This article was originally published on KFF Health News.

With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.

Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.

“We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.

The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.

However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.

Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.

An app for that

Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.

“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”

The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.

But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.

“It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”

The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.

Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.

Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.

The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.

‘It’s like crickets’

Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”

“It’s a big state—58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”

So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.

“Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”

The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.

The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.

KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.

“I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”

Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.

Concern over referrals

Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.

This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature—in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.

While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.

Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.

“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”

Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.

Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.

“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The post Inside California’s $500 million investment in therapy apps for young people appeared first on Popular Science.

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In just a few short years, psychedelic-assisted therapy involving controlled substances like ketamine, MDMA, and psilocybin (the psychoactive compound found in “magic mushrooms”) have evolved from relative obscurity to the far edges of mainstream medical acceptance. Clinical studies have shown that their medical use can have positive effects for patients living with depression and post-traumatic stress disorder. Sometimes, these treatments prove effective where other, more widely-prescribed medications fall short. But new research suggests close bonds with a trained therapist is a key element contributing to effective psychedelic-assisted treatment, specifically psilocybin.

[Related: 4 visionaries on the history and future of psychedelic medicine ]

A surge in interest in therapeutic use of psychedelics has fostered a burgeoning industry of startups specializing in treatments. As of today, according to the psychedelics industry tracker Psilocybin Alpha, more than 50 publicly traded companies currently offer psychedelic therapy (mostly ketamine) and psychedelic retreats. Yet, the exact ways these companies administer psychedelics can vary widely. While some require patients to consume or inject the substance in the presence of a trained clinician, others lean on loose, pandemic-era health regulations to let patients take the medication at home, typically as pills and lozenges. The latter method can carry risks. In some cases, the Federal Drug Administration, which has yet to approve psychedelic drugs for therapy, claims it has received reports of patients experiencing adverse health effects after they’ve taken medically prescribed ketamine at home without a clinician’s supervision. There are currently no legal at-home psilocybin treatments available however individuals in Oregon were able to begin accessing the compound without a prescription last year. 

A new study published in the journal PLOS ONE this week suggests that strong relationships between patients and their therapists could play a crucial role determining whether or not psychedelic-assisted therapy can prove useful as treatments for depression. The study, which analyzed a 2021 clinical study involving 24 patients using psilocybin-assisted therapy to treat severe depression, found that participants with stronger self-reported connections with their therapist were more likely to report a decrease in depression over time.

In other words, the efficacy of psilocybin treatment increases over the long-term when a patient feels more connected to their clinician. The clinician provides hours or preparation and also guides the patient through the experience and dissects it days and weeks later. Findings like these could help influence treatment standards for psychedelic-assisted therapy treatments, especially as the practice gains more widespread clinical acceptance and adoption. 

Patients with stronger connections to their therapists reported better results 

Researchers from Ohio State University examined data from a 2021 clinical trial where 24 adults seeking treatment for severe depression received two doses of psilocybin paired with 11 hours of psychotherapy. Patients completed survey questionnaires where they assessed the strength of the relationship with their therapists, which the researchers refer to as their “therapeutic alliance.” The patients also noted down any mystical or insightful psychological experience they had during the treatment. Researchers say at times these experiences tend to yield positive therapeutic outcomes, particularly in the short and medium term. In this case, these experiences led to positive outcomes around four-weeks after introducing the psilocybin into treatment.

Higher alliance scores, or stronger relationships with therapists, correlated with longer-term psychological insights. One year after the treatments, patients who reported strong connections with their therapist also crucially provided lower self-reported depression scores one year following treatment than those who reported weaker relationships. The research builds off of past studies that show how a strong therapeutic alliance between a therapist and a patient often leads to a more effective outcome following therapy. This new study suggests those same basic findings similarly apply to psychedelic-assisted therapy. 

“This concept is not novel. What is novel is that very few people have explored this concept as part of psychedelic-assisted therapy,” paper senior author and Center for Psychedelic Drug Research and Education associate professor Alan Davis said in a statement. “This data suggests that psychedelic-assisted therapy relies heavily on the therapeutic alliance, just like any other treatment.”

The findings also reinforce the role a patient’s environment and mindset, known colloquially as “set and setting” can have on influencing positive experiences. In this case, hours of preparatory psychotherapy prior to administering psilocybin, along with “supportive, no direct” therapy during the actual psychedelic experience posed to be significant variables contributing to the drug’s overall effectiveness. Patients who were more comfortable with their clinician may be more receptive to the therapy.

“That’s why I think the relationship has been shown to be impactful in this analysis–because, really, the whole intervention is designed for us to establish the trust and rapport that’s needed for someone to go into an alternative consciousness safely,” Davis added.

The study’s findings come during what could be an inflection point for psychedelic-assisted therapy research and treatment in the US. Despite still being labeled a Schedule 1 drug on the national level, several cities including Denver, Oakland, and Washington have decriminalized psilocybin. On the medical front, the FDA in 2019 approved the use of a nasal spray called Spravato, which uses a derivative of ketamine, for treating depression. Just last year, the FDA released its first-ever draft guidance outlining considerations for researchers looking to conduct clinical trials for psychedelic treatments. An MDMA therapy from the MAPS Public Benefit Corporation could reportedly receive FDA approval by the end of the year. 

Ohio State University College of Medicine resident and paper lead author Adam Levin notes he and his fellow researchers’ findings could highlight the importance of maintaining strong connections between patients and physicians, especially with treatments posed to gain wider adoption in the coming years. Levin, and others critical of attempts to rush out access to psychedelic drugs without proper therapeutic support warn such an approach could lead to unintended consequences and even set back efforts to make psychedelic-assisted therapy more widely available. 

“Our concern is that any effort to minimize therapeutic support could lead to safety concerns or adverse events,” Levin said. “…What we showed in this study is evidence for the importance of the alliance in not just preventing those types of events, but also in optimizing therapeutic outcomes.”

The post How psychedelic-assisted therapies can be more effective appeared first on Popular Science.

Articles may contain affiliate links which enable us to share in the revenue of any purchases made.

Best overall		Womanizer OG		SEE IT	Get the best of both worlds with clitoral and G-spot stimulation.
Best for beginners		MysteryVibe Poco		SEE IT	Easy-to-locate buttons takes the mystery out of changing settings.
Best budget		plusOne Fluttering Arouser		SEE IT	Ten different settings, vibration, and a fluttering arouser adds up to eye-fluttering orgasms.

There’s no shame in having a sex toy in your nightstand. Masturbation plays a big role in your sexual health—it’s even good for your mental and physical health! Your body releases endorphins (hormones that block pain and make you feel good) when you orgasm. Orgasms also help you sleep better, reduce stress, and can strengthen your pelvic and anal muscles. Plus, sex toys and masturbation are an excellent way to be in touch with your body and embrace what gives you pleasure. The best sex toys will leave you feeling confident and empowered over and over and over …

• Best overall: Womanizer OG
• Best for phalluses: Arcwave Ion 
• Best for vulvas: Satisfyer Pro 2 Gen 3 Air Pulse Toy
• Best for couples: We-Vibe Chorus
• Best for anal: Lovehoney Rump Workout Silicone Butt Plug Training Set
• Best rated: Magic Wand Rechargeable Massager
• Best for beginners: MysteryVibe Poco
• Best discreet: Womanizer Wave
• Best budget: plusOne Fluttering Arouser

How we chose the best sex toys

In order to find the best sex toys, we looked at reviews, recommendations, and … did lots and lots of personal testing. I’ve written about salacious things in the past, so I have no shame in my coworkers knowing too much about my personal life. Someone’s gotta do the testing, after all! Additionally, we looked at versatility in both features, use, and the kinds of bodies they can be used on. In this case, we do believe a toy that is a jack of all trades might be best, but there’s also nothing wrong with being a master of none.  

Also, everything on this list is body-safe, meaning it is non-toxic and non-porous. You don’t want any bacteria going near the thin, delicate skin around your genitals and in your body. 

The best sex toys: Reviews & Recommendations

Astroglide Sexologist Dr. Jess O’Reilly says, “Sex toy use is associated with a range of benefits, including increased sexual functioning and sexual pleasure. Those who use sexual accouterments, such as sex toys and lube, report higher sexual functioning and greater sexual satisfaction.” Masturbation is also a great way to relieve stress and help relieve period cramps. 

Everybody (and every body) is different when it comes to pleasure—one of our recommendations should butter your biscuit (get your mind out of the gutter, it’s a real turn of phrase!). 

Best overall: Womanizer OG

SEE IT

Why it made the cut: This feature-packed vibe has lots of intensity levels, can be used for clitoral stimulation or on your G-spot, and its Smart Silent tech keeps things discreet. 

Specs

• Settings: 12 intensity levels; 3 vibration levels
• Waterproof?: Yes
• Pleasure point: Clitoral, G-spot
• Battery life: 2 hours

Pros

• Waterproof
• Can be used for multiple kinds of stimulation
• Quiet

Cons

• Limited flexibility
• Controls can be finicky

The Womanizer OG takes all that is good in a bullet vibrator and all that is good in a clit stimulation toy and combines it into a versatile, wunderbar vibrator that you can use on multiple erogenous zones. Yes, it’s marketed as a G-spot stimulation, but we also loved its capabilities as a clit suction toy. Being able to control the 12 levels of Pleasure Air intensity and three vibration modes separately can lead you to all kinds of new highs when other toys only scratch the surface. The Afterglow feature—which senses your orgasm and gradually reverts back to its lowest setting—is a lovely touch, and helps bring you down from a potentially intense body high, like your lover rubbing your back and holding you after … well, you get it. 

The vibe itself isn’t super flexible, meaning you can’t change the angle of the head, and the controls can be a little confusing— the short and long presses are super important in changing the features, and it’s easy to go into a different mode than you wanted. However, this is a small qualm when you consider the multitude of possibilities on how—and where—you can use this toy. 

Best for phalluses: Arcwave Ion 

SEE IT

Why it made the cut: The Arcwave Ion helps you achieve maximum phallic stimulation. 

Specs

• Settings: 8 intensity levels
• Waterproof?: Yes
• Pleasure point: Phallus
• Battery life: 70 minutes on full power

Pros

• Easy to clean
• Intuitive controls
• Smart Silence tech

Cons

• Could be a little intense for newbies

When you think of phallus masturbators, a device that resembles a flashlight tends to come to mind. There’s nothing wrong with that, but there’s a sleeker way to beat off. The Arcwave Ion (made by the same people who make the Womanizer OG) kind of looks like a stapler, but it’s infinitely easier to clean than closed-end strokers—simply twist and rinse under the faucet after use. The Ion works by focusing pulsating air pressure the frenulum, the band of tissue on the underside of the penis toward that head that is packed with sensitive Pacinian pleasure receptors. A DryTech stick inside the Ion uses silica to wick away moisture, and vents on the lid encourage air flow, so you won’t be stuck with a musty stroker when you pull it out for use. Multiple reviews note a bit of a learning curve when first using the Ion, but boy, you’ll be happy when you get over it. If you’re new to using a stroker, try out a Tenga Egg, which is an analog stroker (you power it, buddy). If you like it, step up to the Ion. 

Best for vulvas: Satisfyer Pro 2 Gen 3 Air Pulse Toy

SEE IT

Why it made the cut: It’s like oral without the oral (and you can actually get somewhere when using it). 

Specs

• Settings: 11 pressure wave settings; 12 vibration programs
• Waterproof?: Yes
• Pleasure point: Clitoral
• Battery life: 90 minutes

Pros

• Easy-to-clean silicone
• App control
• Great cost for features

Cons

• Need to change Bluetooth settings so neighbors don’t know your business

Sure, using a good ol’ bullet vibrator will get the job done, but what about something that blows the project out of the water? The Satisfyer Pro 2 Gen 3 Air Pulse Toy has a long name, but it yields fast-acting feel-good feelings. In fact, you might even be done using it after saying the name. Air-pulse stimulation and vibration simulate oral sex, and Liquid Air technology mimics pulsing water. Put it together and you get a device that makes reviewers say, “It couldn’t be named any better because it will definitely satisfy!”

We love that it also comes with a Bluetooth app to customize vibration patterns, access remote controls, or play music. However, one reviewer notes that the name of the toy pops up on the list of available Bluetooth devices. Some may be none the wiser, but do take time to change the device’s name in the Bluetooth settings. 

Best for couples: We-Vibe Chorus

SEE IT

Why it made the cut: G-spot, clitoral, and phallus stimulation all at once? Heck yes. 

Specs

• Settings: 10 pattern modes
• Waterproof?: Yes
• Pleasure point: G-spot, clitoral, phallic
• Battery life: 90 minutes

Pros

• Comes with a remote control
• Quiet
• Sleek charging case

Cons

• Hard to get clitoral stimulation in some positions
• App interface wonky 

The Beatles’ “Come Together” makes great points about … coming together. Achieve that harmony with the WeVibe Chorus, which stimulates the G-spot, clitoris, and penis. A remote control means you don’t have to reach anywhere to change the settings, and it also allows someone else to control it in the bedroom or over long distances (we’re enthusiastic advocates of exploring sex toys for couples). Touch-sense modes let your movements control the vibrations, and Squeeze Remote tech lets you use your own body to change intensity—the vibration gets stronger as you squeeze. 

With all new things, there is a bit of a learning curve. It can be hard to get a good angle on your G-spot while trying to get the toy to touch your clitoris. It may also achieve a different kind of premature exit based on positioning. The app interface can be a little confusing, and leaving it could stop the vibrator from doing its thing, which is a bummer in the heat of the moment. After futzing around, WeVibe Chorus should be a welcome addition to your sex life. 

Best for anal: Lovehoney Rump Workout Silicone Butt Plug Training Set

SEE IT

Why it made the cut: This butt plug set helps you ease into anal with three beginner-friendly plugs equipped with an essential flared base. 

Specs

• Settings: N/A
• Waterproof?: N/A
• Pleasure point: P-spot
• Battery life: N/A

Pros

• Easy to clean
• Great introduction to anal
• Different sizes for versatility

Cons

• More for beginners

Anal doesn’t have to be daunting. If you’ve always wanted to try it and don’t know where to start, consider this Butt Plug training set from Lovehoney. A tapered tip, lengthy neck, and T-bar are all must-haves when it comes to looking for a butt plug—and these three have them all. All three are easy to clean and are made of body-safe silicone for peace of mind as you play. “Start small and work your way up to the desired size and stimulation,” says plusOne Director of Product Development Megan O’Connell.

The small plug is 3 inches long and 2.5 inches in girth; the medium is 3.5 inches long and 3 inches in girth; and the large is 4.5 inches long and 4 inches in girth. And if you don’t like it, Lovehoney has a 100-day money-back guarantee. Being able to try something out and getting a refund if you don’t like it? Sounds good to us. 

If you’re looking for something more advanced, check out the LELO Hugo Butt Plug. It’s remote-controlled and vibrates.

Best rated: Magic Wand Rechargeable Massager

SEE IT

Why it made the cut: The classic remains a classic thanks to buzzy vibration modes and a bevy of separate attachments, making it a true multi-hyphenate. 

Specs

• Settings: 4 speeds, 4 patterns
• Waterproof?: No
• Pleasure point: Anywhere
• Battery life: 180 minutes

Pros

• Great battery life
• A classic made rechargeable
• Doubles as a percussion massager

Cons

• Not everyone’s cup of tea
• Not waterproof

When you think of “sex toy,” the Magic Wand most likely comes to mind. This wand has been around since 1968, and with that history comes with great responsibility. Considering that the Magic Wand has been used in scientific studies, we’ve come to the conclusion that, yeah, it’s pretty legit. And it’s also pretty no-nonsense. You only get four vibration speeds and four vibration patterns. But it lasts for a marathon 180 minutes, which blows the battery life out of every single sex toy on this list. 

The Magic Wand might not be everyone’s cup of tea: it can be a little too intense for you if you don’t like big, buzzy, bed-vibrating sex toys. But, you can always use it for its original use: as a percussion massager.

Best for beginners: MysteryVibe Poco

SEE IT

Why it made the cut: A foldable design and easy-to-press buttons make this a great buy for someone looking for their first sex toy. 

Specs

• Settings: 8 presets; 16 intensities
• Waterproof?: Only showerproof
• Pleasure point: G-spot, but can be used for clitoral stimulation
• Battery life: 90 minutes

Pros

• Designed to mimic fingers
• Easy-to-use app
• Super customizable

Cons

• Have to keep app on in order to stay connected to the vibe

The MysteryVibe Poco’s small size (under 6 inches in length and 1.5 inches at the base) makes it an excellent choice for beginners who are looking for something they can use by themselves, with a partner, and on different parts of the body. It’s designed to mimic fingers—an ode to the OG way of getting off—and includes 16 different intensities for all kinds of moods. It’s showerproof and also super portable, making it perfect to bring on a trip with your lover or pack on a sleepover. Like other Bluetooth-connected toys, your vibe might turn out when you try to leave the app. 

Best discreet: Womanizer Wave

SEE IT

Why it made the cut: Instead of your regular showerhead, this showerhead and clitorial stimulator in one was designed for erogenous zones. 

Specs

• Settings: N/A
• Waterproof?: Yes
• Pleasure point: All over
• Battery life: N/A

Pros

• Looks like a regular showerhead
• Saves water
• Easy installation

Cons

• Not for anyone who doesn’t want to incorporate toys into daily life.

“Discovering masturbation via the showerhead” is a common trope in coming-of-age movies, but it’s also one that many of us have done in real life. It’s an easy, cheap, accessible way to experiment with masturbation. The showerhead has grown up, thanks to the Womanizer Wave, which is made for water-pressure clitoral stimulation. Believe it or not, it also saves water thanks to EcoSmart tech without sacrificing performance. The Wave is also easy to hold in your hand (you can’t say the same for your heavy showerhead). You can change between the three different water jets—PowderRain, PleasureJet, and PleasureWhirl—with the touch of a button. The Womanizer Wave system is easy to swap in and out—however, it might be even easier to accept that your showerhead was made for masturbation and let no one be none the wiser.

Best budget: plusOne Fluttering Arouser

SEE IT

Why it made the cut: You don’t have to spend $100 to “invite a little pleasure” into your life. 

Specs

• Settings: 10 vibration speeds
• Waterproof?: Yes
• Pleasure point: Clitoral
• Battery life: 1.5 hours of use

Pros

• Easy to clean
• Cheap and good quality
• Rechargeable

Cons

• Might not scratch the itch for those who are suction toy stans

“Cheap” tends to get lumped with “poor quality.” And, vibrators under $50 may not be rechargeable. The plusOne rejects those notions with soft, smooth high-quality silicone that yields 1.5 hours of power on a single charge. It combines a fluttering tongue with vibration for extra stimulation and arousal. You just need some warm water and mild soap to clean. And, it’s truly waterproof, so you don’t have to worry about damaging the device when using it in the shower.

However, if suction toys are your jam, you might not get your rocks off with the Fluttering Arouser, since it uses a silicone tongue and vibration. In that case, we recommend the Lovehoney X ROMP Switch Clitoral Suction Stimulator, which has six intensity levels and is less than $35.

What to consider when buying the best sex toys

The world is your oyster when sex toy shopping. However, all sex toys are not built the same. And, like the partnered sex many of us had in college, when a sex toy is bad, it’s bad! Here’s what to look for when looking for a sex toy.

What do you like?

Where do you like to be touched? And how do you like to be touched? Answering those questions can lead you to a perfect match. For example, a vibrating phallus sleeve is going to feel different than a cock ring. Maybe vibration isn’t your style and a stroker sounds more pleasurable to use.  

Experimentation

With this said, sex toys are a great way to try something new. Check to see if the site you’re buying from has a money-back guarantee. Sometimes, you can get a refund if you decide that a toy isn’t making you see fireworks and enter a new dimension. 

What if the vibe isn’t your vibe? Aka, sex toy recycling

Most retailers won’t accept your used sex toys if you change your mind, however. The good news is, there’s a way to not let it sit sad and unused in your nightstand drawer. 

