Hero

Videos

Slideshows

Articles

Podcasts

Poll

 covered a wide variety of psychiatric issues and industry updates, from historic USPSTF draft screening recommendations to the need for novel treatments for bipolar depression. Here are some highlights from the week.

USPSTF Makes Historic Anxiety and Depression Draft Screening Recommendations

The US Preventive Services Task Force (USPSTF) just released a draft recommendation stating that adults under the age of 65 should be screened for anxiety. The USPSTF draft recommendation is not final; it will now enter a public comment period.

The USPSTF draft “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit,” although the evidence for older adults (65 and older) is insufficient. The USPSTF has not previously made a recommendation on this topic. 

In the spring, while the year was still young, 

 published a 7000-word essay entitled “Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.” Some of it recounted the tragic but ultimately heroic story of Caroline Mazel-Carlton, a woman with a long experience of auditory hallucinations who, after much trauma, has become a powerful advocate for humane support and acceptance of those with similar experiences. The story, in the hands of author Daniel Bergner, is not hers alone, but rather the centerpiece of a quasi-editorial calling for a sea-change in psychiatric practice—a “fundamental paradigm shift” in our treatment of mental health. 

The Need for Novel Treatments for Bipolar Depression

Bipolar depression is a condition that proves difficult to treat for many patients. When patients with bipolar disorder (BD) go through a depressive episode, medication adjustment is often the first intervention that clinicians consider. Evidence for standard pharmacologic treatments for bipolar depression shows the strongest support for several dopamine-blocking agents, as well as for lithium and lamotrigine (Lamictal). Recently published treatment guidelines are reflective of this evidence. Pharmaceutical industry support for research on dopamine-blocking medications has contributed to their dominance in the marketplace. Older generic medications are less likely to be included in research trials and thus may not be adopted widely due to a perceived or real lack of evidence. 

Nutritional Treatments: The Next Frontier in Psychiatry

Over the last decade, we have seen an exponential increase in research relating diet quality to mental health. The typical Western diet of ultra-processed foods does not adequately meet the brain’s nutritional requirements and is a proven risk factor for the subsequent emergence of mental disorders in both adults and children. Given the strength of the data supporting the role of optimal nutrition for good mental health, psychiatrists are well positioned to introduce their patients to the topic of diet for mental health and the possible benefit of nutrient supplements for psychiatric conditions. 

. And be sure to stay up-to-date by subscribing to the 

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

From historic USPSTF draft screening recommendations to the need for novel treatments for bipolar depression, here are highlights from the week in Psychiatric Times.

The Week in Review: September 19-23

™ editor, Leah Kuntz, to be sure we knew about the new 

US Prevent Services Task Force recommendations

. Last Tuesday, for the first time, this Task Force recommended that doctors, practically meaning primary care physicians (PCPs), use anxiety screening tools for those aged 19 to 65. Only months before it had also been recommended for those aged 8 to 18. A main concern is that about 30% of people will sometime develop one of the anxiety disorders, but too often do not get help or the right help.

Their recommendations are open to public comment until October 17th. Here’s mine in terms of my initial questions.

How will primary care physicians, already with a still rising epidemic rate of burning out, be able to incorporate testing for anxiety into their already often overwhelming practice?

If abnormal levels of anxiety are picked up by PCPs, are there readily available resources to help?

If medications are relied upon for treatment of too much anxiety, how to control their overuse, addiction, or withdrawal problems?

How do we assess levels of anxiety that are too low, contributing to unhelpful indifference?

Since the level of anxiety often varies over time, what is a way to capture that outside of usual appointments?

In other words, is there a sweet spot for our anxiety that is strong enough to appropriately motivate us, say as I often feel in preparing for my weekly video, but not too strong to paralyze us? The beloved children’s story of The Three Bears suggests that there is as long as we can find it. Goldilocks tasted 3 different bowls of porridge and liked the one that is neither too hot nor too cold.

Anxiety can be said to be an emotional warning signal from internal thought processes, whereas stress is a response to external factors. Each of us has our individual thought tendencies which may be calming or concerning depending on our prior history and current external threats.

In early human history, the external threats commonly were predators or other situations necessitating quick action to survive. More recently, as the just broadcast Ken Burns series on “The US and the Holocaust” tragically depicts, other countries waiting too long allowed the deadly military expansion of Germany until it was almost too late to stop the Nazis. Now, what is the appropriate level of anxiety and response to the Russian invasion of one of the World War II killing fields of Ukraine? Strong cases can be made that we have not been appropriately anxious enough about the pandemic, climate, racism, and other social problems.

