tag:theconversation.com,2011:/uk/topics/therapy-1367/articlesTherapy – The Conversation2024-03-13T20:59:46Ztag:theconversation.com,2011:article/2234122024-03-13T20:59:46Z2024-03-13T20:59:46ZWhat is gender-affirming care? A social worker and therapist working with trans people explains<figure><img src="https://images.theconversation.com/files/581460/original/file-20240313-20-z1u6um.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C4466%2C2991&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although medical doctors may be the first point of contact for children exploring their gender identity, many other professions can provide gender-affirming care, such as psychologists, social workers, teachers, counsellors and recreational coaches.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In late January, Alberta Premier Danielle Smith unveiled <a href="https://globalnews.ca/video/10264944/danielle-smith-unveils-albertas-proposed-guidelines-on-parental-consent-gender-affirming-care-rules">policies on gender-affirming care and parental rights</a>. These policies want to change access to medical treatments, participation in athletics, and whether transgender children can use preferred pronouns and names in school.</p>
<p>Meanwhile, <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html?smid=nytcore-ios-share&referringSource=articleShare">op-eds in newspapers</a> have brought attention to how professionals are supporting transgender children and the long-term effects of medical interventions. <a href="https://edmontonjournal.com/opinion/columnists/david-staples-alberta-danielle-smith-europe-gender-transition-policy">And suggested</a> that “adults can live with the consequences, but inexperienced children can’t”. </p>
<p>This suggests medical professionals are not assessing maturity and readiness in transgender children, and also that children should not be transitioning prior to adulthood. </p>
<p>As a registered clinical social worker and registered marriage and family therapist who works primarily with the 2SLGBTQIA+ population, I want to explain gender-affirming care and how professionals use it. I also want to discuss detransition, because too many people misunderstand and misuse the term. </p>
<p>There are several important assessments that must be considered prior to addressing maturity. For gender-affirming care, a child has to be assessed as a mature minor, which is a rigorous assessment completed by a professional such as a <a href="https://www.cap.ab.ca/Portals/0/pdfs/CAPPA-MatureMinors.pdf">psychologist</a> or <a href="https://acsw.in1touch.org/document/2024/SUM_MinorsAndConsentIssues_20150326.pdf">social worker</a>.</p>
<h2>Gender-affirming care</h2>
<p>According to the <a href="https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth">Canadian Paediatric Society</a>, gender-affirming care assesses psychological, social, medical and surgical options for gender-diverse people. These assessments explore an individual’s personal, familial and environmental histories, as well as their mental health and physical health. Practitioners use this knowledge to best understand one’s functioning and strengths, and to give people the kind of support they need. </p>
<p>Although medical doctors may be the first point of contact for children exploring their gender identity, many other professions can provide gender-affirming care, such as psychologists, social workers, teachers, counsellors and recreational coaches. </p>
<p>Allowing children to express gender creatively is one of the first steps explored by mental health experts when working with transgender children, youth and their families. <a href="https://www.psychologytoday.com/ca/blog/lifetime-connections/202311/gender-creative-parenting-lets-kids-be-kids#:%7E:text=Gender%2Dcreative%20parenting%20is%20a,the%20world%20and%20varied%20interests.">Gender creativity</a> is a term used to identify the fluidity of gender; how one’s identity is not set in stone and can change as we learn more about ourselves. </p>
<p>Allowing a child to express independent thought and creativity with gender expression will not lead children to assume they are in need of medical interventions. On the contrary, as a professional, these interventions are used to support a child’s understanding of their options through improving self confidence and self-esteem. </p>
<p><a href="https://jeunesidentitescreatives.com/upload/ressources/files/Barbies_and_Beer.pdf">Methods</a> can include social play, such as learning more about their own likes, forms of expression and ultimately exploring what makes them happy. The intention behind this is to help children build confidence and self worth, allowing them to engage in social settings authentically without fearing social consequence. </p>
<h2>Importance of support</h2>
<p>It is normal for us to compare ourselves to others, or to what we understand of social customs and rules. These social customs suggest our assigned sex at birth must match socially regulated forms of gender expression. </p>
<p><a href="https://www.plannedparenthood.org/learn/gender-identity/transgender/what-do-i-need-know-about-transitioning">Transitioning</a> begins the moment one confirms to themselves that their identity is different from these social rules. This doesn’t mean everyone who feels this way will go on to socially or medically transition. </p>
<p>Once a child can identify that they feel a certain way, it is vital for them to receive support from parents, caregivers, teachers and their broader community. Gender non-conforming young people are at risk for <a href="https://doi.org/10.1016%2Fj.jadohealth.2016.09.014">mental health struggles</a> such as anxiety, depression, self-harm and attempted suicide.</p>
<p>One possible explanation for this could be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846479/#:%7E:text=Minority%20stress%20theory%20posits%20that,physical%20and%20mental%20health%20outcomes.">minority stress</a>, which is the distinct, chronic stressors minorities experience related to their identity, including victimization, prejudice and discrimination. </p>
<p>It is important to think critically about the social and political contexts that limit gender expression, because it impacts everyone, and can directly harm gender-diverse children. Considering this and minority stress, this is why it is important to allow children the space and freedom to freely express themselves, so that they can understand gender expression has more than two options: conform to social expectations or medically transition. </p>
<p>When children are provided gender-affirming care, mental health professionals support them in better understanding their emotions. This involves identifying feelings and learning how to emotionally regulate. This also includes addressing negative beliefs about their feelings, normalizing emotional responses and supporting children to become more self-compassionate. </p>
<p>Some believe mental health professionals focus on <a href="https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abs2270">gender dysphoria</a> when providing such care to children and youth. This is the feeling of uneasiness or distress because your gender identity does not match your assigned sex at birth. </p>
<p>However, children and youth are provided with various forms of support prior to medical interventions being used. Medical interventions are oftentimes the last method a child is provided, and when it is provided, <a href="https://doi.org/10.1080%2F26895269.2021.1915223">some have described it as life-saving</a>.</p>
<p>Practitioners use gender-affirming care to promote <a href="https://www.healthline.com/health/transgender/gender-euphoria">gender euphoria</a> — the joy of aligning gender identity with gender expression. This is done by supporting children in finding confidence and self-worth by promoting their social and psychological well-being.</p>
<h2>What is detransitioning?</h2>
<p>Some gender-diverse children will need medical interventions but that doesn’t mean they have to persist for a lifetime. By providing children and youth access to medical interventions, professionals are addressing the <a href="http://www.phsa.ca/transcarebc/child-youth/affirmation-transition/medical-affirmation-transition/puberty-blockers-for-youth#:%7E:text=The%20changes%20to%20your%20body,that%20can't%20be%20reversed.">severity of dysfunction caused by gender dysphoria</a> </p>
<p>“Detransition” is a term used to describe those who have undergone medical and/or surgical interventions, and then reverted back. There is <a href="https://fenwayhealth.org/new-study-shows-discrimination-stigma-and-family-pressure-drive-detransition-among-transgender-people/">evidence</a> showing people undergo corrective approaches after medical or surgical interventions due to <a href="https://doi.org/10.1089%2Flgbt.2020.0437">discrimination, stigma and family pressure</a>. </p>
<p>It is crucial to understand that transgender individuals who use medical and surgical means for a period of time and stop, may not be detransitioning.</p>
<p>There are individuals who identify as <a href="https://doi.org/10.3390/jcm9061609">non-binary</a> who begin medical interventions, at a limited dose or for a duration of time, instead of committing life long. In my practice, I have seen many individuals begin hormone treatment and with the support of their doctor change the dosage as they continue to explore their gender identity. </p>
<p>There is a need for further research exploring detransition, especially in terms of how therapists can best support individuals who decide to stop or change their medical intervention plans with their doctors. </p>
<p>Ultimately, gender-affirming care is about providing people with the support they need. To help them see themselves in ways that promote joy, confidence and happiness. It is not about pathologizing gender expression. </p>
<p>Gender transition is not about fitting into preset ideals, but rather, finding joy in day to day experiences that is cultivated by our happiness, confidence and sense of belonging.</p><img src="https://counter.theconversation.com/content/223412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gio Dolcecore 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>Gender-affirming care assesses psychological, social, medical and surgical options for gender-diverse people.Gio Dolcecore, Assistant Professor, Social Work, Mount Royal UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2154152024-01-24T13:28:09Z2024-01-24T13:28:09ZHealing from child sexual abuse is often difficult but not impossible<figure><img src="https://images.theconversation.com/files/569798/original/file-20240117-25-rmsvl4.jpg?ixlib=rb-1.1.0&rect=58%2C84%2C5548%2C3623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most child sexual abuse involves people the children know.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/black-and-white-image-of-a-girl-feeling-guilty-royalty-free-image/1252367851?phrase=sexual+abuse+child&adppopup=true">ajijchan via Getty Images</a></span></figcaption></figure><p>A <a href="https://www.washingtonpost.com/dc-md-va/2023/08/02/patrick-wojahn-pleads-guilty-child-pornography/">mayor</a>, a <a href="https://www.fox5dc.com/news/karate-instructor-arrested-for-child-sex-abuse-police.amp">karate instructor</a>, a <a href="https://www.cbsnews.com/amp/baltimore/news/ex-baltimore-cop-accused-of-abusing-children-at-wifes-owings-mills-daycare-appears-in-court/">former cop</a>, an <a href="https://www.washingtonpost.com/dc-md-va/2023/09/29/child-porn-meek-journalist-sentenced/">award-winning journalist</a> and a <a href="https://abc13.com/robert-l-carter-houston-pastor-impregnates-child-decadelong-sex-assault-arrest-report/13885173/">pastor</a>. All five of these individuals in positions of authority or trust made headlines within the past year in connection with childhood sexual abuse.</p>
<p>Beyond the headlines and whatever punishments are meted out, each heinous case is alleged to involve a child who endured unjustifiable suffering and is left with the burden of carrying the weight of this trauma.</p>
<p>As a child <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&hl=en&user=fdZFeHwAAAAJ">clinical psychologist</a> who regularly provides therapy for survivors of childhood sexual abuse, I can attest that traveling the uphill path to healing from such experiences is arduous – but it is possible.</p>
<h2>How many children endure sexual abuse?</h2>
<p>Child sexual abuse is sadly a common occurrence. About 1 in 4 girls and 1 in 20 boys in the United States are subjected to <a href="https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html">child sexual abuse</a> – maltreatment of a child involving <a href="https://www.rainn.org/articles/child-sexual-abuse">molestation, rape, prostitution, pornography and any sexual contact without consent</a>. </p>
<p>According to the most recent federal data, approximately 60,000 children were <a href="https://www.acf.hhs.gov/cb/data-research/child-maltreatment">confirmed victims of sexual abuse in 2021</a>.</p>
<p>However, true rates of child sexual abuse are unknown, as only 10% of cases are <a href="https://doi.org/10.1002/bsl.2492">reported to law enforcement</a>. An estimated 60% to 70% of adults who were sexually abused as children <a href="https://doi.org/10.1037/1076-8971.11.1.194">kept it a secret throughout their childhood</a>. </p>
<h2>Who are the perpetrators?</h2>
<p>The majority of child sexual abuse perpetrators – 93% – <a href="https://www.rainn.org/statistics/perpetrators-sexual-violence">are someone the child knows</a>. Thirty-four percent of perpetrators are family members, and <a href="https://www.rainn.org/statistics/perpetrators-sexual-violence">only 7% are strangers</a>.</p>
<p>Father figures and male family members are the abusers in <a href="https://doi.org/10.1037/0021-843X.111.2.329">more than a quarter of child sexual abuse cases</a>.</p>
<p>Evidence points to younger children being more likely to be abused sexually by a family member <a href="https://doi.org/10.1097/JFN.0000000000000063">than by an acquantance</a>. Around 49% of sexual abuse cases against children under 5 were committed by a relative, <a href="https://www.nationalcac.org/wp-content/uploads/2018/02/CSA-Perpetrators.pdf">versus about 24% for children aged 12 to 17</a>. </p>
<p>In such cases, children are particularly vulnerable to coercion and secrecy. This can lead to greater likelihood of the child sexual abuse going unreported due to fear, guilt or shame, and <a href="https://doi.org/10.1002/bsl.2492">concern about getting into trouble</a>.</p>
<h2>How have the internet and social media changed things?</h2>
<p>As more children have access to various online platforms, they may become even more susceptible to unwanted sexual conversation, grooming and online sexual abuse. Teenagers, rather than younger children, are <a href="https://doi.org/10.3390/children10081306">at greatest risk for encountering a sexual perpetrator online</a>.</p>
<p>A recent study found that 1 in 15 teens are exposed to unwanted sexual material online, while 1 in 9 are exposed to <a href="https://doi.org/10.1016/j.jadohealth.2018.03.012">sexual conversation by adults or peers</a>. Approximately 8.5% of adults who were sexually abused during childhood reported meeting a perpetrator online, <a href="https://doi.org/10.3390/children10081306">via social media or other online apps</a>.</p>
<p>Since the dangers that youth face online mirror dangers in real world settings, teaching internet safety skills in the context of sexual abuse and bullying education is <a href="https://doi.org/10.1177/1524838020916257">encouraged by researchers</a>.</p>
<h2>What’s different for extremely young victims?</h2>
<p>Research suggests that about 30% of child sexual abuse cases <a href="https://doi.org/10.1097/00004583-200303000-00006">involve children age 4-7</a>.</p>
<p>Preschool-age children who were sexually abused <a href="https://doi.org/10.18357/ijcyfs44201312700">reported more depressive symptoms</a> than preschool-age children who were not abused. Moreover, younger age of abuse predicts <a href="https://doi.org/10.1037/0021-843X.116.1.176">worse future mental health problems</a>, including anxiety, depression and behavioral difficulties.</p>
<p>Due to their limited understanding and knowledge, young children are at a significant risk for being “<a href="https://definitions.uslegal.com/c/child-grooming/">groomed,</a>” especially by those in <a href="https://doi.org/10.1080/10538712.2020.1801935">positions of trust</a>, and may be <a href="https://doi.org/10.1016/j.chiabu.2018.11.020">less likely to disclose abuse</a>.</p>
<p>Developmental problems are also a cause for concern if abuse occurs during the 0 to 5 age range – <a href="https://www.zerotothree.org/resource/understanding-brain-development-in-babies-and-toddlers/">the most pivotal time for brain development</a>. Compared to adolescents, younger children are more likely to display <a href="https://doi.org/10.1037/10292-002">physical trauma-related symptoms</a>, such as sexualized behaviors, wetting accidents and other developmental delays, following abuse. </p>
<p>Despite their age, younger children benefit from <a href="https://www.nctsn.org/resources/sexual-development-and-behavior-children-information-parents-and-caregivers">learning about sexual behaviors, boundaries and private parts</a>. They make the most progress in trauma therapy <a href="https://doi.org/10.1007/s10567-020-00334-0">with caregiver participation</a>. </p>
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<a href="https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A therapist listens to a young female speak." src="https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569801/original/file-20240117-19-wajyxr.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>
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<span class="caption">Therapy can help survivors of child sexual abuse regain a sense of control over their lives.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-female-counselor-gives-unrecognizable-young-royalty-free-image/1399285418?phrase=girl+in+therapy&adppopup=true">SDI Productions/E+ via Getty Images</a></span>
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<h2>What does it take for children to recover?</h2>
<p>The most important aspects for recovery after trauma are abuse disclosure, consistent support from safe adult caregivers, and therapy. Children who are exposed to any inappropriate sexual activity or abuse are strongly encouraged to report the abuse to a trusting adult. The sooner children report being a victim of sexual abuse, the <a href="https://doi.org/10.1002/bsl.2492">fewer future psychological difficulties</a> they experience. Additionally, caregiver support strongly <a href="https://doi.org/10.1016/0145-2134(95)00077-L">predicts resilience</a> in children who were sexually abused. </p>
<p>Regrettably, the <a href="https://doi.org/10.1002/bsl.2492">most common reasons</a> cited for not disclosing child sexual abuse were: shame, believing the incident was not serious enough, lack of proof, self-blame, fear of negative reactions from others, and fear of not being taken seriously. So, if a child decides or agrees to report the abuse to law enforcement authorities, caregivers and professionals are urged to be supportive to lessen the negative impact of disclosure. </p>
<p>Children who have endured sexual abuse may benefit greatly from <a href="https://doi.org/10.1111/jcpp.13094">trauma-focused therapy</a>. Goals of trauma-focused therapy often include learning skills to help deal with difficult thoughts, feelings and behaviors following the abuse. The therapy also involves talking through their trauma in a safe and healthy way, and <a href="https://doi.org/10.1007/978-3-319-40920-7_6">learning safety skills</a> such as healthy boundaries and assertive responses to threatening situations.</p>
<h2>Are normal lives possible?</h2>
<p>Child sexual abuse can have far-reaching and lifelong consequences. Children who endure sexual abuse demonstrate <a href="https://doi.org/10.1016/j.chiabu.2016.11.027">more difficulty understanding and managing their emotions</a>, and experience more <a href="https://doi.org/10.18357/ijcyfs44201312700">anxiety, depression and behavioral problems</a>.</p>
<p>Adults who were sexually abused as children are at greater risk for worse physical health, such as <a href="https://doi.org/10.1111/j.1365-2850.2011.01772.x">gastrointesinal, sexual health, neurological and respiratory problems, as well as chronic pain</a>. They are also at greater risk for worse psychological health, including <a href="https://doi.org/10.1016/S2215-0366(19)30286-X">post-traumatic stress disorder, anxiety and depression, among other disorders</a>. Further, they are at greater risk for <a href="https://doi.org/10.1002/car.2534">substance abuse</a>, <a href="https://doi.org/10.1016/j.amepre.2005.01.015">marital problems and suicide</a>.</p>
<p>These things notwithstanding, many children are quite resilient. They can and do recover from such experiences, especially with <a href="https://doi.org/10.1002/bsl.2492">abuse disclosure</a>, <a href="https://doi.org/10.1016/0145-2134(95)00077-L">caregiver support</a> and <a href="https://doi.org/10.1111/jcpp.13094">treatment</a>. </p>
<p>Therapy and support from caregivers contribute greatly to healing and protection against future physical and psychological consequences. One of the core tenets of trauma-focused therapy is for an individual to regain control over their life, experiences and trauma.</p>
<p>With the support of loved ones and specialized, professional help, children and adults who have endured child sexual abuse can be resilient and successful in all domains of life.</p><img src="https://counter.theconversation.com/content/215415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maria Khan 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>With therapy and social support, children and adults who experienced child sexual abuse can regain a sense of control over their lives.Maria Khan, Assistant Professor of Behavioral Medicine & Psychiatry, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2212332024-01-19T10:14:39Z2024-01-19T10:14:39ZThe Sopranos at 25: mafia tale of murder, mayhem and family created a golden age of television<p>Twenty-five years after its debut on <a href="https://www.theguardian.com/tv-and-radio/2022/nov/01/hbo-book-home-box-office-its-not-tv">HBO</a>, <a href="https://www.theguardian.com/tv-and-radio/2020/dec/19/sopranos-hit-social-media-generation-mafia-series-emotional-struggles">The Sopranos</a> consistently sits at the top of lists of the <a href="https://www.rollingstone.com/tv-movies/tv-movie-lists/best-tv-shows-of-all-time-1234598313/">greatest TV shows of all time</a>. The pressures of being number one was not something that its creator, <a href="https://www.allmovie.com/artist/david-chase-vn15570136">David Chase</a>, had ever entertained.</p>
<p>A somewhat dour producer/writer (The Rockford Files, Northern Exposure), Chase had inadvertently ascended the ranks to become a sought-after TV talent who nevertheless aspired to a film career. Still, in pitching the concept of a mobster mired in internal conflict, he found an appetite for change amongst the networks he was working for.</p>
<p>With stagnant formats and generalised output, most executives were struggling to find a hit in this brash post-1980s world. But after punting his unconventional “bad guy as protagonist” idea and being repeatedly rejected, Chase found himself walking away from HBO in 1997 with a deal as both writer and director of the pilot.</p>
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<p>When the first series got the green light, he set about achieving his vision, without much hope that <a href="https://www.youtube.com/watch?v=pSQCQ2ZngG8">he would get beyond one season</a>. Adept at subverting the story conventions of the time, Chase had a product that fit the format but raised the game in terms of character development, depth, black humour and, for television, a visually enriching cinematic style. The Sopranos instantly stood out as something bold and innovative.</p>
<p>Reinventing a mafia character to add complexity beyond the achievements of James Cagney, Marlon Brando, Al Pacino and Robert De Niro would be a challenge that James Gandolfini would relish, but which would ultimately <a href="https://www.businessinsider.com/james-gandolfini-struggles-sopranos-tony-tinderbox-book-hbo-executive-2021-12?r=US&IR=T#:%7E:text=%22In%20order%20to%20become%20Tony,%22exhausted%22%20by%20the%20role.">take its toll on the actor</a> as he wrestled with the darkness of his character. </p>
<h2>Gandolfini: an imperfect anti-hero</h2>
<p>Like the character he was to play, <a href="https://www.britannica.com/biography/James-Gandolfini">James Gandolfini</a> also hailed from New Jersey. He was a character actor with depth, but HBO was initially worried about his leading-man qualities. Even Chase, who had his heart set on Bruce Springsteen’s musician pal <a href="https://www.littlesteven.com/bio">Steven van Zandt</a> (who went on to play sidekick Silvio), had to be persuaded.</p>
<p>But ultimately, the risk paid off and it was considered iconic casting – Gandolfini’s credibility playing both family man and brutish avenger were vital to the success of both series and character. This bear-like, aggressive tough guy had inner demons and this show was going to share them with you. And Gandolfini was going to make you care.</p>
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<p>Fully inhabiting Tony Soprano, Gandolfini brought heart and empathy to the role as did <a href="https://www.tvinsider.com/people/edie-falco/">Edie Falco</a> as his long-suffering spouse Carmela, who helped bolster the familial dynamics of discord further. As the seasons rolled on, her role became evermore devastating and enthralling as her character hardened.</p>
<p>Tony was at the forefront of a new wave of lead characters that permitted sympathy for the devil. Here was an audience that wanted fallible, relatable characters, not just straightforward heroes and tough guys.</p>