“Should you need to dispose of a product with a lithium-ion battery, the battery should be disposed of in accordance with the local laws and regulations,” Connell says. 

This means its final resting place is not in your home trash can.

“If possible, please recycle it,” adds plusOne Director of Industrial Design Emily Gasta. “Users should not take out or replace the battery by themselves; doing so may damage the product.”

You also don’t want to recycle a used sex toy. Read up on how to clean your sex toys based on what they’re made out of. And if you really want to get rid of it, you can gift it to a treasured and trusted friend (after sanitizing and sterilizing, of course), or you can gift it away on a site like Squeaky Clean Toys, which is like eBay for sex toys. 

Lube up

Not all lubes are made the same, either. You’ll want to use silicone lube like the Shine Silicon lube from Maude on glass toys, when you’re getting frisky in the water, or when you’re just using your hands. However, do not use silicone lube with silicone toys—that will damage them. Instead, use a water-based lube like tried-and-true-blue Astroglide. We also have to recommend Astroglide because of its rocket-science roots. 

FAQs

Final thoughts on the best sex toys

• Best overall: Womanizer OG
• Best for phalluses: Arcwave Ion 
• Best for vulvas: Satisfyer Pro 2 Gen 3 Air Pulse Toy
• Best for couples: We-Vibe Chorus
• Best for anal: Lovehoney Rump Workout Silicone Butt Plug Trainng Set
• Best rated: Hitachi Magic Wand Rechargeable Massager
• Best for beginners: MysteryVibe Poco
• Best discreet: Womanizer Wave
• Best budget: plusOne Fluttering Arouser

Sex toys are fun to use, but they’re also an important part of sexual wellness and building confidence. There’s something for everybody when looking for the best sex toys—and the majority of them can be used on almost every body. Shut the blinds, clear 20 minutes off your schedule, and get to work!

Why trust us

Popular Science started writing about technology more than 150 years ago. There was no such thing as “gadget writing” when we published our first issue in 1872, but if there was, our mission to demystify the world of innovation for everyday readers means we would have been all over it. Here in the present, PopSci is fully committed to helping readers navigate the increasingly intimidating array of devices on the market right now.

Our writers and editors have combined decades of experience covering and reviewing consumer electronics. We each have our own obsessive specialties—from high-end audio to video games to cameras and beyond—but when we’re reviewing devices outside of our immediate wheelhouses, we do our best to seek out trustworthy voices and opinions to help guide people to the very best recommendations. We know we don’t know everything, but we’re excited to live through the analysis paralysis that internet shopping can spur so readers don’t have to.

The post The best sex toys in 2024, tested and reviewed appeared first on Popular Science.

Articles may contain affiliate links which enable us to share in the revenue of any purchases made.

Although it can sound cliché, there’s a lot of truth in the old axiom “face your fears.” In fact, exposure therapy ostensibly puts that adage into practice. For many people, reprocessing their trauma with the help of trained professionals can allow their brains to relearn the important differences between an actual traumatic event and its harmless memories.

Unfortunately, post-traumatic stress disorder often reworks the brain by limiting the ventromedial prefrontal cortex’s ability to control regions like the amygdala. This can lead to memory and safety learning issues that limit exposure therapy’s efficacy.

To potentially solve this issue, researchers wondered if combining the treatment alongside another popular trauma therapy might compensate for this brain barrier. Their results, published this week in JAMA Psychiatry, indicate a workaround may actually be found through a trio of tools: exposure therapy, transcranial direct current stimulation (tDCS), and virtual reality.

[Related: PTSD patients’ brains work differently when recalling traumatic experiences.]

In their recent study, a collaborative team from Brown University and the Providence V.A. Center for Neurorestoration and Neurotechnology asked 54 military veterans to participate in a new, double-blind study. Every volunteer agreed to six VR exposure therapy sessions over two to three weeks that depicted generalized warzone situations.

“It can be difficult for patients to talk about their personal trauma over and over, and that’s one common reason that participants drop out of psychotherapy,” Noah Philip, the study’s author and Brown University psychiatry professor, said in a statement. “This VR exposure tends to be much easier for people to handle.”

During these 25-minute sessions, half of the veterans simultaneously received painless, 2 milliamp tDCS stimulations directed at their ventromedial prefrontal cortex. The other participants, meanwhile, served as controls, and only felt a small sensation meant to mimic tDCS treatment.

According to researchers, veterans who received both therapies reported “meaningful” improvement in their PTSD symptoms after just three sessions, with a “significantly greater” reduction in issues reported during their one month follow-up interviews.

What’s more, the results were achieved much faster than volunteers who only underwent VR exposure therapy. In only two weeks, tDCS/VR approach produced results normally only seen after about 12 weeks of exposure therapy alone.

It’s important to note that this initial participant sample size is relatively small, and researchers need to continue studying the results to better grasp how the treatment works over time. Still, the team hopes to conduct similar experiments on larger populations in the future, potentially alongside additional treatment sessions with longer follow-up times.

The post VR and electric brain stimulation show promise for treating PTSD appeared first on Popular Science.

Articles may contain affiliate links which enable us to share in the revenue of any purchases made.

Best overall		We-Vibe Sync O		SEE IT	A wearable vibe that’s fun during foreplay or during sex.
Best for beginners		Unbound Squish		SEE IT	A squishable entry point to the world of buzzy vibes.
Best budget		plusOne Personal Massager		SEE IT	Low budget, high quality.

We love masturbation, but using a sex toy as a couple is, for lack of a better phrase, incredibly hot. Being behind the steering wheel of someone else’s desires? Doing some long-distance debauchery with the help of a smart vibe and app? Implementing tools so your hands can go other places? You won’t just get two tickets to Pleasureville—you’ll get a season pass, the keys to the city, a memorial plaque along main street, and even a statue built in your joint honor. Casting sexual stigma aside is a task that doesn’t undo itself overnight. If you decide to take the journey, you’ll be a stronger couple thanks to the communication, direction, and confidence you gain from experimentation. The best sex toys for couples make coming together easy, intimate, and even a little spiritual.

• Best overall: We-Vibe Sync O 
• Best rated: Magic Wand Cordless Vibrator
• Best for beginners: Unbound Squish
• Best for men: Fun Factory Manta Vibrating Male Stroker
• Best for women: Womanizer Next
• Best budget: plusOne Personal Massager

How we chose the best sex toys for couples

I previously covered the best sex toys, so I’ve been around the block when it comes to knowing what to look for. We also looked at reviews and recommendations and spoke to experts. We also … tested them ourselves, so you can feel better a real person has handled what’s in this story. We also looked at versatility in use and the kinds of bodies they can be used on. High-end sex toys are well worth the money, but we want to make sure you get your money’s worth out of them.

Everything on this is body-safe, meaning it’s non-toxic and non-porous. Bad bacteria and your sensitive bits aren’t the best couple here.

PS: We know gender is fake! We use some gendered terms here, but just know all these toys are made for bodies regardless of how you identify.

The best sex toys for couples: Reviews & Recommendations

It’s not every day you get to polish the banister (real euphemism for masturbation, by the way) in the name of product journalism. One of our picks should help you and your honey paddle the pink canoe or shuck corn.

Best overall: We-Vibe Sync O 

SEE IT

• Settings: 10 vibration modes
• Waterproof?: Yes, IPX7
• Pleasure point: G-spot, clitoris
• Battery life: 150 minutes

Pros

• Secure fit
• Comfortable to wear
• Waterproof

Cons

• Remote is small, so be cognizant not to lose
• Still hard to keep on the clitoris

I previously tried We-Vibes’ other hands-free C-shaped vibrators, like the Chorus and Sync Go, and found it difficult to keep the internal parts inside my body. I still will recommend both vibes—what isn’t my cup of tea could certainly be yours—but the We-Vibe Sync O is the answer to my personal problem. It provides dual stimulation, and the insertable portion has a little more surface area to stay put. The O-shaped internal arm is flexible and comfortable to insert, and there’s more than one way to use it. You can use it by yourself hands-free, during penetrative intercourse, during foreplay, or with another G-spot toy or dildo. You can control it yourself via the remote or on the device itself. We recommend the remote so your hands can focus on other places.

Its 10 intensity levels range from a low, rumbly purr to a buzzy high. Like the Chorus and the Sync Go, you can control the We-Vibe Sync O on your phone, making it perfect if you’re looking to stay while dating long distance. It’s also IPX7 waterproof rated so that you can use it in the bath or shower, and body-safe silicone gives us peace of mind.

Some reviews mention that you still have to hold the external part in place to really get it on the clitoris. Otherwise, you get overall vulvar stimulation. We also experienced that. Body movement tends to knock anything out of place, so it wasn’t a deal-breaker for us. The remote is very small, which screams “lose me,” so just keep an eye on it or keep it in the included drawstring bag when not in use.

Best rated: Magic Wand Cordless Vibrator

SEE IT

Specs

• Settings: 4 speeds, 4 patterns
• Waterproof?: No
• Pleasure point: Anywhere
• Battery life: 180 minutes

Pros

• Great battery life
• A classic, now rechargeable
• Doubles as a percussion massager

Cons

• Not everyone’s cup of tea
• Not waterproof

The Magic Wand is the toy that people think of when talking about sex toys. This wand has been around since 1968, and with that history comes great responsibility. The Magic Wand has been used in scientific studies, so its power (up to 6,300 RPMs) is pretty legit. Its settings are simple but still get the job done: You only get four vibration speeds and four vibration patterns. It lasts for a marathon 180 minutes, which blows the battery life out of almost every single sex toy on this list. You can use it on clits, frenulums, nipples, or on the shoulders for a nice massage. It did originate as a percussion massager, after all.

We’ve also tried the Magic Wand Micro, which packs the Magic Wand’s simplicity and flexible neck into a pint-sized package. I personally prefer it over the Magic Wand. I love a good buzzy, too, but the Magic Wand can be … a little much! If you’ve found that regular wand massagers leave you uncomfortably numb, give the Micro a try. You can also show your sex toy allegiance by using the Micro as a keychain. Two birds, one stone, you get it.

Sarah Tomchesson, a certified sex educator and Magic Wand’s director of marketing, also recommends using the Magic Wand’s smaller cousin in the bedroom.

“Right now, my favorite toy for couples is the Magic Wand Micro,” she says. “It boasts the power of the famous full-sized Magic Wand but starts at a more subtle vibration on its lowest setting. It is ideal for warming up the body to full arousal, using it on both partners, and its compact size fits nicely between bodies or in your bag for date night or a sexy getaway.”

Best for beginners: Unbound Squish

SEE IT

• Settings: 6 total; 4 intensities and 2 patterns
• Waterproof?: Yes (Rating not listed)
• Pleasure point: Anywhere
• Battery life: 2.5 hours on lowest setting; 1 hour on highest

Pros

• Haptic settings
• Soft silicone
• Easy to hold

Cons

• Reviews note haptic controls are hard to use
• A little expensive for how the user experience is

A bullet vibrator is most often everyone’s entrance into sex toys. However, they can be hard to hold and don’t give you the power or rumble some may crave. They’re also not that waterproof, depending on the kind you buy. That’s not the case with the Unbound Squish. We love that you can control it via the buttons on the vibe or by squeezing it. The tech isn’t perfect, but it does make for a fun experience. The pointed tip can be used on many erogenous zones, and the ridge at the top provides an extra yummy sensation. It’s waterproof, and it comes in its own little bag for easy travel. It is a little pricey for an entry-level vibe and the experience it provides, which isn’t bed-rocking but great as an entrance to sex toys. We also love the MysteryVibe Poco, which is flexible and the best for beginner choice in our original sex toy story.

Best for men: Fun Factory Manta Vibrating Male Stroker

SEE IT

• Settings: 12 total (6 speeds, 6 patterns)
• Waterproof?: Yes (Rating not listed)
• Pleasure point: Penis, frenulum
• Battery life: 40-120 minutes, depending on settings

Pros

• Finger loop base for easy holding
• Can be used in many different ways
• Travel lock
• Quiet

Cons

• Motor could be more powerful

Foreplay and masturbation don’t have to be all spit and friction. Consider adding a toy, like a stroker or cock ring, to experience different sensations. We love the Fun Factory Manta Vibrating Male Stroker just for that reason. Its vibrations (it comes with six speeds and six patterns) and ridges are different than a hand, and you can use it by yourself or with a pal. In fact, it’s designed with couples in mind. You can slide it in-between bodies during penetrative sex, or you can position it at the base of the penis to step up oral sex. Its finger loop base makes it easy to hold, and it’s extremely quiet, meaning noise from vibrations won’t wreck your mood. Plus, it’s waterproof so that you can bring it into the shower built-free. Reviews note, however, that the motor could be more powerful. If you’re looking for something gentler, congratulations, you’ve found it.

Best for women: Womanizer Next

SEE IT

• Settings: 14
• Waterproof?: Yes, IPX7 rated
• Pleasure point: Clitoris
• Battery life: 120 minutes

Pros

• Incredibly quiet
• Climax control
• 3D Pleasure Air is a game-changer
• Extra stimulator head for different bodies

Cons

• Unwieldy

Suction vibrators are some of my favorite vibes to use by myself or with a partner during foreplay. I’ve tried many of them based on the nature of my work, and some have stood out more than others. The Womanizer Next, with its 14 intensity settings and 3D Pleasure Air tech, is at the head of the pack by a mile. It has everything I want in a vibrator: It’s powerful but quiet, waterproof, easy to clean, and made of oh-so-soft silicone. An extra stimulator head helps you find what fits best with your body, and you can order more online. Climax control is the cherry on top, giving you three Air Wave depths to choose from. You know that one SpongeBob meme? You’ll feel like that after using this vibe.

You can also choose Autopilot mode, which puts the control in Next’s metaphoric hands. You won’t have to worry about pushing buttons, and you get to try something new. Win-win!

It has a chunkier profile compared to others I’ve tried, but frankly, I don’t care. I glean over this con. It’s just that good. If it really worries you, consider the Womanizer Pro 40, which is a little sleeker but just as beloved.

Best budget: plusOne Personal Massager

SEE IT

• Settings: 10 vibration modes
• Waterproof?: Yes
• Pleasure point: Everywhere
• Battery life: 4 hours

Pros

• Compact
• Discreet
• Long battery life

Cons

• Reviews note performance issues

The brand plusOne makes some of our favorite budget sex toys. They’re high in quality but won’t leave your wallet dry. This compact wand can be used all over the body, making it a perfect addition to foreplay and sex. It’s also waterproof, meaning you can use it in the shower. The battery life is crazy long for how small it is, and its flexible head is reminiscent of the one on the Magic Wand. It fits well in your hand, isn’t unwieldy, and has soft silicone that rivals higher-end vibes. If you’re beginning your vibrator journey, plusOne is a great place to start.

You get what you pay for with this wand, however. Reviews note that it doesn’t have the vibration juice compared to other vibes, and it doesn’t have the shelf life of higher-end toys.

What to consider when buying the best sex toys for couples

In these kinds of stories, we often say, “Not all [blank] are made equal,” but we really mean it this time. Sex toys, despite being products that promote sexual wellness, are not regulated by the FDA, which means anyone can make, market, and produce a sex toy that’s a little shady, just like that one situationship in college.

“Quality toys are worth the investment,” Sarah Tomchesson, Magic Wand’s marketing director and a certified sex educator, says. “A quality sex toy is user-tested, made of body-safe materials, and components that will last. If budget is a concern for a buyer, the best approach is to join the mailing list for a reputable sex toy retailer and take advantage of seasonal sales promotions rather than searching for the lowest-priced toy online.”

Here’s what you should look for before putting anything in or on your partner’s body or your own:

Material

You want to look for body-safe toys. This means you can use them around and inside your body. If you see that it’s made of silicone, stainless steel, and borosilicate glass, you’re in the clear. Body-safe materials are free from phthalates and won’t change forms when exposed to different temperatures.

Generally, be wary of anything porous. You’ll know something is porous if it’s see-through, sticky, stretchy, or has a strong rubbery odor. “Porous” doesn’t mean “inherently dangerous,” however; some porous materials can be phthalate-free and non-toxic, but they can harbor germs and be almost impossible to disinfect. Most cock rings and a few wand heads use porous materials. You’ll want to keep it to yourself if it’s made from cyber skin, jelly, PVC, rubber (even skin-safe rubber), UR3, and vinyl.

“Beware of ‘silicone blends’ as they may contain unknown plastics or materials,” Tomchesson adds.

If you’re working with porous wand heads and toys, cover them with a polyurethane condom to reduce risk if using it with another person (and change the condom with each new person that uses it), emphasis on “reduce risk.”

If you’re unsure if your sex toy material is body-safe, simply ask. Many manufacturers have emails and customer service chats that can answer any questions about a certain toy.

Buying from reputable brands can also give you peace of mind. Platforms like Lovehoney and Spectrum Boutique, buying right from the manufacturer’s website, and buying from the manufacturer’s Amazon storefront are surefire ways to know you’re purchasing from a good place. If you see a storefront name that looks like it was made by your cat walking across your keyboard, you might want to stay clear of it in this case.

Kinds of sex toys

There are so many kinds of sex toys. So many! Tomchesson says toys that are easy to hold, quiet, can be positioned between bodies, and increase access to previously undiscovered nerve endings during a couple’s play are ideal for couples to add into the mix.

Here are just a few that are perfect for partner play:

• Glass toys: Great for temperature play (can throw it in the freezer/fridge for cold and put it in warm water for hot), also non-porous and easy to clean and maintain.
• Wands: Fun and rumbly, you can use these all over, even for sore shoulders.
• Bullets: Perfect on nipples, clitorises, frenulums, perineums … the world is your oyster.
• Strokers: Great to assist during oral play or add some pizazz to solo play.
• C-shaped toys: Can use them on your partner during foreplay, on yourself during solo play, or with your partner. You can also use them while having sex or with a G-spot vibrator (we’re huge fans of the We-Vibe Rave 2) or dildo. You have options!

When buying a sex toy for the first time, Tomchesson says the first question couples should ask themselves is what their goal is with using a toy. Other follow-up questions include: Is there a new kind of play or sex position they are interested in exploring? Are they experiencing an orgasm gap in the relationship where one partner is experiencing pleasure and orgasms while the other is not? Are they interested in taking their bedroom explorations in a new direction? 

“Once a couple is clear on what they are hoping to achieve with a new toy, the search narrows, and it is easier to find a good fit,” she says. “From there, couples can read online reviews, visit a sex-positive store, or search a Reddit thread for inspiration. A quality sex toy will have positive reviews on reputable online sexual wellness shops, and detailed specs and product information, including the materials.” 

Tomchesson recommends looking for products with versatility, such as variable speeds and the ability to use them in a variety of ways, all over the body, and in solo play and couples play. She says that, for your first toy purchase, find a pleasure product that looks and feels inviting and is simple to use. 

“Your first sex toy should excite you and make you eager to get into the bedroom,” she says. 

Then, she says to test it out before using it with your partner. “Read the instructions, charge it up, and get familiar with the settings before you are in the heat of the moment with your partner. This way, you can intuitively integrate the toy into your play rather than fumbling your way through it.”

Regardless of the sex toy you choose and use, we also recommend the Liberator Fascinator Throw to protect soft surfaces from bodily fluids.

A note on lube and cleaning

Lubes are perfect for getting things slippery, which reduces friction and increases fun. You’ll want to use silicone lube like the Shine Silicon lube from Maude on glass toys, when you’re getting frisky in the water, or when you’re just using your hands. However, do not use silicone lube with silicone toys—that will damage them. Instead, use a water-based lube like good ‘ol Astroglide. We also have to recommend Astroglide because of its rocket-science roots. 

“Lubricant reduces friction and increases your sensitive nerve endings’ receptiveness to pleasurable sensations,” Tomchesson says. “Using a toy for the first time will be more enjoyable with lubricant.”

If you’re using a toy with someone who isn’t fluid bonded to you (aka, you both haven’t had the conversation and taken steps to stop using barrier contraception with each other), or you just want to keep your body fluids separate from your honey’s, use a polyurethane condom with your toy and change it after playtime is over, or when a new partner comes into the mix.