Since we in psychiatry are the experts about anxiety and experts are asked to respond, we should not be indifferent to this recommendation. So, what do you think about them?

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

How can we increase assessment of anxiety without increasing other problems? Where is the balance? 

The Goldilocks Model for Assessing the New Anxiety Screening Recommendations

The USPSTF draft “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit,” although the evidence for older adults (65 and older) is insufficient. The USPSTF has not previously made a recommendation on this topic.

Prominent risk factors for anxiety disorders include sociodemographic factors, such as female sex, African American race, or poverty; psychosocial factors, like traumatic life events or substance use; and physical and mental health factors, like other psychiatric conditions or family history of mental disorders.

The draft also recommends screening for major depressive disorder in adults, which remains consistent with previous 2016 recommendations for depression screening.

1. Draft recommendation statement: screening for anxiety in adults. US Preventative Services Task Force. September 20, 2022. 

https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening#citation1

For the first time, the USPSTF is recommending anxiety screening for adults under 65. 

USPSTF Makes Historic Anxiety and Depression Draft Screening Recommendations 

The first patient received a dose of a pharmaceutically optimized form of lysergic acid diethylamide (LSD) in the phase 2b dose-optimization trial for MM-120 for the treatment of generalized anxiety disorder (GAD), according to biopharmaceutical company MindMed.

"The initiation of our phase 2b clinical trial, the largest well-controlled clinical trial of LSD ever conducted, represents a major milestone for MindMed and for the many patients suffering from GAD," said Robert Barrow, Chief Executive Officer and Director of MindMed. "This exciting next step in the advancement of LSD builds on the positive topline data presented by our partners at University Hospital Basel in May 2022, which demonstrated the rapid, durable, and statistically significant effects of LSD and its potential to safely mitigate symptoms of anxiety and depression. The results of our phase 2b trial will guide the dose selection and development strategy for our pivotal phase 3 clinical trials, as we continue our efforts to bring a new potential treatment to the millions of people living with GAD."

The phase 2b trial is a multi-center, parallel, randomized, double-blind, placebo-controlled, dose-optimization study. Investigators plan to enroll 200 participants who will receive either a single administration of up to 200 µg of MM-120 or placebo. The primary objective is to determine the reduction in anxiety symptoms 4 weeks after a single administration of MM-120, compared across the 5 treatment arms. Key secondary objectives, measured up to 12 weeks after the single administration, include assessments of safety and tolerability as well as quality of life.

Earlier this year, the American Psychiatric Association put out its official statement on psychedelics, encouraging research of this kind: “There is currently inadequate scientific evidence for endorsing the use of psychedelics to treat any psychiatric disorder except within the context of approved investigational studies. APA supports continued research and therapeutic discovery into psychedelic agents with the same scientific integrity and regulatory standards applied to other promising therapies in medicine.”

If you are interested in reading more about psychedelics, check out our February front cover “

Psychedelics and the Future of Psychiatry

,” and coverage from our recent 2022 Annual Psychiatric Times™ World CME Conference, “

The Recent Resurgence of Psilocybin: Is It Here to Stay?

™ Psychedelic Supplement, coming in September.

1. MindMed announces first patient dosed in phase 2b trial of mm-120 in generalized anxiety disorder. News release. PR Newswire. August 25, 2022. 

https://www.prnewswire.com/news-releases/mindmed-announces-first-patient-dosed-in-phase-2b-trial-of-mm-120-in-generalized-anxiety-disorder-301612131.html

2. Position statement on the use of psychedelic and empathogenic agents for mental health conditions. American Psychiatric Association. July 2022. Accessed August 25, 2022. 

https://www.psychiatry.org/getattachment/d5c13619-ca1f-491f-a7a8-b7141c800904/Position-Use-of-Psychedelic-Empathogenic-Agents.pdf

The first patient has been dosed in the phase 2b dose-optimization trial of a pharmaceutically optimized form of LSD for the treatment of generalized anxiety disorder.

First Patient Dosed in Trial of LSD for Generalized Anxiety Disorder 

As immigrant-origin students increasingly become the face of US higher education,

 there is a need for mental health professionals—particularly those in college counseling centers—to better understand the acculturation process, as well as the relationship between acculturative stress and well-being of young adults, in order to more effectively address the ongoing mental health crisis in college students.

