A Canadian landmark court ruling on January 17, 2018 recognized the importance of the mental (and physical) wellbeing of federal prison inmates. How? By ruling to prohibit solitary confinement in Canada. And the impact of the decision is now being felt in courtrooms and prisons throughout the United States.

Writer Jennifer McNulty, in her article last week for the University of California, Santa Cruz (UCSC), explained that in presiding over the court decision, “a Canadian judge relied heavily on expert testimony by [American] psychology professor Craig Haney”.

Haney, currently a UCSC Distinguished Professor of Psychology, is noted for conducting, with colleague Dr. Philip Zimbardo, The Stanford Prison Experiment, when studying at Stanford University in 1971. The results of the experiment served as the foundation for Haney’s immersion into the psychological effects of imprisonment and solitary confinement. He remains an advocate for reform and for improved humanity in the prison system.

Haney was “involved in the nine-week trial that took place last summer in Vancouver [Canada], testifying about the effects of segregation on mental health,” McNulty wrote. "It is a stunning ruling. It could not be more decisive or far reaching," she quoted Haney.

"This decision will help alleviate a great deal of suffering in Canadian prisons," said Haney. "It is part of a worldwide movement to address this cruel practice. I am grateful my work could be part of it.”

With specific reference to the extensive testimony Haney provided, wrote McNulty, “in his ruling, [Canadian] Justice Leask [concluded] that solitary confinement poses ‘significant risk of serious psychological harm’ to inmates, increasing the risk of mental pain and suffering, self-harm, and suicide”.

Based on decades of investigation and scientific study, Haney’s testimony provided evidence of “the impact of solitary confinement on inmates, who are forced to adapt in socially pathological ways,” McNulty quoted Haney. “They gradually change their patterns of thinking, acting, and feeling to cope.”

According to Haney, the psychological effects of solitary confinement are numerous, “including anxiety, withdrawal, hypersensitivity, cognitive dysfunction, hallucination, aggression and rage, paranoia, self-mutilation, and hopelessness.” In addition, the resulting effects of exposure to confinement are made worse if the inmate already suffers from a mental illness when incarcerated.

McNulty wrote that according to Canada’s Justice Leask, “inmates subjected to solitary confinement are at risk of becoming more dangerous within the walls of an institution, as well as in the community outside following their release.” The goal then, Leask said, is for Canada’s correctional system to “invest in . . . a new mindset”.

Haney has previously testified before a U.S. Senate subcommittee on the “harmfulness of segregation”. Among scientific professionals and organizations including the American Psychiatric Association and the American Psychological Association, he said, “there is a growing consensus to restrict or eliminate its use among correctional organizations, human rights groups, religious groups, and mental and medical health associations.”

In some instances in the United States, solitary confinement has been banned “for certain vulnerable populations like juveniles, the mentally ill, and pregnant women and limiting its use for others," Haney added.

While the U.S. has not yet established a sweeping, national elimination of the practice, Haney explained that he has seen a growing trend. McNulty quoted him saying: ‘“Here it's on a case-by-case or state-by-state basis,’ he said, noting that Colorado, Washington, Maine, Mississippi, and California are among the states that have limited or eliminated solitary confinement.”

Haney was among several scientific professionals who collaborated with the U.S. Justice Department during the last few years of Obama’s presidency. Together they established and initiated new limitations on federal prison use of isolation.

In a 2016 opinion piece for The Washington Post, Barack Obama discussed the work of his administration to address the problem of solitary confinement in its prisons. “It has been linked to depression, alienation, withdrawal, a reduced ability to interact with others and the potential for violent behavior,” he wrote. "Some studies indicate that it can worsen existing mental illnesses and even trigger new ones.”

In an article published in the American Psychological Association’s magazine, Monitor on Psychology, writer Kirsten Weir explained the two types of solitary confinement practiced by U.S. prisons. One type, used for only a “specified period of time”, is called disciplinary segregation and is used for inmates who break prison rules. “Steal a cellmate's radio, for instance, and you might be in solitary for a week or two,” Weir wrote.

A second form of confinement, administrative segregation, “is used when prisoners are deemed a risk to the safety of other inmates or prison staff,” Weir explained. “Prisoners in administrative segregation are placed into isolation units for months or years.”

Based on research and the recommendations from the U.S. Justice Department, Obama’s goal was to learn from examples of the positive results seen by some U.S. states already limiting or eliminating such confinements.

“The United States is a nation of second chances, but the experience of solitary confinement too often undercuts that second chance,” Obama wrote. “Those who do make it out often have trouble holding down jobs, reuniting with family and becoming productive members of society.”

References

McNulty, J., University of California (Santa Cruz). Canada’s landmark ruling against solitary confinement. https://www.universityofcalifornia.edu/news/canadas-landmark-ruling-against-solitary-confinement

Mulgrew, I., (January 17, 2018). The Vancouver Sun. Canada’s solitary confinement law unconstitutional, B.C. Supreme Court rules. http://vancouversun.com/news/national/canadas-solitary-confinement-law-unconstitutional-b-c-supreme-court-rules

Obama, B., (January 25, 2016). The Washington Post. Barack Obama: Why we must rethink solitary confinement. https://www.washingtonpost.com/opinions/barack-obama-why-we-must-rethink-solitary-confinement/2016/01/25/29a361f2-c384-11e5-8965-0607e0e265ce_story.html?utm_term=.1a291105b845

Weir, K., (May 2012). American Psychological Association: Monitor on Psychology. Alone, in ‘the hole’. http://www.apa.org/monitor/2012/05/solitary.aspx

The Olympics are on our minds, our televisions and our smart phones. The athletes inspire and amaze. And their performances often make one wonder how they can physically achieve so much. Yet whether one is an Olympic competitor, a state champion or a recreational athlete, researchers are realizing the key to success in sport depends as much on psychology as it does on physiology.

A CNN.com article last week by sport and exercise lecturers and researchers Noel Brick and Richard Metcalfe explained the subtle psychological changes athletes can make to help them succeed.

“For athletes of all levels, endurance--how long they can keep going at their chosen sport--is made up of physiological and psychological factors,” they wrote. According to the pair, one psychological factor integral to success is “how hard we feel we are working during an activity”. Brick and Metcalfe referred to this as perceived effort. “The lower our perceived effort, the easier we feel that an activity is,” they said.

As a result, any method that can help reduce how much an athlete perceives is being expended on an activity is beneficial. “As peculiar as it may seem, many top athletes . . . strategically use periodic smiling during performance to relax and cope,” they explained.

Brick and Metcalfe conducted their own smiling-frowning research and its impact on the mental state of a test group of 24 runners. Their results showed “participants . . . reported a higher perceived effort when frowning than smiling or when attempting to relax their hands and upper body.”

Based on their findings, the two were able to provide support for their concept of embodied emotion or “the idea that adopting a facial expression can influence how emotions are experienced,” they wrote.

In her article this month for PsychCentral.com, health and wellness writer Kaitlin Vogel reflected on her own years as a competitive athlete. “The most successful athletes aren’t necessarily the most talented,” she wrote, “they are the ones who have a strong work ethic, positive attitude and don’t let fear stop them from reaching their full potential.”

Vogel suggested the same mental tactics and mindfulness can be applied to other areas of life to support success. Given that one’s state of mind so significantly influences performance in sport, she believes the concept is applicable in the business world as well. “The most valuable employees aren’t necessarily the most talented,” she added. “They’re the ones who are hard-working, passionate and positive.”

To succeed in sport, as in life, Vogel suggested seven actions to avoid in order to improve one’s positive mental wellness—to succeed in sport, business and more. Her suggestions included:

Stop comparing yourself to others.

The challenge, said Vogel, is to use someone else’s success as personal inspiration and to help with one’s own goal setting. “That’s healthy comparison,” she explained. The problem is when admiration becomes idealization. “When comparison leads to feelings of unworthiness . . . this is what makes us feel like we’re coming up short,” she wrote. Instead, Vogel recommended focusing on one’s personal progress, “not society’s expectations”.

Stop chasing perfection.

Vogel explained that striving for excellence is important, but fear of failure and obsession with perfection can become a detriment to success. Perfectionism can cause one to become less productive by “spending too much time on one task” or repeating a task until it is just right. “It’s in our failures, not our successes, that we learn the most about ourselves,” she wrote.

Stop being a “people pleaser”.

Vogel quoted social psychologist and author of The Book of No, Susan Newman, who wrote, “We live under this misconception that saying yes, being available, always at the ready for other people, makes us a better person, but in fact it does quite the opposite.” Anxiety and mental stress are the result, Vogel explained. “Saying no doesn’t mean you’re being selfish. It means you respect yourself.”

Stop spending time with negative people.

Vogel explained the importance of spending as much time as possible with people “who bring out the best in you”. Positive feelings from others can only help to boost one’s own mood and, potentially, one’s mental wellbeing.

Stop overthinking.

With the current Olympics in mind, Vogel referred to research that shows “visualization boosts athletic performance not only by improving concentration and motivation, but also reduces anxiety and fear”.

Vogel was referring to a 2011 HuffPost.com article by social scientist Frank Niles, Ph.D., in which he explained that visualization is a “technique for creating a mental image of a future event”. By visualizing a “desired outcome,” Niles wrote, “we begin to 'see' the possibility of achieving it.”

Stop being your own worst critic.

“No one judges you more than you judge yourself,” wrote Vogel. In sport and in everyday life, she recommended letting go of self-criticism to boost a positive mental state.

Stop being afraid of change.

Change is inevitable, wrote Vogel, but making the first move can be intimidating. Taking a positive step forward—physically or mentally—can only help successfully achieve a goal, she suggested.

References

American Psychological Association. (August 4, 2017). New Mindfulness Method Helps Coaches, Athletes Score. http://www.apa.org/news/press/releases/2017/08/mindfulness-method.aspx

Brick, N., & Metcalfe, R., (February 12, 2018). CNN.com. A smile will improve your run, research finds. https://www.cnn.com/2018/02/12/health/smile-running-energy-partner/index.html

Niles, F., Ph.D., (August 27, 2011). HuffPost.com. How to Use Visualization to Achieve Your Goals. https://www.huffingtonpost.com/frank-niles-phd/visualization-goals_b_878424.html

Vogel, K., (February 2018). PsychCentral.com. The Olympian Mindset: 7 Things You Need To Stop Doing To Be Successful. https://blogs.psychcentral.com/change-your-mind/2018/02/the-olympian-mindset-7-things-you-need-to-stop-doing-to-be-successful/

The variety of tech-friendly options currently available to assist people with their mental health and wellness challenges is almost overwhelming. Computers and smart phone technology provide opportunities for tele-therapy, avatar communication and mental health apps. Yet, regardless of the ever-changing technological advances in therapy, many researchers and mental health professionals are recognizing the importance of an old-fashioned medium. Some are even calling it groundbreaking. The technology? A pen or pencil and paper.

More specifically, expressive writing.

In his article last week for the National Alliance on Mental Health (NAMI), counseling psychologist Steven Swink discussed the recent renewed interest in longer-form writing. “In 1985, psychologist James W. Pennebaker theorized that the effort it takes to hold back our thoughts and feelings serves as a stressor on our bodies,” wrote Swink. Pennebaker believed that facing the thoughts and recognizing one’s emotions may lessen their negative effects on the mind and body.

Karyn Hall, Ph.D., in her 2012 article for PsychCentral.com, further explained Pennebaker’s work. “[He] discovered that most people who write in a certain way about upsetting events in their past gain an improved mood and health,” she added. “The writing technique is not about reliving the event, but about gaining a better understanding or finding meaning in the event.”