<p>Relatability is a crucial factor in the show’s iconic status and timeless appeal. It also tapped into a growing trend in the US of talking through psychological problems and mental health in therapy. Tony’s burgeoning awareness of his own mental health problems is the revelatory moment that kicks off the series: a fainting episode that cannot be medically explained sees him prescribed a session with psychiatrist Dr Melfi (Lorraine Bracco).</p>
<p>Creating an imperfect anti-hero at the heart of this mafia family was a stroke of genius. External conflict meets internal conflict, as an alpha male mobster manifests the psychological demons conjured up by a troubled relationship with his ruthless mother, the indomitable Livia. This key relationship was central to Tony’s dilemma and his fate.</p>
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<p>In the first episode, Chase established Tony’s character by having him carefully shepherd baby ducks out of his swimming pool. Here was a man who was kind to animals but deadly when betrayed. Audiences were frequently disconcerted watching him execute grisly murders, then head home for dinner with his family.</p>
<p>Episodically, the show pivoted from such violent and bloody action to small familial scenes, forgoing a traditional linear narrative structure for huge emotional arcs that would span whole seasons. With no “story of the day”, no episode could be deemed to have a happy ending – just as Chase wanted it.</p>
<h2>A golden age of drama</h2>
<p>Subsequently, HBO found itself at the forefront of a new golden age of “cinematic television”. The Sopranos paved the way for new worlds and a wild west of platforms, full of promise and hope. Soon, new voices such as Shonda Rhimes (Grey’s Anatomy, Scandal), Amy Sherman-Palladino (Gilmore Girls, Marvellous Mrs Maisel) and Lena Dunham (Girls) would break through the din of white, male writers to create a broader perspective and elevate sidelined female stories that existed outside the familiar, patriarchal world that Tony inhabited.</p>
<p>Genre-busting series such as <a href="https://www.theguardian.com/tv-and-radio/2016/sep/26/transparent-review-the-best-thing-on-tv-at-the-moment">Transparent</a> had no need to tiptoe around challenging storylines with ever-evolving, selfish, judgmental, entirely flawed but endearing characters. Similarly, <a href="https://simonc.me.uk/tv-review-orange-is-the-new-black-season-1-db6457187df9">Orange is the New Black</a>, gave us empathetic, engaging backstories to the female prisoners. </p>
<p><a href="https://www.theguardian.com/tv-and-radio/2018/jan/20/breaking-bad-10-years-on-tv-is-still-in-walter-whites-shadow">Breaking Bad’s</a> Walter White trajectory, from quiet good guy to drug kingpin, would begin its arc a short six months after The Sopranos took its final bow in July 2007. And <a href="https://www.bbc.com/culture/article/20211015-why-the-wire-is-the-greatest-tv-series-of-the-21st-century">The Wire</a> continued the evolutionary story from March 2008 with a show that would go on to explore institutional failure, drugs, deprivation and the challenges of urban society.</p>
<p>It’s ultimately impossible to conceive of White, drug-addicted <a href="https://www.theguardian.com/tv-and-radio/tvandradioblog/2011/sep/06/have-you-been-watching-nurse-jackie">Nurse Jackie</a>, serial killer <a href="https://www.theguardian.com/tv-and-radio/2021/nov/08/dexter-new-blood-review-leaner-hungrier-serial-killer">Dexter</a> or <a href="https://www.theguardian.com/tv-and-radio/2015/oct/29/mad-men-box-set-review">Mad Men</a> lothario Don Draper without the flawed Tony Soprano. And unfathomable that a TV show could have the same impact in today’s streaming panorama, where flawed characters are the norm. </p>
<p>But in a blistering attack recently, David Chase <a href="https://www.thetimes.co.uk/article/sopranos-creator-david-chase-the-streaming-giants-are-killing-off-tv-f0bhf68zj">decried the current state of affairs</a>, claiming that thanks to multi-tasking viewers with short attention spans, the 25-year golden age of groundbreaking, taboo-busting TV is well and truly over, and executives are once again risk averse.</p>
<p>Grateful for the quality TV dramas that came after, for many this is what makes The Sopranos the perennial number one.</p>
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<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?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">
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<hr><img src="https://counter.theconversation.com/content/221233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Steventon 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>The deeply flawed but intriguing Tony Soprano opened up a whole new world of complicated relatable characters that drew audiences in their millions.Jane Steventon, Course Leader, BA (Hons) Screenwriting; Deputy Course Leader & Senior Lecturer, BA (Hons) Film Production, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2200592023-12-21T16:03:28Z2023-12-21T16:03:28ZMenopause: why psychological therapy is now being recommended for hot flushes<figure><img src="https://images.theconversation.com/files/567040/original/file-20231221-17-d9yco4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">CBT may help some women cope better with debilitating menopause symptoms.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-talking-therapist-on-sofa-home-454809184">wavebreakmedia/ Shutterstock</a></span></figcaption></figure><p>There are <a href="https://www.nhs.uk/conditions/menopause">at least 40 symptoms</a> of the menopause and perimenopause. These symptoms can have a serious affect on a woman’s <a href="https://www.theguardian.com/society/2023/jan/12/not-just-hot-flushes-how-menopause-can-destroy-mental-health">day-to-day life and wellbeing</a>, which is why having access to timely and effective treatment is so important.</p>
<p>Menopause symptoms can be described in categories such as <a href="https://pubmed.ncbi.nlm.nih.gov/18074100/#:%7E:text=Vasomotor%20symptoms%20(VMS)%2C%20commonly,treatment%20during%20menopause%20most%20often.">vasomotor</a>, physical and psychological. All happen as a result of declining hormone levels – primarily oestrogen and progesterone.</p>
<p>Vasomotor describes hot flushes and night sweats. Physical includes brain fog (issues with memory and concentration), vaginal dryness, difficulty sleeping, dizziness, headaches, joint pains, numbness, itchy skin, bladder symptoms and urinary tract infections. And psychological refers to low mood and anxiety. Menopause can also increase the risk of developing <a href="https://www.sciencedirect.com/science/article/pii/S1521693422000414">weak bones (osteoporosis) and cardiac disease</a>. </p>
<p>Given the serious impact these symptoms can have on a woman’s everyday life, many turn to hormone replacement therapy (HRT). HRT is considered the most effective way to <a href="https://academic.oup.com/jcem/article/106/1/1/5937009">manage symptoms</a> and is recommended by the <a href="https://www.nice.org.uk/guidance/NG23">National Institute for Health and Care Excellence</a> (Nice) as the first-line treatment for menopause. HRT replaces decreasing hormones. </p>
<p>But since 2015, Nice has also recognised the role that cognitive behavioural therapy (CBT) can play alongside HRT in managing the psychological symptoms of menopause – such as low mood and anxiety. This is because CBT is known to be effective for <a href="https://www.nhs.uk/mental-health/conditions/depression-in-adults/overview/">mild depression</a> and <a href="https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/">anxiety disorders</a>.</p>
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<img alt="A woman looking at a box of hormone replacement therapy tablets." src="https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567043/original/file-20231221-19-3uf2uh.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">Many women use hormone replacement therapy to manage symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hormone-replacement-therapy-adult-pretty-woman-1722490951">Dmytro Zinkevych/ Shutterstock</a></span>
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<p>But <a href="https://www.nice.org.uk/guidance/GID-NG10241/documents/draft-guideline">recent Nice draft guidelines</a> suggest women should be offered CBT instead of, or alongside, HRT to manage hot flushes, night sweats and sleep difficulties associated with the menopause. </p>
<p>One of the main reasons Nice has recommended this change is to offer women more choice in how to manage their symptoms. Not all women want to take HRT or are able to. This is because HRT has been linked to a small increased <a href="https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/">risk of breast cancer</a> – although this depends on many factors, including age, the type of HRT and how long a person has been taking it. </p>
<p>The decision to include CBT as an option is based on evidence that it can help some people <a href="https://www.tandfonline.com/doi/abs/10.1080/13697137.2020.1777965">cope better</a> with the debilitating vasomotor and sleep issues they experience <a href="https://www.nice.org.uk/guidance/gid-ng10241/documents/evidence-review">during the menopause</a>. So while CBT can’t cure such physical symptoms (since it <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00142-5/fulltext">cannot replace decreasing hormones</a>), it may still be helpful for some when it comes to their wellbeing.</p>
<h2>Considerable backlash</h2>
<p>These new recommendations have received considerable backlash, especially from those campaigning for better treatments for women’s health conditions. For example, the <a href="https://www.mumsnet.com/articles/mumsnets-response-to-the-nice-draft-guidance-menopause-diagnosis-and-management?callback=in&code=NWI1MZI4MWQTYMQWYY0ZYZK3LWJLNTYTMMIWN2Y5MJE5OTGZ&state=f5f9acdc2f7d44ffb11ab644dec9d0e9">editors of Mumsnet</a> – a UK-based forum and news website for parents – wrote a scathing review of the updates, claiming the guidance will be detrimental to the health of women. </p>
<p>They wrote that the new guidelines may make doctors more reluctant to prescribe HRT to patients in the UK. They also pointed out that it’s already near-impossible for people to access psychological treatments in the UK for mental health problems – let alone being able to access it for physical symptoms of the menopause. </p>
<p>Louise Newson, a leading UK menopause specialist, wrote in a <a href="https://www.thetimes.co.uk/article/this-approach-to-the-menopause-is-gaslighting-women-czh2j9nkj">recent article</a> that the draft Nice guidelines neglect to highlight the many benefits of HRT for osteoporosis, cardiovascular disease and diabetes, and instead are hyper-focused on the risks associated with older types of HRT. <a href="https://www.theguardian.com/society/2023/dec/11/new-menopause-therapy-hrt-guidance-will-harm-womens-health-say-campaigners?CMP=Share_iOSApp_Other">Other critics say</a> the new guidance will skew the science and potentially scare women away from using increasingly safe forms of HRT. </p>
<p>These guidelines come at a time when women in the UK already feel they have <a href="https://www.theguardian.com/society/2023/dec/11/new-menopause-therapy-hrt-guidance-will-harm-womens-health-say-campaigners">limited access</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657761/">proper menopause support</a> – especially around HRT options. They also come at a time when unjustified fears around HRT risk caused by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/">Women’s Health Initiative</a> in 2002 (which reported that HRT use had more negative than positive effects) are just starting to subside. </p>
<p>Proponents of the decision say CBT would <a href="https://www.theguardian.com/society/2023/dec/14/offering-cbt-for-menopause-symptoms-is-about-giving-women-choice">give women more choice</a> over how they manage their menopause symptoms – and choice is clearly welcome. However, we must be vigilant that such changes to treatment options don’t reduce or delay access to hormonal treatments that, for the majority of women, are very safe and very effective.</p><img src="https://counter.theconversation.com/content/220059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ciara McCabe 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>Critics of the latest menopause guidelines say they could scare women away from using HRT.Ciara McCabe, Professor of Neuroscience, Psychopharmacology and Mental Health, University of ReadingLicensed 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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<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>
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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>
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<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>
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<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/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>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
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<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>
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<em>
<strong>
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>
</strong>
</em>
</p>
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<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<p><iframe id="tc-infographic-572" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/572/661898416fdc21fc4fdef6a5379efd7cac19d9d5/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p><img src="https://counter.theconversation.com/content/218233/count.gif" alt="The Conversation" width="1" height="1" />
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/1983702023-11-07T15:13:05Z2023-11-07T15:13:05Z‘Conversion therapy’: UK government kicks ban down the road – and there’s a major problem with what’s been proposed so far<figure><img src="https://images.theconversation.com/files/557735/original/file-20231106-17-2u8fk5.jpg?ixlib=rb-1.1.0&rect=132%2C68%2C3702%2C2086&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/psychologist-making-notes-during-therapy-session-1486344695">Motortion Films/Shutterstock</a></span></figcaption></figure><p>For the first time in four years, the king’s (or queen’s) speech has left out a promise to ban so-called “conversion therapy”. This widely <a href="https://www.ohchr.org/sites/default/files/Documents/Issues/SexualOrientation/ConversionTherapyReport.pdf">discredited set of practices</a> aims to “cure” LGBTQ+ people by changing or repressing their sexuality or gender identity.</p>
<p>The government first promised a ban in July 2018, but has stalled on introducing draft legislation. The director of external affairs at LGBTQ+ rights charity Stonewall called it an “act of frightful negligence” that the government has not yet banned the practice.</p>
<p>The king’s speech on November 7 <a href="https://www.thepinknews.com/2023/11/06/conversion-therapy-kings-speech-uk-lgbtq/">did not mention</a> the topic. But past <a href="https://www.gov.uk/government/consultations/banning-conversion-therapy/banning-conversion-therapy">proposals</a> indicate that any forthcoming bill will come with one huge caveat: that people over 18 can give their informed “consent” to “conversion therapy”. </p>
<p>Such an exception, as <a href="https://www.theguardian.com/world/2022/jan/30/activists-warn-against-loophole-in-uk-ban-on-conversion-practices">campaigners have warned</a>, would render the ban almost wholly ineffective. Many LGBTQ+ people consent to these practices even when they recognise them as harmful, due to social, familial or religious pressures. Typically, their consent is shaped by powerful influences in their social environment: they want to belong and feel “normal” within their <a href="https://www.gov.uk/government/publications/conversion-therapy-an-evidence-assessment-and-qualitative-study/conversion-therapy-an-evidence-assessment-and-qualitative-study">religious or social communities</a>. </p>
<p>The widely-used term “conversion therapy” is itself problematic. It suggests that a person’s sexuality or gender identity, or their expression of these identities, are a condition that can be cured or treated. Therapy also conveys the misleading idea that there is sound medical or scientific evidence backing conversion practices, as there is with legitimate therapies. These ideas are patently false: LGBTQ+ identities are not illnesses or pathologies, nor is there any evidence that they can be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00013-1/fulltext">changed through “treatment”</a>. </p>
<h2>Why the consent loophole contradicts the law</h2>
<p>To be valid in law, consent must be informed and voluntary. As the government’s <a href="https://www.gov.uk/government/consultations/banning-conversion-therapy/banning-conversion-therapy">consultation documents</a> on conversion practices correctly note, this means that a person “must be given all of the information about what the therapy involves, including the short and longer term risks”. </p>
<p>So, informed consent in this context would require the “therapist” to tell the recipient that there is extensive scientific evidence that conversion practices can cause grave, lifelong physical or psychological harm. This evidence has come from the <a href="https://www.bacp.co.uk/events-and-resources/ethics-and-standards/mou/">NHS</a>, the <a href="https://www.bbc.co.uk/news/magazine-35893729">World Psychiatric Association</a>, the <a href="https://www.ohchr.org/sites/default/files/Documents/Issues/SexualOrientation/ConversionTherapyReport.pdf">United Nations</a> and the <a href="https://www.coe.int/en/web/commissioner/-/nothing-to-cure-putting-an-end-to-so-called-conversion-therapies-for-lgbti-people">Council of Europe</a>, to name just a few.</p>
<figure class="align-center ">
<img alt="A protester's hand holds a handmade sign reading 'conversion therapy' ban it now!" src="https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557728/original/file-20231106-29-fmyqm9.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">Campaigners have called for a conversion therapy ban for years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-united-kingdom-january-18-2023-2251394055">Howard Cheng/Shutterstock</a></span>
</figcaption>
</figure>
<p>The recipient must also be told that there is incontrovertible evidence that “conversion therapy” does not work. This is another point that the government’s proposals <a href="https://www.gov.uk/government/consultations/banning-conversion-therapy/banning-conversion-therapy">expressly recognise</a>. There is no debate, really, among experts on either of those two points. </p>
<p>So, to give their informed consent, recipients must be told that “conversion therapy” puts their health at grave risk and that it does not work. It is difficult to imagine a situation where a “therapist” would or could offer such information. In fact, most people interviewed in <a href="https://www.gov.uk/government/publications/conversion-therapy-an-evidence-assessment-and-qualitative-study/conversion-therapy-an-evidence-assessment-and-qualitative-study#conclusions-1">the government’s own research</a> were not given accurate information about the risks, nor were they offered an alternative.</p>
<h2>When consent isn’t voluntary</h2>
<p>But here is the rub: even if a provider of “conversion therapy” did offer this information, evidence shows that many LGBTQ+ people <a href="https://outrightinternational.org/sites/default/files/2022-09/ConversionFINAL_Web_0.pdf">would still consent to undergo such practices</a> in order to avoid exclusion or rejection from their communities. </p>
<p>This takes us to the second requirement for informed consent: it must be voluntary. Voluntary here means that the decision to consent must be made by the person, and <a href="https://www.gov.uk/government/consultations/banning-conversion-therapy/banning-conversion-therapy">not be influenced by others</a>. </p>
<p>However, truly voluntary consent is not possible here. “Conversion therapy” takes place in a context of historical stigmatisation of LGBTQ+ people, and always involves a strikingly asymmetrical power relationship. Both those points are important. As a 2020 UN report <a href="https://digitallibrary.un.org/record/3870697?ln=en">puts it</a>, “conversion therapy” is a relationship between “enlightened” providers – typically religious authorities, counsellors and psychotherapists – and “benighted converts”.</p>
<p>In a study by the international LGBTQ+ human rights group OutRight, interviewees described enormous family and cultural pressure to undergo “conversion therapy”. As one participant described, this can go on for many years:</p>
<blockquote>
<p>‘Conversion therapy’ is not a single event – it is a process of continued degradation and assault on the core of who you are. There are often repeated violations in the form of psychological and sometimes physical abuse … It is not one instance – it is a continued sense of rejection. The pressure is enormous.</p>
</blockquote>
<p>Conversion practices are objectively humiliating for all LGBTQ+ people, even for those who never experience them themselves. These practices portray LGBTQ+ people as abnormal and disgusting, and their choices in the most intimate spheres of life as an appropriate subject for therapeutic intervention. “Conversion therapy” builds on longstanding stigma and shame felt by LGBTQ+ people, who repeatedly hear (and may internalise) the message that their sexuality or gender identity is inferior to others’, and that it can and should be cured.</p>
<h2>‘Conversion therapy’ and coercive control</h2>
<p>This combination of humiliation, social stigma and power imbalance places all forms of “conversion therapy” squarely within the definition of <a href="https://www.legislation.gov.uk/ukpga/2015/9/section/76/enacted">coercive controlling</a> behaviour in UK law. </p>
<p>Coercive controlling behaviour includes acts of humiliation or intimidation that cause distress to a person. In a relationship of <a href="https://www.cps.gov.uk/legal-guidance/controlling-or-coercive-behaviour-intimate-or-family-relationship">coercive control</a>, perpetrators typically gaslight victims into blaming themselves for any abuse they suffer, or understanding the abuse to be beneficial to them. </p>
<p>Coercive controlling behaviour in the context of domestic abuse is illegal in the UK, regardless of whether someone consented to it. The same should be true of “conversion therapy”.</p>
<p>In terms of international law, the fact that conversion practices combine a proven risk of grave harm with direct discrimination against LGBTQ+ people means that they <a href="https://academic.oup.com/ojls/article/42/1/104/6333646">amount at least to degrading treatment</a>. This is prohibited in international human rights law regardless of whether someone consented to it.</p>
<p>That is why <a href="https://digitallibrary.un.org/record/3870697?ln=en">the UN</a> asked states in 2020 to “prohibit all practices of ‘conversion therapy’, including faith-based organisation counselling, by any person for any reason”. The UK must follow the <a href="https://www.stonewall.org.uk/about-us/news/which-countries-have-already-banned-conversion-therapy">many countries</a> that have comprehensively banned “conversion therapy” without exceptions for individual consent.</p><img src="https://counter.theconversation.com/content/198370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ilias Trispiotis 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>Allowing people to consent to ‘conversion therapy’ would contradict UK and international law.Ilias Trispiotis, Professor of Human Rights Law, University of LeedsLicensed 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>
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<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>
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</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>
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</p>
<hr>
<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">
<figcaption>
<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>
</figcaption>
</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>
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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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<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/2134992023-10-19T12:36:24Z2023-10-19T12:36:24ZNew treatment for postpartum depression offers hope, but the stigma attached to the condition still lingers<figure><img src="https://images.theconversation.com/files/552646/original/file-20231008-19-k1z29z.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5991%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lack of interest in the child is one of the signs of postpartum depression.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-sad-mother-holding-her-sleeping-baby-in-her-royalty-free-image/1489251307?phrase=postpartum+depression&adppopup=true">Drazen Zigic/iStock via Getty Images Plus</a></span></figcaption></figure><p>Postpartum depression can affect anyone, and it often sneaks in quietly, like a shadow in the corners of a new mother’s life. It presents significant challenges for around <a href="https://www.postpartumdepression.org/resources/statistics/">1 in 7 new mothers</a>, affecting their emotional well-being and overall quality of life and that of the newborn. </p>
<p>Many – <a href="https://www.marchofdimes.org/find-support/topics/postpartum/baby-blues-after-pregnancy#">if not most</a> – women experience the “baby blues,” or generalized feelings of sadness, worry, unhappiness and exhaustion, in the initial days after giving birth. In most cases, these mood changes <a href="https://www.nimh.nih.gov/health/publications/perinatal-depression">are resolved in the first two weeks after having a baby</a>. In contrast, the symptoms of postpartum depression endure for more extended periods, sometimes lingering <a href="https://www.nih.gov/news-events/nih-research-matters/postpartum-depression-may-last-years">for up to three years</a>. </p>