“Christine” is an 18-year-old young woman in her first year of college. At 14, she immigrated from South Korea to the United States with her parents, who moved to pursue their doctoral degrees. She performed well in her international high school and matriculated into a prestigious predominantly white college on academic scholarship while her parents wrapped up their programs and returned to South Korea. During the first semester of her freshman year, Christine had trouble maintaining the high grades that seemed to come naturally to her in high school. She could not seem to manage her time and was often late for or missed classes. In class, she had difficulty following the instructors. She joined the Korean American Student Association, a small student club, seeking out advice on how she could better manage in her first year of college. However, she had difficulty connecting with her US-born peers, as she felt “too Korean.” She missed her family and the ease of connection she had with her peers back home. By the second semester, in the context of the pandemic isolation, and aggression toward people of Asian descent, Christine lost the drive to attend her classes and subsequently began failing a class. Feeling disappointed with herself and too ashamed to speak with her parents, she sought help at her college’s student mental health center after being recommended to do so by her dean.

A nationwide survey showed a rapid deterioration of mental health among the college student population during the COVID-19 pandemic, worsening the preexisting college student mental health crisis.

 Colleges have been struggling to meet the increasing demand for student counseling and mental health services. US college counseling centers are insufficiently staffed and underfunded, and often operate on waitlists.

 Further, college mental health centers are often not equipped to work with immigrant and international students, as opportunities for cultural responsiveness training in professional psychology are scarce within both doctoral training programs and professional development contexts.

 In addition to the developmentally appropriate stressors of individuation and identity exploration,

 immigrant students like Christine are at risk for an additional, unique type of stress known as acculturative stress.

Acculturative stress refers to the specific stress reaction of immigrants in response to their acculturation process, which can be described as the “changes following contact between culturally different people.”

, a term that implies involvement of a singular culture and negative connotations in its name

is a preferred term to describe the phenomenon that affects performance, mental and physical health, and sociocultural adjustment.

 Stressors can be social, cultural, familial, environmental, institutional, or perceived difficulties (

Acculturative stress can lead to anxiety, depression, somatization, and behavior problems, as well as exacerbate underlying psychiatric disorders.

 Thus, recognizing acculturative stress may be one integral aspect in an immigrant student’s mental health care to consider in their psychiatric evaluation. In Christine’s case, going to college led to the loss of the social support of family, friends, and community that may have provided the scaffolding to buffer acculturative stress.

Students need to feel that they have adequate support to handle the stress around them. Stress arises when individuals believe they do not have the tools or coping response to handle a demanding or threatening situation. Although stress and stressful situations are parts of life, managing stress in a healthy, productive way does not always come naturally. Identifying and reinforcing buffers can help mitigate the pathogenic effects of stress. More simply put, keeping the stress at bay can prevent it from boiling over. According to the stress-buffering hypothesis, having social support—even the perception of social resources—could buffer the stress response and lessen the perceived potential harm of stressful situations.

 By reinforcing to students that they are heard, accepted, and valued in the social and clinical setting, clinicians and counselors can help their students develop better coping efficacy with stressors.

 We provide 4 strategies that mental health counselors and clinicians can adopt to help explore and better support students as they grapple with differences in their culture of origin and their new majority culture.

There are a variety of scales available, including the Acculturative Stress Scale for Chinese College Students scale (ASSCS),

 the Social, Attitudinal, Familial, and Environmental scale (SAFE),

 the Race-Based Traumatic Stress Symptom Scale,

 and the Riverside Acculturation Stress Inventory,

 which address similar factors such as: work/academics stress, language insufficiency, intercultural relationship, perceived discrimination, and social/cultural isolation.

We present a few questions from the Riverside Acculturative Stress Inventory

 for consideration when working with immigrant and international students (

Student responses from targeted acculturative stress exploration can help clinicians better understand how their students might be suffering and what their patients may need. For example, if language plays a large part in the student’s acculturative stress, supporting the student in finding a tutoring program with an emphasis on language skills may be helpful.

2) Provide Language Tools to Combat Social Constraints

While feelings of belonging and support are integral with stress buffering, social constraints interfere with the cognitive and emotional processing of stress. Social constraint refers to an individual's perception that their social networks are unsupportive or unreceptive to discussions regarding stress related to their cultural background. Racial and ethnic minorities who havehigher social constraintsmay experience more psychological distress. In a study on acculturative stress in Hispanic/Latino and Asian immigrant college students, Asians who felt constrained to not express their thoughts and feelings about their acculturative stress by their social network experienced more psychological distress. It is important to recognize that it is not necessarily a lack of support that attributes to acculturative stress, but rather a mismatch between desired and received support.

