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In times of uncertainty, modern humans have a need for information and often turn to the news, social media, and other sources to make sense of that information. Dr Judson Brewer explains the science behind these coping mechanisms and offers tips to navigate uncertainty and to avoid pitfalls of rumination that often takes on a life of its own.

he says, as we notice acts of kindness and allow the examples of others to guide and inform positive behaviors, we adopt new habit loops. We may also replace worry and anxiety with more constructive patterns of thinking.

Dr Brewer is a neuroscientist and psychiatrist. He is Associate Professor in Behavioral and Social Sciences at Brown School of Public Health and Psychiatry and Director of Research and Innovation at the 

, a Massachusetts-based company that develops digital therapeutic apps.

As we notice acts of kindness and allow them to guide us into new behaviors and habit loops, we replace worry and anxiety with altruistic thinking. 

Strategies for Keeping Our Prefrontal Cortex Online

Anxiety is not unusual during pregnancy and postpartum for new mothers. However, for some women, anxiety symptoms are more severe, and cause distress, avoidance of activities, interfere with their ability to function at home or at work, or care for their children. One-third of women will suffer from an anxiety disorder in their lifetime.

 Perinatal anxiety is common and often underreported, with the prevalence ranging from 4% to 33.4% (

 Multiple factors may contribute to anxiety during the perinatal period, including rapid hormone fluctuations, biological predispositions, as well as psychosocial challenges that accompany the transition to parenthood.

 American College of Obstetrics and Gynecology 

(ACOG) recommends screening women for depression and anxiety at least once during the perinatal period followed by appropriate referral and treatment when necessary. Although common and impairing, much less attention has been focused on the treatment of perinatal anxiety, both in the literature and in the media. Untreated mood and anxiety disorders during pregnancy have been associated with multiple adverse outcomes for both the mother and baby, including a worsening of medical conditions, lack of medical care, substance use, smoking, suicide, and infanticide. Anxiety itself is a strong predictor of postpartum depression.

 Anxiety disorders have also been associated with negative birth outcomes such as preterm birth, lower birth weight, earlier gestational age, increased odds for being small for gestational age, and smaller head circumference.

Current treatment recommendations for perinatal anxiety disorders include psychotherapy alone or in combination with pharmacotherapy. A variety of therapeutic modalities, such as cognitive behavioral therapy (CBT), have been shown to be both safe and effective for treating mild to moderate perinatal mood and anxiety disorders as an adjunctive measure or as monotherapy.

 Unfortunately, less resourced and geographically isolated communities may experience cultural, logistical, and financial barriers to accessing psychotherapy services.

For women with moderate to severe anxiety disorders that do not respond to psychotherapy and/or that is impairing functioning, ACOG recommends considering the initiation or re-initiation of pharmacotherapy with a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI).

 These medications are well studied and can be very helpful and, in some cases, necessary for managing symptoms.

The choice to use medications is very personal; the woman’s obstetrician and/or psychiatrist should discuss this option with her. The decision should be based on risks and benefits, weighing the risk of exposure to medication on the unborn baby against the severity and risk of untreated illness. The most common risks associated with antidepressant medications exposure are low birth weight, preterm birth, poor neonatal adaptation syndrome, and persistent pulmonary hypertension of the newborn (

 Among women taking antidepressants, more than 50% will discontinue these medications during pregnancy.

 However, women should be encouraged to continue treatment during pregnancy and be provided with a variety of options, including non-pharmacological approaches.

An increasing number of women consider complementary and integrative approaches for alternatives or as adjunctives for treatment options during pregnancy. Complementary and integrative medicine emphasizes a 

to health care and includes natural products and mind body approaches such as mindfulness training and yoga.

 Women utilize complementary medicine more frequently than men; data from the 2007 National Health Interview Survey found that 39.9% of pregnant and 28% of postpartum women reported using some form of complementary or alternative medicine in the past 12 months.

 Additionally, pregnant women who participated in mind-body interventions, including mindfulness and yoga practice have reported an overall satisfaction with these interventions and described the practices as enjoyable, valuable, and beneficial.

 Specifically, becoming aware of the causes of anxiety and the ability to reflect on thoughts and emotions were reported as beneficial by women across all categories of interventions.