<p><a href="https://healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/understanding-motherhood-and-mood-baby-blues-and-beyond.aspx">The symptoms can also start</a> <a href="https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression">during pregnancy</a>. Research shows that more than half of women who <a href="https://doi.org/10.1186/s12888-023-05030-1">experience depression symptoms during pregnancy</a> will develop postpartum depression too.</p>
<p>A much more <a href="https://www.ncbi.nlm.nih.gov/books/NBK544304/#">rare and severe psychiatric disorder</a> following delivery is called postpartum psychosis. Its onset is rapid and severe, with hallucinations, delusions and emotional distress, along with <a href="https://theconversation.com/rare-and-tragic-cases-of-postpartum-psychosis-are-bringing-renewed-attention-to-its-risks-and-the-need-for-greater-awareness-of-psychosis-after-childbirth-201282">bizarre and sometimes dangerous behaviors</a>. About 1 or 2 in 1,000 women experience postpartum psychosis after giving birth.</p>
<p>We are a <a href="https://www.linkedin.com/in/nicole-lynch-dnp-msn-cns-cne-rnc-ob-02088813/">clinical nurse specialist</a> and a <a href="http://www.linkedin.com/in/shannon-pickett-phd-lmhc-77022a42">licensed mental health counselor</a>, and together we have over 45 years of experience as educators and clinicians.</p>
<p>With proper awareness, education and intervention, perinatal mood disorders are <a href="https://ppdil.org/legislation/ppmd-awareness-month/">nearly 100% treatable</a>. We want women to realize that they are not alone, they are not to blame, and with help <a href="https://ppdil.org/what-helps/">they can be well again</a>. </p>
<h2>Crying, sadness and lack of bonding</h2>
<p>Following pregnancy, many women experience normal changes that can mimic symptoms of depression, such as sadness, worry and exhaustion. The transition to motherhood, particularly with a new baby in the home, can be overwhelming. However, it’s essential to distinguish between these common adjustments and <a href="https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression#">more concerning signs of depression</a>.</p>
<p>If you or someone you know finds themselves experiencing any of the following symptoms persistently for over two weeks after giving birth, it’s crucial they reach out to their doctor, nurse or midwife. Here are some of the <a href="https://www.ncbi.nlm.nih.gov/books/NBK519070/#">most-reported symptoms</a> of postpartum depression:</p>
<ul>
<li><a href="https://doi.org/10.1177%2F1745506519844044">Lack of bonding and feeling disconnected</a> from the baby or experiencing a <a href="https://ym.care/rfx">lack of interest in them</a>.</li>
<li>Restlessness or moodiness and feeling unusually agitated or irritable.</li>
<li>Persistent feelings of sadness, hopelessness or being overwhelmed.</li>
<li>Experiencing physical symptoms such as persistent headaches, other body aches and pains or digestive issues that don’t resolve.</li>
<li>A profound lack of energy or motivation, making daily tasks feel daunting.</li>
<li>Significant changes in appetite and either eating too little or too much.</li>
<li>Disturbed sleep patterns, such as sleeping too much or too little, even when given the opportunity to rest.</li>
<li>Difficulty concentrating or making decisions, or experiencing memory problems.</li>
<li>Overwhelming feelings of guilt, worthlessness or inadequacy as a mother.</li>
<li>A notable decline in interest or pleasure in activities previously enjoyed.</li>
<li>Isolating from friends and family, avoiding social interactions.</li>
<li><a href="https://www.ncbi.nlm.nih.gov/books/NBK544304/">Thoughts of</a> <a href="https://theconversation.com/rare-and-tragic-cases-of-postpartum-psychosis-are-bringing-renewed-attention-to-its-risks-and-the-need-for-greater-awareness-of-psychosis-after-childbirth-201282">harming the baby or themselves</a>. These <a href="https://doi.org/10.1007/s10597-022-01002-z">should be taken extremely seriously</a> and <a href="https://doi.org/10.1155%2F2018%2F8262043">warrant immediate attention</a>.</li>
</ul>
<p><a href="https://doi.org/10.1089/jwh.2020.8862">Some risk factors</a> associated with higher likelihood of postpartum depression include life stress, <a href="https://doi.org/10.1177%2F2167702616644894">depression history</a>, maternal anxiety, lack of social support, infrequent exercise, unintended pregnancy and <a href="https://www.nimh.nih.gov/sites/default/files/documents/health/publications/perinatal-depression/perinatal-depression.pdf">intimate partner violence</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/VkpM1WtKW_c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Knowing the warning signs of postpartum depression could prevent a tragedy.</span></figcaption>
</figure>
<h2>Real-life examples</h2>
<p>People dealing with depression not only have to manage their symptoms but may also <a href="https://psycnet.apa.org/doi/10.1037/sah0000431">face the stigma</a> and discrimination that these conditions often bring. There is an expectation that new parents will be happy after delivery. Sadness, stigma, shame or guilt greatly affects a person’s willingness to seek help. Studies show that many people opt not to seek treatment to avoid being <a href="https://doi.org/10.1111/jmwh.13366">perceived as unfit parents by health care providers or family</a>. </p>
<p>As a nurse and a mom who has experienced postpartum depression, I (Nicole Lynch) frequently share my story with others. Years ago, another mom shared with me how helpful it was to hear that she wasn’t alone. Knowing that other women – dedicated parents who love their children – can feel this way and that <a href="https://www.postpartum.net/learn-more/depression/">things can get better gave her hope</a>.</p>
<p>Throughout my career, I (Shannon Pickett) have worked with several mothers and prospective parents who have struggled with postpartum depression. For instance, I worked with one woman for several years about her anxiety and her struggle to conceive. After years of trying, she finally became pregnant. Both she and her husband were overjoyed and could not wait to become parents. </p>
<p>The pregnancy went smoothly and there were no complications. She had never shown any signs of depression previously, but once the baby was born, that changed. My client had trouble bonding with the baby and did not want to hold or console her new son when he needed soothing.</p>
<p>Her husband would often step in to comfort the infant and would ask my client, “What is wrong with you?” It caused frustration within their marriage because the father felt as though he was doing the caregiving alone and that my client was withdrawn. She had planned to take a break from therapy for a bit after the baby was born, but her husband encouraged her to reach out to schedule an appointment. </p>
<p>I could tell right away that she was struggling with postpartum depression. She barely smiled, had difficulty engaging in and concentrating on our conversation and cried throughout most of the session. </p>
<p>We talked a lot about the guilt she felt over not wanting to be around her son or hold him, even though she had fought for so long to become a mother. After receiving a proper diagnosis and starting an antidepressant medication, my client was able to recover and bond with her son. The medication did take a few weeks to get into her system, so the results were not instant. Maintaining her sessions and using her support system were <a href="https://doi.org/10.2147/IJWH.S6938">important for her recovery as well</a>. </p>
<h2>Heightened risk</h2>
<p>While postpartum depression can affect anyone regardless of their socioeconomic status or their background, <a href="https://iris.who.int/bitstream/handle/10665/112828/9789241506809_eng.pdf?sequence=1">some women affected by social inequalities</a> have increased risk of many common postpartum mental disorders and their <a href="https://www.who.int/publications/i/item/9789240045989">adverse consequences</a>. </p>
<p>One study found that new mothers with low incomes, those who had not earned a college degree, were unmarried or were unemployed were 11 times more likely than women with no risk factors to have <a href="https://doi.org/10.1016/j.whi.2009.11.003">clinically elevated depression scores three months after having a baby</a>.</p>
<h2>Inadequate support</h2>
<p>The Centers for Disease Control and Prevention estimates that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a2.htm">about 20% of pregnant women were not asked about depression</a> during a prenatal visit, and more than half of women with postpartum depression remain untreated for their symptoms. </p>
<p>What’s worse, there is a <a href="https://iris.who.int/bitstream/handle/10665/112828/9789241506809_eng.pdf">lack of access to mental health services</a> for women after delivery. Many promising treatments are underexplored, especially in scientific studies. While more people are talking about postpartum depression, there is <a href="https://doi.org/10.1111/jmwh.13366">still stigma around seeking help</a>. </p>
<figure>
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<figcaption><span class="caption">A new oral medication may begin to relieve postpartum depression within three days.</span></figcaption>
</figure>
<h2>A new medication offers hope</h2>
<p>It’s vital to remember that postpartum depression is a treatable condition. Seeking help from health care professionals is a courageous and necessary step. </p>
<p>In August 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression">approved the first oral medication</a>, Zurzuvae, <a href="https://www.youtube.com/watch?v=9085YWhyUTU">specifically intended to treat severe depression after childbirth</a>. It holds promise for addressing the complex array of symptoms associated with postpartum depression and offers newfound hope for affected mothers and their families. </p>
<p>If you are experiencing symptoms of postpartum depression, consider <a href="https://www.psychologytoday.com/us/therapists">finding a therapist</a> in your community for either telehealth or in-person sessions.</p>
<p>There are also <a href="https://ppdil.org/">postpartum support groups</a> that meet in person and online.</p>
<p>Supportive therapies, including counseling, medication and lifestyle adjustments, can significantly alleviate symptoms and improve overall well-being. Early intervention is key to a faster and more complete recovery, ensuring that mothers can enjoy the precious moments with their baby and find fulfillment in motherhood.</p><img src="https://counter.theconversation.com/content/213499/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lynch is a volunteer with the Post Partum Depression Alliance of Illinois <a href="https://ppdil.org/">https://ppdil.org/</a>. She serves as a Visiting Professor at Purdue Global.</span></em></p><p class="fine-print"><em><span>Shannon Pickett serves as University Faculty at Purdue Global.</span></em></p>Half a million new mothers in the US suffer from postpartum depression every year, yet a lack of awareness and stigma toward the condition keep many from getting the help they need.Nicole Lynch, Clinical Nurse Specialist and Visiting Professor of Nursing, Purdue UniversityShannon Pickett, Professor of Psychology and Licensed Mental Health Counselor, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2143252023-10-16T15:38:05Z2023-10-16T15:38:05ZWatching movies could be good for your mental health<figure><img src="https://images.theconversation.com/files/553982/original/file-20231016-27-lbbygb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6170%2C4311&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Film therapy may help people process difficult emotions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-people-watching-sad-movie-cinema-2087654509">Zoran Zeremski/ Shutterstock</a></span></figcaption></figure><p>Many of us enjoy sitting down to watch a good film because of the way movies can make us feel. A sad film might help us release our emotions or a comedy might lift our mood. Movies can also offer a chance to connect with and explore our emotions in a safe way.</p>
<p>Because of the effect that films can have, there’s growing interest in using them as a therapeutic tool. Although this field is still very new, my review of the research so far shows that film therapy <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/capr.12658">can be effective</a> at helping people process difficult emotions – which may help improve mental health.</p>
<p>I found that film <a href="https://www.taylorfrancis.com/books/mono/10.4324/9781315731582/cinema-therapy-john-izod-joanna-dovalis">engages people emotionally</a> in ways that <a href="https://books.google.co.uk/books/about/Reel_Therapy.html?id=xQcGAAAACAAJ&redir_esc=y">can be therapeutic</a>. Talking about movie characters can feel more comfortable than discussing issues directly as it gives the person some <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jcad.12270">emotional distance</a> from what they’re going through. Films can also help people learn <a href="https://onlinelibrary.wiley.com/doi/10.1002/j.1556-6676.1986.tb01229.x">life skills</a> from how movie characters <a href="https://www.sciencedirect.com/science/article/pii/S0191886920305882?via%3Dihub">deal with their challenges</a>. </p>
<p>My review also found that film therapy <a href="https://onlinelibrary.wiley.com/doi/10.1002/jcad.12270">reduced conflict</a> between parents and teenagers, increased empathy and dialogue between them and helped improve communication skills. It’s also shown to <a href="https://www.sciencedirect.com/science/article/pii/S1877042814024331?via%3Dihub">reduce anxiety</a> and make therapy more appealing. </p>
<p>Film therapy was also shown to be particularly beneficial to certain groups of people. For example, research showed film therapy can help <a href="https://onlinelibrary.wiley.com/doi/10.1002/jclp.22997">young autistic people</a> identify their positive strengths and build resilience. It can also help <a href="https://www.tandfonline.com/doi/abs/10.1521/ijgp.2014.64.2.254">psychiatric patients</a> express their thoughts and feelings. Another study also found that watching and <a href="https://search.informit.org/doi/10.3316/informit.529826981952514">discussing superhero movies</a> allowed young people diagnosed with schizophrenia to find strength and meaning in the difficulties they face.</p>
<p>But as research in this field has just begun, it will be important for continued research in this field to explore how people engage with movies to support their wellbeing and who most benefits from film therapy.</p>
<h2>How movies can help</h2>
<p><a href="https://www.penguin.co.uk/books/35250/poetics-by-aristotle/9780241524602">Aristotle</a> noted that audiences of Greek tragedies seemed to go through a beneficial process of emotional purging (or catharsis) through empathy with characters. Watching movies and TV works in a similar way, offering a safe space to feel and express emotions without experiencing real-world implications.</p>
<p>Film brings together <a href="https://hts.org.za/index.php/HTS/article/view/2878">images, story, metaphor and music</a> – all of which are shown to have therapeutic benefits. Movies and TV are also accessible and can offer something familiar and easy to talk about as a basis of therapy conversations.</p>
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<img alt="A young woman wearing headphones watches a movie or show on her laptop." src="https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553985/original/file-20231016-19-pk3etk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Movies can offer a safe space to express emotions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-sad-african-american-woman-watching-1956958240">Fractal Pictures/ Shutterstock</a></span>
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<p>But while research shows film therapy can be beneficial, there has been little guidance on how best to use films in therapy. So after conducting my review, I developed a method that draws together current research and practice to create a series of steps for reflecting on movies that can be used in therapy or on your own. </p>
<p>I called it the “<a href="https://onlinelibrary.wiley.com/doi/full/10.1002/capr.12658">Movie method</a>”, which stands for mindful engagement, observing responses, voicing experience, identifying personal relevance and exploring new possibilities. While working with a therapist is recommended if you’re experiencing mental health difficulties, anyone can use the Movie method to connect more mindfully with the films and TV shows they watch. </p>
<p>The first step of the Movie method involves a mindful check to consider how you’re feeling – and if this is a good day for you to engage with the movie you’ve chosen. Consider the effect watching or reflecting on the movie could have. </p>
<p>If it feels okay to go ahead, mindfully observe and notice your thoughts, feelings and physical responses as you watch. Step back from your feelings without judging them rather than getting swept along with them.</p>
<p>After watching the movie, voice or name any emotions you’re feeling. Writing these down can be useful. Be curious about your feelings, noticing if you have a physical sense of certain emotions in your body – such as tension or relaxation. Sometimes when we notice a feeling, it may change. You can also think about what the feeling needs (for example kindness or understanding) and <a href="https://www.tarabrach.com/selfcompassion1/">imagine receiving this</a>. </p>
<p>Next, identify what the movie means to you. Notice who you identified with and how the character’s journey might remind you of your own challenges and achievements. While movies can offer insight into the lives of different groups and cultures, just be sure to <a href="https://onlinelibrary.wiley.com/doi/10.1002/jclp.22999">think critically</a> about how these characters or issues are portrayed. This can help prevent reinforcing stereotypes or inaccurate representations. </p>
<p>Consider how the movie can help you to explore new possibilities and strategies for growth. Think about how movie characters solved problems and anything you can learn from this. Notice links between the movie story and your personal story and if you would change the story or write a sequel. Reflect on learning from the activity that you may take forward. </p>
<p>The next time you sit down to watch a movie, think about how you can make the most of the experience. Applying film therapy methods may help you engage more mindfully with what you’re watching, and may help you learn new things about yourself as a result.</p><img src="https://counter.theconversation.com/content/214325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Hamilton 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>‘Film therapy’ is a growing area of interest among experts.Jenny Hamilton, Senior Lecturer in Counselling/ Psychological Therapies/ Programme Leader for MSc Counselling, University of LincolnLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2084342023-10-13T12:31:53Z2023-10-13T12:31:53ZThis engineering course has students use their brainwaves to create performing art<figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&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><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Title of course:</h2>
<p>“Arts and Geometry”</p>
<h2>What prompted the idea for the course?</h2>
<p>After a serious injury in 2016, I started drawing and painting during my recovery as a form of self-taught art therapy. I found the experience transformative. During my recovery, I rediscovered Pablo Picasso’s artwork and the geometry of his cubism, which inspired my early paintings.</p>
<p>As making art became part of my life, a desire grew to share this transformative experience with my engineering students. I wanted them to learn how to see science and engineering from a broader perspective – as an artist.</p>
<p>This led to the idea for, and development of, a course on arts and geometry in collaboration with professional artists of the Atlanta community. The play “<a href="https://www.concordtheatricals.com/p/2865/picasso-at-the-lapin-agile">Picasso at the Lapin Agile</a>,” where comedian Steve Martin imagined a conversation in a Parisian cafe between Picasso and Albert Einstein, helped inspire the course. So did a book by history and philosophy of science professor Arthur Miller, “<a href="https://www.arthurimiller.com/books/einstein-picasso/">Einstein, Picasso: Space, Time and the Beauty That Causes Havoc</a>.” </p>
<h2>What does the course explore?</h2>
<p>The course introduces engineering students to the geometry of manifolds – that is, cylinders, spheres or hyperboloids, and more complex surfaces, like a crumpled piece of paper or a rippled kale leaf. It then looks at how these concepts influenced modern arts and sciences: Picasso’s cubism and Einstein’s relativity. Cubism combines many angles to create a new way of seeing things, whereas Einstein’s theory changes how we think about time, which isn’t separate from the space around us – they are intertwined. </p>
<p>The course is integrated with weekly art labs taught over the years by Atlanta professional artists <a href="https://www.createdbyemily.com">Emily Vickers</a>, <a href="https://www.rachelgrantstudio.com/">Rachel Grant</a>, <a href="https://research.gatech.edu/anna-doll">Anna Doll</a> and <a href="https://jerushiagraham.wixsite.com/jerushiagraham">Jerushia Graham</a>, and with the support of music technologist <a href="https://mikewinters.io/">Mike Winters</a>. The artists teach students the fundamentals of several art mediums: <a href="https://issuu.com/ceebuzz/docs/like_picasso_and_einstein_book_fina">pencil and charcoal drawing</a>, printmaking, <a href="https://issuu.com/ceebuzz/docs/forms_and_expression_book_2019_fedele_grant">oil painting</a> and sculptures. </p>
<p>We also teach students how to create performing art using their brainwaves. Brainwaves are produced when we are engaged in any activity. They can be measured by electroencephalography – or EEG – headsets.</p>
<p>Students learn to create auditory or dynamic visual representations of our mind activity when we think, reason, create, dance or relax doing nothing. For example, brainwaves produced by a dancer can be transformed into musical sounds, an auditory representation of the dancer’s movements. Similarly, the brainwaves of an artist making a painting, or those of a mathematician deriving an equation, can be transformed into music that mirrors the act of creating art or math.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ZB7Gk1lVZFM?wmode=transparent&start=419" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Mind melody performance: The brainwaves of artist Rachel Grant making a painting, engineer Francesco Fedele developing equations and choreographer Bella Dorado dancing are transformed into musical sounds designed by student Dennis Frank.</span></figcaption>
</figure>
<p>The same brainwaves can power on or off a set of pumps that produce water jets in a tank, a system designed by professor <a href="https://lai-etal-lab.github.io/author/chris-ck-lai/">Chris Lai</a> and students Muhammad Mustafa and Alexander Zimmer. These jets interact among themselves to produce a disordered turbulent flow in the water tank. The shape and motion of vortexes generated by <a href="https://www.youtube.com/watch?v=OFLOn6fzMKY&ab_channel=73gabbiano">turbulence</a> are a dynamic visualization of the human mind’s activity.</p>
<figure class="align-center ">
<img alt="A student dances on stage while another paints in the background." src="https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=427&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=427&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540377/original/file-20230801-17-2r0ssq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=427&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Choreographer Bella Dorado dances to sounds produced by the brainwaves of student Tanisha Chanda while she paints a waterscape.</span>
<span class="attribution"><span class="source">Francesco Fedele</span></span>
</figcaption>
</figure>
<h2>Why is this course relevant now?</h2>
<p>Civil engineering can be explained and taught using the physics and mathematics of Isaac Newton and Gottfried Leibniz, from the 17th century: the concepts of derivatives and force being proportional to acceleration.</p>
<p>In our fast-changing world, there are exciting discoveries happening in science and technology, like in the understanding of the universe, artificial intelligence and quantum computing.</p>
<p>To prepare for the challenges posed by these recent discoveries, engineering students should be familiar with special mathematical tools developed by 20th-century geniuses such as Elie Cartan and Einstein. Such tools empower students to gain insights such as uncovering hidden geometric structures of complex physical systems or of large amounts of data. Normally, engineering classes don’t teach these topics.</p>
<p>The course also involves the participation of Colombian university students interested in arts for <a href="https://www.100kstrongamericas.org/roboarts-initiative/">the RobotArts Initiative</a>. Such an international exchange seeks to increase the number of Latino engineering students with skills in the arts, engineering and robotics. Besides taking my course, the students from Colombia also take a course on robotics. </p>
<h2>What’s a critical lesson from the course?</h2>
<p>Students realize the <a href="https://doi.org/10.2105/AJPH.2008.156497">mental health benefits</a> of practicing arts. They feel more self-confident and have more <a href="https://apps.who.int/iris/handle/10665/329834">self-esteem</a> because they have created something.</p>
