellbeing, improved concentration, and increased morality. Physical health benefits of mindfulness include improved immune functioning and improved cardiovascular health (1, 5). Relationships also benefit when at least one of the individuals has a high level of trait mindfulness (1). A few of these benefits include less emotional stress and better communication. Trait mindfulness also acts as a predictor of overall relationship satisfaction. After a review of the research, it's clear that mindfulness can play an important role in the treatment of several mental illnesses, and it can be used to improve the quality of life for normal-functioning individuals. If you would like to keep reading about mindfulness, and how it can be applied in treatment, I suggest picking up Jon Kabat-Zin's book, Wherever You Go, There You Are (linked below).