Referring to the years of research into the topic, Swink continued: “One of the best ways to confront our feelings is through writing, . . . [and] expressive writing can help improve mood, increase psychological well-being, reduce depressive symptoms, decrease PTSD avoidance symptoms, reduce days spent in a hospital and improve immune system functioning (to name a few).”

The concepts of journaling or letter writing are not new, Swink explained, but in this 21^st century technology-reliant society, more and more it has become a “fading art”. He referred to the more common, ubiquitous use of social media sites as the places people are turning to for expression of ideas and tip of the iceberg emotions—that is, expressing only limited messages or superficial information sharing.

“For someone with mental illness, taking time beyond a social media post to write expressively can be very helpful,” said Swink. He pointed to a 2014 psychology study directed by Andrea N. Niles et al at the University of Los Angeles. Results of the study found “that participants who wrote in detail about [one] particular stressor showed the most improvement versus writing about general facts of a stressful event,” Swink wrote. “Participants who did not just recount events but rather wrote about how they felt about the event had marked improvement in their health.”

According to researchers Niles et al, asking study participants to label the content of distressing images presented to them resulted in reports of lower overall mental stress. “Affect labelling, or ‘putting feelings into words’, is the verbal labelling of emotional stimuli or one’s reaction to them,” the researchers explained.

The reduction in mental distress from writing or verbalizing “can be attributed to activation of an area of the prefrontal cortex . . .which reduces activity in the amygdala, an area associated with emotional processing,” they wrote.

Based on this evidence, Swink interpreted Pennebaker’s concept of expressive writing to mean: “You should write about a specific experience and all its features—how it made you feel, and any thoughts or ideas you had as result. Don’t just rehash what happened.”

In addition to this advice, Swink interpreted additional studies based on Pennebaker’s work and suggested expressive writing should be done in a consistent manner—for two or three days in a row, for example. And, Swink supported Pennebaker’s recommendation to allow oneself at least 15-20 minutes a day for more in-depth writing.

According to Swink’s research, shorter writing sessions provide less improvement to an individual’s long-term mental health. “By dedicating a set amount of time to write, you can dive deeper into your feelings and experiences rather than just brush the surface,” he wrote. “[And] giving yourself a focused time, day and schedule to write improves the ability for your mind to dive deeper into processing your feelings.”

In keeping with Pennebaker’s advice, Swink suggested that when using expressive writing, one should be less concerned with grammar, spelling and editing, but more focused on allowing the mind to relax, to write freely, and explore the experiences and emotions invoked.

“The art of expressive writing has been researched and studied for decades, and the findings demonstrate that it has a positive impact on symptom reduction and overall well-being for participants who use the process as it was intended,” Swink explained.

Nevertheless, he tempered his enthusiasm for expressive writing, recognizing that although testing of the method has been extensive, “there is still much to learn about the implications of writing about emotional topics such as PTSD, anxiety or depression”.

As a result, Swink suggested that for anyone interested in using expressive writing, it would be wise to “seek support from a mental health professional to help you through any challenges that may arise during these exercises.”

The importance of having professional resources available for support while experiencing new or difficult reactions, feelings and emotions cannot be over-emphasized, he concluded

References

Hall, K., Ph.D., (February 2012). PsychCentral.com. Expressive Writing. https://blogs.psychcentral.com/emotionally-sensitive/2012/02/expressive-writing/

Murray, B., (June 2002). American Psychological Association. Writing to heal. http://www.apa.org/monitor/jun02/writing.aspx

Niles, A.N., Byrne Haltom, K.E., Lieberman, M.D., Hur, C., & Stanton, A.L., (January 14, 2016). University of California. Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation. http://www.scn.ucla.edu/pdf/Niles(2016)Cog&Emo.pdf

Swink, S., (February 16, 2018). National Alliance on Mental Illness. Writing Tips That Can Reduce Symptoms. https://www.nami.org/Blogs/NAMI-Blog/February-2018/Writing-Tips-that-Can-Reduce-Symptoms

Social anxiety disorder—that is, possessing the fear of social situations in which one must interact with other people—remains a prevalent mental health issue in North American society. According to the Social Anxiety Association (SAA), a U.S. non-profit organization that “promotes understanding and treatment of [the] disorder”, at any given time, approximately seven percent of the population suffers from social anxiety. And more than 13 percent of the population face the possibility of developing social anxiety at some time during their lifetime.

SAA’s website explains that based on “the latest epidemiological data . . . social anxiety disorder is the third largest mental health care problem in the world today”.  Recently, however, therapists and professionals in the field of psychology are part of a current explosion in the application of virtual reality that, when used in therapeutic settings, allows psychotherapists to control and assist patients with anxiety-based disorders--to face their apprehensions and successfully practice behavior in realistic situational simulations.

In her recent article published by the American Psychological Association (APA), writer Kirsten Weir described the work of Sean Sullivan, Psy.D., the head psychologist at Limbix, “a startup producing virtual reality therapy software to help treat anxiety-based disorders with exposure therapy, provide relapse prevention for substance abuse and teach mindfulness and relaxation”.

Weir explained that Limbix is one of several virtual reality platforms being used “to address phobias, post-traumatic stress disorder (PTSD), substance use disorders and more”. The benefits of virtual reality were being investigated and proven almost 25 years ago. Based on the results of a 1995 study published in The American Journal of Psychiatry, Emory University’s Barbara Rothbaum, Ph.D. and her colleagues concluded that virtual reality-based exposure therapy could assist people in reducing their acrophobia—or fear of heights.

Rothbaum believed in the possibility for even more benefits of applying virtual reality in exposure therapy clinical settings. Since “people respond physiologically to their virtual experiences,” Weir wrote of Rothbaum’s perspective, “an important part of managing anxiety is learning to control the body's fear response.”

Early on, Rothbaum envisioned that virtual reality experiences could cause real situational responses—rapid breathing and a racing heart, for example. "People often think virtual reality won't scare them, since they know it's not real. But it doesn't take a whole lot to tap into that fear," Rothbaum said. "Their brains and bodies fill in the details, and suddenly they are shaking and hyperventilating."

In the years since Rothbaum’s research, “the field has exploded thanks to newer systems that operate through cellphones, making them less expensive, more portable and a lot more practical than their predecessors,” Weir wrote.

She quoted Sullivan’s comparison of the technological evolution of virtual reality over the past decade: "Even 10 years ago, it cost $30,000 to set up a virtual reality rig, and it was big and clunky and limited. Now that virtual reality can be delivered through mobile technologies, you can do it on a cellphone with a $70 headset," Sullivan said. "For the first time, it's really accessible."

Even with virtual reality still in its infancy, professionals and therapists were quick to recognize it could assist in providing patients with exposure therapy, having patients face their fears in a safe environment.

Weir referred to the work of Albert ‘Skip’ Rizzo, Ph.D., a psychologist from the University of Southern California. Rizzo studied virtual reality programs in clinical settings. “As a patient makes progress confronting his or her fears, virtual scenes can be adjusted to make the feared stimulus more provocative,” Weir quoted Rizzo. “At its core, virtual reality is essentially a controlled stimulus environment,” he said.

While the positive results of virtual reality use with patients suffering from social anxiety disorders are encouraging, some professionals caution against assuming success is ubiquitous for all patients in all situations. “As virtual reality takes off in so many directions, researchers are enthusiastic—and cautious,” Weir wrote.

She indicated one study, published in 2009 by Media Psychology, in which researchers Kathryn Segovia, Ph.D. and Jeremy N. Bailenson concluded “that when elementary school-age children watched a virtual version of themselves swimming with whales, many later believed it had happened in real life," Thus, over the next few years as these technologies continue to improve and evolve, “more research is needed to understand the risk of creating false memories through virtual reality,” added Weir.

Laura Stiles, in an article this month for Psychiatry Advisor, presented commentary from a study by Kristiina Kompus, PhD, from Bergen University in Norway, who questioned “whether the benefits that virtual reality can bring to therapy extend to complex challenges involving social cognition, such as positive and negative symptoms or social participation in patients with psychosis.”

Stiles noted that results from the Kompus study and others recognized that the technology is indeed a positive addition to therapy, but “more research is needed to determine the long-term effects of virtual reality”.

References

Social Anxiety Association. (Retrieved February 21, 2018). Social Anxiety Fact Sheet: What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis.  http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis

Stiles, L., Editor., (February 8, 2018). Psychiatry Advisor. Virtual Reality Can Reduce Anxiety, Improve Social Interactions in Psychosis. https://www.psychiatryadvisor.com/schizophrenia-and-psychoses/schizophrenia-psychosis-anxiety-paranoia-social-avoidance-cbt-cognitive-behavioral-therapy-vr/article/742962/

The American Journal of Psychiatry. (Retrieved February 21, 2018). Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.152.4.626

Weir, K., (February 2018). American Psychological Association. Virtual reality expands its reach. http://www.apa.org/monitor/2018/02/virtual-reality.aspx

It’s no surprise that healthy eating equates to a healthy body. But based preliminary findings, a new study shows consuming fruits, vegetables and whole grains is also good for one’s mental health. More specifically, it may help reduce depression over time.

In her article today for Medical News Today, writer Honor Whiteman explained researchers recently found “that people with closer adherence to the Dietary Approaches to Stop Hypertension (DASH) [diet] were less likely to [develop depression] over 6.5 years than people with lower adherence to the diet.”

The study’s co-author Laurel Cherian, M.D., of Chicago’s Rush University Medical Center plans to present these findings, along with her colleagues, next month at one of the annual meetings of the American Academy of Neurology.

“It is estimated that around 16.2 million adults in the United States--approximately 6.7 percent of the country's adult population--had at least one major depressive episode in 2016,” Whiteman wrote, “making it one of the most common mental health conditions.” She cited other risk factors for depression as family history, stress or traumatic experiences, and physical illness.

Created by the National Heart, Lung and Blood Institute, the DASH diet is an eating plan“high in fruits, vegetables, and whole grains but low in foods that are high in sugar and saturated fats,” she explained.

Writer Janice Wood, in her article yesterday for PsychCentral.com, quoted the study’s co-author, Dr. Laurel Cherian: “Depression is common in older adults and more frequent in people with memory problems, vascular risk factors, such as high blood pressure or high cholesterol, or people who have had a stroke,” she said.

“Making a lifestyle change, such as changing your diet, is often preferred over taking medications so we wanted to see if diet could be an effective way to reduce the risk of depression.”

Wood explained that 964 individuals “with an average age of 81” participated in Cherian’s study. They took part in annual evaluations for approximately 6.5 years.

“They were monitored for symptoms of depression, such as being bothered by things that usually didn’t affect them and feeling hopeless about the future,” Wood continued. “They also filled out questionnaires about how often they ate various foods, and the researchers looked at how closely the participants’ diets followed diets such as the DASH diet, Mediterranean diet and the traditional Western diet.”

Based on which diet participants most closely followed, they were divided into three groups. “The study found that people in the two groups that followed the DASH diet most closely were less likely to develop depression than people in the group that did not follow the diet closely,” Wood wrote.

After the six and a half years of follow-up, test results indicated “the odds of becoming depressed over time was 11 percent lower among the top group of DASH adherers versus the lowest group.”

By contrast, participants who adhered more closely to a Western-style diet—one containing high amounts of saturated fats and red meats, and low amounts of vegetables and fruits—were more likely to show signs of developing depression over the same period of time.

“According to Cherian,” Wood added, “the study does not prove that the DASH diet leads to a reduced risk of depression, it only shows an association.”

