tag:theconversation.com,2011:/au/topics/post-traumatic-stress-disorder-ptsd-1058/articlesPost-traumatic stress disorder (PTSD) – The Conversation2024-01-23T13:28:45Ztag:theconversation.com,2011:article/2203622024-01-23T13:28:45Z2024-01-23T13:28:45ZA TikTok ‘expert’ says you have post-traumatic stress disorder − but do you? A trauma psychiatrist explains what PTSD really is and how to seek help<figure><img src="https://images.theconversation.com/files/568961/original/file-20240111-27-ffd7jx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8000%2C4000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some social media posts about PTSD mislead rather than inform.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/flat-vector-conceptual-illustration-of-fake-royalty-free-illustration/1357666155?phrase=Flat+Vector+Conceptual+Illustration+of+Fake+News%2C+Information+Noise+and+Misinformation+%28&adppopup=true">Tarik Vision/iStock via Getty Images Plus</a></span></figcaption></figure><p>Among the many emerging trends on social media, one recent concerning fad is a casual and often <a href="https://www.psychologytoday.com/us/blog/prisons-and-pathos/202209/how-tiktok-and-twitter-get-trauma-so-wrong">inaccurate portrayal of trauma</a> and post-traumatic stress disorder, or PTSD – along with an array of questionable interventions suggested for its cure. </p>
<p>But what really is PTSD, who suffers from it, and what are the available treatments?</p>
<p><a href="https://psychiatry.med.wayne.edu/profile/dz0083">As a psychiatrist specializing in trauma</a>, I’ve worked with hundreds of people with PTSD. Some are refugees, <a href="https://theconversation.com/the-aching-red-firefighters-often-silently-suffer-from-trauma-and-job-related-stress-164994">first responders</a> and survivors of torture and human trafficking. Others have survived childhood trauma, shootings, assault, rape or robbery. </p>
<p>As part of my outreach, I post educational material about trauma and PTSD <a href="https://www.instagram.com/arash_javanbakht/">on social media</a>, so my news feeds often contain misleading material along these lines:</p>
<p>“Procrastination is not laziness. It is childhood trauma.”</p>
<p>“Trauma test: What image did you see first? A shark, A leg?”</p>
<p>“People who say sorry for no reason have PTSD.”</p>
<p>Mental health advocacy work has led to great progress in making the public aware of trauma and overcoming its stigma. But misuse of terms such as “trauma,” “childhood trauma” and “PTSD” has <a href="https://www.psychologytoday.com/us/blog/prisons-and-pathos/202209/how-tiktok-and-twitter-get-trauma-so-wrong">filled the social media sphere with misinformation</a>. It is often spread by people with a financial or emotional incentive, such as those seeking followers, selling tests, therapies, interventions, coaching and more.</p>
<p>Such posts treat trauma and PTSD as something that’s trendy, at times even romanticizing trauma. In turn, this trivializes the suffering of those who really have endured traumatic experiences. It can also create confusion for those with a real need for help and prevent them from receiving the right support.</p>
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<figcaption><span class="caption">It’s normal to have bad dreams following a trauma, or even to feel like the trauma is happening again.</span></figcaption>
</figure>
<h2>Trauma explained</h2>
<p>In popular culture and in the everyday vernacular, the word trauma is often used too loosely. As a result, on social media a difficult breakup or an argument with a family member might be portrayed as traumatic. While these experiences could be highly stressful, they are not considered trauma in the clinical world.</p>
<p>The field of <a href="https://www.psychiatry.org/file%20library/psychiatrists/practice/dsm/apa_dsm-5-ptsd.pdf">psychiatry defines trauma</a> as direct exposure to actual or threatened death, serious injury or sexual violence. That includes experiences <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">such as war</a>, assault, sexual abuse and rape, robbery, being shot at, severe car accidents and natural disasters. Trauma exposure is common among, though certainly not limited to, <a href="https://doi.org/10.1016/j.genhosppsych.2011.01.002">urban populations</a>. </p>
<p>Trauma exposure does not necessarily have to be direct; it can also happen by witnessing or being near the event or by exposure to its aftermath. This is what often happens to <a href="https://theconversation.com/the-aching-blue-trauma-stress-and-invisible-wounds-of-those-in-law-enforcement-146539">first responders</a>, those in the vicinity of or exposed to the <a href="https://theconversation.com/mass-shootings-leave-emotional-and-mental-scars-on-survivors-first-responders-and-millions-of-others-157935">aftermath of mass shootings</a>, and <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">refugees</a>, all of whom see the worst of what humans do to each other. </p>
<p>The <a href="https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/what-trauma-what-ptsd-who-affected-and-how-get">immediate response to trauma</a> can include shock, severe anxiety or panic, confusion, helplessness, constant recall of the event, feeling on edge, difficulty sleeping, anger, guilt or physical discomfort. Trauma can have <a href="https://doi.org/10.1007/s10903-018-0797-3">numerous long-term effects</a>, including anxiety, difficulty with trust, depression and substance use. </p>
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<figcaption><span class="caption">Trauma can lead to PTSD but doesn’t necessarily have to.</span></figcaption>
</figure>
<h2>PTSD explained</h2>
<p>Not everyone who experiences trauma has PTSD. For the majority of people exposed to trauma, <a href="https://www.ptsd.va.gov/understand/common/common_adults.asp#">symptoms subside over time</a>. But some people remain in a <a href="https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response">constant state of “fight or flight</a>,” a physiological response in which the brain stays fully alert to ensure escape or to neutralize a real or perceived danger. </p>
<p>When the severity of symptoms passes a specific threshold, mental health clinicians consider a PTSD diagnosis. To be diagnosed with the disorder, the person must have one or two symptoms from <a href="https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp">all of the following categories</a>: </p>
<ul>
<li><p>“Intrusion” symptoms, such as recurring, unwanted memories of the traumatic event, or frequent nightmares or flashbacks as if the event is happening again. This includes seeing the scenes, hearing the sounds or experiencing the smells of the event.</p></li>
<li><p>Intense avoidance of anything that is a reminder of the trauma, including thoughts and memories of the event, people who could resemble the perpetrator, and places or times of day that are associated with where, when or how the trauma happened.</p></li>
<li><p>Persistent negative emotions and thoughts, such as anxiety, sadness, guilt, a negative perception of self – that is, a feeling that you’re permanently damaged – or a mistrust of the world. This might include an inability to experience positive emotions.</p></li>
<li><p>Hyperarousal – meaning constantly being on the lookout for danger – and being easily startled or angered and being unable to sleep.</p></li>
</ul>
<h2>Getting help</h2>
<p>Like any other medical condition, a diagnosis of PTSD must be made by a mental health professional, preferably one skilled in trauma and PTSD. Some people endure certain symptoms without meeting all criteria for PTSD. If this causes significant social, academic or occupational dysfunction and distress, the person will still need help. </p>
<p>If you have endured traumatic experiences, first understand that PTSD is not your identity. It is a disease that can be and should be treated. Getting an evaluation from your primary care doctor is the first step. They may refer you to a mental health professional. Or you can reach out directly to a psychiatrist, a clinical psychologist or a licensed social worker for an evaluation. </p>
<p>Your insurance provider can help you find a therapist or psychiatrist, preferably specialized in trauma. You can also find a list of providers through the <a href="https://adaa.org">Anxiety and Depression Association of America</a>. If you don’t have insurance, you can get help at a local community mental health clinic or a <a href="https://www.fqhc.org/what-is-an-fqhc">federally qualified health center</a>. </p>
<p>If a diagnosis is confirmed, know that you do not have to suffer for years to come. There are <a href="https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/treatment-facts">effective and safe psychotherapy treatments</a> that can help process the traumatic memories, overcome the related negative thoughts or feelings of guilt and shame and help overcome avoidance of normal life situations because of the trauma. </p>
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<figcaption><span class="caption">There are treatment options for PTSD, along with ways to get support.</span></figcaption>
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<p><a href="https://rowman.com/ISBN/9781538170380/Afraid-Understanding-the-Purpose-of-Fear-and-Harnessing-the-Power-of-Anxiety">In my newly published book</a>, I discuss new, cutting-edge treatments as well as stories from those who overcame their illness. </p>
<p>For instance, our team has created <a href="https://www.youtube.com/watch?v=fQCw-35S5Vs">AI-enhanced mixed reality technologies</a> to produce immersive and interactive diverse situations of encounters with digital humans. This will allow the patients to, for example, experience the sensation of being in a crowded grocery store, with their therapist alongside to help them navigate and overcome their fears. </p>
<p>Medications can also help. Often labeled as antidepressants, these medications are safe and nonaddictive, and they can lower the intensity of anxiety to a level that allows the patients to deal with their fears.</p>
<p><a href="https://theconversation.com/to-feel-happier-we-have-to-resolve-to-the-life-we-evolved-to-live-108965">Lifestyle changes</a> like <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">diet</a>, <a href="https://theconversation.com/meditation-and-mindfulness-offer-an-abundance-of-health-benefits-and-may-be-as-effective-as-medication-for-treating-certain-conditions-195276">mindfulness</a> and <a href="https://theconversation.com/the-exercise-pill-how-exercise-keeps-your-brain-healthy-and-protects-it-against-depression-and-anxiety-155848">exercise</a> can also help a lot.</p>
<p>I have seen many traumatized people get back on their feet and resume their normal lives after the right intervention and lifestyle adjustments. Those who continue to have some symptoms often manage to build life around them without letting the trauma take away the joy and prosperity of their lives.</p><img src="https://counter.theconversation.com/content/220362/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Post-traumatic stress disorder can’t be diagnosed over social media.Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194702024-01-08T21:22:07Z2024-01-08T21:22:07ZService dogs play vital roles for veterans, but Canada’s lack of standards makes travel and access difficult<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/service-dogs-play-vital-roles-for-veterans-but-canadas-lack-of-standards-makes-travel-and-access-difficult" width="100%" height="400"></iframe>
<p>It is becoming common to see dogs assisting people with their mental health in Canadian communities. Over the past five years, our <a href="https://www.pawsitiveconnectionslab.com">research lab</a> has been studying the <a href="https://doi.org/10.21061/jvs.v7i1.194">benefits of service dogs for Canadian veterans</a> dealing with post-traumatic stress injuries and other mental health challenges. </p>
<p>Our findings align with research from the <a href="https://doi.org/10.1002/jts.22587">United States</a> and <a href="https://doi.org/10.1016/j.psychres.2023.115212">Australia</a> emphasizing the valuable role of service dogs in veterans’ treatment plans. For example, service dogs can wake a veteran from a traumatic nightmare. </p>
<p>This finding also aligns with studies examining the positive effects of owning a pet on mental health. While there is a need for <a href="https://doi.org/10.1371/journal.pone.0274960">more research</a>, most anyone with a pet in their family can attest to some benefit. </p>
<p>Our research team is not only adding to the growing evidence about the benefits of specific tasks a trained service dog can assist a veteran with, but we are also uncovering the positive impacts of the human-animal bond. The <a href="https://www.avma.org/one-health/human-animal-bond">human-animal bond</a> is understood as a mutually beneficial relationship between people and animals. </p>
<h2>Approaches to training and standards</h2>
<p>In early 2023, our research lab identified nearly <a href="https://static1.squarespace.com/static/629f8dcf8cbdb56e047bb866/t/642b0b527763c50e7c2be22a/1680542550706/UofS+-+Canadian+Service+Dogs.pdf">100 service dog training organizations</a> in Canada. The number is likely even higher today. This ranged from not-for-profit organizations that train a person’s pet dog to be a service dog, to for-profit organizations that provide a service dog to a veteran for a fee they are commonly asked to fundraise — this can be upwards of $30,000. </p>
<p>Considering this difference alone, it is easy to see why there is a need for service dog standards in Canada. </p>
<p><a href="https://www.scc.ca/en/standards/what-are-standards">Standards</a> are generally agreed upon rules, guidelines or characteristics for activities or their results. Basically, they offer guidance, just like a recipe to make dog biscuits would! An example of a standard for service dogs is requirements for their selection, training, safety and welfare. </p>
<p>Given that there are very different approaches among organizations in how service dogs are trained and matched with veterans, neither the service dog industry nor Canada’s federal, provincial or territorial governments have come to any consensus on what the standards should be. </p>
<p>In fact, in 2017, the <a href="https://www.cbc.ca/news/politics/service-dogs-ptsd-standards-1.4625484">Canadian General Standards Board</a> continued a process that was initiated by members of the service dog community in <a href="https://www.cf4aass.ca/application/files/7516/6665/7748/firstcndmilassistdogsummitreport2013finalversion.pdf">2013</a>. The aim was to reach a consensus, but it was unsuccessful and may have inadvertently increased confusion and tension in the field. <a href="https://cf4aass.ca/application/files/6616/7651/1209/consensus-_standards_-are_they_going_to_the_dogs.pdf">The need for service dog standards was identified</a> at least two decades earlier in Canada. </p>
<h2>Impact of lack of standards</h2>
<p>The lack of national standards has led provinces and territories to take <a href="https://www.cf4aass.ca/resource-one/resource-six">assorted approaches</a>, if any, to public access for service dogs. This has resulted in numerous challenges for veterans, such as <a href="https://www.alberta.ca/service-dogs-in-public">travelling between provinces</a> with their service dogs. </p>
<p>It has prompted <a href="https://policies.usask.ca/documents/procedures-student-service-animals.pdf">businesses and organizations</a> lacking expertise about service dogs to create their own policies. It has also made human rights commissions and tribunals busy with <a href="https://www.winnipegfreepress.com/breakingnews/2022/12/02/service-dog-user-urged-to-file-human-rights-case">complaints</a>. </p>
<p>The impact of the lack of standards extends beyond its effects on veterans with service dogs. It also affects others matched with service dogs, including first responders and current Canadian Armed Forces members, as well as other forms of service dogs who are trained to assist, like <a href="https://autismdogservices.ca/">autism service dogs</a> and <a href="https://www.dogguides.com/programs/diabetic-alert/">diabetes alert</a> service dogs.</p>
<h2>Taking action to improve veteran health</h2>
<p>There may not be consensus in Canada right now about national and/or provincial and territorial service dog standards, but we are confident the field can agree upon one thing — our commitment to improving veteran health. </p>
<p>In the meantime, we propose a shift toward practical approaches that government, service dog organizations and trainers, businesses and members of the general public can take to improve veteran health. These suggestions recognize the value of the human-animal bond. </p>
<h2>Role of governments:</h2>
<ul>
<li><p>Recognize the merits of developing standards through a process that honours the human-animal bond experiences of veterans and service dogs. Consider the guidance offered from the 2023 voluntary process undertaken by the <a href="https://www.cf4aass.ca/application/files/7216/9543/2723/CAN.HRSO-500.01-2023-A.1-EN.pdf">Canadian Foundation for Animal Assisted Support Services</a> to develop a management system for all animal-involved human support services. </p></li>
<li><p>Be familiar with the value of accreditation for organizational quality standards. In 2023, two service dog programs, <a href="https://www.canadianaccreditation.ca/accreditation/accredited-organizations/?wpv_view_count=937&wpv-wpcf-organization=audeamus&wpv_filter_submit=Submit&wpv_aux_current_post_id=932&wpv_aux_parent_post_id=932">Audeamus Inc.</a> and <a href="https://www.canadianaccreditation.ca/accreditation/accredited-organizations/?wpv_view_count=937&wpv-wpcf-organization=courageous+comp&wpv_filter_submit=Submit&wpv_aux_current_post_id=932&wpv_aux_parent_post_id=932">Courageous Companions Inc.</a>, achieved several accreditation standards (for example, Governance & Management) for the first time in Canada through the <a href="https://www.canadianaccreditation.ca/accreditation/accredited-organizations/">Canadian Accreditation Council</a>. Both Audeamus and Courageous Companions recognize the bond between a veteran and their service dog. </p></li>
<li><p>Accreditation in this case is not to be confused with service dog standards. <a href="https://www.canadianaccreditation.ca/">Accreditation typically reviews an organization’s general structures, programs and practices involving humans against the accrediting body’s standards</a>. </p></li>
<li><p>Review the <a href="https://www.canada.ca/en/revenue-agency/programs/about-canada-revenue-agency-cra/federal-government-budgets/budget-2018-equality-growth-strong-middle-class/medical-expenses-tax-credit.html#wb-cont">Medical Expense Tax Credit — Service Animals</a> program that applies to veterans and consider the applicability of such a program to pets. Service dogs are specially trained to perform technical tasks well beyond what a pet can. However, recognition of the health benefits of the human-animal bond with pets is likewise important. </p></li>
<li><p>The <a href="https://otc-cta.gc.ca/eng/content/canadian-transportation-agency-issues-final-decision-about-travelling-emotional-support">Canadian Transportation Agency</a> can be looked to for guidance with its recent decision on how individuals being treated for a mental disability can travel in an air, rail or ferry passenger cabin with an <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/pov-sorting-out-the-service-dog-confusion-ainsley-hawthorn-1.5471013">emotional support animal</a>, and specifically dogs in an approved animal carrier. These passengers are recognized by a mental health professional to have a beneficial emotional connection or bond with their pet.</p></li>
</ul>
<h2>Role of service dog organizations and trainers:</h2>
<ul>
<li><p>Service dog trainers embrace a <a href="https://www.saskhealthauthority.ca/our-organization/our-direction/engagement/sha-engagement-framework/trauma-informed-engagement">trauma-informed approach</a> to provide services to people with a mental health concern. The online, three-hour <a href="https://servicedogtoolkit.ca/">Connecting for Veteran Wellness</a> certificate course recognizes the role of trauma and the beneficial influence of the human-animal bond on client health. It is now available at no cost.</p></li>
<li><p>Acknowledge the interconnectedness of human and animal welfare by exploring a
<a href="https://www.animalhealthcanada.ca/work-areas/one-welfare">One Welfare framework</a> to challenge the influence of <a href="https://www.britannica.com/topic/speciesism">speciesism</a>, the assumption of human superiority over animals, in the service dog field. This aligns with <a href="https://doi.org/10.3390/h6040078">Indigenous worldviews</a> of the relationship between human, animal and planetary health.</p></li>
</ul>
<h2>Role of the general public:</h2>
<ul>
<li><p>Recognize the challenges veterans face when in public with their service dogs, such as being denied access to a business because of <a href="https://www.cbc.ca/news/canada/london/this-service-dog-isn-t-a-golden-retriever-or-lab-is-that-why-this-woman-wasn-t-allowed-in-an-ontario-hotel-1.6711426">stigma</a> or having a stranger <a href="https://www.alberta.ca/service-dogs-in-public">ask them to disclose their disability</a> for their own interest by inquiring about the reason they need a service dog. </p></li>
<li><p>Be informed about what service dogs do and who they are, including that they can be any breed of dog. </p></li>
</ul>
<p>A recent <a href="https://doi.org/10.3390/ani13193091">Canadian survey</a> by our research lab found that the Canadian public generally holds positive views of service dogs, with some groups (for example, women) more supportive than others. In this area, Canada is doing well!</p><img src="https://counter.theconversation.com/content/219470/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colleen Dell receives funding from the Canadian Institutes of Health Research and has received funding from Health Canada and Veterans Affairs Canada to study service dogs.</span></em></p><p class="fine-print"><em><span>Linzi Williamson receives funding from the Canadian Institutes of Health Research (CIHR). </span></em></p>Organizations have very different approaches to training service dogs and matching them with veterans. Neither the industry nor Canada’s provinces and territories have come to a consensus on standards.Colleen Dell, Professor and Research Chair in One Health & Wellness, University of SaskatchewanLinzi Williamson, Assistant Professor, Psychology & Health Studies, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2171792023-12-19T13:17:23Z2023-12-19T13:17:23ZWhy do some men commit domestic violence? Trauma and social isolation may play a role<figure><img src="https://images.theconversation.com/files/565296/original/file-20231212-23-6xbunh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Domestic violence is experienced unevenly across the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/argument-man-and-woman-having-an-argument-at-home-royalty-free-image/1321546697">kieferpix/iStock via Getty Images Plus</a></span></figcaption></figure><p>Support for survivors of domestic violence is important, but to end domestic violence once and for all, society needs to understand the people who perpetrate it and how to successfully intervene.</p>
<p>Domestic violence is very common in the United States. <a href="https://www.cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">Nearly half of women and men in the U.S.</a> experience sexual or physical violence, stalking or psychological harm or coercion in a romantic relationship during their lifetime. </p>
<p>Domestic violence is also experienced unevenly across the U.S population. Young people are most vulnerable, with <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">nearly three-fourths</a> of female victims reporting that their first experience of domestic violence occurred before age 25. <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">People of color</a> and <a href="https://cdc.gov/violenceprevention/pdf/nisvs/nisvsReportonSexualIdentity.pdf">LGBTQ+</a> <a href="https://doi.org/10.2105/AJPH.2020.305774">people</a> also experience considerably higher rates of domestic violence than the national average. And despite similar rates of domestic violence across men and women, women report <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">more severe effects on their lives</a>, including higher rates of injury and need for medical care, needing help from law enforcement and post-traumatic stress disorder symptoms.</p>
<p>I am a social worker who has spent the <a href="https://scholar.google.com/citations?user=OtG3yWgAAAAJ&hl=en">past 10 years studying</a> how men come to use violence against their intimate partners, since the <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">effects of their violence</a> is often the most severe. My research has found that consistent supportive relationships with attentive adults in childhood and adulthood, along with stress management that takes trauma into account, are two promising approaches to prevent domestic violence.</p>
<h2>The roots of domestic violence</h2>
<p>Understanding how someone comes to perpetrate violence is necessary to stop violence from happening in the first place.</p>
<p>Certain childhood experiences can put people at risk of committing domestic violence in the future. Researchers have found that child abuse, neglect and a <a href="https://doi.org/10.1016/j.avb.2015.06.001">negative parent-child relationship</a> are significant risk factors that may lead someone to later perpetrate domestic violence. </p>
<p>Experiencing trauma in early childhood can <a href="https://doi.org/10.1542/peds.2011-2663">alter the brain, how the body responds to stress</a> and whether someone sees the world as a <a href="https://doi.org/10.1177/1524838018791268">threatening, harmful and untrustworthy place</a>. For example, research has shown that people who have been exposed to trauma have increased activity in the amygdala of the brain, resulting in <a href="https://doi.org/10.1016/j.ynstr.2014.10.002">heightened fear and arousal</a> that can lead to aggressive responses in the face of conflict and stress. Trauma exposure is also linked to a <a href="https://doi.org/10.1016/j.jadohealth.2012.04.010">decrease in activity in the prefrontal cortex</a> – that’s the part of the brain responsible for impulse control, concentration and emotional reasoning. These are essential qualities to navigate interpersonal relationships. </p>
<p>Toxic stress – excessive or prolonged activation of the body’s stress response – happens when someone encounters constant threats to their physical or mental safety during sensitive developmental periods. Compared to their peers, youth facing <a href="https://doi.org/10.1542/peds.2021-054493">disproportionate levels of hardship</a> and threats of poverty, racism and other structural inequities are at greater risk for toxic stress. These bodily changes can set kids up for <a href="https://doi.org/10.1037/vio0000156">PTSD, depression</a>, and <a href="https://doi.org/10.1037/vio0000237">alcohol or drug abuse</a> later in life, which are some of the most common risk factors of perpetrating domestic violence. One study found that nearly one-third of men in a domestic violence intervention program <a href="https://doi.org/10.1111/famp.12533">reported clinical levels of PTSD</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Couple arguing in hallway of home" src="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are ways to navigate complex emotional challenges without resorting to violence.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stressed-couple-arguing-blaming-each-other-royalty-free-image/1454529507">bymuratdeniz/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Beliefs about <a href="https://doi.org/10.1007/s10896-022-00451-0">traditional gender roles</a> dictating how men and women should act is another significant contributing factor to domestic violence. Unresolved trauma mixed with rigid gender views can limit the coping skills and tools people have to navigate complex emotional challenges in romantic relationships. For example, homes that promote rigid gender scripts, such as “boys don’t cry,” and limit opportunities to learn from activities that are considered “feminine,” like caring for baby dolls, can <a href="https://doi.org/10.1016/j.neuropsychologia.2011.12.022">stunt the emotional expression</a> of boys and make them less skilled in recognizing emotions in others and themselves. Anger typically becomes the most accessible emotion.</p>
<p>Certainly not all people who have faced childhood adversity and trauma are destined to perpetrate violence. Studies show that a <a href="https://doi.org/10.1177/1524838017692383">secure parent-child attachment</a> and the presence of safe, nurturing relationships and environments during childhood protect against future violence. Positive childhood experiences, such as feeling understood in difficult times and having at least two nonparental adults taking interest in your life, can help. One study of over 6,000 adults in Wisconsin found that those reporting <a href="https://doi.org/10.1001/jamapediatrics.2019.3007">three to five positive childhood experiences</a> were 50% less likely to have depressive symptoms or poor mental health days compared to those who had fewer or no positive childhood experiences.</p>
<p>Without these protective factors, however, many children are at risk of <a href="https://doi.org/10.1007/s00406-005-0624-4">carrying their trauma</a> into their adolescent and adult romantic relationships.</p>
<h2>Prevention and intervention</h2>
<p>Supporting the health and well-being of society calls for research-based efforts to prevent and address domestic violence. Responsive relationships, or relationships where the other person is attentive, attuned and supportive, are a key way to improve the well-being of children and adults, including the <a href="https://doi.org/10.1371/journal.pone.0235177">mental health of survivors</a> of abuse. </p>
<p>Researchers are paying more attention to the dangers of <a href="https://www.cdc.gov/aging/publications/features/lonely-older-adults.html">social isolation among adults</a>. This has been <a href="https://theconversation.com/curing-americas-loneliness-epidemic-would-make-us-healthier-fitter-and-less-likely-to-abuse-drugs-206059">exacerbated by cultural shifts</a> stemming from the COVID-19 pandemic, remote work and social media. Social isolation and unhealthy social networks can be <a href="https://doi.org/10.1016/j.ijintrel.2019.07.005">dangerous for victims of violence</a> and damaging for someone prone to committing violence because they can <a href="https://doi.org/10.3390/ijerph18083890">worsen mental health conditions</a> like PTSD. <a href="https://teamchangingminds.org/">Community-based programs</a> that build supportive social networks have the potential to improve mental health risk factors for perpetrating violence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person holding their hand on another person's shoulder in a supportive gesture" src="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Supportive social networks are essential for mental health.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hand-of-young-supportive-man-consoling-his-friend-royalty-free-image/1430601013">shironosov/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>Most <a href="https://doi.org/10.1177/1524838018791268">domestic violence intervention programs for men</a> have not incorporated the understanding that trauma registers in the body as much as it does in someone’s way of thinking. These programs mostly focus on unlearning abusive tendencies and relearning healthy ways of engagement. This kind of approach includes using workbooks and thought exercises to identify abusive behaviors and thoughts about subjugating women, understand why they’re harmful, and learn healthy ways to resolve conflict. </p>
<p>However, focusing on cognitive thought processes as the primary mechanism for change by itself is insufficient for lasting change. In order to meaningfully alter the effects of trauma, interventions must also <a href="https://doi.org/10.1016/j.neubiorev.2023.105033">engage autonomic brain processes</a>. </p>
<p>Interventions that focus on <a href="https://doi.org/10.1177/1524838018791268">regulating stress and emotions</a>, such as deep breathing and mindfulness, can help address physiological symptoms of trauma and reset the body’s stress response. Resetting the body’s stress response can then help people engage in the higher-level learning necessary to adopt nonviolent thinking and behaviors and discard abusive tendencies.</p>
<p>Alleviating symptoms of PTSD and trauma in people who have perpetrated domestic violence may help them identify key triggers and develop the coping skills to respond to stress in healthier ways instead of violence.</p><img src="https://counter.theconversation.com/content/217179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Voith receives funding from the National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Human Development; the U.S. Department for Health and Human Services, Administration for Children and Families; and Victims of Crime Acts (VOCA), Office for Victims of Crime. </span></em></p>Childhood adversity can put people at risk of perpetrating domestic violence in the future. Having a supportive social network and learning ways to regulate the stress response, however, can help.Laura Voith, Associate Professor of Applied Social Sciences, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2140532023-12-15T13:22:43Z2023-12-15T13:22:43ZRacism produces subtle brain changes that lead to increased disease risk in Black populations<figure><img src="https://images.theconversation.com/files/565115/original/file-20231212-21-79wl3z.jpg?ixlib=rb-1.1.0&rect=50%2C30%2C6659%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coping with everyday affronts comes at a cost and requires a certain level of emotional suppression. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/composite-of-portraits-with-varying-shades-of-skin-royalty-free-image/1249641728?phrase=discrimination&searchscope=image%2Cfilm&adppopup=true">RyanJLane/E+ via Getty Images</a></span></figcaption></figure><p>The U.S. is in the midst of a racial reckoning. The COVID-19 pandemic, which took a particularly <a href="https://covidtracking.com/race">heavy toll on Black communities</a>, turned a harsh spotlight on long-standing health disparities that the public could no longer overlook.</p>