 Counselors can offer interventions to reduce stress caused by social constraints, such as exercises with students to identify and understand their social constraints and to develop the language to communicate their thoughts, feelings, and needs effectively. Developing alternative outlets for emotional expression, such as expressive writing or online support groups, can give students ownership of their experiences and their voices, which can be helpful in situations where support from their community cannot be attained.

Mental health professionals should encourage students to explore self-agency and develop values that can support them making their own decisions while also preserving their cultural heritage. Those who adopt values of individualism and self-agency are more likely to have positive attitudes toward seeking professional psychological help, which is important for immigrant students who struggle with mental health disorders. If these skills of self-agency conflict with the student’s cultural or ethnic identity and values, it is vital for clinicians to help students integrate and reconcile those incompatibilities and hopefully maintain their bicultural or multicultural identity.

 Taking pride in both cultural backgrounds seems to be associated with well-being for first-generation and second-generation immigrants.

 The discarding of one’s heritage culture, rather than adapting to the United States, is associated with increased health risk behaviors.

 Strong racial identification and racial pride can also provide a buffer against discrimination and distress

 and is connected to positive mental and physical health outcomes.

Most clinicians who work at academic mental health centers are not immigrants and do not have extensive experience working with or treating immigrant students. Therefore, practicing cultural responsiveness, such as keeping an open mind and learning more about different cultures without overgeneralizing, will help providers better serve this population. In the United States, race and ethnicity are often conflated, resulting in racialization—the process of stereotyping a group of peoples—of immigrants who may not fit into their “assigned” racial role.

 For instance, the racial group Black consists of many ethnic groups including but not limited to African Americans, Afro-Caribbean immigrants, and African immigrants, but those classified as Black may not all identify as African American. School-based and clinic-based interventions that work for one group may not apply to another. With this in mind, we must approach each student’s care based on their individual story and context.

For Christine, an essential part of her care involved connecting with a therapist who helped her navigate through the guilt she experienced for struggling academically in the face of her parents’ sacrifices and the shame of “not measuring up” to the expectations of her family. Because the Korean-immigrant community she grew up in had many cultural values that differed from those of her Korean-American peers, she had to reassess her own ethnic identity as a Korean in America, especially during a time of increased Asian hate. Her therapist also recognized that while the acculturative stress caused significant psychological distress, Christine still needed further care. History-taking by her psychiatrist revealed that Christine had symptoms of attention-deficit/hyperactivity disorder (ADHD) as a child. These symptoms were missed due to her parents’ heavy involvement in her education and were exacerbated by the increasing cognitive challenges and acculturative stress of her new environment. She was started on Ritalin, and with continued therapy, she saw improvement in her grades and increased ability to navigate her new environment.

As international students, first- and second-generation immigrants continue to make up more of the higher-education population in the United States, mental health professionals must be equipped to help this growing population with their needs.The ability of mental health counselors and clinicians to recognize acculturative stress and to help provide support for immigrant college students becomes even more pertinent as the school year starts again. Hopefully, this year, we will be more ready.

is a fourth-year medical student at Georgetown University School of Medicine.

is a licensed clinical psychologist, clinical director, and assistant professor in the Department of Educational and Psychological Sciences at the University of Miami. 

is a child and adolescent psychiatry fellow at Medstar-Georgetown, board-certified adult psychiatrist with attending privileges at Howard University Hospital, and an American Psychiatric Association SAMHSA fellow.

1. Batalova J, Feldblum M. Immigrant-origin students in U.S. higher education: a data profile. Migration Policy Institute. 2021. Accessed July 21, 2022. 

https://www.migrationpolicy.org/research/immigrant-origin-students-us-higher-education

2. Kim H, Rackoff GN, Fitzsimmons-Craft EE, et al. 

College mental health before and during the COVID-19 pandemic: results from a nationwide survey.

Are we in crisis? National mental health and treatment trends in college counseling centers.

4. Cadenas GA, Neimeyer G, Suro B, et al. Developing cultural competency for providing psychological services with immigrant populations: a cross-level training curriculum. 

Training and Education in Professional Psychology

5. Umaña-Taylor AJ, Quintana SM, Lee RM, et al. 

Ethnic and racial identity during adolescence and into young adulthood: an integrated conceptualization.