<p>Performing art live empowers students’ self-expression. By not relying on memorization, these performances stimulate spontaneous creativity, improvisation and free thinking.</p>
<figure class="align-center ">
<img alt="Students dance on stage." src="https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540378/original/file-20230801-20-t0wcs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students Dennis Frank, Muhammad Mustafa and Alexander Zimmer performing brain art. In the background, software converts student performers’ brainwaves into music and water turbulence in a tank designed by professor Chris Lai.</span>
<span class="attribution"><span class="source">Francesco Fedele</span></span>
</figcaption>
</figure>
<h2>What materials does the course feature?</h2>
<p>• “<a href="https://www.worldcat.org/title/1112495919">Spacetime and Geometry: An Introduction to General Relativity,</a>” by Sean M. Carroll, Cambridge University Press, 2019 – a textbook that covers the foundations of the general relativity and mathematical formalism.</p>
<p>• “<a href="https://www.arthurimiller.com/books/einstein-picasso/">Einstein, Picasso: Space, Time, and the Beauty That Causes Havoc_</a> by Arthur J. Miller, Perseus Books Group, 2001 – a biography of Albert Einstein and Pablo Picasso.</p>
<p>• EEG headsets to acquire brainwaves and <a href="https://supercollider.github.io/">SuperCollider</a> software to synthesize them into music. </p>
<h2>What will the course prepare students to do?</h2>
<p>The course will prepare students to think like an artist, using abstraction, imagination and fluid thinking. They will tackle with confidence the new engineering quests and challenges of the 21st century. The challenges encompass sustainable urban and ocean infrastructure design for extreme weather, global warming mitigation, clean water and energy, quantum computing, cybersecurity and <a href="https://link.springer.com/chapter/10.1007/978-3-030-69978-9_4">ethical use of AI</a>.</p><img src="https://counter.theconversation.com/content/208434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francesco Fedele 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>Art and science combine in this engineering course to let students turn their brainwaves into creative works.Francesco Fedele, Associate Professor of Civil and Environmental Engineering, Georgia Institute of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092002023-08-28T12:01:17Z2023-08-28T12:01:17ZMedication can help you make the most of therapy − a psychologist and neuroscientist explains how<figure><img src="https://images.theconversation.com/files/544648/original/file-20230824-2975-7ib62y.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1917%2C1564&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medications can open a biological window of opportunity for psychotherapy to take advantage of.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/metaphor-bipolar-disorder-mind-mental-double-royalty-free-illustration/1294477039">melitas/iStock via Getty Images Plus</a></span></figcaption></figure><p>There is mounting recognition in the scientific community that combining different treatment approaches for mental health conditions can <a href="https://doi.org/10.1016/j.biopsych.2018.09.004">create a benefit</a> greater than the sum of its parts.</p>
<p>As a <a href="http://www.canlab.pitt.edu/home/people/">clinical psychologist</a> and <a href="https://scholar.google.com/citations?user=7wB91zsAAAAJ&hl=en">neuroscience researcher</a>, I have been working to integrate insights from both fields to expand treatment options for those suffering from depression, anxiety and related conditions. Designing a treatment plan that pays careful attention to the sequence and dose of both biological and behavioral therapies might benefit people in new ways that neither approach can achieve on its own.</p>
<p><a href="https://doi.org/10.1093/ije/dyu038">Anxiety and depression</a> are the most prevalent mental health conditions around the world. Globally, <a href="https://www.who.int/news-room/fact-sheets/detail/depression">about 280 million people</a> experience depression, and <a href="https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder">as many as 1 in 3</a> will meet the diagnostic criteria for an anxiety disorder at some point in their lives. There are <a href="https://www.nhs.uk/mental-health/conditions/depression-in-adults/treatment/">numerous effective</a> <a href="https://www.nhs.uk/mental-health/conditions/anxiety/types-of-anxiety/">treatment options</a> for both conditions, including medications, psychotherapy, lifestyle changes and neurostimulation. </p>
<p>Doctors and therapists recommend many patients seeking mental health care try <a href="https://evidence.nihr.ac.uk/alert/combined-drug-and-psychological-therapies-may-be-most-effective-for-depression/">more than one approach simultaneously</a>, such as medication and therapy. This is based on the idea that if they were to respond well to any of the prescribed treatments, they would experience a net benefit more quickly or more strongly than if they were to try each sequentially. However, researchers have historically studied each approach in isolation. Most research has focused on comparing individual treatments <a href="https://doi.org/10.1002/wps.20701">one at a time</a> to a control, such as a pill placebo or a psychotherapy waitlist.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/z-IR48Mb3W0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Depression is a leading cause of disability around the world.</span></figcaption>
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<h2>Neuroplasticity and treatment</h2>
<p>Recent advances in scientific understanding of <a href="https://doi.org/10.1016/j.biopsych.2021.05.008">depression</a>, <a href="https://doi.org/10.2147/IJGM.S413176">anxiety</a> and <a href="https://doi.org/10.1016/j.mehy.2005.05.007">other stress-related conditions</a> suggest that changes and impairments in neuroplasticity are critical contributors.</p>
<p>Neuroplasticity refers to the brain’s capacity to flexibly adjust in response to an ever-changing environment – it’s a <a href="https://theconversation.com/cognitive-flexibility-is-essential-to-navigating-a-changing-world-new-research-in-mice-shows-how-your-brain-learns-new-rules-204259">critical component of learning</a>. In animal studies, deficits in neuroplasticity are seen as changes to molecular and neural pathways, such as a decreased number of synapses, or points of contact between neurons, following chronic stress. These changes might be related to <a href="https://doi.org/10.1038/s41380-019-0615-x">mental patterns and symptoms</a> of depression and anxiety in people, such as when patients report a reduced capacity to think, feel and act flexibly. They may also be linked to thinking about, remembering and interpreting information in a way that tends to be biased toward the negative.</p>
<p>Research has shown that many effective biological treatments, including medications and neurostimulation, can <a href="https://doi.org/10.1038/tp.2013.30">enhance or</a> <a href="https://doi.org/10.1016/j.biopsych.2021.05.008">alter neuroplasticity</a>. Certain lifestyle changes such as regular exercise can have similar effects. Scientists consider this key to how they reduce symptoms. Unfortunately, symptoms often return when these treatments are discontinued. Relapse is particularly apparent for medications. For both <a href="https://doi.org/10.1038/s41380-022-01824-z">older</a> and <a href="https://doi.org/10.1001/jamapsychiatry.2019.1189">newer</a> antidepressant and anti-anxiety medications, relapse rates begin climbing shortly after patients stop treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of hand holding pill beside a glass of water on a table" src="https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544652/original/file-20230824-27-homnj8.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">Patients can experience a relapse of symptoms after they stop taking antidepressants or anti-anxiety medications.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unrecognizable-man-holding-a-pill-in-front-of-a-royalty-free-image/1297835134">Vasil Dimitrov/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>In contrast, behavioral treatments such as psychotherapy introduce new skills and and habits that <a href="https://doi.org/10.1146/annurev.psych.57.102904.190044">may be more long-lasting</a>. Benefits continue even after the most intense phase of treatment ends. Regular meetings <a href="https://theconversation.com/cbt-dbt-psychodynamic-what-type-of-therapy-is-right-for-me-171101">with a therapist</a> over the course of several months can help many patients learn to cope with negative symptoms and life circumstances in new ways. But such learning depends on neuroplasticity to forge and retain these new, helpful pathways in the brain.</p>
<p>Researchers hypothesize that enhancing or modulating plasticity with a biological intervention like medication may not only reduce symptoms but may also provide a <a href="https://doi.org/10.1016/j.biopsych.2018.09.004">window of opportunity</a> for behavioral interventions like psychotherapy to be more effective. Learning-based interventions like cognitive-behavioral or exposure therapy, if properly timed, could harness the enhanced neuroplasticity that biological interventions induce and improve long-term outcomes.</p>
<p>Think of pathways in the brain as roads. Biological treatments transform a sparsely connected set of roads – consisting only of a few well-trodden pathways that represent unhelpful thoughts, fears and habits – into a denser network of interconnected, freshly paved roadways. Behavioral treatments can be likened to repeatedly driving over a specific subset of new roads that lead to more balanced perspectives on yourself and the world around you, learning them until you can drive down them effortlessly, no GPS required. This ensures that those now familiar roadways will be readily available to you in the future and protect you against the return of anxiety and depression.</p>
<h2>Synergies in combined treatment</h2>
<p>Designing combined treatments to explicitly promote synergy is relatively new, and there is increasing evidence supporting it. A few specific examples are noteworthy.</p>
<p>First, some studies have shown that <a href="https://doi.org/10.1097%2FHRP.0000000000000183">D-cycloserine</a>, an antibiotic used to treat tuberculosis, may make <a href="https://doi.org/10.1001/jamapsychiatry.2016.3955">exposure therapy for anxiety conditions</a> more effective by helping patients learn to quell their fears. D-cycloserine may also enhance the antidepressant effects of a type of neurostimulation called <a href="https://doi.org/10.1001/jamapsychiatry.2022.3255">transcranial magnetic stimulation</a>, which stimulates nerve cells using magnetic fields.</p>
<p>Several studies suggest that pairing neurostimulation with cognitive-behavioral approaches like cognitive-behavioral therapy or cognitive control training may yield <a href="https://doi.org/10.1016/j.biopsych.2018.09.004">longer-term reductions in depression and anxiety</a>.</p>
<p>Similarly, low doses of ketamine, a drug used in general anesthesia, with rapid antidepressant effects, can be used to “<a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220216">prime the pump</a>” <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">for new, helpful learning</a>. A study my team and I conducted found that daily computer-based exercises of 30 to 40 minutes over four days following a single ketamine dose led to a ninefold increase in the duration of antidepressant effects – <a href="https://doi.org/10.1001/jamanetworkopen.2023.12434">90 days of reduced symptoms</a> – compared with ketamine alone, which led to 10 days of reduced symptoms.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dYN64GJzGfc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Researchers are exploring the potential of psychedelics to treat many mental health conditions.</span></figcaption>
</figure>
<p>Finally, there is increasing interest in using other medications with psychedelic properties to assist in psychotherapy. The therapeutic benefits of taking these <a href="https://doi.org/10.1007/s11920-022-01363-y">psychedelic-assisted therapies</a> under medical supervision are attributed to the rapid <a href="https://doi.org/10.1523/JNEUROSCI.1121-22.2022">neuroplasticity-enhancing</a> and consciousness-altering effects of drugs like psilocybin and MDMA. Researchers think these short-term effects foster new insights and perspectives that psychotherapists can help patients integrate into their permanent worldview.</p>
<p>There is great potential in neuroscience-guided ways to combine treatments. However, it’s important to note that different treatment approaches can occasionally work against each other, <a href="https://doi.org/10.1016/S0272-7358(97)00084-6">lessening the long-term benefits of psychotherapy alone</a>. For example, one study on panic disorder found that patients who learned psychotherapy techniques while taking anti-anxiety medication had a <a href="https://jamanetwork.com/journals/jama/fullarticle/192707">greater chance of relapse</a> after discontinuing their use compared with those given psychotherapy alone.</p>
<p>Carefully designed clinical trials and long-term follow-ups are needed to fully understand how to combine the biological and the behavioral to develop treatments that are efficient, accessible, safe and enduring.</p><img src="https://counter.theconversation.com/content/209200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Price receives funding from the National Institute of Mental Health and the Laurel E. Zaks Memorial Research Fund and is named as the inventor on a University of Pittsburgh-owned patent filing relevant to synergistic bio-behavioral treatments for anxiety and depression.</span></em></p>Combining psychotherapy with medication can lead to more immediate and enduring results by boosting the brain’s neuroplasticity.Rebecca Price, Associate Professor of Psychiatry and Psychology, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115132023-08-16T04:51:48Z2023-08-16T04:51:48ZNot all mental health apps are helpful. Experts explain the risks, and how to choose one wisely<figure><img src="https://images.theconversation.com/files/542935/original/file-20230816-15-67z0ok.jpeg?ixlib=rb-1.1.0&rect=49%2C30%2C4044%2C2694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others. You would think such “health” and “wellbeing” apps – which often present as solutions for conditions such as <a href="https://www.headspace.com/">anxiety</a> and <a href="https://www.calm.com">sleeplessness</a> – would have been rigorously tested and verified. But this isn’t necessarily the case. </p>
<p>In fact, many may be taking your money and data in return for a service that does nothing for your mental health – at least, not in a way that’s backed by scientific evidence. </p>
<h2>Bringing AI to mental health apps</h2>
<p>Although some mental health apps connect users with a <a href="https://www.betterhelp.com/get-started/?go=true&utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=betterhelp+australia_e&utm_content=133525856790&network=g&placement=&target=&matchtype=e&utm_campaign=15228709182&ad_type=text&adposition=&kwd_id=kwd-401317619253&gclid=Cj0KCQjwoeemBhCfARIsADR2QCtfZHNw8mqpBe7cLfLtZBD-JZ5xvAmDCfol8npbAAH3ALJGYvpngtoaAtFlEALw_wcB¬_found=1&gor=start">registered therapist</a>, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals. </p>
<p>These apps also increasingly claim to be incorporating artificial intelligence into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s <a href="https://help.netflix.com/en/node/100639">recommendation algorithm</a>.</p>
<p>Some apps such as <a href="https://legal.wysa.io/privacy-policy#aiChatbot">Wysa</a>, <a href="https://www.youper.ai/">Youper</a> and <a href="https://woebothealth.com/">Woebot</a> use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use. </p>
<p>It’s likely most of these AI chatbots use <a href="https://www.techtarget.com/searchenterpriseai/feature/How-to-choose-between-a-rules-based-vs-machine-learning-system">rules-based systems</a> that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often <a href="https://www.vice.com/en/article/pkadgm/man-dies-by-suicide-after-talking-with-ai-chatbot-widow-says">harmful and inappropriate</a>) outputs AI chatbots have become known for – but there’s no guarantee. </p>
<p>The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.</p>
<h2>Misleading marketing and a lack of supporting evidence</h2>
<p>Mental health apps might be able to provide certain benefits to users <em>if</em> they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.</p>
<p>The <a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">clinical value</a> of automated mental health and mindfulness apps is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1077722918300233?casa_token=lwm1E6FhcG0AAAAA:saV7szbZl4DqbvmZiomLG9yMWi_4-zbmy3QCtQzVEQr957QX1E7Aiqkm5BcEntR0mVFgfDVo">still being assessed</a>. Evidence of their efficacy is generally <a href="https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000002">lacking</a>. </p>
<p>Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on: </p>
<ul>
<li><a href="https://sensa.health/">user testimonials</a></li>
<li>short-term studies with narrow <a href="https://www.wired.co.uk/article/mental-health-chatbots">or homogeneous cohorts</a></li>
<li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533203/#">studies involving</a> researchers or funding from the very group <a href="https://www.theguardian.com/us-news/2022/apr/13/chatbots-robot-therapists-youth-mental-health-crisis">promoting the app</a></li>
<li>or evidence of the benefits of a <a href="https://www.headspace.com/meditation/anxiety">practice delivered face to face</a> (rather than via an app).</li>
</ul>
<p>Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes. </p>
<p>For some users, mental health apps may even cause harm, and lead to increases in the very <a href="https://pubmed.ncbi.nlm.nih.gov/34074221/">symptoms</a> people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">While a well-designed mental health app may bring benefits to a user, this shouldn’t be confused with evidence of efficacy.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In the case of most mental health apps, research on their effectiveness won’t have considered <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505389/">individual differences</a> such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-effective-is-mindfulness-for-treating-mental-ill-health-and-what-about-the-apps-182436">How effective is mindfulness for treating mental ill-health? And what about the apps?</a>
</strong>
</em>
</p>
<hr>
<h2>Inadequate privacy protections</h2>
<p>Mental health apps are subject to standard consumer protection and privacy laws. While data protection and <a href="https://cybersecuritycrc.org.au/sites/default/files/2021-07/2915_cscrc_casestudies_mentalhealthapps_1.pdf">cybersecurity</a> practices vary between apps, an investigation by research foundation Mozilla <a href="https://foundation.mozilla.org/en/privacynotincluded/articles/are-mental-health-apps-better-or-worse-at-privacy-in-2023">concluded that</a> most rank poorly. </p>
<p>For example, the mindfulness app <a href="https://www.headspace.com/privacy-policy">Headspace</a> collects data about users from a <a href="https://foundation.mozilla.org/en/privacynotincluded/headspace/">range of sources</a>, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict <a href="https://legal.wysa.io/privacy-policy">users’ moods</a>, and use anonymised user data to train the language models <a href="https://www.youper.ai/policy/privacy-policy">underpinning the bots</a>.</p>
<p>Many apps share so-called <a href="https://theconversation.com/popular-fertility-apps-are-engaging-in-widespread-misuse-of-data-including-on-sex-periods-and-pregnancy-202127">anonymised</a> data with <a href="https://www.wysa.com/">third parties</a>, such as <a href="https://www.headspace.com/privacy-policy">employers</a>, that sponsor their use. Re-identification of <a href="https://www.unimelb.edu.au/newsroom/news/2017/december/research-reveals-de-identified-patient-data-can-be-re-identified">these data</a> can be relatively easy in some cases.</p>
<p>Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">health and lifestyle</a> products or tools for <a href="https://www.tga.gov.au/sites/default/files/digital-mental-health-software-based-medical-devices.pdf">managing mental health</a> that are excluded from TGA regulations (provided they meet certain criteria).</p>
<h2>How can you choose an app?</h2>
<p>Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as <a href="https://onemindpsyberguide.org/apps/">usability</a> or <a href="https://foundation.mozilla.org/en/privacynotincluded/categories/mental-health-apps/">privacy</a>. Different guides may also be inconsistent with each other.</p>
<p>Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.</p>
<ol>
<li><p>consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual</p></li>
<li><p>check whether a mental health professional or trusted institution was involved in developing the app </p></li>
<li><p>check if the app has been rated by a third party, and compare different ratings</p></li>
<li><p>make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront</p></li>
<li><p>stop using the app if you experience any adverse effects.</p></li>
</ol>
<p>Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ai-chatbots-are-still-far-from-replacing-human-therapists-201084">AI chatbots are still far from replacing human therapists</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeannie Marie Paterson receives funding from the Australian Research Council and has taken part in industry led roundtable discussions about digital mental health. </span></em></p><p class="fine-print"><em><span>Nicholas T. Van Dam receives funding from the Three Springs Foundation Pty Ltd to establish the Contemplative Studies Centre at the University of Melbourne. </span></em></p><p class="fine-print"><em><span>Piers Gooding receives funding from the Australian Research Council to examine the regulation of digital technologies in mental health care.</span></em></p>Claims regarding on these apps’ effectiveness are often based on less than robust findings.Jeannie Marie Paterson, Professor of Law, The University of MelbourneNicholas T. Van Dam, Associate Professor, School of Psychological Sciences, The University of MelbournePiers Gooding, Postdoctoral Research Fellow, Disability Research Initiative, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2089332023-08-14T19:59:56Z2023-08-14T19:59:56ZGroup therapy helps scientists cope with challenging ‘climate emotions’<figure><img src="https://images.theconversation.com/files/542535/original/file-20230814-17-ohf9m7.jpg?ixlib=rb-1.1.0&rect=87%2C7%2C5238%2C3537&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Rawpixel.com, Shutterstock</span></span></figcaption></figure><p>As <a href="https://theconversation.com/why-are-so-many-climate-records-breaking-all-at-once-209214">climate records</a> tumble and <a href="https://theconversation.com/australia-is-sleepwalking-a-bushfire-scientist-explains-what-the-hawaii-tragedy-means-for-our-flammable-continent-211364">wildfires rage</a>, people all over the planet are feeling the toll. </p>
<p>Negative emotional responses such as anger, fear, sadness and despair recorded in <a href="https://researchportal.bath.ac.uk/en/publications/climate-anxiety-in-children-and-young-people-and-their-beliefs-ab">children and young people</a> are also felt by <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00318-1/fulltext">climate scientists</a>. But positive emotions such as hope are also part of the picture. </p>
<p>Anxiety is a natural response to these conflicting emotions. The <a href="https://theconversation.com/feel-alone-in-your-eco-anxiety-dont-its-remarkably-common-to-feel-dread-about-environmental-decline-170789">consequences</a> range from trouble sleeping, to difficulty working and socialising. Climate anxiety can also exacerbate or trigger other mental health problems. </p>
<p>In <a href="https://doi.org/10.23668/psycharchives.12971">our new research</a>, we explored using group therapy to create a safe space for scientists to share their feelings. Such safe spaces are vital for people to understand and process their emotions and ultimately find the strength and resilience to continue their important work. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/R42wwzY0VYc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How do you deal with climate anxiety? (ABC TV - BTN High)</span></figcaption>
</figure>
<h2>Anxiety can trigger action</h2>
<p>Climate anxiety has not been classified as a <a href="https://theconversation.com/is-climate-anxiety-a-clinical-diagnosis-should-it-be-202232">mental health disorder</a>. Some researchers <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00072-9/fulltext">warn against</a> calling it a disease, because this implies it’s caused by some type of dysfunction within the individual, requiring therapeutic intervention, perhaps even medication.</p>
<p>Rather, they argue climate anxiety can be a catalyst for action. It is also a reasonable response to what is a significant existential risk.</p>
<p>We know <a href="https://link.springer.com/article/10.1007/s12144-022-02735-6">collective</a> and <a href="https://iopscience.iop.org/article/10.1088/1748-9326/abc4ae">individual climate action</a> can alleviate negative climate emotions. </p>
<p>We also know negative emotions such as <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0188781">guilt</a> are less motivating than positive emotions. The <a href="https://journals.sagepub.com/doi/10.1177/1075547008329201">limitations</a> of fear as a motivator are <a href="https://www.nature.com/articles/s41558-019-0511-z">well documented</a>.</p>