Some of the most common forms of integrative practice are mindfulness-based interventions. Mindfulness-based stress reduction (MBSR) provides training in mindfulness meditation techniques as a self-regulation approach to stress reduction and emotion management. Mindfulness-based cognitive therapy is an adaptation of cognitive behavioral therapy with a focus on developing 

 The use of various forms of meditation such as those used in mindfulness-based interventions has increased more than three-fold in the past 5 years.

 Multiple studies of mindfulness-based interventions have demonstrated significant reductions on multiple measures (self-reported and interview screening scales) of anxiety in pregnant women.

Yoga is a mind and body practice with origins in ancient Indian philosophy that combines postures, breathing, and meditation. Yoga has been associated with a reduction in sympathetic activity, balancing heart rate variability, normalizing HPA axis activity, and influencing monoamine changes.

 Over the past decade, yoga has become increasingly popular for promotion of fitness and relaxation, and prenatal yoga classes have become widely available both in studios and online.

The 2017 National Health Interview Survey (NHIS) found that yoga is the most common complementary practice used by US adults.

 Studies looking specifically at the practice of yoga in pregnant women have shown that anxiety symptoms (self-reported and interview screening scales) were significantly decreased in response to even a one-time 20-minute yoga session, and participants continued to show 

in anxiety symptoms with ongoing, regular practice.

 An instructor registered and trained in prenatal yoga is necessary for practice during pregnancy, as certain positions and overheating, “Hot Yoga” should be avoided during pregnancy.

Regular physical activity has also been shown to be beneficial for pregnant and postpartum women for both physical and mental health. ACOG recommends that healthy pregnant women should aim to get at least 2.5 hours of moderate-intensity activity per week. Physical activity has been associated with reduction of pregnancy-related complications, including the risk of weight gain and gestational diabetes, as well as enhancing overall psychological well-being.

 During pregnancy, exercise may reduce the symptoms of anxiety as well as increase overall quality of life. Women who report exercising more frequently during pregnancy have lower than average anxiety symptoms (self-report measures).

 Findings indicate that exercise during pregnancy can be an important component of mental health treatment in addition to psychotherapy or medication management.

Anxiety is common during the perinatal period and can have negative effects on mother and neonate. Women should be provided with multiple options for treatment and encouraged and supported to engage in care during this critical period. The high prevalence of 

 disorders indicates a need to broaden the evidence base for treatment interventions. Therapy and medications are evidence-based and effective options for treating anxiety disorders in pregnancy. However, it is important to take into account patient preferences regarding treatment during pregnancy, as well as access to care.

Complementary approaches are becoming increasingly used by women and may provide benefits for mental health treatment. Available evidence suggests that complementary approaches, specifically mindfulness-based interventions, yoga, and exercise have shown benefit for improving symptoms of perinatal anxiety disorders. Reductions in anxiety symptoms with mindfulness-based interventions, yoga, and exercise suggest an expanding and adjunctive role for complementary approaches to perinatal mental health treatment. More research is needed to systematically evaluate the use of nonpharmacological, integrative modalities for maternal mental health.

is a Consultation-Liaison Psychiatry Fellow, The George Washington University Medical Center/Inova Fairfax Hospital Department of Psychiatry, Falls Church, VA; 

is an MD Candidate, Sidney Kimmel Medical College, Philadelphia; 

is Associate Professor and Director, Graduate Medical Education, Integrative Women’s Mental Health, Department of Integrative Medicine and Department of Psychiatry and Human Behavior, Thomas Jefferson University and Jefferson Health, Philadelphia, PA. The authors have nothing to disclose regarding the subject of this manuscript.

1. Kessler RC, Petukhova M, Sampson NA, et al. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. 

2. Wisner KL, Sit DKY, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. 

3. Fairbrother N, Young AH, Janssen P, et al. Depression and anxiety during the perinatal period. 

4. Figueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: parity differences and effects. 

5. Kendig S, Keats JP, Hoffman MC, et al. Consensus bundle on maternal mental health: perinatal depression and anxiety. 

6. Grigoriadis S, Graves L, Peer M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. 

7. Marchesi C, Ossola P, Amerio A, et al. Clinical management of perinatal anxiety disorders: a systematic review. 

8. O’Mahen H, Himle JA, Fedock G, et al. A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes. 

9. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. 

