Preventing Mental Health Problems From The Startin Utero
In 2017, the American Medical Association published new advice recommending that prenatal vitamins include evidence-based amounts of the relatively unknown nutrient choline. Soon after came the nod from the American Academy of Pediatrics, which recognized the brain-building benefits of choline and urged clinicians to ensure that expectant women had adequate intakes.
What was the fuss? A growing body of evidence was showing thatmuch as pre-natal folate can lower risk for neural tube defectsadequate choline intake in utero could lower the risk of certain mental health problems, including schizophrenia and . Cholinewhich is also important to brain development during early childhoodis readily available in a variety of foods, such as whole eggs, fish, beef, and poultry.
Yet 90% of expectant mothers do not meet the FDAs recommended goal of 450 mg of the nutrient daily. Supplementation is a simple way to address that gap. Choline is needed.by the fetal brain to promote the emergence of inhibition which leads to proper brain function for the remainder of that individuals life, says Camille Hoffman, MD, who has been studying choline at the University of Colorado with support from the Brain and Behavior Research Foundation.
Results From A Concurrent Review Of Behavioral Treatments For Addictions
While recent evidence for active ingredients of treatment and mechanisms of change is encouraging, the limited number of these studies and patterns of inconsistent results is not. In addition to limiting growth of the knowledge base, use of this knowledge in everyday treatment delivery is thwarted by clinical uncertainty. When is it helpful to implement a particular treatment ingredient? When should the clinician focus on trying to activate a particular mechanism of change? Clinician resistance to using specific empirically-supported treatments is grounded in part by the belief that a particular treatment must be adapted to the needs and characteristics of the patient, as well as the treatment context . Identifying active ingredients of treatment offers guidance to clinicians as to which relational or technical components of the treatment may be most helpful. Information as to which mechanism of change might be particularly effective for a given patient or patient circumstance then aids differential responding to patient needs. Exploring this additional level of complexity is an important next step for mechanisms of change research.
Mediated Moderation Moderated Mediation And Conditional Indirect Effects
Inconsistency in potential mediation effects across studies can be attributed to a number of possible explanations. One likely explanation is that the mediation model tested has been miss-specified because it has been under-specified, i.e., it has failed to differentiate the set of conditions under which mediation will occur as opposed to those conditions in which it will not. In other words, whether or not mediation occurs is conditional upon other variables, as yet unspecified. These variables may reside in the patient, the therapist, the treatment context, variables outside of treatment, or some combination of these.
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Scientific Advances Supporting New And Improved Treatment Strategies In Psychiatry
Although current treatments are effective for many of our patients, numerous individuals fail to achieve complete remission, only partially respond to treatment, or discontinue treatment because of intolerable side effects. There is no doubt that we are more successful in treating some illness as compared with others. For example, we generally do well with patients suffering from depression but not as well, especially over the long term, with those struggling with schizophrenia. Most of our treatments result in demonstrable symptom reduction however, when treatment is discontinued, relapse rates tend to be high. Fortunately, exciting recent advances from clinical and translational research hold promise for the development of new and more effective treatments.
The examples mentioned above represent some of the exciting new opportunities for therapeutics in the treatment of depression. However, it is important to recognize that additional studies need to address many unanswered questions and issues related to some of the new treatments noted above. These include optimal dosing strategies, the maintenance of acute efficacy over the long term, concerns related to significant side effects in vulnerable individuals, and concerns regarding potential misuse or abuse.