When you’re cleaning toys, don’t submerge non-waterproof toys in water. You can wash them with warm water and mild, fragrance-free soap, or you can use sex toy cleaner like this one from Hello Cake.

“Sex toy cleaners are a great option for cleaning because they are body-safe and designed to be compatible with every sex toy material,” Tomchesson says. “Soap and warm water can be an effective way to keep your toys clean as long as you use a body-safe soap that you would also feel comfortable using on your sensitive bits. Sometimes people think they need to wash their toys in alcohol to get them clean, but alcohol and harsh cleaners can irritate the skin and therefore should not be used to clean sex toys.” 

Add a soft toothbrush if your toy has crevices, like suction toys. You can also boil toys made from silicone, borosilicate glass, and stainless steel to disinfect them. You can even disinfect your toy in the dishwasher. If your toys have mechanical parts, it’s best to keep them out of boiling water. As we mentioned, ask the manufacturer before you mix your vibrator with last night’s dishes. Last, air dry your toys to prevent lint and fibers from sticking to your toys.

FAQs

Final thoughts on the best sex toys for couples

• Best overall: We-Vibe Sync O 
• Best rated: Magic Wand Cordless Vibrator
• Best for beginners: Unbound Squish
• Best for men: Fun Factory Manta Vibrating Male Stroker
• Best for women: Womanizer Next
• Best budget: plusOne Personal Massager

There is nothing wrong with good old regular missionary. But what if you could add some seasoning—say, something spicy and rich like Tajín or harissa—to your vanilla sex life? Sex toys for couples do just that, making foreplay and partnered play more pleasurable than it already is. Trying something new in the bedroom can bring you and your sweetie closer and rekindle a flame into a roaring fire.

Why trust us

Popular Science started writing about technology more than 150 years ago. There was no such thing as “gadget writing” when we published our first issue in 1872, but if there was, our mission to demystify the world of innovation for everyday readers means we would have been all over it. Here in the present, PopSci is fully committed to helping readers navigate the increasingly intimidating array of devices on the market right now.

Our writers and editors have combined decades of experience covering and reviewing consumer electronics. We each have our own obsessive specialties—from high-end audio to video games to cameras and beyond—but when we’re reviewing devices outside of our immediate wheelhouses, we do our best to seek out trustworthy voices and opinions to help guide people to the very best recommendations. We know we don’t know everything, but we’re excited to live through the analysis paralysis that internet shopping can spur so readers don’t have to.

The post The best sex toys for couples, tested and reviewed appeared first on Popular Science.

Articles may contain affiliate links which enable us to share in the revenue of any purchases made.

This article was originally published on KFF Health News.

In the year and a half since its launch, 988—the country’s easy-to-remember, three-digit suicide and crisis hotline — has received about 8.1 million calls, texts, and chats. While much attention has been focused on who is reaching out and whether the shortened number has accomplished its goal of making services more accessible to people in emotional distress, curiosity is growing about the people taking those calls.

An estimated 10,000 to 11,000 counselors work at more than 200 call centers nationwide, fielding calls from people experiencing anxiety, depression, or suicidal thoughts.

A newly released report, based on responses from 47 crisis counselors, explored variations in their training and work experiences. The survey “is not large enough to support conclusions” about all 988 staffers, said Dan Fichter, the report’s author and a former program manager for the Substance Abuse and Mental Health Services Administration’s 988 team. Still, the first-of-its-kind survey—published by CrisisCrowd, a new noncommercial project focused on raising the voices of 988’s workforce—surfaced interesting snapshots.

For instance, counselors who responded noted wide variations in training, from four days or less to two weeks.

“We know that there are significant workforce challenges for 988 including staffing shortages and burnout, like much of the health care industry is experiencing today,” Monica Johnson, director of SAMHSA’s 988 & Behavioral Health Crisis Coordinating Office, wrote in a statement. “Ensuring that 988 crisis counselors are properly trained and supported to do this life-saving work is critical.”

Different training approaches emerged as one of the report’s central themes. Most counselors who responded said they were trained in four weeks or less and didn’t consider it adequate.

“I understand that even with about 120 hours of training, we can’t get through all the nuances that boost confidence,” said one anonymous survey response.

Some counselors said they had received training only in talking to people experiencing suicidal thoughts and not how to deal with other mental health issues, such as anxiety attacks, substance intoxication and withdrawal, and mood disorders. They said they had not been prepared for the wide range of calls of varying levels of intensity they would face.

“There could have been more emphasis on how different each convo would be,” noted one.

Some also suggested that opportunities to listen to 988 calls or sessions that used role-playing exercises to practice handling calls would have been helpful.

The risks of counselors not being properly trained are high, said Eric Rafla-Yuan, a member of the California Governor’s Office of Emergency Services’ 9-8-8 Technical Advisory Board and a psychiatrist at San Diego County Psychiatric Hospital. He said it is concerning that some callers may not “feel that they have the support that they need” when reaching out to 988, and “may not call again in the future.” The situation could possibly “cause more stress rather than support,” he added.

Hannah Wesolowski, chief advocacy officer of the National Alliance on Mental Illness, said these differences were not a surprise since 988 brought together a patchwork of local and state efforts to provide a hotline specifically for mental health emergencies. In addition, Fichter said, centers’ different training approaches and time frames may “have to do with funding differences that there are between some centers.”

The survey also found that crisis counselors have different expectations for how long they should stay on the phone with callers.

Some counselors, for instance, said they were expected to end conversations with first-time callers and texters who didn’t have immediate plans of suicide within 15 minutes. Others reported limits of up to an hour.

Wesolowski said this issue stood out to her. “That’s certainly not in the spirit of what 988 stands for because there is no exact time that’s perfect to address a crisis,” she said. “Every crisis is unique; every situation, every health seeker is unique.”

The report also noted that centers have different policies on whether counselors should inform callers with imminent plans of suicide or those who are actively attempting suicide that first responders are being dispatched.

Involuntary intervention is used as a last resort to keep someone safe, but some centers believe that telling a caller that police are on their way may lead them to hang up the call, Fichter said. Other centers allow counselors to be transparent with callers about interventions and help callers prepare for the police.

Efforts to make improvements to the hotline’s operations are underway. For example, Vibrant Emotional Health, the company that administers 988, recently created online, self-paced training courses for crisis counselors, according to Tia Dole, Vibrant Emotional Health’s chief 988 Suicide & Crisis Lifeline officer. These classes, she said, are designed to “assist local centers in delivering training and supporting crisis counselor skill development.” She added that these courses are intended to supplement the training local centers already do.

“The success of 988 hinges on those vital people answering calls, texts, and chats every single day,” Wesolowski said of crisis counselors. “They are the heart of this system, and we have to value them. We have to invest in them and give them what they need to be successful.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

The post Many 988 crisis hotline counselors want more training to juggle a mix of calls appeared first on Popular Science.

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Meta is attempting to encourage Instagram’s younger users to put down their phones in favor of a solid night’s rest. According to a January 18 Meta blog post, the company will begin showing “new nighttime nudges” for 13-to-17-year-olds after they spend more than 10 minutes scrolling through Instagram sections such as Reels or Direct Messages sections “late at night.”

“Sleep is important, particularly for young people,” Meta states—which, fair enough.

A sample app screenshot provided in Meta’s newsroom post depicts a black screen asking “Time for a break?” alongside the ever-so-slightly passive aggressive “It’s getting late. Consider closing Instagram for the night.”

[Related: Meta begins automatically restricting teen users to more ‘age-appropriate’ content.]

In an email provided to TechCrunch on Thursday, a Meta spokesperson confirmed Instagram will enable the new reminders after 10pm local time for some users. Technically, although teens can’t disable the feature, they can simply ignore the message to continue scrolling through their feeds through the wee hours of the morning.

Meta’s “nighttime nudges” are the latest in a string of recently introduced oversight features aimed specifically at addressing longrunning criticisms regarding social media’s harmful psychological effects on users—particularly younger audiences. Last week, the company announced impending plans to enforce new, mandatory Instagram and Facebook content restrictions for teens and minors. Established “in line with expert guidance,” the new guidelines will institute new privacy safeguards meant to block content related to self-harm, graphic violence, and eating disorders. A staggered rollout of Instagram’s and Facebook’s respective “Sensitive Content Controls” and “Reduce” features is expected to finish “in the coming months,” according to Meta’s January 9 update.

Before that, Meta instituted a suite of parental supervision tools in the latter half of 2023, including the ability to see their children’s time spent on Facebook, Messenger, and Instagram, an option to schedule breaks, and access to teens’ blocked contacts list. Last December, Meta also finally made good on its years’ long promise to establish default end-to-end encryption protocols for its over one billion global Messenger and Facebook users.

The belated slow-drip of new self-regulations may not be enough to prevent continued public and political pressure, not to mention potential legal consequences. Meta CEO Mark Zuckerberg—along with the heads of TikTok, Snap, Discord, and X—are currently scheduled to testify at a Senate hearing pertaining to online child safety on January 31. Meanwhile, major social media providers still face a number of high-profile lawsuits filed by multistate coalitions accusing them of wantonly ignoring their products’ adverse effects on adolescent users in favor of corporate profits.

The post Instagram will start telling teens to put down their phones and go to sleep appeared first on Popular Science.

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New research indicates that the traumatic memories of patients with post-traumatic stress disorder are represented very differently in the brain than “regular” sad autobiographical memories. A small study published November 30 in the journal Nature Neuroscience supports the idea that traumatic memories are a different cognitive entity than more routine bad memories. This may provide a biological explanation for why recalling traumatic memories can manifest as intrusive thoughts that are different from other negative recollections. 

[Related: PTSD found in 1 in 4 adults in Flint, Michigan, after water crisis.]

The study was conducted by a team from the Icahn School of Medicine at Mount Sinai in New York and Yale University. It examined patients’ real-life personal memories in an effort to link their lived experiences with the brain’s functioning.

“For people with PTSD, recalling traumatic memories often displays as intrusions that differ profoundly from processing of ‘regular’ negative memories, yet until now, the neurobiological reasons for this qualitative difference have been poorly understood,” study co-author and Icahn Mount Sinai neuroscientist Daniela Schiller, said in a statement. “Our data show that the brain does not treat traumatic memories as regular memories, or perhaps even as memories at all. We observed that brain regions known to be involved in memory are not activated when recalling a traumatic experience.”

Schiller told The New York Times that the brain can be in a different state in two different memories, depending on which type of memory is playing out. When recalling trauma, the brain looks like it is processing experiences of something in the present instead of the past. 

What is PTSD?

Posttraumatic stress disorder may occur in people who have experienced or seen a traumatic event, series of events, or set of circumstances. The American Psychiatric Association says PTSD may affect mental, physical, social, and/or spiritual well-being. Some events that can cause PTSD are are natural disasters, war or combat, sexual assault, intimate partner violence, and bullying.

PTSD symptoms are generally grouped into four types, according to The Mayo Clinic. These include intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can be very individual and include things like flashbacks, avoiding specific places or people, and hopelessness. They can also vary over time.

According to data from the United States Department of Veterans Affairs, about six percent of people in the US will have PTSD at some point in their lives. Many with PTSD will recover and no longer meet diagnostic criteria for the disorder following treatment. Some treatments for PTSD include cognitive behavioral therapy and cognitive processing therapy. There are also four medications (sertraline, paroxetine, fluoxetine, and venlafaxine) that have a conditional recommendation to treat PTSD.

Where does PTSD affect the brain?

Earlier studies showed that a brain region called the hippocampus governs both the formation and retrieval of episode memories. PTSD is associated with structural abnormalities of the hippocampus, mostly a reduction of its volume. Impairments to the processes of the hippocampus are a focal point in studying how PTSD affects the brain. 

A region called the posterior cingulate cortex is also heavily involved in both narrative comprehension and processing of our memories. The PCC is particularly involved in the imagery of more emotional memories. Alterations in PCC function and connectivity are also very  focal to PTSD the way that the hippocampus is. 

Differentiating between traumatic memories and sad memories 

In the study, the team examined whether and how the hippocampus and posterior cingulate cortex differentiate a traumatic autobiographical memory from merely a sad one. They used functional magnetic resonance imaging to look at the brains of 28 participants diagnosed with PTSD. 

[Related: New human brain atlas is the most detailed one we’ve seen yet.]

They asked each of the participants a range of questions. These questions pertain to their traumatic experiences, sad events, and the moments when they felt relaxed. A team member wrote each person’s story down and then read it back to them while they underwent fMRI scans. The fMRI mapped the brain’s activity based on blood flow during the process.

Researchers found that the activity in the hippocampus followed similar patterns of activity among all of the subjects when they were reminded of sad or relaxing experiences. This suggests the memory formation here is more typical. 

However, when the stories of their traumatic experiences were read, that similar activity in the hippocampus disappeared. The hippocampus of each subject showed individualized and disjointed activity. The activity was more disorganized and fragmented across the brain and did not look like the more in-sync patterns the brain exhibits during normal memory formation. 

Additionally, if more PTSD symptoms were present, more activity appeared in the PCC.

How this could shape future PTSD treatment

The results may explain why PTSD patients have difficulty recalling traumatic experiences in a coherent way. It could also indicate why these past experiences can trigger disabling symptoms in patients with the disorder.

PTSD patients’ brains work differently when recalling traumatic experiencesudy co-author and Yale University clinical psychologist Ilan Harpaz-Rotem said in a statement. “However, when presented with stories of their own traumatic experiences, brain activity was highly individualized, fragmented, and disorganized. They are not like memories at all.”

Future treatments aimed at “returning” the traumatic memory to a more typical representation in the hippocampus may be beneficial. According to Harpaz-Rotem, this research could help psychotherapists guide PTSD patients to construct more helpful thought patterns that could help the brain eliminate the sense of immediate threat that trauma can cause.

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The holidays are stressful. Good thing having sex and/or masturbating reduces stress and helps you sleep. So drop what you’re doing and get on the gift of getting off with these Cyber Monday sex toy deals at Amazon.

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The post Sneak away for some arousing browsing … of the best Cyber Monday sex toy deals appeared first on Popular Science.

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This article was originally featured on Undark.

Tess Olmsted stopped eating sugar when she was just 12 years old. She had previously been treated for obsessive compulsive disorder, or OCD, and soon found herself following rituals around eating. “For me it was never, ‘Oh I need to get skinnier,’” she recalls. Once she started to diet, she simply couldn’t stop.

Two years later, on a summer day in 2019, her father saw her on the family’s patio wearing a loose-fitting swimsuit. He soon noticed how little Tess was eating and insisted she see the pediatrician. During a subsequent appointment with a specialist, he recalls, the family learned that Tess’s blood pressure and heart rate were dangerously low. She was admitted to a hospital in life-threatening condition.

Across the United States, up to 2 million adults have had anorexia, a mental health condition in which a person severely restricts their food intake, often due to an intense fear of gaining weight. Almost 1 percent of all U.S. women will experience anorexia at some point in their lives. Patients are developing the condition increasingly early in life—sometimes as young as 8 years old—and new figures suggest that symptoms in children worsened during the Covid-19 pandemic, leading to increased numbers of hospitalizations. At one treatment center in Michigan, the admission rate of young people aged 10 to 23 more than doubled during the pandemic’s first year.

These sobering developments are due, in part, to the fact that there are no drugs or devices approved by the U.S. Food and Drug Administration to treat the condition. For adults, there are three first-line treatments: an adapted form of cognitive behavioral therapy, known as CBT-E; a structured psychotherapy designed with patient input; and an approach that combines psychotherapy with nutritional support. Studies have shown that these approaches can help more than 50 percent of patients. But experts acknowledge that the studies are not high quality. Patients with anorexia are hard to engage in treatment, and as a result, studies are small and drop-out rates are high.

For patients younger than 18, one psychological intervention—family-based treatment, or FBT—has emerged as a leading evidence-based treatment in randomized clinical trials. The approach takes up to a year, and for part of that time, parents assume total control over planning, preparing, and supervising the child’s meals. In one clinical trial, nearly half of patients maintained a full recovery a year after follow-up.

Since family-based treatment was rolled out in the U.S., the United Kingdom, and elsewhere, many families say that this intervention has helped their children. Even so, some experts warn that it’s not for everyone. Parents may be ill-suited for acting as full-time chefs and meal-planners, and they may not be financially able to take time away from work to do the therapy. And critics point out that the approach blurs the boundaries between home and hospital while failing to probe the condition’s psychological causes.

“At least in my case, FBT definitely backfired,” said a 19-year-old from Texas, who said her mental health got worse while she was in treatment. (The young woman asked to remain anonymous due to the stigma that surrounds eating disorders.)

When the Olmsteds eventually tried FBT, they also struggled with the demands of the protocol, which sparked fighting, tension, and even calls to the police. But Tess and her parents say the end result was worth the tribulation: Family-based treatment really worked. “I don’t want to go overboard,” Tess’s dad, Kevin, said. “But it probably saved her.”

Anorexia nervosa occurs when a person loses more than 20 percent of their body weight within a six-month period or has a BMI of less than 18.5 in adults (although BMI is increasingly seen as a flawed criterion for assessing health). The condition can disrupt menstrual periods and cause a soft light hair, called lanugo, to grow on the body. Anorexia can lead to kidney and heart problems, and even death. The condition is distinct from bulimia nervosa, a condition in which patients overeat and then empty their stomachs by vomiting or using laxatives. But patients can slip from one condition to the other with time.

Anorexia is one of the hardest psychiatric illnesses to treat, partly because of what psychologists call its “egosyntonic” nature—it offers those who suffer from it unique rewards, which make them value their illness. In one study, for example, patients said the weight-loss allowed them to feel safe, structured, and in control. Others described their dieting as a unique skill that made them special, even superior to other people.

“When you have someone who’s successfully restricting, they don’t necessarily see too many downsides of it,” said Zafra Cooper, a professor of psychiatry at Yale School of Medicine and an emeritus professor of clinical psychology for the University of Oxford Department of Psychiatry.

The condition was first described by a Parisian neuropsychiatrist, Ernest-Charles Lasègue, in 1873. He described an illness he called hysterical anorexia, in which a female patient gripped by emotional suffering, would abstain from food. Around the same time, a British doctor, William Withey Gull, described a similar condition occurring primarily in young women and characterized by “extreme emaciation.” Gull prescribed milky foods, soup, eggs, fish, or chicken every two hours accompanied with a shot of brandy.

Doctors came to view parents as having a pernicious role in the illness and urged their exclusion from care. This is perhaps not surprising, said Daniel Le Grange, a professor in the psychiatry department at the University of California, San Francisco. The mental health field has a long history of blaming parents, mothers in particular, for a child’s diagnosis, he said. Practitioners even developed a specialized vocabulary to express this supposed problem: “the ‘schizophreno-genic mother,’ ‘autisto-genic mother,’ ‘anorexi-genic mother,’ and so on.”

By the 1960s, anorexia was thought to affect about 1 in 10,000 women, although under-reporting and lack of awareness are likely to distort any long-term surveys. At the time, information about the illness was still not available in medical schools, said Patricia Santucci, who has been a fellow of the American Psychiatric Association and is a founding member of the Academy for Eating Disorders. This left practitioners ill-prepared for what they would encounter, she added: “All of a sudden, you got out in practice. And you said, ‘What’s going on here? What is this thing?’”

Providers would try to reshape patients’ behavior through punishments and rewards, according to Andrea Marks, a pediatrician who published a paper on the history of anorexia treatments in the Journal of Clinical Psychology in 2019. Throughout the 1980s, struggling patients would typically be hospitalized and put on a feeding tube. As they gained weight and started feeding themselves, they could earn privileges such as unsupervised time in the bathroom and visits from friends and family. Still, Marks writes, patients often found themselves stuck in a cycle of recovery, relapse, and return to the hospital.