10. National Center for Complementary and Integrative Health. Complementary, Alternative, or Integrative Health: What’s In a Name? 2018. 

https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

11. Birdee GS, Kemper KJ, Rothman R, Gardiner P. Use of complementary and alternative medicine during pregnancy and the postpartum period: an analysis of the National Health Interview Survey. 

12. Evans K, Spiby H, Morrell JC. Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women: a systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. 

What do we really know about mindfulness-based stress reduction? 

14. Clarke TC, Barnes PM, Black LI, et al. Use of yoga, meditation, and chiropractors among US adults aged 18 and over. 

15. Shi Z, MacBeth A. The effectiveness of mindfulness-based interventions on maternal perinatal mental health outcomes: a systematic review. 

16. Brown RP, Gerbarg PL. Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II—clinical applications and guidelines.

Effects of yoga intervention during pregnancy: a review for current status

18. ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. 

19. Watson SJ, Lewis AJ, Boyce P, Galbally M. Exercise frequency and maternal mental health: Parallel process modelling across the perinatal period in an Australian pregnancy cohort. 

20. Haßdenteufel K, Feißt M, Brusniak K, et al. Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool. 

Women should be provided with multiple options for treatment if they decide to engage in mental health care during this critical period.

Conventional and Integrative Approaches to Treating Anxiety in Pregnancy

During times of stress and anxiety, it is natural to look for something to “take the edge off.” Fortunately, there is an option that is low cost with relatively no adverse effects that can be used as often you deem it necessary, explains Philip R. Muskin, MD, MA, DLFAPA, LFACLP, Professor of Psychiatry and Senior Consultant in C-L Psychiatry at Columbia University Irving Medical Center in New York City.

In this video, Dr Muskin shares his approach to “chill out” using hypnosis and imagery. Find a comfortable chair, and get ready to take this journey to relaxation.

, MD, is considered one of the first people to use the ideas associated with hypnosis. In late 1700s, he developed a system of therapeutics known as mesmerism, which he practiced first in Germany and later in Paris. Mesmerism was based on the idea that there were fluids in the body that were influenced by “animal magnetism.” Disease, he believed, was caused by obstacles that blocked the fluids. The obstacles, in turn, could be broken via trance states, which would return the harmonious flow of fluids. Although his patients were loyal supporters, the medical profession was critical of his ideas and practices. After a commission appointed by King Louis XVI was unable to find support for his claims, the mesmerist movement declined.

In an ironic twist of fate, a skeptic attempting to discredit the ideals of mesmerism actually became the father of hypnosis after observing a traveling mesmerist. Scottish neurosurgeon 

 conducted trials and experiments on himself and others; he eventually developed a technique of relaxation and eye-fixation that resulted in a trance-like state that could also be achieved by suggestions alone. Braid published “Neurypnology or The Rationale of Nervous Sleep Considered In Relation With Animal Magnetism” in 1842. He coined the terms 

, since he believed the trance-like state was related to sleep. His ideas continued to spread and gain popularity through the late 1800s.

Acceptance for its use often came from odd places. The 

 decreed it was not morally forbidden in 1847. And, in 1956, 

 indicated it was useful in treating pain, including during childbirth.

 issued a report endorsing hypnosis, stating there can be “definite and proper uses of hypnosis in medical and dental practice.” The 

 followed suit, and approved its use in 1958. Last to the party, the American Psychiatric Association issued a position statement in 1961 noting that “hypnosis has definite application in the various fields of medicine.”

, hypnosis is used for relaxation as well as to relieve pain and for psychotherapeutic purposes.

A simple exercise and tools to "find your Zen." 

A Journey To Relaxation

Fears about the overprescription of opioid analgesics and the opioid epidemic have resulted in initiatives for physicians to prescribe these medications more judiciously. However, new concerns about patients needlessly suffering untreated or undertreated pain have been raised.

Unfortunately, many lay people and even many health care providers still believe that opioids are the optimal treatment for all forms of pain and that there are no good alternatives. Studies, however, have shown that nonopioid pharmacologic therapies and nonpharmacologic therapies can be as effective and, in many cases, even more effective than opioids.

and meta-analysis of mind-body therapies (MBTs) for patients whose pain is being treated with opioids highlights how useful these modalities can be and the importance of considering them when caring for patients suffering with pain.