<p>Although the health disparities for Black communities have been well known to researchers for decades, the pandemic put real names and faces to these numbers. Compared with white people, Black people are at much greater risk for developing a range of health problems, including <a href="https://minorityhealth.hhs.gov/heart-disease-and-african-americans">heart disease</a>, <a href="https://minorityhealth.hhs.gov/diabetes-and-african-americans">diabetes</a> and <a href="https://doi.org/10.1016/j.jalz.2018.09.009">dementia</a>. For example, Black people are twice as likely as white people to <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">develop Alzheimer’s disease</a>.</p>
<p>A vast and growing body of research shows that <a href="https://doi.org/10.1146/annurev-publhealth-040218-043750">racism contributes to systems that promote health inequities</a>. Most recently, our team has also learned that racism directly contributes to these inequities on a neurobiological level.</p>
<p>We are <a href="https://www.negarfani.com/">clinical</a> <a href="https://www.mcleanhospital.org/profile/nathaniel-harnett">neuroscientists</a> who study the multifaceted ways in which racism affects how our brains develop and function. We use brain imaging to study how trauma such as sexual assault or racial discrimination can cause stress that leads to mental health disorders like depression and post-traumatic stress disorder, or PTSD. </p>
<p>We have studied trauma in the context of a study known as the <a href="https://www.gradytraumaproject.com/">Grady Trauma Project</a>, which has been running for nearly 20 years. This study is largely focused on the trauma and stress of Black people in the metropolitan Atlanta, Georgia, community.</p>
<h2>How discrimination alters the brain</h2>
<p>Racial discrimination is commonly experienced through subtle indignities: a woman clutching her purse as a Black man walks by on the sidewalk, a shopkeeper keeping close watch on a Black woman shopping in a clothing store, a comment about a Black employee being a “diversity hire.” These slights are often referred to as <a href="https://www.med.unc.edu/inclusion/justice-equity-diversity-and-inclusion-j-e-d-i-toolkit/microaggressions-microaffirmations/#">microaggressions</a>.</p>
<p>Decades of research has shown that the everyday burden of these race-related threats, slights and exclusions in day-to-day life translates into a <a href="https://doi.org/10.1146/annurev-publhealth-040218-043750">real increase in disease risk</a>. But researchers are only beginning to understand how these forms of discrimination affect a person’s biology and overall health.</p>
<p>Our team’s research shows that the <a href="https://doi.org/10.1016/j.bpsc.2022.05.004">everyday burden of racism</a> <a href="https://doi.org/10.1001/jamapsychiatry.2021.1480">affects the function</a> and <a href="https://doi.org/10.1016/j.biopsych.2021.08.011">structure</a> <a href="https://doi.org/10.1038/s41386-022-01445-8">of the brain</a>. In turn, these changes play a major role in risk for health problems.</p>
<p>For instance, our studies show that racial discrimination <a href="https://doi.org/10.1001/jamapsychiatry.2021.1480">increases the activity of brain regions</a>, <a href="https://doi.org/10.1038/s41386-023-01737-7">such as the prefrontal cortex</a>, that are involved in regulating emotions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Scientist and technologist view brain images." src="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565418/original/file-20231213-25-bah2a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Negar Fani and a team member view brain images.</span>
<span class="attribution"><span class="source">Patrick Heagney</span></span>
</figcaption>
</figure>
<p>This increased activity in prefrontal brain regions occurs because responding to these types of affronts requires high-effort coping strategies, such as suppressing emotions. People who have experienced more racial discrimination also show more activation in brain regions that enable them to <a href="https://doi.org/10.1016/j.dr.2021.100967">inhibit and suppress anger, shock or sadness</a> so that they can curate a socially acceptable response. </p>
<h2>A cost for overcompensating</h2>
<p>Despite the fact that high-energy coping allows people to manage a constant barrage of threats, this comes at a cost.</p>
<p>The more brain energy you use to suppress, control or manage your feelings, the more energy you take away from the rest of the body. Over time, and without prolonged periods of rest, relief and restoration, this can contribute to other problems, a process that public health researcher <a href="https://psc.isr.umich.edu/news/a-monumental-new-book-weathering-arline-geronimuss-lifes-work/">Arline Geronimus termed “weathering</a>.” Having these brain regions in continual overdrive is <a href="https://doi.org/10.1016/j.socscimed.2020.113169">linked with</a> <a href="https://doi.org/10.1007%2Fs12110-010-9078-0">accelerated biological aging</a>, which can <a href="https://doi.org/10.1016%2Fj.ssmph.2018.11.003">create vulnerability for health problems</a> and early death. </p>
<p>In our research, we have found that this <a href="https://doi.org/10.1038/s41386-022-01445-8">weathering process is evident</a> in the <a href="https://doi.org/10.1016/j.biopsych.2021.08.011">gradual degradation</a> <a href="https://doi.org/10.1016/j.bpsc.2022.05.004">of brain structure</a>, particularly in the heavily myelinated axons of the brain, known as “<a href="https://medlineplus.gov/ency/article/002344.htm#">white matter</a>,” which serve as the brain’s information highways. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Computer-generated image of white matter tracts in the brain." src="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565504/original/file-20231213-21-yeiyph.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rendering of white matter fibers − shown in color − throughout the brain.</span>
<span class="attribution"><span class="source">Negar Fani</span></span>
</figcaption>
</figure>
<p><a href="https://medlineplus.gov/ency/article/002261.htm">Myelin</a> is a protective sheath around nerve fibers that allows for improved communication between brain cells. Similar to highways for vehicles, without sufficient maintenance of the myelin, degradation will occur. </p>
<p>Erosion in these brain pathways can affect self-regulation, making a person more vulnerable to developing unhealthy coping strategies for stress, such as <a href="https://doi.org/10.1176/appi.ajp.2015.15060710">emotional eating or substance use</a>. These behaviors, in turn, can increase one’s risk for a wide variety of health problems. </p>
<p>These racism-related changes in the brain, and their direct effects on coping, may help to explain why Black people are twice as likely to develop brain health problems such as <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">Alzheimer’s disease</a> compared with white people.</p>
<h2>Recognizing racial gaslighting</h2>
<p>In our view, what makes racism particularly insidious and pernicious to the health of Black people is the societal invalidation that accompanies it. This makes racial trauma effectively invisible. Racism, whether it <a href="https://doi.org/10.1177/1745691616659391">originates from people</a> or from institutional systems, is often rationalized, <a href="https://doi.org/10.1016/j.beth.2020.09.001">excused or dismissed</a>. </p>
<p>Such invalidation leads those who experience racism to second-guess themselves: “Am I just being too sensitive?” People who have the temerity to report racist events are often ridiculed or met with skepticism. This <a href="https://doi.org/10.1038/s41578-021-00361-5">extends to</a> <a href="https://doi.org/10.1177/2372732220984183">academic spheres</a> <a href="https://doi.org/10.1016/j.cell.2020.06.009">as well</a>.</p>
<p>This continual questioning and doubting of the circumstances around racist experiences, or <a href="https://doi.org/10.1080/21565503.2017.1403934">racial gaslighting</a>, may be part of what depletes the brain of its resources, causing the weathering that ultimately increases vulnerability to brain health problems.</p>
<p>Interrupting this cycle requires that people learn to identify their biases toward people of color and people in marginalized groups more generally, and to understand how those biases may lead to discriminatory words and behavior. We believe that by finding their blind spots, people can see ways in which their actions and behaviors could be viewed as hurtful, exclusionary or offensive. Through recognition of these experiences as racist, people can become allies rather than skeptics. </p>
<p><a href="https://www.institutionalcourage.org/">Institutions can help</a> to create a culture of <a href="https://doi.org/10.1176/appi.focus.20220045">healing, validation and support</a> for people of color. A validating, supportive institutional culture may help people of color normalize their reactions to these stressors, in addition to the connection – and restoration – they may find within their communities.</p><img src="https://counter.theconversation.com/content/214053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Negar Fani receives funding from the National Institutes of Health and Emory University School of Medicine. </span></em></p><p class="fine-print"><em><span>Nathaniel Harnett receives funding from the National Institutes of Health, the Brain and Behavior Research Foundation, and the Presidents and Fellows of Harvard College. </span></em></p>Racial threats and slights take a toll on health, but the continual invalidation and questioning of whether those so-called microaggressions exist has an even more insidious effect, research shows.Negar Fani, Associate Professor of Psychiatry and Neuroscience, Emory UniversityNathaniel Harnett, Assistant Professor of Psychiatry, Harvard Medical School Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2187842023-12-12T19:53:39Z2023-12-12T19:53:39ZCanada owes its veterans new mental health tools: Access to psychedelic therapies is overdue<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-owes-its-veterans-new-mental-health-tools-access-to-psychedelic-therapies-is-overdue" width="100%" height="400"></iframe>
<p>The Canadian Senate Subcommittee on Veterans Affairs recently released a striking report entitled <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/"><em>The Time is Now: Granting Equitable Access to Psychedelic Therapies</em></a>. </p>
<p>To address high rates of suicide and post-traumatic stress disorder (PTSD) among veterans, the report calls on Veterans Affairs Canada (VAC) to immediately implement “a robust research program funded by VAC and the Department of National Defence (DND) in partnership with Health Canada, the Canadian Institutes of Health Research, and all other relevant partners.”</p>
<p>With psychedelic research, Veterans Affairs Canada has a real chance to live up to its mandate “to provide exemplary, client-centred services and benefits that respond to the needs of veterans, our other clients and their families.” </p>
<p>As a psychedelics researcher with an interest in veteran health, I couldn’t be happier, especially with the Senate focus on timeliness, equity and access. </p>
<p>Not only is <a href="https://www.researchgate.net/publication/372244882_Knowledge_Synthesis_in_the_Science_of_Psilocybin_Scoping_Reviews_of_Clinical_and_Preclinical_Research">my PhD on the therapeutic application of psilocybin</a>, but my father was a veteran of the Canadian Forces, as is my brother and two uncles and both of my grandfathers. I grew up on Canadian Forces bases.</p>
<h2>Canada’s veterans</h2>
<p>Lt. Col. (ret’d) Jack Shore, my father, graduate of the <a href="https://www.btb.termiumplus.gc.ca/tpv2alpha/alpha-eng.html?lang=eng&srchtxt=APPRENTICE%20SOLDIER">Soldier Apprentice Program</a> and a United Nations Peacekeeper in the <a href="https://peacekeeping.un.org/sites/default/files/past/onucB.htm">Congo mission</a> of the early 1960s, passed away as I was working as a guest co-editor of a special edition of the <a href="https://jmvfh.utpjournals.press/toc/jmvfh/current"><em>Journal of Military, Veteran and Family Health</em></a>. The theme of the edition is “Therapeutic use of psychedelics, entheogens, entactogens, cannabinoids and dissociative anesthetics for military members and veterans.” </p>
<p>While my Dad rarely talked about his time in the Congo, he experienced what we would now recognize as moral injury, and most likely PTSD. These conditions directly shaped our family life and upbringing. That was before Sudan, Rwanda, the Yugoslav wars and Afghanistan.</p>
<p>My childhood on bases occurred in time of relative peace, but Canada has now had a few generations of soldiers experience active combat. </p>
<p>The <a href="https://patientsmedicalhome.ca/resources/best-advice-guides/best-advice-guide-caring-for-veterans/">629,000 veterans living in Canada have rates of depression, anxiety and substance use disorder that are higher than the civilian population</a>. <a href="https://doi.org/10.1002/jts.21956">One in seven is living with PTSD</a>. Veterans are <a href="https://www.mcgill.ca/maxbellschool/files/maxbellschool/ofha_veteran_homelessness_policy_brief_-_2023.pdf">two to three times more likely</a> to experience homelessness compared to the general population. </p>
<h2>Duty of care</h2>
<p>To veterans of the Canadian Forces and to their families, we owe a duty of care, and not just to provide services and access to novel treatments. We also have a duty to care enough to do the science well and to tackle the public policy challenges (including regulatory drug reform) necessary to provide Canadian veterans with effective care.</p>
<blockquote>
<p>“It is the Government of Canada’s duty to assure veterans that it is doing everything in its power, immediately, to respect its solemn commitment to support, at any cost, those who chose to defend us with honour.” — <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/">The Subcommittee on Veterans Affairs, Senate of Canada</a> </p>
</blockquote>
<p>The role of the VAC includes paying for the cost of health-care benefits and other services for veterans through the <a href="https://www.canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/health-care-plan.html">Public Service Health Care Plan</a> and supplemental treatment benefits. While this single-payer provider model has advantages, it relies heavily on VAC staff and managers to assess and approve plans of care. </p>
<p>Developing a psychedelics research program for veterans should be seen as a public health priority. It will most likely require an independent panel of experts and stakeholders, including veterans, to help shape the agenda in a timely manner for the VAC. </p>
<h2>Psychedelic therapies</h2>
<p><a href="https://cimvhr.ca/">The Canadian Institute for Military and Veteran Health Research</a> (CIMVHR), founded in 2010, is well positioned as the Canadian hub for military, veteran and family health research to provide the infrastructure to foster collaboration, ensure stakeholder engagement and work on the knowledge translation so necessary to rapidly developing the capacity and expertise of Canadian researchers.</p>
<p>We can build on the work of the U.S. Department of Veterans Affairs, which is <a href="https://clinicaltrials.gov/study/NCT05876481?term=Veteran&intr=Psilocybin&rank=1">currently conducting several psilocybin trials</a>, and the long-standing work of <a href="https://maps.org/">MAPS (Multi-disciplinary Association of Psychedelic Studies)</a> in advancing MDMA-assisted therapy for PTSD towards regulatory approval. We can also listen to the experts, such as Canada Health Research Chair in Mental Health Disparities Monnica Williams, who are calling for <a href="https://doi.org/10.1007/s11469-023-01160-5">greater equity and improved inclusion of BIPOC veterans and researchers</a>. </p>
<blockquote>
<p>“When we have tried everything in our toolbox but still cannot help our patients, it is truly time for some new tools.” —<a href="https://jmvfh.utpjournals.press/toc/jmvfh/9/5">Monnica Williams</a>, Canada Health Research Chair in Mental Health Disparities </p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-potential-of-psychedelics-to-heal-our-racial-traumas-218233">The potential of psychedelics to heal our racial traumas</a>
</strong>
</em>
</p>
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<p>Psychedelic ketamine appears to have <a href="https://doi.org/10.1192%2Fbjo.2021.1061">positive but short-lived outcomes</a> in the treatment of mood disorders, and ketamine clinics require evaluation given recent <a href="https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine">FDA warnings</a> about risks of commercialized mental health telemedicine and take-home doses.</p>
<p>Ultimately, the Canadian public may want to reconsider the policy framework that still severely limits access to these promising compounds for researchers, clinicians and those in need. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
</strong>
</em>
</p>
<hr>
<p>Veterans have taken it upon themselves to support each other and to advocate for change. <a href="https://heroicheartsproject.org/">The Heroic Hearts Project</a> helps veterans access psychedelic therapies and has long championed the potential benefits of plant medicine ceremony.</p>
<p><a href="https://www.heroicheartsproject.ca/">Heroic Hearts Canada</a>, which aims to provide Canadian veterans with equitable access to safe, effective and affordable psychedelic therapies, has recently partnered with University of Calgary for some <a href="https://www.ucalgary.ca/research/participate/study/16168/are-you-veteran-canadian-armed-forces-have-you-investigated-working-psychedelics-legally">important observational research</a>.</p>
<h2>Faster progress to medical use</h2>
<p>The time lag from drug discovery to patient care is often decades, prompting the expression “<a href="https://doi.org/10.1186/s41231-019-0050-7">valley of death</a>” to refer to the gap between bench science and bedside care. </p>
<p>Given the real mental health needs of Canadian veterans, and the known limits on effectiveness for current standards of care, we must aim for quicker progress towards medical use, <a href="https://www.unodc.org/res/WDR-2023/WDR23_B3_CH2_psychedelics.pdf">as both the United States and Australia have done</a>. However, this progress must not be at the expense of safety and quality, and definitely not simply for commercialization. </p>
<p>Thought needs to be given to the development, evaluation and quality assurance of accessible programs for veteran-centred care, with Veterans’ voices at the table. It is time for more emphasis on psychedelics-related <a href="https://doi.org/10.1016/j.psychres.2019.04.025">implementation science</a>, the study of methods to promote the uptake (and identify barriers) of research findings into routine clinical use in order to improve effectiveness of health services.</p>
<p>There is <a href="https://healthsci.queensu.ca/source/Psychedelics%2520Research/Psychedelic%2520Medicine%2520Report%2520-%2520Final.pdf">robust and mounting evidence to support regulatory approval for MDMA and psilocybin-assisted therapies</a>. Their availability and uptake by clinicians and the public is only a matter of time. </p>
<h2>The need for more diverse research</h2>
<p>Research funds now are best allocated towards large Phase 3 trials that treat wider cross-sections of the veteran community, to begin to assess the safety and efficacy of interventions such as the naturally ocurring and culturally significant psychedelic compounds <a href="https://doi.org/10.1080/00952990.2023.2220874">ibogaine and 5-MeO-DMT</a> <a href="https://www.proquest.com/openview/2d897baa8a8203979eaf5ee7deb9037e/1?pq-origsite=gscholar&cbl=18750&diss=y">and ayahuasca</a>, and to invest in knowledge translation, program evaluation and training researchers and clinicians. </p>
<p>Apart from new biomedical research, it is time we recognized the widespread personal use of psychedelics, including among veterans, and develop safer use guidelines for psychedelics like those in place <a href="https://www.canada.ca/en/health-canada/services/substance-use/alcohol/low-risk-alcohol-drinking-guidelines.html">for alcohol</a> and <a href="https://doi.org/10.1007/BF03404169">cannabis</a>.</p>
<p>While the Senate report does not mention cannabis, it is worth noting that veterans in Canada have been <a href="https://dimensionsretreats.com/dimensions-retreats-algonquin-elevate-veterans-only/#:%7E:text=The%2520program%2520does%2520not%2520include,mind%252Dbody%2520practices%2520in%2520nature.">approved for treatment with cannabis-assisted therapy</a>. </p>
<p>This includes the use of <a href="https://doi.org/10.1177/0269881121997099">cannabis as a psychedelic</a> and mimics the <a href="https://doi.org/10.1007/s40429-021-00401-8">preparation-session-integration protocols</a> of psychedelic therapies. This intervention is also worth rapid evaluation and possible expansion. </p>
<p>Given the pressing needs of Canadian veterans and the limitations of our current tools, the need for research on psychedelic therapies, as well as for timely and equitable access, is urgent.</p><img src="https://counter.theconversation.com/content/218784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ron Shore worked for, and consulted to Dimensions Health Centres in 2021 and 2022; he continues to own shares in the company.</span></em></p>One in seven Canadian veterans is living with PTSD. Developing a psychedelics research program for veterans should be a public health priority.Ron Shore, Research Scientist, Queen's Health Sciences and Assistant Professor, Department of Psychiatry, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2185722023-11-29T22:24:58Z2023-11-29T22:24:58ZAid workers in war zones like Gaza face impossible choices that can leave them traumatized<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/aid-workers-in-war-zones-like-gaza-face-impossible-choices-that-can-leave-them-traumatized" width="100%" height="400"></iframe>
<p>The <a href="https://www.aljazeera.com/news/2023/11/29/efforts-under-way-to-extend-israel-hamas-truce-for-second-time">shaky pause in fighting</a> agreed between Hamas and Israel is bringing much needed relief to the civilians of Gaza. With its future still uncertain, aid workers are rushing to deliver food, water and other vital supplies. However, it is clear that resources are insufficient to meet the current needs of Palestinian civilians. </p>
<p>As a result, <a href="https://www.theguardian.com/world/2023/nov/03/doctors-and-aid-workers-fight-to-survive-in-gaza-abandoned">aid workers have to make difficult decisions and are feeling helpless in the face of immense necessity</a>. Because of the moral challenges that aid workers in Gaza and all over the world face, they are at great risk of moral injury. </p>
<p><a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp">Moral injury</a> is a form of psychological trauma that occurs after events that are so incompatible with our moral values that they have the power to shatter our deeply held assumptions about justice, about one’s ability to be a moral being and about what is good or right. </p>
<h2>Morally challenging events weigh heavily on aid workers</h2>
<p>Aid workers consistently face a host of moral challenges. Colleagues and I recently conducted a study on the psychological effect of moral challenges. We interviewed 243 aid workers about their work, morally distressing events they may have experienced and their mental health. Most were working in Africa, the Middle East and Asia. </p>
<p>We found that <a href="https://doi.org/10.3389/fpsyg.2023.1171629">81 per cent of aid workers</a> have experienced events that are traumatic because they violated core moral beliefs. Some events had to do with aid workers’ own actions. For example, aid workers struggled to decide how to allocate and use insufficient resources like food, medicine. </p>
<p>Similarly, another study found that <a href="https://doi.org/10.1111/j.1467-7717.2011.01232.x">medical staff</a> had a deep sense of unease in having to choose which seriously ill patients to treat (and which ones not to treat) because of limited resources. Aid workers have to deal with these kinds of lose-lose decisions that have no possible good outcome.</p>
<p>Other times, aid workers may have done something they believed right, only to find out that their decisions had unintended negative consequences. For instance, deciding to distribute food to women and children first, resulting in a series of assaults on them. </p>
<p>Our research also shows that aid workers were often frequently disturbed by events that they witnessed. Aid workers may <a href="https://doi.org/10.1177/1534765609332325">struggle to understand the actions of others</a> in survival situations or witness the inhumane treatment of other human beings. They may have difficulty not to intervene in the face of violence or injustice. </p>
<p>Other morally challenging events involve aid workers feeling that they have been betrayed. For example, aid workers could have a deep sense of betrayal when they feel that their organization or a leader have failed to sufficiently protect them. Around 27 per cent of aid workers reported at least one disturbing event that left them feeling betrayed. </p>
<h2>Aid workers left traumatized</h2>
<p>People experience moral injury in many different ways. We know from research on veterans that most report very <a href="https://doi.org/10.1037/gpr0000018">strong emotions of anger, disgust, shame or guilt</a>. </p>
<p>They often experience symptoms of <a href="https://doi.org/10.1002/jts.22362">depression, anxiety and post-traumatic stress disorder (PTSD)</a>. They may withdraw from loved ones or self-sabotage. Those affected by moral injury often have negative thoughts about themselves. For example, they may feel weak or have suicidal thoughts. They may feel that they are broken or that their life has lost meaning.</p>
<p>Morally challenging events appear to be an important risk factor for aid workers. <a href="https://doi.org/10.3389/fpsyg.2023.1171629">Our research</a> suggests that many may suffer from moral injury. Such events were significantly associated with more symptoms of PTSD and depression. In fact, morally challenging events contributed more strongly to symptoms of PTSD and depression than events where their safety was compromised. </p>
<h2>Coping with moral injury</h2>
<p>Aid workers operate in complex and often chaotic environments. They are <a href="https://doi.org/10.1080/21577323.2015.1093565">very resilient</a>, but the nature of their work inevitably involves moral challenges and, thus, risks of moral injury. Nonetheless, there are some steps that individuals and organizations can take to alleviate moral injury.</p>
<p>First, establishing procedures to help aid workers make difficult decisions could help reduce the personal burden of aid workers. For instance, research on <a href="https://www.moralinjuryguide.ca/Documents/Moral-Injury-Guide.pdf">other high-risk occupations</a> suggests that making decisions as a team, fostering team cohesiveness, and routinely discussing moral struggles could better protect people from moral injury.</p>
<p>Second, discussing moral injury as an occupational risk of aid work is important to make this hazard better known. Aid organizations should recognize that their workers might question the morality of some events, and may have difficulty understanding their own actions, the actions of others and events that are perceived as betrayals. This is essential to reduce stigmatization and validate the experiences of aid workers. </p>
<p>Third, shame, disgust, anger and guilt are signs of healthy moral functioning and should not be taken as objective signs of wrongdoing. Reconnecting back to an individual’s values and to why they got into this line of work can be a good place to start unpacking those feelings.</p>
<p>Lastly, <a href="https://doi.org/10.1016/j.janxdis.2013.10.005">psychological vulnerability and strength in the aftermath of trauma often go hand in hand</a>. We found evidence that morally challenging events can lead to psychological growth for aid workers. </p>
<p>These distressing events may lead aid workers to revisit their life objectives, to develop a new understanding of what is important in their lives, to develop a stronger sense of personal strength, to feel that their social relations are more intimate or meaningful, and to have a greater appreciation of life. </p>
<p>This kind of self-care can meaningfully help aid workers as they deal with the moral challenges they encounter. The current situation in Gaza shows just how important aid workers are to civilians in crisis. Research on the psychological well-being of aid workers is important to better support them in this role and in the work that they do.</p><img src="https://counter.theconversation.com/content/218572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Dewar received funding from the Social Sciences and Humanities Research Council of Canada and the Fonds de recherche du Québec en société et culture.</span></em></p>Aid workers consistently face a host of moral challenges and often have to make difficult choices. Organizations need to be aware of the mental impact on their staff and provide support.Michelle Dewar, Doctorante en psychologie (Ph.D/D.ps), Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2182332023-11-23T16:32:58Z2023-11-23T16:32:58ZThe potential of psychedelics to heal our racial traumas<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/f2e5423c-d81f-41aa-a3c8-e7a6bb396a7b?dark=true"></iframe>
<p><em>Clinical psychologist and professor Monnica Williams is on a mission to bring psychedelics to therapists’ offices to help people heal from their racial traumas. To do this, she’s jumping over some big hurdles.</em></p>
<p>Judging from the colourful signs advertising mushrooms that we are seeing on our streets and the presence of psychedelics in pop culture, we are in the middle of a psychedelic renaissance. For example, in the TV program <em>Transplant</em>, a Syrian Canadian doctor experiencing trauma is treated by his psychiatrist with psilocybin therapy. </p>
<p>On a more official front, this month, the <a href="https://globalnews.ca/news/10079020/psychedelics-veteran-ptsd/">Canadian Senate recommended the federal government fast-track a research program</a> into how psychedelics can help veterans suffering from Post Traumatic Stress Disorder (PTSD). PTSD covers a range of issues, including racial trauma. </p>
<p><a href="https://dont-call-me-resilient.simplecast.com/episodes/the-potential-of-psychedelics-to-heal-our-racial-traumas">On this week’s episode of <em>Don’t Call Me Resilient</em></a>, we explore how psychedelics — including psilocybin (“magic mushrooms”) and MDMA — can help heal racial trauma. Racial trauma, Williams explains, is not necessarily something that happens through one event. It’s usually ongoing experiences of stress, including “daily insults to your person.” </p>
<p>With racial trauma, therapists are also looking at events beyond an individual’s lifetime. “We’re looking at historical trauma, that may have happened decades or even centuries ago, that is still associated with the person’s cultural group. These could be catastrophes that happened to a whole group of people, like ethnic cleansing or genocide, the Holocaust, or it could be a natural disaster.”</p>
<p>Intergenerational trauma is something Williams has experienced personally. Her parents grew up in the Deep South in the United States during the Jim Crow era. As African Americans, they were subject to segregation and extreme oppression. She says that affected the whole African American community.</p>
<p>People with racial trauma can have symptoms like depression or anxiety or may be despondent or angry. </p>
<h2>Research studies show results for psychedelics</h2>
<p>Once Williams saw the research studies coming out of <a href="https://maps.org/about-maps/">MAPS, a multidisciplinary association for psychedelic studies</a>, she was convinced that psychedelics can work: “The medicine does its thing and the brain starts to heal itself.”</p>
<p>But there are some big hurdles before we get there, including the fact that many mental health professionals don’t have any “training or knowledge in working with people across race, ethnicity and culture,” according to Williams. </p>
<p>And we don’t exactly have a great track record when it comes to communities of colour and drugs. There is a long and ugly history of institutions using Black, Indigenous and racialized bodies without consent for medical experimentation, including drug testing. We also can’t forget the racial roots of the <a href="https://apnews.com/article/war-on-drugs-75e61c224de3a394235df80de7d70b70">war on drugs</a> and the devastating impact it had — and continues to have — on Black and other racialized communities. </p>
<p>All this begs the question: As psychedelics appear to be entering the mainstream, how can we open up their healing properties to people in need in an inclusive way? </p>
<p>To find out more, listen to this week’s podcast with Monnica Williams, clinical psychologist and professor in the School of Psychology at the University of Ottawa, where she is the Canada Research Chair in Mental Health Disparities. She is also the Clinical Director of the Behavioral Wellness Clinic in Connecticut.</p>
<blockquote>
<p>People heal through connecting with other people. That’s how we get through traumas. Our society suffers from a mental illness called racism, and we as a society need to heal from this disease where you have one part of the body attacking another part of the body. It’s like an autoimmune disorder, right? Doesn’t make any sense: makes the whole body sick. And we’re on a planet that we all share and we’re all human beings, we’re all connected, even in ways we don’t realize or understand. We could think of it as a single organism and we all need to heal so that we can all function in a way that’s in the best interest of the whole entity.