In the 1980s, an innovative approach emerged. Salvador Minuchin, the famed Argentine-born therapist who cared for troubled teens by focusing on their families, had devised a model for treating anorexia, as had a group of therapists in Italy. Gerald Russell, a psychiatrist at the Institute of Psychiatry and the Maudsley Hospital in London, wanted to verify the two groups’ claims in a clinical trial, hoping to figure out if families might be able to help their loved ones achieve a more durable recovery.

Russell developed an approach that lasted 12 months or longer that included all members of the household. The treatment steps used in that trial later evolved into family-based therapy’s three main phases: The first is re-feeding, in which parents are tasked with making all decisions about the child’s food consumption and exercise. After the child has regained the weight, they are able to assume responsibility for their own eating—a change that marks phase two. In phase three, the family and psychologist review the outcome.

In family-based therapy, anorexia is viewed as an external threat, akin to a medical illness that must be vanquished. Parents are called on as helpers while therapists guide them through the process. Professionals do not try to explore what caused the illness, and above all, they must not suggest that it’s the parents’ fault. This refusal to place blame on parents “was really a profound sea change in our field,” said Le Grange, who joined the Maudsley Hospital team in 1986 just as Russell and his colleagues were preparing to analyze the results of a pivotal study comparing FBT with individual therapy.

Russell’s study was a randomized controlled trial of 80 patients between the ages of 14 and 55. Fifty-seven had anorexia and 23 had bulimia. As it turned out, patients who had developed anorexia when they were younger than 18 and had lived with the condition for less than three years and then received family therapy showed markedly better outcomes than their peers who had been randomized to individual therapy: six out of 10 had a “good” outcome, according to the authors, compared with one out of 11 in the individual-therapy group. The results were published in 1987.

Five years on, the team revisited the 80 patients. Some did not want to participate and three had died, but many were doing better, the team found. Although differences between the two approaches had diminished over time, the early onset patients allocated to family therapy maintained a slightly higher weight and more regular menstrual periods than those who’d had individual treatment.

The Maudsley Method, named after the institution where it originated, was born. In Britain it’s known as Maudsley family therapy and in the U.S., where, with some minor differences, it was championed by Le Grange, as FBT. Forty years after its inception, FBT remains the leading evidence-based treatment for young people under 18.

The therapy has obvious advantages over alternatives such as hospitalization, practitioners say. For one, kids can stay in school and continue to live with their families, allowing for a more normal adolescence. There’s also much to be gained from giving parents a bigger role in their child’s recovery, said Renee Rienecke, who trained with Le Grange and is now the research director for the Eating Recovery Center and an adjunct professor at Northwestern University in Illinois: Parents “can really use the best weapon against the eating disorder, which is their love for their children.”

But roughly 70 clinicians certified in family-based treatment, the U.S. is not in a position to provide FBT to the hundreds of thousands of teens with anorexia, experts say. And even when FBT works, the process is not easy — for kids, parents, or therapists.

Christina Olmsted decided to take temporary leave from her job as a marketing executive, and Kevin Olmsted quit his role at a wine company to become his daughter’s main carer. In 2020, he wrote a book about helping Tess recover, “Scared Dad Feeding” (an homage to the FBT classic, “Brave Girl Eating”). Kevin describes how under FBT his daughter was obliged to eat whatever he and his wife put on her plate. One of her parents sat with her during every meal and for an hour afterwards to make sure she didn’t purge what she had eaten or hide the food away. She ate five times a day—three meals and two snacks—and had to gain 1 to 2 pounds per week.

Kevin went to elaborate lengths to boost her diet. He’d add an extra yolk to omelets, mix in two tablespoons of heavy whipped cream and an ounce and a half of Benecalorie, then fry the mixture in two tablespoons of butter. “Once I came to know that the demon of anorexia was a terrorist, who would stop at nothing to kill my daughter, who would know nothing of compromise or diplomacy, I then knew no amount of fighting dirty was off the table,” he wrote.

The Olmsteds shut the world out and disappeared for six months, something not every family is able to do. “It’s a luxury to treat this, just so we’re clear,” Kevin said to Undark. “Just to be able to swing at a pitch in this ballpark takes so many resources it’s ridiculous.”

The process was rough for Tess, who still recalls how it felt to be so closely monitored. Sometimes she would butt heads with her mother. She was too preoccupied with the illness to engage with her friends during senior year of high school and wasn’t able to play on the lacrosse team. “It was just a really difficult time,” she said.

Therapists can struggle, too. During the first phase of FBT, the clinician weighs the child at the start of each session. This practice, along with the need to offer dietary advice, makes some professionals uncomfortable. The family must also eat a meal together at the clinician’s office. “You have to be ready for anything,” said Rienecke, “for food being thrown across the room, for kids screaming and running out of the office. For a lot — a lot — of crying.” She continued, “oftentimes the kid just hates you at the beginning of treatment.”

In online discussions, young people sometimes vent their frustration with the approach. Family-based therapy “is the WORST” wrote one person on an eating disorder support forum. “I don’t understand how this could work,” the post continued. “When people control me and suffocate me, it triggers me tenfold.”

And sometimes parents’ desire to save—and control—their child goes too far, according to therapists and patients.

The 19-year-old from Texas said she began FBT in 2022. She had already been hospitalized once and relapsed while doing stints with different outpatient psychotherapists. She had experienced anorexia for four years and was almost 18, too old for family-based treatment. Nevertheless, her parents were able to sign up for a virtual program.

“Family-based therapy became more like family-based trauma,” the woman wrote on a Reddit forum for anonymously discussing eating disorders earlier this year. As her parents assumed the roles of dieticians and therapists, home started to feel like a hospital, she later told Undark. Her father was heavily involved in her care, even though she believes his earlier comments about her physical appearance had helped trigger her disorder. She said that during the therapy, her mental health deteriorated. She had thoughts of suicide and she started to self-harm.

What FBT failed to account for, the woman recently told Undark, is that for nearly five years, her eating disorder had actually given her some relief from difficult emotions. Her parents seemed to believe that weight regain alone would erase any feelings of depression and anxiety, she said. Weight gain is important, she acknowledged, but not without psychological healing.

Le Grange is aware that FBT has been carried too far by some parents but said it is fortunately rare. “Clinicians should always be on the lookout for a parent who takes a license to be critical and unkind to the young person.”

A survey by Australian researchers suggests that some parents also have doubts about FBT. In an interview, one father noted that the treatment’s focus was entirely on food. In his experience, however, his child’s restrictive eating was a symptom of a deeper problem. “What’s going on underneath?” he asked. “What’s causing all this?”

There are other criticisms, too. The therapy is “based on the idea that the young patient has no control,” said Riccardo Dalle Grave, who is head of a department of eating and weight disorders in Villa Garda Hospital in northern Italy. “The goal is to engage the parents, not the young patient. I was always in doubt about this.”

And yet some patients find that weight regain offers a path toward improved wellbeing. As Tess gained back weight, she was able to think more clearly. Eating an extra portion or a snack no longer felt like a catastrophe. “I really just figured out, such minor things didn’t mean as much as I used to think they did when I was younger,” she said.

Around the same time as the Maudsley Method emerged in London, researchers at Oxford University began working on a different model, focusing on adults. Cognitive behavioral therapy, or CBT, was developed in the 1970s by Aaron Beck, a researcher in Pennsylvania. It probes patients’ reactions to specific situations and posits that their interpretations of reality may be maladaptive or distorted. In the U.K., CBT has been approved for treating conditions ranging from childhood anxiety to adult schizophrenia, and it is recognized as clinically effective by the National Institute for Health and Care Excellence, the government approval body.

In 1981 Christopher Fairburn, a now-retired lecturer at Oxford, had shown CBT’s possible efficacy for bulimia. He applied it to anorexia, with results he described as “mixed.” Over time, Fairburn and his colleagues realized that anorexia tended to migrate. Patients might start out restricting food but then develop symptoms of bulimia, for example, if a patient’s psychological issues went unresolved. So they developed an approach that could work across different eating disorders, adding modules as necessary to target core problems like poor body image, perfectionism, or low self-esteem, and described this type of CBT as “enhanced.” In the U.K., CBT-E, as it’s known, is a second line treatment for teens, to be tried when family therapy fails.

While cognitive therapy typically has a timeframe of 20 weeks, CBT-E can take longer, up to 40 weeks to allow for weight regain. Clinicians and patients may explore the pros and cons of the need for change. Patients may say things like, “‘I don’t know who I’ll be, I won’t have control,’ all those sorts of things—‘I’ll lose my identity,’” said Cooper, who was recently given a Lifetime Achievement Award from the Academy of Eating Disorders.

CBT-E also has three phases, but it inverts their emphasis: The first phase involves helping patients think afresh about their condition and analyze the pros and cons of change. Only then are patients urged to address their eating habits. Under this model, parents are viewed as helpers, said Dalle Grave, the director of the eating disorder unit at Villa Garda Hospital.

Cara Lisette, who is 33 and lives in the U.K., suffered from anorexia for 20 years, cycling through hospitalization, in-patient care, and outpatient support. She first encountered CBT-E in 2011, but had no rapport with her therapist. When another clinician suggested CBT-E three years ago, Lisette decided to give it another try. This psychologist seemed to understand her better and was kind. Lisette said she was older and in a better position to be receptive.

Lisette describes how enhanced CBT was tailored to her illness. “Stuff like the body image distortions and things that people get when they have anorexia are quite unique,” she said. “I think it really takes into account just how people’s brains work a little bit differently when they have an eating disorder compared to something like anxiety disorder.”

While still finishing her own treatment, Lisette began her own training as a CBT therapist, and now uses cognitive therapy with children.

Evidence for the effectiveness of CBT-E for young people with anorexia is based on just a couple of non-randomized studies. In 2013, Dalle Grave published an account of 46 young patients with a mean age of 15-and-a-half, aiming to see if they could complete the treatment as out-patients. Almost two-thirds did so and their weight increased substantially, with 13 teens reaching an almost normal weight. The authors saw the findings as making a compelling case for comparing CBT-E and FBT in randomized controlled trials.

In a non-randomized comparative study of 12-to-18-year-old patients, led by Le Grange and Dalle Grave that was published three years ago, FBT and CBT-E came out as just about equally effective.

Le Grange, Dalle Grave, and a Norwegian colleague are now collaborating on the first ever randomized-controlled trial comparing CBT-E and FBT for adolescents with eating disorders, based at Oslo University Hospital. Initial enrollments are in January next year but obtaining a full picture will take years, Le Grange said: “It’s going to be a while.”

“I’m seeing younger and younger and younger patients,” said Suzanne Straebler, a CBT-E eating disorder therapist providing therapy to people with anorexia. “These are babies, right? They are children, and here they are with full blown eating disorders.” In the past, she said, her clinic in New York would occasionally see an 11-year-old patient. Currently, the clinic is treating several 8-year-olds.

Researchers believe the Covid-19 pandemic and protracted school closures are the likely culprits, creating an uncertain environment, where everything seemed out of control. Isolated at home and unable to meaningfully engage with friends, teachers, and the wider society, vulnerable youth trained their focus on exercise and food intake, said Jessica Van Huysse, an assistant professor in the Department of Psychiatry at the University of Michigan. These conditions made it easier to carry out restrictive behaviors, she noted, “and then that’s a rabbit hole, right?”

“Eating disorders tend to thrive in secrecy,” Straebler observed. She is also concerned about the ability of social media to disseminate dieting fads to young people online.

While some children have been able to fully recover through CBT-E or FBT, the consensus is that more research is needed. “Our therapies are okay, they’re an option,” said Straebler, “but they’re not as good as they need to be. So we need more research, more funding.”

Additionally, clinical trials often enroll people with a single psychological disorder, Cooper said. But in the real world, patients may struggle with multiple conditions. Tess, for example, had a history of OCD and anxiety before she developed anorexia.

Neither FBT nor CBT-E, the researchers admit, is good enough, or sufficient on its own.

“I want to go on paper that I’m not an FBT evangelist. I’m a scientist,” said Le Grange. He estimates that in real world settings, FBT works for 60 to 65 percent of children. He asked: What can be done for those who aren’t helped?

Even those who do gain weight may continue to struggle, said Kevin Olmsted. He compared FBT to pulling a child from the mud and taking them to dry land. The therapy brings patients back to a stable weight where they’re healthy and safe. But they will still have plenty of psychological work to do.

Tess is now 18, and a full recovery remains elusive. In August, as she prepared for college, she noted that she’s in a much better place, but she struggles to balance her social life, schoolwork, and eating. Anorexia can fuel an all-or-nothing approach to life, which can be dangerous, she said: “It’s definitely still a battle—but it’s a different battle.”

If you are struggling with an eating disorder, call or text the National Eating Disorders Association at 1-800-931-2237.

The post The challenge of providing treatment for children with anorexia appeared first on Popular Science.

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Best overall		Quility 20-Pound Weighted Blanket with Soft Cover		SEE IT	Helps promote relaxation and temperature control for a great night’s sleep.
Best knit		Bearaby Weighted Blanket		SEE IT	This chunky blanket is hand-knit from organic cotton and looks great in your home.
Best fleece		Uttermara Sherpa Fleece Weighted Blanket		SEE IT	The smooth fleece top and wool-like Sherpa reverse offer unmatched coziness.

If you’ve tried all the usual suspects to help fall asleep at night, such as a sleep schedule, getting plenty of exercise, and avoiding caffeine, but are still having trouble, it may be time to invest in a weighted blanket. Weighted blankets can help reduce stress while promoting a feeling of calmness by evenly applying firm yet gentle pressure throughout the body, similar to getting a hug or swaddling a baby. So, if you’re sold on the idea that these products could help you achieve optimal rest, we’ve rounded up some of the best weighted blankets on the market today.

• Best overall: Quility 20-Pound Weighted Blanket with Soft Cover
• Best knit: Bearaby Napper Organic Hand-Knit Weighted Blanket
• Best for adults: WONAP Weighted Blanket for Couples
• Best for kids: Sivio Kids Weighted Blanket
• Best throw: Baloo Weighted Cotton Blanket
• Best breathable: Brooklyn Bedding Chunky Knit Weighted Blanket
• Best cooling: YnM Bamboo Weighted Blanket
• Best fleece: Uttermara Sherpa Fleece Weighted Blanket

How we chose the best weighted blankets

Weighted blankets have only been seeing mainstream popularity for the past few years since a Kickstarter campaign for a product called the Gravity Blanket raised nearly $5 million. Unfortunately, the success of the Kickstarter quickly inspired countless knockoffs, which is why it’s even more important to vet these products for exceptional quality and value. With so many inferior products on the market, we took a look at roughly 25 to 30 of the highest-rated weighted blankets before arriving at the ones we chose for this guide.

One of the characteristics, in particular, that we honed in on was high-quality glass bead filling that is sewn into interior pockets so it won’t shift or even spill out of the blanket, which is common in inferior models. We also ensured that all of the products featured here use 100% cotton or bamboo fabric, except for one blanket with a reversible Sherpa and fleece cover. Most of the products listed also had removable, machine-washable covers to keep your weighted blanket clean and feeling like new for years to come.

The best weighted blankets: Reviews & Recommendations

The science behind weighted blankets checks out. The approach is called deep pressure stimulation, which uses this controlled pressure to stimulate the natural production of mood-boosting serotonin and increase melatonin levels while reducing the stress hormone cortisol. As such, many experts believe weighted blankets can improve sleep for people experiencing conditions including insomnia, anxiety, and autism.

Occupational therapists often use weighted blankets for sensory integration therapy, particularly among children and young adults with trouble processing their senses. Simulating these senses of touch can help the patient’s brain to adapt. Weighted blankets can also be soothing for the general populace, and we’ve rounded up some of the best weighted blankets on the market below.

Best overall: Quility 20-Pound Weighted Blanket with Soft Cover

SEE IT

Why it made the cut: Evenly distributed micro glass beads provide gentle pressure to help even the most restless sleepers reduce tossing and turning and get through the night, making this an easy pick for the best weighted blanket overall.

Specs

• Fabric type: 100% cotton blanket, 100% polyester duvet cover
• Fill: Glass microbeads
• Weight: 20 pounds

Pros

• Even weight distribution across sections
• Removable duvet cover
• Seven-layer system shapes to your body

Cons

• Beads spread out over time
• Could be too warm for sleepers who run hot

Get better sleep with the Quility 20-Pound Weighted Blanket that wraps you in warmth and comfort. The gentle pressure of the micro glass bead filling should help reduce tossing and turning for even the most restless sleepers to make it through the night. The blanket’s seven-layer system shapes to your body for added comfort, with even weight distribution to balance the pressure across the quilted sections.

The 100% cotton material is designed to keep you cool. Although, some sleepers who run hot or live in warm climates may still think it’s too warm. So that’s something to consider if you fall into either of those categories. There’s also a removable duvet cover for easy cleaning, with a durable zipper and eight duvet tie-loops to keep the blanket in place. 

A handful of customers have also had issues with the glass beads redistributing after a few weeks or months of use but seem to be in the minority. However, those who have experienced problems also seem to have had good luck by contacting customer service.

Best knit: Bearaby Napper Organic Hand-Knit Weighted Blanket

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Why it made the cut: This gorgeous chunky blanket is made from sustainable materials, customizable in size, weight, and color, and feels delightful to snuggle under.

Specs

• Fabric type: Organic cotton
• Fill: N/A
• Weight: Available in 10-, 15-, 20-, and 25-pound sizes

Pros

• Beautiful design
• Eco-friendly
• Machine-washable

Cons

• More expensive
• If your home is drafty, cold air can seep in
• Some users say can be stiff at first

If you’re looking for a weighted blanket that looks as good as it feels, consider the Bearaby Napper. The company began as a Kickstarter campaign led by a former World Bank economist who was looking for a solution for her chronic insomnia. These chunky knit blankets are made with organic cotton, are free of artificial fillers, and have earned the OEKO-TEX Standard 100 for not containing harmful chemicals, so you can feel good about sleeping under one.

Bearaby recommends that you choose a weighted blanket that’s roughly 10 percent of your body weight, and provides a simple calculator to help you find the best option for your size of bed. The blankets are available in 10-, 15-, 20-, and 25-pound sizes and in a range of muted colors (Olive Night, Asteroid Grey, Moonstone Grey, Midnight Blue, Evening Rose, and Cloud White.) I tried the 10-pound version and can attest that these blankets provide a soothing amount of weight and look great at the foot of a bed or as a throw. They’re also machine-washable, and you can toss them in the dryer for a tumble dry.

Best for adults: WONAP Weighted Blanket for Couples

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Why it made the cut: Perfect for couples, the soothing touch of the bamboo blanket combined with glass beads provides a deep and relaxing sleep for you and your partner.

Specs

• Fabric type: 100% bamboo
• Fill: Glass beads
• Weight: 25 pounds

Pros

• Hypoallergenic glass beads
• Breathable natural bamboo fabric
• Four-by-four-inch diamond design

Cons

• Couples may find the blanket too restrictive

Both you and your partner will get a good night’s rest when using the extra-large WONAP Weighted Blanket for Couples. Constructed of 100% breathable Natural Bamboo fabric, the inner part of the blanket includes ultra-soft cotton compartments filled with hypoallergenic, non-toxic, and odorless premium glass beads. The beads are evenly distributed thanks to a four by four-inch diamond design that applies the same amount of pressure throughout the entire body for a more restful sleep.

The combination of the bamboo fabric and glass beads also creates a cooling effect to use the blanket year-round. In fact, one of the biggest problems some users have noted is that the blanket is so heavy and secure that it actually even may prevent you and your partner from getting near each other at night. Is there such a thing as a product doing its job too well?

Though the dense stitches and the durable thread of the bamboo fabric are intended to prevent leakage of the glass beads, a small number of reviewers complained of finding sand or dust in the bed after using it, so that is something to keep in mind.

Best for kids: Sivio Kids Weighted Blanket

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Why it made the cut: This blanket effectively simulates the hug of a mother so your child can fall asleep faster and sleep deeper and longer through the night. It’s easily one of the best weighted blankets for kids.