6. Ferguson GM, Iturbide MI, Gordon BP. Tridimensional (3D) acculturation: ethnic identity and psychological functioning of tricultural Jamaican immigrants. 

7. Berry JW. Acculturative stress. In: Wong PTP, Wong LCJ, eds. 

Handbook of Multicultural Perspectives on Stress and Coping.

Acculturation, enculturation, and Asian American college students' mental health and attitudes toward seeking professional psychological help.

9. Schwartz SJ, Weisskirch RS, Zamboanga BL, et al. 

Dimensions of acculturation: associations with health risk behaviors among college students from immigrant families.

Acculturative stress, anxiety, and depression in Latinx youth: the role of behavioral inhibition, cultural values, and active coping.

11. Wong CCY, Correa A, Robinson K, Lu Q. 

The roles of acculturative stress and social constraints on psychological distress in Hispanic/Latino and Asian immigrant college students.

Stress, social support, and the buffering hypothesis.

13. Bai J. Development and Validation of the Acculturative Stress Scale for Chinese College Students in the United States (ASSCS). Indiana University; 2014. Accessed July 21, 2022. 

https://scholarworks.iupui.edu/bitstream/handle/1805/3194/Jieru%20Bai%20Dissertation_submission%20to%20Scholarworks%208-22-2012.pdf;jsessionid=9399EFC0F282404BE470CBAA0F75766A?sequence=6

14. Mena FJ, Padilla AM, Maldonado M. Acculturative stress and specific coping strategies among immigrant and later generation college students. 

15. Carter RT, Mazzula S, Victoria R, et al. 

Initial development of the Race-Based Traumatic Stress Symptom Scale: assessing the emotional impact of racism.

16. Miller MJ, Kim J, Benet-Martínez V. 

Validating the Riverside Acculturation Stress Inventory with Asian Americans.

Recommendations for counselors working with Jamaican immigrant families and children.

18. Ho Misiaszek K. Expanding perceptions of identity in the U.S.: the Chinese Jamaican immigrant experience. University of Miami; 2019. Accessed July 21, 2022. 

https://scholarship.miami.edu/esploro/outputs/doctoral/Expanding-Perceptions-of-Identity-in-The/991031447278502976

Acculturation: when individuals and groups of different backgrounds meet.

20. Kaholokul JK. Racism and physical health disparities. In: Alvarez AN, Liang CTH, Neville HA, eds. 

The Cost of Racism for People of Color: Contextualizing Experiences of Discrimination.

 American Psychological Association; 2016:163-188.

21. Douyon CM. Black in America but not Black American: a qualitative study of the identity development of Black Caribbean immigrants. Boston College. 2020. Accessed July 21, 2022. 

https://dlib.bc.edu/islandora/object/bc-ir:108836

With more immigrant students enrolling in US colleges, what can we do to help with their transition?

4 Ways to Help Immigrant and International College Students Deal With Acculturative Stress

A study found that psilocybin-assisted meditation interventions alter the neural processes that underlie symptoms of social anxiety disorder (SAD) and may have complementary effects.

In the study, a qualitative systematic literature review, researchers aimed to address the limited efficacy of current first-line treatment for SAD by identifying the potential mechanisms used in a combination of psilocybin and mindfulness treatment to adjust the anomalous neural activity underlying SAD. Researchers followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines in a literature search on PubMed using separate search strings for psilocybin treatment and mindfulness meditation.

In the search string for psilocybin, researchers used the keywords “Psilocybin, LSD, Neural activation, brain imaging, nuclear, tomography, fMRI”; for the search string on mindfulness, they used “Mindfulness meditation, Neuronal Activity, Networks, Brain imaging, Tomography.” They selected 30 experimental studies that all had been published in a peer-reviewed journal, assessed the effects of psilocybin/lysergic acid diethylamide (LSD) or mindfulness meditation, and involved the performance of neuroimaging with fMRI.

The researchers analyzed these studies for the effects of combined psilocybin treatment and mindfulness meditation on brain activation and connectivity, biased attention toward social threats, heightened self-focused attention, negative self-perception, brain regions involved in low perceived emotional control, and brain regions involved in post-event rumination.

Their findings suggested a complementary effect of the combined treatments on the neurological mechanisms involved in SAD symptomatology: Psilocybin appears to cause acute disintegration of core neural networks, which are reintegrated in the post-acute phase, during which, the integration of mindfulness meditation exerts modulatory effects. The researchers suggested that this breaks the “vicious maintenance” of SAD by decreasing self-focused attention, while additional complementary effects of the treatments on frontoparietal control over the limbic cortex alter negative self-perception and emotional regulation.