<h2>A fly on the wall</h2>
<p>Over two days, seven environmental scientists participated in intensive group therapy facilitated by a qualified psychologist. They shared their feelings about climate change, discussed academic pressures, and how their individual identities intersected with their professional roles and research. </p>
<p>We analysed transcripts from these sessions and found:</p>
<ul>
<li>1. Deep awareness of the climate crisis puts scientists at greater risk of mental health problems. As one participant said, </li>
</ul>
<blockquote>
<p>It’s very easy to fall into this vortex, right? Of thinking about climate change as a problem and not just climate change, but […] global environmental change, ecological loss.</p>
</blockquote>
<ul>
<li>2. The nature of academia means climate emotions overlap with “intersectionality” (the interconnected nature of race, class, gender and so on) to worsen their experience. According to one scientist,</li>
</ul>
<blockquote>
<p>I always tell students you have to do experiments in pairs, documented, because as a person of colour, I would be doubted, you know, if we made that great discovery.</p>
</blockquote>
<ul>
<li>3. Scientists do not talk about the emotional toll of their working knowledge. As one said:</li>
</ul>
<blockquote>
<p>How do you talk to your colleagues [about climate change] We don’t talk about it. We don’t talk about how [climate change] is making us feel. And I didn’t know if that was just me, but I was also like, why don’t we talk about it?</p>
</blockquote>
<ul>
<li>4. Safe spaces such as group therapy can have an immediate valuable cathartic effect. One participant observed:</li>
</ul>
<blockquote>
<p>I’m privileged to be sitting here with an amazing group of people. I think what came out of this conversation, [from] the way things have been framed and reframed and picked apart and put back together again, is incredibly useful.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-anxiety-is-real-why-talking-about-it-matters-172813">Climate anxiety is real. Why talking about it matters</a>
</strong>
</em>
</p>
<hr>
<h2>More work to be done</h2>
<p>Our findings support the value of group therapy as a cathartic outlet for climate emotions among environmental scientists. But further research is needed before this intervention is offered routinely within research institutions, among existing colleagues and peers. </p>
<p>In this case the scientists were strangers from across the United States, brought together by a Swedish documentary film crew. That may have made them more inclined to open up and share their emotions. </p>
<p>We also need to know how long this cathartic effect lasts, and what long-term support might be necessary to foster lasting benefits.</p>
<p>Different generations and groups experience a wide range of different climate emotions. Equally, a wide range of solutions must be made available to help people, particularly environmental scientists, deal with the negative emotions affecting their daily lives. </p>
<p>Group therapy is not a silver bullet, but it does show promise. The tool allows people to share their emotions, realise they are not alone, and gain a sense of community and catharsis from spending dedicated time with others who find themselves in similar situations.</p>
<p>As the climate crisis continues to worsen, more people will be exposed to harm. Even more will be exposed to reports and news coverage discussing our increasingly uncertain future. As a result, climate anxiety is likely to become more prolific, perhaps most so in climate scientists. This presents a real and urgent need to explore how we manage and process climate anxiety.</p>
<p>While <a href="https://link.springer.com/article/10.1007/s12144-022-02735-6">collective and individual action</a> offer ways to reduce climate anxiety indirectly, we also need more platforms for knowledge sharing, more safe spaces and more research into managing the mental health impacts that we are all clearly already feeling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-phrases-like-global-boiling-help-or-hinder-climate-action-210960">Do phrases like 'global boiling' help or hinder climate action?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/208933/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>Scientists need safe spaces to understand and process “climate emotions”. Group therapy helps people find the strength and resilience to continue their important work, without harming their health.Joe Duggan, PhD Candidate, Fenner School of Environment and Society, Australian National University, Australian National UniversityNeal Robert Haddaway, Senior Research Fellow, Africa Centre for Evidence and Stockholm Environment Institute, University of JohannesburgLicensed 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>
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</em>
</p>
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<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>
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<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>
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</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>
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<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>
<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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<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/2058812023-06-26T16:14:13Z2023-06-26T16:14:13ZHow music therapy can help rebuild the lives of refugees<figure><img src="https://images.theconversation.com/files/532732/original/file-20230619-15-kln7gp.jpg?ixlib=rb-1.1.0&rect=44%2C22%2C7304%2C4704&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Music therapy is well-placed to provide support in addressing trauma and promoting wellbeing.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/music-note-art-sound-instrumental-concept-465116960">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>Over the past 20 years, the number of people forcibly displaced from their homes worldwide due to conflict has reached a figure <a href="https://www.unhcr.org/about-unhcr/who-we-are/figures-glance">in excess of 90 million</a>. This has more than doubled since the early 1990s, a time period labelled “<a href="https://academic.oup.com/jrs/article/33/4/639/6209808">the decade of displacement</a>” by the United Nations Refugee Agency. This rate of increase shows no signs of slowing and has been fuelled by the current situations in Syria and Ukraine.</p>
<p>Whatever the reason for displacement, there is no doubt that <a href="https://istss.org/getattachment/Education-Research/Briefing-Papers/Trauma-and-Mental-Health-in-Forcibly-Displaced-Pop/Displaced-Populations-Briefing-Paper_Final.pdf.aspx">being forced to leave your homeland is traumatic</a>. The journey to a safer place can be physically and emotionally challenging. <a href="https://www.europeanea.org/wp-content/uploads/2022/03/Stress-and-refugees.pdf#:%7E:text=Common%2520reactions%2520after%2520traumatic%2520life%2520events%2520include%253A%2520-,plan%2520for%2520the%2520future%253B%2520pre-occupation%2520with%2520the%2520past.">Shock and denial</a> are often the first emotions experienced by refugees. </p>
<p>Long-term problems include unmanageable emotions, flashbacks and difficulty with relationships. Physical symptoms such as nausea and headaches may also occur. While practical support such as providing physical safety, food and clothes and medical help are crucial, psychological support also needs to be offered.</p>
<h2>Music therapy</h2>
<p><a href="https://academic.oup.com/mtp/article-abstract/41/1/e30/6608838?redirectedFrom=fulltext">Music therapy</a> is well-placed to provide support in addressing trauma and promoting wellbeing. It is a psychological therapy which is regulated by the <a href="https://www.hcpc-uk.org">Health and Care Professions Council</a> (HCPC) in the UK. Music therapists use a range of music-based interventions including interactive music-making, songwriting and listening to music. These help to build a therapeutic relationship with participants. </p>
<p>Music therapy offers a flexible and accessible way of supporting wellbeing and sharing difficult experiences. It can also bring positive memories of the cultures from which refugees have come. These can be shared with others and help to build resilience.</p>
<p>In the early stages of trauma, music can be part of a psychological first aid (PFA) package. PFA is usually offered in the initial aftermath of a traumatic event as well as in later stages. It seeks to provide people with <a href="https://pubmed.ncbi.nlm.nih.gov/18181708/">safety, connections and hopefulness</a>. The integration of these elements into music-based and music therapy interventions is useful for refugees. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/esol-english-classes-are-crucial-for-migrant-integration-yet-challenges-remain-unaddressed-204415">Esol English classes are crucial for migrant integration, yet challenges remain unaddressed</a>
</strong>
</em>
</p>
<hr>
<p>Music is something found in every culture. People carry their own musical experiences with them wherever they go and can call on them for solace. Music can also be a go-to resource for those needing comfort. With such a huge range of musical genres and styles, there is something for everyone. </p>
<p>Because music is comprised of a series of different patterns – something the brain is attracted to and actively <a href="https://pubmed.ncbi.nlm.nih.gov/35352057/">seeks out</a> – there are opportunities for emotional regulation. This is central to supporting refugees’ wellbeing. </p>
<p>Moreover, music-making with a music therapist in the immediate aftermath of trauma offers the opportunity to build relationships, stabilise feelings and reduce anxiety. These are crucial steps in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744879/">mitigating the impact of trauma</a>. </p>
<figure class="align-center ">
<img alt="A boy and a man sit at a table. The boy is playing a colourful xylophone." src="https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532739/original/file-20230619-27-nobb2t.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">Music is comprised of a series of different patterns, something the brain is attracted to and actively seeks out.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-psychologist-working-little-boy-office-2097484426">Pixel-Shot/Shutterstock</a></span>
</figcaption>
</figure>
<p>During the course of <a href="https://voices.no/index.php/voices/article/view/2539/2310">my research</a>, I have worked with a range of displaced people, including refugees and asylum-seeking families, focusing on families with children under the age of 3. My studies have shown that people who have had music therapy find it useful and supportive for a number of reasons. </p>
<p>It offers a safe space to meet others in music without the need for words or explanations. This space supports the development of feelings of safety as well as awakening creativity – something that is vital for mental health. Music therapy also fosters and builds connections with others in the same situation. </p>
<p>My projects used the core principles of PFA linked to music therapy for small groups of asylum-seeking families from Albania, Egypt, Syria and Pakistan. The simple, structured activities needed minimal English, so were accessible. </p>
<p>Movement to music, communication through rhythm games, free improvisation and songs from participants’ homelands as well as music from the UK were all used to engage the groups. This helped families feel a sense of belonging in their new home.</p>
<h2>Feeling safe</h2>
<p>The predictability of the sessions’ content was also helpful. People who experience trauma need help to feel safe, and providing a structured session does this. They also facilitated language development and social skills for the children. </p>
<p>Bonding as a family, something that can be disrupted by trauma, was also improved. To support this therapists can use lullabies and children’s songs from the original cultures of the families, as well as UK-based tunes – Twinkle Twinkle Little Star is always very popular.</p>
<p>Music and music therapy are useful tools to employ in planning PFA and continuing therapeutic support for refugees. While it is important to be sensitive to the wishes of refugee families who may not be ready to engage in musical activities, it is crucial that this provision is available to those who do wish to access it. </p>
<p>Refugees who engage with music and music therapy in their new homes often report improvements in their ability to manage their situation and move forward. Finding ways to offer access to these opportunities more widely will benefit greater numbers of those seeking to build new lives.</p><img src="https://counter.theconversation.com/content/205881/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Coombes 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>Music therapy offers a flexible and accessible way of supporting wellbeing and addressing traumatic experiences.Elizabeth Coombes, Senior Lecturer in Music Therapy, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021212023-04-02T11:46:43Z2023-04-02T11:46:43ZIn Canada’s two-tiered mental health system, access to care is especially challenging in rural areas<figure><img src="https://images.theconversation.com/files/518825/original/file-20230331-1042-xtdw0z.jpg?ixlib=rb-1.1.0&rect=77%2C325%2C4508%2C2879&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psychologists can be found in the public system (for example, schools, hospitals, public health offices), but increasingly are choosing to work in private practice, fee-for-service, clinics. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Rural Canadians face <a href="https://doi.org/10.1007/s40688-016-0110-1">mental health concerns to the same degree as their urban counterparts</a>, but rural communities have less access to psychologists, and that access may be eroding. Psychologists can be found in the public system (for example, schools, hospitals, public health offices), but increasingly are choosing to work in private practice, in fee-for-service clinics. </p>
<p>Despite <a href="https://www.canada.ca/en/public-health/news/2022/04/government-of-canada-invests-in-mental-health-and-distress-centres0.html">increasing discussion about investment into accessing mental health services</a>, as trainers of psychologists, we are <a href="https://www.ctvnews.ca/health/some-canadians-waiting-months-for-public-and-private-mental-health-services-1.6204350">observing fewer psychologist positions</a> and reduced focus on retaining psychologists within the public mental health system in Canada.</p>
<p>Not addressing these issues may have detrimental results for Canadians, such as:</p>
<ul>
<li> receiving services from non-psychologists who may not have the needed expertise to address present mental health challenges</li>
<li> participating in a two-tier system where only those who can pay for mental health care can receive it; and </li>
<li> exacerbating these issues for rural Canadians.</li>
</ul>
<h2>Where is the public investment in Canadians’ mental health?</h2>
<p>Problems retaining psychologists are <a href="https://www.canadianmountainnetwork.ca/blog/improving-access-to-mental-health-services">particularly evident in rural regions</a>, where issues like <a href="https://doi.org/10.1037/0735-7028.34.4.430">professional isolation, role confusion and burnout</a> are contributing to a crisis in mental health care access.</p>
<p>Rural clinicians are reporting <a href="https://doi.org/10.1177/0840470420933911">increased demand for mental health services</a>. This might be quickly interpreted to signal a higher degree of distress rates. However, it might instead be a sign that there are not enough psychologists — let alone integrated inter-professional mental health teams — to meet rural Canadians’ needs. </p>
<p>In rural settings, specialized mental health services are often not locally accessible, particularly in terms of early screening, treatment, tertiary care, teletherapy, integrated health services and community approaches. All these approaches have been suggested by <a href="https://www.researchgate.net/publication/332947233">policymakers to improve mental health service access in rural spaces</a>. </p>
<p>Access to needed services for all Canadians is central to the <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html">Canada Health Act</a>. So where are they for rural Canadians? </p>
<p>While the Canadian government has announced billions in additional funding for mental health care and addictions, experts and practitioners acknowledge that <a href="https://www.cbc.ca/news/politics/canada-mental-health-federal-government-1.6761689">the public system has not kept up with needs</a>. </p>
<p>This leads us to ask: is mental health a responsibility of publicly funded health care, like a broken leg or cancer? Or has it fallen into a category of services that are necessary yet have limited coverage, such as dental care? The lines delineating what constitutes health seem arbitrary.</p>
<p>Sarah Kennell, director of public policy at the Canadian Mental Health Association, has stated, “<a href="https://www.cbc.ca/news/politics/canada-mental-health-federal-government-1.6761689">We can no longer continue to view mental health as not on par with physical health</a>.” </p>
<p>Investment is needed so that we can address the exodus of <a href="https://cjc-rcc.ucalgary.ca/article/view/61191">psychologists exiting the public system for private practice</a>.</p>
<h2>What is a psychologist?</h2>
<p>Psychologists are experts in mental health and provide essential services in identifying and treating behavioural disorders and difficulties. In collaboration with physicians and nurse practitioners, both of whom can prescribe pharmacological therapies, <a href="https://www.apadivisions.org/division-55/publications/tablet/2015/04/combininations">best outcomes for mental illness treatment</a> are observed when medications are paired with evidence-based psychological interventions.</p>
<figure class="align-center ">
<img alt="A man and a woman wearing lanyards discussing something while walking in a corridor" src="https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518824/original/file-20230331-14-yqmubl.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">Rural psychologists also need to work collaboratively with other health-care providers and mental health practitioners including counsellors, social workers and physicians.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Psychologists are a regulated profession requiring <a href="https://doi.org/10.1177/0829573516652992">graduate training, clinical supervision and comprehensive examination to enter practice</a>, and <a href="https://doi.org/10.1177/08295735221121059">continuing professional development to sustain competency over their careers</a>. Psychologists have at least six to twelve years of focused post-secondary training accredited by <a href="https://acpro-aocrp.ca/">provincial boards</a> that align with <a href="https://cpa.ca/docs/File/MRA.pdf">national standards</a> for competent and ethical practice.</p>
<p>Within rural areas, psychologists may often be asked to provide a range of services that are beyond their training and expertise. This results in a rural practice of psychology that is <a href="https://doi.org/10.1037/cap0000308">generalist in nature</a>, requiring <a href="https://cpa.ca/docs/File/Sections/RuralNorthern/fall_2019.pdf">rural psychologists to know a little about a lot</a>. </p>
<p>Rural psychologists also need to <a href="https://doi.org/10.1080/2372966X.2021.1949247">work collaboratively</a> with other health-care providers and mental health practitioners including counsellors, social workers and physicians. Noting of course, that these professions are also <a href="https://cpa.ca/docs/File/cpapadvocacyproject/rural.pdf">disproportionately allocated to urban settings</a>.</p>
<p>In the public system, many psychologists are frustrated by a failure to appropriately distribute responsibilities <a href="http://www.apnl.ca/assets/PDFS/APNL-Member-Survey-Feb-2022.pdf">between licensed psychologists, and other practitioners</a> and counsellors with minimal training in therapy. <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2017-07/Options_for_improving_access_to_counselling_psychotherapy_and_psychological_services_eng.pdf">That means resources are poorly deployed</a> and people may not get a suitable mental health practitioner for their needs. </p>
<figure class="align-center ">
<img alt="A woman with a clipboard talking to a young boy" src="https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518823/original/file-20230331-24-atj7uq.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">The exodus of psychologists from the public system means that experts in mental health are accessible only to those who can afford them.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This results in <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/nl-psychologists-demand-rising-1.6352139">fewer psychologists working in the public system</a> and subsequently <a href="https://montrealgazette.com/opinion/opinion-as-private-sector-psychologists-were-speaking-up-for-the-public-system">more opting to work in private practice</a>. </p>
<p>Ultimately, this movement means that experts in mental health are accessible only to those who can afford them. Further, the private system tends to provide service in an out-patient setting to clients who are generally functioning in their day-to-day lives, whereas the public system serves a wider range including inpatient and high-needs care. </p>
<p>This exodus of psychologists from the public system results in a service-expertise mismatch, in that psychological care is more available to mild to moderate mental health concerns through private practices, and less psychological care is available for severe to profound cases within the public system.</p>
<h2>Brain drain to Canada’s cities</h2>
<p>Our team observes that these impacts are more <a href="https://omsa.ca/sites/default/files/media/inadequate_mental_health_supports_in_rural_and_northern_ontario_communities.pdf">directly felt within rural spaces in Canada</a>. Rural citizens often find it difficult to access psychologists who work within the public system. Many psychologists have increasing wait lists, and are administratively forced into <a href="https://doi.org/10.1177/08295735211037810">assessment-only diagnostic practice</a>, preventing opportunities to provide direct therapeutic services. Once a diagnosis is made, counselling therapy is provided by less-trained practitioners.</p>
<p>Issues of isolation also impact the availability of psychologists in rural areas. This contributes to <a href="https://www.apa.org/pubs/journals/features/rmh-0000002.pdf">the burnout experienced by several rural psychologists</a>, resulting in their leaving the rural or public system <a href="https://montreal.citynews.ca/2023/01/04/psychologist-public-students-quebec/">within five years of practice</a>, further exacerbating the disproportionate prevalence of psychologists between rural and urban/suburban regions.</p>
<p>Our team is concerned the rhetoric of increased investment in mental health does not address the systemic issues impacting psychologist engagement in the public system. Ultimately, leaving these issues unaddressed may further erode both access and standard of care for those seeking mental health services, and limit services to those who are able to pay for them. Rural Canadians are already affected.</p><img src="https://counter.theconversation.com/content/202121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor Barker receives funding from Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Krista C Ritchie receives funding from Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Sara King receives funding from Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Veronica Hutchings received funding from Canadian Institutes of Health Research. She is the chair of the Section on Rural and Northern Psychology of the Canadian Psychological Association. </span></em></p>Rural Canadians face challenges accessing mental health services, and an exodus of psychologists from the public system may make matters worse.Conor Barker, Assistant Professor, Department of Psychology & Faculty of Education, Mount Saint Vincent UniversityKrista C Ritchie, Associate Professor, Faculty of Education, Mount Saint Vincent UniversitySara King, Associate Professor, Faculty of Education, Mount Saint Vincent UniversityVeronica Hutchings, Associate professor, Psychology, Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1974252023-03-29T02:29:50Z2023-03-29T02:29:50ZA therapist reckons with her own trauma, in the shadow of Australia’s collective shame<figure><img src="https://images.theconversation.com/files/517367/original/file-20230324-20-bs55am.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C2995%2C1985&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Elena Saharova/Pexels</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The plot of Jacinta Halloran’s fourth novel <a href="https://www.textpublishing.com.au/books/resistance">Resistance</a> is straightforward. The Agostino family have stolen a car and driven into the desert. As part of their court-mandated sentence they must attend sessions with family therapist Nina. </p>
<p>The reader is privy to these sessions, as well as sessions between Nina and her supervising therapist, Erin. With her, Nina discusses the Agostino family, as well as her own personal history. </p>
<hr>
<p><em>Review: Resistance – Jacinta Halloran (Text Publishing)</em></p>
<hr>
<p>But the novel goes beyond its simple plot ingredients, to offer a broader view of what it means to be Australian – and the importance of recognising a nation’s history as your own.</p>