Specs

• Fabric type: 100% cotton
• Fill: Glass beads
• Weight: 3 pounds

Pros

• Seven-layer design prevents leakage
• Fun, kid-friendly designs
• Smaller pockets evenly distribute weight

Cons

• Suggested weight may be too light
• Some children could use a larger size

Parents of young children with special needs or separation anxiety may find the Sivio Kids Weighted Blanket to be an absolute game-changer. This thermostabilized weighted blanket aligns naturally with your child’s body to simulate the gentle hug of a mother. Many customers who have tried nearly everything else have reported that this blanket dramatically reduces or eliminates the number of times their children get up through the night.

Parents will also rest assured knowing that the blanket is crafted with 100% natural, breathable cotton fabric, with an upgraded seven-layer design and square four by four-inch pockets to prevent the beads from leaking. Not only do these pockets make sure that the weight is more evenly distributed, but they also won’t make any noise to wake your child up during the night.

However, some user reviews have noted that the size and weight recommendations are too small and light. So if your child is on the higher end of the height and growth charts for their age or could benefit from the extra weight, you may want to size up out of precaution. In any case, that also ensures that you won’t have to replace the blanket in six months to a year.

Best throw: Baloo Weighted Cotton Blanket

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Why it made the cut: These weighted blankets are made from all-natural cotton, chemical-free, and a portion of the company’s proceeds go toward ocean restoration.

Specs

• Fabric type: Organic cotton
• Fill: Glass microbeads
• Weight: 12 pounds

Pros

• Versatile
• Eco-friendly
• Machine-washable

Cons

• Not as attractive a design

Baloo describes their weighted throws, blankets, and comforters as a hug that molds to your body and calms you down. Their satin-y quilted throws, which weigh 12 pounds and are 42 inches wide by 72 inches long, are substantial enough for curling up on the couch, but can easily double as a travel blanket for people who get nervous when they fly. The throw is also large enough to cover a twin bed and has attachments if you’d like to attach one of the company’s linen duvet covers.

The company also highlights their sustainable practices: All of their products are made from organic cotton, their packaging is plastic-free, they meet the OEKO-TEX Standard 100, and a portion of the proceeds from their sales go toward replanting mangrove and kelp forests. The cotton is breathable, which makes the blanket suitable for use throughout the year. And the throws are machine-washable and available in Pebble White, Luna Blue, and Silver Sage.

Best breathable: Brooklyn Bedding Chunky Knit Weighted Blanket

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Why it made the cut: This beautiful hand-knit blanket features an open weave that allows for plenty of cooling airflow.

Specs

• Fabric type: Polyester jersey
• Fill: Polyester
• Weight: 10 or 15 pounds

Pros

• Hand-knit
• Promotes airflow
• Pretty design
• Can help reduce stress

Cons

• Made from synthetic material
• Only available in two weights

Blankets can sometimes look sloppy, but that’s not the case with Brooklyn Bedding’s Chunky Hand-Knit Weighted Blanket. Like the Beararby, this attractive blanket is crafted with care. It features soft polyester jersey outer shell and polyester fill—available in two weights (10 and 15 pounds) and two subtle colors (cream, shown here, and gray). Combined with the open-knit design, that material promotes airflow, making this blanket breathable and suitable for all seasons and members of the household (including furry friends enjoying their morning solar recharge, as seen above).

It’s cozy and comforting and threatens to keep you ensconced in bed or on the couch all day—partially because it provides just the right amount of calming pressure and partially because your toes might get tangled in the hand-knitted weave. Of course, we’d expect nothing less from Brooklyn Bedding—makers of the Aurora Luxe Cooling mattress, a top pick for hot sleepers thanks to its cool tech fibers and foams.

Best cooling: YnM Bamboo Weighted Blanket

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Why it made the cut: Even the hottest sleepers will rest comfortably year-round with cooling, silky-soft bamboo fabric and even more glass beads for optimal temperature control.

Specs

• Fabric type: 100% bamboo
• Fill: Glass beads
• Weight: 15 pounds

Pros

• All-natural cooling bamboo materials
• Smaller inner pockets for even distribution
• More glass beads and thinner fiber

Cons

• Slick bamboo may cause duvet to need readjusting
• Not cool enough for warm climates

You can feel the difference from the moment you touch the YnM Bamboo Weighted Blanket. Made out of 100% breathable bamboo fabric and premium glass beads, this is one of the softest weighted blankets on the market while still managing to stay incredibly cool. The manufacturer is so confident of the blanket’s cooling properties that they even go so far as to describe it as “like sleeping in a pool of cool water,” except that you don’t get wet.

The seven-layer system is designed to contour to the shape of your body for maximum comfort. This cooling weighted blanket also features more glass beads and less fiberfill for exceptional breathability and better temperature control. Unfortunately, a few customers who live in exceptionally warm climates claim that they still need their air conditioning on full blast while using this product.

Two additional layers combined with a three-dimensional lock bead sewing method also ensure against leakage, and the extremely fine stitching prevents weight shifting from one compartment to another. One of the only user complaints is that the bamboo material is so slick that it can be challenging to keep the blanket inside the duvet without adjusting it frequently.

Best fleece: Uttermara Sherpa Fleece Weighted Blanket

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Why it made the cut: This super-soft, super comfy heavy blanket keeps you warm by forming a gentle hug along your body without bunching up or causing excess heat.

Specs

• Fabric type: Sherpa and fleece
• Fill: 1-millimeter ceramic beads
• Weight: 15 pounds

Pros

• Smooth fleece top and Sherpa reverse
• Unique bead-filling technology
• Eye-catching unicolor pattern

Cons

• Commercial washing only
• Some users find it too heavy

The Uttermara Sherpa Fleece Weighted Blanket pairs a smooth, 220 GSM fleece top and wool-like Sherpa reverse for the softest, coziest weighted blanket money can buy. Sherpa is more resistant to fading and stain than traditional fabrics used in weighted blankets and won’t pill or shed after prolonged use. Though, on the downside, the blanket isn’t machine washable and requires commercial washing.

Still, that’s a small price to pay for the superior craftsmanship you’re getting with this high-quality blanket. Neat stitches create both an integrated look and strong seaming. The tiny 1-millimeter ceramic beads are sewn into small squares, which are further sandwiched with non-glue polyester and brushed fabric that prevent the beads from clustering or moving around when shuffled so that the blanket can be totally conformed to your body.

When choosing a size, however, one thing to note is that the fleece and Sherpa exterior may add extra weight, as some users actually find their blankets to almost be too heavy. So if you’re on the fence about which weight blanket to choose, it may be wiser to size down. Sherpa is also on the warmer side for standard weighted blankets, so it may not be ideal for those who run hot.

What to consider before buying the best weighted blankets

Size

Aside from quality, there are two primary features that you should take into consideration when deciding to purchase a weighted blanket: size and weight. As to the former point, ask yourself if you’ll be using the blanket by yourself or if you’ll be sharing with a partner. Weighted blankets do come in up to king and queen sizes to accommodate larger beds. However, weighted blankets are also not for everyone, and if your partner isn’t into the idea, you may be stuck with too large of an unwieldy blanket for just one person. 

Intended Use

Another thing to ask yourself is whether you’ll be using the blanket primarily for sleeping or lounging, and even if you’ll need a new pillow or even a new mattress to go along with your weighted blanket. However, if your objective for a isn’t for sleeping, but as a throw while you’re watching TV or reading a book, then you could absolutely meet your needs with a smaller size.

Weight

Of course, weight is perhaps the most critical factor to consider before buying a weighted blanket. Generally, most experts suggest getting one that weighs approximately eight to 12% of your overall body weight—or an even 10% is also a good rule of thumb. Depending on what you think your needs will be, you can easily size up or down, as some people say they prefer a heavier blanket while others don’t like to be weighed down too much.

We also can’t stress enough the importance of thoroughly reading user reviews. All too often, these types of products come with shoddy construction. So it’s especially crucial to choose a weighted blanket of exceptional craftsmanship and quality, that won’t tear open at the seams and leave glass sand and dust all over your bed.

FAQs

Final thoughts on the best weighted blankets

• Best overall: Quility 20-Pound Weighted Blanket with Soft Cover
• Best knit: Bearaby Napper Organic Hand-Knit Weighted Blanket
• Best for couples: WONAP Weighted Blanket for Couples
• Best for kids: Sivio Kids Weighted Blanket
• Best throw: Baloo Weighted Cotton Blanket
• Best breathable: Brooklyn Bedding Chunky Knit Weighted Blanket
• Best cooling: YnM Bamboo Weighted Blanket
• Best fleece: Uttermara Sherpa Fleece Weighted Blanket

Oddly enough, our top picks for the best weighted blanket couldn’t be more different from one another, between the Bearaby Napper and the Uttermara Sherpa Fleece Weighted Blanket. We love the Bearaby because of the combination of beautiful design and comfort. However, those who prefer a blanket that provides added warmth will likely find the super soft Sherpa and fleece of the Uttermara to be a better fit.

Why trust us

Popular Science started writing about technology more than 150 years ago. There was no such thing as “gadget writing” when we published our first issue in 1872, but if there was, our mission to demystify the world of innovation for everyday readers means we would have been all over it. Here in the present, PopSci is fully committed to helping readers navigate the increasingly intimidating array of devices on the market right now.

Our writers and editors have combined decades of experience covering and reviewing consumer electronics. We each have our own obsessive specialties—from high-end audio to video games to cameras and beyond—but when we’re reviewing devices outside of our immediate wheelhouses, we do our best to seek out trustworthy voices and opinions to help guide people to the very best recommendations. We know we don’t know everything, but we’re excited to live through the analysis paralysis that internet shopping can spur so readers don’t have to.

The post The best weighted blankets of 2024 appeared first on Popular Science.

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We’re closer than ever to mapping the entire brain to the microscopic level. Hundreds of neuroscientists across the world recently characterized more than 3,000 human brain cell types as part of the National Institute of Health’s BRAIN Initiative Cell Census Network, publishing almost two dozen papers in four Science journals today. This super-focused attention to detail could unlock many mysteries surrounding that complex organ, such as what happened in our brains to distinguish us from other primates. 

“This is the first large-scale, detailed description of all the different kinds of cells present in the human brain,” says Rebecca Hodge, an assistant investigator at the Allen Institute in Seattle who co-authored multiple studies in the paper package. Her hope is that this brain atlas provides a community resource for scientists to explore how the wide variety of brain cells contribute to health and disease.

Mark Mapstone, a professor of neurology at University of California, Irvine School of Medicine, who wasn’t involved with these studies, likened the new data about the brain to a tourist’s guide. “Imagine navigating an unfamiliar city with a roughly drawn street map containing only the major streets of the downtown compared to navigating the same city with a detailed map extending beyond the downtown to the suburbs and including all highways, two-way and one-way streets, alleyways, sidewalks, location of street signs and traffic signals, speed limits, and location of coffee shops and restaurants,” he says. “Cleary, the latter would make navigation and understanding the city much easier.” This first suite of studies shows three main ways the brain map can be used for biology and medicine.

An evolving brain

A human brain atlas can teach us about our evolutionary history. One study published today in Science used single-nucleus RNA sequencing to measure the gene expression of individual brain cells in humans and five other primate species, including chimpanzees and gorillas. In this method, scientists pull out individual cells from a piece of tissue, break them open to expose the genetic messengers inside, then use tags akin to tiny barcodes to identify that material. “This is the main technology used in some of these papers that are coming out and it’s a technique that’s only been around for the past 10 years,” Hodge says. Getting this genetic profile allows researchers to group clusters of cells into specific types. 

[Related: Psychedelics and anesthetics cause unexpected chemical reactions in the brain]

Our cells’ composition and organization is similar to those of our close relatives. However, the biggest differences seemed to occur in a brain region called the middle temporal gyrus, which is involved in processing semantic memory and language. Humans had higher numbers of projecting neurons in this area compared to other species. What’s more, the researchers highlighted a difference in gene expression that promoted synaptic plasticity, which is the ability of neurons to strengthen brain connections. This feature is an important component for learning and memory, and it might explain how humans developed complex cognitive skills.

There was some variation within humans, too. Another study found the most differences across humans in immune cells called microglia as well as deep-layer excitatory neurons, which are involved in the communication between distant brain regions. Researchers are not quite sure why—one theory is that deep-layer excitatory neurons develop earlier and are more exposed to environmental factors that could diversify their gene patterns. “Everyone’s brain is largely similar. Even though we have the same building blocks, it’s the small number of differences that matter,” says Jeremy Miller, a senior scientist at the Allen Institute, and co-author of the study. “We’re now starting to understand how important these changes are and figuring out what makes us uniquely human.”

Animal models

Because human brains share many features with other mammals, neurologists frequently use the small brains of mice to study diseases. The one problem, Miller says, is that mice don’t naturally develop neurodegenerative diseases common in humans. Scientists who want to study Alzheimer’s disease, for example, would need to manipulate multiple mouse genes to cause the kind of brain pathology seen in older people. This requires a comprehensive understanding of how cell types in the brain work together and how they change in the context of disease. 

[Related: How your brain conjures dreams]

Much brain research in mice focuses on the neocortex, responsible for higher cognitive function. It might seem reasonable to assume that much of the brain’s cellular complexity appears here. But this doesn’t seem to be the case. In one of the first studies to create a cell map of the entire adult brain, neuroscientists have found high levels of diversity in older evolutionary structures such as the midbrain, which is involved in movement, vision, and hearing, and the hindbrain, which governs vital bodily functions such as breathing and heart rate. In subcortical areas, there also appears to be a supercluster of cells called splatter neurons that control innate behaviors and physiological functions. Replicating the complexity of these particular brain regions in animal models could help better identify the cellular origins of human diseases. 

Personalized medicine

Imagine a future where treatments are tailored to someone’s specific needs. To do that, scientists would use a person’s genetic profile, rather than characteristics such as weight or age, to inform any medical decisions. Clinicians could also use this genetic information to identify the risks of potential diseases and provide early preventative measures. 

“A detailed brain atlas can help us understand what successful brain function looks like so we can maximize brain cells and circuits that promote brain heath,” Mapstone says. “Addressing brain disease and promoting brain health can be more easily accomplished if we know how these cells are organized. “

Doctors are already using people’s genetic information to assess whether patients would be good candidates for a particular cancer treatment or to find the proper dose of a drug. This may soon include testing for neurological conditions. One study, which analyzed 1.1 million cells in 42 brain regions of neurotypical adults, identified specific neuronal cell types—mainly in the basal ganglia, a region involved in addictive behaviors—that were linked to 19 neuropsychiatric disorders and traits. Those conditions included schizophrenia and bipolar disorder as well as alcohol and tobacco use disorder.

This project is a step in the right direction for advancing research in personalized medicine, says Miller, though he warns this is only one of many to make this a reality for everyone. 

Miller and Hodge are optimistic there will be other versions of the human brain atlas completed in the next five years, as other groups wrap up similar projects. 

But there’s a possibility that we’ll never get the full picture. While Miller finds a half-decade timeframe reasonable, he says there’s always a chance science develops a new technology that could unearth something unexpected about the brain. “We can always do more,” he says.

This post has been updated.

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Adjusting to prosthetic limbs isn’t as simple as merely finding one that fits your particular body type and needs. Physical control and accuracy are major issues despite proper attachment, and sometimes patients’ bodies reject even the most high-end options available. Such was repeatedly the case for a Swedish patient after losing her right arm in a farming accident over two decades ago. For years, the woman suffered from severe pain and stress issues, likening the sensation to “constantly [having] my hand in a meat grinder.”

Phantom pain is an unfortunately common affliction for amputees, and is believed to originate from nervous system signal confusions between the spinal cord and brain. Although a body part is amputated, the peripheral nerve endings remain connected to the brain, and can thus misread that information as pain.

[Related: We’re surprisingly good at surviving amputations.]

With a new, major breakthrough in prosthetics, however, her severe phantom pains are dramatically alleviated thanks to an artificial arm built on titanium-fused bone tissue alongside rearranged nerves and muscles. As detailed in a new study published via Science Robotics, the remarkable advancements could provide a potential blueprint for many other amputees to adopt such technology in the coming years.

The patient’s procedure started in 2018 when she volunteered to test a new kind of bionic arm designed by a multidisciplinary team of engineers and surgeons led by Max Ortiz Catalan, head of neural prosthetics research at Australia’s Bionics Institute and founder of the Center for Bionics and Pain Research. Using osseointegration, a process infusing titanium into bone tissue to provide a strong mechanical connection, the team was able to attach their prototype to the remaining portion of her right limb.

Accomplishing even this step proved especially difficult because of the need to precisely align the volunteer’s radius and ulna. The team also needed to account for the small amount of space available to house the system’s components. Meanwhile, the limb’s nerves and muscles needed rearrangement to better direct the patient’s neurological motor control information into the prosthetic attachment.

“By combining osseointegration with reconstructive surgery, implanted electrodes, and AI, we can restore human function in an unprecedented way,” Rickard Brånemark, an MIT research affiliate and associate professor at Gothenburg University who oversaw the surgery, said via an update from the Bionics Institute. “The below elbow amputation level has particular challenges, and the level of functionality achieved marks an important milestone for the field of advanced extremity reconstructions as a whole.”

The patient said her breakthrough prosthetic can be comfortably worn all day, is highly integrated with her body, and has even relieved her chronic pain. According to Catalan, this reduction can be attributed to the team’s “integrated surgical and engineering approach” that allows [her] to use “somewhat the same neural resources” as she once did for her biological hand.

“I have better control over my prosthesis, but above all, my pain has decreased,” the patient explained. “Today, I need much less medication.” 

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If you think your mental health might benefit from psychotherapy, booking an appointment with a professional—often an Herculean task—is only the beginning. Before you start, there might be some mental cobwebs you’ll need to clear out to make therapy work for you. 

Maybe you feel like your problems are insurmountable, or even doubt a therapist’s ability to make a difference. Maybe you fear or distrust the medical system, and opening up seems terrifying. 

Therapists often see these hesitations with their clients and assure that by addressing them, you can overcome them and fully benefit from your time, financial, and emotional investment in the process.

“Me and my therapist didn’t click”

So you went to a therapist and after talking to them for an hour you decided there was no connection. It happens—as much as they’re professionals, they’re also just people, and it’s impossible to connect with everybody. Maybe they were poorly trained, which is not only discouraging, but also downright harmful, says Josh Jonas, a psychotherapist at The Village Institute, a therapy practice in New York City.

This is why it’s so important to find a good fit. Meeting with multiple therapists in your quest to find a dynamic that works for you is normal. Whenever it doesn’t feel right, just try another one. But, as anyone who has looked for this unicorn knows, it’s easier said than done.

[Related: Boost your health with a little nature therapy]

Mental healthcare needs have spiked in the US over the past four years, according to the Centers for Disease Control and Prevention, and a shortage of mental health professionals that predated the COVID-19 pandemic only worsened after the health crisis. This has made it hard to find a therapist that’s a good match. The reality is even grimmer for the 160 million Americans that live in states like California, Texas or Arkansas, where mental healthcare access is limited. 

To increase the chances of finding a match, ask for a quick intro call with the therapist you’re planning to see. Even if you are using an online platform where you are matched with someone through a questionnaire, you can request to interview them ahead of your first session and change therapists at any time. 

You can ask them anything you want that will make you feel more at ease about working with them. But if you don’t know what to ask, Jonas suggests some ideas to get you started:

• What is your typical process for getting to know your patients and their concerns?
• What type of therapy do you use and why? 
• How quickly might I anticipate seeing some sort of progress?
• Do you anticipate me needing to set aside time outside of therapy for “homework” or other to-dos?

It will take time and some effort, but Jonas says finding a good therapist is a fight worth fighting. 

“My therapist won’t ‘get’ me”

Your therapist might be a person with an entirely different background than you, which might result in them not understanding you at first. But even if that’s the case, they should really want to try. 