Cherian concluded that “future studies are now needed to confirm these results and to determine the best nutritional components of the DASH diet to prevent depression later in life and to best help people keep their brains healthy.”

PsychCentral’s Associate Editor Therese J. Borchard agrees that while healthy eating may be inherent to improved mental health, medication should not be taken off the list. In her article on the subject, she referred to author Stephen Ilardi’s 2009 book, “The Depression Cure: The 6-Step Program to Beat Depression without Drugs”.

According to Borchard, Ilardi blamed the North American “modern lifestyle” for depression rates that are “roughly ten times higher today than . . . just two generations ago”. Borchard explained that although she “wholeheartedly” supported the six steps Ilardi offered to beat depression, “I am uncomfortable with his dismissal of medication.”

Borchard admitted to trying all six of Ilardi’s steps in her own mental health recovery program, but “I didn’t get well until I found the right medication combination–which included two antidepressants in addition to a mood stabilizer–to treat my bipolar disorder,” she wrote.

Nevertheless, wrote Borchard, Ilardi’s six steps are worthy of praise for their importance in one’s overall mental and physical well-being. Like Cherian’s study incorporating the DASH diet, reducing depression is based on each individual’s response to lifestyle changes and medication and may require ongoing modification. And the importance of seeking the professional advice of physicians and therapists cannot be overlooked.

Borchard listed Ilardi’s six recommendations “because I do think they are crucial to a recovery program from depression,”: Omega-3 fatty acids, engaged activity, physical exercise, sunlight exposure, social support, and sleep.

References

Borchard, T.J., (Retrieved February 25, 2018). PsychCentral.com. 6 Steps for Beating Depression. https://psychcentral.com/blog/6-steps-for-beating-depression/

National Heart, Lung, and Blood Institute. (Retrieved February 26, 2018). DASH Eating Plan. https://www.nhlbi.nih.gov/health-topics/dash-eating-plan

Whiteman, H., (February 26, 2018). Medical News Today. The diet that could reduce the risk of depression. https://www.medicalnewstoday.com/articles/321010.php

Wood, J., (February 25, 2018). PsychCentral.com. Healthy Diet Linked to Reduced Risk of Depression. https://psychcentral.com/news/2018/02/25/healthy-diet-linked-to-reduced-risk-of-depression/132953.html

For a majority of the population, each day begins with the routine of maneuvering through the outside world--through crowds of people on public transit, in elevators, in schools and colleges, and in stores. For a smaller portion of the population, each day begins with fear, dread and potentially panicky symptoms—and the inability to get onto that bus, into that subway car, or into that grocery store.

For those individuals, agoraphobia is derailing their lives.

In her article published by Psychiatry Advisor this week, counselor and writer Batya Swift Yasgur provided a definition of the phobia taken from a 2010 study into anxiety disorders by O.J. Bienvenu et al. She wrote, “Agoraphobia can be defined as ‘irrational or disproportionate fear of a range of situations in which a person believes escape or access to help may be impossible.’”

According to Yasgur’s research looking at the American general population, the frequency with which agoraphobia may occur over a lifetime stands at about two percent, although one study suggested a higher incidence in adults over age 65—at 10.4 percent. Still, the “average age of onset is actually between ages 25 and 30 years,” she wrote. And the phobia is more “disabling in women” and occurs twice as often in them than in men.

Considering the prevalence of agoraphobia in the population, Yasgur described it as a phobia that continues to often be “misunderstood”, but medical science’s understanding of it--and of the best treatments for it—continues to evolve.

In an interview with Psychiatry Advisor, C. Alec Pollard, Ph.D., professor emeritus of family and community medicine at Saint Louis University School of Medicine, and Mark H. Pollack, director of the Center for OCD and Anxiety-Related Disorders at the Saint Louis Behavioral Medicine Institute explained that “a common misconception is that agoraphobia necessarily means fear of going outside or that individuals with [it] are usually housebound”.

According to Pollard, famed psychoanalyst Sigmund Freud’s idea of exposure was the precursor to one of the two current “trajectories of research and understanding” of the phobia. Following Freud’s idea, behavioral therapists now suggest Cognitive Behavioral Therapy (CBT), wrote Pollard, “working with exposure therapy and having people gradually face their phobias . . . [in] the external situation . . . going to the mall, being in crowds, . . . one step at a time.”

The second trajectory of understanding focused on panic attacks “which were often the center of the fear,” Pollard said. For individuals with agoraphobia, the actual fear tends not to be of the situation, “but of having a panic attack in that particular situation”.

The result of the two paths of understanding have led to agoraphobia recently being reframed as a “fear of fear”, wrote Yasgur. Pollard explained that the medical focus is on “stopping the panic attacks” with “an array of pharmacotherapies”. The CBT aims to “help patients become less afraid of [panic attacks] because when a person becomes less afraid, he or she has fewer attacks,” he said.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the official guide to the diagnosis of mental health—Agoraphobia and panic disorders are separated, in keeping with ongoing changes to the understanding of the phobia, wrote Yasgur.

The DSM-5 lists the latest criteria for Agoraphobia as : “Intense fear or anxiety prompted by the actual or predicted exposure to two or more of the following situations: using public transportation; being in open areas; being in closed-off areas; standing in line or [in] a crowd; [and] being alone outside of the house.”

In keeping with the understanding that Agoraphobia is a “fear of fear”, those with the phobia will avoid the listed situations “because [they] believe they may become stuck or help might be unavailable in the event that the individual begins to panic,” Yasgur added.

"Agoraphobia involves the fear of some type of attack that can come out of the blue,” Dr. Mark Pollack explained. While panic attacks tend to be unexpected, individuals do not worry about the symptoms when they occur. By contrast, he said, individuals with agoraphobia do not “know why the panic attack suddenly came on . . . [and] worry that they are losing control or having a heart attack.”

With agoraphobia, sufferers are actually not afraid of the setting (school, store, bus), but they “become afraid of having an attack in [the setting] and begin to avoid going,” Pollack clarified.

Like the evolving understanding of the disorder, successful treatment of agoraphobia is also changing, wrote Yasgur. “The most well-researched psychotherapeutic approach is CBT with clinical gains maintained at two-year follow-up,” she said.

And although a combination of CBT and pharmacotherapy has been found to be the best treatment during the disorder’s “acute” phase, Pollack acknowledged that over time, CBT proved better than medication, “with lower rates of relapse”.

For patients who choose both medicine and CBT, Pollack said the exposure therapy can be very helpful when patients are “tapering off” of medications or when facing future stressful life events.

References

Bienvenu, O.J., Wuyek, L.A., Stein, M.B., (2010). U.S. Natinal Library of Medicine. Anxiety disorders diagnosis: some history and controversies. https://www.ncbi.nlm.nih.gov/pubmed/21309103

Sideman, N., (Retrieved February 28, 2018). Anxiety and Depression Association of America. How I Achieved My Cure of Panic Disorder and Agoraphobia. https://adaa.org/living-with-anxiety/personal-stories/how-i-achieved-my-cure-panic-disorder-and-agoraphobia#

Yasgur, B.S., M.A., L.S.W., (February 28, 2018). Psychiatry Advisor. Agoraphobia: An Evolving Understanding of Definitions and Treatment. https://www.psychiatryadvisor.com/anxiety/agoraphobia-definitions-diagnosis-management/article/747238/

Rather than looking for a label or a concrete diagnosis of a mental health challenge, some professionals are instead examining an individual’s mental health based on an ever-changing, fluid, sliding scale—more specifically, a spectrum-based approach.

In an article today for the Canadian edition of the HuffPost, Liz Bernier, managing editor of Canada’s HR Professional Magazine, revealed that through her own research in the field, she recognizes the importance of “the Canadian Armed Force's spectrum based approach [that] presents mental health much like physical health in that it exists on a continuum”.

Furthermore, Bernier explained, while issues of mental illness and mental health are finally being acknowledged in the workplace, statistics show that most workers still do not disclose their situations to their employers. “Forty per cent of employees report that they are willing to disclose mental health difficulties to their employer, according to the Anxiety and Depression Association of America," she wrote.

It was during her examination of the Canadian Armed Forces’ (CAF) Road to Mental Readiness program for an interview back in 2014 that Bernier believes she may have found a successful concept for the examination, disclosure and acceptance of mental illnesses in civilian workplaces.

“I was interviewing two of the [CAF] experts . . . when I first saw mental health presented as a spectrum,” she explained. Based on what she saw in the CAF representation, Bernier concluded that the army’s approach aimed not to reduce an individual’s identified challenges to a specific diagnosis accompanied by diagnostic labels and “all the associated stigma”.

And while Bernier was quick to emphasize the importance, and necessity, of the diagnostic method historically practiced in mental health sectors, she was fascinated by the stigma reduction that resulted from CAF’s concentration on mental health and mental illness on a continuum-based approach.

Bernier admitted she has experienced her own mental health challenges and that, in conjunction with working a journalism beat in "workplace issues", she is amazed at "the lingering workplace stigma inherent in a mental health diagnosis".  

“The military is a unique employer in that it can be an extremely high-risk environment for psychological stress injuries,” Bernier said. “Coupled with that is a very particular culture where "toughness" is prized and praised, while disclosing a mental health diagnosis hasn't historically been well received.”

In an effort to accommodate its inherent sensitivities surrounding the disclosure of mental health challenges, “the CAF's spectrum based approach presents mental health much like physical health,” Bernier added.

The Military Mental Health Continuum Model is posted on the National Defence and the Canadian Armed Forces website. In its explanation of the model, the CAF not only recognizes the fluidity of an individual’s mental health status, but the community-based responsibility for each member’s wellbeing.  

“The health and well-being of CAF members is the shared responsibility of the member, the chain of command, and the individual,” the website states. “Leaders always have a role and responsibility to . . . support their members throughout the continuum of mental health.”

Visually, the CAF Mental Health Continuum is composed of four color blocks (green, yellow, orange, red) on a sliding scale from left to right. “The arrows under the four color blocks denote the fact that this is a continuum, with movement in both directions along the continuum,” the site explains, “indicating that there is always the possibility for a return to full health and functioning.”

Bernier emphasized the positivity of the spectrum’s recognition of ongoing changeability. “It exists on a continuum, is highly variable and can change from day to day, and perhaps most importantly, it requires ongoing care,” Bernier wrote. “Your mental health could be green or ‘healthy’ one day, and slide into ‘reacting’, ‘injured’ or ‘ill’ over a very short period of time.”

Rather than situating an individual on a “fixed point on the spectrum”, Bernier applauded the model for accepting the constant ebb and flow naturally occurring in mental health challenges, for removing the permanence of labels and “because [it] removes the illusion of separation between ‘us’ and ‘them’—mentally ill or healthy”.

Thanks to its recognition of constant change, the CAF model, Bernier believes, is highly applicable to civilian workplaces as well as to the armed forces. “We all exist somewhere on the continuum, and every single one of us has the potential to slide down the spectrum if faced with a stressor or catalyst,” she said.

The CAF’s website clearly encourages de-stigmatization by identifying its model and the mental health challenges it represents: “In this way, no one is ‘written off’ simply because they are showing symptoms of an illness, or are being treated for a disorder or disease.”

Traci Pedersen, in her article for PsychCentral.com last week, referred to a recent study published in the journal Military Medicine. Results of the study, she said, indicate that the stigma of mental illness continues to negatively impact American military personnel in their search for assistance.

Based on the study’s findings, Pedersen wrote, “Military personnel are making extensive use of outside mental health services, suggesting that the mental health services offered within the military are not meeting the needs of active duty service members.”