The review included 60 studies with 6404 participants. A variety of MBTs were employed, including meditation, hypnosis, relaxation, guide imagery, therapeutic suggestion, and cognitive-behavioral therapy (CBT) depending on the individual studies. The types of pain varied from procedural pain to burn pain to cancer-related pain to chronic pain. The impact of various MBTs on the pain and on the use of opioids were examined.

The findings indicated that meditation, hypnosis, therapeutic suggestion, and CBT were most likely among the MBTs to provide the greatest pain relief with moderate to large improvements. Meditation, hypnosis, and CBT appeared to have the greatest impact on opioid use. The researchers noted that the lack of evidence for the impact of the other MBTs may reflect that there were fewer studies rather than evidence that those MBTs are less likely to have an effect on either the pain or opioid use.

There were also indications that MBTs may provide some benefit for opioid craving and misuse, another reason why their use should be considered for patients on opioids for whom it is believed these medications should be discontinued.

There were differences between the types of pain for which the individual MBTs were studied. Studies that looked at meditation-based therapies primarily focused on chronic noncancer pain while most hypnosis, relaxation, and imagery studies focused on acute, procedural, or cancer-related pain. Whether this provides any guidance as to which type of therapy would be most beneficial for which type of pain is open to question and warrants further study.

It is worth noting that there is a great deal of overlap between many of the MBTs and what might be considered meditation by some could be considered relaxation or even hypnosis by others, so there is often a lack of clear demarcation between them. MBTs are not a magic bullet for the management of pain. They showed a moderate but statistically significant effect on the pain and resulted in a small but statistically significant reduction in opioid use.

In addition to these apparent benefits, MBTs also have one very significant advantage over many of the other treatments for pain: they are essentially free of adverse events. If they are tried and do not provide any benefit, the patient will be no worse off. As with all the other interventions to manage pain, no one can guarantee that MBTs will provide improvement but one can be as close as possible to certainty that they will not have any negative impact on those being treated with them. If the opioid epidemic has taught us anything it is that therapies initiated to help patients can end up having a destructive effect.

There is one very real limitation in the introduction of the MBTs as major treatments for pain. For the most part, in academic centers and hospitals, pain management is primarily considered to be a subspecialty of a single medical specialty—anesthesiology. The only significant exception to this is headache management, which is usually considered to be a part of neurology.

The reality is that few anesthesiologists and neurologists, even those who specialize in pain management, receive much, if any, training in the use of MBTs, nor do most primary care physicians upon whom the management of pain often falls. Thus, most patients with pain are unlikely to come into contact with caregivers who are knowledgeable about MBTs, much less know how to utilize them.

Obviously, the physicians most likely to be trained in the use of MBTs are psychiatrists, and this is one of many reasons why psychiatrists should be more involved in the care for patients with all forms of pain and not just those patients with diagnosable mental disorders.

There is a need for more and better studies on MBTs for pain. However, this can be said of all the other treatments for it. Let us recall that millions of patients have been prescribed opioids for the management of chronic pain although there are virtually no studies demonstrating their efficacy.

1. Garland EL, Brintz CEE, Hanley AW, et al. 

Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis

This article was originally posted on February 20, 2020, and has since been updated. -Ed

For the millions of patients whose pain is being treated with opioids, mind-body interventions are proving to be important considerations to ease suffering.

Mind-Body Therapies for the Management of Pain: How Effective Are They?

 asked integrative psychiatrist James Lake, MD, for insights and advice for patients to reduce stress and take care of their mental health on a day to day basis, especially important now when life seems to be in upheaval for so many. It is of utmost importance to focus on improving lifestyle factors, which may then translate into improved general mental health, and more resilience in the face of stress. 

Dr Lake talks about 4 pillars of mental health and health: getting enough sleep, regular physical activity, healthy nutrition, and a practice addressed at stress management.

In order to optimize your mental well being, a healthy diet with the essential nutrients are vital to healthy brain function. Individuals who have healthy diets tend to function better, feel better, and manage better in the face of stress, whether that is day-to-day work stress, or in this case, the extraordinary unprecedented stress that we are all experiencing. Because of the COVID-19 pandemic a healthy diet that includes fresh fish, vegetables, and grains is essential. 