- Monnica T. Williams</p>
</blockquote>
<h2>Read more in The Conversation</h2>
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Read more:
<a href="https://theconversation.com/the-real-promise-of-lsd-mdma-and-mushrooms-for-medical-science-100579">The real promise of LSD, MDMA and mushrooms for medical science</a>
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Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
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Read more:
<a href="https://theconversation.com/mdma-assisted-couples-therapy-how-a-psychedelic-is-enhancing-intimacy-and-healing-ptsd-127609">MDMA-assisted couples therapy: How a psychedelic is enhancing intimacy and healing PTSD</a>
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Read more:
<a href="https://theconversation.com/psychedelic-medicine-is-on-its-way-but-its-not-doing-shrooms-with-your-shrink-heres-what-you-need-to-know-208568">Psychedelic medicine is on its way. But it's not 'doing shrooms with your shrink'. Here's what you need to know</a>
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<h2>Resources</h2>
<p><a href="https://link.springer.com/article/10.1007/s11469-023-01160-5?sv1=affiliate&sv_campaign_id=922583&awc=26429_1700596296_e8eeb80cdaec76f40d0015d156200eef&utm_medium=affiliate&utm_source=awin&utm_campaign=CONR_BOOKS_ECOM_DE_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=922583">“Psychedelics and Racial Justice”</a> by Monnica T. Williams</p>
<p><em><a href="https://podcasts.apple.com/ca/podcast/truth-be-told/id1462216572">Truth be Told</a></em> Season 5 (American Public Media/Tonya Mosley)</p>
<p><a href="https://www.nytimes.com/2023/10/23/us/oregon-psychedelic-mushrooms.html">“A New Era of Psychedelics in Oregon”</a> by Mike Baker</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811257/">“The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision”</a> by Darron T. Smith, Sonya C. Faber, NiCole T. Buchanan, Dale Foster and Lilith Green</p>
<p><a href="https://www.penguinrandomhouse.ca/books/529343/how-to-change-your-mind-by-michael-pollan/9780735224155"><em>How to Change Your Mind: The New Science of Psychedelics</em> by Michael Pollan
</a></p>
<p><a href="http://doi.org/10.1037/0022-006X.76.2.208">“Anger and Posttraumatic Stress Disorder symptoms in Crime Victims: A Longitudinal Analysis”</a>. <em>Journal of Consulting and Clinical Psychology</em>. by Orth, U., Cahill, S.P., Foa, E.B., & Maercker, A.</p>
<h2>Listen and follow</h2>
<p>You can listen to or follow <em>Don’t Call Me Resilient</em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a>, <a href="https://www.youtube.com/playlist?list=PL_mJBLBznANz6ID9rBCUk7gv_ZRC4Og9-">YouTube</a> or wherever you listen to your favourite podcasts. </p>
<p><a href="mailto:DCMR@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.instagram.com/dontcallmeresilientpodcast/">Instagram</a> and <a href="https://www.tiktok.com/@theconversation">TikTok</a> and use #DontCallMeResilient.</p>
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Clinical psychologist and professor Monnica Williams is on a mission to bring psychedelics to therapists’ offices to help people heal from their racial traumas. To do this, she’s jumping over some big hurdles.Vinita Srivastava, Host + Producer, Don't Call Me ResilientLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168142023-11-14T13:24:49Z2023-11-14T13:24:49ZMass shootings often put a spotlight on mental illness, but figuring out which conditions should keep someone from having a gun is no easy task<figure><img src="https://images.theconversation.com/files/557887/original/file-20231106-23-j6y1eu.jpg?ixlib=rb-1.1.0&rect=34%2C8%2C5687%2C3791&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mass shooting in Lewiston, Maine -- the worst in the state's history -- was carried out by a gunman with a known history of mental illness.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MaineShooting/2b2097e7f3514fddb03d55ee1bd4db36/photo?hpSectionId=a91e5e04eacf4709a84586d6c00d3577&st=hpsection&mediaType=text,photo,video,graphic,audio&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=1758&currentItemNo=128">AP Photo/Matt York</a></span></figcaption></figure><p>Every time the country is shaken by a tragic mass shooting and the loss of innocent lives, mental illness and its role in the actions of the mass shooter come under scrutiny.</p>
<p>Mental illness again became a central theme after the mass shooting in Maine on Oct. 25, 2023, in which records suggest that the shooter had a <a href="https://www.cbsnews.com/news/who-is-robert-card-confirmed-details-maine-shooting-suspect-person-of-interest/">history of serious mental health issues</a>. Months before the tragedy, the family of gunman Robert Card, as well as Army Reserve staffers, had contacted law enforcement expressing high levels of concern about his mental health and noting his access to guns.</p>
<p>Since 1999, 19 states along with the District of Columbia have <a href="https://www.poynter.org/reporting-editing/2022/19-states-have-red-flag-laws-but-they-are-rarely-used-to-stop-gun-violence/">passed legislation</a>, commonly known as <a href="https://www.pbs.org/newshour/politics/michigan-governor-signs-red-flag-gun-law-as-questions-linger-over-enforcement">red flag laws</a>, that allow law enforcement and other people in a person’s life to petition for removal of firearms when there are imminent safety concerns about a gun owner. However, <a href="https://www.poynter.org/reporting-editing/2022/19-states-have-red-flag-laws-but-they-are-rarely-used-to-stop-gun-violence/">reports suggest that this law is rarely used</a>.</p>
<p>Maine, though, has what’s known as a <a href="https://www.cbsnews.com/boston/news/yellow-red-flag-gun-laws-massachusetts-maine/">yellow flag law</a>. It requires reporting to local law enforcement that a person poses an imminent threat, but it then relies on the police to take the person into custody, order a mental health evaluation and request a court order to have that person’s guns removed. The yellow flag law <a href="https://www.cnn.com/2023/11/05/us/robert-card-lewiston-shooting-maine-yellow-flag-law/index.html">was not used</a> in Card’s case.</p>
<p>The relationship between mental illness and guns, and risk mitigation, is complicated. Specifically, there is no clear and uniform consensus on who should determine when to restrict access to firearms – should it be a psychiatrist, an independent forensic psychiatrist, a committee of psychiatrists or a judge? The majority of people with mental illness <a href="https://www.nimh.nih.gov/health/statistics/mental-illness">do not seek treatment</a>. </p>
<p>In that light, it might make sense to mandate a psychiatric examination into the background check process for purchasing a gun. As severe mental illness can start at any point in life, will gun owners need periodic psychiatric assessment, akin to a vision exam for renewing a driver’s license? If so, who will pay for the visits? </p>
<p>I am a <a href="https://www.starclab.org">trauma psychiatrist</a> who regularly deals with the outcome of gun violence, whether in victims or first responders. In my book “<a href="https://rowman.com/ISBN/9781538170380/Afraid-Understanding-the-Purpose-of-Fear-and-Harnessing-the-Power-of-Anxiety">Afraid</a>: Understanding the Purpose of Fear and Harnessing the Power of Anxiety,” I have examined mental health issues related to gun violence and the social consequences of mass shootings.</p>
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<figcaption><span class="caption">Maine has a ‘yellow flag’ law aimed at restricting access to firearms when a person is deemed potentially dangerous.</span></figcaption>
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<h2>The complexity of defining mental illness</h2>
<p>The term <a href="https://www.nimh.nih.gov/health/statistics/mental-illness">“mental illness”</a> covers a wide range of conditions, and there are more than 200 diagnoses listed in the most recent version of the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostic Statistical Manual of Mental Disorders</a>, which is the gold standard for psychiatric diagnosis in the U.S. Mental illness includes diverse conditions like phobias, <a href="https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561">social anxiety disorder</a>, <a href="https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/what-trauma-what-ptsd-who-affected-and-how-get">post-traumatic stress disorder</a>, <a href="https://www.nhs.uk/mental-health/conditions/trichotillomania/#">hair-picking disorder</a>, <a href="https://www.psychiatry.org/patients-families/gambling-disorder/what-is-gambling-disorder">gambling disorder</a>, <a href="https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia#">schizophrenia</a>, <a href="https://www.cdc.gov/aging/dementia/index.html#">dementia</a>, various forms of <a href="https://www.psychiatry.org/patients-families/depression/what-is-depression">depression</a> and personality disorders, such as antisocial personality disorder.</p>
<p>Mental illnesses are also very common: Nearly <a href="https://www.nami.org/learn-more/mental-health-by-the-numbers">1 in 5 people experience clinical depression</a> during their lives; 1 in 5 people experience an anxiety disorder; <a href="https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml">1 in 100 experience schizophrenia</a>; and <a href="http://www.ptsdunited.org/ptsd-statistics-2/">nearly 8 in 100</a> of the general population experiences PTSD. People with higher exposure to trauma, <a href="https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp">such as veterans</a> and <a href="https://theconversation.com/the-aching-blue-trauma-stress-and-invisible-wounds-of-those-in-law-enforcement-146539">first responders</a>, have higher rates of PTSD, up to about 30%. </p>
<p>So when suggesting that gun access should be restricted for people with mental illness, does that mean all of these conditions? Or just some, or some in defined circumstances? For example, should all veterans with PTSD or those with social anxiety disorder have their guns removed? Neither of these conditions is known to commonly impair judgment. </p>
<p>Defining the specific conditions that can impair judgment or significantly increase risk of harm to self or others is an important step in this process, which needs serious involvement of mental health professionals, stakeholders, law enforcement and policymakers. </p>
<h2>Knowing when a person could be a risk of harm</h2>
<p>The majority of mental illnesses <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686644/">do not pose a risk</a> to others. When there is a risk, in the majority of cases when someone is involuntarily admitted to a psychiatric inpatient unit, it is not because the person poses a risk to others. Rather, it is more often the case that the person is at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686644/">risk of self-harm</a>, as in the case of a depressed, suicidal patient. Sadly, people with severe mental illness are <a href="https://doi.org/10.3389/fpsyt.2020.563860">often the victims of violence and abuse</a>.</p>
<p>In psychiatric disorders, concerns typically arise in acutely psychotic patients with paranoid delusions that convince them to harm others. This may happen in – but is not limited to – schizophrenia, dementia, severe <a href="https://www.webmd.com/depression/psychotic-depression">psychotic depression</a> or <a href="https://www.healthline.com/health/bipolar-disorder/bipolar-psychosis">psychotic bipolar illness</a>.</p>
<p>These conditions are rather strongly associated with <a href="https://psychiatryonline.org/doi/pdf/10.5555/appi.books.9781615371099">increased risk of suicide</a>, not homicide. Therefore, more realistic gun laws in regards to mental illness could also save many lives from suicide.</p>
<p>Substance use is a <a href="https://doi.org/10.1093%2Fepirev%2Fmxaa006">major contributor to violence</a> in mental illness, and it needs to be included in the calculations when it comes to gun restriction. Other situations with increased risk of harm to others are personality disorders with a high level of impulsivity or lack of remorse, such as <a href="https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/symptoms-causes/syc-20353928">antisocial personality disorder</a>. </p>
<p>But the reality is that most people with personality disorders do not seek treatment and are not known to mental health providers. </p>
<p>It is also worth noting that most countries have a similar prevalence of severe mental illness compared with the U.S., yet they have <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders#">much lower rates of mass murder</a> than the U.S.</p>
<h2>The harms of using ‘mental illness’ so vaguely</h2>
<p>Every time <a href="http://blogs.bmj.com/bmj/2017/10/06/doctors-need-to-speak-up-against-the-use-of-mental-illness-as-an-insult/">mental illness is linked by the media or politicians to acts of violence</a>, the highly charged emotions of the moment can affect those with mental illness and their families, and that can perpetuate stigma.</p>
<p>When “mental illness” is <a href="https://www.nytimes.com/2012/12/18/health/a-misguided-focus-on-mental-illness-in-gun-control-debate.html">vaguely addressed in gun debates</a>, those with a psychiatric condition such as anxiety or phobia but without an increased risk of violence or impairment in judgment may avoid seeking treatment.</p>
<h2>Mental illness gun laws that can have real preventive impact</h2>
<p>In my view, to turn the focus on the role of mental illness in gun violence into meaningful actions, the following steps are needed:</p>
<p>– Clear, uniform criteria need to be established on when mental illness justifies restriction of access to firearms. Would this be specific mental disorders or specific mental disorders in crises? This requires defining signs of imminent threat to self or others, and also defining how and when a person is relieved of that status. A great deal of discussion and coordination will be needed between mental health, legal and law enforcement experts.</p>
<p>– As it was noted before, the majority of patients with mental illness do not seek care. A comprehensive preventive plan would necessitate screening everybody who applies to purchase a firearm. This step ensures meaningful screening, as well as avoiding discrimination. Other countries such as Japan, Canada, New Zealand and Austria <a href="https://www.nytimes.com/interactive/2018/03/02/world/international-gun-laws.html">have such requirements</a>.</p>
<p>– Since potentially dangerous psychiatric conditions can begin at any age in an otherwise healthy person, regular mental health screening for gun owners would be justified, similar to eye exams for drivers.</p>
<p>– There should be clear mechanisms for determining lack of mental fitness for access to firearms when concerns are raised by those who know the person or by law enforcement. Red flag gun laws are a good beginning for this path.</p>
<p>The bottom line is that determining who may or may not have access to firearms based on mental illness, as outlined, is indeed very challenging and requires more serious work. And the common denominator in all these tragedies still is the access to assault rifles.</p>
<p><em>This is an updated version of <a href="https://theconversation.com/mental-illness-and-gun-laws-what-you-may-not-know-about-the-complexities-92337">an article</a> that was originally published on Feb. 26, 2018.</em></p><img src="https://counter.theconversation.com/content/216814/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Red flag laws are an important step in the right direction, but much more work is needed to determine the role of mental health in the lead-up to and aftermath of mass shootings.Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160772023-11-08T13:37:22Z2023-11-08T13:37:22ZKetamine can rapidly reduce symptoms of PTSD and depression, new study finds<figure><img src="https://images.theconversation.com/files/555141/original/file-20231022-23-svzzue.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6949%2C4615&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ketamine is an anesthetic that must be administered carefully and by a health care professional.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/professional-wearing-gloves-injecting-ketamine-in-a-royalty-free-image/1614335455?phrase=ketamine&adppopup=true">Jeniffer Fontan/iStock via Getty Images Plus</a></span></figcaption></figure><p>The <a href="https://www.dea.gov/factsheets/ketamine">drug ketamine</a> can reduce the symptoms of post-traumatic stress disorder, or PTSD, and symptoms of depression in patients as early as a day after injection. That is the key finding of my team’s new meta-analysis, <a href="https://doi.org/10.1177/10600280231199666">just published in the journal Annals of Pharmacotherapy</a>. </p>
<p>Ketamine is an anesthetic that is sometimes used as a substance of abuse but is increasingly being <a href="https://theconversation.com/ketamine-paired-with-looking-at-smiling-faces-to-build-positive-associations-holds-promise-for-helping-people-with-treatment-resistant-depression-190950">explored as a treatment</a> for a range of mental health conditions.</p>
<p>We analyzed <a href="https://doi.org/10.1177/10600280231199666">six randomized controlled trials</a> representing 259 patients with moderate to severe PTSD. In all trials, about half were injected with ketamine. The rest received either salt water or the <a href="https://doi.org/10.1002/jcph.2233">drug midazolam</a>, a benzodiazepine like <a href="https://www.webmd.com/drugs/2/drug-9824/xanax-oral/details">Xanax</a> that is also used as an anesthetic agent. </p>
<p>Patients receiving ketamine saw their PTSD symptoms reduced by about 25% both at one day and one week after therapy. But if patients received <a href="https://doi.org/10.1038/s41386-022-01266-9">repeated injections over four weeks</a>, PTSD symptoms declined by only 12%. Reduction of depression symptoms were more modest but still significant.</p>
<p>In most of these trials, patients only received a single shot; in the other two, they were given an injection at the same dose six or more times over two to four weeks. The benefits after the first injection were similar across studies, but it’s unclear how well additional doses of ketamine over time maintain these benefits. </p>
<p>Overall, the benefits of even a single ketamine injection occur rapidly, but are modest in magnitude. The best regimen to maintain these benefits by reinjecting ketamine has not been determined.</p>
<h2>Why it matters</h2>
<p>PTSD, a <a href="https://doi.org/10.1016/j.comppsych.2012.02.009">debilitating mental health disorder</a>, occurs when past trauma causes flashbacks, nightmares, depressed mood, anxiety and avoidance of activities that could trigger traumatic memories. Patients with PTSD are <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/suicide_ptsd.asp">twice as likely to attempt suicide</a> than the general population. </p>
<p>About <a href="https://www.ptsd.va.gov/understand/common/common_adults.asp">13 million Americans have PTSD</a> in a given year, which translates to nearly 5% of the adult population. PTSD is caused by experiencing or witnessing a traumatic event. Many combat veterans have the disorder, as do survivors of physical assault, natural disasters, child abuse and sexual abuse. Those with moderate to severe disease cases lose an average of about three and a half days of work per month due to triggered symptoms or treatment for the illness. </p>
<p><a href="https://www.healthquality.va.gov/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPG.pdf">Trauma-focused psychotherapy</a> – techniques that help patients <a href="https://www.nctsn.org/sites/default/files/interventions/tfcbt_fact_sheet.pdf">recall, process and respond</a> to traumatic memories – is the treatment of choice for PTSD, but it <a href="https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp">can take several weeks to see benefits</a>, and not all patients respond. </p>
<p>For these people, antidepressants such as <a href="https://www.apa.org/ptsd-guideline/treatments/medications">paroxetine, sertraline and venlafaxine</a> are recommended as alternatives, or as an addition to psychotherapy. </p>
<p>But like psychotherapy, these drugs may not work for a while – about <a href="https://pubmed.ncbi.nlm.nih.gov/35234292/">five to eight weeks</a> – unlike ketamine, which seems to begin working almost immediately. That said, the reduction in PTSD and depression symptoms over time following ketamine injection is about the same as what the traditional antidepressants provide once they take effect.</p>
<p>Because some people with severe PTSD may be experiencing suicidal thoughts, time is of the essence; they simply might not be able to wait for traditional options to begin working. Ketamine might be an effective bridge to immediately reduce patients’ symptoms until trauma-focused psychotherapy and other antidepressants can kick in. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/isla6iFR9eM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Researchers agree that new treatments for PTSD patients are greatly needed.</span></figcaption>
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<h2>What still isn’t known</h2>
<p>The big unknown with using ketamine for PTSD and depressive symptoms is how often the injections are needed. The data simply is not robust enough to determine whether multiple doses maintain the effects better than simply using a single dose.</p>
<p>Ketamine costs around <a href="https://psychedelicspotlight.com/ketamine-therapy-how-much-does-it-cost-who-is-eligible/">US$800 per injection</a>, so knowing how much to administer each treatment and how many injections to give over time is important.</p>
<p>Importantly, ketamine can be abused. If purchased from <a href="https://doi.org/10.1177/10600280221092482">unlicensed pharmacies or online stores</a>, the ketamine product is not approved by the Food and Drug Administration. It may not have the correct dose, may have expired or might not even have any ketamine in it. Or, it may contain a substitute drug with a dangerous active ingredient, like the <a href="https://www.dea.gov/factsheets/lsd">synthetic street drug LSD</a>. Such fake products <a href="https://doi.org/10.1016/j.japh.2020.04.020">can harm or even kill patients</a></p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/216077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The analysis shows that ketamine may start relieving symptoms of PTSD within one day, but it is still unclear how long the effects last and how many injections are needed to maintain benefits.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2143602023-11-02T01:21:09Z2023-11-02T01:21:09ZWhat is eye movement desensitisation and reprocessing? And can EMDR help children recover from trauma?<figure><img src="https://images.theconversation.com/files/554456/original/file-20231018-15-xrpphz.jpg?ixlib=rb-1.1.0&rect=0%2C28%2C3872%2C2556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/-Ux5mdMJNEA?utm_content=creditCopyText&utm_medium=referral&utm_source=unsplash">Charlein Gracia/Unsplash</a></span></figcaption></figure><p>Childhood traumatic experiences are common. Almost one in three <a href="https://www.mja.com.au/journal/2023/218/6/australian-first-study-finds-child-maltreatment-widespread">(32%)</a> Australians reported being physically abused as a child, 31% experienced emotional abuse, 28.5% were victims of sexual abuse and 9% were neglected. Some 40% of Australians were exposed to domestic violence against a parent. </p>
<p>Untreated childhood trauma is <a href="https://www.acms.au/findings/">associated</a> with an increased risk of mental health disorders. These children are more likely to become teens and adults who binge drink, attempt suicide and self-harm. </p>
<p>To reduce the chance of these <a href="https://www.researchgate.net/profile/Onno-Hart/publication/265099248_The_Assessment_and_Treatment_of_Complex_PTSD/links/545a3d1f0cf2cf5164843be5/The-Assessment-and-Treatment-of-Complex-PTSD.pdf">long-term negative effects</a>, it’s important to understand what <a href="https://www.theguardian.com/lifeandstyle/2023/apr/12/the-trauma-doctor-gabor-mate-on-happiness-hope-and-how-to-heal-our-deepest-wounds#:%7E:text=Mat%C3%A9%20says%20trauma%2C%20from%20the,says%2C%20is%20the%20good%20news.">treatments</a> work for trauma in children. One option is eye movement desensitisation and reprocessing, or EMDR, a therapy which aims to reduce distress and traumatic memories. </p>
<p>So how does EMDR work? And how strong is its evidence base?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-consequences-of-childhood-trauma-on-childrens-mental-health-196178">The consequences of childhood trauma on children's mental health</a>
</strong>
</em>
</p>
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<h2>What is EMDR?</h2>
<p>EMDR first emerged in the late 1980s and is now <a href="https://istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL.pdf.aspx/">recognised</a> as a <a href="https://www.who.int/news/item/06-08-2013-who-releases-guidance-on-mental-health-care-after-trauma">suitable</a> approach for adults and <a href="https://psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/evidence-based-psych-interventions.pdf">children</a>. </p>
<p>In EMDR, clients are first assisted to gain insight into what is causing their distress. </p>
<p>In a subsequent phase of the therapy, the client holds the traumatic memory in their mind, while moving their eyes backwards and forward, tracking the therapist’s hand. </p>
<p>Their eye movements are complemented by a tapping technique (tapping the knees one at a time) or an auditory tone played in each ear. </p>
<p>The client then focuses on a preferred positive belief to replace the trauma they have processed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-emdr-therapy-and-how-does-it-help-people-who-have-experienced-trauma-161743">What is EMDR therapy, and how does it help people who have experienced trauma?</a>
</strong>
</em>
</p>
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<h2>How does EMDR work? The two main theories</h2>
<p>It is <a href="https://emdr-belgium.be/wp-content/uploads/2023/01/01-The-Effectiveness-of-EMDR-for-Medically-Unexplained-Symptoms-A-Systematic-Literature-Review.pdf">suggested</a> eye movements decrease the physical distress sensations by activating the parasympathetic nervous system, associated with a restful and calm state. Moving the eyes backwards and forward is also <a href="https://www.sciencedirect.com/science/article/pii/S1162908812000692">thought to assist</a> with accessing earlier memories.</p>
<p>Another theory to explain why EMDR is effective centres on the different activities the client is doing all at once, and how this impacts working memory. By moving the eyes, holding the distressing memory front of mind, tapping on the knees and/or listening to auditory tones in each ear, it is <a href="https://www.sciencedirect.com/science/article/pii/S1162908812000692">thought</a> the working memory is disrupted, and therefore open to being changed. </p>
<figure class="align-center ">
<img alt="Mother conforts son" src="https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554695/original/file-20231019-28-1fuqbt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">EMDR aims to change the traumatic memory.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/careful-mother-pities-son-woman-hugs-2181054171">Shutterstock</a></span>
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</figure>
<h2>How does EMDR compare with CBT for children?</h2>
<p>The small number of studies conducted so far suggests EMDR can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641384/">help children</a> with post-traumatic stress disorder to <a href="https://pubmed.ncbi.nlm.nih.gov/24965797/">reduce symptoms</a> of emotional upset, depression, <a href="https://pubmed.ncbi.nlm.nih.gov/30416901/">anxiety</a> and behavioural issues such as sleeping. </p>
<p>These <a href="https://pubmed.ncbi.nlm.nih.gov/24965797/">outcomes are similar</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217870/#:%7E:text=The%20results%20of%20this%20meta,recommended%20to%20build%20conclusive%20evidence.">trauma-focused</a> cognitive behaviour therapy.</p>
<p>EMDR has also been <a href="https://pubmed.ncbi.nlm.nih.gov/28397633/">beneficial</a> (and as effective as other therapies) for children who experienced natural disasters.</p>
<p>Generally, six to 12 sessions is <a href="https://pubmed.ncbi.nlm.nih.gov/24965797/">sufficient</a> for EMDR treatment, compared to 12 to 15 for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476061/">trauma-focused cognitive behaviour therapy</a>.</p>
<p>However, EMDR cannot be used with clients unless the therapist is appropriately <a href="https://emdraa.org/training-accreditation/">trained and qualified</a>.</p>
<h2>How does EMDR compare with other ‘exposure’ therapies?</h2>
<p>An American Psychological Association review <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcad.12418">concluded</a> the effectiveness of EMDR for adults and children is still <a href="https://div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/">inconsistent</a>. </p>
<p>While EMDR appears <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217870/">more efficient</a> than <a href="https://pubmed.ncbi.nlm.nih.gov/30416901/">trauma-focused cognitive behaviour therapy</a>, with fewer sessions required, the outcomes are equivalent to other exposure therapies (which use the same process to work through trauma) <em>without</em> eye movements. </p>
<figure class="align-center ">
<img alt="Girl talks to therapist" src="https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554693/original/file-20231019-21-hh15g4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">EMDR is an alternative to trauma-focused cognitive behaviour therapy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/supportive-psychologist-clipboard-listening-little-child-1891127098">Shutterstock</a></span>