Echoing the stigma the CAF model is attempting to eliminate, Pedersen listed the study’s most common reasons individuals in the military service were seeking outside professional help. Among the reasons were “fear of reprisal for seeking services”, “mistrust of command”, and the potential for “a negative impact of seeking care on one’s career”.

References

Bernier, L., (March 6, 2018). HuffPost CA. Civilian Workplaces Can Learn From How The Army Approaches Mental Illness. http://www.huffingtonpost.ca/liz-bernier/de-stigmatizing-mental-health-spectrum-canadian-armed-forces_a_23377672/

National Defence and the Canadian Armed Forces. (Retrieved March 6, 2018). The Military Mental Health Continuum Model. http://www.forces.gc.ca/en/caf-community-health-services-r2mr-deployment/mental-health-continuum-model.page

Pedersen, T., (February 28, 2018). PsychCentral.com. Many in Military Seek Mental Health Care Elsewhere. https://psychcentral.com/news/2018/02/28/many-military-personnel-seek-mental-health-care-outside-of-military/133118.html

It isn’t difficult to think of someone who has a fear of heights or an aversion to snakes, spiders or bugs. But there is one phobia many people may not be familiar with—one that remains something of a mystery even to psychology professionals—trypophobia.

An article posted only last month in the journal Frontiers in Psychiatry explained the current knowledge and ongoing obscurities of a phobia that is not yet recognized by such diagnostic classification publications as the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In the article, researchers Juan Carlos Martinez-Aguayo et al discussed the case of “a girl who suffers from a phobia to repetitive patterns, known as trypophobia”. The condition is said to “usually [involve] an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general.”

Fear, Martinez-Aguayo wrote, “is the normal response to danger, while phobias are characterized by excessive, unconscious, and persistent fear that constantly triggers anxiety.” The word trypophobia, he wrote, comes from the Greek trypa meaning drilling or hole. “Trypophobia is basically referred to by people who suffer from it, through communications such as social networks and personal blogs.”

Martinez-Aguayo and his colleagues explained that in the case of the 12-year old referenced in their article, “the patient also suffered from generalized anxiety disorder and was treated with sertraline”. In her initial diagnosis, she displayed “symptoms of both fear and disgust towards trypophobic images [shown to her],” the researchers explained. “After some time following treatment, she only showed disgust towards said images.”

In his recent article for AllPsych.com, writer Neil Petersen examined the research and findings of Martinez-Aguayo et al. He revealed that some hypotheses into the phobia have held that the fear of bumps or holes in repetitive configurations “have historically been associated with evolutionary threats like infectious disease or poisonous animals, but the authors of the recent article point out that so far there’s not much hard evidence for this explanation.”

Petersen explained that in the case of the 12-year-old girl, her fear of repeating bumps and holes could be triggered by a variety of seemingly benign everyday objects . . . [that] included a wall that was being remodeled and a sidewalk with pebbles embedded in it.” Strong emotions of fear and disgust even resulted from “food items like a slice of bread with holes in the surface or a meringue pie with a pattern of bumps in the frosting”.

The girl’s mother explained to the study investigators that her pregnancy for this daughter had been a normal one, and her daughter’s current sixth-grade work produced outstanding scholastic marks—in the 90^th percentile.

Further information published about the girl included the fact that she was residing with her mother and a younger sister. She had never lived with her father, but maintained a close relationship, continuing twice-monthly visits.

The girl’s mother experienced generalized anxiety disorder (GAD) herself and had developed “three depressive episodes successfully treated with sertraline”.

For individuals who do not suffer from trypophobia, Petersen wrote in AllPsych, “you might not have noticed, but it turns out that repetitive patterns of bumps and holes are everywhere.”

During an interview with the study’s researchers, the girl was shown “an image of a strawberry” and although she had never eaten the fruit before, she “manifested progressive anguish as the image was expanded; the same happened to the image of vents.”

Based on the information provided by the authors of the Frontiers article, there is some variance in the emotional responses of individuals with trypophobia. “Research indicates that some people react with extreme fear and disgust while others react only with disgust,” Petersen explained.

Based on the limited number of peer-reviewed articles on the subject, researchers Martinez-Aguayo et al concluded that there is much still to be discovered and understood about the phobia.

Petersen too concluded his article with more questions than answers. “Why do these particular images cause such strong reactions for some, and is it a phobia in the traditional sense?” he asked.

“It’s definitely something, though,” Petersen reasoned, given that “as the case of the 12-year-old girl tells us, it has the potential to interfere in everyday life.” The responses also coincide with other types of psychiatric symptoms, he said. “As more research is done, repetitive patterns of bumps and holes could have something to teach us about mental health.”

Although trypophobia may not be mainstream to some, such social media sites as Pinterest and Buzzfeed have received dozens of reports that the recent movie box office hit Black Panther has been triggering audience members who suffer from the phobia. Many moviegoers indicated discomfort when watching a certain character who often appeared shirtless onscreen. The character’s torso was covered with numerous, small, bump-like scars.

Similarly, viewers of American television’s anthology horror series American Horror Story last year reported episodes of trypophobia resulting from ads for the show. Business Insider reporter John Lynch wrote, “An advertising campaign for the new season of American Horror Story has been giving people panic attacks with its disturbing, hole-covered imagery, and the underlying cause is a rare but intense feeling of disgust that scientists are still trying to figure out.”

References

Lynch, J., (September 20, 2017). Business Insider. Ads for this season of ‘American Horror Story’ are giving people panic attacks—here’s the science behind it. http://www.businessinsider.com/why-american-horror-story-ad-giving-americans-panic-attacks-2017-9

Martinez-Aguayo, J.C., Lanfranco, R.C., Arancibia, M., Sepúlveda, E., & Madrid, E., (February 9, 2018). Frontiers in Psychiatry. Trypophobia: What Do We Know So Far? A Case Report and Comprehensive Review of the Literature. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00015/full

Petersen, N., (February 27, 2018). AllPsych.com The Mystery of Trypophobia. https://blog.allpsych.com/the-mystery-of-trypophobia/

TimesHeraldNews.com. (Retrieved March 10, 2018). “Black Panther” Triggered My Trypophobia And I Watched It Anyway. https://www.timesheraldnews.com/world/-black-panther-triggered-my-trypophobia-and-i-watched-it-anyway-k5ejuhwaoe

Every six months, much is written about the seasonal time change. Either the change from standard to daylight savings time or daylight savings time to standard. But, many of us experience time changes more often than every six months by travelling--and changing time zones--for business, vacation or educational reasons. And, like the twice-yearly fall back or spring ahead by an hour, long distance travel takes its toll on sleep schedules and natural circadian rhythms.

It can also negatively affect one’s mental health.

Jet lag has long been recognized as a bothersome but common part of long distance travel. Yet recognition of the potential for it to pose a danger to one’s mental health is just becoming commonplace.  

In his article last week for Business Insider UK, writer Jacob Shamsian described the latest studies of jet lag and its influence on the mind as well as the body. Studies, he explained, that have surprisingly been taking place since as early as 1968.

Shamsian referred to the explanation of jet lag posted on the website of the National Institute of General Medical Sciences: “Circadian rhythms are physical, mental, and behavioral changes that follow a daily cycle,” it explained. “People get jet lag when travel disrupts their circadian rhythms.”

And jet lag, Shamsian wrote, can be “something more sinister: a trigger for mental illness.”

The idea of it challenging one’s mental health came to light earlier this year, said Shamsian, when New York Times magazine writer Jon Mooallem discussed the repercussions of an extreme example of jet lag at a Pop-Up Magazine performance. Pop-Up Magazine is a ‘live’ magazine bringing stories to life on stage.

According to Shamsian, Mooallem “unearthed the strange story of Sarah Krasnoff who, at 74 years old, . . . [took] around 160 flights between New York and Amsterdam with her grqandson in the summer of 1971.”

Although Krasnoff died of a heart attack that year, Mooallem spoke to her grandson and later hypothesized that hers may have been “history’s only lethal case of jet lag”. The notion caused him to begin investigating the connection between jet lag and mental illness.

The term jet lag explains, fundamentally, the “physical and psychological effects you experience after you go on a long flight that puts you into a different time zone,” Shamsian explained. "Basically, it throws off your body’s circadian rhythm—the 24-hour internal clock that tells you when you should be tired and when you should be awake.”

Mooallem is not the only person investigating the incidence of jet lag induced mental illness. “A significant body of research shows that jet lag can be more than simply feeling tired in Tokyo or restless in Rome,” wrote Shamsian. “It can trigger relapses in psychiatric illnesses. And, similarly, it can be treated with the same types of therapies used to handle mental illnesses.”

While scientists have studied the effects of jet leg on one’s psychological wellbeing since at least 1968, “one of the most comprehensive studies on the subject was published in 1982 and found jet lag as the culprit to psychiatric breakdowns,” he added.

In 1982, researchers looked at two years-worth of accounts of “186 patients who were admitted . . . to the nearest psychiatric facility following a breakdown at the airport,” Shamsian said. The synthesis showed “half of them were previously diagnosed as schizophrenic, and most of the rest were diagnosed with other mental illnesses.”

The study’s authors found that “people who traveled from east to west . . . [experience more sleep loss and] were diagnosed with depression more often than those who hadn't,” he added. “People who traveled from west to east, on the other hand, were diagnosed with hypomania--basically, a state of elated, restless energy--more often.”

The 1982 findings have been supported by other, similar major studies done in 2002 and 2011. In 2002, headed by Gregory Katz, researchers from the Kfar Shaul Mental Health Center in Jerusalem studied psychiatric illnesses among foreign tourists.

Katz’s study explained, “The possible association between jet lag and psychotic or major affective disorder was evaluated according to the following criteria: (1) absence of major mental problems before the flight or good remission of an existing disorder one year or more before flight; and (2) the appearance of psychotic or major affective syndromes during the first seven days after landing.”

Results of his study validate the current understandings of the potential for the negative influence of jet lag on mental health: “The results suggest that the [change in] circadian rhythms and jet lag possibly play a role in the exacerbation of major psychiatric disorders.”

Shamsian clarified that the studies’ findings do not indicate that jet lag will cause mental illness. “It means that jet lag can trigger manic or depressive episodes in people who have already been diagnosed with mental illnesses because of the way it disrupts a person's circadian rhythm,” he clarified.

Since jet lag is “a mismatch between a person’s circadian rhythm and the world around them,” he added, “solutions [often] involve light therapy or taking supplements for melatonin, the hormone that regulates the circadian rhythm.” Other sleep therapy methods like chronotherapy (light exposure/blocking) can also be used.

Shamsian referred to information provided by New York’s Weill Cornell Medical College clinical psychiatry professor Richard A. Friedman, in his 2017 article for the New York Times. In it, Friedman explained that treatments for jet lag are similar to some methods used by psychiatrists to treat patient depression and bipolar disorder.

“Clinicians have long known that there is a strong link between sleep, sunlight and mood,” Friedman wrote. “The notion that we can manipulate sleep to treat mental illness has also been around for many years.”