People who engage in regular physical activity tend to feel better and function better. This does not necessarily mean vigorous workouts every day today, but staying active is key. Moderate level of activity might include regular walks (up to 30 minutes or more per day); strength training; using weights; and hiking on the weekends. Nature is always a wonderful way to be active and refreshed, especially during these times of confinement. There is an enormous body of research showing the relationship between regular physical activity and good mental health. In fact, many studies show that individuals who have moderate depression or anxiety or who engage in regular physical activity, including patients who take antidepressants, derive benefit.

A consistent pattern of rest means a patient has enough time to get into deep sleep. This enables one to wake up the next day refreshed, ready go to work or school. Good sleep hygiene entails the things you do from the beginning of your day until the time you go to sleep that night. They will predispose you sleeping better. Try to turn off the television or any other electronics. Students should stop studying at least an hour before going to bed. Don't drink alcohol right before bed and try to avoid it the last few hours of the day. For patients with anxiety disorders, go into a very quiet, peaceful space using gentle yoga or simple mindfulness practice to take their minds off their worries before trying to fall asleep.

People who sleep tend to be more emotionally resilient. In the context of what we are dealing with now, sleep is fundamental to those who are struggling with depression

This can be simple or it can be elaborate, depending on your preferences, or religious or spiritual bearings. Listening to music with earbuds, while also engaged in very relaxing breathing practice can be very calming and can significantly lower your baseline anxiety.

Tools for reducing stress include mindfulness, such as meditation, simple yoga styles that are calming and relaxing, and breathing. Some yoga postures can promote improved sleep, and those should be done at night, an hour or so before bed.

During this time of extreme stress, spiritual practices can help relieve anxiety. Because we don't know what the future will bring, it is particularly important and valuable for people to engage in their spiritual work or to get closer to their religious community, whichever is more personally useful. It can provide enormous peace at to delve into, spiritual practice, which might be meditation and even Buddhist prayer, Christianity or Judaism.

There can be enormous power from thinking more deeply in one's spiritual life. and through affiliation with religious community or fellowship for support and for sharing faith with others. 

A Mental Health Pandemic: The Second Wave of COVID-19

 is a Psychiatrist in private practice in California. His most recent book is 

An Integrative Paradigm for Mental Health Care: Ideas and Methods Shaping the Future

Psychiatric Times asked integrative psychiatrist James Lake, MD, for insights and advice for patients to reduce stress and take care of their mental health on a day to day basis.

4 Pillars of Good Mental Health

Neda Gould, PhD, a clinical psychologist in the 

, directs a daily mindfulness program. In this video, she will share with you a bit about what mindfulness meditation is and then guide you through a brief practice. 

Mindfulness is something that I found incredibly helpful for myself in general in terms of 

, and certainly during this stressful time it has been even more valuable. Essentially, mindfulness is bringing your attention to the present moment. It is a pretty easy concept to think about in terms of just returning your attention to what you are doing as an anchor to the present such as your breathing. 

You will notice when you practice or if you have been practicing, it does take time to begin to be able to return our attention to the present moment; but it can be an incredible way to reduce stress, as so much of our time is spent thinking about the future and the past. 

During a stressful period, our thoughts are generally stress-related. So I'd like to guide you through a brief meditation practice focusing on the breath. The breath is a great anchor because it is always in the present moment and it is rhythmic, and so it's a simple way to begin if you've never done meditation before.

Mindfulness meditation can be an excellent resource to manage stress and anxiety during uncertain times. Dr Neda Gould, faculty member in the Department of Psychiatry and Behavioral Sciences and Director of the Mindfulness Program, leads daily meditations. Sessions are 30 minutes in length and include a variety of mindfulness meditation practices in a virtual format. Open the following zoom link at the scheduled times to join.

Mindfulness is an effective tool to reduce stress and bring us to the present moment. 

Using Mindfulness of the Breath for Stress Reduction

The COVID-19 pandemic is causing suffering on a magnitude that is unprecedented in living memory. Millions have lost their livelihoods and are struggling financially. Tens of thousands have lost loved ones, and hundreds of thousands who have been infected with the virus face the very real prospect of serious illness or death. The health and financial costs of COVID-19 have resulted in widespread feelings of helplessness and overwhelming anxiety and despair in response to circumstances over which we have little or no control. Chronic exposure to severe stress in the absence of control among countless millions constitutes a perfect storm, with severe mental health consequences on a global scale, including increased rates of depressed mood, suicide, and posttraumatic stress disorder.