Cognitive & Behavioral Psychology
Advances In Mental Health& Addictions Treatment, Inc is a Cognitive & Behavioral Psychology practice in Long Beach, CAwith healthcare providers who have special training and skill in researching and treating disorders of human cognition.Cognitive & Behavioral Psychologists at Advances In Mental Health& Addictions Treatment, Inc performtherapy and research focused on treating by helping patients adjust their feelings and actions. Cognitive & Behavioral Psychology isa medical specialty centered on understanding human thought and behavior as it relates to mental health. Significant diseases and conditions treated atCognitive & Behavioral Psychology practices include depression, anxiety, phobias, substance abuse, obsessive-compulsive disorder , panic disorders, and sleeping disorders.Medical tests, procedures and therapies provided by Cognitive & Behavioral Psychologypractices include mental health assessment, cognitive behavioral therapy , cognitive awareness activities, mindfulness activities, breathing exercises, and referral to other specialists as needed.
A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.
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The Rise Of Telemedicine/teletherapy
Virtual therapy and telemedicine started gaining traction in the 2000s. Many traditional practitioners, however, held their ground, dismissing telehealth as an inferior, less-lucrative alternative to in-person treatment.
Then came COVID. By May 2020, health professionalsout of necessitywere seeing 50 to 175 times the number of patients via telehealth than they had prior to the pandemic. Some of the greatest gains came in and telepsychiatry.
It didnt take long for mental health providers and patients to recognize telemedicines many upsides. Teletherapy and telepsychiatry provide easier, private access to a broader base of patients, often at a lower cost.
It is especially valuable in rural areas, where access to mental health specialists is limited. Plusa hefty body of research has found that teletherapy is as effective as in-person treatment in most cases.
There are limitations and issues with teletherapy, and some insurance coverage and licensing issues are still evolving. But teletherapy is still the single most significant change I have seen during this time, at least in terms of potentially benefitting patients. The pandemic has shifted teletherapy from fringe to mainstream. It will be interesting to see where it goes from here, says Jean Kim, MD, clinical assistant professor of psychiatry at George Washington University in Washington, D.C. and Psycom editorial board advisor.
A New Partnership: Clinicians And Engineers
Researchers have found that interventions are most effective when people like them, are engaged, and want to continue using them. Behavioral health apps will need to combine the engineers skills for making an app easy to use and entertaining with the clinicians skills for providing effective treatment options.
Researchers and software engineers are developing and testing apps that do everything from managing medications to teaching coping skills to predicting when someone may need more emotional help. Intervention apps may help someone give up smoking, manage symptoms, or overcome anxiety, depression, post-traumatic stress disorder , or insomnia. While the apps are becoming more appealing and user-friendly, there still isnt a lot of information on their effectiveness.
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Mental Health Help On Your Smartphone
From the time IBM sold the first smartphone in 1994 to the launch of the iPhone in 2007 to the app-packed multifunctional minicomputers that now fill the pockets and purses of half the worlds population, smartphones have hugely impacted mental health.
Negatively, as numerous studies show. But also, to a positive extent, by revolutionizing how we access mental health information and support. Having a smartphonewhich applies to 85% of us in the UShas meant faster access to emergency hotlines, including the National Suicide Prevention Lifeline , the Crisis Text Line , and launched in 2022, 988the first federally designated universal telephone number for national suicide prevention and mental health crisis.
None of this is to mention the tens of thousands of mental health-related apps that now potentially calm us with meditation, track our moods, allow us to text with a therapist, and guide us with artificial-intelligence-directed chatbots.
Evidence supporting the efficacy of mental health apps needs beefing up, but their value cannot be overlooked. Not just because they provide new options for support at a time when many still cant access or afford traditional treatment, but because of the apps mass-market appeal. We still have a long way to go, but with this new technology comes a greater awareness and normalization of managing mental health issues, says Sarah Kaufman, LMSW, of Cobb Psychotherapy in Brooklyn, New York.