References

Arehart-Treichel., J., (May 2002). Jet Lag May Trigger Mental Illness Relapse. American Psychiatric Association: Psychiatric New. https://psychnews.psychiatryonline.org/doi/10.1176/pn.37.9.0029

Friedman, R.A., (March 10, 2017). New York Times. Yes, Your Sleep Schedule Is Making You Sick. https://www.nytimes.com/2017/03/10/opinion/sunday/can-sleep-deprivation-cure-depression.html

Katz. G., Knobler, H.Y., Laibel, Z., Strauss, Z., Durst, R., (January-February 2002). U.S. National Library of Medicine National Institutes of Health. Time zone change and major psychiatric morbidity: the results of a 6-year study in Jerusalem. https://www.ncbi.nlm.nih.gov/pubmed/11788917

Shamsian, J., (March 7, 2018). Business Insider, UK. Jet lag is more than just annoying—it could be a trigger for mental illness. http://uk.businessinsider.com/jet-lag-mental-illness-treatment-2018-3

Not only is smoking bad for your physical health, but recent scientific findings report it is a habit that can be dangerous to your mental health as well. In his article last week for Psychiatry Advisor, Gary Rothbard, M.D., M.S. discussed the results of a study just published in the Scandinavian medical journal Acta Psychiatrica Scandinavica.

Much has been written about the potential for psychosis in complementary studies of long-term marijuana smokers, however, the study of the mental challenges experienced by long-term tobacco smokers is relatively new.

A 15-year follow-up of “adolescents who smoked cigarettes heavily, and particularly those who began early, [indicated they] were more prone to develop psychotic symptoms than their nonsmoking counterparts,” Rothbard summarized.

In a description of the research findings, the Academy of Finland wrote: “Smoking at least ten cigarettes a day is linked to a higher risk of psychoses compared to non-smoking young people. The risk is also raised if the smoking starts before the age of 13.”

The study was led by Academy Research Fellow, Professor Jouko Miettunen. In a press release, Miettunen explained, “This was an extensive longitudinal study based on the general population. It revealed that daily and heavy smoking are independently linked to the subsequent risk of psychoses, even when accounting for previous psychotic experiences, the use of alcohol and drugs, substance abuse and the parents’ history of psychoses.”

Miettunen and his colleagues recognized that, specifically for adolescent populations, research was lacking. Since tobacco use by adolescents has the potential to affect the “trajectory of a maturing brain”, and future mental health, this research became a “priority”.

According to Miettunen, data collected from the research revealed that smoking that began early in a young person’s life presented “a particularly significant" risk factor. “Based on the results," he wrote, “prevention of adolescent smoking is likely to have positive effects on the mental health of the population in later life.”

In addition to researchers from the University of Oulu--one of Finland’s largest universities, the team brought together researchers from England’s University of Cambridge and the University of Queensland in Australia. The Academy of Finland’s website explained the composition of the long-term study.

The research began with a “1986 birth cohort” from Northern Finland—comprised of an original group of more than 9,000 people. Of the 9,000, relying on national health registers, researchers examined a final sample of 6,081 subjects aged 15-16—to identify smoking status, other substance use, potential psychosis predictors, etc. Male participants made up 47.7 percent of this population. This group was invited to take part in a follow-up study in 2001-2002 to answer a questionnaire on psychotic experiences, and drug and alcohol use. "The follow-up continued until the subjects had reached the age of 30”.

Of the respondents to the follow-up study, medical records indicated there were 110 cases, or 1.8 percent, “of psychosis diagnosed over the course of [the]15 years”. While heavy smokers “had the highest risk for later psychosis . . . there was no significant association between lighter smoking and future psychosis risk.”

In addition, smoking at an earlier age presented a higher percentage of later psychosis than it did for those “with later initiation” at 5.1 percent compared to 2.2 percent respectively.

The United Kingdom’s Mental Health Foundation website link, Smoking and mental health, identified similar negative mental health effects from the habit. “Most adults in the U.K. are aware of the physical health risks of smoking tobacco, but research shows that smoking also affects people’s mental health,” its website states.

"Although many people with mental health problems say that they smoke to reduce their symptoms, they usually start smoking before their problems begin.”

Interestingly, Juoko Miettunen’s research team also established a study on the use of cannabis. The results of this study have recently been published in The British Journal of Psychiatry.  

Like the conclusions from tobacco use, this study similarly showed that cannabis use in teenagers is indicative of “an increased risk of psychosis”. In addition, this study showed that participants who used cannabis and experienced psychotic episodes early in their lives--then also reported experiencing additional psychoses within the time of the study.

“We found that young people who had used cannabis at least five times had a heightened risk of psychoses during the follow-up, even when accounting for previous psychotic experiences, use of alcohol and drugs and the parents’ history of psychoses,” said Antti Mustonen, Lic. Med., one of the study's researchers.

“Our findings are in line with current views of heavy cannabis use, particularly when begun at an early age, being linked to an increased risk of psychosis,” she added. “Based on our results, it’s very important that we take notice of cannabis-using young people who report symptoms of psychosis. If possible, we should strive to prevent early-stage cannabis use.”

References

Academy of Finland. (March 12, 2018.) Smoking heightens risk of psychoses. http://aka.fi/en/about-us/media/press-releases/2018/smoking-heightens-risk-of-psychoses/

Mental Health Foundation (U.K.), (Retrieved March 14, 2018). Smoking and mental health. https://www.mentalhealth.org.uk/a-to-z/s/smoking-and-mental-health

Mustonen, A., Ahokas, T., Nordstrom, T., Murray, G.K., Mäki, P., Jaaskeläinen, E., Heiskala, A., Mcgrath, J.J., Scott, J.G., Miettunen, J., Niemela S., (January 25, 2018). Smokin’ hot: adolescent smoking and the risk of psychosis. http://onlinelibrary.wiley.com/doi/10.1111/acps.12863/epdf?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=onlinelibrary.wiley.com&purchase_site_license=LICENSE_DENIED

News Medical Life Sciences. (March 12, 2018). Heavy smoking linked to higher risk of psychoses. https://www.news-medical.net/news/20180312/Heavy-smoking-linked-to-higher-risk-of-psychoses.aspx

Rothbard, G., M.D., M.S., (March 9, 2018). Psychiatry Advisor. Heavy Cigarette Smoking in Adolescence May Increase Risk for Psychosis. https://www.psychiatryadvisor.com/schizophrenia-and-psychoses/cigarettes-tobacco-increase-psychosis-risk/article/749917/?utm_source=newsletter&utm_medium=email&utm_campaign=pa-spotlight-20180313&dl=0&DCMP=EMC-pa-spotlight-20180313&cpn=psych_all&hmSubId=0o1kVhC9ORk1&hmEmail=0o1kVhC9ORk1&NID=&dl=0&spMailingID=19174900&spUserID=NDA3NTg3NDkyNzA3S0&spJobID=1220695326&spReportId=MTIyMDY5NTMyNgS2

Do you feel guilty when you are not working? Do you put in a lot of overtime at work? Do you put more energy into your work than into relationships with family and friends?

Having a strong work ethic has long been considered a positive characteristic. Yet in recent years, much more is being published about the negative impacts to one’s health--specifically to one's mental health--as a result of too much work.

In an article published last week in the Harvard Business Review, researchers Lieke ten Brummelhuis and Nancy P. Rothbard discussed the issue of working too much. “Is it working long hours that increases our risk of developing health issues?” they asked. “Or is it something else, like . . . compulsive work mentality, that is harmful for health?”

Their study helped “unravel the difference between behavior (working long hours) and mentality (a compulsion to work, or what we call workaholism).” In 2010, the two researchers piloted a study “at the Dutch subsidiary of an international financial consulting firm with over 3,500 employees”.

The survey questioned the participants about their workaholic behaviors with questions about guilty feelings or self-imposed deadlines. It also examined their work hours, skills, and motivation on the job. Employees were also asked to report any psychosomatic health problems such as stomach issues or headaches.

Health screenings of the participants looked at a variety of “biomarkers (such as waist measurement, triglycerides, blood pressure, and cholesterol), which, when aggregated, are a reliable gauge for an employee’s risk of developing cardiovascular diseases and diabetes . . . referred to as Risk for Metabolic Syndrome (RMS),” the researchers explained. “We also controlled for a host of factors such as gender, age, education, and family history of cardiovascular disease.”

Based on the results of their research of 763 workers who completed both a survey and health screening, Brummelhuis and Rothbard reported that the number of hours worked surprisingly did not correlate to health issues. Workaholism did.

It was the obsession over their work that caused people surveyed to report a greater number of health complaints. “Employees who worked long hours, . . . but who did not obsess about work, did not have increased levels of RMS and reported fewer health complaints than employees who demonstrated workaholism,” they wrote.

Workaholics’ complaints were not affected by the number of hours worked. Instead, however, they reported “more sleep problems, more cynicism, more emotional exhaustion, and more depressive feelings than employees who merely worked long hours but did not have workaholic tendencies.”

The difficulty for workaholics, the duo discovered, was their struggle to “psychologically detach from work”.

One study participant who was not a workaholic, did work long hours but reported feeling “fulfilled”, able to fall asleep easily at night and awaken refreshed. Brummelhuis and Rothbard quoted from her survey response: “I take my work very seriously while I’m working,” she reported, “but I forget about work the minute I decide I’ve done enough for the day.”

By contrast, the answers from a workaholic survey respondent illustrated his “compulsion to work hard” and restlessness when not working. “He continues to ruminate about his job and often finds it difficult to fall asleep and recharge before the next morning,” the researchers wrote. “When asked about his general stress levels, he mentioned that he ‘cannot remember the last time not feeling stressed or anxious about work.’”

Brummelhuis and Rothbard explained that rumination often coexists with such mental health challenges as anxiety, depression, sleep difficulties, and stress. “Stress levels in workaholics are therefore chronic,” they said. For workaholics, the body’s stress systems (cardiovascular, neuroendocrine, etc.) that are called into action when one is facing an extreme assignment, do not have the chance to relax since the workaholic's level of stress is constantly elevated.

“When you’re working an excessive workload and continually pushing your system beyond its range . . . Elevated blood pressure may become chronic, and cortisol levels stay elevated,” they wrote. “When your biological systems keep working around elevated set points, you have a greater risk of cardiovascular disease (CVD), diabetes, and even death.”

Interestingly, the two noticed that for a minority of workaholics who truly loved their work, they were “somewhat protected from the most severe health risks”.

The pair examined their research findings and “we differentiated between workaholics who reported being highly engaged with their work--meaning they enjoyed their work, felt vigorous at work, and got easily absorbed in their work--and workaholics who reported low work engagement.”

Both groups of workaholics indicated experiencing more psychosomatic health issues and more mental health problems than did non-workaholics. But non-engaged workaholics exhibited a 4.2 percent higher risk of elevated RMS than did engaged workaholics—illustrating that those workaholics who loved their jobs were indeed somewhat more protected mentally and physically. “This number might seem small, but even a small increase can pose a serious health risk,” the researchers wrote.

An article published by the American Psychiatric Association in 2017 explained that although workaholism “is not a condition formally defined as a mental disorder or addiction--it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”, it does possess several characteristics common to other disorders. In the article, University of Georgia researcher Malissa Clark, Ph.D, said workaholism is an “internal compulsion [that] is similar to having an addiction.”

“Ultimately, the challenge for anyone is to identify a compulsive work mentality and prevent its consequences,” Brummelhuis and Rothbard concluded.

References

American Psychiatric Association. (August 3, 2017). Working too Much: Hard Worker or Workaholic? https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2017/08/working-too-much-hard-worker-or-workaholic

CNN. (May 25, 2011). CNN.com. Are you a workaholic? http://www.cnn.com/interactive/2011/05/living/workaholic.test/index.html

ten Brummelhuis, L., & Rothbard, N.R., (March 22, 2018). Harvard Business Review. How Being a Workaholic Differs from Working Long Hours—and Why That Matters for Your Health.

https://hbr.org/2018/03/how-being-a-workaholic-differs-from-working-long-hours-and-why-that-matters-for-your-health?utm_medium=email&utm_source=newsletter_daily&utm_campaign=dailyalert&referral=00563&deliveryName=DM3402

Would you be comfortable talking to your employer or co-workers about your need for time off work to address a physical health issue? Perhaps. But how comfortable would you be if the time you need is due to a mental health condition?