Individuals who were already struggling with mental illness before COVID-19 are now facing even greater challenges. After effective antivirals and vaccines have been developed and we have begun to contain the pandemic, the US and many other countries will be faced with a mental health pandemic that will probably continue for years to come. Historically, increases in rates of severe mental illnesses have often followed in the aftermath of national crises. For example, during the decade of the Great Depression from 1929 to 1939, the suicide rate rose from 13.9 to 17.4 per 100,000. Traumatic memories of surviving years of hardship during the Great Depression resulted in high rates of anxiety and depressed mood for generations. Although economic downturns disproportionately affected the health and well-being of the lower income segment of the population, all socioeconomic groups are negatively impacted.

A second wave of the pandemic will be driven by intense feelings of anxiety and despair in a world that is no longer predictable and safe due to high rates of unemployment and homelessness coupled with traumatic memories of surviving one’s own brush with 

 or the death of a partner, parent, or loved one. The personal, social, and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to mental health problems in normal times have been major public health issues in the US and worldwide. This pandemic has served to amplify the personal, social, and economic costs of mental illness to a magnitude that is unprecedented. It is likely that the mental health consequences of COVID-19 will become the most urgent public health challenge worldwide for decades to come, impacting the well-being and productivity of billions. If left untreated, the psychiatric sequelae associated with the pandemic will have serious long-term social and financial consequences for all areas of human life, including personal relationships, family dynamics, academic performance, and work productivity. 

Developing and implementing programs aimed at enhancing resilience and treating individuals struggling with the mental health consequences of COVID-19 deserves the same urgent priority that is now being assigned to the development and testing of vaccines and antivirals. Large scale proactive measures are a key part of successfully preparing millions of people as they resume their day-to-day lives and livelihoods and is an essential step in re-starting stalled economies on a global scale. In the absence of such proactive measures, COVID-19’s long-term global impact on mental health could easily be as devastating and costly as the financial impact of the virus.

Such large-scale programs must be realistic from a cost perspective. Implementing resources that are both adequate and affordablecalls for a review of limitations of the existing model of mental health care. In the current model of care (so-called 

), individuals with medical problems are triaged and treated by family physicians while individuals with mental health complaints are seen in a different outpatient setting by psychiatrists and psychologists. The result is that individuals who have both medical and mental health problems typically receive care at different times, in different clinical settings, and from different clinicians who often do not have pertinent information about pre-existing health problems and treatment history. In outpatient medical clinics, the priority on efficient triage of medical problems may cause delays in the diagnosis and treatment of serious psychiatric disorders, including major depressive disorder and PTSD, due to the 

 spent screening patients for mental health problems.

Although usual care segregates medical care and mental health services, depressed mood, anxiety, and other common mental health problems are frequently comorbid with medical problems such as cardiovascular disease, lung disorders, chronic pain, and diabetes. In addition, usual care is associated with disparities in the delivery of mental health services to different socioeconomic classes.

In response to the limitations of usual care, innovative collaborative care models are being developed and implemented in outpatient clinic settings. In collaborative care, a team of family physicians (or other primary care providers) and behavioral health clinicians work together using systematic and cost-effective approaches aimed at providing patient-centered care that addresses both medical and mental health problems. Studies show that collaborative care models are more effective than usual care for treatment of mental health problems while simultaneously reducing health care disparities. Collaborative care has also been shown to be more effective for managing patients with chronic mental health problems who have comorbid medical disorders, and is more cost-effective than usual care.

Rethinking mainstream mental health approaches

In addition to improving the existing model of care, we need to rethink current mainstream approaches in mental health care in order to adequately address the mental health impacts of the pandemic. Although psychotropic medications are often effective treatments of depression, anxiety, and PTSD, such conventional treatments have limited effectiveness and safety problems, and they are unaffordable to large numbers of individuals who would otherwise benefit from them. Initiatives aimed at enhancing psychological resilience and treating mental health problems resulting from the pandemic should include non-medication (ie, complementary and alternative medicine [CAM]) interventions supported by research evidence. Examples include a regular mindfulness practice for anxiety, exercise for depression, and select natural supplements known to be safe and efficacious adjunctive treatments of specific mental health problems.