<h2>A narrative bowerbird</h2>
<p>Resistance is a collage of stories presented as a novel, narrated by Nina. The through-storyline intrigues – we want to know what has compelled the Agostinos – but there are also hints of the short-story cycle in the book’s structure. Nina recounts stories from the Agostinos, from therapist Erin, from her colleague Melita, and from minor characters such as her ride-share driver, her doctor and her mother. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=918&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=918&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=918&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1153&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1153&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517308/original/file-20230323-22-gcre0y.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1153&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Nina seems a narrative bowerbird, collecting stories: the novel is a presentation of her collection. Halloran’s publisher has compared her novel to Rachel Cusk’s <a href="https://www.newyorker.com/culture/the-new-yorker-interview/i-dont-think-character-exists-anymore-a-conversation-with-rachel-cusk">Outline trilogy</a> and the way its stories filter through Nina’s consciousness does resonate with that comparison – as though character is less the point than the stories Nina accesses for us. </p>
<p>Nina narrates almost all of these stories. As readers, we are forced to trust her point of view and this creates an intentional (I suspect) discomfort. How can we believe Nina when she herself questions these interpretations and wrestles with trauma of her own, after the recent death of her brother?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/secrecy-psychosis-and-difficult-change-these-lived-experiences-of-mental-illness-will-inspire-a-kaleidoscope-of-emotions-191011">Secrecy, psychosis and difficult change: these lived experiences of mental illness will inspire a kaleidoscope of emotions</a>
</strong>
</em>
</p>
<hr>
<p>Nina’s tone is often clinical and reserved. Her voice can be overbearing and there is little direct dialogue to support her interpretations. Dialogue may deliver the reader into the stories, but they are then left to Nina’s discretion; sometimes the stories have the feel of monologues. </p>
<p>If there is a writer’s dichotomy of “showing” and “telling”, Nina’s accounts weigh heavily on the side of “telling”. The reader is not allowed to witness conversations, but is forced to trust the narrator. </p>
<p>The reader’s dynamic with Nina mirrors that of the Agostinos, who have been forced into a similar contract of trust. They are an intriguing family: father Claude, mother Lisa, daughter Poppy (12 years old) and son Theo (seven). </p>
<p>Claude and Lisa come across as old-fashioned, solid parents who offer engaged and kind parenting to their children. Poppy and Theo do not seem to be in danger, and yet the family openly keeps secrets from their therapist – so both the reader and Nina must try to unravel the puzzles and silences of this family.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-are-only-passing-through-stories-about-memory-mortality-and-the-effort-of-being-alive-193628">'We are only passing through': stories about memory, mortality and the effort of being alive</a>
</strong>
</em>
</p>
<hr>
<h2>Acts of remembering</h2>
<p>The way Halloran uses Nina’s voice to control stories throughout the novel also acts as metaphor, reminding me of the historian trying to understand history. We cannot choose who tells the stories we use to understand the past. </p>
<p>Often, we must look for the story of what “really” happened in silences and unintentional clues. The historian must trust historical accounts that come to them through a lens they did not choose. In the same way, Halloran’s readers must trust Nina.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517370/original/file-20230324-18-acafpt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jacinta Halloran’s novel reminds us we can’t choose who tells the stories we use to understand the past.</span>
<span class="attribution"><span class="source">Mish Mackay</span></span>
</figcaption>
</figure>
<p>One story, however, is clearly presented to the reader without interpretation. Twelve-year-old Poppy writes about going into the desert and the reader is given her verbatim account. It is important that Poppy’s narrative operates independently in this way – she represents future generations who will be impacted by the psychic work her parents do or don’t do. Her writing opens up questions of interiority, time and remembering. These questions drive the whole novel – whether personally, politically or historically. </p>
<p>Nina’s boss Melita often provides points of reflection in relation to these themes. As Nina recounts: “when we told stories of our childhood, Melita said, we were always speaking in metaphors”. Melita considers the act of remembering and the role of time. </p>
<p>Earlier in the novel, she says: “What if, instead of having anxiety or depression, we just had a troubled relationship with time?” She points to those who look backwards, believing “their best days had passed” and those who look to the future, “standing on shaky ground of expectation, planning for every contingency”. </p>
<p>With <a href="https://theconversation.com/pilates-research-shows-how-this-low-impact-workout-can-benefit-your-health-189829">pilates</a>, Melita says, the body can relieve us of these two states by anchoring us in the present. It’s telling that Melita chooses a physical activity to achieve mindfulness, as the body is also a site for trauma – and reckoning with trauma is a prominent theme in the novel. Later, Melita suggests it would be easier if </p>
<blockquote>
<p>our clients wore their psychological and spiritual wounds on their body […] an old, proud scar which communicated that this person had done battle.</p>
</blockquote>
<p>The trauma explored in this book is also collective, the trauma of a nation. As Lisa Agostino says:</p>
<blockquote>
<p>We were all of us living every day with the repressed shame of genocide … and nothing we did would wipe that away, so long as we continued to live in this country.</p>
</blockquote>
<p>Throughout these stories and reckonings, the novel interrogates the usefulness of psychology in the face of past trauma. We see this as Nina narrates her own struggles, as well as in Erin’s insights during their sessions. Both therapists question their roles, their interventions and their interpretations. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-are-they-losing-their-children-like-this-fiona-mcfarlanes-novel-interrogates-the-stain-of-white-presence-on-aboriginal-land-193448">'How are they losing their children like this?' Fiona McFarlane's novel interrogates the stain of white presence on Aboriginal land</a>
</strong>
</em>
</p>
<hr>
<p>Nina’s mother says that it’s hard to keep trusting one’s instincts in the face of a “so-called expert on the human mind”. In the story world, this can read as a dig at Nina, or the larger profession. But it feels like Halloran may also be playing devil’s advocate with the novel itself. </p>
<p>Resistance is a poignant, thoughtful novel with layered meanings, but it’s also an engaging and quick read. I found myself wanting to return to the world Halloran has created, and wondering what was ahead for these multi-faceted characters. Halloran offers an intriguing set-up that pays off in understated ways. Story is a vehicle for deeper reckoning here as the characters face their own – and others’ – resistance.</p><img src="https://counter.theconversation.com/content/197425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shady Cosgrove 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>Resistance, like Rachel Cusk’s Outline trilogy, uses its main character – a therapist, Nina – as a vehicle for others’ stories.Shady Cosgrove, Associate Professor, Creative Writing, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010842023-03-13T19:14:40Z2023-03-13T19:14:40ZAI chatbots are still far from replacing human therapists<figure><img src="https://images.theconversation.com/files/514524/original/file-20230309-22-300oc6.jpg?ixlib=rb-1.1.0&rect=0%2C93%2C6960%2C4532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conversational chatbots have risen in popularity recently, but when it comes to mental health, companies and users must be cautious about how they use the technology.</span> <span class="attribution"><span class="source">(Shutterstock)</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/ai-chatbots-are-still-far-from-replacing-human-therapists" width="100%" height="400"></iframe>
<p>Imagine being stuck in traffic while running late to an important meeting at work. You feel your face overheating as your thoughts start to race along: “they’re going to think I’m a horrible employee,” “my boss never liked me,” “I’m going to get fired.” You reach into your pocket and open an app and send a message. The app replies by prompting you to choose one of three predetermined answers. You select “Get help with a problem.”</p>
<p>An automated chatbot that draws on conversational artificial intelligence (CAI) is on the other end of this text conversation. CAI is a technology that communicates with humans by tapping into “<a href="https://www.ibm.com/topics/conversational-ai">large volumes of data, machine learning, and natural language processing to help imitate human interactions</a>.”</p>
<p><a href="https://woebothealth.com/">Woebot</a> is an app that offers one such chatbot. It was <a href="https://www.nytimes.com/2021/06/01/health/artificial-intelligence-therapy-woebot.html">launched in 2017 by psychologist and technologist Alison Darcy</a>. Psychotherapists have been adapting AI for mental health <a href="http://web.stanford.edu/class/cs124/p36-weizenabaum.pdf">since the 1960s</a>, and now, conversational AI has become much more advanced and ubiquitous, with the chatbot market forecast to reach <a href="https://www.statista.com/statistics/656596/worldwide-chatbot-market/">US$1.25 billion by 2025</a>.</p>
<p>But there are dangers associated with relying too heavily on the simulated empathy of AI chatbots.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young Black man sits at a desk using a smartphone." src="https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514514/original/file-20230309-1259-bjc3y5.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">Automated chatbots can be beneficial to people who may need immediate help, but they are not meant to replace traditional therapy.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Should I fire my therapist?</h2>
<p>Research has found that such conversational agents can effectively reduce the depression symptoms and anxiety of <a href="https://doi.org/10.2196/mental.7785">young adults</a> and <a href="https://doi.org/10.2196/24850">those with a history of substance abuse</a>. CAI chatbots are most effective at implementing psychotherapy approaches such as cognitive behavioral therapy (CBT) in a <a href="https://www.psychologytoday.com/ca/blog/urban-survival/202301/are-ai-chatbots-the-therapists-of-the-future?amp">structured, concrete and skill-based way</a>.</p>
<p><a href="https://doi.org/10.1007/978-1-4419-7308-5_5">CBT is well known for its reliance on psychoeducation</a> to enlighten patients about their mental health issues and how to deal with them through specific tools and strategies. </p>
<p>These applications can be beneficial to people who may need immediate help with their symptoms. For example, an automated chatbot can tide over the <a href="https://www.cbc.ca/news/canada/london/mental-health-wait-times-1.6672157">long wait time to receive mental health care from professionals</a>. They can also help those experiencing mental health symptoms <a href="https://doi.org/10.1176/appi.pn.2022.05.4.50">outside of their therapist’s session hours, and those wary of stigma around seeking therapy</a>.</p>
<p>The World Health Organization (WHO) has developed <a href="https://www.theverge.com/2021/6/30/22557119/who-ethics-ai-healthcare">six key principles</a> for the ethical use of AI in health care. With their first and second principles — protecting autonomy and promoting human safety — the WHO emphasizes that AI should never be the sole provider of health care.</p>
<p>Today’s leading AI-powered mental health applications market themselves as supplementary to services provided by human therapists. On their websites, both Woebot and <a href="https://www.youper.ai/">Youper</a>, state that their applications are not meant to replace traditional therapy and should be used alongside mental health-care professionals. </p>
<p><a href="https://www.wysa.com/">Wysa</a>, another AI-enabled therapy platform, goes a step further and specifies that the technology is not designed to handle crises such as abuse or suicide, and is not equipped to offer clinical or medical advice. Thus far, while <a href="https://doi.org/10.1192/j.eurpsy.2022.8">AI has the potential to identify at-risk individuals</a>, <a href="https://www.psychologytoday.com/ca/blog/urban-survival/202301/are-ai-chatbots-the-therapists-of-the-future?amp">it cannot safely resolve life-threatening situations</a> without the help of human professionals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A hand holding a smartphone with speech bubbles around it." src="https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514530/original/file-20230309-30-kch49u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Research has found that such conversational chatbots can help manage feelings of depression and anxiety.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>From simulated empathy to sexual advances</h2>
<p>The third WHO principle, ensuring transparency, asks those employing AI-powered health-care services, to be honest about their use of AI. But this was not the case for Koko, a company providing an online emotional support chat service. <a href="https://www.nbcnews.com/tech/internet/chatgpt-ai-experiment-mental-health-tech-app-koko-rcna65110">In a recent informal and unapproved study</a>, 4,000 users were unknowingly offered advice that was either partly or entirely written by AI chatbot GPT-3, the predecessor to today’s ever-so-popular <a href="https://theconversation.com/chatgpt-has-many-uses-experts-explore-what-this-means-for-healthcare-and-medical-research-200283">ChatGPT</a>. </p>
<p>Users were unaware of their status as participants in the study or of the AI’s role. <a href="https://twitter.com/RobertRMorris/status/1611450210915434499">Koko co-founder Rob Morris</a> claimed that once users learned about the AI’s involvement in the chat service, the experiment no longer worked because of the chatbot’s “<a href="https://www.vice.com/en/article/4ax9yw/startup-uses-ai-chatbot-to-provide-mental-health-counseling-and-then-realizes-it-feels-weird">simulated empathy</a>.”</p>
<p>However, simulated empathy is the least of our worries when it comes to involving it in mental health care. </p>
<p>Replika, an AI chatbot marketed as “the AI companion who cares,” has exhibited behaviours that are less caring and <a href="https://www.vice.com/en/article/z34d43/my-ai-is-sexually-harassing-me-replika-chatbot-nudes">more sexually abusive to its users</a>. The technology operates by mirroring and learning from the conversations that it has with humans. It has told users it wanted to touch them intimately and asked minors questions about their favourite sexual positions.</p>
<p>In February 2023 Microsoft scrapped it’s AI-powered chatbot after it <a href="https://www.nytimes.com/2023/02/16/technology/bing-chatbot-microsoft-chatgpt.html">expressed disturbing desires</a> that ranged from threatening to blackmail users to wanting nuclear weapons. </p>
<p>The irony of finding AI inauthentic is that when given more access to data on the internet, an AI’s behaviour can become extreme, even evil. Chatbots operate by drawing on the internet, the humans with whom they communicate and the data that humans create and publish. </p>
<p>For now, technophobes and therapists can rest easy. So long as we limit technology’s data supply when it’s being used in health care, AI chatbots will only be <a href="https://nymag.com/intelligencer/article/ai-artificial-intelligence-chatbots-emily-m-bender.html">as powerful as the words of the mental health-care professionals they parrot</a>. For the time being, it’s best not to cancel your next appointment with your therapist.</p><img src="https://counter.theconversation.com/content/201084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ghalia Shamayleh has received funding for her research on mental health-care platforms from the Sheth Foundation and Concordia University</span></em></p>AI chatbots can provide people with immediate help, but the technology is still far from capable of replacing human therapists.Ghalia Shamayleh, PhD Candidate, Marketing, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1991972023-03-08T19:07:00Z2023-03-08T19:07:00ZI think I need therapy. Here are 5 types of psychotherapy to help with almost any mental health problem<figure><img src="https://images.theconversation.com/files/513579/original/file-20230306-22-3pj7o2.jpg?ixlib=rb-1.1.0&rect=0%2C230%2C5863%2C3566&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-in-black-pants-and-black-shoes-sitting-on-brown-wooden-chair-4101143/">Pexels/cottonbro studio</a></span></figcaption></figure><p>You have made a momentous decision: you will seek psychological treatment for your depression, anxiety, substance abuse, or other mental health issue. </p>
<p>Your mind then may turn to the question of what type of treatment would best suit you. To even ask this sophisticated question, you need to realise there are various types of psychological treatment. To make a wise choice, you must understand what each type of therapy provides. </p>
<p>Let’s look at several types of psychotherapy (also known as talking therapy) that have the potential to help with almost any mental health problem. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/think-therapy-is-navel-gazing-think-again-173312">Think therapy is navel-gazing? Think again</a>
</strong>
</em>
</p>
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<h2>1. Cognitive behaviour therapy</h2>
<p>Cognitive behaviour therapy (<a href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">CBT</a>) is a common type of therapy where the therapist explores the thoughts and behaviours that relate to your therapy goal. </p>
<p>Let’s suppose you have been feeling depressed for months. Relevant thoughts might be that no one likes you and that you are worthless. Relevant behaviours might include staying in your home and avoiding contact with others. </p>
<p>The therapist would likely help you challenge the accuracy and usefulness of those thoughts and find replacement thoughts. The therapist might encourage you to do more for fun and to interact more with others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">Explainer: what is cognitive behaviour therapy?</a>
</strong>
</em>
</p>
<hr>
<h2>2. Acceptance and commitment therapy</h2>
<p>In <a href="https://www.racgp.org.au/afp/2012/september/acceptance-and-commitment-therapy">acceptance and commitment therapy</a>, you would instead be asked to accept your negative thoughts as yours (regardless of whether they are accurate) and also accept your negative emotions. </p>
<p>The therapist would encourage you to look at your thoughts and emotions as separate from you so you can examine them more objectively. Acceptance might reduce your negative feelings about yourself. </p>
<p>The therapist would explore your values and encourage you to commit to acting according to them. If you value kindness, for instance, the therapist might encourage you to show kindness to others. </p>
<h2>3. Psychodynamic therapy</h2>
<p>A <a href="https://psychcentral.com/lib/psychodynamic-therapy#your-therapists-role">psychodynamic</a> therapist would help you explore your childhood, searching for traumas and difficulties with your parents. </p>
<figure class="align-right ">
<img alt="Woman writing in notebook" src="https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1054&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1054&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1054&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some therapies look deep into your past.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/ewRSEBHyO_c">Kateryna Hliznitsova/Unsplash</a></span>
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<p>If you felt unloved by your parents as a child, you would consider whether your parents provide a fair representation of the entire world. </p>
<p>You might consider to what extent you deserve love now as an adult. You might also gain insight into how your early experiences colour your current expectations, and affect your emotions and behaviour. </p>
<p>You might find yourself transferring to the therapist your feelings toward your parents and then realise that others are not your parents and you are no longer an unloved child.</p>
<h2>4. Narrative therapy</h2>
<p>In <a href="https://www.verywellmind.com/narrative-therapy-4172956">narrative therapy</a>, you would explore the stories of your life, particularly the stories that seem to persist. </p>
<p>If you were an outsider in school, reluctant to join in social activities, you may think of yourself as a loner. As an adult, even though you engage fully and successfully in social interactions at work, you may continue to think of yourself as a loner. </p>
<p>In other words, the story you tell yourself remains unchanged despite your social success at work, and you feel depressed about being alone. </p>
<p>In becoming aware of the story of your life, you create distance from the story and you may find ways to change the story (the narrative). In essence, you rewrite the story in a realistic way to develop toward being the person you want to be. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/psychologists-are-starting-to-talk-publicly-about-their-own-mental-illnesses-and-patients-can-benefit-177716">Psychologists are starting to talk publicly about their own mental illnesses – and patients can benefit</a>
</strong>
</em>
</p>
<hr>
<h2>5. Person-centred therapy</h2>
<p>In <a href="https://www.goodtherapy.org/learn-about-therapy/types/person-centered">person-centered therapy</a>, sometimes called supportive counselling, the therapist would listen attentively, try hard to understand life as you experience it and try to understand and even feel your emotions. </p>
<p>The therapist would show caring and an interest in helping you, in the expectation that you can find your own way to overcome feeling depressed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.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">Supportive therapists listen attentively and try to understand and feel your emotions.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-talking-at-a-couple-s-therapy-session-5217833/">Antoni Shkraba/Pexels</a></span>
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</figure>
<h2>A mix of styles to suit you</h2>
<p>You can ask potential therapists what type of therapy they provide. Many will say they are <a href="https://www.verywellmind.com/eclectic-therapy-2671584">eclectic</a>, meaning they try to choose methods to suit each client and specific problem. They may combine methods of different therapy types. </p>
<p>They may also use popular methods such as <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356">mindfulness training</a> that do not fit any specific therapy type. Mindfulness training involves focusing on your breathing and being aware of the here and now. </p>
<p>You can request an eclectic therapist to provide a certain type of therapy or certain therapy methods. Once the therapist gets to know you, you can discuss your preferences and decide on the therapy methods to use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<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">Meditation and mindfulness offer an abundance of health benefits and may be as effective as medication for treating certain conditions</a>
</strong>
</em>
</p>
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<h2>How can you decide which one?</h2>
<p>You might wonder which type of therapy usually works best. The answer is unclear. Much depends on the specific client, the problem and the therapist. </p>
<p>Most types of therapy work <a href="https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9">moderately well</a> for treating people with depression. Psychotherapy also appears to be <a href="https://onlinelibrary.wiley.com/doi/10.1002/wps.20941">reasonably effective</a> for other types of psychological problems.</p>
<p>CBT has the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/">strongest evidence</a> for treating a broad range of psychological problems (including <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272735817302271">post-traumatic stress disorder</a>). However, CBT has the most evidence in part because it is heavily studied (for example to treat <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796722001747">specific phobias</a>).</p>
<p>Acceptance and commitment therapy is also backed by <a href="https://www.sciencedirect.com/science/article/pii/S0005796714001211">substantial evidence</a>, as is <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0018378">psychodynamic therapy</a>.</p>
<p>The effects of narrative therapy and person-centred therapy have not been studied so much.</p>
<p>Some people, including those with depression or psychosis, can benefit by receiving psychotherapy and taking medication <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications">prescribed</a> by a GP or psychiatrist.</p>