</figcaption>
</figure>
<p>The <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcad.12418">true mechanism</a> of the eye movements in EMDR is still unclear. <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcad.12418">Research suggests</a> the benefits of EMDR may come from other factors that assist with behaviour-change or reducing distress, such as the relationship between the therapist and client or the client’s motivation to change. </p>
<p>So overall, the research on EMDR is still mixed. Studies conducted on children with trauma and larger sample sizes are needed for more conclusive results. </p>
<h2>What really matters in trauma therapy for kids?</h2>
<p>If children view themselves as being responsible for the traumatic event, in order to cope they will distance themselves from ongoing trauma by disowning that bad or wounded part of themselves. This alienation of themselves helps them survive but maintains their trauma symptoms. </p>
<p>Shame and suppression of self <a href="https://janinafisher.com/wp-content/uploads/2023/03/trauma.pdf">can lead to</a> behavioural outbursts or shut-down coping strategies. This leaves the child easily triggered, living in their survival brain and oscillating between their fight, flight, freeze or fawn (people-pleasing) states. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-fawning-how-is-it-related-to-trauma-and-the-fight-or-flight-response-205024">What is 'fawning'? How is it related to trauma and the 'fight or flight' response?</a>
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</em>
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<hr>
<p>Helping children <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0038264">restore their sense of self</a>, assisting them to learn to cope with big emotions is important and we can do that in safe relationships. </p>
<p>It’s also crucial to help parents understand the impact of their wellbeing on the their child’s recovery. Improving parents’ wellbeing and feelings of competence can help heal themselves and their children. </p>
<p>Physician and trauma expert Gabor Mate rightly said children don’t get traumatised because they are hurt. They get traumatised because they’re <a href="https://raisingchildren.net.au/school-age/health-daily-care/mental-health/children-s-mental-health">alone with the hurt</a>.</p><img src="https://counter.theconversation.com/content/214360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One treatment option for children’s trauma is eye movement desensitisation and reprocessing, or EMDR. Here’s how it works and what the research says about its effectiveness.Peta Stapleton, Associate Professor in Psychology, Bond UniversityCher McGillivray, Assistant Professor Psychology Department, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2143672023-10-03T04:36:46Z2023-10-03T04:36:46ZMy Sister Jill: Patricia Cornelius’ new play is a blistering post-war social and cultural commentary<figure><img src="https://images.theconversation.com/files/551612/original/file-20231003-22-sjuwc0.jpg?ixlib=rb-1.1.0&rect=12%2C6%2C4236%2C2816&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Sarah Walker/MTC</span></span></figcaption></figure><p>Emerging from one of Australia’s most enduring and significant theatrical partnerships between director Susie Dee and playwright Patricia Cornelius, My Sister Jill is a contemporary homage to George Johnston’s classic 1964 Australian novel My Brother Jack. </p>
<p>Both these works are set in post-war suburban Australia in the 1960s. But instead of the longing for the classic values of an older Australia that valorise war heroism and stoic masculinity, My Sister Jill centres the perspectives of those impacted by this narrative. </p>
<p>Parents Jack (Ian Bliss), a war veteran and prisoner of war from Changi on the Thai-Burma railway, and Martha (Maude Davey) have five children. Jill (Lucy Goleby), the eldest daughter, is intelligent and fierce. Johnnie (James O'Connell) frequently experiences his father’s violent ire as he is deemed “soft”. Door (Benjamin Nichol) and Mouse (Zachary Pidd) are twin brothers with mental telepathy and a joyful desire to be physically close at all times. </p>
<p>Christine (Angourie Rice), the youngest, plays the narrator. She seeks to connect with and understand her father through his stories of the horrors of war, sometimes biting off more than she can chew when the tales become deeply bleak and disturbing. </p>
<p>In a blistering post-war social and cultural commentary, My Sister Jill disrupts ideas of colonial glory with a troubling depiction of family violence, PTSD, homophobia and the ruinous intergenerational impacts of patriarchal oppression on everyone.</p>
<h2>The volatility of trauma</h2>
<p>The show is set in and around the family’s weatherboard home, and the set design by Marg Horwell features a beautifully restored 1953 FX Holden on stage. </p>
<p>It is a pared back, familiar landscape of dry yellow light, lino tiles, fading wallpaper and porch chairs, and the site of a cultural identity permeated by patriarchal violence from the perspective of White Australian culture. </p>
<p>As the story progresses, the children grow up under the volatility of their father’s trauma. They are frustrated by their mother’s fear and inaction. We witness Jack’s anger and violence toward his wife and children, his alcoholism and failure to hold down a job, his nightmarish memories and the anti-therapeutic 1960s attitude towards mental health. In one scene we watch Martha diligently “change the subject” to bring Jack back from the emotional edge as his memories of war threaten to overwhelm him. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A weatherboard house." src="https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551613/original/file-20231003-26-eqmv5e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The set is a pared back, familiar landscape.</span>
<span class="attribution"><span class="source">Sarah Walker/MTC</span></span>
</figcaption>
</figure>
<p>Jack’s story about surviving a torpedoing of a Japanese freighter by clinging to a raft while covered in thick black oil is taken from aspects of Cornelius’ own father’s life. The harrowing details of this particular scene as Jack recalls this moment of survival to Christine are profound and unsettling. </p>
<p>On stage, Christine is deeply impacted by this story, its retelling taking her into an imagined reality too frightening to contemplate. War is hell, the play reminds us, an indiscriminate false moral vacuum full of deep harm. Any notion of national pride that persists constitutes a dangerous narrative that whitewashes the violence of colonisation in our own backyards and homes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-shell-shock-to-ptsd-proof-of-wars-traumatic-history-37858">From shell shock to PTSD: proof of war's traumatic history</a>
</strong>
</em>
</p>
<hr>
<h2>Idealism and false promise</h2>
<p>Throughout the play, Jill emerges as a resistor to her father, incapable of holding back her fury at his behaviour. </p>
<p>Jill carefully looks after Johnnie when he returns to bed with urine-soaked pyjamas after being beaten. We see her refusing to wait inside the freezing cold FX Holden with the others when Jack leaves his family for hours outside the pub. Ultimately Jill is unable to “cut her father some slack”, as her mother suggests. She continually confronts her father, is forced to leave school and find work and ultimately moves out of home and becomes an organiser of anti-war demonstrations. </p>
<p>Christine travels from undying support of the wonderful father hero and a desire to head to war herself, to becoming the only child left in the family home. At this point, as she describes her father yelling at her mother all day long, she begins to echo her sister Jill’s intolerance of her dad and we see the full circle impact of intergenerational trauma. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The family look out as if watching television." src="https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551614/original/file-20231003-21-zqq5eo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We see the full circle impact of intergenerational trauma.</span>
<span class="attribution"><span class="source">Sarah Walker/MTC</span></span>
</figcaption>
</figure>
<p>Christine reunites with Jill as a young adult, about to head to university, the first of the family to attend. Jill is proud of her, and promises she, too, will attend university one day. We are reminded of what has been lost for Jill. Christine speaks to the audience one of the last lines in the play “She will, won’t she, My Sister Jill? She will. Will she?” </p>
<p>Wrapped up in this moment is the idealism and false promise of the late 1960s Australia. </p>
<p>My Sister Jill raises the spectre of the question about what has changed in Australian culture since that time and what harmful narratives we continue to deny – or are we now able to collectively address? </p>
<p>One can only hope the answer to Christine’s question “will she?” is, like the answer to other questions aimed at addressing the ongoing impact of colonial violence on our national culture, a huge resounding yes.</p>
<p><em>My Sister Jill is at the Melbourne Theatre Company until October 28.</em></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-half-of-australians-will-experience-trauma-most-before-they-turn-17-we-need-to-talk-about-it-159801">More than half of Australians will experience trauma, most before they turn 17. We need to talk about it</a>
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</p>
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<img src="https://counter.theconversation.com/content/214367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Austin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>My Sister Jill disrupts ideas of colonial glory with a troubling depiction of family violence, PTSD, homophobia and the ruinous intergenerational impacts of patriarchal oppression on everyone.Sarah Austin, Lecturer in Theatre, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2136432023-10-01T19:16:32Z2023-10-01T19:16:32ZOur mood usually lifts in spring. But after early heatwaves and bushfires, this year may be different<p>When we think of spring, we might imagine rebirth and renewal that comes with the warmer weather and longer days. It’s usually a time to celebrate, flock to <a href="https://floriadeaustralia.com">spring flower festivals</a> and spend more time in nature.</p>
<p>Spending time in nature or doing things outside, such as <a href="https://journals.sagepub.com/doi/abs/10.1177/1757913915589845">exercising</a> or <a href="https://www.sciencedirect.com/science/article/pii/S2352827321002093">gardening</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272494419301185">lifts our mood</a>.</p>
<p>But this year, with an <a href="https://twitter.com/Reuters/status/1704325785627050136">early start</a> to the bushfire season, and the <a href="https://theconversation.com/worried-about-heat-and-fire-this-summer-heres-how-to-prepare-212443">promise of</a> long, hot months ahead, we may see our views about the warmer months start to shift.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1704325785627050136"}"></div></p>
<p>For some people, the coming months are not a celebration. They are something to fear, or feel sad about.</p>
<p>In particular, communities and emergency responders who have experienced bushfires or drought in the past may see rising levels of <a href="https://search.informit.org/doi/pdf/10.3316/ielapa.588776016823324">stress and anxiety</a> as they face the months ahead.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/here-comes-the-sun-how-the-weather-affects-our-mood-19183">Here comes the sun: how the weather affects our mood</a>
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<h2>How’s this spring different?</h2>
<p>In recent weeks, the Australian Bureau of Meteorology has <a href="http://www.bom.gov.au/climate/enso/">declared</a> two climate events are now under way: <a href="https://theconversation.com/explainer-el-nino-and-la-nina-27719">El Niño</a> and a positive <a href="http://www.bom.gov.au/climate/iod/">Indian Ocean Dipole</a>. </p>
<p>These events predict warmer, drier conditions through to summer, as well as more intense heatwaves, bushfires and droughts.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1703999811136205005"}"></div></p>
<p>In temperate and subtropical regions, our summers are on average <a href="https://australiainstitute.org.au/wp-content/uploads/2020/12/P834-Out-of-Season-WEB.pdf">becoming</a> hotter and longer, and winters are becoming warmer and shorter. Climate change is the <a href="https://www.csiro.au/en/research/environmental-impacts/climate-change/climate-change-information">primary driver</a> of these shifts.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-el-nino-and-la-nina-27719">Explainer: El Niño and La Niña</a>
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</em>
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<h2>What happens to our mood as the temperature rises?</h2>
<p>Hotter temperatures and prolonged heat is linked to <a href="https://link.springer.com/article/10.1007/s40641-019-00121-2">aggression</a> and <a href="https://link.springer.com/article/10.1007/s00420-010-0534-2">higher rates</a> of emergency hospital admissions due to health conditions, heat-related injuries, and mental health concerns. </p>
<p>After an extreme weather event or disaster, rates of anxiety, depression and post-traumatic stress <a href="https://pubmed.ncbi.nlm.nih.gov/33227944/">rise</a>. </p>
<p>Many Australians have already experienced the psychological and physical <a href="https://journals.sagepub.com/doi/abs/10.1177/00048674221107872">impacts</a> of bushfires, droughts, floods and heatwaves. </p>
<p>For some communities and individuals, experiencing these types of events may mean they are <a href="https://www.sciencedirect.com/science/article/pii/S0887618520301110">more</a> resilient or prepared for the future. For others, the anticipation of rising heat or other climatic threats may cause <a href="https://www.mdpi.com/1660-4601/10/1/1">concern</a>. They may also prompt <a href="https://journals.sagepub.com/doi/full/10.1177/00048674221107872">pre-traumatic stress</a> – the stress that comes ahead of expected loss or trauma.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1466521425888620550"}"></div></p>
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<em>
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Read more:
<a href="https://theconversation.com/worried-about-heat-and-fire-this-summer-heres-how-to-prepare-212443">Worried about heat and fire this summer? Here's how to prepare</a>
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<h2>Anxiety, anger and sadness</h2>
<p>As climate-related events become more widespread, people may also become increasingly affected by feelings such as anxiety, anger and sadness.</p>
<p><a href="https://www.nature.com/articles/s41558-021-01251-y">Climate anxiety</a> refers to the fear, dread and worry about climate change. Anxiety can be a helpful response as it allows us to prepare and respond to future threats. For instance, climate anxiety <a href="https://www.sciencedirect.com/science/article/pii/S0272494422001323">may help prompt</a> pro-environmental behaviour and climate action, such as attending a protest. But this type of anxiety can also become <a href="https://www.sciencedirect.com/science/article/pii/S0887618520300773">overwhelming</a>.</p>
<p>The loss of wildlife and nature due to bushfires can leave people feeling <a href="https://www.mdpi.com/1660-4601/19/4/2461">grief</a> over what’s lost, and <a href="https://www.sciencedirect.com/science/article/pii/S2667278221000018">anger</a> about the lack of action to prevent these losses.</p>
<p>Losses could also be more personal, including damage to health, livelihoods, homes, or even the ability to do enjoyable outdoor activities, such as playing sports or exercising outside.</p>
<p>Another experience, solastalgia, is the “homesickness you have when you are still at home”. <a href="https://pubmed.ncbi.nlm.nih.gov/18027145/#:%7E:text=As%20opposed%20to%20nostalgia%2D%2D,connected%20to%20their%20home%20environment.">Researchers suggest</a> solastalgia is a type of distress when someone perceives negative changes and gradual deterioration to their own home environment. These feelings could arise when we notice seasonal and environmental changes to the places we love and call home.</p>
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<strong>
Read more:
<a href="https://theconversation.com/youre-not-the-only-one-feeling-helpless-eco-anxiety-can-reach-far-beyond-bushfire-communities-129453">You're not the only one feeling helpless. Eco-anxiety can reach far beyond bushfire communities</a>
</strong>
</em>
</p>
<hr>
<h2>But there are things you can do</h2>
<p>Heading into the hotter months, strong <a href="https://www.sciencedirect.com/science/article/pii/S0887618520301110">community</a> support, cohesion and preparedness may be especially important. There are also things you can do to maintain and manage your mental health and wellbeing. Though more research is needed to understand which strategies work best, health professionals <a href="https://headspace.org.au/assets/Factsheets/headspace_how-to-cope-with-the-stress-of-natural-disasters_Fact-Sheet_FA01_DIGI-1.pdf">suggest</a>:</p>
<ul>
<li><p>connecting with others, especially people you trust and who support your wellbeing </p></li>
<li><p>finding ways to connect with your community either in person (for example, through <a href="https://theconversation.com/how-community-gardening-could-ease-your-climate-concerns-211316">community gardening</a>) or online (for example, via discussion groups)</p></li>
<li><p>being mindful of your physical and psychological safety (for instance, especially during climate-related events) and, if you need it, seeking professional support</p></li>
<li><p>taking a break from distressing media content when needed. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/keeping-your-cool-in-a-warming-world-8-steps-to-help-manage-eco-anxiety-212174">Keeping your cool in a warming world: 8 steps to help manage eco-anxiety</a>
</strong>
</em>
</p>
<hr>
<p>Understandably, people may continue to be anxious about the seasons to come with the ongoing threat of climate change.</p>
<p>To avoid becoming overwhelmed, you can also respond to and channel your distressing feelings. You can <a href="https://link.springer.com/article/10.1007/s12144-022-02735-6">take part in</a> community-led climate action projects, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272494419301185">spend time outdoors</a> and in nature (even for <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2018.1557242">short bursts of time</a>). </p>
<p>These actions might help uphold the positive links between wellbeing and nature, no matter the season.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/213643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tara Crandon receives funding from the Child and Youth Mental Health group at QIMR Berghofer Medical Research Institute.</span></em></p>We’ve had an early start to the bushfire season and there’s more to come. No wonder spring isn’t always a celebration.Tara Crandon, Psychologist and PhD Candidate, QIMR Berghofer Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092942023-07-19T20:41:05Z2023-07-19T20:41:05ZHealing through witnessing: Documenting the stories of Yazidi refugees in Canada<figure><img src="https://images.theconversation.com/files/537175/original/file-20230712-22-gost18.jpg?ixlib=rb-1.1.0&rect=20%2C0%2C5532%2C4023&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Yazidi refugee woman's upper body is tattooed with the names of her missing family members and fiancé.</span> <span class="attribution"><span class="source">(Leah Hennel)</span>, <span class="license">Author provided</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/healing-through-witnessing-documenting-the-stories-of-yazidi-refugees-in-canada" width="100%" height="400"></iframe>
<p>Weeks after Yazidi refugees were rescued from horrific captivity and enslavement imposed by Daesh (also known as ISIS) and <a href="https://www.canada.ca/en/immigration-refugees-citizenship/news/2021/03/canada-expands-efforts-to-welcome-more-yazidi-refugees-and-other-survivors-of-daesh.html">arrived in Canada</a>, we began to document the harm. </p>
<p>At the <a href="https://mosaicpcn.ca/programs/refugee-health/">Mosaic Refugee Health Clinic</a> in Calgary, we tallied the physical damage, mental trauma and how families were ripped apart. </p>
<p>Our new patients’ intent was clear: They wanted the world to know. They insisted that the atrocities of genocide should never be forgotten and the culprits face justice. Beyond holding the guilty accountable, they also wanted to restore fragments of the familial and communal societies from which they’d been uprooted.</p>
<p>After centuries of religious persecution, their community had been dealt a deadly blow in <a href="https://www.nytimes.com/2016/06/17/world/middleeast/isis-genocide-yazidi-un.html">August 2014</a>. A massacre — <a href="https://press.un.org/en/2021/sc14514.doc.htm">labelled a genocide by the United Nations</a> — resulted in approximately 200,000 displaced Yazidis, <a href="https://doi.org/10.1186/s12916-017-0965-7">7,000 murdered</a>, 7,000 women and children abducted into <a href="https://doi.org/10.1371%2Fjournal.pmed.1002297">enslavement</a>, and the <a href="https://www.nobelprize.org/prizes/peace/2018/murad/lecture/#:%7E:text=Thank%20you%20very%20much%20for,solely%20because%20they%20were%20Yazidis">destruction of farms, villages, homes and places of worship</a>.</p>
<p>These are the narratives shared by Yazidi refugees who were resettled through Canada’s <a href="https://www.canada.ca/en/immigration-refugees-citizenship/news/2017/02/helping_vulnerableyazidiwomenandchildrenandothersurvivorsofdaesh.html">Survivors of Daesh Program</a> in Calgary and three other major Canadian cities between 2017 and 2019. Although our clinic is one of the largest and longest-running specialized refugee health clinics in Canada, the rapid resettlement of 242 Yazidi refugees <a href="https://doi.org/10.7326/M20-0151">nearly broke us</a>. </p>
<p>Their stories were profoundly vivid, their trauma piercing. They gave horrific accounts of Daesh’s invasion and the ensuing genocide, recounting their enslavement, slaughter and forced indoctrination.</p>
<figure class="align-center ">
<img alt="Three women on a sofa in a room with a Canadian flag on the wall" src="https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537174/original/file-20230712-23-q1est.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Three sisters, all of whom had been abducted and enslaved by ISIS, were reunited in Calgary.</span>
<span class="attribution"><span class="source">(Leah Hennel)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We tried to listen empathetically, without judgement — unaware that doing so all but guaranteed a crippling <a href="https://doi.org/10.7326/M20-0151">vicarious trauma</a> that led to intense symptoms of post-traumatic stress disorder among our physicians, nurses and other health-care staff.</p>
<p>Over time, with immense effort, patients and providers began to heal together. Our Yazidi patients have launched their <a href="https://www.theglobeandmail.com/canada/alberta/article-torn-apart-by-islamic-state-and-reunited-in-calgary-three-yazidi/">new lives</a>, and are chasing ambitious dreams.</p>
<p>As part of this healing, they tasked us with ensuring the world would not forget their plight. As co-directors of <a href="https://www.refugeehealthyyc.ca/">Refugee Health YYC</a> — a research, education, and innovation platform at the University of Calgary — we obeyed. With our research team and <a href="https://www.ucalgary.ca/news/academic-journey-connects-head-and-heart-bachelor-health-sciences-alumna">Nour Hassan</a>, an undergraduate student in the Health and Society program, we began the process of meticulously investigating and documenting the harm through research.</p>
<h2>Documenting genocide</h2>
<p>We reviewed the medical records of every Yazidi patient at the <a href="https://mosaicpcn.ca/programs/refugee-health/">Mosaic Refugee Health Clinic</a>. We recorded the direct exposure to Daesh and nearly universal family separations. We assembled a panel of expert clinicians to review almost 1,400 individual diagnoses and determine which were most likely caused by exposure to Daesh. We found, in addition to the psychological trauma, the physical consequences of violence, <a href="https://doi.org/10.1001/jamapediatrics.2022.4782">starvation</a> and rape.</p>
<p>To ensure our findings were accurate and meaningful, we collaborated with the Yazidi community and their leaders, one of whom is still languishing in an internally displaced camp in northern Iraq. The group provided insights, offered recommendations and made edits. We listened and obeyed.</p>
<blockquote>
<p>“When genocide is committed, it must be seen.” – Yazidi refugee, Nobel Peace Prize laureate and human rights activist <a href="https://www.nadiasinitiative.org/">Nadia Murad</a></p>
</blockquote>
<p>The resulting research is a community- and clinician-engaged cross-sectional study, which was <a href="https://doi.org/10.1001/jamanetworkopen.2023.23064">recently published</a> in the <em>JAMA Network Open</em>. Though our methodology was simple and the output inefficient from a research perspective — it took us nearly four years to summarize the ordeals of 242 Yazidi genocide survivors — this stands among the research we are most proud of.</p>
<p>We offer it as a testament to the world, documenting the depths of human depravity and its darkest impulses. The horrors of genocide defy comprehension, but in our ongoing struggle for human rights amid increasing global displacement, we must confront them. So far, we are failing. </p>
<p>Yazidi refugees are calling on the world to open its eyes to genocide, while indiscriminate killings and violence against women and children are, yet again, being used as weapons of war in <a href="https://www.amnesty.org/en/latest/news/2023/06/afghanistan-talibans-cruel-attacks-in-panjshir-province-amount-to-war-crime-of-collective-punishment-new-report/">Afghanistan</a>, <a href="https://www.cbc.ca/news/world/ukraine-un-investigation-report-1.6780600">Ukraine</a> and <a href="https://www.who.int/news/item/05-07-2023-sudan-top-un-officials-sound-alarm-at-spike-in-violence-against-women-and-girls">Sudan</a>.</p>
<p>In Calgary, a city leading the country in per capita refugee resettlement among major urban centres, we’ve resettled approximately <a href="https://open.canada.ca/data/en/dataset/4a1b260a-7ac4-4985-80a0-603bfe4aec11/resource/1938d8f2-177c-4f1b-8f6f-1fd7ea1acc78?inner_span=True">24,000 refugees since 2015</a>, surpassing the total for all of British Columbia, and nearly the number received by Manitoba, Nova Scotia, New Brunswick, P.E.I. and Newfoundland <a href="https://open.canada.ca/data/en/dataset/4a1b260a-7ac4-4985-80a0-603bfe4aec11/resource/1938d8f2-177c-4f1b-8f6f-1fd7ea1acc78?inner_span=True">combined</a>. </p>
<p>We’re proud of this work, carried out largely behind the scenes by passionate coalitions across the settlement, health care, public health and education <a href="https://www.ccisab.ca/">sectors</a>. Our efforts are boosted by a welcoming and generous population that opens its doors to those in need, regardless of local challenges.</p>
<h2>Refugee health policy summit</h2>
<p>In the final act of healing, Refugee Health YYC will host Yazidi refugee, Nobel Peace Prize laureate and human rights activist <a href="https://www.nobelprize.org/prizes/peace/2018/murad/facts/">Nadia Murad</a> in Calgary, a <a href="https://www.refugeehealthyyc.ca/pre-conference">refugee health policy summit</a>, and for the first time, the <a href="https://refugeesociety.org/narhc-conference/">North American Refugee Health Conference</a> July 21-23. </p>
<figure class="align-center ">
<img alt="A woman in a light blue jacket, wearing headphones, in front of a microphone" src="https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537987/original/file-20230718-19-qf2dvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Refugee Health YYC will host Yazidi refugee, Nobel Peace Prize laureate and human rights activist Nadia Murad in Calgary during the North American Refugee Health Conference July 21-23.</span>
<span class="attribution"><span class="source">(The Associated Press/Kay Nietfeld)</span></span>
</figcaption>
</figure>
<p>These events will bring together health-care providers, researchers, policymakers and refugee leaders to learn from one another and develop new models to improve health care and well-being for the <a href="https://www.unhcr.org/global-trends">108.3 million people forcibly displaced</a> around the world. Among these, only two per cent are resettled each year. The rest remain trapped in unstable and unsafe situations, often in countries that are not their homes.</p>
<p>These small offerings symbolize our commitment to work alongside refugees, as <a href="https://www.unhcr.ca/wp-content/uploads/2020/12/Seven-Decades-of-Refugee-Protection-In-Canada-14-December-2020.pdf">Canada</a> again led the world in the number of <a href="https://www.unhcr.org/global-trends">refugees resettled in 2022</a>. They underscore our dedication to ensuring the world never forgets the horrors of genocide and its devastating multi-generational impact on the communities targeted. </p>
<p>Our Yazidi patients arrived in Canada, courageously telling their stories. We need to listen. Otherwise, the crimes committed against them, and other refugees, will be repeated.</p><img src="https://counter.theconversation.com/content/209294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel E. Fabreau MD, MPH, FRCPC receives research grants from the Canadian Institutes of Health Research (CIHR), Alberta Innovates, MSI Foundation, and the University of Calgary.