“People can have the sense that because of disparities, you might not get the same treatment,” says Marlene Watson, a licensed therapist and director of training at the Ackerman Institute, a family therapy clinic in New York City, 

People of color, for example, might feel an inherent mistrust in psychotherapy (a field where the grand majority of professionals are white) based on the known history of systemic racism in the medical community. 

In addition, some women might be concerned that male providers will be more dismissive of their experiences based on a history of sexism in healthcare. A 2021 study published in the journal Psychological Services, shows that women with serious mental illness are often overlooked in mental health and rehabilitation settings, and have a higher risk of treatment bias, abuse, and violence compared to men. 

But even if you and your therapist have physical, cultural, or communicational differences, Watson says a good professional will not only have training on cultural bias, but will actively and openly talk to you about not feeling understood. 

“We talk about communication as our business […] a therapist engaging in that type of dialogue is a sign you are in the right place,” she says.

If, on the other hand, they don’t initiate a conversation about it, you can. And if they seem closed off to it, it might be time to look for another therapist.

“I’m going to get reported or committed to a hospital” 

Jonas and Watson validate that the fear of real life repercussions from opening up to a therapist can cause clients to think twice about what they share. From patients sufferring from suicidal ideations or self-harm, to parents worrying Child Protective Services might get involved, some people wonder where the line is when it comes to sharing the hard stuff.

Watson and Jonas say that outcomes where authorities need to get involved are rare and only happen when there’s a serious and imminent risk to the safety of the patient or someone in their life. Both professionals encourage those with suicidal thoughts to seek help, and clarify that asking about these ideations is actually a normal part of their job. Watson says that bringing it up themselves helps patients relax and turns treatment into “just a conversation”. 

“I’d say to people, we are here to help you. To make sure you are safe, and that those around you are safe,” Watson says. 

“I’ll be seen as weak”

There’s long been a negative social stigma around mental illness, implying that seeking therapy is a sign of weakness. This, Jonas says, is especially true among men and particularly prevalent in certain cultural groups, where the notion is exacerbated by the fear that this prejudice might permeate other areas of the patient’s life. 

But Jonas explains this belief is not based on reality, especially as pursuing therapy becomes more common. According to the Substance Abuse and Mental Health Services Administration, 42 million people in the US sought help with their mental health in 2021, a number that has been steadily increasing since 2019.  

In fact, he explains physical and emotional strength are much more similar than people realize. The emotional equivalent of being able to lift and hold 50 pounds at the gym is handling and processing your own emotions in a healthy way without offloading the weight onto someone else. Because that’s what snapping and yelling at people at home or in line at the register is—dropping those heavy dumbbells on the people around you. So therapy is your workout, says Jonas: “It makes you stronger emotionally.”

“Therapy doesn’t work… nobody can really help me”

A lot of people want to work on dealing with the long lasting effects of neglect and emotional disconnection. Ironically, this experience can perpetuate the feeling of neglect, because if a patient was abandoned once, they might feel it’s likely they’ll be abandoned again—even by their therapist. This feeling is also prevalent in patients suffering from addiction, who generally can’t find solace in people but in whatever they’re addicted to. 

[Related: Mental wellness apps are basically the Wild West of therapy]

Luckily, Jonas says a lot of the time you only need one good experience with psychotherapy to dispel that belief. A 2018 literature review published in the journal Psychotherapy showed that a positive relationship between a patient and their therapist is strongly related to a good outcome, so unpacking your own barriers and challenges in that relationship is a must. 

“There are many people I’ve seen who don’t trust, but for some reason trust you. That’s reparative, and a huge win, and the beginning of them learning people can help,” he says.

This is yet another reason why finding the right therapist for you is so important—it can change your entire disposition to your mental health journey. Because trusting the process, Watson says, is essential: “It’s not all about what the therapist can do, but it’s also about what you do.”

The post 5 common concerns about therapy and how to overcome them appeared first on Popular Science.

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The best workout apps will save you time and (often) money, and many include social features that allow you to get some of the in-person benefits that you’d find at the gym. These apps vary in the quality and variety of instruction, but you might be surprised by the caliber of some free exercise apps—some feature top-notch fitness pros. 

As a personal trainer, I’ve used some of these apps myself and have recommended them for clients and friends. Some apps sync with devices or equipment like heart rate monitors, fitness watches, or exercise bikes. Some offer live instruction along with a wide selection of on-demand classes. They often provide expert guidance on form and let you work out whenever you want, without having to schedule a class or wonder if the gym is open.

Before you sign up for a subscription for one of the many fitness apps available, consider your workout preferences. Do you like to kickbox or strength train? Do you want the option to do both with some yoga or pilates on recovery days? Your goals, lifestyle, and budget play a big role in the best workout app for you. We’ve rounded up our favorites below.

• Best overall: Peloton
• Best free: Nike Training Club
• Best for yoga: Asana Rebel
• Best weightlifting: Fitbod

1. Best overall: Peloton App

First things first: You don’t need a Peloton bike or treadmill to use the Peloton app. Peloton offers different subscription levels to fit a range of budgets and fitness goals, including a free subscription that provides access to 50 classes. 

You can get by on the free subscription if you don’t rely on the app for all of your workouts, and it will give you a good sense of what to expect from the paid tiers. But you can also take advantage of a 30-day trial period for the paid subscriptions to see how the app fits into your workout style. I personally don’t think you need to pay for more than the $12.99 per month subscription unless you’ve got a Peloton bike or treadmill, which requires a $44 per month, all-access subscription.

The Peloton app offers a wide range of exercise modalities, like rowing, strength training, kickboxing, and pilates. The quality of Peloton’s instructors sets them apart from other apps, and in some cases, can feel like a virtual personal trainer. Plus, the fitness coach app features training programs if you’d like to focus on a specific area for a few weeks. Peloton also offers an excellent selection of live leaderboards and social motivation that creates a sense of community for users.

Peloton App is available on Android and iOS for $12.99 per month.

[Related: A beginner’s guide to Google Fit and Apple Health]

2. Best free: Nike Training Club

The Nike Training Club (NTC) is the best free workout app, hands down. Nike removed the subscription fee during the COVID-19 pandemic, and they haven’t reinstated it. This app offers 190 free workouts in a wide range of modalities, from dance and pilates to bodyweight strength training and running warm-ups. It also includes pre-designed programs that run from one to six weeks, helping you build strength and endurance over time. 

NTC also lets you easily build a customized workout. I love good filters because they minimize scrolling through an endless list of workouts. You can filter based upon:

• Available equipment
• Muscle group
• Workout focus
• Trainer-led classes
• Workout length

The app also includes a workout history so you can see your progress. Plus, it offers suggestions based on your past workouts and your preferences. Lasting fitness requires a planned approach, and NTC gives you that option. While instruction isn’t as dynamic as the Peloton app, the classes are led by Nike Master Trainers and the app includes excellent tips on form to maximize your workout time. And you can’t beat the price.

Nike Training Club is free on iOS and Android.

3. Best for yoga: Asana Rebel

As a trainer and a yoga practitioner, I love Asana Rebel. I recommend it to anyone who prefers yoga as their main form of exercise. 

When you sign up, you fill out a survey and the app tailors your options based on your preferences. Strong filter features help you find workouts by length, muscle group, experience level, and workout goals. Plus, there are meditations if you feel like you need something quieter than yoga. For the desk-bound, this app includes yoga for the office to give you a stretch and rejuvenation from your chair. But don’t let the ease of use fool you. Most yoga practitioners can find challenging workouts. 

One of my favorite features is the add-on option at the end of each workout. You can start with a five-minute focus on flexibility and finish your session with a routine that targets the upper body, followed by some meditation. Plus, the app offers nutrition and meditation guidance, providing a holistic approach to physical and mental health. 

Asana Rebel offers a yearly subscription that costs around $6 per month. However, the subscription frequently goes on sale for 50 percent off, so you can snag yourself a good deal.

Asana Rebel is available for Android and iOS for about $6 a month.

[Related: The best fitness trackers]

4. Best for weightlifting: Fitbod

Building muscle safely requires a plan, and the Fitbod app helps you develop a tailored regimen and record your progress for long-term success. The app guides you through a strength training plan, offering suggestions as you progress. You get three workouts for free before you have to pay for the $12.99-per-month subscription. 

The app customizes exercises based on your fitness level and access to equipment. When you sign up, you put in your fitness level, goals, and add a checkmark next to the equipment available to you. If you’re limited to dumbbells and body weight, the app provides suggestions based on your answers. Fitbod can help you create workouts whether you have access to a full gym or not. 

You can also create your own workout programs or customize suggestions made by the app. Selection starts with choosing a muscle group or two, and Fitbod provides suggestions that include circuits and supersets to give you options to choose from. The app also provides instructions for strength moves ranging from bench presses to mountain climbers. And instructors demonstrate proper form in included videos.

While this app may not be robust enough for pro lifters, Fitbod is an excellent choice for people designing their lifting programs on their own, as it combines instruction and a workout planner. Even those with more experience can use it as an exercise plan, tallying sessions and sets to monitor progress.

Fitbod is available for Android and iOS for $12.99 per month after three free workouts.

The post The best workout apps for all kinds of exercise appeared first on Popular Science.

Articles may contain affiliate links which enable us to share in the revenue of any purchases made.

Best overall		Verilux HappyLight Luxe		SEE IT	Get everything you need without paying for features you’ll never use.
Best intensity		Carex Day-light Classic Plus		SEE IT	This powerful light offers ample adjustability for placement.
Best compact		Circadian Optics Lumos 2.0		SEE IT	This battery-powered lamp is simple to travel with.

When the dog days of summer give way to the darkening skies of fall, the never-ending grays of winter, and the rainy doldrums of spring, a light therapy lamp can really save the day. Options for recharging indoors with simulated sunshine have proliferated, with everything from tiny desktop lamps to floor lamps available to boost your mood. There are some generally recommended times to use them: soon after waking, for about 30 minutes, about 1.5 to 2 feet from your face, and with your eyes open but not looking directly at the light. In short, the best light therapy lamps to combat seasonal affective disorder (SAD) can help to reset your biological clock via the body’s natural circadian rhythms, boost the happy chemical serotonin, and provide a mental health lift to support a healthy mood, appetite, and sleep—and an overall healthier, happier you.

• Best overall: Verilux HappyLight Luxe
• Best for light intensity: Carex Day-light Classic Plus Light Therapy Lamp
• Best floor lamp: Flamingo Floor Lamp II by Northern Technologies
• Best compact: Circadian Optics Lumos 2.0
• Best budget: Light Therapy Lamp by Erligpowht

How we choose the best light therapy lamps

With so many light therapy lamps on the marketplace, the best light therapy lamp will fit your space and bath your face to help treat seasonal affective disorder (SAD). We narrowed the list by looking for lights that provided the recommended 10,000 lux of light and produced as little UV light as possible. We also wanted the light therapy lamps to be easy to use (if stepping outside into the sun during the summer is simple, so should turning on or adjusting your lamp) and easy on the eyes—no need to have an ugly light in this day and age of cute, clever design. We also wanted to highlight a range of products, from desktop setups to lamps that double as furniture. The chosen light therapy lamps come in a range of prices, and we cut the price off at $200 to keep the recommendations within reach of most consumers. And don’t miss our best sunset lamps and sunrise alarm clocks on the way to bed, either.

The best light therapy lamps: Reviews & Recommendations

You may need something very specific in your lamp, perhaps a certain size or one that can be used at a certain distance from your face. If our top pick isn’t just right for you, scroll down to find the perfect fit for you.

Best overall: Verilux HappyLight Luxe

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Why it made the cut: It’s bright, good-looking, and easy to move around.

Specs

• Brightness: Adjustable brightness
• Color temperature: Adjustable color temperature
• Dimensions: 11.8 x .5 x 7.5 inches

Pros

• Compact size and lightweight for easy portability 
• Intuitive adjustable brightness and color temperature
• Countdown timer to take the guesswork out of light therapy

Cons

• Non-adjustable stand
• For 10,000 lux, you’ll need to be at a 6-inch distance

The Verilux HappyLight Luxe is an economical light therapy lamp with a retail price that comes in well below $100 that’s also loaded with important features. The sleek, slim design is more reminiscent of an iPad than a medical device, with a modern look that fits into most people’s home decor. It doesn’t vie to be a centerpiece, either, offering a nice balance when it comes to function and form. For the truly looks conscious, the frame comes in white, marble, and champagne. 

At 11.8 inches tall, 7.5 inches wide, and a slender half-inch in depth, the lamp can sit unobtrusively on a desk or table, delivering the benefits of light therapy without drawing attention to itself. It’s also small enough to slip into a backpack or overnight bag so you can take the benefits of light therapy to the office, on the road, or on vacation. The two-pound lamp comes with a detachable stand, or it can be wall-mounted. It is corded.

On the function side, the powerful LED, full-spectrum light panel reaches up to the recommended brightness of 10,000 lux. With a push of a button, you can adjust the brightness in four settings or the light color in three settings. Note that for the full 10,000 lux exposure you’ll need to be about 6 inches away from the lamp. Its built-in countdown timer (up to one hour, down to five-minute increments) ensures you’ll get the recommended amount of light without keeping track of it yourself. You can also pause the timer if you get up for a coffee break. This light therapy lamp is UV-free, as too much UV light can damage your eyes and skin.

Controls on the Verilux HappyLight Luxe are simple and straightforward. There’s an on-off button on the top of the device. All other controls are on the front-facing panel, below the light screen. The left button allows you to switch between three color temperatures (measured in Kelvin): warm white (3,500K), medium white (4,250K), and daylight (5,000K). The right button toggles you through four brightness levels: 2,500, 5,000, 7,500, and 10,000 lux. The brighter the light, the shorter you’ll need to sit in front of it for maximum effect. The center button is the automatic count-down timer, which you can set for up to an hour and which shuts the lamp off, so you don’t have to remember to turn it off when your session is done. The general recommendation, whether to combat SAD or to get a mental boost, is to start at the lowest brightness for a short period of time, say 10 minutes, and then work your way up to the one-hour mark from there. 

The lamp uses Flicker Elimination Technology and Optix Glare Control to make the light easier on your eyes. No matter which light therapy device you use, it’s recommended that you place the light at an off-center angle from your body so you’re not looking directly into the light. Your eyes do have to be open to receive the effects, so it’s best to use the lamp while working on the computer, reading, or doing stationary hobbies. Napping next to any light therapy lamp, including this one, won’t deliver the physical and mental health benefits.

Best for light intensity: Carex Day-light Classic Plus Light Therapy Lamp

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Why it made the cut: It’s powerful enough that even at 12 inches away, you’re getting full “sun.”

Specs

• Brightness: 10,000 lux at 12 inches
• Color temperature: N/A
• Dimensions: Large light size at 16″ x 13″ 

Pros

• Ability to angle downward to better mimic sunlight and for less glare
• Sit 12-14 inches away and still reap maximum benefits
• Light screen can be adjusted up to 31 inches from base 

Cons

• Space hog
• Only two light settings
• Plastic base

This full-coverage desktop light therapy lamp goes where the sun don’t shine. You’ll get the recommended 10,000 lux of glare-free white LED light (at 4000K) whenever you flip the switch and sit 12 to 14 inches away from the large light area. Unlike many light therapy lamps on the market, this one does not skimp on the light surface size. Expect 16-by-12 inches of glowing light. Think of it as the equivalent of sitting in front of an oversized monitor versus working on a small handheld device compared to other models on this list. You’ll also escape the harmful effects of UV rays with this one. The ability to tilt the light downward is a big plus, which helps to mimic the direction of sunlight and generally allows for less glare. 

While this larger lamp won’t work for tight desktop spaces, it is a good fit for those who want to bathe in manmade light without worrying about sitting too close to the lamp’s base. And it’s pretty good looking, with a silver base and center and a light area reminiscent of a pro photographer’s light rig. 

Best floor lamp: Flamingo Floor Lamp II by Northern Technologies

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Why it made the cut: It offers the benefits of light therapy in the design of a traditional floor lamp.

Specs

• Brightness: 10,000 lux of light at 12-inch distance
• Color temperature: Uses replaceable LED bulbs
• Dimensions: 4 feet tall

Pros

• Doubles as a regular floor lamp
• 4-foot height ideal for using next to a recliner
• Easy to assemble

Cons

• Non-adjustable height
• Only one light setting
• No timer, only on/off switch

The Flamingo Floor Lamp—with its skinny angled central pole—does bear a passing resemblance to one familiar long-legged wading bird, although it has neither beak nor is it pink. It is, however, one of the few traditional stand-up floor lamps that also work as a light therapy lamp available today. From Northern Technologies, the lamp leans into its 10,000 lux capacity as a big selling point, and you’ll get that brightness at 12 inches away. 

The LED bulbs in this Canadian-made lamp are fully replaceable, full-spectrum, and UV-free, and they boast no hum or flicker when turned on. The lamp is also energy efficient, using two 18-watt LED bulbs. And while we don’t recommend knocking this lamp around too much, the light bulb cover isn’t glass, so any accidental tippage won’t send sharp shards skittering across your floor.

As a 4-foot-tall floor lamp, it looks right at home next to an easy chair or sofa, but it can also be used as a bedside stand-up lamp, next to a desk, or in a corner of a dark room to brighten a living space. The light fixture itself measures 13 by 7 inches, and it swivels. The lamp has no timer, but it is compatible with an external programmable light timer. 

Best compact: Circadian Optics Lumos 2.0

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Why it made the cut: This reading-style lamp offers superior brightness in a space-conscious design.

Specs

• Brightness: 10,000 lux and 3 brightness settings
• Color temperature: UV-free LED light
• Dimensions: 14.4 x 3.5 x 1.5 inches

Pros

• 3 brightness settings via a single touch
• LED light up to 50,000 hours
• Small design that swivels open

Cons

• Small area illuminated due to lamp’s size
• Bulb is not replaceable, rendering the lamp useless when the bulb burns out
• Small base leaves it prone to tipping when open

There’s a lot to like about this reading-style lamp, which is really a cleverly designed light therapy lamp. When in its “standing” position that resembles a tall, skinny speaker, it’s just 14 inches high, 3.5 inches deep, and 1.5 inches wide. From the closed position, a hinged arm swings from the top and opens the arm out like a fan so you can set the optimal light angle for your activity—reading, writing, computing, sewing, woodworking, or whatever desktop work you have in store.

A one-touch button lets you control the UV-free LED’s brightness, starting with bright, to brighter, to brightest, with the brightest setting delivering 10,000 lux. It’s a uniform, dot-free light comparable to full spectrum sun. There’s no timer, but the daily recommendations are to place the lamp 16-18 inches from your face for anywhere from 15 to 60 minutes for the full circadian rhythm reset. 

And while an appearance on Shark Tank isn’t reason enough to buy a product, it’s worth noting that Circadian Optics founder Amber Leong appeared on season 11 of the show in 2019 with her idea for light therapy lamps. Sharks Mark Cuban and Lori Greiner believed enough in her idea to invest. And the company now has five light therapy lamp designs for sale.

Best budget: Light Therapy Lamp by Erligpowht

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Why it made the cut: This powerful mini-sized light therapy lamp slips right into a pocketbook or small bag.

Specs

• ‎Brightness: 10,000 lux capacity
• Color temperature: N/A
• Dimensions: 5.11 x 6.69 x .59 inches

Pros

• Adjustable among three brightness levels 
• 90-degree rotation standing bracket to angle light
• Inexpensive

Cons

• Default turn-on starts at the brightest setting
• Unstable base may topple if jostled

The Light Therapy Lamp by Erligpowht is more short story than hero epic. It comes in at just over half an inch in depth, 5.11 inches wide, and 6.69 inches tall. For comparison, that’s smaller than an iPad Mini, and just the right size to slip into a small purse or desk drawer unobtrusively. Its 10.86-ounce weight means you won’t develop shoulder or back strain from adding this to your luggage, as that’s less than the weight of a standard-size battle of water.