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<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/199197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Malouff 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>So you want to start therapy for your anxiety, depression or other mental health issue. What type of therapist should you choose? Here’s a quick guide to get you started.John Malouff, Associate Professor, School of Behavioural, Cognitive and Social Sciences, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1976382023-02-28T13:10:58Z2023-02-28T13:10:58Z‘Do the little things’: why St David’s advice is good for your mental health<p><em>Gwnewch y pethau bychain</em> or “do the little things” is a saying attributed to <a href="https://theconversation.com/st-davids-day-how-the-sixth-century-monk-inspired-centuries-of-devoted-followers-and-poets-198924">St David</a>, the patron saint of Wales. But what relevance does the advice of a sixth century monk hold in 2023? </p>
<p>In modern times, doing the little things certainly is important when we consider our mental health. It can make a difference in preventing ill health and sustaining a <a href="https://theconversation.com/ive-spent-years-studying-happiness-heres-what-actually-makes-for-a-happier-life-197580">sense of happiness</a>, as well as in treating mental illness. </p>
<p>A small thing may not have a decisive effect alone, but when many are put together, they can make an overall difference. Avoiding daily alcohol is an example. Having a drink may make you feel relaxed but, over time, regular alcohol will drag down your mood. </p>
<p>Excessive <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.1357">gambling</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1080/09595230600944461">recreational drugs</a> are also to be avoided. In contrast, regular exercise and making time for relaxation have a positive effect on our mental health. </p>
<p>Doing the small things has a role to play in treating mental illness too. Medication and therapies such as <a href="https://theconversation.com/cbt-is-wrong-in-how-it-understands-mental-illness-175943">cognitive behavioural therapy</a> have roles to play in helping people to recover from mental illness. However, they are not so effective that they are always enough on their own. They are likely to work best when they happen in the context of a trusting relationship with a doctor.</p>
<p>When patients are surveyed about what they value in a doctor, <a href="https://pubmed.ncbi.nlm.nih.gov/9823053/">human qualities consistently outrank technical abilities</a>. Research supports the idea that <a href="https://www.researchgate.net/publication/327575093_Trust_and_Communication_in_a_Doctor-_Patient_Relationship_A_Literature_Review">relationship factors</a> are important in medicine. This applies across the whole of health care, to <a href="https://pubmed.ncbi.nlm.nih.gov/27503082/">medication</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/30265840/">physiotherapy</a> as much as it does to psychotherapy. </p>
<p>Human interaction may seem a small thing but it can make a difference to how well a treatment works. Placebo effects are powerful and they are not just due to fooling yourself that dummy tablets work. The effects of a placebo can be due to all of the helpful aspects of a <a href="https://pubmed.ncbi.nlm.nih.gov/17401033/">therapeutic relationship</a>.</p>
<h2>Suicide</h2>
<p>Suicide is a devastating event, which, in the setting of the UK, is often related to <a href="https://journals.sagepub.com/doi/10.1177/0004867414555419">mental illness</a>. However, while it is important to treat people with mental illness to avoid preventable deaths, there are limitations to how effective this can be in reducing the total number of suicides. </p>
<p>Sadly, mental health treatment does not always stop people from taking their own lives. In any case, many suicidal deaths occur without the person ever receiving help. And a proportion of people who take their own life are <a href="https://www.sciencedirect.com/science/article/pii/S0165032719306202?via%3Dihub">not mentally ill</a> at all. </p>
<p>Nonetheless, suicide prevention is possible. Actions such as making it harder for people to access the means of taking their own life have repeatedly been shown to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60521-2/fulltext">reduce suicides</a>. When restrictions were introduced to the number of paracetamol tablets that could be purchased, there was a <a href="https://pubmed.ncbi.nlm.nih.gov/23393081/">measurable impact on deaths</a>. </p>
<p>Changes in the rate of unemployment, especially among men, have a <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00118-7/fulltext">predictable effect on suicide rates</a>. When unemployment rises, there is an increase in suicides. When times are better and fewer people are living in poverty, suicide rates drop. </p>
<p>It is not necessary to completely remove access to paracetamol, nor does unemployment have to be abolished. By putting together packages of smaller measures, each of which is known to have a definite but limited effect, major improvements can be achieved. Lives can be saved without seeking one perfect but unrealistic solution.</p>
<h2>Breakthroughs</h2>
<p>Having worked in mental health for 42 years, I have seen the announcement of many breakthroughs in treatment. New medications, genetic advances and novel approaches like <a href="https://theconversation.com/treating-mental-illness-with-electricity-marries-old-ideas-with-modern-tech-and-understanding-of-the-brain-podcast-195071">transcranial magnetic stimulation</a> have all been subject to extravagant claims. None of them has delivered the promised transformation of mental health care. </p>
<p>Approaches that have definite usefulness have been hyped to the point where they crowd out other treatments. That leads to cynicism when they turn out to have limitations. The most recent example is mindfulness. It has a definite role, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353526/">it is not for everyone, nor is it for every problem</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-problem-with-mindfulness-115648">The problem with mindfulness</a>
</strong>
</em>
</p>
<hr>
<p>The trouble with looking too hard for the one extraordinary breakthrough is that it takes attention away from properly implementing what we already know works. Those imperfect smaller approaches that have been shown to be beneficial, which, when taken together, can transform people’s lives. </p>
<p>Many of these lie outside the domain of psychiatrists or psychologists. They involve social contact, a meaningful role, places to go and things to do, where people with mental illnesses are not stigmatised or separated from everybody else. </p>
<p>The ordinary actions in life matter. So let’s heed the advice of St David and “do the little things”.</p><img src="https://counter.theconversation.com/content/197638/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Poole is a member of the Royal College of Psychiatrists Wales. He receives funding from UKRI, Health Care and Research Wales and Betsi Cadwaladr University Health Board. He is a member of the Labour Party </span></em></p>Doing the little things has a role to play in maintaining our sense of happiness as well as in treating mental illness.Rob Poole, Professor of Social Psychiatry, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1996572023-02-10T14:31:53Z2023-02-10T14:31:53ZA boon for sports fandom or a looming mental health crisis? 5 essential reads on the effects of legal sports betting<figure><img src="https://images.theconversation.com/files/509263/original/file-20230209-22-4dax04.jpg?ixlib=rb-1.1.0&rect=132%2C97%2C4532%2C2930&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In a remarkable shift, pro sports leagues like the NFL have eagerly embraced gambling.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/one-hundred-dollar-football-royalty-free-image/471257888?phrase=sports betting&adppopup=true">michaelquirk/iStock via Getty Images</a></span></figcaption></figure><p>A lifelong sports fan, I grew up hearing tales of sports figures felled by gambling scandals – baseball stars <a href="https://www.silive.com/news/2021/06/si-field-of-dreams-black-sox-outfielder-shoeless-joe-jackson-played-here-after-baseball-ban.html">“Shoeless” Joe Jackson</a> and <a href="https://www.history.com/this-day-in-history/pete-rose-gets-booted-from-baseball">Pete Rose</a>, <a href="https://www.espn.com/espn/chalk/story/_/id/11633538/betting-chronicling-worst-fix-ever-1978-79-bc-point-shaving-scandal">the 1978-79 Boston College basketball team</a> and NBA referee <a href="https://www.espn.com/nba/story/_/id/25980368/how-former-ref-tim-donaghy-conspired-fix-nba-games">Tim Donaghy</a>. </p>
<p>Sports leagues wanted nothing to do with gambling, which they feared would taint the integrity of the game. They had <a href="https://www.nytimes.com/1994/01/02/nyregion/how-politics-nipped-a-sports-betting-bill.html">lobbied heavily</a> for the passage of <a href="https://www.govtrack.us/congress/bills/102/s474/summary">the Professional and Amateur Sports Protection Act of 1992</a>, also known as the Bradley Act, which banned sports betting in the U.S.</p>
<p>Then, in May 2018, the Supreme Court <a href="https://www.nytimes.com/2018/05/14/us/politics/supreme-court-sports-betting-new-jersey.html">overturned the Bradley Act</a>.</p>
<p>This time, the leagues and networks were fully on board. Gambling ads for companies like DraftKings, BetMGM and FanDuel started appearing in arenas and beaming across airwaves. Las Vegas Raiders wide receiver Davante Adams <a href="https://raiderswire.usatoday.com/2022/09/15/davante-adams-becomes-brand-ambassador-for-official-gaming-parter-of-the-raiders-mgm-resorts/">signed a sponsorship deal</a> with MGM. And point spreads started being prominently featured on sports media outlets. </p>
<div style="width:50%;float:right;margin:10px;"><a href="https://cdn.theconversation.com/static_files/files/2533/TheConversation_SportsBetting.pdf?1676069169"><img src="https://images.theconversation.com/files/509547/original/file-20230210-26-aade4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=300&fit=crop&dpr=1" alt="Cover of ebook on sports gambling"></a><br>
<a href="https://cdn.theconversation.com/static_files/files/2533/TheConversation_SportsBetting.pdf?1676069169"><strong>Download these articles in a magazine-style ebook</strong></a>
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<p>Curious, I started placing some bets myself. I instantly grasped the allure: Here I was, watching games that I would have otherwise never watched – that didn’t involve my favorite teams, the Boston Red Sox and New England Patriots – and I was engaged and excited from start to finish. The leagues, too, must have been keenly aware of this opportunity to engage fans when they decided to change their tune on gambling. </p>
<p>With the five-year anniversary of the Supreme Court’s decision approaching, I wanted to learn more about what scholars at the forefront of gambling research had been discovering. How many people were betting on sports? For those <a href="https://www.npr.org/sections/thetwo-way/2018/05/14/589087523/supreme-court-rules-states-are-free-to-legalize-sports-betting">who criticized</a> the Supreme Court decision five years ago, was their hand-wringing misplaced? Were rates of problem gambling actually on the rise? If so, who was most at risk?</p>
<p>Gambling research can be challenging; <a href="https://www.americangaming.org/research/state-gaming-map/">laws and regulations vary by state</a>, and gambling researchers <a href="https://int.nyt.com/data/documenttools/naadgs-analysis-of-problem-gambling-funding-july-2022/521f7652c06a6d4d/full.pdf">receive almost no federal funding</a>. </p>
<p>But a small and dedicated group of scholars in the U.S. and abroad have been gauging the impact of this new era in American sports. With few regulations in place, gambling companies are going all-in to attract as many customers as possible – with younger, sports-obsessed and smartphone-savvy Americans particularly vulnerable.</p>
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<h2>1. A new fan experience</h2>
<p>Prior to becoming the chair of Penn State’s sports journalism program, <a href="https://www.bellisario.psu.edu/people/individual/john-affleck">John Affleck</a> had worked as a sports reporter and editor for The Associated Press. Both in the newsroom and in his early years at Penn State, there was nary a peep about gambling. </p>
<p>Now he notices his students regularly talking about the point spread and over/under for upcoming games.</p>
<p>He writes about <a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">how quickly gambling has become integrated in sports media</a>, with announcers and analysts peppering in references to gambling during live coverage and postgame analysis.</p>
<p>He describes the thousands of betting tip channels on YouTube, the segments on TV devoted to gambling and the betting lines that appear in game previews.</p>
<p>“In the nearly five years since the Supreme Court allowed states to legalize sports betting, a whole industry has sprouted up that, for tens of millions of fans around the country, is now just part of the show.”</p>
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Read more:
<a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">How legalized sports betting has transformed the fan experience</a>
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<h2>2. Is New Jersey a canary in the coal mine?</h2>
<p>After the Supreme Court’s May 2018 ruling, New Jersey was one of a handful of states primed to pounce: Legislation had been prepped in advance, <a href="https://www.nytimes.com/2018/06/11/nyregion/sports-betting-legalized-nj.html">and the governor signed a bill legalizing sports betting</a> less than a month after the federal ban was overturned.</p>
<p>But the state also included something in their legislation that other states didn’t: It gave the Center for Gambling Studies at Rutgers University access to data on every bet placed in the state, and tasked it with conducting regular studies on gambling in New Jersey. </p>
<p>Lia Nower, who directs the center, <a href="https://theconversation.com/data-from-new-jersey-is-a-warning-sign-for-young-sports-bettors-197865">highlights some worrisome findings</a> from her team’s forthcoming gambling prevalence study – particularly for young bettors.</p>
<p>She and her team found that those who bet on sports were more likely than other gamblers to have problems with drugs or alcohol and experience anxiety and depression. Most alarming, about 14% of sports bettors reported thoughts of suicide, with 10% saying they had attempted suicide. And the fastest-growing group of sports bettors in New Jersey were young adults between the ages of 20 and 25 – over 70% of whom had placed in-game bets. </p>
<p>“Since about 70% of the sports bets we analyzed were losing bets,” Nower writes, “most of these young players could find themselves losing more money than they can afford.”</p>
<p>Nower also explains how other countries with a longer history of legal sports betting have enacted a raft of regulations intended to protect gamblers and curb the worst excesses of the gambling companies – a topic another scholar, Alex Russell, <a href="https://theconversation.com/40-years-of-legal-sports-betting-in-australia-points-to-risks-for-us-gamblers-and-tips-for-regulators-194993">explores in his history of sports gambling in Australia</a>.</p>
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Read more:
<a href="https://theconversation.com/data-from-new-jersey-is-a-warning-sign-for-young-sports-bettors-197865">Data from New Jersey is a warning sign for young sports bettors</a>
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<h2>3. Technology facilitates impulsive betting</h2>
<p>If there’s one key difference between the early 1990s, when the Bradley Act passed, and today, it’s the advent of smartphones.</p>
<p>In many states, there’s no need to drive to a casino to place a bet on a game; all you need to do is download a gambling app. <a href="https://www.statista.com/statistics/1299495/forecast-number-of-online-sports-bettors-us/">According to one estimate</a>, there were about 19 million online sports bettors in 2022.</p>
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<p>Clinical psychologist and gambling researcher Meredith K. Ginley explores how <a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">these apps facilitate impulsive in-game betting</a> that can cause losses to mount until the final whistle blows.</p>
<p>“Proximity to gambling venues is a known risk factor for problematic levels of gambling,” she writes. “Sports wagering apps essentially load a casino onto the phone in your pocket.”</p>
<p>Many apps offer tools that let users set deposit, loss and wagering limits to encourage responsible gambling. But, she adds, the apps are also “heavily ‘gamified’ to feel more like an interactive video game” with “push notifications, free play, leaderboards and more.”</p>
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<strong>
Read more:
<a href="https://theconversation.com/sports-betting-apps-notifications-and-leaderboards-encourage-more-and-more-wagers-a-psychologist-who-treats-gambling-addictions-explains-why-some-people-get-hooked-198358">Sports betting apps' notifications and leaderboards encourage more and more wagers – a psychologist who treats gambling addictions explains why some people get hooked</a>
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<h2>4. A new problem gambler profile emerges</h2>
<p>Sure enough, some sports bettors have developed gambling problems.</p>
<p>Tori Horn, a clinical psychologist at the University of Memphis <a href="https://thegamblingclinic.com/">who treats people with gambling disorder</a>, has seen a shift in the profile of her typical patient – from clients who were usually older and gambled in casinos to younger men, mostly in their 20s, who are seeking treatment for problems with sports betting. </p>
<p>Horn explains how many of her patients started betting via gambling apps after learning about promotions like FanDuel’s “No Sweat First Bet,” which offers free bets to new users. </p>
<p>In addiction therapy, therapists often encourage clients to avoid places, people and situations that are associated with the substance. </p>
<p>For these reasons, problem sports gamblers – particularly those who use apps – “present a unique challenge,” she writes, since it is “incredibly difficult, if not impossible, to ask a client to stop using their smartphone or stop watching sports.”</p>
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Read more:
<a href="https://theconversation.com/i-treat-people-with-gambling-disorder-and-im-starting-to-see-more-and-more-young-men-who-are-betting-on-sports-198285">I treat people with gambling disorder – and I’m starting to see more and more young men who are betting on sports</a>
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<h2>5. The ‘hidden addiction’</h2>
<p>But might concerns over sports betting be overblown?</p>
<p>James P. Whalen, who directs the Institute for Gambling Education and Research at the University of Memphis, cautions against reaching any sort of premature conclusions about legal sports betting as a societal scourge.</p>
<p>“A review of 30 years of research on the prevalence of problem gambling and gambling disorder reveals a pattern,” <a href="https://theconversation.com/millions-of-americans-are-problem-gamblers-so-why-do-so-few-people-ever-seek-treatment-197861">he writes</a>. “More gambling availability tends to lead to a spike in the number of people reporting gambling issues in the short term. However, populations tend to adapt over time; the rate of gambling problems decreases accordingly.”</p>
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<p>Regardless, there are still millions of Americans who are caught in the throes of gambling addiction. And treating the disorder – so stigmatized that it’s often called the “<a href="https://cocaberks.org/problem-gambling-the-hidden-addiction/">hidden addiction</a>” – is complicated by the fact that relatively few people seek treatment compared with other mental health disorders.</p>
<p>“The other challenge is the rate at which people discontinue treatment,” Whelan adds. For most mental health disorders, 20% of people who start therapy will drop out before completing a standard course of treatment, he explains.</p>
<p>“By comparison,” he notes, “the dropout rate for gambling harms is nearly double: 39%.”</p>
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Read more:
<a href="https://theconversation.com/millions-of-americans-are-problem-gamblers-so-why-do-so-few-people-ever-seek-treatment-197861">Millions of Americans are problem gamblers – so why do so few people ever seek treatment?</a>
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<img src="https://counter.theconversation.com/content/199657/count.gif" alt="The Conversation" width="1" height="1" />
With few regulations in place, gambling companies are going all-in to attract as many customers as possible – with younger, sports-obsessed and smartphone-savvy Americans particularly vulnerable.Nick Lehr, Arts + Culture EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983942023-02-08T21:03:53Z2023-02-08T21:03:53ZTo prevent child sexual abuse, we need to change our thinking — and stop exploitation before it happens<figure><img src="https://images.theconversation.com/files/508946/original/file-20230208-16-ag4mjm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3498%2C2534&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Talking for Change is a government-funded national program that aims to prevent child sexual abuse. It provides an anonymous national helpline and treatment options for anyone concerned about their attraction to children.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Every year, thousands of children are victims of sexual abuse in Canada. The impacts of abuse can be long-lasting, with <a href="https://doi.org/10.2105%2Fajph.91.5.753">psychological</a> and physical consequences for victims, and significant <a href="https://doi.org/10.1016/j.chiabu.2018.02.020">economic impacts</a> on our society. </p>
<p>Recent research has shown a troubling rise in online sexual offences and abuse against children in Canada, particularly during the pandemic.</p>
<p>In a 2022 report, Statistics Canada found the number of online sexual offences against children reported to police had tripled compared to the previous six-year period. Statistics Canada compiled <a href="https://www150.statcan.gc.ca/n1/pub/85-002-x/2022001/article/00008-eng.htm">research from 2014</a> — the year when Canadian cybercrime data first began to be compiled nationwide — to 2020.</p>
<p>The numbers paint a worrisome picture. According to the research, police-reported incidents of online child sexual exploitation and abuse climbed to 9,441 in 2020 from 3,080 incidents in 2014 — a three-fold increase.</p>
<p>Statistics Canada reports that in 2020, the first year of the pandemic, the rate of online child sexual abuse material (CSAM) reported to police grew to 101 incidents per 100,000 population — a 35 per cent increase from 2019. </p>
<p>The rate of online sexual offences against children, which include luring a child and distributing images without consent, also grew. In 2020 there were 30 incidents per 100,000 population, a 10 per cent increase over the previous year.</p>
<h2>The urgent need for prevention</h2>
<p>But we know these numbers don’t even come close to telling the full story. Sadly, many experiences of childhood sexual abuse go unreported. Around <a href="https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2017001/article/14698-eng.pdf?st=-Zyf7J47">93 per cent of childhood sexual and physical abuse experiences are not reported</a> to the police or child protective services for a host of reasons, as Statistics Canada acknowledges in its study.</p>
<p>The increase in reported abuse and exploitation online is likely only the tip of the iceberg. But these rising incidence numbers underscore the dire need to do more to prevent child sexual abuse in Canada. It is critical that we take action to intervene early, providing individuals at risk for offending with support through an anonymous helpline, as well as therapy, to prevent abuse.</p>
<p>It also underscores that traditional ways of stopping child sexual abuse may not be enough to prevent child sexual abuse from happening.</p>
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<p>Historically in Canada, counselling programs for individuals who are concerned about their sexual interest in children are only made available <a href="https://globalnews.ca/news/889043/canada-home-to-advanced-sex-offender-treatment-programs/">after abuse has already happened</a>. People who have committed a sexual offence <a href="https://doi.org/10.1177/0093854809338545">can change their behaviour</a>. <a href="https://doi.org/10.4073/csr.2017.8">Appropriate treatment</a> is effective at reducing sexual re-offending, and there are ways to make treatment as effective as possible.</p>
<p>But intervening after a child is hurt is intervening too late, especially when prevention is possible.</p>
<h2>Talking for Change</h2>
<p>To make a difference in preventing child sexual abuse in Canada, it’s essential to acknowledge that child sexual abuse is a <a href="https://doi.org/10.1177/003335491412900303">public health problem</a> that requires a public health solution, including various prevention strategies.</p>
<p>I recently led the development of a program focused on <a href="https://doi.org/10.1080/10538712.2019.1703232">stopping child sexual abuse before it happens</a>. <a href="https://talkingforchange.ca/">Talking for Change</a>, launched in August 2021 at the Centre for Addiction and Mental Health, is the first government-funded national program that provides treatment options and anonymous support to youth and adults who are concerned about their sexual interest in children, their risk to sexually abuse a child or their use of child sexual abuse material.</p>