The work presented and the study it describes were unfunded.</span></em></p><p class="fine-print"><em><span>Annalee Coakley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A Calgary refugee health clinic documented the stories of 242 Yazidi genocide survivors, recounting enslavement, slaughter and forced indoctrination.Gabriel Fabreau, Assistant Professor - General Internal Medicine; Depts. of Medicine and Community Health Sciences | Cumming School of Medicine, University of CalgaryAnnalee Coakley, Clinical Assistant Professor, Department of Family Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050242023-07-06T00:29:44Z2023-07-06T00:29:44ZWhat is ‘fawning’? How is it related to trauma and the ‘fight or flight’ response?<figure><img src="https://images.theconversation.com/files/532081/original/file-20230614-13019-qg1vh4.jpg?ixlib=rb-1.1.0&rect=26%2C53%2C5964%2C3880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/WeFXenDHgVk">Radu Florin/Unsplash</a></span></figcaption></figure><p>You have probably heard of “fight or flight” responses to distressing situations. You may also be familiar with the tendency to “freeze”. But there is another defence or survival strategy a person can have: “fawn”. </p>
<p>When our brain perceives a threat in our environment, our <a href="https://www.healthline.com/health/mental-health/fight-flight-freeze#in-the-body">sympathetic nervous system</a> takes over and a person can experience any one or combination of the <a href="https://pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm">four F</a> responses.</p>
<h2>What are the four Fs?</h2>
<p>The <strong>fawn</strong> response usually occurs when a person is being attacked in some way, and they try to appease or placate their attacker to protect themselves.</p>
<p>A <strong>fight</strong> response is when someone reacts to a threat with aggression.</p>
<p><strong>Flight</strong> is when a person responds by fleeing – either literally by leaving the situation, or symbolically, by distracting or avoiding a distressing situation. </p>
<p>A <strong>freeze</strong> response occurs when a person realises (consciously or not) that they cannot resist the threat, and they detach themselves or become immobile. They may “space out” and not pay attention, feel disconnected to their body, or have difficulty speaking after they feel threatened. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-half-of-australians-will-experience-trauma-most-before-they-turn-17-we-need-to-talk-about-it-159801">More than half of Australians will experience trauma, most before they turn 17. We need to talk about it</a>
</strong>
</em>
</p>
<hr>
<h2>What does fawning look like?</h2>
<p>Previously known as appeasement or “people pleasing”, the term “fawning” was coined by psychotherapist <a href="http://pete-walker.com/complex_ptsd_book.html">Pete Walker</a> in his 2013 book <a href="https://www.goodreads.com/book/show/20556323-complex-ptsd">Complex PTSD: From Surviving to Thriving</a>. </p>
<p>A fawn response can look like:</p>
<ul>
<li>people-pleasing (doing things for others to gain their approval or to make others like you)</li>
<li>being overly reliant on others (difficulty making decisions without other people’s input)</li>
<li>prioritising the needs of others and ignoring your own</li>
<li>being overly agreeable</li>
<li>having trouble saying no</li>
<li>in more severe cases, <a href="https://www.sciencedirect.com/science/article/pii/S0149763421004917?casa_token=FzabbqNoE0UAAAAA:DAr_QkVegIa70Zheq6vTkCrsYPJdw06kdds659h-VHSRtPSUErDzVgj-YsLunjvGkn4Mwyb1">dissociating</a> (disconnecting from your mind and/or body).</li>
</ul>
<p>While there isn’t yet much research on this response, the fawn response is seen more in people who have experienced <a href="https://www.tandfonline.com/doi/abs/10.1080/00958964.2022.2163220?journalCode=vjee20">complex trauma</a> in their childhood, including among children who grew up with emotionally or physically abusive caregivers. </p>
<p>Fawning is also observed in people who are in situations of <a href="https://europepmc.org/article/MED/37052112">interpersonal violence</a> (such as domestic violence, assault or kidnappings), when the person needs to appease or calm a perpetrator to survive. </p>
<p>Fawning is also different to the other F responses, in that it seems to be a uniquely human response. </p>
<figure class="align-center ">
<img alt="Woman with tattoos crosses her arms" src="https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532087/original/file-20230615-5932-evcfml.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fawning is seen more in people who have had emotionally abusive caregivers.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/TOfxVzsuaKc">Annie Spratt/Unsplash</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emotional-abuse-is-a-pattern-of-hurtful-messages-building-parenting-skills-could-help-prevent-it-203556">Emotional abuse is a pattern of hurtful messages – building parenting skills could help prevent it</a>
</strong>
</em>
</p>
<hr>
<h2>Why do people fawn?</h2>
<p><a href="https://www.proquest.com/docview/2447256147/abstract/13E401AC2C1C40C6PQ/1">Research</a> suggests people fawn for two reasons:</p>
<ol>
<li> to protect themselves or others from physical or emotional harm (such as childhood trauma)</li>
<li> to create or improve the emotional connection to the perpetrator of harm (for example, a caregiver).</li>
</ol>
<p>This type of response is adaptive at the time of the traumatic event(s): by appeasing an attacker or perpetrator, it helps the person avoid harm.</p>
<p>However, if a person continues to use this type of response in the long term, as an automatic response to everyday stressors (such difficult interactions with your boss or neighbour), it can have negative consequences. </p>
<p>If a person is continually trying to appease others, they may experience issues with boundaries, forming a cohesive identity, and may not feel safe in relationships with others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/trauma-is-trending-but-we-need-to-look-beyond-buzzwords-and-face-its-ugly-side-201564">Trauma is trending – but we need to look beyond buzzwords and face its ugly side</a>
</strong>
</em>
</p>
<hr>
<h2>What can I do if I ‘fawn’?</h2>
<p>Because fawning is typically a response to interpersonal or complex trauma, using it in response to everyday stressors may indicate a need for healing. </p>
<p>If this is you, and you have a history of complex trauma, seek psychological support from a professional who is trained in trauma-informed practice. Trauma-informed means the psychological care is holistic, empowering, strengths-focused, collaborative and reflective. </p>
<p>Evidence-based therapies that are helpful following trauma include:</p>
<ul>
<li><p><a href="https://www.emdr.com/what-is-emdr/">eye movement desensitisation therapy</a>, which focuses on <a href="https://theconversation.com/what-is-emdr-therapy-and-how-does-it-help-people-who-have-experienced-trauma-161743">processing traumatic memories</a></p></li>
<li><p><a href="https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy#:%7E:text=In%20this%20form%20of%20therapy,reduce%20fear%20and%20decrease%20avoidance.">exposure therapy</a> to help expose people to things they fear and avoid</p></li>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396183/">trauma-focused cognitive behavioural therapy</a> that aims to alleviate trauma symptoms by overcoming unhelpful thoughts and behaviours.</p></li>
</ul>
<p>Depending on where you live, <a href="https://www.childabuseroyalcommissionresponse.gov.au/support-services">free counselling services</a> may be available for people who have experienced childhood abuse. </p>
<p>Setting healthy boundaries is also a common focus when working with the fawn response, which you can do by yourself or alongside a therapist. </p>
<p><em>If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p>
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Read more:
<a href="https://theconversation.com/what-is-emdr-therapy-and-how-does-it-help-people-who-have-experienced-trauma-161743">What is EMDR therapy, and how does it help people who have experienced trauma?</a>
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<img src="https://counter.theconversation.com/content/205024/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alix Woolard receives funding from Embrace at Telethon Kids Institute. </span></em></p>You have probably heard of ‘fight or flight’ responses to distressing situations. You may also be familiar with the tendency to ‘freeze’. But there is another response a person can have: ‘fawn’.Alix Woolard, Senior Researcher, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088572023-07-05T04:08:40Z2023-07-05T04:08:40ZDo psychedelics really work to treat depression and PTSD? Here’s what the evidence says<figure><img src="https://images.theconversation.com/files/535446/original/file-20230704-19-n5mgl2.jpg?ixlib=rb-1.1.0&rect=33%2C22%2C7315%2C4880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/relaxed-young-caucasian-patient-lying-on-1925319578">Shutterstock</a></span></figcaption></figure><p>As of July 1, authorised psychiatrists have been allowed to prescribe MDMA (the chemical found in “ecstasy”) to treat post-traumatic stress disorder (PTSD), and psilocybin (found in “magic mushrooms”) to treat depression that hasn’t responded to other treatment. </p>
<p>Psychedelic therapies have researchers excited because evidence suggests they might have lasting beneficial effects on factors that cause psychological distress beyond the treatment period. These include <a href="https://link.springer.com/article/10.1007/s00213-017-4701-y">feeling disconnected from other people</a>, <a href="https://link.springer.com/article/10.1007/s00213-019-05391-0">fear of death</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S2212144719301140?casa_token=OP6tKGxjPHAAAAAA:NTQ4khgsOY5wmsQ5HzCMcZ4eZ43wQV-sdhUbf5LXFiIeKWNwdonhfCxo77k7QbNk4G69EfX-">rigid ways of thinking</a>. </p>
<p>This stands in contrast to most medications for psychological issues, which only directly help while people keep taking them regularly. </p>
<p>But how strong is the evidence for psychedelic therapy? </p>
<h2>Early promise</h2>
<p>Early results from studies around the world have found psychedelic therapy <a href="https://www.ranzcp.org/getmedia/0cf57ea2-0bd7-4883-9155-d2ba1958df86/cm-therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression.pdf">might be effective</a> for treating a range of psychological issues. </p>
<p>For instance, most studies (<a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">but not all</a>) have found patients tend to report <a href="https://pubmed.ncbi.nlm.nih.gov/37357767/">fewer depression symptoms</a> for periods ranging from several weeks to several months after psilocybin therapy. </p>
<p>Similarly, studies have found <a href="https://journals.sagepub.com/doi/10.1177/0269881120965915">reductions in PTSD symptoms</a> three weeks after MDMA therapy. </p>
<h2>Not so fast</h2>
<p>However, as psychedelic research has grown, <a href="https://pubmed.ncbi.nlm.nih.gov/35243919/">limitations</a> of the research have been identified by researchers both <a href="https://psyarxiv.com/ak6gx/">within</a> and <a href="https://www.sciencefictions.org/p/psychedelics">outside</a> the psychedelic field. </p>
<p>One issue is that we aren’t sure whether findings might be due to a <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo effect</a>, which occurs when a treatment works because people expect it to work. </p>
<p>In clinical trials, participants are often given either a medication or a placebo (inactive) drug – and it’s important they don’t know which they have been given. However, due to the strong effects, it is difficult to prevent participants from knowing whether they have been given a psychedelic drug. </p>
<p>Researchers have tried to use a range of different drugs (such as Ritalin) as a placebo in order to “trick” those participants not given a psychedelic into thinking they have received one. But this can be difficult to achieve.</p>
<p>In 2021, researchers <a href="https://www.tandfonline.com/doi/full/10.1080/17512433.2021.1933434?casa_token=Dovn7x_rkdUAAAAA%3AsPzBTYNTPnNwqj9NvwN0m9ptrP4x4-c83gp3tGcshs30dWHNnmB_Vx-X5H5Y3pZJdG02IWW6X2E">reviewed</a> clinical trials involving psychedelics such as LSD, psilocybin, and dimethyltryptamine (found in animals and plants) for mood and anxiety disorders. They found trials either had not assessed whether participants guessed correctly which drug they had been given, or that this had been tested and participants tended to guess correctly. </p>
<p>More recent trials <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">either don’t measure this</a> or find participants have a <a href="https://journals.sagepub.com/doi/full/10.1177/02698811231154852?casa_token=VsPt344fVGwAAAAA%3AA-i1VPBE1EWyFITWNncZEt876lWMiC7rtTOLJBQnb2pHI2775imUJhrzeSZW6r9doaBeDaj61D0">pretty good idea</a> of whether they’ve had a placebo or a psychedelic drug.</p>
<p>Given the publicity and excitement around psychedelic research in recent years, it is likely most participants have <a href="https://culanth.org/fieldsights/the-pollan-effect-psychedelic-research-between-world-and-word">strong beliefs</a> such therapies work. This could lead to a significant placebo effect for participants given a psychedelic dose. Additionally, participants who realise they have received a placebo could experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184717/">disappointment and frustration</a>, resulting in worse symptoms. The benefits of a psychedelic may seem even greater when they are compared to the experiences of disappointed participants. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-tga-has-approved-certain-psychedelic-treatments-the-response-from-experts-is-mixed-199290">The TGA has approved certain psychedelic treatments: the response from experts is mixed</a>
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<h2>Translating trials to practice</h2>
<p>Anecdotally, patients might be motivated to report they have gotten better, even when they haven’t. </p>
<p>On a 2021 podcast, one clinical trial participant <a href="https://www.psymposia.com/powertrip/">described</a> how, in hindsight, the information they provided to the trial did not accurately capture the worsening of their symptoms. Trial participants are likely aware their results might affect whether treatments are legalised. They may not want to “ruin” the research by admitting the treatment didn’t work for them. </p>
<p>There is also uncertainty about whether the findings from clinical trials mean treatments will work in private practice. There may be a lack of clarity around <a href="https://psyarxiv.com/ak6gx/">how trial participants</a> are recruited and selected. Therefore participants may not represent the typical person with PTSD or treatment-resistant depression. </p>
<p>And while <a href="https://journals.sagepub.com/doi/full/10.1177/02698811211069100">the safety of psychedelics</a> within controlled contexts is often emphasised by advocates, less is known about safety of psychedelic therapy <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.737738/full">outside</a> clinical trials. </p>
<h2>Resolving issues</h2>
<p>These issues do not mean the promising psychedelic research conducted over the past several decades is worthless. Nevertheless, a <a href="https://pubmed.ncbi.nlm.nih.gov/35285280/#full-view-affiliation-1">recent review</a> of the effects of MDMA and psilocybin on mental, behavioural or developmental disorders by Australian researchers concluded the “overall certainty of evidence was low or very low”.</p>
<p>Dutch researchers recently drafted a <a href="https://psyarxiv.com/ak6gx/">roadmap for psychedelic science</a> with a checklist for future research to help avoid these pitfalls. When more research is done, it might turn out psychedelic treatments help patients and don’t come with unacceptable harms – we simply don’t know that yet.</p><img src="https://counter.theconversation.com/content/208857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Moreton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In addition to placebo effects, patients might be motivated to report they have gotten better, even when they haven’t.Sam Moreton, Associate Lecturer, School of Psychology, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2036342023-06-27T12:24:26Z2023-06-27T12:24:26ZA trauma-focused therapy is helping Ukrainian children besieged by war – a clinical psychologist explains how it could bring resilience to kids around the world<figure><img src="https://images.theconversation.com/files/530453/original/file-20230606-23-sk1fy7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8243%2C5499&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Lviv, Ukraine, a 15-year-old girl recovers from injuries sustained in the war. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ukrainian-schoolgirl-anastasia-pryhoda-recovers-from-news-photo/1407335132">Scott Peterson via Getty Images</a></span></figcaption></figure><p>Childhood trauma is a global health problem. Every year, up to 1 billion children worldwide experience <a href="https://doi.org/10.1192/bjp.bp.110.080499">some form of emotional, physical or sexual abuse</a>. More than two-thirds of children report at least <a href="https://doi.org/10.1001/archpsyc.64.5.577">one traumatic event by age 16</a>. </p>
<p>Without early intervention, these experiences may deeply infiltrate the minds of children, who may reenact their original trauma by entering <a href="https://minds.wisconsin.edu/bitstream/handle/1793/75416/MonahanDela.pdf?sequence=5">toxic relationships that repeat the dynamics of parental abuse</a>. Or they might <a href="https://doi.org/10.1007/s10567-011-0094-3">engage in high-risk behaviors</a>, including unsafe sexual relationships, delinquency or substance abuse. </p>
<p>Childhood trauma can lead to guilt, shame, anxiety, depression <a href="https://doi.org/10.2105/AJPH.2013.301257">and even suicide</a>. Its effects <a href="https://doi.org/10.1002/jts.21833">often last well beyond childhood</a> and affect physical and mental health into adulthood.</p>
<p><a href="https://profiles.umassmed.edu/display/24318052">I am a clinical psychologist</a> and director of training at the nonprofit <a href="https://www.umassmed.edu/cttc/#">Lifeline for Kids</a>, a center for childhood trauma at UMass Chan Medical School. I have been participating in a project that <a href="https://doi.org/10.1080/20008066.2023.2207422">treats Ukrainian children and families affected by the war</a> since March 2022. </p>
<p>The project is being <a href="https://www.uniklinik-ulm.de/kinder-und-jugendpsychiatriepsychotherapie/sektionen-und-arbeitsgruppen/sektion-psychotherapieforschung-und-verhaltensmedizin/tf-cbt-ukraine/tf-cbt-ukraine-engl.html">carried out by German researchers</a> in collaboration with several organizations. Through this program – called Trauma-Focused Cognitive Behavioral Therapy Ukraine – I provide online training and consultation calls to the Ukrainian therapists who are treating children who have been directly affected. </p>
<p>This experience has impressed upon me the great importance of the power of intervening directly during ongoing trauma and early enough in a person’s life to help heal the wounds of complex adversities.</p>
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<figcaption><span class="caption">Memories of traumatic events can bring back the fear, helplessness or anger of the moment.</span></figcaption>
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<h2>The Ukraine project</h2>
<p>During the first tragic months of the war, my job was to educate therapists about this form of treatment so that they could counsel the war-impacted children and their families.</p>
<p>Given that they were <a href="https://doi.org/10.1037/a0032533">still exposed to an ongoing threat in Ukraine</a>, it was critical to help the children differentiate between a real danger and what was only a reminder of their trauma. So the therapist would teach them relaxation skills to manage the stress from hearing sirens or being evacuated to a new location. </p>
<p>Our team of international trainers also addressed secondary trauma – in this case, the <a href="https://doi.org/10.1007/s10597-020-00602-x">traumatic stress that mental health care providers are experiencing</a>. </p>
<p>Initial results show that <a href="https://doi.org/10.1080/20008066.2023.2207422">more than 130 clinicians were trained</a> in trauma-focused cognitive behavioral therapy. In turn, they collected data from more than 140 children and caregivers. The therapists rated their overall satisfaction with the training as high. </p>
<h2>A different brain architecture</h2>
<p>Although events like wars, pandemics and school violence are some of the most obvious reasons for trauma, approximately three-quarters of reported cases of child abuse – such as sexual abuse – <a href="http://www.acf.hhs.gov/programs/cb/pubs/cm05/cm05.pdf">are committed by family members or other people</a> who are part of the victim’s “circle of trust.” </p>
<p>Children experiencing complex trauma – whether parental abuse or the crossfire of war – develop a biology that is very different from their nontraumatized peers. Studies show that trauma leaves marks not only on the brain but also on other parts of the body.</p>
<p>Chronic stress leads to ongoing activation of the stress response system, which activates neural connections <a href="https://doi.org/10.1016/j.acap.2015.05.010">involved in fear, anxiety and impulsive reactions</a>. </p>
<p>Even in the absence of a real threat, the fight-flight-freeze response – located in the amygdala, or the <a href="https://doi.org/10.3390%2Fbiom11060823">primitive, instinctual and survival-oriented part of the brain</a> – remains constantly activated. Something as simple as a change in someone’s facial expression <a href="https://harvardcenter.wpenginepowered.com/wp-content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_Brain-1.pdf">can activate the fear circuits</a>. </p>
<p>The chronic stress response leads to the <a href="https://doi.org/10.1542/peds.2021-052582">release of the hormones cortisol and adrenaline</a>, which then has downstream effects on other systems. This can lead to suppression of the immune system and small shifts in how a person’s underlying genetics respond to their environment. In addition, other brain regions that are less important for survival – such as problem-solving, learning and memorizing – are less developed in children who have experienced trauma. </p>
<p>But there can be another, more positive reaction to stress, which involves <a href="https://doi.org/10.1111/j.1467-8721.2006.00451.x">asking for help and support</a> from safe people. That’s why the presence of supportive adults, along with acquisition of new coping skills, can blunt the impact of trauma. Ultimately, it is the buffering, not the suffering, that determines how a child reacts to trauma.</p>
<p>Children are resilient. With appropriate treatment and support from caregivers and professionals, they can heal and thrive. </p>
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<figcaption><span class="caption">The war has left millions of Ukrainian children terrified and uncertain of their future.</span></figcaption>
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<h2>Storytelling as a means of healing</h2>
<p>Cognitive behavioral therapy is <a href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">effective for many mental health conditions</a>. It is a form of talk therapy based on the understanding that psychological problems come from unhelpful or inaccurate ways of thinking; these thoughts then affect our emotions and behaviors. </p>
<p>Trauma-focused cognitive behavioral therapy differs in several ways. First, it helps the child recognize how past trauma affects their view of themselves and their behavior. For example, a female adolescent who was sexually abused may be triggered by a male friend who comes physically close to her. </p>
<p>The therapy also uses a well-established technique called trauma narration. Here, the child <a href="https://www.simplepractice.com/blog/how-trauma-narratives-help-clients-heal/#:%7E">narrates the traumatic experiences</a> that happened to them. It can be spoken, written or expressed in a drawing, poem or song. </p>
<p>With the therapist’s help, the child identifies the distorted thoughts that negatively affect their views of themselves, others and the future: “It was my fault that I was sexually abused; I cannot trust anyone; I will be broken forever.” </p>
<p>The therapist then helps the child shift their perspective and incorporate the trauma in their life story in a way that is no longer overwhelming, harmful and shameful. </p>
<p>When this happens, trauma-related symptoms such as <a href="https://www.webmd.com/mental-health/what-is-hypervigilance#:%7E">hypervigilance</a>, repetitive thoughts and <a href="https://www.psychologytools.com/professional/mechanisms/avoidance/#:%7E">avoidance</a> significantly decrease. Instead of seeing themselves as broken, damaged and unlovable, these children recognize their resiliency and strength. </p>
<p>One example: An 8-year-old boy who saw his mother die from cancer was having severe nightmares. The thought of sickness or death terrified him. He was refusing to go outside his home, was emotionally withdrawn and didn’t want to see friends. </p>
<p>But after receiving trauma-focused cognitive behavioral therapy, he could express his emotions over his mother’s death. He was no longer afraid at night and his nightmares decreased. He formed new friendships. </p>
<p>The therapy typically requires from eight to 25 sessions, depending on the number of traumatic experiences and the complexity of the symptoms. </p>