Addiction / Substance Abuse Counseling
Advances In Mental Health & Addictions Treatment Center is an Addiction / Substance Abuse Counseling practice in Long Beach, CAwith healthcare providers who have special training and skill in diagnosing and treating addiction and mental health disorders responsible for addiction.Addiction / Substance Abuse Counselors at Advances In Mental Health & Addictions Treatment Center performdiagnosis and treatment of addiction to alcohol and drugs. Addiction / Substance Abuse Counseling isa medical specialty dedicated to researching and treating all types of substance addiction disorders. Significant diseases and conditions treated atAddiction / Substance Abuse Counseling practices include alcohol and drug addiction.Medical tests, procedures and therapies provided by Addiction / Substance Abuse Counselingpractices include conducting patient interviews, administering drug tests, creating treatment plans, participating in therapy sessions, and referring patients to other medical specialists as needed.
- Tobacco Use Disorder
- Video Game Addiction
- Intravenous NAD+ Addiction Treatment
- Opiate Addiction Treatment
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Moderated Mediation And Mediated Moderation As Conditional Indirect Effects
Preacher et al differentiate CIE’s on the basis of which paths, a or b or both, are conditional upon other variables. In the work of Witkiewitz and colleagues , the conditional variable affected both the a and b paths. Karno et al. provide an example of a CIE model where only the a path is conditional on another variable. Here the researchers found that increased patient speech regarding taking steps to maintain their abstinence was predictive of post treatment drinking . However, the relationship between the predictor, amount of structure in therapy across three different treatment conditions, and the mediator , taking steps, was conditional upon whether the patient was high or low in trait reactance . For patients low in reactance, high structure predicted taking steps statements for patients high in reactance, low structure tended to predict taking steps. This result can be directly applied by clinicians to help determine the amount of structure they should incorporate into their therapy with low and high reactant patients.
Project Match: A Transitional Step From Main Effect Treatment Outcome Studies To The Study Of Conditional Indirect Effects
In the above three examples, tests of differences between the two treatments would not have demonstrated differential effects. Because the a priori hypotheses were based on predictions of moderated treatment effects, none would be expected. What was hypothesized, a relationship between the interaction of treatment modality with a patient variable and outcome was supported but how this effect was transmitted was unknown. Through mediated moderation analyses, mediators of these moderated effects were identified .
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More Equitable Insurance Coverage For Treating Mental Illness And Substance Use Disorders
Passage of the Mental Health Parity & Addiction Equity Act in 2008was a major step toward ending discriminatory practices of covering mental health and at lower levels than coverage for other medical and surgical care, says Hannah Wesolowski, interim national director of government relations, policy and advocacy at NAMI.
For many, this helped put an end to inequitable limits on provider visits and inpatient stays. Same for outsize copays, coinsurance, and deductibles for mental health treatment.
Of course, MHPAEA didnt apply to individual and small-group plans. It also didnt help the 48 million in this country who were uninsured. But MHPAEA set precedent. And fast on its heels came the Affordable Care Act, which guaranteed mental health coverage for those with individual, small-group, and Medicaid expansion plans.
Its taken a long time to make fair coverage for mental and addictive illnesses the law of the land, says Richard Frank, senior fellow in economic studies and director of the USC-Brookings Schaeffer Initiative on Health Policy. Still, Frank says, there are many areas of behavioral health care that continue to disappoint. If we are going to meet our commitments to people with mental illnesses and substance use disorders, we have got to look beyond parity and dedicate ourselves to using all the policy, clinical, and programmatic tools at our disposal to promote fair, effective, efficient, and accessible care for all.
The Rise Of Alternative Treatments For Mental Health Conditions
Addiction specialist and Psycom editorial board advisor Michael McGee, MD, says compelling research and the opioid crisis have made him a more reluctant prescriber.
I think the Prozac era may have done more harm than good, as there is evidence that antidepressants can make us more vulnerable to depression, Dr. McGee explains. are a great tool for severe depression, but I think they are overused for the distress of a sick society and the challenges of being human.
In some parts of the country, momentum is building for a treatment approach known as functional psychiatry. Functional psychiatry examines the underlying causes of mental health conditions as opposed to our current model which emphasizesand treatsthe symptoms of mental illness, often with medication.
Experts like Dr. McGee believe this is a step in the right direction.