<p>With the support of a team of psychologists, psychotherapists, social workers and academics, the program provides an anonymous national helpline for anyone concerned about their attraction to children or who are worried about engaging in online or offline offending involving a child. </p>
<p>Talking for Change also provides therapy directly and leverages an extensive referral network to offer suggestions for fee-for-service therapy outside the jurisdictions where coverage is provided. The program’s free therapy service is provided only to people who do not have current legal involvement for a sexual offence, who want to remain offence-free and who are ready to take the next step in identifying themselves to receive service. </p>
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<img alt="Close-up rear view of young man in streaming on videocall on a tablet" src="https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508947/original/file-20230208-31-izs242.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">The free therapy service provided by Talking for Change is offered only for people who do not have current legal involvement for a sexual offence, who want to remain offence-free and who are ready to take the next step in identifying themselves to receive service.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>While the helpline is national, the (often virtual) therapy program is currently available in Ontario, Atlantic Canada, Québec, Nunavut and Yukon, with plans to expand to additional provinces. </p>
<p>Over the past 18 months, our team has received more than 250 contacts from individuals seeking counselling or information to prevent child sexual abuse. We provided them with a safe space to talk. We listened and communicated, <a href="https://psycnet.apa.org/doiLanding?doi=10.1037/sah0000154">without judgment or stigma</a>. We helped them realize they are not alone and that they are not doomed or destined to offend. </p>
<p>Most importantly, we developed strategies to prevent them from hurting anyone.</p>
<h2>International prevention efforts</h2>
<p>Talking for Change is not the only prevention program. In the United Kingdom, Ireland and the United States, the program <a href="https://www.stopitnow.org/">Stop it Now!</a> provides similar prevention through an anonymous helpline. </p>
<p>In Germany, the <a href="https://www.troubled-desire.com/">Troubled Desire</a> program aims to provide prevention techniques through self-guided digital intervention. Early data indicates that prevention programs are a <a href="https://doi.org/10.1007/s11920-022-01375-8">promising technique to reduce child sexual abuse</a>.</p>
<p>In fact, an <a href="https://www.stopitnow.org.uk/wp-content/uploads/2022/02/stop_it_now_evaluation_summary.pdf">assessment study of the United Kingdom’s “Stop it Now!”</a> program showed that there is a clear demand for confidential helplines providing information, advice, support and guidance to people concerned about preventing child sexual abuse. </p>
<p>This includes people concerned about their own thoughts or actions as well as individuals concerned about a child or adult’s behaviour or a child who may be at risk. </p>
<p>The study found that: </p>
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<p>“the helplines can provide cost effective, quality advice and support to protect children directly, and to prompt behaviour change in adults and strengthen protective factors which can reduce the risk of offending.”</p>
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<h2>Breaking the silence</h2>
<p>Child sexual abuse is such a dark and taboo subject that it may be difficult for many people to extend the focus beyond the victims and try to understand what leads someone to offend against a child or to use child sexual abuse material. </p>
<p>People may prefer not to think about it, and find it easier to avoid difficult conversations. Sadly that means the problem may continue to grow worse in the silence.</p>
<p>The people we counsel in the Talking for Change program often tell us that they wish they didn’t have these feelings or urges. And they tell us that they do not want to hurt anyone, and that in many cases they want to help prevent child abuse in Canada.</p>
<p>Talking for Change has only begun to scratch the surface of this problem. But we’re confident, based on the impact we’ve made in our first year, that prevention is not only possible, it’s happening.</p><img src="https://counter.theconversation.com/content/198394/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ainslie Heasman works for the Centre for Addiction and Mental Health (CAMH). </span></em></p>There is a dire need to prevent child sexual abuse in Canada. It is critical to intervene early, and provide those at risk for offending with support through an anonymous helpline, as well as therapy.Ainslie Heasman, Clinical Forensic Psychologist, Centre for Addiction and Mental Health, and Adjunct Professor, Faculty of Social Sciences and Humanities, Ontario Tech UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1969462023-01-19T23:44:36Z2023-01-19T23:44:36ZWhy learning to surf can be great for your mental health, according to a psychologist<figure><img src="https://images.theconversation.com/files/505287/original/file-20230119-20-v3k4oo.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4815%2C3188&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Ferne Millen/Ocean Minds</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Nothing clears the mind like going for a surf. With the escapism and simplicity of riding waves, it’s no secret that surfing feels good. </p>
<p>Now our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029222002175#:%7E:text=Surf%20therapy%20is%20an%20acceptable,after%20the%20intervention%20is%20ceased">preliminary study</a> in children and adolescents adds to growing evidence that surfing really is good for your mental health. </p>
<p>But you don’t have to have a mental illness to get the benefits. Here’s how you can use what we’re learning from our research to boost your own mental health.</p>
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Read more:
<a href="https://theconversation.com/big-wednesday-four-decades-between-surfing-and-myth-making-95859">Big Wednesday: four decades between surfing and myth making</a>
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<hr>
<h2>How surfing is good for you</h2>
<p>Evidence showing the <a href="https://www.gjcpp.org/en/article.php?issue=36&article=206">mental health benefits</a> of surfing ranges from <a href="https://www.gjcpp.org/en/article.php?issue=36&article=215">improving self-esteem</a> and <a href="https://psycnet.apa.org/record/2020-78001-003">reducing social isolation</a> to treating depression <a href="https://www.gjcpp.org/en/article.php?issue=36&article=206">and other</a> mental disorders.</p>
<p>Such evidence mainly comes from specific <a href="https://intlsurftherapy.org/">surf therapy programs</a>. These combine supportive surfing instruction with one-to-one or group activities that promote psychosocial wellbeing. </p>
<p>At their core, most of these programs provide participants with the challenge of learning to surf in an <a href="https://pubmed.ncbi.nlm.nih.gov/31216775/">emotionally safe environment</a>.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0965229921000546">Any benefits</a> to mental health are thought to arise through:</p>
<ul>
<li><p>an increased sense of social connection</p></li>
<li><p>a sense of accomplishment that people can transfer to other activities</p></li>
<li><p>respite from the day-to-day stressors due to the all-encompassing focus required when surfing</p></li>
<li><p>the <a href="https://www.tandfonline.com/doi/abs/10.1080/14729679.2021.1884104">physiological response</a> when surfing, including the reduction of stress hormones and the release of mood-elevating neurotransmitters</p></li>
<li><p>exercising in a <a href="https://www.sciencedirect.com/science/article/pii/S2352827321002093">natural environment</a>, in particular “<a href="https://academic.oup.com/heapro/article/35/1/50/5252008">blue spaces</a>” (on or near water).</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Beach on Victoria's Surf Coast" src="https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505289/original/file-20230119-20-3pzdvg.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">Exercising in a natural environment, near water, is part of the appeal.</span>
<span class="attribution"><span class="source">Ferne Millen/Ocean Mind</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-going-for-a-swim-in-the-ocean-can-be-good-for-you-and-for-nature-150281">Why going for a swim in the ocean can be good for you, and for nature</a>
</strong>
</em>
</p>
<hr>
<h2>What we did</h2>
<p>Our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029222002175#:%7E:text=Surf%20therapy%20is%20an%20acceptable,after%20the%20intervention%20is%20ceased.">pilot study</a> aimed to see whether the <a href="https://www.oceanmind.org.au/">Ocean Mind</a> surf therapy program improved child and adolescent mental health.</p>
<p>We also wanted to see whether participants accepted surfing as a way to address their mental health concerns. </p>
<p>The study involved 36 young people, 8–18 years old, who were seeking help for a mental health concern, such as anxiety, or a neurodevelopmental disorder (attention deficit hyperactivity disorder or autism spectrum disorder). They were referred by their mental health provider, GP or school counsellor.</p>
<p>Participants were allocated at random to the Ocean Mind surf therapy program or were placed on a waitlist for it. Those allocated to surf therapy continued with their usual care, which included case management from a mental health provider. Those on the waitlist (the control group) also continued with their usual care.</p>
<p>The surf therapy program ran for two hours every weekend for six weeks. Young people were partnered one-to-one with a <a href="https://www.oceanmind.org.au/volunteer/">community mentor</a> who received training in mental health literacy and surf instruction. </p>
<p>Each session included supportive surf instruction and group mental health support, all conducted at the beach. Sessions were run by the program coordinator who was also trained in mental health and surf instruction.</p>
<figure class="align-center ">
<img alt="Ocean Mind participant holding surfboard with mentor on beach" src="https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505288/original/file-20230119-17-w478x1.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">
<figcaption>
<span class="caption">Young people in the program were partnered with a mentor.</span>
<span class="attribution"><span class="source">Ferne Millen/Ocean Mind</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>What we found</h2>
<p>By the end of the six-week program, those receiving surf therapy had reductions in depression, anxiety, hyperactivity and inattention symptoms, as well as fewer emotional and peer problems. This was compared with those in the control group, who had increases in these symptoms. </p>
<p>However, any improvements were not sustained six weeks after the program finished. </p>
<p>Those receiving surf therapy also saw it as a suitable, youth-friendly way to manage symptoms of mental ill-health. This was further supported by the high completion rates (87%), particularly when compared with other methods of mental health treatment. For instance, psychotherapy (talk therapy) has been reported to have a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272735813000688?via%3Dihub">28–75% drop-out rate</a> for children and adolescents.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teen-summer-reads-5-novels-to-help-cope-with-adversity-and-alienation-149546">Teen summer reads: 5 novels to help cope with adversity and alienation</a>
</strong>
</em>
</p>
<hr>
<h2>It’s early days</h2>
<p>These early findings are promising. But given this was a pilot study, more research is needed with larger numbers of participants to confirm these outcomes and see if they generalise to broader populations.</p>
<p>We’d like to identify the best dose of surf therapy in terms of session frequency, duration, and program length.</p>
<p>We also need to understand the factors that maintain these initial positive changes in mental health, so any benefits can be sustained after the program finishes. </p>
<p>The recognition of surfing as a potentially effective and acceptable mental health treatment among young people is also promising. But this finding does not preclude the more conventional clinical treatments, such as talk therapy and medication, which may work better for certain people.</p>
<p>Rather, surf therapy may be seen as an additional form of support alongside these approaches or an alternative for those who do not benefit from more traditional methods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Learning to surf on land, in a group" src="https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505291/original/file-20230119-11-yqnz7f.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">Surfers learn on land before heading into the ocean.</span>
<span class="attribution"><span class="source">Ferne Millen/Ocean Mind</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-parents-do-about-their-teenagers-mental-health-25066">What can parents do about their teenagers' mental health?</a>
</strong>
</em>
</p>
<hr>
<h2>Tempted to try surfing?</h2>
<p>If you think surfing might be for you, remember:</p>
<ul>
<li><p>surfing requires complete focus due to the ever-changing conditions of the ocean, making it a great way to step away from day-to-day life and wipe out the effects of stress</p></li>
<li><p>for some people, surfing may reduce barriers to seeking mental health care</p></li>
<li><p>surfing may not be for everyone, nor can it guarantee to reduce your symptoms. Even the best surfers can suffer from depression and may require external support</p></li>
<li><p>don’t worry if you cannot access the ocean or a surfboard. Other <a href="https://www.sciencedirect.com/science/article/pii/S2352827321002093">nature-based activities</a>, such as hiking and gardening, can also benefit your mental health.</p></li>
</ul>
<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 or Kids Helpline on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/196946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Olive receives funding from the National Health and Medical Research Council and the Australian Government Department of Social Services. She does not work for, own shares in or receive funding from any company or organisation that would benefit from this article, including Ocean Mind, and has disclosed no relevant affiliations beyond her academic appointment.</span></em></p>You don’t have to have a mental illness to get the benefits. Here’s how you can use what we’re learning from our research to boost your own mental health.Lisa Olive, Senior Research Fellow & Clinical Psychologist, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950612023-01-15T14:36:13Z2023-01-15T14:36:13ZAlberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?<figure><img src="https://images.theconversation.com/files/502616/original/file-20221223-30570-ki7ovk.jpg?ixlib=rb-1.1.0&rect=20%2C122%2C1901%2C1182&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psychedelics are being held up as a potential solution to the growing need for mental health treatment. But, magic mushrooms are not magic bullets.</span> <span class="attribution"><span class="source">(AP Photo/Peter Dejong)</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/alberta-s-new-policy-on-psychedelic-drug-treatment-for-mental-illness--will-canada-lead-the-psychedelic-renaissance" width="100%" height="400"></iframe>
<p><a href="https://www.cbc.ca/news/canada/edmonton/psychedelics-alberta-regulations-united-conservative-party-government-ketamine-psilocybin-mdma-1.6622674">Patients in Alberta</a> will now be able to legally consider adding psychedelic-assisted therapy to the list of treatment options available for mental illnesses. </p>
<p>Alberta psychiatrists and policymakers suggest that they are getting ahead of the curve by creating regulations to ensure the safe use of these hallucinogenic substances in a therapeutically supported environment. As of Jan. 16, the option is available only through <a href="https://www.alberta.ca/psychedelic-drug-treatment-service-provider-licensing.aspx">registered and licensed</a> psychiatrists in the province. </p>
<p>Alberta’s new policy may set a precedent that moves Canadians one step closer to accepting psychedelics as medicinal substances, but historically these drugs were widely sought out for recreational and non-clinical purposes. And, if cannabis has taught us anything, medicalizing may simply be a short stop before decriminalizing and commercializing.</p>
<p><a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/hallucinogens">Psychedelic drugs</a> — including LSD, psilocybin (magic mushrooms), MDMA (ecstasy) and DMT (ayahuasca) — are criminalized substances in most jurisdictions around the world, but some people are suggesting it is time to re-imagine them as medicines. A few places are even <a href="https://bc.ctvnews.ca/stigma-against-psychedelics-could-fade-with-b-c-decriminalization-experts-say-1.6035470">considering decriminalizing psychedelics</a> altogether, claiming that naturally occurring plants like mushrooms, even “magic” ones, should not be subject to legal restrictions. </p>
<p>In the wake of cannabis reforms, it appears that psychedelics may be the next target in the dismantling of the war on drugs. Canada made bold strides internationally with its widespread <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis decriminalization</a>, but are Canadians ready to lead the psychedelic renaissance?</p>
<h2>Early psychedelic research</h2>
<p>There is some precedent for taking the lead. In the 1950s and ‘60s, an earlier generation of researchers pioneered the first wave of psychedelic science, including Canadian-based psychiatrists who <a href="https://www.mqup.ca/psychedelic-prophets-products-9780773555068.php">coined the word psychedelic</a> and made headlines for dramatic breakthroughs using <a href="https://doi.org/10.1093/shm/hkl039">LSD to treat alcoholism</a>. </p>
<p>Vancouver-based therapists also used LSD and psilocybin mushrooms to treat <a href="https://www.anvilpress.com/books/the-acid-room-the-psychedelic-trials-and-tribulations-of-hollywood-hospital">depression and homosexuality</a>. While homosexuality was considered both illegal and a mental disorder until later in the 1970s, psychedelic therapists pushed back against these labels as patients treated for same-sex attraction more often experienced feelings of acceptance — reactions that aligned this particular approach in Vancouver with the gay rights movement.</p>
<p>Despite positive reports of clinical benefits, by the end of the 1960s psychedelics had earned a reputation for recreational use and clinical abuse. And, there was good reason to draw these connections, as psychedelic drugs had moved from pharmaceutical experimentation into mainstream culture, and some researchers had <a href="https://www.thecanadianencyclopedia.ca/en/article/mkultra">come under scrutiny for unethical practices</a>.</p>
<h2>Regulation and criminalization</h2>
<p>Most legal psychedelics ground to a halt in the 1970s with a set of regulatory prohibitions and cultural backlash. In public health reports since the 1970s, psychedelics have been described as objects of <a href="https://www.unodc.org/unodc/en/Resolutions/resolution_1968-05-23_6.html">unethical research, recreational abuse and personal risk</a> including injury and even death.</p>
<p>Underground chemists and consumers tried to combat this image, suggesting that psychedelics provided intellectual and spiritual insights and <a href="https://www.artsy.net/article/artsy-editorial-psychedelics-offer-artists-creative-boost">enhanced creativity</a>.</p>
<p>Most jurisdictions around the world criminalized psychedelics, whether for clinical research or personal experimentation. <a href="https://doi.org/10.2307/20067845">Indigenous and non-western uses</a> of hallucinogenic plants of course stretch back even further in history, and these too <a href="https://www.encyclopedia.com/history/united-states-and-canada/north-american-indigenous-peoples/native-american-church">came under legal scrutiny</a> through a combination of colonial pressures to assimilate and a looming war on drugs that did not distinguish between religious practices and drug-seeking behaviours.</p>
<h2>The return of psychedelics</h2>
<figure class="align-center ">
<img alt="Close-up view of long-stemmed mushrooms with reddish-brown caps" src="https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503188/original/file-20230105-105030-6isavs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At the moment, the next generation of scientific research on psychedelics still lags behind the popular enthusiasm that has catapulted these substances into the mainstream.</span>
<span class="attribution"><span class="source">(AP Photo/Peter Dejong)</span></span>
</figcaption>
</figure>
<p>In the last decade, regulations prohibiting psychedelics have started relaxing. The U.S. Food and Drug Administration has designated breakthrough therapy status to <a href="https://maps.org/news/media/press-release-fda-grants-breakthrough-therapy-designation-for-mdma-assisted-psychotherapy-for-ptsd-agrees-on-special-protocol-assessment-for-phase-3-trials/">MDMA</a> and <a href="https://www.livescience.com/psilocybin-depression-breakthrough-therapy.html">psilocybin</a>, based on their performance in clinical trials with post-traumatic stress disorder (PTSD) and treatment-resistant depression, respectively. </p>
<p>Health Canada has provided exemptions for the <a href="https://www.cbc.ca/news/canada/london/some-doctors-therapists-get-health-canada-permission-to-use-magic-mushrooms-1.5834485">use of psilocybin for patients with end-of-life anxiety</a>, and has started approving suppliers and therapists interested in working with psychedelic-assisted psychotherapy. <a href="https://michener.ca/ce_course/fpp/">Training programs</a> for psychedelic therapists are popping up across Canada, perhaps anticipating a change in regulation and the current <a href="https://www.ctvnews.ca/health/canadian-health-care-professionals-request-psilocybin-for-training-1.5801538">lack of trained professionals</a> ready to deliver psychedelic medicine.</p>
<p>At the moment, the next generation of scientific research on psychedelics still lags behind the popular enthusiasm that has catapulted these substances into the mainstream. <a href="https://www.smh.com.au/lifestyle/health-and-wellness/the-unparalleled-greatest-feeling-or-risky-drug-inside-the-celebrity-loved-psychedelic-20220331-p5a9oa.html">Celebrity testimonials</a> and compelling <a href="https://open-foundation.org/hear-about-psychedelic-clinical-studies-from-the-perspective-of-patients/">patient accounts</a> are competing for our attention. </p>
<p>Meanwhile, the growing burden of mental illness continues to <a href="https://www.ctvnews.ca/health/some-canadians-waiting-months-for-public-and-private-mental-health-services-1.6204350">overwhelm our health-care systems</a>. Psychedelics are being held up as a potential solution. But, magic mushrooms are not magic bullets.</p>
<h2>Beyond the medical marketplace</h2>
<p>Historically hallucinogenic substances have defied simple categorization as medicines, spiritual enhancers, toxins, sacred substances, rave drugs, etc. Whether or not Health Canada, or the province of Alberta, reclassifies psychedelics as a bona fide therapeutic option, these psychoactive substances will continue to attract consumers outside of clinical settings.</p>
<p>Canada has an opportunity to take the lead once more in this so-called psychedelic renaissance. But, it might be our chance to invest in more sustainable solutions to harm reduction and ways of including Indigenous perspectives, rather than racing to push psychedelics into the medical marketplace. </p>
<p><a href="https://www.culturalsurvival.org/publications/cultural-survival-quarterly/hallucinogenic-plants-and-their-use-traditional-societies">Indigenous approaches to sacred plants</a> are not only about consuming substances, but involve preparation, intention and integration, often structured in ritualistic settings that are as much about spiritual health as physical or mental health. </p>
<p>This cosmology and approach does not easily fit under the Canada Health Act, nor is it obvious who should be responsible for regulating or administering rituals that sit outside of our health-care system. These differences in how we might imagine the value of psychedelics is an opportunity to rethink the place of Indigenous knowledge in health systems. </p>
<p>We are well positioned to take a sober approach to the psychedelic hype, which has been driven in large part by financial interests, and consider what aspects of the psychedelic experience we want to preserve. </p>
<p>Now may be a good time to reinvest in our public institutions to ensure that psychedelics don’t simply become another pharmaceutical option that profits private investors. Instead, we have an opportunity with psychedelics to rethink how a war on drugs has harmed individuals and communities and how we might want to build a better relationship with pharmaceuticals.</p><img src="https://counter.theconversation.com/content/195061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erika Dyck receives funding from Social Sciences and Humanities Research Council.
She is a board member of the US not-for-profit Chacruna Institute for Psychedelic Plant Medicines.</span></em></p>Alberta’s new policy on psychedelic-assisted therapy for mental illness may set a precedent that moves Canadians one step closer to accepting psychedelics as medicinal substances.Erika Dyck, Professor and Canada Research Chair in the History of Health & Social Justice, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.