<h2>Caregivers are critical</h2>
<p>The No. 1 factor for healing from trauma is the presence of a <a href="https://doi.org/10.3928/19382359-20190618-01">safe, nurturing and predictable caregiver</a> – a parent, grandparent, social worker, pastor or coach.</p>
<p>One of the most powerful moments in treatment is when the child – with the support of the therapist – <a href="https://www.simplepractice.com/blog/how-trauma-narratives-help-clients-heal/#:%7E">shares the narrative with the caregiver</a> or another significant adult in the child’s life. These sessions give an opportunity for the caregiver to praise the child and acknowledge the strength it took to create and share their narrative. </p>
<p>Clinical studies have shown that trauma-focused cognitive behavioral therapy <a href="https://doi.org/10.1159/000442824">works for children and young adults from ages 3 to 21</a> across all geographic, ethnic, gender, religious and socioeconomic settings. It works for a Ukrainian teenager victimized by war – or for an <a href="https://doi.org/10.1037/a0029095">abused child living in a U.S. suburb</a>.</p>
<p>Studies on this form of psychotherapy consistently show that patients have <a href="https://doi.org/10.1016/j.jaac.2013.01.013">less anxiety, depression and post-traumatic stress disorder</a> <a href="https://doi.org/10.1007/s40653-018-0212-1">than patients who have undergone other forms of treatment</a>. Children become more resilient and the benefits of therapy last longer. </p>
<p>Trauma-focused cognitive behavioral therapy helps children change their story from a broken one to a heroic one. </p>
<p>As a 16-year-old girl told me: “This therapy has completely changed my life for better. I now wake up everyday without having this weight of shame and depression hanging on me. I can finally live my life without feeling like I’m going to break down at any second.”</p><img src="https://counter.theconversation.com/content/203634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zlatina Kostova does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No matter their age, gender, ethnicity or locale, kids undergoing this therapy can make real progress in recovering from the most devastating traumas.Zlatina Kostova, Instructor in psychiatry, clinical psychologist and director of training at Lifeline for Kids, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077522023-06-22T11:55:17Z2023-06-22T11:55:17ZHow new UK immigration rules will separate more international students from their families<figure><img src="https://images.theconversation.com/files/532669/original/file-20230619-22-lvp5er.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-male-university-college-student-poor-2149313641">Daisy Daisy/Shutterstock</a></span></figcaption></figure><p>The UK government <a href="https://www.gov.uk/government/news/changes-to-student-visa-route-will-reduce-net-migration">has changed</a> its policy on international students, restricting them from bringing their families with them during their studies. This change to how student visas are allocated, the government argues, will help reduce net migration. </p>
<p>Scottish MP Carol Monaghan has been a vocal critic of the new immigration policy. She <a href="https://erudera.com/news/mp-opposes-uks-ban-on-international-students-families-warns-of-economic-consequences/">emphasises</a> the substantial economic contributions made by international students, pointing to the impressive £40 billion they added to the UK economy in 2022. </p>
<p>Also in 2022, Russell Group universities <a href="https://inews.co.uk/news/education/university-plans-limit-foreign-student-numbers-warns-sector-1995558">reportedly warned</a> that such restrictions could harm Britain’s economy, not to mention its reputation. In June 2023, Jo Johnson, former minister for universities and science, echoed this warning, saying:</p>
<blockquote>
<p>As a strong advocate for international students in our system, I am conscious that there is much to lose from further crackdowns. </p>
</blockquote>
<p>Public opinion is <a href="https://yougov.co.uk/topics/politics/articles-reports/2021/11/03/what-concerns-british-public-about-immigration-pol">largely in favour</a> of legal immigration. The UK public generally perceives legal migrants as having the potential to contribute positively to the UK. Our analysis <a href="https://journals.sagepub.com/doi/full/10.1177/1354067X221111456">shows</a>, however, that the government’s new rules have the potential to significantly – and adversely – impact these very people’s mental health, particularly through what one of the authors (Olumba Ezenwa) has termed <a href="https://theconversation.com/cognitive-immobility-when-youre-mentally-trapped-in-a-place-from-your-past-185913">“cognitive immobility”</a>.</p>
<figure class="align-center ">
<img alt="A sculpture of a globe in front of a brick building." src="https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532661/original/file-20230619-15-60sm64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">International students contribute to the UK economy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-december-2019-school-economics-old-1636234735">William Barton/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Cognitive immobility</h2>
<p><a href="https://doi.org/10.1177/1354067X221111456">Cognitive immobility</a> exists when your mind is stuck in the past, constantly replaying old memories or experiences about people, events, or cultures you encountered in places you lived or visited in the past, causing you to stress, which could be even worse. This <a href="https://www.insider.com/guides/health/mental-health/cognitive-immobility">can lead</a> to emotional exhaustion and other mental health issues including anxiety, depression, social isolation and, in severe cases, post-traumatic stress disorder. </p>
<p>Informal <a href="https://www.youtube.com/watch?v=7vytDwQmIds">stories or reports</a> indicate that many international students may already be facing difficulties, even before the new policy has been put into place. The chemist, Chisom Chuba, who relocated from Nigeria to Ireland in 2020, <a href="https://www.theguardian.com/global-development/2022/nov/29/migration-wave-tears-at-fabric-of-life-in-nigeria">has equated</a> ending video calls with her family to the sensation of a plaster being torn from her skin. In an interview, published in November 2022, with the journalist Olayide Oluwafunmilayo Soaga, she said: </p>
<blockquote>
<p>I don’t know if it is the sound of the call dropping or just watching the screen go blank with their image gone. But it is all I can get for now.</p>
</blockquote>
<p>This description of feeling like a plaster is being torn from your skin suggests the onset of cognitive immobility. Without proper support, you might see your mental health deteriorate. This can lead to the second stage, which can be severe and even pose a risk of self-harm. </p>
<h2>How the new rules might affect students</h2>
<p>The <a href="https://www.theguardian.com/politics/2023/may/23/suella-braverman-restrictions-overseas-international-students-family">new immigration rules</a> are set to apply uniformly to almost all international students. By separating families, these could exacerbate feelings of isolation, affect academic performance and trigger cognitive immobility. </p>
<p>Separation affects <a href="https://pubmed.ncbi.nlm.nih.gov/32438881/">children</a> as much as <a href="https://journals.sagepub.com/doi/10.1177/0011392118792927">adults</a>. Individually, it causes stress, anxiety, depression, mood changes and frustration due to negative family dynamics. It also represents the loss of your primary support system, which can make adjusting to a new environment particularly challenging. </p>
<figure class="align-center ">
<img alt="Students walk into a large university building." src="https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532666/original/file-20230619-23-tlbu11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Family support is crucial to international students being able to settle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bristol-mar-24-view-exterior-entrance-229818697">1000 Words/Shutterstock</a></span>
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<p>International postgraduate students in particular <a href="https://www.researchsquare.com/article/rs-287018/v1">are already found</a> to experience heightened levels of depression, anxiety, stress and even suicidal thoughts, compared to the general UK population. As psychologist Philip Dimka told <a href="https://www.theguardian.com/global-development/2022/nov/29/migration-wave-tears-at-fabric-of-life-in-nigeria">the Guardian</a>:</p>
<blockquote>
<p>There is a tendency for you to adjust more to a new environment when you are with your family, but when you are separated, you are likely to develop stress and anxiety. </p>
</blockquote>
<p>Cognitive immobility <a href="https://doi.org/10.1177/1354067X2211114">unfolds in three stages</a>: awareness/separation, retrieval and stabilisation. The <a href="https://www.transformingsociety.co.uk/2022/08/31/supporting-refugees-by-addressing-cognitive-immobility/">awareness/separation</a> stage is characterised by individuals feeling disoriented and confused as they grapple with persistent thoughts or longings for (familial) experiences or the places left behind. </p>
<p>In the <a href="https://www.transformingsociety.co.uk/2022/08/31/supporting-refugees-by-addressing-cognitive-immobility/">retrieval stage</a>, individuals strive to revisit or relive the places or experiences they feel lost. This process can be physically returning to those places or mentally recreating those memories, leading to discomfort, especially when these memories, such as the absence of loved ones, surface unconsciously and cause stress. </p>
<p>The <a href="https://www.insider.com/guides/health/mental-health/cognitive-immobility">final stage</a>, stabilisation, shifts focus from trying to reclaim the past to retaining values and setting goals to cope with the sense of loss; this helps alleviate the feeling of entrapment. This is often the desired stage for those experiencing cognitive immobility.</p>
<p>There are four essential things you need in order to mitigate the negative impacts of <a href="https://www.insider.com/guides/health/mental-health/cognitive-immobility">cognitive immobility</a>: a profession; a community or family; time for reflection; and good health. It is through developing <a href="https://theconversation.com/cognitive-immobility-when-youre-mentally-trapped-in-a-place-from-your-past-185913">coping strategies</a> that tie in with these four elements that enable you to settle somewhere new and <a href="https://www.tandfonline.com/doi/abs/10.1080/1369183X.2021.1965471?journalCode=cjms20">make a new home</a>. </p>
<p>In depriving international students of the primary support system provided by their families, therefore, the new immigration guidelines may exacerbate cognitive immobility. The impact will be worse for students from some developing countries, where talking about mental health is disregarded or <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/stigma-misconceptions/">stigmatised</a>. This situation will worsen if students do not understand the nature and seriousness of the mental health problems they face. This could put themselves and others at risk.</p>
<p>This is an urgent call to action. Without the new policies being revisited, and crucially, without more effective support services within universities, international students will struggle to transition smoothly, excel academically and thrive personally.</p><img src="https://counter.theconversation.com/content/207752/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cognitive immobility, brought on by being separated from family, can lead to emotional exhaustion, anxiety, depression and post-traumatic stress disorder.Chijioke D Uba, Senior Lecturer in International Business & Sustainability, University of NorthamptonOlumba E. Ezenwa, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081392023-06-21T02:01:49Z2023-06-21T02:01:49Z‘Psychological debriefing’ right after an accident or trauma can do more harm than good – here’s why<figure><img src="https://images.theconversation.com/files/532949/original/file-20230620-27-6ltoty.jpg?ixlib=rb-1.1.0&rect=43%2C60%2C5665%2C3733&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-glum-girl-during-psychotherapy-session-247411363">Shutterstock</a></span></figcaption></figure><p>The recent <a href="https://www.abc.net.au/news/2023-06-18/hunter-valley-wedding-bus-crash-survivors-remain-in-hospital/102487630">tragic bus accident</a> in the New South Wales Hunter Valley has again raised the issue of how we address the potential psychological effects of traumatic events. </p>
<p>It is interesting we revisit the same debate after each disaster, and few lessons have apparently been learned after decades of research. After the Hunter Valley accident, immediate psychological counselling was <a href="https://www.theguardian.com/australia-news/2023/jun/15/hunter-valley-bus-crash-company-issued-with-defect-notices-after-police-raid">offered to those affected</a>. </p>
<p>While we can’t say what form of counselling was offered, the traditional approach is known as “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118833/">psychological debriefing</a>”. This typically involves counsellors providing trauma survivors with a single counselling intervention within days of the event. </p>
<p>Although the content of the intervention can vary, it usually involves education about stress reactions, encouragement to disclose their memories of the experience, some basic stress-coping strategies and possibly referral information. </p>
<p>But the evidence shows this approach, however well-meaning, may not help – or worse, do harm.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/experiencing-trauma-can-change-some-peoples-outlook-on-life-sometimes-for-the-better-199088">Experiencing trauma can change some people's outlook on life – sometimes for the better</a>
</strong>
</em>
</p>
<hr>
<h2>The belief that feelings must be shared</h2>
<p>The encouragement of people to discuss their emotional reactions to a trauma is the result of a long-held notion in psychology (dating back to the classic writings of Sigmund Freud) that disclosure of one’s emotions is invariably beneficial for one’s mental health. </p>
<p>Emanating from this perspective, the impetus for psychological debriefing has traditionally been rooted in the notion trauma survivors are vulnerable to psychological disorders, such as post-traumatic stress disorder (PTSD), if they do not “talk through their trauma” by receiving this very <a href="https://journals.sagepub.com/doi/full/10.1177/1529100610387086">early intervention</a>.</p>
<p>The scenario of trauma counsellors appearing in the acute aftermath of traumatic events has been commonplace for decades in Australia and elsewhere. </p>
<p>Following the 9/11 terrorist attacks in New York City in 2001, up to 9,000 counsellors were mobilised and more than <a href="https://www.nytimes.com/2002/07/22/nyregion/finding-cure-for-hearts-broken-sept-11-is-as-difficult-as-explaining-the-cost.html">US$200 million</a> was projected to meet a surge in mental health needs. But fewer people than expected sought help under this program and $90 million remained <a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">unspent</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">9/11 anniversary: a watershed for psychological response to disasters</a>
</strong>
</em>
</p>
<hr>
<h2>What do we know about psychological reactions to disasters?</h2>
<p>The overwhelming evidence indicates the majority of people will <a href="http://www.psychologicalscience.org/publications/journals/pspi/weighing-the-costs-of-disaster.html">adapt</a> to traumatic events without any psychological intervention.</p>
<p>Long-term studies indicate approximately 75% of trauma survivors will not experience any long-term distress. Others will experience short-term distress and subsequently adapt. A minority (usually about 10%) will <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086">experience chronic psychological problems</a>. </p>
<p>This last group are the ones who require care and attention to reduce their mental health problems. Experts now agree other trauma survivors can rely on their own <a href="https://www.rcpsych.ac.uk/mental-health/problems-disorders/coping-after-a-traumatic-event">coping resources and social networks</a> to adapt to their traumatic experience.</p>
<p>The finding across many studies that most people adapt to traumatic experiences <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086">without formal mental health interventions</a> has been a major impetus for questioning the value of psychological debriefing in the immediate aftermath of disasters. </p>
<p>In short, the evidence tells us universal interventions – such as psychological debriefing for everyone involved in a disaster – that attempt to prevent PTSD and other psychological disorders in trauma survivors are not indicated. These attempts <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086#bibr448-1529100610387086">do not prevent</a> the disorder they are targeting. </p>
<h2>Not a new conclusion</h2>
<p>In the aftermath of the 2004 Indian Ocean earthquake and tsunami, the World Health Organization listed a warning (which <a href="https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/other-significant-emotional-and-medical-unexplained-somatic-complaints/psychological-debriefing-in-people-exposed-to-a-recent-traumatic-event">still stands</a>) that people should not be given single-session psychological debriefing because it is <a href="https://journals.sagepub.com/doi/10.1177/1529100610387086#bibr448-1529100610387086">not supported</a> by evidence.</p>
<p>Worse than merely being ineffective, debriefing can be <a href="https://www.jenonline.org/article/S0099-1767(19)30453-2/fulltext#:%7E:text=It%20is%20for%20these%20reasons,%2C%20anxiety%20or%20depressive%20symptoms.%E2%80%9D">harmful for some people</a> and may increase the risk of PTSD.</p>
<p>The group of trauma survivors that are most vulnerable to the toxic effects of debriefing are those who are more distressed in the acute phase right after the trauma. This group of people have worse mental health outcomes if they are provided with early debriefing. </p>
<p>This may be because their trauma memories are over-consolidated as a result of the emotional disclosure so shortly after the event, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/#:%7E:text=Brain%20areas%20implicated%20in%20the,norepinephrine%20responses%20to%20subsequent%20stressors.">stress hormones</a> are still highly active. </p>
<p>In normal clinical practice a person would be assessed in terms of their suitability for any psychological intervention. But in the case of universal psychological debriefing there is no prior assessment. Therefore, there’s no assessment of the risks the intervention may pose for the person.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-the-psychological-effects-of-natural-disasters-194">How to manage the psychological effects of natural disasters</a>
</strong>
</em>
</p>
<hr>
<h2>Replacing debriefing</h2>
<p>Most international bodies have shifted away from psychological debriefing. Early intervention might now be offered as “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/psychological-first-aid">psychological first aid</a>”. </p>
<p>This newer approach is meant to provide <a href="https://www.who.int/publications/i/item/9789241548205">fundamental support and coping strategies</a> to help the person manage the immediate aftermath of adversity. One of the most important differences between psychological first aid and psychological debriefing is that it does not encourage people to disclose their emotional responses to the trauma. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1668845730402893824"}"></div></p>
<p>But despite the increasing popularity of psychological first aid, it is difficult to assess its effectiveness as it does not explicitly aim to prevent a disorder, such as PTSD.</p>
<h2>Wanting to help</h2>
<p>So if there is so much evidence, why do we keep having this debate about the optimal way to assist psychological adaptation after disasters? Perhaps it’s because it’s human nature to want to help. </p>
<p>The evidence suggests we should monitor the most vulnerable people and target resources towards them when they need it – usually some weeks or months later when the dust of the trauma has settled. Counsellors might want to promote their activities in the acute phase after disasters, but it may not be in the best interest of the trauma survivors. </p>
<p>In short, we need to develop better strategies to ensure we are meeting the needs of the survivors, rather than the counsellors.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/208139/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Bryant receives funding from the NHMRC and the ARC. </span></em></p>Psychological debriefing usually involves counsellors providing survivors with a single counselling session soon after an event. But ‘talking through’ trauma can over-consolidate painful memories.Richard Bryant, Professor & Director of Traumatic Stress Clinic, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2052702023-05-25T08:55:50Z2023-05-25T08:55:50ZMental health: research reveals harrowing impact of traumatic material on crime investigators<figure><img src="https://images.theconversation.com/files/527978/original/file-20230524-25-y567ma.png?ixlib=rb-1.1.0&rect=6%2C6%2C890%2C328&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">According to recent by the University of Birmingham, 37% of analytical practitioners have been diagnosed with severe depression, while approximately 55% of them suffer from moderate depression</span> <span class="attribution"><span class="source">University of Birmingham/Author</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Rape, murders, torture, arson, acts of terrorism and even genocide: if there is one thing police and justice staff know, it is that humanity’s cruelty and destruction knows no bounds. In their jobs, the professionals working to bring offenders to justice are routinely exposed to traumatic experiences through written witness accounts, video footage or recordings. And there is <a href="https://www.qao.qld.gov.au/reports-resources/managing-mental-health-queensland-police-employees">increasing concern</a> that the systems in place are failing to protect them.</p>
<p>In Europe, the figures are alarming. In 2022, mental health issues led police officers in England to take <a href="https://www.mirror.co.uk/news/uk-news/huge-rise-number-police-officers-29251463">730,000 days of sick leave</a> – up from 320,000 in 2012/13. In Spain, <a href="https://theobjective.com/espana/2023-01-01/suicidio-agentes-peores-datos/">28 committed suicide</a> – 21.4% less than in 2021, but the second worst figure since records began. This climbs to <a href="https://www.leparisien.fr/faits-divers/pas-une-fois-on-ne-sattaque-aux-problemes-de-management-deux-flics-sortent-un-livre-choc-sur-les-suicides-dans-la-police-27-01-2023-2F4MJ3UFOBHC7CW4ZHFXF5SCRA.php">78 suicides</a> in France when including prison guards, while Greece <a href="https://spectrumlocalnews.com/nys/rochester/news/2019/09/25/greece-police-spearhead-law-enforcement-suicide-awareness-walk">recorded 159 suicides</a> among police forces in 2019. The situation is compounded by the stigmatisation of opening up about mental health issues, where officers fear that it could lead them to be seen as weak or deny them the chances of career progression.</p>
<p>To better grasp how traumatic material affects police forces, our team of psychologists at the University of Birmingham conducted <a href="https://www.axa-research.org/en/project/fazeelat-duran">surveys and 40 interviews with analytical practitioners in the UK, Belgium, Spain, Netherlands and Canada</a>. This group of professionals work in the shadows of crime investigations. They include crime analysts, intelligence analysts, intelligence officers, digital forensic analysts and behavioural investigative advisors. An integral part of the criminal justice system, they provide analysis, intelligence and support to investigations and prosecutions for the most serious of crimes. Among them, 37% were diagnosed with severe depression and approximately 55% with moderate depression, as per our analysis conducted early this year.</p>
<h2>Echoes of trauma</h2>
<p>Analytical practitioners have reported how this constant exposure negatively influences their feelings about the world, their home life and social life. Reflecting a general concern among these professionals over their loved ones’ safety, one woman said:</p>
<blockquote>
<p>“I am more worried about my sister is she would tell her [she were] going for a walk in the night on a quiet road.” </p>
</blockquote>
<p>Interviewees report precautionary and avoidance behaviour related to the trauma they have read or heard about via their work. This affects their lives and the lives of close family. One of them, S. (all interviewees are anonymous) wonders how can he “leave his children at someone’s place for sleepover”. His voice noticeably shaking, he says that he “thinks he is more sceptical than a normal parent would be”. Meanwhile, Y. says she doesn’t leave a phone charger on her bedside, as she “thinks the burglar would strangle her with that”.</p>
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<p>Interviewees grappled with intense emotions, mentioning instances of “emotional meltdown”. “The victim’s interviews are distressing to watch,” Z. said, her eyes searching around her nervously. “They are written in such detail that I often feel tears rolling down my cheeks.”</p>