When it comes to mental illness, maintaining privacy in the professional sphere is not always possible, wrote Barbara Ricci, a senior advisor in behavioral health at the University of Pennsylvania’s Center for High Impact Philanthropy in an article this week for Harvard Business Review. A board member at the National Alliance on Mental Illness (NAMI), Ricci recalled that over the last three decades she has “been approached by hundreds of colleagues and clients . . . seeking advice . . . on how best to manage professional life while dealing with a mental health condition”.

Ricci said her advice begins with the need to recognize the commonality of the situation. “Just because you don’t know of anyone else at your company who has taken time off for mental health reasons doesn’t mean there isn’t precedent,” she wrote.

Quoting statistics available on NAMI’s website, Ricci explained that mental health challenges are likely to affect 20 percent of Americans each year. Unfortunately, while treatments of diagnosable mental health issues have an 80 percent success rate, “fewer than half of the people who need help get it, often because of social stigma, the fear of repercussions at work, or lack of access to quality, affordable care,” she said.

Although Ricci recognizes that “workplace culture” may not be the cause of someone’s illness, elements of a work atmosphere “can make an [existing] illness difficult to manage”. Work that calls on employees to put in long hours “in sedentary conditions”, to lose sleep and personal time for physical exercise, friends and family, can result in “substance misuse and deteriorating mental health,” she explained, “which can make it hard to keep up at work.”

In a perfect world, suggested Ricci, an employee who needs to take a leave of absence should be easily able to inform their employer or human resources—a process that should require “sharing only a minimal amount of information and keeping your diagnosis private”.

In the case of “a longer-term disability leave, . . . your doctor will likely need to provide documentation to your firm’s disability insurance provider,” Ricci wrote. “The disability provider acts as an intermediary between you and your employer and does not share your diagnosis with your employer.”

While it may seem daunting to ask for and negotiate time away from work for a mental health issue, Ricci thinks the real challenge lies in the “big question . . . how to return to work.” The path to return is also filled with smaller questions: “What do you tell coworkers? Your boss? How do you get back into the swing of things without compromising your health?”

In a 2017 article for CNN, writer Rose Schmidt quoted findings from a 2016 American Psychological Association survey that found “less than half of working Americans say the climate in their workplace supports employee well-being”.

With statistics like these, Ricci advised looking at the positives and negatives about disclosing one’s diagnosis. “In my experience, there are typically two types of people who will disclose, despite the fear of prejudice or discrimination at work,” she wrote. “The first group is those who want to bring their whole selves to work and don’t want to hide. The second group includes leaders . . . who understand that openly acknowledging their diagnosis can shed a positive light on what it means to work with someone with a mental, or invisible, disability.”

Which path one takes is a personal choice, but Ricci recommended being prepared for questions from co-workers about the absence. “A brief and consistent narrative will help you stay focused on readjusting to work,” she explained. Something like: “I took time off for health [or personal] reasons, but things are fine now and I’m happy to be back to work.”

Ricci emphasized other important considerations to make as one settles back into work. They included: 

• Consider whether to initially return to full-time or part-time. Consider the potential for exhaustion and the effects of any new medications that could cause drowsiness, physical responses or mood changes at work.

• “Develop a personal mantra” of positive thoughts and self-talk. Use such phrases as: “Be compassionate to myself.” “I’m on a learning curve.” “Take it a few hours at a time.”

• Have a support team to rely on—a trusted co-worker, a close friend or family member, or a therapist. These people can help with transitioning back to work, provide feedback and reduce stress.

• Establish a routine that includes brief breaks during the day—even moments to meditate. At day’s end, take time to make a short list of priorities to accomplish the next day. Later at night, think back on the day and try to pick out the positive things that took place.

• Prevent setbacks by becoming your own best monitor and learn to recognize your warning signals: “Are you stressed, anxious, or getting into conflicts at work? Keep in mind that there is a difference between a bad day and relapsing.”

In her 2014 article for PsychCentral.com, writer Christine Stapleton described her own experience returning to work after eight weeks away to care for depression. “Anxiety plagues us as we recover and return to work,” she wrote. “A wise boss will embrace these facts and realize that an employee who is both physically and mentally healthy is a better, more productive worker.” 

Ricci agreed. “If you want to have a conversation with your boss or colleagues about your health, do it on your terms,” she advised. “You might make yourself more vulnerable with those you trust, but being able to share your diagnosis can help to dispel myths and reduce stigma. Talking about mental health, just as one would talk about physical health, sends a powerful message that it’s OK to get help.”

References

Ricci, B., (March 27, 2018). Harvard Business Review. When You Need to Take Time Off Work for Mental Health Reasons. https://hbr.org/2018/03/when-you-need-to-take-time-off-work-for-mental-health-reasons

Schmidt, R., (July 13, 2017). CNN.com. When a woman took sick days for mental health, her email sparked a larger discussion. https://www.cnn.com/2017/07/12/health/mental-health-response-from-company-ceo-trnd/index.html

Stapleton C., (June 2014). PsychCentral.com. Depression: How do you tell your boss you can’t work? https://blogs.psychcentral.com/depression/2014/06/depression-how-do-you-tell-your-boss-you-cant-work/

Rather than looking for a label or a concrete diagnosis of a mental health challenge, some professionals are instead examining an individual’s mental health based on an ever-changing, fluid, sliding scale—more specifically, a spectrum-based approach.

In an article today for the Canadian edition of the HuffPost, Liz Bernier, managing editor of Canada’s HR Professional Magazine, revealed that through her own research in the field, she recognizes the importance of “the Canadian Armed Force's spectrum based approach [that] presents mental health much like physical health in that it exists on a continuum”.

Furthermore, Bernier explained, while issues of mental illness and mental health are finally being acknowledged in the workplace, statistics show that most workers still do not disclose their situations to their employers. “Forty per cent of employees report that they are willing to disclose mental health difficulties to their employer, according to the Anxiety and Depression Association of America," she wrote.

It was during her examination of the Canadian Armed Forces’ (CAF) Road to Mental Readiness program for an interview back in 2014 that Bernier believes she may have found a successful concept for the examination, disclosure and acceptance of mental illnesses in civilian workplaces.

“I was interviewing two of the [CAF] experts . . . when I first saw mental health presented as a spectrum,” she explained. Based on what she saw in the CAF representation, Bernier concluded that the army’s approach aimed not to reduce an individual’s identified challenges to a specific diagnosis accompanied by diagnostic labels and “all the associated stigma”.

And while Bernier was quick to emphasize the importance, and necessity, of the diagnostic method historically practiced in mental health sectors, she was fascinated by the stigma reduction that resulted from CAF’s concentration on mental health and mental illness on a continuum-based approach.

Bernier admitted she has experienced her own mental health challenges and that, in conjunction with working a journalism beat in "workplace issues", she is amazed at "the lingering workplace stigma inherent in a mental health diagnosis".  

“The military is a unique employer in that it can be an extremely high-risk environment for psychological stress injuries,” Bernier said. “Coupled with that is a very particular culture where "toughness" is prized and praised, while disclosing a mental health diagnosis hasn't historically been well received.”

In an effort to accommodate its inherent sensitivities surrounding the disclosure of mental health challenges, “the CAF's spectrum based approach presents mental health much like physical health,” Bernier added.

The Military Mental Health Continuum Model is posted on the National Defence and the Canadian Armed Forces website. In its explanation of the model, the CAF not only recognizes the fluidity of an individual’s mental health status, but the community-based responsibility for each member’s wellbeing.  

“The health and well-being of CAF members is the shared responsibility of the member, the chain of command, and the individual,” the website states. “Leaders always have a role and responsibility to . . . support their members throughout the continuum of mental health.”

Visually, the CAF Mental Health Continuum is composed of four color blocks (green, yellow, orange, red) on a sliding scale from left to right. “The arrows under the four color blocks denote the fact that this is a continuum, with movement in both directions along the continuum,” the site explains, “indicating that there is always the possibility for a return to full health and functioning.”

Bernier emphasized the positivity of the spectrum’s recognition of ongoing changeability. “It exists on a continuum, is highly variable and can change from day to day, and perhaps most importantly, it requires ongoing care,” Bernier wrote. “Your mental health could be green or ‘healthy’ one day, and slide into ‘reacting’, ‘injured’ or ‘ill’ over a very short period of time.”

Rather than situating an individual on a “fixed point on the spectrum”, Bernier applauded the model for accepting the constant ebb and flow naturally occurring in mental health challenges, for removing the permanence of labels and “because [it] removes the illusion of separation between ‘us’ and ‘them’—mentally ill or healthy”.

Thanks to its recognition of constant change, the CAF model, Bernier believes, is highly applicable to civilian workplaces as well as to the armed forces. “We all exist somewhere on the continuum, and every single one of us has the potential to slide down the spectrum if faced with a stressor or catalyst,” she said.

The CAF’s website clearly encourages de-stigmatization by identifying its model and the mental health challenges it represents: “In this way, no one is ‘written off’ simply because they are showing symptoms of an illness, or are being treated for a disorder or disease.”

Traci Pedersen, in her article for PsychCentral.com last week, referred to a recent study published in the journal Military Medicine. Results of the study, she said, indicate that the stigma of mental illness continues to negatively impact American military personnel in their search for assistance.

Based on the study’s findings, Pedersen wrote, “Military personnel are making extensive use of outside mental health services, suggesting that the mental health services offered within the military are not meeting the needs of active duty service members.”

Echoing the stigma the CAF model is attempting to eliminate, Pedersen listed the study’s most common reasons individuals in the military service were seeking outside professional help. Among the reasons were “fear of reprisal for seeking services”, “mistrust of command”, and the potential for “a negative impact of seeking care on one’s career”.

References

Bernier, L., (March 6, 2018). HuffPost CA. Civilian Workplaces Can Learn From How The Army Approaches Mental Illness. http://www.huffingtonpost.ca/liz-bernier/de-stigmatizing-mental-health-spectrum-canadian-armed-forces_a_23377672/

National Defence and the Canadian Armed Forces. (Retrieved March 6, 2018). The Military Mental Health Continuum Model. http://www.forces.gc.ca/en/caf-community-health-services-r2mr-deployment/mental-health-continuum-model.page

Pedersen, T., (February 28, 2018). PsychCentral.com. Many in Military Seek Mental Health Care Elsewhere. https://psychcentral.com/news/2018/02/28/many-military-personnel-seek-mental-health-care-outside-of-military/133118.html

The American Sleep Association reports that 50-70 million adults in the United States have a sleep disorder, with short-term insomnia reported by 30% of adults and chronic insomnia by 10% of adults.

If you are one of the people with trouble sleeping, whether it is short term or chronic insomnia, you may improve your sleep if you attend church. And no, this does not mean sermons are so boring that they cause people to fall asleep. It also does not improve the chance of sleeping because the church pew is a comfortable place for a nap. However, there is a connection between religious activity and sleep.

A recent study in Sleep Health: Journal of the National Sleep Foundation found that those who attend church and pray regularly sleep better than those who do not.  It is possible that participation in religion by attending church reduces stress, decreases substance abuse, and facilitates social support when people engage with church members. All of these factors contribute to positive mental health and therefore influence quality of sleep.