The researchers concluded that the complementary effects of psilocybin and mindfulness meditation interventions may help patients with SAD experience unbiased perception of social situations by improving their control over attention allocation and facilitating regulation of negative self-referential processing and emotional control. They concluded that “future studies should investigate whether psilocybin-assisted mindfulness-based intervention can provide therapeutic benefits to SAD patients who do not remit following conventional therapy.”

Don’t be afraid, ty to meditate—potential effects on neural activity and connectivity of psilocybin-assisted mindfulness-based intervention for social anxiety disorder: a systematic review

Treatments alter the neural processes underlying SAD symptoms.

Complementary Effects of Combined Alternative Treatments on Social Anxiety Disorder

A study found that exercising and playing online games were the most common means of addressing mental health issues during the COVID-19 pandemic.

The international study, conducted by digital board game publisher Marmalade Game Studio, highlighted the mental health issues individuals have experienced during the pandemic and the steps these individuals have taken to address the issues. The study included adults from across France, Germany, Hong Kong, Singapore, and the United States. Nearly 6 out of 10 (57%) of all participating individuals reported experiencing mental health issues, with individuals in Singapore (65%) and Hong Kong (64%) the most affected, followed by France (57%), Germany (56%), and the United States (52%). The most commonly cited mental health issues were stress (38%), anxiety (30%), and depression (22%), with 4% of individuals reporting that they have had suicidal thoughts.

In order to address these issues, 38% of individuals reported exercising more, and 30% reported playing online games, with 29% visiting with friends and family more often, 27% seeking help from a doctor, 26% speaking to their loved ones, and 25% seeking help from mental health professionals. The study also found that 42% of gamers from the European Union said playing multiplayer games during lockdown made them happier, while 16% said that playing games online and connecting with others—particularly family—helped them during lockdown.

“The pandemic has had a huge effect on mental health globally, and millions have at points suffered from a range of conditions caused by worries about their own and others physical health as well as financial worries,” said Cristina Mereuta, Marmalade Game Studio co-CEO, in a press release. “Many people are clearly taking action, with increased exercise and online gaming appearing to be the most popular ways of relieving stress and anxiety. It is important, however, that people seek professional help where appropriate.”

Exercise and online gaming are helping beat mental health issues.

 News release. The Worldliness. April 6, 2022. Accessed April 21, 2022.

The most common issues during the COVID-19 pandemic included stress, anxiety.

Individuals Cite Exercise, Gaming as Top Ways to Address Mental Health Issues

, we connected with experts from across psychiatry to bring you thoughtful articles about a wide variety of psychiatric issues, including the latest in psychedelics; the relationship between neuroplasticity and smart phones; malingering in the COVID-19 era; and ethical considerations for vaccine mandates. Here are some highlights from the issue:

Over the past several years, we have witnessed a psychedelic renaissance, and a growing body of evidence suggests that several psychedelic compounds hold strong therapeutic potential for a wide array of mental health conditions.

Once dismissed as dangerous and having little therapeutic potential, 

 are gaining mainstream acceptance. Research data continue to demonstrate that, on the whole, these medicines are not only safe, but mostly well tolerated. Although more research is needed to better understand safety, especially in the context of at-risk conditions, these favorable safety profiles are enabling deeper exploration of these medicines. 

One of my favorite quotes from philosopher Jiddu Krishnamurti is, “Consciousness is its content.” It makes perfect sense. After reading a book, watching a movie, traveling to Italy, visiting with family over the holidays, finishing a grueling day at work, or surviving a traumatic experience, our mind retains the memories of these experiences in varying regions of our brain. If we ensure a 

, the memories of the previous day will be stored for long-term recall in various brain structures during the night by our hippocampus, along with neuronal connections that will allow us to reconstruct all these memory fragments to recreate the experience. 

Vaccine Mandate Exemptions for Anxiety: Ethical and Practical Considerations

Lauren T. Edwards, MD; Margaret Emerson, DNP, APRN, PMHNP-BC; David Cates, PhD; and Robert Steel, PhD

Many US health care institutions have established mandatory 

 vaccination policies to protect employees, patients, and the community, as well as to comply with the Occupational Safety and Health Administration’s anticipated emergency temporary standard requiring health care providers with 100 or more employees to ensure that staff are vaccinated.