<p>Overall, many report having “forgotten how to trust”. “I’m more socially aware of my surroundings,” one man says. “I’d say I’m more cautious, and I don’t make friends as easily”. “It’s turned me into a paranoid wreck in relationships,” another woman admits “Like if I dated a man, he’d behave like one of those offenders whose cases I’ve worked on”.</p>
<p>We found that analytical practitioners with a belief that good things happen to good people and bad things happen to bad people (known as “belief in a just world”) are at greater risk of depression and post-traumatic stress disorder (PTSD). It is possible experience bad things happening to good people and that bad deeds go unpunished, leading to psychological distress.</p>
<h2>Ignored by governments</h2>
<p>Despite the toll this exposure takes, our interviewees felt invisible to policy-makers, commenting that little consideration was given to their mental health and well-being compared to that given to front-line officers. One woman expressed relief the focus was finally turned toward them.</p>
<p>Most analytical practitioners who spoke to us said they had received no training on what are adaptive and maladaptive coping mechanisms to manage working with traumatic content. They felt the support provided to them was reactive not preventative, and mental health stigmatisation in the workplace was certainly a barrier to help-seeking for some.</p>
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<figcaption><span class="caption">Ways police and staff personnel cope.</span></figcaption>
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<blockquote>
<p>“Seeking private support is my only option. All will know what problems I am facing and some will think I cannot do my job or I’m unfit for the job.”</p>
</blockquote>
<p>For these professionals to protect us, we need to protect them. On top of our academic research, we produced <a href="https://www.birmingham.ac.uk/schools/psychology/research/protecting-the-protectors/resources.aspx">two videos</a> to give them a voice and raise awareness of the impact of this work on their mental health.</p>
<p>We are also co-producing a tool kit with practical recommendations for organisations and we are working with the lead of Strand 3 of the National Well-being Group for UK policing that focuses on the well-being of investigators. The aim of our work is to give them a voice and recognition.</p>
<p>Looking forward, more research is required to understand the mechanisms for what could be the risk and resilience factors for these analytical practitioners and other professionals experiencing difficulties working indirectly with traumatic experiences of other people. This will help employers and policy-makers provide adequate support.</p>
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<img alt="" src="https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=158&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=158&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=158&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=198&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=198&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310261/original/file-20200115-134768-1tax26b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=198&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Created in 2007 to help accelerate and share scientific knowledge on key societal issues, the AXA Research Fund has supported nearly 700 projects around the world conducted by researchers in 38 countries. To learn more, visit the site of the AXA Research Fund or follow on Twitter @AXAResearchFund.</em></p><img src="https://counter.theconversation.com/content/205270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fazeelat Duran a reçu des financements de AXA. </span></em></p>The mental health of front-line officers has drawn considerable attention, yet research shows that justice professionals working with traumatic material can also suffer psychological distress.Fazeelat Duran, Postdoctoral researcher in occupational psychology, AXA Fonds pour la RechercheLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2046122023-05-24T12:17:56Z2023-05-24T12:17:56ZAnesthesia can cause disturbing sexual hallucinations, leading to lasting psychological trauma<figure><img src="https://images.theconversation.com/files/527119/original/file-20230518-17-zdnrt1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2119%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Having witnesses or recording devices during procedures requiring anesthesia could help prevent opportunities for sexual assault.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/anaesthetist-placing-mask-on-patient-royalty-free-image/1178748279">Science Photo Library/Getty Images</a></span></figcaption></figure><p>Some patients can have vivid and detailed <a href="https://doi.org/10.1002/jcph.2233">sexual hallucinations during anesthesia with sedative-hypnotic drugs</a> like propofol, midazolam, diazepam and nitrous oxide. Some make suggestive or sexual comments or act out, such as grabbing or kissing medical professionals or touching themselves in a sexual way. Others awaken erroneously believing they were sexually assaulted. Why does this happen? </p>
<p>Doctors have long known that <a href="https://www.britannica.com/science/sedative-hypnotic-drug">sedative-hypnotic drugs</a>, which slow down brain activity to induce calm or sleep, can affect a patient’s perception of reality. A 1984 review of the drugs midazolam, ketamine and thiopental found that 18% of patients receiving anesthesia for a dental or medical procedure had a <a href="https://www.accessdata.fda.gov/drugsatfda_docs/nda/pre96/018654Orig1s000rev.pdf">hard time distinguishing reality from fantasy</a> during and shortly after administration. Similarly, a 1980 study found that around 14% of patients report some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516323/">sexual dreaming or arousal</a> while under anesthesia. It’s no surprise that together these two features of anesthesia could sometimes manifest in sexual hallucinations.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ziPDLMQaTa0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Propofol is a commonly used anesthetic.</span></figcaption>
</figure>
<p>There have been rare cases in which medical professionals <a href="https://www.rollingstone.com/culture/culture-news/coma-birth-woman-arisona-hacienda-healthcare-776902/">used a patient’s unconscious state</a> to commit sexual assault. For instance, in 1991, a health professional <a href="https://doi.org/10.1016/0140-6736(91)90890-2">sexually assaulted a university student</a> under anesthesia. Although the case was initially dismissed on the grounds that the patient could have had a drug-induced sexual hallucination, genetic evidence the health professional left behind later led to his conviction. It cannot be assumed that all cases of reported sexual assault under anesthesia are due to a sexual hallucination. </p>
<p>We are <a href="https://scholar.google.com/citations?user=lWAD9d8AAAAJ&hl=en">pharmacology researchers</a> who recently <a href="https://doi.org/10.1002/jcph.2233">reviewed the medical literature</a> on sexual assault or sexual fantasy during anesthesia from the earliest documented case to February 2023, finding 87 reported cases from 17 published papers. Better understanding what triggers unpleasant or sexual dreams under anesthesia could help researchers figure out how to reduce the risk of hallucinations to keep both patients and providers safe.</p>
<h2>Reports of sexual hallucinations</h2>
<p><a href="https://doi.org/10.1002/jcph.2233">Sixteen of the individual cases</a> we found in our review involved patients reporting sexually amorous behavior or perceived sexual assault. In these cases, observers like health professionals or family members were also present during the procedure, reducing the chance that the sexual behavior actually occurred versus being hallucinated.</p>
<p>We also found a striking match between the anatomic location of the procedure and where the patient perceived inappropriate sexual contact. Procedures involving the mouth were perceived as oral sex, squeezing a ball to make a vein more accessible as squeezing a penis, chest procedures as breast fondling and groin procedures as vaginal penetration. </p>
<p>This may explain why <a href="https://doi.org/10.1111/j.1365-2044.1988.tb05529.x">one assessment of 200 patients</a> found no cases of sexual hallucination for those undergoing gallbladder or appendix procedures involving the abdomen, but around 12% of those undergoing vaginal procedures noted amorous or sexually disinhibited behavior.</p>
<h2>Trauma for both patients and providers</h2>
<p>These anesthesia effects can have major real-world impacts on patients and providers that last long after the surgery.</p>
<p>The <a href="https://doi.org/10.1002/jcph.1995">emotional turmoil</a> a patient undergoes is likely the same whether actually experiencing sexual assault under anesthesia or having vivid hallucinations of the event. And practitioners too can experience distress: <a href="https://doi.org/10.14219/jada.archive.1980.0343">Some medical professionals</a> accused of real or perceived sexual assault have been brought before regulatory boards or the courts and lose their license to practice.</p>
<p>It is possible that if patients knew a hallucination of sexual assault is a rare but possible adverse effect of anesthesia before they receive it, and were aware of the steps medical providers are taking to reduce that risk, they would be less likely to believe their sexual hallucinations were real. But this would not lessen the trauma of the hallucination. In one case, an anesthesiology student <a href="https://pubmed.ncbi.nlm.nih.gov/3469766/">volunteered in a study</a> where she experienced sexual hallucination after taking sedative-hypnotics. Although she knew her vivid memories of the sexual assault weren’t real, the distress she felt over them led her to withdraw from the study.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient sitting on hospital bed looking out window" src="https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527121/original/file-20230518-24-wwrsrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An experience of sexual assault can lead to significant psychological trauma.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patient-sitting-on-hospital-bed-waiting-royalty-free-image/493991213">Portra Images/Stone via Getty Images</a></span>
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<p>In our review of the literature, we found <a href="https://doi.org/10.1002/jcph.2233">71 individual cases</a> in which the medical professional was alone with the patient at the time of the alleged sexual assault or sexual behavior. For the safety and well-being of both patients and medical professionals, having witnesses in the room or recording devices during dental or medical procedures could help prevent an opportunity for sexual assault and reassure patients that the hallucinations they may experience are not real.</p>
<p>However, the health care system needs to go further to protect patients. Patients struggling with the trauma of hallucinated sexual assault, even if there is evidence that it did not occur in reality, should be referred to counseling and supported just like someone who was physically harmed during a medical or dental procedure.</p>
<h2>Many unknowns remain</h2>
<p>What makes some people more likely to recall their dreams while under anesthesia is unclear. A 2009 study of 97 patients receiving propofol reported that those who <a href="https://doi.org/10.1097/EJA.0b013e32832c500c">frequently remember their dreams</a> after anesthesia received higher doses of anesthetics, were younger than 50 years old and took longer to recover from anesthesia. A 2013 study of 200 patients receiving propofol found that men were more likely to <a href="https://doi.org/10.1097/WNR.0b013e3283644b66">remember dreams after anesthesia</a> but women were more likely to remember unpleasant dreams. While dreaming and hallucinations are related experiences, people experiencing hallucinations believe they could plausibly be real.</p>
<p>While we reviewed all published cases of sexual hallucinations in the medical literature, the actual incidence of anesthesia-induced sexual hallucinations remains unknown. Given the decades that have passed since the first reported cases, more work needs to be done. Data from a very large sample size of patients will be required to understand the prevalence of sexual hallucinations under anesthesia. However, drug companies are reluctant to spend money on research that may show that their drugs cause adverse side effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two white pills in one hand and glass of water in the other" src="https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527122/original/file-20230518-27-rp4r6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A number of prescription sedative-hypnotic drugs can cause hallucinations.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-view-of-hands-holding-pills-and-water-royalty-free-image/1171196510">Grace Cary/Moment via Getty Images</a></span>
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<p>Finally, though we limited our review to reports of sexual hallucinations during anesthesia, millions of Americans use other prescription sedative-hypnotic drugs. <a href="https://doi.org/10.1177/070674370204700823">Benzodiazepines</a> like alprazolam (Xanax) and temazepam (Restoril) are used to treat anxiety and induce sleep. <a href="https://doi.org/10.1007%2Fs13181-013-0294-y">Z-drugs</a> like zolpidem (Ambien) and eszopiclone (Lunesta) as well as suvorexant (Belsomra) and sodium oxybate (Xyrem) are also used to induce sleep. <a href="https://doi.org/10.1213%2FANE.0000000000001417">Opioids</a> like morphine and oxycodone and <a href="https://doi.org/10.2146/ajhp150136">gabapentinoids</a> like gabapentin (Neurontin) and pregabalin (Lyrica) are used to treat pain. <a href="https://doi.org/10.4088%2FPCC.14l01773">Muscle relaxers</a> like carisoprodol (Soma) and cyclobenzaprine (Flexeril) are used for muscle spasms. All of these drugs have had reported cases of patients experiencing hallucinations while taking them.</p>
<p>In a review of the <a href="https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers">FDA Adverse Events Reporting System</a>, which public health officials and researchers use to monitor drug safety, 30,728 cases of “abnormal dreaming” were reported from 1974 through 2022. Most involved sedative-hypnotic drugs treating insomnia, anxiety, pain and muscle spasms. The reports do not specify the nature of these dreams, or how they affected the patient’s own perceived well-being. </p>
<p>It is important for patients to be aware that abnormal dreaming is a possibility when starting a sedative-hypnotic medication, and to inform their health professional if they experience hallucinations. These symptoms could indicate that the drug is not the right choice for you or that the dose may be too high.</p><img src="https://counter.theconversation.com/content/204612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sedative-hypnotic drugs can distort a patient’s perception of reality. Some patients wake up from a procedure believing they have been sexually assaulted.Melody White, Ph.D. Candidate in Pharmaceutical Sciences, University of ConnecticutC. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2033072023-05-03T12:15:54Z2023-05-03T12:15:54ZBlack mothers trapped in unsafe neighborhoods signal the stressful health toll of gun violence in the U.S.<figure><img src="https://images.theconversation.com/files/523312/original/file-20230427-18-2ufwkh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The stress of experiencing high levels of community violence harms entire families.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-mother-consoling-her-sad-girl-at-royalty-free-image/1077179266">skynesher/E+ via Getty Images</a></span></figcaption></figure><p>Black mothers are the canaries in the coal mine when it comes to the mental and physical harms of stress from living with gun violence in America.</p>
<p>In the U.S., Black people are likelier than white people to reside in impoverished, <a href="https://doi.org/10.1007/s12552-019-09280-1">racially segregated communities</a> with high levels of gun violence. Research has suggested that <a href="https://doi.org/10.1176/appi.ajp.2021.21060558">living in</a> <a href="https://doi.org/10.1590/S1413-81232006000200007">violent and unsafe</a> environments can result in <a href="https://doi.org/10.1037/a0032484">continuous traumatic stress</a>, a constant form of PTSD. Researchers have also linked experiences of violence and poverty to an increased risk of <a href="https://doi.org/10.1016/j.healthplace.2022.102746">chronic disease</a> such as cancer and cardiovascular, respiratory and neurodegenerative diseases.</p>
<p>We are Black women and <a href="https://scholar.google.com/citations?user=mrM-LJsAAAAJ&hl=en">public policy</a> and <a href="https://scholar.google.com/citations?user=xIwwuN4AAAAJ&hl=en">sociology professors</a> who study health inequities and sustainable policy solutions. Our research has found that Black mothers who feel trapped in neighborhoods they perceived as unsafe because of high levels of community violence are more likely to report <a href="https://doi.org/10.1007/s40615-022-01432-1">elevated PTSD and depression symptoms</a>, as well as elevated stress hormone levels.</p>
<p>The trauma of gun violence and systemic racism isn’t simply a Black mother’s story – it’s an American story. </p>
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<figcaption><span class="caption">Gun violence is an epidemic in the U.S.</span></figcaption>
</figure>
<h2>Health effects of feeling trapped</h2>
<p>Our research team sought to understand <a href="https://doi.org/10.1007/s40615-022-01432-1">how stress from structural violence affects the body</a>, specifically the immune system. We talked to 68 low-income single Black mothers living on the South Side of Chicago about how they deal with gun violence in their communities and how it affects their health. </p>
<p>We asked these Black mothers to complete surveys that measured depression and PTSD symptoms. We also asked them to provide blood samples to examine the effects of stress at the cellular level, measuring the activity of genes that code for the receptors for the <a href="https://doi.org/10.1016/j.ejphar.2007.11.071">stress hormone cortisol</a>. Looking at cortisol receptors offers a more cumulative measure of cortisol levels over time.</p>
<p>We found that about 65% of the mothers wanted to move out of their neighborhoods but could not afford to do so. These mothers felt trapped in areas with high levels of gun violence that fostered a sense of not feeling safe for adults and children. One mother in our study, whom we will call Ellan, described her neighborhood as dangerous and wanted to leave as soon as she could. “I’m very terrified of my kids going out to the park, playing in front of the house,” she said. “And I’m afraid that a car might come past shootin’ and one of my kids get hurt.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mother cradling child against chest" src="https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523308/original/file-20230427-2243-r895dy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Black mothers who feel trapped in their neighborhoods feel terrified for their children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-holding-sleeping-son-royalty-free-image/84910809">Jose Luis Pelaez/The Image Bank via Getty Images</a></span>
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<p>Another mother in our study, whom we will call Skylar, felt she couldn’t escape to a safer community. “I don’t really want to raise my kids there, but I don’t have a choice. You know, cause it’s what I can afford. But it’s real violent.”</p>
<p>Mothers who felt trapped reported more symptoms of PTSD, like disturbing memories and dreams and reliving stressful experiences, than mothers who did not feel trapped. They also reported more depressive symptoms, such as feeling down and hopeless, taking little pleasure in doing things and having trouble sleeping. </p>
<p>Mothers unable to afford the move to safer neighborhoods had lower levels of glucocorticoid receptors. Having fewer glucocorticoid receptors helped protect their bodies from being overwhelmed by high cortisol levels caused by stress. Nevertheless, high cortisol levels from chronic stress are linked to a number of <a href="https://www.pbs.org/wgbh/nova/article/racism-stress-covid-allostatic-load/">negative mental and physical health outcomes</a>.</p>
<h2>Environment determines health</h2>
<p>Where someone lives, learns, works, plays and worships can <a href="https://pubmed.ncbi.nlm.nih.gov/28845341">determine their health</a> and has the power to make them sick and cause premature death.</p>
<p>Researchers have estimated that around <a href="https://doi.org/10.1377/hlthaff.24.2.459">83,570 Black people die prematurely</a> each year in the U.S. because of health disparities, using 2002 data. Some scholars have previously described this as equivalent to a <a href="https://unnaturalcauses.org/amazing_facts.php">plane full of Black passengers</a> falling out the sky every day every year.</p>
<p>It is important to note that it is not the racial makeup of where a person lives that shapes the significant disparities they face, but exposure to violence, poverty and lack of resources as a result of <a href="https://doi.org/10.1146/annurev-soc-073014-112305">structural racism</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497358/">Redlining</a>, <a href="https://doi.org/10.1089/env.2020.0019">environmental contamination</a>, <a href="https://doi.org/10.1111/soc4.12846">food deserts</a> and gun violence are a part of the <a href="https://doi.org/10.1177%2F1090198120922942">racial capitalism</a>, or exploitation of marginalized communities, that affect the health of Black women.</p>
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<figcaption><span class="caption">Black people face systemic economic and health disparities in the U.S.</span></figcaption>
</figure>
<p>What we are learning about the constant threats to the safety of Black mothers and their families also applies to the general American public. </p>
<p>The <a href="https://www.pewresearch.org/short-reads/2023/04/26/what-the-data-says-about-gun-deaths-in-the-u-s/">rate of mass shootings</a> is increasing. Firearm fatalities are a <a href="https://doi.org/10.1056/NEJMc2201761">leading cause of death among children</a> ages 1 to 19 in the U.S. Gun violence has harmed people while they are <a href="https://theconversation.com/scapegoating-rap-hits-new-low-after-july-fourth-mass-shooting-186443">watching a parade</a>, <a href="https://theconversation.com/rampage-at-virginia-walmart-follows-upward-trend-in-supermarket-gun-attacks-heres-what-we-know-about-retail-mass-shooters-195241">shopping at a store</a>, <a href="https://theconversation.com/fueled-by-virtually-unrestricted-social-media-access-white-nationalism-is-on-the-rise-and-attracting-violent-young-white-men-186896">worshipping</a>, <a href="https://theconversation.com/five-years-after-parkland-school-shootings-havent-stopped-and-kill-more-people-198224">attending school</a> and <a href="https://theconversation.com/hate-crimes-against-lgbtq-people-are-a-public-health-issue-61186">other</a> <a href="https://theconversation.com/stand-your-ground-laws-empower-armed-citizens-to-defend-property-with-violence-a-simple-mistake-can-get-you-shot-or-killed-204012">ordinary</a> <a href="https://theconversation.com/monterey-park-a-pioneering-asian-american-suburb-shaken-by-the-tragedy-of-a-mass-shooting-198373">events</a>.</p>
<h2>Increasing access to wellness</h2>
<p>Understanding the <a href="https://doi.org/10.1021/acs.estlett.1c00648">complexity of the exposome</a> – the word researchers use for environmental factors like gun violence that affect an individual’s health and well-being – can help extend the <a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">years of healthy life</a> of groups who typically experience premature death. Building this knowledge requires input from people of color and others who have traditionally been pushed to the margins of society.</p>
<p>We are currently creating a “<a href="https://www.youthwellnessproject.com/wellness-store">wellness store</a>” that places wellness tools and health knowledge at the fingertips of individuals, especially for those experiencing interlocking traumas such as racism, sexism, classism, incarceration, racial segregation and rural geographic isolation. These tools, co-created with community health workers and citizen scientists, range from phone apps to public policy designed to get stress “out from under the skin.” Our goal is to work with clinics, hospitals and community organizations to provide accessible tools to prevent illness.</p>
<p>Black communities are filled with resilient and vulnerable individuals who deserve urgent policy solutions that lead to societal change. We believe that more investment in disease prevention and health equity can help the U.S. use the knowledge, technology and finances that it already has to help people access its most precious resource: a healthy life and the ability to pursue wellness.</p><img src="https://counter.theconversation.com/content/203307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Loren Henderson is affiliated with Association of Black Sociologists. I am the Executive Officer of the Association of Black Sociologists.