, the National Institutes of Mental Health, the 

, the American Psychological Association, and experts in complementary and alternative medicine to join forces and propose a national strategy for developing and implementing large-scale programs and resources needed to adequately address the growing COVID-19 mental health pandemic. Clinical resources should ideally be implemented following a collaborative care model placing equal emphasis on enhancing psychological resilience in healthy individuals and treating serious mental health problems. In order to be most effective and cost-effective, a COVID-19 mental health initiative should incorporate evidence-based conventional and alternative treatments, and should be made available at little or no cost to the millions of Americans who have lost their jobs and their health insurance.

Urgent need for improved mental health care and a more collaborative model of care, special report

The pandemic has brought about uneasy feelings that can exacerbate mental illness and cause further mental health issues. In its current state, our mental health system is not prepared to deal with what may become a global mental health pandemic, but there are ways to address it.

In this video, Neda F. Gould, PhD, Associate Director of 

Johns Hopkins Bayview Medical Center Anxiety Disorders Clinic

Johns Hopkins Department of Psychiatry and Behavioral Sciences

, discusses her work in mindfulness for patients as well as faculty. She describes what mindfulness is and how it can be useful for stress management, and she will walk through a practice session.

Mindfulness is a tool that I found really helpful in managing stress in my own life and so I found that it was a gift that was given to me that I like to share with other people. Mindfulness is basically bringing your attention to the present moment. Much of our time is about the past and thinking about the future, and that can contribute to our distress. Our minds often latch on to worst case scenarios and catastrophes, and we really miss out on the present moment. Mindfulness is a way to build resilience.

During stressful times, it is a muscle we need to build and so there are a couple of ways to build that muscle of being in the present moment. One is informal meditation or mindfulness practice and the other is formal. The formal practice will be the meditation I'll guide you through in this video. But informally at any point during the day, pause and bring attention back to the present moment. That can help us build that muscle of being present more often.

It turns out that if we can do that repeatedly over time, we are happier if we are in the present moment, and we're actually more productive. By focusing on the present moment, we can lower our stress and anxiety. Informally you can pause at any point during the day and just take a breath. That simple practice can turn off the stress response and start to turn on the relaxation.

As soon as you can bring your attention to the sensations in the body, you can separate or get a little bit of space from the narrative of the mind, and that helps us relax as well as our bodies always in the present moment. Our mind is rarely in the present. So I'd like to spend just a couple of minutes walking you through a meditation practice, you can certainly use apps or whatever you'd like to continue this if you find it useful.

In this video, Neda F. Gould, PhD, discusses her work in mindfulness for patients as well as faculty. She describes what mindfulness is and how it can be useful for stress management, and she will walk through a practice session.

Mindfulness Practice: Simple But Not Easy

Virtual happy hours abound, but this is also quite worrisome, especially for those struggling with alcohol and substance use. Dr Packer offers alternative solutions in this video. She recently coined the term 

. The British ritual is built around the time of day circadian rhythms drop, when most people's concentration it at its lowest.

Social isolation presents a good opportunity to grow plants and herbs for tea. Certainly, we can purchase it online; but growing a simple garden in a pot or a window sill can reap many rewards. Such rituals are just perfect for people who struggle with anxiety and depression and they bring real joy. Enjoyable activities are known in psychiatry as behavioral activation and they are proven to help in emotional well-being in the long term, unlike substances like alcohol and drugs that have a very short window of pleasure and end in remorse and, for some, full-blown despair.

Wordsworth's Wisdom During Troubled Times

 is Assistant Clinical Professor of Psychiatry and Behavioral Sciences at Icahn School of Medicine at Mt Sinai, New York, NY.

Virtual happy hours abound, but this is also quite worrisome, especially for those struggling with alcohol and substance use. Alternative solutions are offered in this video.

Ditch the Quarantini: Healthy Options for Psychological Well-Being

Dr Jud Brewer discusses the benevolent effects of altruism during the coronavirus pandemic and tools to cope with self-isolation.

His work has been featured on 60 Minutes, Time, NPR, and 

Dr Jud Brewer discusses the benevolent effects of altruism during the coronavirus pandemic in this brief podcast.

Integrative Psychiatry