 In response, some health care workers are submitting vaccine exemption requests for religious, medical, and mental health reasons, and organizations are challenged with determining the validity of these requests with little precedent to inform current policy. The purpose of this article is to discuss how behavioral health (BH) experts in one organization conceptualized anxiety-related medical exemption requests for the COVID-19 vaccine, in an effort to inform others confronted with similar circumstances. 

Malingering as a Maladaptive Pattern of Survival During the Pandemic

Teofilo Matos Santana, MD; Matthew N. Goldenberg, MD, MSc; and Seth Powsner, MD

 is a common challenge for emergency department (ED) clinicians, and disasters such as the COVID-19 pandemic tip more people into such dysfunctional adaptations. We present 3 cases of COVID-19–induced malingering. 

The experts weighed in on a wide variety of psychiatric issues for the Psychiatric Times February 2022 issue.

From the Pages of Psychiatric Times: February 2022

Everyone has experienced moments when one bad outcome convinces us we are doomed to a life of failure. These catastrophic thoughts are akin to making a proverbial mountain out of a mole hill. It is why after a breakup, we think no one will ever love us. It is that seizing fear when waiting on a doctor’s report. It is that gnawing feeling when someone vaguely texts “we need to talk.”

This exaggerated expectation that only the worst possible outcome will occur can exert a powerful and debilitating influence over our lives. Left unchecked, these catastrophic thoughts can set dangerous patterns that prohibit us from taking reasonable chances, following inspiration, or recognizing life’s silver linings.

As psychiatrists, we often encounter catastrophic thinking in our patients. We understand how difficult it can be to change these patterns, even with professional help. And while it is often easier to see this in others, the demands of our profession make us susceptible to falling into these very same traps. Tasked with supporting our patients’ well-being, psychiatrists—and physicians in general—feel enormous pressure to produce positive changes in their lives. When our patients suffer setbacks, it is hard to not take it personally. And it can cast a strong and deeply personal shadow of doubt on our abilities.

Then there are the traps of burnout that can lead to catastrophic thinking: regulatory hoops, the ever-increasing bureaucracy and paperwork, clinician shortages, training mandates, the threat of 

. Like a hamster on a treadmill, it is easy to feel that there is never enough time and no end in sight.

Getting out of a catastrophic funk requires following the same treatment and advice we might give our patients. This means asking for help when we need it—something many physicians find difficult to do. Our jobs require us to be stalwart and seemingly infallible, but without balance and mindfulness, we continue to walk a dangerous razor’s edge of catastrophic thinking.

Catastrophic thinking, also known as magnifying, is a kind of cognitive distortion—a thought pattern that is irrational or exaggerated. Psychologist Albert Ellis, PhD, first coined the phrase in 1957 as he was developing his rational-emotive behavior therapy, a precursor to modern-day 

. His ABC model involved an activating event, beliefs that were irrational, and the consequences of those beliefs. His theory was that our emotions and perceptions are not formed by an event—rather, how we think about the event directs how we feel.

Catastrophic thinking can be triggered by one’s perception of what is happening at present or what they anticipate will happen in the future. Situations that trigger magnifying usually fall into 3 categories: how we interpret vague or ambiguous information, how we cope with the loss of someone or something valuable, and fear—especially irrational fear.

Catastrophic thinking shares some similarities with 

. The difference is that anxiety may serve a purpose, such as justified fear, while catastrophizing involves irrational magnification. It is also linked to depression, where feelings of unhappiness and helplessness can trigger an avalanche of catastrophic thoughts. Catastrophizing is common among those who have experienced traumatic events, or anything that threatens their safety and security or shatters their sense of control. It is common among those suffering from 

 (PTSD), depression, and anxiety. Among combat military troops, those with high levels of catastrophic thinking were 29% more likely to develop PTSD. Additionally, those who experienced high levels of catastrophic thinking coupled with higher combat intensity were 274% more likely to develop PTSD.

Ironically, catastrophic thinking can serve as a dysfunctional coping mechanism. After all, if you are always expecting the worst, you will rarely be disappointed. But this comfort can come at a steep price—one that can increase debilitating feelings of anxiety, avoidance, and isolation.

Magnifying can also affect and intensify how we experience pain. This is especially true with those suffering from chronic 

. Pain catastrophizing can feed on the memory and 

 of past events, which can influence how patients perceive future pain. Additionally, it can cause patients to ruminate on it and ultimately feel helpless against the idea of it. Pain symptoms account for 80% of physician visits and $100 billion a year in health care expenditures and lost productivity.