</span></em></p><p class="fine-print"><em><span>Ruby Mendenhall receives funding from the National Science Foundation, the MacArthur Foundation and the University of Illinois at Urbana-Champaign.</span></em></p>Chronic stress from living with systemic racism and gun violence can lead to increased symptoms of PTSD and depression as well as elevated cortisol levels.Loren Henderson, Associate Professor of Public Policy, University of Maryland, Baltimore CountyRuby Mendenhall, Associate Professor in Sociology, African American Studies, Urban and Regional Planning and Social Work, University of Illinois at Urbana-ChampaignLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037272023-04-30T13:12:16Z2023-04-30T13:12:16ZThe power of cultural identity on psychological well-being: Singing, trauma and the resilience of the Yazidi population of northern Iraq<figure><img src="https://images.theconversation.com/files/520700/original/file-20230413-20-8ypkl.jpg?ixlib=rb-1.1.0&rect=28%2C84%2C3748%2C2230&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mourners preparing to bury the remains of 104 Yazidi victims in a cemetery in Sinjar, Iraq on Feb. 6, 2021. The Yazidis were killed by the Islamic State group in 2014, and were given a proper burial after the bodies were exhumed from mass graves and identified through DNA tests.</span> <span class="attribution"><span class="source">(AP Photo/Farid Abdulwahed)</span></span></figcaption></figure><p>Behind each door and gate in Sinuni, Iraq, there is a different story of trauma and resilience. The Yazidi community is still coping with the trauma and mental health burden following the <a href="https://theconversation.com/a-year-after-massacre-by-islamic-state-iraqs-yazidis-are-clinging-on-44494">ISIS genocide of 2014</a>, where thousands of men, women and children were killed, tortured and kidnapped for sexual slavery. </p>
<p><a href="https://www.aa.com.tr/en/middle-east/81-mass-graves-of-yazidis-found-in-iraqs-sinjar-since-2014-official/2538307#:%7E:text=A%20total%20of%2081%20mass,the%20Daesh%2FISIS%20terrorist%20group">Eighty-one mass graves</a> have been discovered, the most recent of which was found in June 2022.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A collage of nine different ornamental gates" src="https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520732/original/file-20230413-26-483g5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ornamental property gates from random houses in the Sinuni region of Iraq.</span>
<span class="attribution"><span class="source">(Mylène Ratelle)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The Yazidi community is based in Sinjar region, which is located in Nineveh Governorate, in northern Iraq. For thousands of years, this Mesopotamian-based population was <a href="https://www.cbc.ca/news/world/iraq-s-yazidi-minority-has-long-been-singled-out-for-hatred-1.2732115">persecuted for their unique ethno-cultural and religious beliefs</a>, which promote harmony and peace. </p>
<p>After the genocide of 2014, members of the Yazidi community <a href="https://www.ourcommons.ca/Content/Committee/421/CIMM/Brief/BR9342569/br-external/Yazda-e.pdf">looked for safety</a> in countries all over the world. However, a community core still stands with resolution on the land where their ancestors were born, around the Sinjar Mount. Some by choice, some because they were not able to leave.</p>
<p><a href="https://doi.org/10.1371/journal.pmed.1002297">A study from 2015</a> estimated that 2.5 per cent of the Yazidi population was either killed or kidnapped over the course of a few days in August 2014. Thousands were kept as sexual slaves. As such, it is not surprising that <a href="https://doi.org/10.1177/0020764021994145">a study published in 2022</a> investigating the traumatic experience of displaced Yazidis living in a Kurdistan camp estimated that about four out of five respondents had PTSD symptoms, and that women had a higher rate and score of trauma and PTSD symptoms. <a href="https://doi.org/10.1097/nmd.0000000000001400">Resilience strengthening</a> is a key for the treatment of those survivors, especially for the Yazidi individual, collective and <a href="https://doi.org/10.1186%2Fs12916-017-0965-7">transgenerational traumatization</a>.</p>
<h2>Link between mental health and cultural identity</h2>
<p><a href="https://doi.org/10.1177/0020764003494001">Research has indicated</a> that a positive cultural identity contributes to better mental health. Cultural identity is a concept that encompasses <a href="https://doi.org/10.1007%2Fs11013-016-9514-7">personal, ethnic and social self-identity</a>, which is critical for self-esteem.</p>
<p>In a <a href="https://doi.org/10.1037/a0029329">longitudinal study with Asian and Latino youth</a>, cultural identity was associated with lower levels of depression symptoms. In addition, for <a href="https://doi.org/10.1007/s00127-017-1424-7">Syrian refugees</a>, the sense of belonging to a social or cultural community was a predictor of lower levels of depression symptoms, as well as greater life satisfaction.</p>
<p>Historical colonialism, oppression and marginalization have contributed to poor mental health of Indigenous Peoples in Canada and Australia. However, cultural identity seems to have a role to play in health and well-being. </p>
<p>For example, for Australian Indigenous people in custody, <a href="https://doi.org/10.1186/s12889-017-4603-2">their cultural engagement was associated with non-recidivism</a>. Cultural continuity helped Indigenous communities of Canada to thrive, and <a href="https://doi.org/10.1177/070674370004500702">promoting the sense of collective pride</a> might contribute to positive mental health.</p>
<p>As such, the idea was suggested recently that <a href="https://doi.org/10.1002/jcop.22827">mental health programs should support the development of cultural identities</a>, with the potential to improve psychological well-being.</p>
<p>Since the genocide, some <a href="https://theconversation.com/5-years-after-islamic-state-massacre-an-iraqi-minority-is-transformed-by-trauma-126917">Yazidis report a renewed interest in their Yazidi cultural and political identity</a>. They have a stronger will than before to protect Yazidi holy sites, preserve oral traditions and hymns and their unique cultural practices.</p>
<h2>Humanitarian intervention</h2>
<p>My work is usually done in collaboration with Indigenous Peoples in North America, who deal with systematic racism, exclusion and stigma, generational trauma, awful abuses from residential schools and thousands of unmarked graves of children. </p>
<p>The Yazidi issues are a different type of deliberate horror, and are still very recent in the memory of survivors. <a href="https://www.msf.org/msf-warns-mental-health-crisis-among-yazidis-iraq">Médecins Sans Frontières warned the world in 2019 of the mental health crisis</a> and of increasing suicide rates in the region.</p>
<p>I was recruited by Médecins Sans Frontières in summer 2022 to support a health promotion program in Sinuni, Iraq. The role of our health promotion team was to provide a bridge between the local hospital services and the population, as well as to implement preventive initiatives to improve physical and mental health in the community. In parallel, mental health professionals were offering support to the residents.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Photo of a mountain landscape" src="https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=332&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=332&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=332&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=417&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=417&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520735/original/file-20230413-22-uny1dy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=417&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sinjar Mount is the core of the Yazidi community location in Iraq.</span>
<span class="attribution"><span class="source">(Mylène Ratelle)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>During our outreach activities, we often got a glimpse of the depth of the trauma of some community members, and witnessed their mental challenges. These included expressions such as:</p>
<ul>
<li> How can I be stress-free while there are 21 members of my family who are still missing?</li>
<li> My father’s house was destroyed years ago. Every time I see it, next to my house, it makes me sad.</li>
<li> I think about killing myself, day after day. We don’t have skills, hobbies, hope.</li>
<li> Many of us have someone we don’t let alone in the house because we fear they might kill themselves.</li>
</ul>
<p>As part of the mental health activities, I developed the content of a series of workshops, with the aim to: </p>
<ol>
<li><p>destigmatize mental health issues, </p></li>
<li><p>improve individual resiliency to stress by learning techniques to decrease anxiety at home,</p></li>
<li><p>increase community support, social capital and cultural identity to prevent and cope with mental health issues. </p></li>
</ol>
<p>Those workshops were implemented by the team in homes and schools. As part of the last workshop, there were participatory activities on the importance of peer groups, on the role of cooking and traditional practices. One key activity was to invite participants to sing traditional songs together. </p>
<p>The aim of those activities was to bring awareness on the positive impact of cultural identity, and strengthen social relations between neighbours. Those activities were evaluated, with participants reporting immediate and lasting positive impacts. </p>
<p>Assessment of the workshops indicated increased happiness index: 58 per cent were above the threshold for depressive symptoms before the workshop while 92 per cent of participants were above the threshold immediately after. In addition, after two weeks post workshop, there were fewer participants self-isolating and meeting socially once a month or less (30 per cent versus 10 per cent post-workshop), and there was an increased average number of social activities. </p>
<p>Our team observed that the Yazidi are collectively strong, resilient and hopeful. However, the trauma is still acute, and the extent of the mental health issues is such that it could pass on a <a href="https://dictionary.apa.org/intergenerational-trauma">generational trauma</a>. </p>
<p>As several <a href="https://www.thenewhumanitarian.org/news-feature/2023/03/20/un-united-nations-shift-away-emergency-aid-iraq">NGOs cease their activities in the region</a>, there are fewer organizations offering mental health care for the Yazidis, on the south and north side of Sinjar Mount. </p>
<p>However, more work needs to be done to improve mental health in the region via health promotion, counselling, therapy and psychiatry. There is also an opportunity to support cultural identity to reinforce mental health resilience.</p><img src="https://counter.theconversation.com/content/203727/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mylene Ratelle worked on a health promotion program for Doctors without Borders in 2022-2023 in Iraq, but her views are not those of Doctors Without Borders.</span></em></p>For the Yazidi communities in northern Iraq, there is a need to improve mental health. The sense of cultural identity has the potential to improve psychological well-being.Mylène Ratelle, Adjunct Professor, School of Public Health Sciences, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2019372023-04-17T12:42:31Z2023-04-17T12:42:31ZPsychedelics may better treat depression and anxiety symptoms than prescription antidepressants for patients with advanced cancer<figure><img src="https://images.theconversation.com/files/521074/original/file-20230414-28-z0dpc7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psilocybin and other psychedelics could help patients process the challenges of a cancer diagnosis.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/magic-mushrooms-illustration-royalty-free-illustration/1390280399">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>In people with advanced cancer, psychedelic drugs like psilocybin, LSD and MDMA may significantly <a href="https://doi.org/10.1097/coc.0000000000000998">reduce the severity of depression and anxiety</a> symptoms.</p>
<p>Roughly 10% of <a href="https://doi.org/10.1016/S1470-2045(11)70002-X">patients with cancer</a> experience anxiety, while 20% report depression. However, current research suggests that available prescription antidepressants <a href="https://doi.org/10.1002%2F14651858.CD011006.pub2">do not significantly decrease depressive symptoms</a> in cancer patients compared with a placebo. </p>
<p><a href="https://scholar.google.com/citations?user=lWAD9d8AAAAJ&hl=en">My team and I</a> recently completed a <a href="https://doi.org/10.1097/coc.0000000000000998">meta-analysis of five clinical trials</a> examining anxiety and depression symptoms in patients with advanced forms of cancer and other life-threatening diseases. We found that taking psychedelic medication alone – specifically LSD, psilocybin or MDMA – reduced depression scores as measured by the <a href="https://instruct.uwo.ca/kinesiology/9641/Assessments/Psychological/BDI.html">Beck’s Depression Inventory</a> by six points, where a score below 10 indicates minimal to no depression and above 30 indicates major depression. The average scores at baseline were between 15 and 18 for most studies, though one trial had a baseline of <a href="https://doi.org/10.1038/s41598-020-75706-1">approximately 30</a>. Psychedelics also reduced anxiety scores as measured by the <a href="https://doi.org/10.1159/000478993">State-Trait Anxiety Inventory</a> by seven to eight points, where a score of 20 to 37 indicates no or minimal anxiety and a score of 45 to 80 indicates high anxiety. The average scores were between 40 and 55 but <a href="https://doi.org/10.1038/s41598-020-75706-1">approximately 60 in one trial</a>.</p>
<p>In one trial of 51 cancer patients, 60% of those who received a single high-dose psilocybin session <a href="https://doi.org/10.1177/0269881116675513">achieved clinical remission</a> for depression, and 52% did for anxiety. In comparison, 16% of those who received a placebo achieved remission for depression and 12% for anxiety. These effects were still maintained six months later.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/b5i0aY_rUZU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Researchers are studying the use of psychedelics to treat a number of mental health conditions.</span></figcaption>
</figure>
<h2>Psychedelics and trauma</h2>
<p>Why would one to two psychedelic therapy sessions be more effective than taking daily prescription medications like fluoxetine (Prozac) and paroxetine (Paxil)?</p>
<p>Receiving a cancer diagnosis and experiencing adverse effects from treatments can be traumatic. In severe cases, patients can develop <a href="https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq">cancer-related post-traumatic stress disorder</a>. </p>
<p>People who develop PTSD from military service or physical or sexual violence <a href="https://doi.org/10.1002%2Fda.22881">commonly experience depression and anxiety</a>. Research on <a href="https://doi.org/10.1002/jcph.1995">MDMA-facilitated psychotherapy</a>, in which psychotherapists incorporate psychedelic sessions with traditional counseling, has shown that this treatment approach can effectively reduce PTSD symptoms by allowing patients to be willing and able to share traumatic memories to help process them. These reductions were larger than those seen in studies on prescription antidepressants alone.</p>
<p>Based on this research, my team and I hypothesize that psychedelic sessions might have an advantage over traditional prescription antidepressants for patients with cancer-related depression or anxiety because it may help them deal with their underlying trauma. </p>
<p>Some of the trials in our review noted what patients perceived as the <a href="https://doi.org/10.1177/10600280221144055">reasons for the reduced anxiety and depression symptoms</a> they experienced. Patients stated that the psychedelic sessions helped them process the intense feelings they were repressing without being overwhelmed. While the catharsis was emotional and difficult, it helped them achieve acceptance of those emotions, lessening their feelings of isolation and inner withdrawal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient in hospital gown with IV sitting on bed, looking out window" src="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521093/original/file-20230414-24-x6w4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cancer can be a traumatic experience.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patient-woman-in-hospital-room-royalty-free-image/1468190611">aquaArts studio/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Unknowns in psychedelic therapy</h2>
<p>While these results are promising, there are limitations to the available research that could bias the results. A <a href="https://doi.org/10.1097/coc.0000000000000998">number of the advanced cancer studies</a> we examined included people with a history of psychedelic use. People with prior positive recreational psychedelic experiences may be more likely to participate in these studies than those who experienced a “bad trip” or were opposed to recreational drugs altogether. Additionally, even though the placebo was made to look identical, it is unlikely that patients or caregivers were fooled if it did not elicit a psychedelic effect.</p>
<p>While past studies have found lackluster benefits from traditional antidepressant medications compared with placebos <a href="https://doi.org/10.1002/jcph.1995">in PTSD</a> and <a href="https://doi.org/10.1002%2F14651858.CD011006.pub3">cancer-induced anxiety and depression</a>, there have not been any clinical trials directly comparing the effectiveness of traditional antidepressants with psychedelics for PTSD or cancer patients. However, one completed early-phase trial that compared psilocybin with the traditional antidepressant escitalopram (Lexapro) in <a href="https://doi.org/10.1056/NEJMoa2032994">patients with major depression</a> found that 57% of people receiving psilocybin achieved clinical remission, compared with only 28% receiving escitalopram.</p>
<p>Finally, psychedelic sessions caused large <a href="https://doi.org/10.1097/coc.0000000000000998">increases in blood pressure</a>. This might not be the best treatment for patients with poorly controlled hypertension or with heart disease. </p>
<h2>Next steps for psychedelics</h2>
<p>More research is needed on effectiveness of psychedelics to treat anxiety and depression in cancer patients. Exploring psychedelic treatments for patients with other life-threatening diseases that cause trauma, anxiety or depression could clarify their potential therapeutic benefits.</p>
<p>Were the Food and Drug Administration to approve psychedelics for this kind of use, the agency would need to figure out how these psychedelics can be used legally. As <a href="https://www.ecfr.gov/current/title-21/chapter-II/part-1308#p-1308.11(d)">Schedule 1 drugs</a>, they are currently banned from any medical use in the U.S. Researchers must <a href="https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-057)(EO-DEA217)_Researchers_Manual_Final_signed.pdf">register with the U.S. Drug Enforcement Agency</a> to study controlled substances. However, the FDA has already set a precedent with its June 2018 approval of <a href="https://doi.org/10.1002/jcph.1387">cannabadiol (Epidiolex)</a> for the treatment of rare childhood seizure disorders, even though this cannabis derivative remains banned by the Drug Enforcement Administration.</p><img src="https://counter.theconversation.com/content/201937/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Receiving a cancer diagnosis and undergoing cancer treatment can be a traumatizing experience. Psychedelics like LSD, psilocybin and MDMA could help alleviate symptoms from cancer-related PTSD.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987472023-04-12T17:21:31Z2023-04-12T17:21:31ZNot doomed: How the right coping mechanisms can save trauma victims from PTSD<figure><img src="https://images.theconversation.com/files/517703/original/file-20230327-653-eh60zz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">file pzr xe</span> </figcaption></figure><p>Those who have experienced the horrors of war see their lives clearly delineated between a “before” and an “after”. This singular ordeal does not, as is often believed, mean that it is impossible to live, but generally forces people to live in a very different way. The disruption of the life process that results from this situation causes upheavals that each individual faces by drawing onto their capacity to adapt. But not everyone reacts in the same way.</p>
<p>To describe the mechanisms at work, health psychologists have coined the concept of “coping”, which is closely linked to that of adaptation. However, its outcome varies depending upon whether it is geared toward impacting upon the situation through action, or managing associated emotional states stemming from it.</p>
<h2>Forms and styles of coping</h2>
<p>In one 1986 study, scientists asked 100 adults every month for a year to record a recent event that had upset them and their reactions to it by answering a questionnaire, the <a href="https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_222">Ways of Coping Checklist</a>. The results revealed that there are <a href="https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_215">two main forms of coping</a>: <em>problem-focused</em> and <em>emotion-focused</em>.</p>
<p><em>Problem-focused coping</em> refers to the set of behavioural and cognitive steps that an individual takes in a bid to impact upon the situation in which they find themselves. This form has two essential aspects: confrontation with the event, which translates into efforts to change the situation, and resolution of the problem, which translates into the search for a set of means – information, help – to achieve this. The person then grapples with the problem directly and openly. </p>
<p><em>Emotion-focused coping</em> refers to the set of efforts to mitigate and cope with the emotional states triggered by the stressful situation. There are many expressions of this form of coping, most of which consist of intrapsychic action-oriented processes: avoidance (no longer thinking about the problem), distraction, denial, dramatisation, etc.</p>
<p>Problem-focused coping and emotion-focused coping are not two perfectly separate processes: in a given situation, one can use either one or the other, or both together. Moreover, these two main forms of coping correspond to the strategies generally used, but there are also some that are more specific and that vary from one individual and one situation to another.</p>
<p>Some authors have proposed to classify active and/or avoidant coping according to the strategies used to cope. In doing so, we can distinguish <a href="https://psycnet.apa.org/record/1993-97397-012">four basic categories</a> :</p>
<ul>
<li><p>Active/cognitive coping, which consists in logical analysis and positive reframing;</p></li>
<li><p>Active/behavioural coping, which consists in seeking support and taking action to resolve the problem;</p></li>
<li><p>Avoidant/cognitive coping, resulting in cognitive avoidance and resigned acceptance;</p></li>
<li><p>Avoidant/behavioural coping, which corresponds to the search for other activities and emotional release.</p></li>
</ul>
<h2>Emotional coping strongly linked to post-traumatic stress disorder</h2>
<p>Several studies have shown that adults with post-traumatic stress (PTSD) disorder are significantly more likely than others to engage in avoidance or escape, and thus <a href="https://doi.org/10.1521/psyc.2012.75.2.135">non-problem solving</a>. In 2007, a meta-analysis also revealed that avoidance was a predictor of the risk of developing <a href="https://doi.org/10.1002/jts.20276">PTSD, depression and distress</a>. PTSD
is the most common form of psychotrauma. It is characterised in particular by the presence of intrusive symptoms, such as persistent memories that overwhelm the victim’s consciousness, who experiences them as new events taking place in the present, avoidance behaviours and sleep disorders.</p>
<p>Scientists have spotted similar patterns in the experiences of traffic accident victims. Subjects with avoidance-oriented coping showed <a href="https://doi.org/10.1016/0005-7967(94)00093-Y">more intrusive symptoms</a> than others. A study of victims of the 2007 <a href="https://doi.org/10.1080/10615806.2010.500722">Virginia Tech University shooting</a> in Blacksburg, USA, reached similar conclusions, as did research <a href="https://doi.org/10.1080/10615800500392732">with victims of terrorism</a>.</p>
<p>Similarly, PTSD symptoms were more severe in Israeli soldiers who had resorted to <a href="https://doi.org/10.1002/per.2410030404">emotional strategies during the Israeli-Palestinian war</a>. Other work on a cohort of subjects followed for one year showed that, among the participants who experienced the most stressful events during this period, those who privileged avoidance strategies suffered from significantly more psychosomatic symptoms at the end of the study (headaches, stomachaches) than those who employed <a href="https://doi.org/10.1037//0022-3514.52.5.946">active strategies</a>.</p>
<p>Furthermore, academics have noted victims of violence crime showing symptoms of <a href="https://www.inserm.fr/dossier/troubles-stress-post-traumatique/">acute stress disorder</a> for more than one month tend to develop PTSD. Such symptoms include repetitive reliving of events, avoidance, mood disorders, hypervigilance, irritability, difficulty concentrating and sleep disorders.</p>
<p>The results obtained showed that the type of coping was a factor to be taken into account in order to explain why acute stress disorder does not systematically turn into <a href="https://www.intechopen.com/books/5272">PTSD</a>.</p>
<p>Thus, it appears that trauma victims who adopt an avoidance-oriented coping strategy (or a low-problem-oriented coping strategy) are more likely to develop PTSD over time.</p>
<p>Conversely, recent research has shown that problem-focused coping reduces the stress experienced by the individual by eliminating (or mitigating) the stressor. People who use this strategy seem to be less likely to suffer from <a href="https://doi.org/10.1037//0022-3514.66.5.895">anxiety and depression</a>.</p>
<p>Things are not that simple, however, as a coping strategy’s effectiveness also depends on the characteristics of the situation, including its duration, or the capacity to control the stressor.</p>
<h2>The importance of the subject’s hold on the situation</h2>
<p>In controllable situations (or perceived controllable situations) problem-focused coping appears to be <a href="https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_215">more effective</a> than emotion-focused coping, as it is associated with less subsequent distress. Such an effect is reversed in uncontrollable situations, where the subject’s repeated efforts to control the situation are useless and exhausting.</p>
<p>In this case, an emotional avoidance strategy may be more appropriate, especially in the short term. </p>
<p>The relative effectiveness of coping strategies also seems to vary according to the time that elapses after the stressful or traumatic event. Emotional coping is only protective immediately after the event.</p>
<h2>Adopting the most appropriate coping strategy</h2>
<p>Ultimately, much research has shown that coping strategies can buffer the <a href="https://doi.org/10.1176/appi.ajp.2008.07121939">psychic impacts of traumatic exposure</a>. This capacity for resilience and for maintaining a certain psychological and physical balance following the confrontation with traumatic or undesirable events seems to be enhanced in subjects who are able to “juggle” the entire cognitive and affective register of coping. People who are able to use different coping strategies are better able to adapt to life-threatening situations.</p>
<p>The nature of the coping strategies used may be an indicator to be taken into account in order to better understand why stress or PTSD will have a greater or lesser impact on different individuals. However, it is important not to leave it at that, and then to find ways of coping with these clinical conditions.</p>
<p>To cope with stress, one can turn to methods of emotional management, physical activity, meditation, cardiac coherence, an approach based on <a href="https://observatoireprevention.org/2017/08/02/la-coherence-cardiaque/">breath control</a>. For acute stress disorder or PTSD, one should rather turn to psychotherapy, which is more likely to provide effective responses.</p><img src="https://counter.theconversation.com/content/198747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cyril Tarquinio ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Be it violence, war or natural disasters, there is no shortage of trauma which to adapt. A psychologist takes us through our full arsenal of coping mechanisms.Cyril Tarquinio, Professeur de psychologie clinique, Université de LorraineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990882023-04-06T02:14:30Z2023-04-06T02:14:30ZExperiencing trauma can change some people’s outlook on life – sometimes for the better<figure><img src="https://images.theconversation.com/files/518421/original/file-20230330-911-xyrjtj.jpg?ixlib=rb-1.1.0&rect=287%2C8%2C2708%2C1985&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/rXrMy7mXUEs">Joice Kelly/Unsplash</a></span></figcaption></figure><p>Traumatic experiences are surprisingly common, with about <a href="https://www.aihw.gov.au/reports/mental-health-services/stress-and-trauma">three-quarters</a> of the population dealing with some form of trauma at least once in their lives. This might mean experiencing things like abuse, violence or natural disasters. </p>
<p>Experiencing a traumatic event alone is not enough to cause traumatic stress (a “trauma”). The person experiencing the trauma needs to view the event as highly distressing or life-threatening. </p>
<p>While trauma can be incredibly difficult to process and can leave lasting scars, there is another side to the story: post-traumatic growth. </p>
<p>Post-traumatic growth is the positive psychological change that can occur in response to a traumatic event. It is often mistaken as resilience, which means bouncing back to baseline following adversity. Post-traumatic growth, on the other hand, refers to an improvement in your life or outlook.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-half-of-australians-will-experience-trauma-most-before-they-turn-17-we-need-to-talk-about-it-159801">More than half of Australians will experience trauma, most before they turn 17. We need to talk about it</a>
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</p>
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<h2>What does this growth look like?</h2>
<p>People who have experienced post-traumatic growth describe having a greater appreciation for life, increased personal strength, deeper relationships, a greater sense of spirituality or meaning, or a new sense of possibilities for the future. </p>
<p>Someone who has experienced a traumatic event may decide, for example, to make a career change or start a new hobby. Some people report wanting to give back to the community or others in need after experiencing situations where they needed help after trauma. Or they may begin to prioritise their relationships more or focus on personal growth and self-improvement.</p>
<p>While post-traumatic growth can be a powerful force for positive change, it’s not guaranteed. About <a href="https://pubmed.ncbi.nlm.nih.gov/30268956/">one in two people</a> who experience trauma will undergo post-traumatic growth. Younger people and those who experienced trauma recently are more likely to have post-traumatic growth.</p>
<p><a href="https://www.mdpi.com/2673-1991/3/1/9">Our research</a> has found some common elements that make it more likely for a person to experience post-traumatic growth, <a href="https://www.researchgate.net/profile/Richard-Tedeschi/publication/247504165_Tedeschi_RG_Calhoun_LGPosttraumatic_growth_conceptual_foundations_and_empirical_evidence_Psychol_Inq_151_1-18/links/548aee9a0cf225bf669f7e6c/Tedeschi-RG-Calhoun-LGPosttraumatic-growth-conceptual-foundations-and-empirical-evidence-Psychol-Inq-151-1-18.pdf">regardless of the type of trauma experienced</a>. </p>
<h2>1. Strong social supports</h2>
<p>The most important factor promoting post-traumatic growth is support from friends, family, and those around you after you have experienced a traumatic event. Seeking and accepting social support are crucial, and it can be helpful to reach out to people who have experienced similar trauma through things like support groups.</p>
<figure class="align-center ">
<img alt="Woman places her head on a friend's shoulder" src="https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519484/original/file-20230405-22-wecbdo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social supports can help people heal from trauma.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/KQfxVDHGCUg">Unsplash/Kulli Kittus</a></span>
</figcaption>
</figure>
<p>Research shows the <a href="https://psycnet.apa.org/record/2019-81725-001">quality of social support</a> is important too. People report more post-traumatic growth if the support they receive comes from people they trust. </p>
<p>Social support is so crucial that some treatments <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235177">interventions</a> have focused on the use of social networks to improve the recovery of people who have experienced trauma. For example, some post-traumatic stress disorder (PTSD) recovery programs include support groups to help people heal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">Explainer: what is post-traumatic stress disorder?</a>
</strong>
</em>
</p>
<hr>
<h2>2. Coping skills</h2>
<p>Coping strategies such as humour, acceptance and focusing on the future are effective at reducing our distress after trauma, and they make it more likely we will heal and find positive aspects in our experiences. </p>
<p>People who experience post-traumatic growth often say they have a greater sense of inner strength and feel better equipped to handle stress and hardship in the future. These types of coping strategies are sometimes inherent, but often they can also be enhanced by therapy.</p>
<h2>3. Personality traits</h2>
<p>People who tend to be optimistic are more likely to experience post-traumatic growth. Instead of seeing the traumatic event as purely negative, optimistic people are able to find some positive aspects of their experience. </p>
<p>This can be difficult, as traumatic experiences often involve loss, pain, and suffering. However, by finding meaning and purpose in the experience – for example, by sharing their story with others going through similar experiences – people can begin to see themselves and the world in a new light. </p>
<p>Again, this is sometimes inherent, but can be enhanced by engaging with a mental health professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/for-people-with-chronic-pain-flexibility-and-persistence-can-protect-wellbeing-199008">For people with chronic pain, flexibility and persistence can protect wellbeing</a>
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<p>Some <a href="https://opennursingjournal.com/VOLUME/12/PAGE/238/FULLTEXT/">studies</a> have also found being more extroverted can help people experience post-traumatic growth. This may be because extroverted people are more likely to seek social support because they tend to find themselves in more social situations. </p>
<h2>4. Religion or spirituality</h2>
<p>Religion often teaches that transformation and power can arise in the face of suffering.</p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/1367467032000157981">Research</a> shows people who are religious (or spiritual) often experience post-traumatic growth because they have a greater sense of community, pastoral support and a higher meaning behind hardship.</p>
<figure class="align-center ">
<img alt="Two men pray at church" src="https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519485/original/file-20230405-20-uzlbrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Religion or spirituality can bring support and a higher meaning.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WNVnnHHcBeM">Sam Balye/Unsplash</a></span>
</figcaption>
</figure>
<h2>Treatment also prioritises the same factors</h2>
<p>The ways people flourish after adversity have helped inform researchers and clinicians on the best ways to treat post-traumatic stress. </p>
<p>Social support, helpful coping and finding meaning are core components of therapies commonly used by people who have experienced adversity, such as trauma-focused cognitive behavioural therapy, family therapy, and trauma-focused acceptance and commitment therapy. </p>
<p>Of course, post-traumatic growth is only part of the story, and it is an ongoing process. Trauma impacts people in many different ways. Sometimes healing from trauma or experiencing post-traumatic growth can be related to factors outside of a person’s control, such as their resources or socioeconomic status. </p>
<p>There are no guarantees a person will experience growth after trauma, but factors like social support, helpful coping, personality traits, and finding meaning make it more likely. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-reporting-process-was-more-traumatising-than-the-assault-itself-lgbtq-survivors-on-accessing-support-after-sexual-violence-202142">‘The reporting process was more traumatising than the assault itself’: LGBTQ+ survivors on accessing support after sexual violence</a>
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<img src="https://counter.theconversation.com/content/199088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alix Woolard receives funding from the Perth Children's Hospital Foundation and Channel Seven Telethon Trust. </span></em></p>People respond to trauma in different ways, with some people experiencing post-traumatic growth.Alix Woolard, Postdoctoral research fellow, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.