A study from 2011 discovered that veterans who attended church services were less likely to have problems with sleep even with previous exposure to combat situations and prior reports of sleep difficulties, implying that even those at risk of having mental health problems and insomnia can benefit from religious activities.

Belief in one’s salvation decreases the amount of sleep deprivation people experience during particularly stressful times. It could be that those who are confident in their salvation, meaning what happens to them after they die, experience less anxiety and depression which has a positive correlation with good sleep. Religious people view God as in control of their lives so they are less inclined to have mental health symptoms that have a negative impact on length and quality of sleep. If God is in charge, why would they worry?

Religion also may have a biological buffer impact on the stress response, called “allostatic load”, which refers to the negative impacts of chronic stress. When stress hormones are thrown out of whack and religious beliefs help to reduce the allostatic load, it increases the length of sleep.

In another study by Wallace and Forman, they surveyed teens from 135 high schools in the United States. Those who attended church once a week or more, got at least seven hours of sleep, higher than those teens who never attend church. This implies that religious activities have the potential to benefit teens as much as adults.

Whether or not a person attends church, it is worth making prayer or meditation part of a daily routine. This practice intentionally moves people out of the fight or flight mode, which people get stuck in with today’s busy culture. When people pray or meditate, they cannot react. Instead, cultivating this practice reengages the prefrontal cortex, which enables rational, mindful decisions, and releases feel good chemicals in the brain. And feeling good is of course good for mental health and good mental health puts people in a position to sleep better.

This does not mean that mental health providers should have church attendance written on a prescription pad, where patients attend church on Sunday for a better life starting Monday.   “We just need more studies,” says co-author Christopher Ellison of The University of Texas at San Antonio. “This is an area that is ripe for more exploration. Given how important sleep quality is for Americans in every phase of their lives, and given how many Americans profess some kind of religious belief, we need to understand the connection much more thoroughly than we do.”

At the very least, there does seem to be a correlation between church attendance and sleep quality which invites consideration for further research and offers an option for patients who want a solution other than yet another prescription. There are enough initial findings to indicate religious activity, including church attendance, prayer, and mediation do have a positive impact on sleep that may be overlooked by many. There is a clear benefit of the lack of unpleasant side effects or potential of addiction with a pharmaceutical solution and is certainly a low risk alternative to losing sleep.

References:

https://www.sleephealthjournal.org/article/S2352-7218(18)30043-3/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/29564619

Everyone loves taking a vacation, but whether it benefits your health may depend on your employer.

A recent survey by the American Psychological Association of 1512 adults in the US found that although vacations and taking time off help the large majority of US workers relax, almost two thirds of those lose any benefit from their time off within just a few days.

The 2018 Work and Well-Being Survey looked at just over a thousand US employees who were either working full time, part time or were self-employed.

Nearly a quarter (24 per cent) of the adults in the survey said that the benefits they received from time off, like feeling more relaxed and having more energy vanished as soon as they returned to work and for 40 per cent of respondents the benefits were gone in a few days. 

David Ballard leads the American Psychological Association’s Center for Organizational Excellence.

He says that workers need to take time away from work to prevent burnout and recover from stress they might be experiencing, but it’s not enough for employers to assume the occasional vacation will cancel out a stressful work environment.

“Unless they address the organizational factors causing stress and promote ongoing stress management efforts, the benefits of time off can be fleeting. When stress levels spike again shortly after employees return to work, that’s bad for workers and for business. Employers can do better,” he said in a press release.

The survey examined attitude of workers towards both paid and unpaid time off, as well as employee well being whilst at work.

Of those surveyed, 58 per cent of respondents reported that they felt they were more productive whilst at work after taking a vacation. 55 per cent said that their work was of better quality after a vacation and 57 per cent of respondents said that they had more energy and were less stressed after they took some time off.

Overall, the majority of survey participants said that taking time off had a positive impact. 69 per cent of the people surveyed said that they felt more positive upon returning to work after a vacation.

But not everyone is feeling the benefits of time away from work. Around one in five of those surveyed (21 per cent) said they still felt stressed or were tense whilst they were on vacation away from the office. That may have something to do with employees still having to do work whilst on a break. Over a quarter of survey participants (28 per cent) said they had to do more work whilst on vacation than they had hoped for.

42 per cent of people said they dreaded returning to work after a vacation. For some employees, workplace culture plays a big role in determining whether they will feel good about taking some time off.

Less than half of those involved in the survey (41 per cent) said that their workplace culture fostered an environment where employees were encouraged to take time off. Only 39 per cent of respondents said their supervisor encouraged taking time off work. 

For employees to properly recharge, ballard says, the culture of encouraging time off needs to come from the top of an organisation. He says there should be effective policies in place that enable employees to take an adequate amount of paid time off, and that employees should feel like they are being trusted and treated fairly.

Although a certain level of stress can be a positive and even helpful thing under the right circumstances, too much stress for a prolonged period can have serious negative impacts. People may experience fatigue, poor concentration, irritability, lack of motivation, headaches, changes in appetite and sex drive. As well as impacting mental health, stress puts pressure on every system of the body; the reproductive, cardiovascular, endocrine, gastrointestinal, nervous, respiratory and muscle systems are all impacted by stress.

If workplaces do support their workers in taking time off, they will also benefits. 71 per cent of employees returning from vacation who have a workplace that encourages time off said they had more motivation after returning to work. Of those who worked for organisations who don’t actively encourage time off, only 45 per cent said they felt motivated about returning to work.

The survey found that employees from organisations who encouraged time off were also more productive and had better quality work.

We’ve all been there; you’re going about your day and you’re hungry. Suddenly every little thing annoys you, you become irritable, you snap. You’re “hangry” (that’s hungry and angry for the uninitiated). 

The term hangry was accepted by the Oxford dictionary and is defined as being “bad-tempered or irritable as a result of hunger”. You may have seen advertisements for candy bars declaring that ‘you’re not you when you’re hungry’. It turns out there may actually be some truth in that. According to research from the American Psychological Association, transitioning from just hungry to “hangry” may be much more complex than a drop in blood sugar. It may actually be an emotional response that takes into account personality, biology and even cues from the environment.  

Jennifer MacCormack, a doctoral student in the psychology department at University of North Carolina Chapel Hill undertook research to try and understand what she describes as the psychological mechanisms resulting from hunger-induced emotional states.

MacCormack and her colleagues conducted two experiments with more than 400 participants in the United States. Participants were shown images that were expected to cause a positive, negative or neutral reaction. Participants were then shown a Chinese character and were asked to rate it on a scale from unpleasant to pleasant. Finally, participants were asked to share how hungry they were at the time of undertaking the experiment.  

The results of the experiment showed that the participants who reported being hungry  were more likely to rank the Chinese character as negative if they had earlier been shown a negative image. MacCormack says the negative images created a context in which the hungry people interpreted their feelings of hunger by then ranking the Chinese characters as unpleasant. This suggests in unpleasant situations people are more likely to draw on their hungry feelings for a negative outcome. 

Not everyone who is hungry will become hangry. Whether this occurs depends on two factors: context and self-awareness.

“You don’t just become hungry and start lashing out at the universe,” said assistant professor Kristen Lindquist, PhD, co-author of the study. “We’ve all felt hungry, recognized the unpleasantness as hunger, had a sandwich and felt better. We find that feeling hangry happens when you feel unpleasantness due to hunger but interpret those feelings as strong emotions about other people or the situation you’re in.”

A person’s emotional awareness also contributes to whether they transition from just hungry to hangry. Those who are aware that their hunger is causing them to have an emotional response are less likely to become hangry than those who are unaware of their hunger related emotions. 

To put this to the test, the researchers enlisted 200 university students and asked them either to eat or fast before the experiment. Some students were asked to undertake an exercise that would focus their emotions. Then all of the participants participated in a scenario that would spark negative emotions; the students were asked to complete a dull task on a computer that was programmed to crash right before the students could complete the task, a research who was in on the scenario then entered the room and blamed the students for the crash.

After the experiment, the students were asked to fill out a survey detailing their emotions and their thoughts on the study. The students who were hungry reported a greater level of negative emotions such as stress and hate. They also thought the researcher conducting the task was harsh or judgmental.

The participants who were asked at the beginning of the exercise to focus on their emotions did not report an increase in negative emotions, even if they were hungry.

MacCormack says this suggests that stepping back from a situation and recognizing your emotions means you can stop yourself from becoming hangry. 

So next time you feel yourself descending into a rage… stop for a moment and  acknowledge how you’re feeling. It may stop you becoming hangry. And if that fails? Maybe try a Snickers. 

As the United States government works to reunite migrant children separated from their families, psychologists are warning of the long-term effects on their mental health. They say the children are becoming more likely to face toxic stress, leading to health problems like PTSD and substance abuse.

“As mental health experts, we remain deeply concerned about the continued separation of migrant children from their parents pending immigration proceedings or following the deportation of their parents", says Jessica Henderson Daniel, PhD, president of the American Psychological Association. "The longer these children remain away from their parents in shelters, the greater their distress and the greater the likelihood that they will experience long-term negative effects."

“Decades of psychological research have shown that children and parents may experience toxic stress as a result of lengthy separations", adds Henderson Daniel. "Toxic stress can cause irreparable harm to children’s cognitive development and can lead to a host of mental, social and physical health problems later in childhood and well into adulthood. These problems can include severe psychological distress, PTSD, sleep disturbances, social withdrawal, substance use, aggressive behavior and a decline in educational achievement."

Henderson Daniel's comments came days before government officials announced they've reunited more than 1,800 children ages 5 and over with parents or sponsors. But, they say more than 700 children remain in custody because officials have deemed their parents or relatives not eligible for reunification. The parents of 431 children have already been deported.

NBC News reports a U.S. District judge commended the Trump administration Friday for reuniting hundreds of families, but added "the government is at fault for losing several hundred parents in the process and that's where we go next." Judge Dana Sabraw is requiring written updates every Thursday on still-separated families from the government and the American Civil Liberties Union. The ACLU represents the parents.

APA President Henderson Daniel says if a solution doesn't come soon, officials need to work on alternate plans. “If these children cannot be immediately returned to their parents as ordered by U.S. District Judge Dana Sabraw", she says, "then they should receive a mental health screening by a qualified health care professional. Based on the outcome of this assessment, they might receive mental health care at the shelter or be moved to a therapeutic foster home to receive the level of care that they need.”

The APA describes therapeutic foster care parents as specially trained to work with children with significant mental health needs. To prepare, the parents take on trauma-informed care education. They also have more pre-service training hours than required for a more traditional foster home, and may be required to do ongoing training hours to be licensed as a therapeutic foster home.

It's not the first time Henderson Daniel has voiced concern about the mental health of migrant children and their caretakers. She's issued three press releases since the end of May, saying “The American Psychological Association stands ready to assist in getting these children the psychological care that they will need during the time they are in U.S. custody and upon their release."

The American Psychological Association is based in Washington, D.C., and describes itself as the largest scientific and professional organization representing psychology in the United States. Members include more than 115,000 researchers, educators, clinicians, consultants, and students.

Open office plans are common with startups and trendier technology companies to foster collaboration in the workplace. The goal is to have an open area where people can see, hear and interact with each other throughout the workday. Employers not only save money with this plan but hope it facilitates teamwork.