Travelers who want to take a light therapy device with them on the road to help adjust to time changes or erratic sleep/wake schedules will appreciate this product’s compact size, as well as a price point that’s low enough that you won’t worry as much about accidents like forgetting it in your hotel room or spilling a cup of coffee on it in your morning haze. Likewise, apartment dwellers or workers using a small desk will appreciate the compact design that takes up very little room, whether in use or stowed away.

For the price, its features—three brightness levels and four pre-programmed timer settings—compete with more bougie brands. It’s also simple to operate. Use the angled kickstand to set the light up where you want it, and in the direction you’d like the light to shine, and then click it on to your desired setting, from 100% capacity to 50% to 30%. The timer button (both buttons are on the front, at the base of the unit) is preset for options. Simply click through to your desired time. The LED lamp is UV-free. A USB-C cord comes with the unit, but you can swap out your own if you’d like a longer or shorter cord.

What to consider when shopping for light therapy lamps

To get the most out of your light therapy lamp, you’ll want to sneak a peek at the fine print on your chosen lamp. Here are a few things to consider before you put that lamp into your virtual shopping cart and click “buy now.”

What is the lux capacity of the lamp?

Most experts agree that a lux capacity of 10,000 is necessary to get your circadian rhythm, sleep, and mood in sync. Your circadian rhythm dictates your sleep/wake cycle, which helps to regulate the mental, behavioral, and physical changes that happen throughout a 24-hour cycle. Getting plenty of natural light during the day helps to regulate this cycle, whether for those traveling to different time zones or for people dealing with Seasonal Affective Disorder, or SAD.  Most experts think that, among other things, too little light from the sun during fall, winter, and spring can lead to SAD. This concern magnifies in areas of the world where the daylight hours are especially short. A lamp that doesn’t put out the full recommended 10,000 lux may not deliver the full potential positive effects of a light therapy lamp.

Is the lamp’s brightness adjustable?

Unless you’re a pro therapy light user and you know you like your light bright, it’s wise to start with a lamp that has adjustable brightness. You may also find that in the dead of winter, you prefer the brightest setting, while on sunnier spring and fall days, you don’t need the full brightness. Choosing a lamp with adjustable brightness gives you more control over what kind of light you’ll be basking under.

Does the lamp have a preset timer?

Timers exist for a reason. It’s because humans easily lose track of time. The phone rings; a computer notification dings; a dog barks outside. Whatever the uncontrollable distractions are, it’s nice not to have to worry about how long you’ve been soaking up the rays from your light therapy lamp. With a built-in preset timer, the lamp turns off when your time is up, and you never have to lift a finger. While it’s not a necessary feature, it is a nice-to-have one.

FAQs

Final thoughts on the best light therapy lamps 

• Best overall: Verilux HappyLight Luxe
• Best for light intensity: Carex Day-light Classic Plus Light Therapy Lamp
• Best floor lamp: Flamingo Floor Lamp II by Northern Technologies
• Best compact: Circadian Optics Lumos 2.0
• Best budget: Light Therapy Lamp by Erligpowht

The best light therapy lamps have light settings of up to 10,000 lux, can change the color temperature settings, and have adjustable brightness settings. Features that make keeping track of time easy, such as a countdown timer or programmable timer add appeal. The more intuitive and easy a light therapy lamp is to use, the more likely you are to use it every day, and daily use is key to getting your mental and physical health on track. Check out one of the above options if you want to try light therapy for yourself.

Why trust us

Popular Science started writing about technology more than 150 years ago. There was no such thing as “gadget writing” when we published our first issue in 1872, but if there was, our mission to demystify the world of innovation for everyday readers means we would have been all over it. Here in the present, PopSci is fully committed to helping readers navigate the increasingly intimidating array of devices on the market right now.

Our writers and editors have combined decades of experience covering and reviewing consumer electronics. We each have our own obsessive specialties—from high-end audio to video games to cameras and beyond—but when we’re reviewing devices outside of our immediate wheelhouses, we do our best to seek out trustworthy voices and opinions to help guide people to the very best recommendations. We know we don’t know everything, but we’re excited to live through the analysis paralysis that internet shopping can spur so readers don’t have to.

The post The best light therapy lamps for 2024 appeared first on Popular Science.

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Excerpted from Powered by Me: From Burned Out to Fully Charged at Work and in Life by Neha Sangwan, MD, with permission from McGraw Hill, pages 44-49, September 2023.

How do you tell the difference between when your body is casually communicating with you and when it is trying to alert you to signs of burnout? Well, that depends on how closely you’re listening and whether you’re numbing the early signals. Your body has manners. It knows you’re busy, so it starts with a whisper, at a low volume (say one or two out of 10), but if you don’t pay attention, it continues to get louder, until it eventually stops you in your tracks. If you’ve gotten in the habit of hitting snooze on your body’s signals with various coping mechanisms, you can reach an 11—a heart attack, pneumonia, or other crisis—without even realizing it. That’s scary. 

It’s important to note that your body is more than just an alarm system. It wants to be your friend, and it talks to you about everything. Yes, it’s also informing you in your everyday communication with others when something is:
 

• Important to you 
• Out of balance 
• Different from what you expected 
• Not quite right 
• Exactly right 

Your body’s signals will not only give you a heads-up when something is wrong and it’s time to see the doctor, but also day-to-day updates on what resonates with you and what just feels off. Once you learn how to interpret these powerful signals, you’ll have a distinct advantage in every conversation, interaction, and experience in your life. 

The body map

Begin by ruling out any medical problems. Any new and unusual signals from your body need to be checked out by a medical professional. Once you’ve gotten a clean bill of health, then you can explore how the collection of symptoms may potentially be caused by burnout. 

When we’re acutely focused on everyone and everything around us (external data), it’s easy to miss what’s happening inside us (internal data). Recognizing and healing burnout depends on how attuned you are to interpreting your own physiology and responding to the data your body is sending. 

Each person’s body has a unique communication style. For some people, it’s their heart racing, stomach turning, or muscles tensing. For others, it’s sweating or shallow, rapid breathing. All day long, your body communicates with you, and it’s critical that you’re able to decipher those signals. These physical sensations are the gateway of awareness to valuable information that will guide you on this journey. 

Take a look at the Body Map illustration below to get a few ideas of how your body might be trying to communicate with you. By no means is this an exhaustive list. Feel free to add your own physical sensations to the diagram. 

One of the fastest ways to tune in to your physiology is by becoming aware of your physical body in space and where it meets the external world. By this, I mean literally shifting your attention to where your body meets the chair or wherever you are sitting. If you’re standing, notice where your feet meet the floor. As you take your next deep breath, focus on the expansion and contraction of your rib cage. Next, become aware of the sensations of clothing on your body, such as the tightness or looseness of your waistband.

Don’t worry if this doesn’t come naturally. If you’ve experienced high stress over long periods of time, you may have adapted to tuning out your body’s sensations. It’s a common coping mechanism. For example, Alex, my seatmate on my latest flight, was adept at silencing his body’s signals (headaches, insomnia, and back pain). He went searching for clues to heal himself, but in the interim, prescriptions and cocktails brought the only relief he could find. 

If you’ve been relying on your own coping mechanisms, whatever they may be, and are out of practice at listening to your body, try expanding your awareness in everyday activities: 

1. While you’re on a call or in a meeting, hold a smooth stone or weight that fits comfortably in your hand.

2. Each time you notice the weight in your hand, use it as a reminder to check in with your body (meaning, is your body trying to get your attention? Do your wrists hurt from too much typing? Is your rear end numb from sitting for too long? Do you need to stand up, stretch, or get some water?). 

3. Don’t be discouraged if you don’t feel anything. Instead, take a deep breath and refocus your attention back on the weight in your hand.

 4. Anytime you notice an emotion arise in another person or a shift in intensity in the conversation, that’s a good time to bring your awareness back to the weight in your hand. 

5. Be patient. You will begin to tune in to your body’s signals.

The signals are already there

You probably feel more than you realize. What about that pesky neck or shoulder pain? A 3 o’clock energy dip? Any intermittent headaches? What about joint stiffness? These are all signals from your body. 

Once you identify and understand its unique language, you will be able to decipher the physical clues even earlier (at lower intensities), get curious and ask yourself, What happens before that? And just before that?

Interpreting your body  

Understanding your body’s unique language can seem confusing at first. That’s only until you learn how to interpret the intensity and frequency of the signals as well as the context of the situation. The data from your body typically falls into one of three main categories:   

Everyday guidance: low volume, low frequency

Helping you navigate everyday situations and a changing environment and recalibrating your internal GPS in new experiences. These physical signals can show up in many ways: intermittent muscle tension, throat constriction, jaw tightness, knots in your stomach, to name a few. 

Chronic depletion: mid-volume, more frequent

Alerting you to a drain of energy and lack of alignment in your internal GPS. These physical signals can show up as individual symptoms, such as fatigue, heart palpitations, insomnia, headaches, imbalance, pain, brain fog, forgetfulness, diarrhea, constipation, or a collection of symptoms known as a syndrome. 

The post Are you burned out? Here’s how your body might be telling you. appeared first on Popular Science.

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More people in the United States are dying from causes related to excessive alcohol consumption since 1999. Surprisingly, this is particularly true for American women, according to a study published July 28 in the journal JAMA Network Open. While men are roughly three times more likely than women to die from alcohol use, the gap has narrowed and the risk to women has grown recently.  

[Related: COVID lockdown drinking habits led to a rise in deaths from alcoholic liver disease.]

The study looked at Centers for Disease Control and Prevention (CDC) data on more than 600,000 deaths linked to alcohol between 1999 and 2020. The data included deaths from alcoholic liver disease, alcohol poisoning, acute intoxication, alcoholic cardiomyopathy, and mental and behavioral disorders that can be linked to alcohol consumption, and other causes.

It found that alcohol-related deaths steadily increased in the United States in that period. However, from 2018 to 2020, the rate increased by 14.7 percent for women compared to 12.5 percent for men. The study also found rising rates among older women in particular. Alcohol-related deaths rose in women over 65 and older by 6.7 percent from 2012 to 2020, compared with a 5.2 percent increase per year in men 65 and older. 

According to the authors, this shift does not necessarily mean that women in this age group are drinking more, but could point to “the larger burden of accumulating harms of chronic alcohol use among female individuals.”

While this study did not point to the reasons behind this increase, co-author and assistant professor of population health at Hofstra University Ibraheem Karaye offered a few potential theories to The New York Times. Karaye said that alcohol consumption is likely increasing among women and that alcohol affects women’s bodies differently. Women’s bodies typically have less fluid to dilute alcohol, which can result in higher blood-alcohol concentrations, which may make women more vulnerable to health complications, according to Karaye.

Stress is also a major factor in alcohol misuse among both men and women. The narrowing gap could reflect an increase in both stress and stress-related disorders among women, according to the team. 

[Related: A powerful combo of psilocybin and therapy might help people overcome alcohol use disorder.]

Excessive drinking during the COVID-19 pandemic has also increased alcoholic liver disease deaths, with a recent report from KFF Health News finding that the condition killed more Californians than car accidents or breast cancer. The lockdowns made people feel isolated, depressed, stressed, and anxious, says KFF’s Philip Reese, which led to some increases in drinking and an increase in alcohol sales.

Additionally, shifting attitudes towards heavy drinking by women may be a factor.  Associate professor in the division of gastroenterology and liver disease at NYU Langone Health Lisa Ganjhu told NBC News that she regularly sees women who are not aware of how physically toxic it can be. 

“The article didn’t surprise me. Women are overusing alcohol with more frequency now. I’ve had to talk to a fair number of women about their alcohol use,” said Ganjhu, who was not affiliated with the new study. “I had one patient who developed pancreatitis from drinking ask me when she could start drinking again. She said it wasn’t acceptable to not drink with clients. It’s mind-boggling.”

Regardless of gender, Karaye agrees with most physicians that “reducing or eliminating exposure [to alcohol] at any point would be valuable.” The National Institute on Alcohol Abuse and Alcoholism’s Rethinking Drinking program can help people evaluate alcohol usage and create plans to scale down or quit drinking. 

The post Deaths related to excessive alcohol consumption rise in recent years—especially for women appeared first on Popular Science.

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This article was originally published on Undark.

The transition to online learning in the United States during the Covid-19 pandemic was, by many accounts, a failure. While there were some bright spots across the country, the transition was messy and uneven—countless teachers had neither the materials nor training they needed to effectively connect with students remotely, while many of those students were bored, isolated, and lacked the resources they needed to learn. The results were abysmal: low test scores, fewer children learning at grade level, increased inequity, and teacher burnout. With the public health crisis on top of deaths and job losses in many families, students experienced increases in depression, anxiety, and suicide risk.

Yet society very well may face new widespread calamities in the near future, from another pandemic to extreme weather, that will require a similarly quick shift to remote school. Success will hinge on big changes, from infrastructure to teacher training, several experts told Undark. “We absolutely need to invest in ways for schools to run continuously, to pick up where they left off. But man, it’s a tall order,” said Heather L. Schwartz, a senior policy researcher at RAND. “It’s not good enough for teachers to simply refer students to disconnected, stand-alone videos on, say, YouTube. Students need lessons that connect directly to what they were learning before school closed.”

More than three years after U.S. schools shifted to remote instruction on an emergency basis, the education sector is still largely unprepared for another long-term interruption of in-person school. The stakes are highest for those who need it most: low-income children and students of color, who are also most likely to be harmed in a future pandemic or live in communities most affected by climate change. But, given the abundance of research on what didn’t work during the pandemic, school leaders may have the opportunity to do things differently next time. Being ready would require strategic planning, rethinking the role of the teacher, and using new technology wisely, experts told Undark. And many problems with remote learning actually trace back not to technology, but to basic instructional quality. Effective remote learning won’t happen if schools aren’t already employing best practices in the physical classroom, such as creating a culture of learning from mistakes, empowering teachers to meet individual student needs, establishing high expectations, and setting clear goals supported by frequent feedback. While it’s ambitious to envision that every school district will create seamless virtual learning platforms—and, for that matter, overcome challenges in education more broadly—the lessons of the pandemic are there to be followed or ignored.

“We haven’t done anywhere near the amount of planning or the development of the instructional infrastructure needed to allow for a smooth transition next time schools need to close for prolonged periods of time,” Schwartz said. “Until we can reach that goal, I don’t have high confidence that the next prolonged school closure will be substantially more successful.”

Before the pandemic, only 3 percent of U.S. school districts offered virtual school, mostly for students with unique circumstances, such as a disability or those intensely pursuing a sport or the performing arts, according to a RAND survey Schwartz co-authored. For the most part, the educational technology companies and developers creating software for these schools promised to give students a personalized experience. But the research on these programs, which focused on virtual charter schools that only existed online, showed poor outcomes. Their students were a year behind in math and nearly a half-year behind in reading, and courses offered less direct time with a teacher each week than regular schools have in a day.

The pandemic sparked growth in stand-alone virtual academies, in addition to the emergency remote learning that districts had to adopt in March 2020. Educators’ interest in online instructional materials exploded, too, according to Schwartz, “and it really put the foot on the gas to ramp them up, expand them, and in theory, improve them.” By June 2021, the number of school districts with a stand-alone virtual school rose to 26 percent. Of the remaining districts, another 23 percent were interested in offering an online school, the report found.

But the sheer magnitude of options for online learning didn’t necessarily mean it worked well, Schwartz said: “It’s the quality part that has to come up in order for this to be a really good, viable alternative to in person instruction.” And individualized, self-directed online learning proved to be a pipe dream—especially for younger children who needed support from a parent or other family member even to get online, much less stay focused.

“The notion that students would have personalized playlists and could curate their own education was proven to be problematic on a couple levels, especially for younger and less affluent students,” said Thomas Toch, director of FutureEd, an education think tank at Georgetown University’s McCourt School of Public Policy. “The social and emotional toll that isolation and those traumas took on students suggest that the social dimension of schooling is hugely important and was greatly undervalued, especially by proponents for an increased role of technology.”

Students also often didn’t have the materials they needed for online school, some lacking computers or internet access at home. Teachers didn’t have the right training for online instruction, which has a unique pedagogy and best practices. As a result, many virtual classrooms attempted to replicate the same lessons over video that would’ve been delivered at school. The results were overwhelmingly bad, research shows. ​​For example, a 2022 study found six consistent themes about how the pandemic affected learning, including a lack of interaction between students and with teachers, and disproportionate harm to low-income students. Numb from isolation and too many hours in front of a screen, students failed to engage in coursework and suffered emotionally.

After some districts resumed in-person or hybrid instruction in the 2020 fall semester, it became clear that the longer students were remote, the worse their learning delays. For example, national standardized test scores for the 2020-2021 school year showed that passing rates for math declined about 14 percentage points on average, more than three times the drop seen in districts that returned to in-person instruction the earliest, according to a 2021 National Bureau of Economic Research study. Even after most U.S. districts resumed in-person instruction, students who had been online the longest continued to lag behind their peers. The pandemic hit cities hardest and the effects disproportionately harmed low-income children and students of color in urban areas.

“What we did during the pandemic is not the optimal use of online learning in education for the future,” said Ashley Jochim, a researcher at the Center on Reinventing Public Education at Arizona State University’s Mary Lou Fulton Teachers College. “Online learning is not a full stop substitute for what kids need to thrive and be supported at school.”

Children also largely prefer in-person school. A 2022 Pew Research Center survey suggested that 65 percent of students would rather be in a classroom, 9 percent would opt for online only, and the rest are unsure or prefer a hybrid model. “For most families and kids, full-time online school is actually not the educational solution they want,” Jochim said.

Virtual school felt meaningless to Abner Magdaleno, a 12th grader in Los Angeles. “I couldn’t really connect with it, because I’m more of, like, a social person. And that was stripped away from me when we went online,” recalled Magdaleno. Mackenzie Sheehy, 19, of Fond du Lac, Wisconsin, found there were too many distractions at home to learn. Her grades suffered, and she missed the one-on-one time with teachers. (Sheehy graduated from high school in 2022.)

Many teachers feel the same way. “Nothing replaces physical proximity, whatever the age,” said Ana Silva, a New York City English teacher. She enjoyed experimenting with interactive technology during online school, but is grateful to be back in person. “I like the casual way kids can come to my desk and see me. I like the dynamism—seeing kids in the cafeteria. Those interactions are really positive, and they were entirely missing during the online learning.”

During the 2022-2023 school year, many districts initially planned to continue online courses for snow days and other building closures. But they found that the teacher instruction, student experience, and demands on families were simply too different for in-person versus remote school, said Liz Kolb, an associate professor in the School of Education at the University of Michigan. “Schools are moving away from that because it’s too difficult to quickly transition and blend back and forth among the two without having strong structures in place,” Kolb said. “Most schools don’t have those strong structures.”

In addition, both families and educators grew sick of their screens. “They’re trying to avoid technology a little bit. There’s this fatigue coming out of remote learning and the pandemic,” said Mingyu Feng, a research director at WestEd, a nonprofit research agency. “If the students are on Zoom every day for like, six hours, that seems to be not quite right.”

Despite the bumpy pandemic rollout, online school can serve an important role in the U.S. education system. For one, online learning is a better alternative for some students. Garvey Mortley, 15, of Bethesda, Maryland, and her two sisters all switched to their district’s virtual academy during the pandemic to protect their own health and their grandmother’s. This year, Mortley’s sisters went back to in-person school, but she chose to stay online. “I love the flexibility about it,” she said, noting that some of her classmates prefer it because they have a disability or have demanding schedules. “I love how I can just roll out of bed in the morning, and I can sit down and do school.” Some educators also prefer teaching online, according to reports of virtual schools that were inundated with applications from teachers because they wanted to keep working from home. Silva, the New York high school English teacher, enjoys online tutoring and academic coaching, because it facilitates one-on-one interaction.

And in rural districts and those with low enrollment, some access to online learning ensures students can take courses that could otherwise be inaccessible. “Because of the economies of scale in small rural districts, they needed to tap into online and shared service delivery arrangements in order to provide a full complement of coursework at the high school level,” said Jochim. Innovation in these districts, she added, will accelerate: “We’ll continue to see growth, scalability, and improvement in quality.”