 Because of this, it is essential for physicians to gauge patterns of catastrophic thinking in their patients—not just to recognize the exaggerations, but to notice symptoms of other potential problems. Patients suffering from painful medical disorders in particular report high levels of catastrophic thoughts, along with self-reported pain, disability, and fear-avoidance behaviors.

 In a worst-case situation, catastrophic pain is a risk factor for suicidal ideation in those suffering from chronic pain.

 is a leading cause of catastrophic thinking. Defined as emotional and physical exhaustion brought on by prolonged stress, burnout has been noted in 50% of physicians-in-training and practicing physicians.

 It is generally attributed to work environments rooted in excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, and a lack of input or control, leadership culture, or organizational support. Female and younger physicians are more likely to report higher rates of burnout.

 can reduce one’s sense of effectiveness and personal accomplishment, leaving a person feeling emotionally drained. At worst, depersonalization associated with burnout can lead some to regard patients as objects rather than human beings.

 Physical symptoms include fatigue, body aches, 

, gastrointestinal effects, increased susceptibility to common infections, and disrupted sleep patterns.

Physician burnout is a common problem that has far-reaching effects. For patients, it can result in lower-quality care, medical errors, longer recovery times, and lower patient satisfaction. Physicians are more likely to experience substance abuse problems, depressive and 

, and motor vehicle crashes. The health care industry suffers at large due to reduced physician productivity, turnover, and less access for patients. All of this has resulted in $4.6 billion a year in costs.

The pandemic has created its own unique breeding ground for burnout, with 53% of health care workers reporting high levels. Heading into its third year, the rebounding pandemic and its relentless pressure on the health care system creates an environment ripe for catastrophic thinking. Rather than succumb to its pitfalls, awareness is the first step in fortifying our mental defenses.

Psychiatrists are particularly susceptible to burnout, more so than surgeons and other physicians. In some ways, the stakes are higher, as our patients are more prone to violence and suicide. Because we use ourselves as tools to treat patients, we are vulnerable to a powerful range of emotions. These include feeling powerless against illness, fear of becoming ill, and the obsessive need to rescue patients.

Ellis did more than identify catastrophic thinking. He highlighted a way out of it by expanding the original ABC model to include ABCDE. The “D” refers to the disputation of beliefs, which calls for irrational thoughts to be converted into rational ones. And the “E” represents the effects these new and healthier thoughts might have on a person’s well-being. One of the best ways to counteract catastrophic thinking is by challenging it. Ellis’ method of decatastrophizing involves posing rational questions,

-What is the worst thing that can happen?

Sometimes, saying “stop” out loud can help disrupt the pattern of repetitive negative thoughts. In the heat of the moment, it can be difficult to recognize catastrophic thinking as it is happening. The help of a clinician can clearly define these patterns and use a cognitive-behavioral approach to decatastrophizing. In some situations, clinicians may prescribe antidepressants or other medications to address the root causes of catastrophic thinking.

Over time, this hard work of observing patterns and reframing our reaction pays off in the form of hard-earned 

. Resilience is measured by our ability to quickly recover from stress. It is a way of building mental fortitude despite—and because of—life’s hardships. Another benefit is that it can drown out catastrophic thoughts by interpreting failures as opportunities to learn and grow. Techniques to build resilience include taking on challenges where the risks are reasonable, discovering one’s personal meaning of life, and being surrounded by people who believe in you. Other methods to build resilience include:

TM is a meditation technique that involves silently repeated mantras to help reduce stress and promote a relaxed state of awareness. In one of the author’s studies, health care workers during the pandemic who practiced TM for 3 months showed significantly improved symptoms of emotional exhaustion, anxiety, and 

Here’s how to help patients—and ourselves—recognize cognitive distortions.

Anxiety & Stress Disorders

The Week in Review: September 19-23

The Goldilocks Model for Assessing the New Anxiety Screening Recommendations

USPSTF Makes Historic Anxiety and Depression Draft Screening Recommendations

First Patient Dosed in Trial of LSD for Generalized Anxiety Disorder

4 Ways to Help Immigrant and International College Students Deal With Acculturative Stress

Complementary Effects of Combined Alternative Treatments on Social Anxiety Disorder

Individuals Cite Exercise, Gaming as Top Ways to Address Mental Health Issues

From the Pages of Psychiatric Times: February 2022

Defusing Catastrophe

Depression/Anxiety: Dimensional Treatment Decisions