I fear we now have an epidemic of popping pills for problems that might be better addressed by cultivating community, healthier lifestyles, self-care, and through strong and loving connectionsrather than medications, says Dr. McGee.
In the wake of the COVID-19 pandemic, many Americans are taking a hard look at their lives and making important changes to and prioritize their mental health.
“I think what is most needed for mental health to improve overall right now is a move away from junk values such as materialism, consumerism, and status-seeking, toward love-based values.
Indeed. That may well be just what the doctor ordered.
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Mechanisms Of Change Research
Lacking knowledge of how behavioral interventions worked was not unique to addictions researchers. A seminal paper by Kazdin and Nock described this absence in behavioral treatment research for child and adolescent psychiatric disorders. The authors also suggested that this was a central problem for psychological treatments more generally, and until significant progress was made, further scientific advances would be limited. The zeitgeist for mechanisms of behavioral change research in the addictions field was facilitated by Request for Application initiatives by NIAAA and NIDA. This has set in motion an increasing number of studies focused on mechanisms of behavioral change now making their way into research publications.
Modern Understanding Of Addiction And Effective Treatment
Modern psychiatry has helped shape approaches to addiction treatment and counseling over the last 50 years. Gaining a better understanding of how and why addiction occurs and what is needed to help people recover has led to improvements in treatment programs. These newer approaches provide more effective treatment for individuals who struggle with alcohol or drug addiction.
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Widespread Use Of Cbt And Other Evidence
The work of the late Aaron Beck, MD, a psychiatrist who helped shape 21st-century talk therapy, was hailed by many experts we consulted.
Dr. Beck rejected Freudian psychoanalysis in the 1970s and proposed a more pragmatic approach to talk therapy. Time-limited and goal-focused, Dr. Becks Cognitive Behavioral Therapy hinged on the belief that by altering our thoughts, we can change how we feel and behave.
short-term, structured nature made it well-suited for empirical study and paved the way for a new era of evidence-based treatment. Today, this approach to talk therapy is dominant. Adaptions such as and rational emotive behavior therapy, are now used to manage , addiction, insomnia, PTSD, , even athletic performance anxiety.
The recognition and use of cognitive behavior therapy for as an accepted form of treatment for people with schizophrenia is another important breakthrough, says Dr. Duckworth.
Time-limited, evidence-based mental health treatment is appealing to patients and insurance providers alike. There are still detractors who believe that this form of therapy is too superficial for some patients, who may then be denied the therapy they need because it isnt evidence-based.
But, as Steven Hollon, PhD, professor of psychology at Vanderbilt University in Nashville, summed it up, took a hundred years of dogma, found that it didnt hold up, and invented something brief, lasting and effective to put in its place. He basically saved psychotherapy from itself.
Shifting The Focus Of Research And Clinical Practice
Ms Hargitai said, “Our findings suggest that research and clinical practice must shift some of the focus from autism to ADHD. This may help to identify those most at risk of anxiety and depression so that preventative measuressuch as supporting children and adults with the management of their ADHD symptomscan be put in place earlier to have a greater impact on improving people’s well-being.”
According to Dr. Punit Shah, senior author and associate professor of Psychology at Bath, another important aspect of the new study is that it advances scientific understanding of neurodevelopmental conditions.
“By addressing the shortcomings of previous research, our work provides fresh information about the complex links between neurodiversity and mental health in adultsan area that is often overlooked.
“Further research is now needed to delve deeper into understanding exactly why ADHD is linked to poor mental health, particularly in terms of the mental processes that might drive people with ADHD traits to engage in anxious and depressive thinking.
“At the moment, funding for ADHD researchparticularly psychological researchis lacking. This is especially pronounced when you compare it to the relatively high level of funds directed at autism.
“As the evidence becomes clear that ADHD isn’t just a childhood condition but persists throughout life, we must adjust our research agendas to better understand ADHD in adulthood.”
Journal information:
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