In the United States, 80% of offices are designed with an open plan. With leading companies such as Google and Facebook adopting this layout, others may see this design as a sign of a successful, forward-thinking company and follow suit as a result. Josh Silverman, a tech entrepreneur, felt working in an open office space was a positive thing. "What an open office environment taught me was the ability to focus in on the task at hand in any situation, no matter the distraction.  It has enabled me to work literally anywhere I need to, which has been an invaluable skill as an entrepreneur."

Some people feel that it encourages the flow of ideas among employees and two-thirds of workers believe it has the potential to promote collaboration. However, the cons of an open office plan are a decrease in productivity for some employees, an increase in sick time and just over half of high-performing employees find it distracting as they are interrupted every three minutes throughout the workday. 

Not everyone loves the idea of an open, collaborative workspace, especially those who are more sensitive to noise. Some people feel that it inhibits their productivity because of the constant distractions around them from their co-workers and of course there is the lack of privacy when an employee does need to make a private call to set up a doctors appointment. Cheryl Smithem, a professional in the PR space, says it wouldn't work for her. "I'm one of those folks that if someone is talking next to me or down the hall or around the corner or if there's background music with lyrics it totally removed my ability to stay concentrated on my task."

Other employees feel awkward because if they do stand up to go talk to someone, everyone sees exactly what they are doing so they feel self-conscious. Plus people may feel uncomfortable interrupting a colleague (and those around him or her), so they may be more inclined to send an email rather than having an in-person conversation, which is the whole goal of an open-plan office.

It turns out the collaboration and teamwork that was expected by these plans may not be happening. A recent study by the Harvard Business School discovered that in an open office, employees actually have less interaction than they do when there is some kind of boundary while electronic communications such as email or chat actually increased by up to 50%.  The study’s authors describe it as follows: “Like social insects which swarm within functionally-determined zones ‘partitioned’ by spatial boundaries (e.g. hives, nests or schools), human beings — despite their greater cognitive abilities — may also require boundaries to constrain their interactions, thereby reducing the potential for overload, distraction, bias, myopia and other symptoms of bounded rationality…”

Multiple studies highlight other negative aspects of an open plan. A study from Karlstad University in Sweden, published in Scandinavian Journal of Work, Environment & Health discovered that a shared workplace led to less satisfied employees and a decrease in the sense of well-being. The University of Canterbury reported that an open office plan is actually bad for mental health. "There was evidence that they increase sickness, absence and emotional cognitive irritation, and decrease mental work ability and productivity and job satisfaction." Additional research published in the Journal of Environmental Psychology, and based on 42,764 surveys, noted that open plan offices have a significantly higher rate of employee dissatisfaction than enclosed offices.

This complete transparency in terms of people being seen all the time, and lack of a spatial boundary, could lead to surveillance anxiety which is when people feel they are in constant observation mode or feeling that they are being monitored. As employees feel more anxious, they try to look busy and tend to avoid interaction with her co-workers to avoid being in the spotlight.

The bottom line is that positioning a group of people together does not necessarily guarantee collaboration or communication. Look at any crowded situation where people are forced to be in a setting where they are packed closely together, such as an elevator or a crowded market. Proximity alone is not the answer and workplaces are not one-size-fits-all.

An open-plan that encourages discussion throughout the workday may not be the right environment for every workplace and the research clearly shows it is not the best option for every personality. Although employers who advocate for this open plan setup save money due to practicalities around office configuration, the cost savings could result in a decline in productivity, increase in sick time, and decrease in satisfaction, which makes this option worth reconsidering. Employers may need to take a closer look at their own open-plans and ask if the trade-off is worth it. Dr Paul Kegel, an instructor in Innovation & Entrepreneurship at Full Sail University, sums it up this way: "You can’t really say that an open office environment is good or bad for collaboration. The most important thing to consider is …what is the activity that needs to be done and who will be doing the activity? Once you have the answer to these questions, you can design the most effective environment."

Mindfulness is a hot topic. Researchers study the impact of mindfulness on the brain, noting the positive changes, and advocates of the practice insist it improves their well-being. Mindfulness  today is used for more than personal improvement as mindfulness programs have reached into the workplace.  A study published in Journal of Occupational Health Psychology in August of this year found that participants in mindfulness training improved their focus at work and had a slight increase in job satisfaction.

Workplaces recognize the impact of mindfulness-based programs as a tool to manage stress and enhance resilience. Some app providers, such as Calm and Headspace, are expanding into the corporate space with employee memberships. We invited entrepreneurs to share their experience with mindfulness and how it pays off for them.

Beth Gerstein, co-Founder and co-CEO of Brilliant Earth, starts her day with a short meditation and chooses to walk to work.  “The fresh air and movement make a big difference in my mental state – the walk allows me to daydream, take in my surroundings and think of new ideas.”

For James Dimovski, Chief Operating Officer/Founder of Gallant State, mindfulness is a core component of his days. It is key to “sustaining motivation and reducing stress whilst dealing with a busy schedule, particularly when I find myself procrastinating about a certain task.” James Pollard, with TheAdvisorCoach.com, agrees that practicing it throughout the day is part of his success. Before doing so, he would go through his day “like a zombie.”  “I definitely wasn't as productive, because I wasn't as intentional with my activities.”

All responders to this inquiry agree the life of an entrepreneur is challenging. There are risks combined with long days. Summer Suleiman, of The Distillery, hosts retreats for entrepreneurs because anyone starting a business is “overwhelmed by the multitude of tasks they must tackle with with no blueprint on how to do so.”

Caleb Ellis, a Health and Wellness Expert, teaches mindfulness because it “increases your capacity to focus and think clearly in what is typically a hectic and fast-paced environment. Entrepreneurs gain a sense of clarity which can help their daily decision-making process as well as their ability to respond to unforeseen situations.” Recent behavioral and imaging research support these claims that mindfulness can improve decision-making.

The fast paced environment of an entrepreneur not only requires quick decision making, but also times of silence to generate new ideas. Sarah Moe, Co-Founder / Chief Happiness Officer of Flauk, agrees.  Mindfulness “increases creativity and innovation. When you are able to silence your mind, you make room for new ideas.” Frances Geoghegan, with Healing Holidays, believes “It is [only] in this quiet state that truly innovative and effective ideas can spring into your mind; if you are just staring at a computer screen and forcing inspiration, it won’t come half as easily.”

Entrepreneurs may exude confidence to the outside observer, but that does not always reflect what they feel. They experience “negative self-talk and self-doubt … when pursuing an idea,” says Suleiman. She teaches mindfulness to entrepreneurs because it “helps them manage the significant amount of stress that comes with starting and growing a business by helping them improve focus, gain clarity in their entrepreneurial vision, and combat that potentially detrimental negative self-talk.” It can also indicate when it is time to recharge. Without this self-awareness, entrepreneurs "become burnt out, [make] terrible decisions and become overwhelmed with daily tasks that leads them and their businesses to failure,” says Dr. Daryl Cioffi, a licensed therapist

Whether a formal practice appeals to you or you simply take time to stop and notice what you are doing, mindfulness clearly has implications for personal and professionals well-being. Jonathan Denn, author of Drumbeat: Business Productivity Playbook, views mindfulness as creating a “great rhythm.” Being mindful “quiets the noise so you can hear the rhythm.”

Heading off to college can be an exciting time for parents and students alike, but the start of a new school years isn’t always happy times and fun moments.

A recent study published in Depression & Anxiety has found that college years can also be a time of increased risk of stressful life events. With these come an increased risk for a range of mental health obstacles and an added risk of suicide.

The study of more than 67 thousand college students across 100 different institutions found that high rates of mental health diagnoses, stress events and risk of suicide or suicidal thoughts were reported by every student who participated in the study.

“College students often experience overwhelming anxiety when they are freed from their parents’ control and are responsible for their behavior. All of a sudden, they are in control of their academic schedule and making sure they keep up with their work. There are no more parent portals or guidance counselors. If they live on campus, they are their own parent: responsible for getting out of bed, obtaining food, and traveling between home and school and other activities,” Dr. Shane Owens, a psychologist who works with young adults and their families, who was not associated with the study, told Theravive.

He says that students may be experiencing increased stress because they have failed to learn how to cope with challenging circumstances earlier in life.

“Well-intentioned parents have worked too hard to clear the path to college. These parents have protected their kids from conflict, from chores, from anything that might tarnish their academic record or reputation. At the same time, these parents have kept their kids from learning how to cope with adversity. Having fewer well-practiced coping skills in your toolbox leads you to easier, often unhealthy, coping mechanisms like alcohol, drugs, and, in extreme cases, suicide,” he said.

The researchers of the study, from Brigham and Women’s Hospital, examined data from the American College Health Association National College Health Assessment, a survey that took place in spring of 2015. 

The survey included questions like whether students had been diagnosed or treated for mental health concerns, whether they had contemplated suicide or attempted suicide, whether they had self-harmed, and the number of stressful events they had been through in the previous 12 months.

Stressful life events were considered to be exposure to a situation the student felt was difficult to cope with. This may have related to academic work, death of a family member, relationship issues, finances, career problems, sleep difficulties, concerns around personal appearance and personal health, or the health of a family member.

Three quarters of students reported at least one stressful life event in the previous year and over 20 per cent of students said they had been through six or more stressful life events in the last 12 months.

One fifth of the students said they had thought about suicide, 20 per cent said they had engaged in self-harm and nine per cent had attempted suicide. Exposure to stress was found to have a significant link with self-harm, suicidal thoughts and mental health diagnoses.

“The rates of suicidal ideation are somewhat concerning. The rate of students who have “seriously considered” suicide has nearly doubled since the first version of this survey in 2008. It’s interesting to see that the rates of attempts have not increased nearly as much over the same period. Knowing why one increased so much while the other didn’t could tell us a lot about effective prevention and treatment,” Dr. Owens said.

Experiencing a stressful situation is inevitable for most college students. Owens says limiting the risk of mental health ramifications is not about avoiding stress, but about changing the way a person responds to a difficult situation. 

“A person’s response to stress and trauma is more important than exposure to either of those things. Reframing stressful events changes the effects those have on a person, and most people who experience a traumatic event recover naturally with time,” he said.

Of the students surveyed, those who identified as being a sexual minority were more likely to have a mental health diagnoses, and more likely to experience suicidality or self harm. Two thirds of transgender students said they had self-harmed and one third had attempted suicide. More than half of students who identified as bisexual said they had thought about suicide and self harm, and more than a quarter had attempted suicide.

The authors of the research say their study highlights the need for better support of college students experiencing stress.

Dr. Owens says some of this support should begin at home before students even go to college.

“The best way to fix any health issue is to prevent it. Many of the problems which college students face could be prevented if they were given the opportunity to practice coping with adversity. Helping kids get into college and healthy adulthood has to be as much about teaching them resilience as it is about making sure they get good grades, play sports, and join the right clubs.”

“I would advise families to start early training their kids to do things for themselves. They should know how to wash dishes. They should know how to sort and do their own laundry. They should know how to shop for and prepare food. They should know how to negotiate a bad grade with a professor. They must know how to bounce back from failure. They must know how to have a respectful, productive disagreement,” he said.

Before a student even walks on to campus, Owens advises that every student should know the relevant contact information for campus police or security, campus health services and mental health services.

College happens at the same time the average person is more vulnerable to anxiety and depression, and Owens says that campus mental health services should be focusing on students with emerging mental health problems. He says it is important students can access mental health assistance on campus whenever they need it.

“Colleges should offer on-campus, evidence based, mental health services that are available whenever the college is open. If a college offers classes and other activities between 8 AM and 8 PM, those services should be available at those times. If a campus has residential facilities, those services should be accessible 24 hours per day,” he said.