There were also some schools that were largely successful at switching to online at the start of the pandemic, such as Vista Unified School District in California, which pooled and shared innovative ideas for adapting in March 2020; the school quickly put together an online portal so that principals and teachers could share ideas and the district could allot the necessary resources. Digging into examples like this could point the way to the future of online learning, said Chelsea Waite, a senior researcher at the Center on Reinventing Public Education, who was part of a collaborative project studying 70 schools and districts that pivoted successfully to online learning. The project found three factors that made the transition work: a focus on resilience, collaboration, and autonomy for both students and educators; a healthy culture that prioritized relationships; and strong yet flexible systems that were accustomed to adaptation.

“We investigated schools that did seem to be more prepared for the Covid disruption, not just with having devices in students’ hands or having an online curriculum already, but with a learning culture in the school that really prioritized agency and problem solving as skills for students and adults,” Waite said. “In these schools, kids are learning from a very young age to be a little bit more self-directed, to set goals, and pursue them and pivot when they need to.”

Similarly, many of the takeaways from the pandemic trace back to the basics of effective education, not technological innovation. A landmark report by the National Academies of Sciences called “How People Learn,” most recently updated in 2018, synthesized the body of educational research and identified four key features in the most successful learning environments. First, these schools are designed for, and adapt to, the specific students, building on what they bring to the classroom, such as skills and beliefs. Second, successful schools give their students clear goals, showing them what they need to learn and how they can get there. Third, they provide in-the-moment feedback that emphasizes understanding, not memorization. And finally, the most successful schools are community-centered, with a culture of collaboration and acceptance of mistakes.

“We as humans are social learners, yet some of the tech talk is driven by people who are strong individual learners,” said Jeremy Roschelle, executive director of Learning Sciences Research at Digital Promise, a global education nonprofit. “They’re not necessarily thinking about how most people learn, which is very social.”

Another powerful insight from pandemic-era remote schooling involves the evolving role of teachers, said Kim Kelly, a middle school math teacher at Northbridge Middle School in Massachusetts and a K-8 curriculum coach. Historically, a teacher’s role is the keeper of knowledge who delivers instruction. But in recent years, there has been a shift in approach, where teachers think of themselves as coaches who can intervene based on a student’s individual learning progress. Technology that assists with a coach-like role can be effective—but requires educators to be trained and comfortable interpreting data on student needs.

For example, with a digital learning platform called ASSISTments, teachers can assign math problems, students complete them—potentially receiving in-the-moment feedback on steps they’re getting wrong—and then the teachers can use data from individual students and the entire class to plan instruction and see where additional support is needed.

“A big advantage of these computer-driven products is they really try to diagnose where students are, and try to address their needs. It’s very personalized, individualized,” said WestEd’s Feng, who has evaluated ASSISTments and other educational technologies. She noted that some teachers feel frustrated “when you expect them to read the data and try to figure out what the students’ needs are.”

Teacher’s colleges don’t typically prepare educators to interpret data and change their practices, said Kelly, whose dissertation focused on self-regulated online learning. But professional development has helped her learn to harness technology to improve teaching and learning. “Schools are in data overload; we are oozing data from every direction, yet none of it is very actionable,” she said. Some technology, she added, provided student data that she could use regularly, which changed how she taught and assigned homework.

When students get feedback from the computer program during a homework session, the whole class doesn’t have to review the homework together, which can save time. Educators can move forward on instruction—or if they see areas of confusion, focus more on those topics. The ability of the programs to detect how well students are learning “is unreal,” said Kelly, “but it really does require teachers to be monitoring that data and interpreting.” She learned to accept that some students could drive their own learning and act on the feedback from homework, while others simply needed more teacher intervention. She now does more assessment at the beginning of a course to better support all students.

At the district or even national level, letting teachers play to their strengths can also help improve how their students learn, Toch, of FutureEd, said. For example, if a teacher is better at delivering instruction, they could give a lesson to a larger group of students online, while another teacher who is more comfortable in the coach role could work in smaller groups or one-on-one.

“One thing we saw during the pandemic are smart strategies for using technology to get outstanding teachers in front of more students,” Toch said, describing one effort that recruited exceptional teachers nationally and built a strong curriculum to be delivered online. “The local educators were providing support for their students in their classrooms.”

Remote schooling requires new technology, and already, educators are swamped with competing platforms and software choices—most of which have insufficient evidence of efficacy. Traditional independent research on specific technologies is sparse, Roschelle said. Post-pandemic, the field is so diverse and there are so many technologies in use, it’s almost impossible to find a control group to design a randomized control trial, he added. However, there is qualitative research and evidence that give hints about the quality of technology and online learning, such as case studies and school recommendations.

Educational leaders should ask three key questions about technology before investing, recommended Ryan Baker, a professor of education at the University of Pennsylvania: Is there evidence it works to improve learning outcomes? Does the vendor provide support and training, or are teachers on their own? And does it work with the same types of students as are in their school or district? In other words, educators must look at a technology’s track record in the context of their own school’s demographics, geography, culture, and challenges. These decisions are complicated by the small universe of researchers and evaluators, who have many overlapping relationships. (Over his career, for example, Baker has worked with or consulted for many of the education technology firms that create the software he studies.)

It may help to broaden the definition of evidence. The Center on Reinventing Public Education launched the Canopy project to collect examples of effective educational innovation around the U.S.

“What we wanted to do is build much better and more open and collective knowledge about where schools are challenging old assumptions and redesigning what school is and should be,” she added, noting that these educational leaders are reconceptualizing the skills they want students to attain. “They’re often trying to measure or communicate concepts that we don’t have great measurement tools for yet. So they end up relying on a lot of testimonials and evidence of student work.”

The moment is ripe for innovation in online and in-person education, said Julia Fallon, executive director of the State Educational Technology Directors Association, since the pandemic accelerated the rollout of devices and needed infrastructure. There’s an opportunity and need for technology that empowers teachers to improve learning outcomes and work more efficiently, said Roschelle. Online and hybrid learning are clearly here to stay—and likely will be called upon again during future temporary school closures.

Still, poorly-executed remote learning risks tainting the whole model; parents and students may be unlikely to give it a second chance. The pandemic showed the hard and fast limits on the potential for fully remote learning to be adopted broadly, for one, because in many communities, schools serve more than an educational function—they support children’s mental health, social needs, and nutrition and other physical health needs. The pandemic also highlighted the real challenge in training the entire U.S. teaching corps to be proficient in technology and data analysis. And the lack of a nimble shift to remote learning in an emergency will disproportionately harm low-income children and students of color. So the stakes are high for getting it right, experts told Undark, and summoning the political will.

“There are these benefits in online education, but there are also these real weaknesses we know from prior research and experience,” Jochim said. “So how do we build a system that has online learning as a complement to this other set of supports and experiences that kids benefit from?”

Katherine Reynolds Lewis is an award-winning journalist covering children, race, gender, disability, mental health, social justice, and science.

This article was originally published on Undark. Read the original article.

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This article was originally published on The Markup. This article was copublished with STAT, a national publication that delivers trusted and authoritative journalism about health, medicine, and the life sciences. Sign up for its health tech newsletter here.

Websites for mental health crisis resources across the country—which promise anonymity for visitors, many of whom are at a desperate moment in their lives—have been quietly sending sensitive visitor data to Facebook, The Markup has found. 

Dozens of websites tied to the national mental health crisis 988 hotline, which launched last summer, transmit the data through a tool called the Meta Pixel, according to testing conducted by The Markup. That data often included signals to Facebook when visitors attempted to dial for mental health emergencies by tapping on dedicated call buttons on the websites. 

In some cases, filling out contact forms on the sites transmitted hashed but easily unscrambled names and email addresses to Facebook. 

The Markup tested 186 local crisis center websites under the umbrella of the national 988 Suicide and Crisis Lifeline. Calls to the national 988 line are routed to these centers based on the area code of the caller. The organizations often also operate their own crisis lines and provide other social services to their communities. 

The Markup’s testing revealed that more than 30 crisis center websites employed the Meta Pixel, formerly called the Facebook Pixel. The pixel, a short snippet of code included on a webpage that enables advertising on Facebook, is a free and widely used tool. A 2020 Markup investigation found that 30 percent of the web’s most popular sites use it.

The pixels The Markup found tracked visitor behavior to different degrees. All of the sites recorded that a visitor had viewed the homepage, while others captured more potentially sensitive information. 

Many of the sites included buttons that allowed users to directly call either 988 or a local line for mental health help. But clicking on those buttons often triggered a signal to be sent to Facebook that shared information about what a visitor clicked on. A pixel on one site sent data to Facebook on visitors who clicked a button labeled “24-Hour Crisis Line” that called local crisis services.

Clicking a button or filling out a form also sometimes sent personally identifiable data, such as names or unique ID numbers, to Facebook. 

The website for the Volunteers of America Western Washington is a good example. The social services nonprofit says it responds to more than 300,000 requests for assistance each year. When a web user visited the organization’s website, a pixel on the homepage noted the visit.

If the visitor then tried to call the national 988 crisis hotline through the website by clicking on a button labeled “call or text 988,” that click—including the text on the button—was sent to Facebook. The click also transmitted an “external ID,” a code that Facebook uses to attempt to match web users to their Facebook accounts. 

If a visitor filled out a contact form on the Volunteers of America Western Washington’s homepage, even more private information was transmitted to Facebook. After filling out and sending the form, a pixel transmitted hashed, or scrambled, versions of the person’s first and last name, as well as email address. Volunteers of America Western Washington did not respond to requests for comment. 

The Markup found similar activity on other sites. 

The Contra Costa Crisis Center, an organization providing social services in Northern California, noted to Facebook when a user clicked on a button to call or text for crisis services. About 3,000 miles away, in Rhode Island, an organization called BH Link used a pixel that also pinged Facebook when a visitor clicked a button to call crisis services from its homepage. (After publication of this article Contra Costa Crisis Center told The Markup that it had removed the pixel.)

Facebook can use data collected by the pixel to link website visitors to their Facebook accounts, but the data is collected whether or not the visitor has a Facebook account. Although the names and email addresses sent to Facebook were hashed, they can be easily unscrambled with free and widely available web services. 

After The Markup contacted the 33 crisis centers about their practices, some said they were unaware that the code was on their sites and that they’d take steps to remove it. 

“This was not intentional and thank you for making us aware of the potential issue,” Leo Pellerin, chief information officer for the United Way of Connecticut, a partner in the national 988 network, said in an emailed statement. Pellerin said they had removed the code, which they attributed to a plug-in on their website.

Lee Flinn, director of the Idaho Crisis and Suicide Hotline, said in an email that she had “never heard of Meta Pixel” and was asking the outside vendor who had worked on the organization’s site to remove the code. “We value the privacy of individuals who reach out to us, and any tracking devices are not intentional on our part, nor did we ask any developer to install,” she said. “Anything regarding tracking that is found will be immediately removed.”

Ken Gibson, a spokesperson for the Crisis Center of Tampa Bay, said the organization had recently placed the pixel on its site to advertise for staff but would now reduce the information the pixel gathers to only careers pages on the site.

In follow-up tests, four organizations appeared to have completely removed the code. The majority of the centers we contacted did not respond to requests for comment. 

“Advertisers should not send sensitive information about people through our Business Tools,” Meta spokesperson Emil Vazquez told The Markup in an emailed statement that mirrored those the company has previously provided in response to reporting on the Meta Pixel. “Doing so is against our policies and we educate advertisers on properly setting up Business tools to prevent this from occurring. Our system is designed to filter out potentially sensitive data it is able to detect.”

Vazquez did not respond to a question about whether or how Meta could determine if this specific data was filtered.

There is no evidence that either Facebook or any of the crisis centers themselves attempted to identify visitors or callers, or that an actual human ever identified someone who attempted to call for help through a website. Some organizations explicitly said in response to The Markup’s requests for comment that they valued the anonymity promised by the 988 line. 

Mary Claire Givelber, executive director of New Jersey–based Caring Contact, said in an email that the organization had briefly used the pixel to recruit volunteers on Facebook but would now remove it. 

“For the avoidance of all doubt, Caring Contact has not used the Meta Pixel to identify, target, or advertise to any potential or actual callers or texters of the Caring Contact crisis hotline,” Givelber said.

Meta can use information gathered from its tools for its own purposes, however, and data sent to the company through the pixels scattered across the web enters a black box that can catalog and organize data with little oversight. 

Divendra Jaffar, a spokesperson for Vibrant Emotional Health, the nonprofit responsible for administering the national 988 crisis line, pointed out in an emailed statement that data transmitted through the pixel is encrypted. 

“While Vibrant Emotional Health does not require our 988 Lifeline network of crisis centers to provide updates on their marketing and advertising practices, we do provide best practices guidelines to our centers, counselors, and staff and hold them to rigorous operating standards, which are reviewed and approved by our government partners,” Jaffar said.

The organization did not respond to a request to provide any relevant best practices.

Jen King, the privacy and data policy fellow at the Stanford Institute for Human-Centered Artificial Intelligence, said in an interview that, regardless of the reasons, Meta is gathering far too much data through its tools.

“Even if this is accidental still on the part of the developers, you shouldn’t still be able to fall into this trap,” she said. “The time has long passed when you can use that excuse.”

The Pixel and Sensitive Data 

Meta, Facebook’s parent company, offers the pixel as a way to track visitors on the web and to more precisely target ads to those visitors on Facebook. For businesses and other organizations, it’s a valuable tool: A small company can advertise on Facebook directly to people who purchased a certain product, for example, or a nonprofit could follow up on Facebook with users who donated on their last visit to a website. 

One organization, the Minnesota-based Greater Twin Cities United Way, said it did not use its website to reach out to potential 988 callers but instead focused on “donors and other organizational stakeholders.” Sam Daub, integrated marketing manager of the organization, said in an emailed statement that the organization uses tools like the pixel “to facilitate conversion-tracking and content retargeting toward users who visit our website” to reach those people but did not track specific activity of 988 callers.  

Apart from encouraging users to buy ads, this sort of data is also potentially valuable to Meta, which, in accordance with its terms of service, can use the information to power its algorithms. The company reserves the right to use data transmitted through the pixel to, for instance, “personalize the features and content (including ads and recommendations) that we show people on and off our Meta Products.” (This is one of the reasons an online shopper might look at a pair of pants online and suddenly see the same pair follow them in advertisements across social media.)

The pixel has proved massively popular. The company told Congress in 2018 that there were more than two million pixels collecting data across the web, a number that has likely increased in the time since. There is no federal privacy legislation in the United States that regulates how most of that data can be used.

Meta’s policies prohibit organizations from sending sensitive information through the pixel on children under 13, or generally any data related to sensitive financial or health matters. The company says it has an automated system “designed to filter out potentially sensitive data that it detects” but that it is advertisers’ responsibility to “ensure that their integrations do not send sensitive information to Meta.”

In practice, however, The Markup has found several major services have sent sensitive information to Facebook. As part of a project in partnership with Mozilla Rally called the Pixel Hunt, The Markup found pixels transmitting information from sources including the Department of Education, prominent hospitals, and major tax preparation companies. Many of those organizations have since changed how or whether they use the pixel, while lawmakers have questioned the companies involved about their practices. Meta is now facing several lawsuits over the incidents. 

The types of sensitive health information Meta specifically prohibits being sent include information on “mental health and psychological states” as well as “physical locations that identify a health condition, or places of treatment/counseling.” Vazquez did not directly respond to a question about whether the data sent from the crisis centers violated Meta’s policies. 

There is evidence that even Meta itself can’t always say where that data ends up. In a leaked document obtained and published by Vice’s Motherboard, company engineers said they did not “have an adequate level of control and explainability over how our systems use data.” The document compared user data to a bottle of ink spilled into a body of water that then becomes unrecoverable. A Facebook spokesperson responded to the report at the time, saying it left out a number of the company’s “extensive processes and controls to comply with privacy regulations,” though the spokesperson did not give any specifics. “It’s simply inaccurate to conclude that it demonstrates non-compliance,” the spokesperson said.

“The original use cases [for the pixel] perhaps weren’t quite so invasive, or people weren’t using it so widely,” King said but added that, at this point, Meta is “clearly grabbing way too much data.”

988 History and Controversy

The national 988 crisis line is the result of a years-long effort by the Federal Communications Commission to provide a simple, easy-to-remember, three-digit number for people experiencing a mental health crisis. 

Crisis lines are an enormously important social service—one that research has found can deter people from suicide. The new national line, largely a better-funded, more accessible version of the long-running National Suicide Prevention Lifeline, answered more than 300,000 calls, chats, and texts between its launch in the summer of last year and January. 

But the launch of 988 has been accompanied by questions about privacy and anonymity, mostly around how or whether callers to the line can ever be tracked by emergency services. The national line is advertised as an anonymous service, but in the past callers have said they’ve been tracked without their consent when calling crisis lines. Police have sometimes responded directly in those incidents, leading to harrowing incidents.

The current 988 line doesn’t track users through geolocation technology, according to the service, although counselors are required to provide information to emergency services like 911 in certain situations. That requirement has been the source of controversy, and groups like the Trans Lifeline, a nonprofit crisis hotline serving the trans community, stepped away from the network. 

The organization has launched a campaign to bring the issue more prominence. Yana Calou, the director of advocacy at Trans Lifeline, told The Markup in an interview that there are some lines that “really explicitly don’t” track, and the campaign is meant to direct people to those lines instead. (Trans Lifeline, which is not involved in the national 988 network, also uses the Meta Pixel on its site. After being alerted by The Markup, a Trans Lifeline spokesperson, Nemu HJ, said they would remove the code from the site.)

Data-sharing practices have landed other service providers in controversy as well. Last year, Politico reported that the nonprofit Crisis Text Line, a popular mental health service, was partnering with a for-profit spinoff that used data gleaned from text conversations to market customer-service software. The organization quickly ended the partnership after it was publicly revealed. 

Having a space where there’s a sense of trust between a caller and an organization can make all the difference in an intervention, Calou said. “Actually being able to have people tell us the truth about what’s going on lets people feel like they can get support,” they said.

This article was originally published on The Markup and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

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For more than 20 years, the National Eating Disorders Association has operated a phone line and online platform for people seeking help for anorexia, bulimia, and other eating disorders. Last year, nearly 70,000 individuals used the help line.

NEDA shuttered that service in May, saying that, in its place, a chatbot called Tessa, designed by eating disorder experts with funding from NEDA, would be deployed.

When NPR aired a report about this last month, Tessa was up and running online. Since then, both the chatbot’s page and a NEDA article about Tessa have been taken down. When asked why, NEDA said the bot is being “updated,” and the latest “version of the current program [will be] available soon.”

Then NEDA announced on May 30 that it was indefinitely disabling Tessa. Patients, families, doctors, and other experts on eating disorders were stunned. The episode has set off a fresh wave of debate as companies turn to artificial intelligence as a possible solution for a mental health crisis and treatment shortage.

Paid staffers and volunteers for the NEDA help line said that replacing the service with a chatbot could further isolate the thousands of people who use it when they feel they have nowhere else to turn.

“These young kids … don’t feel comfortable coming to their friends or their family or anybody about this,” said Katy Meta, a 20-year-old college student who has volunteered for the help line. “A lot of these individuals come on multiple times because they have no other outlet to talk with anybody. … That’s all they have, is the chat line.”

The decision is part of a larger trend: Many mental health organizations and companies are struggling to provide services and care in response to a sharp escalation in demand, and some are turning to chatbots and AI, even though clinicians are still trying to figure out how to effectively deploy them, and for what conditions.

The help line’s five staffers formally notified their employer they had formed a union in March. Just a few days later, on a March 31 call, NEDA informed them that they would be laid off in June. NPR and KFF Health News obtained audio of the call. “We will, subject to the terms of our legal responsibilities, [be] beginning to wind down the help line as currently operating,” NEDA board chair Geoff Craddock told them, “with a transition to Tessa, the AI-assisted technology, expected around June 1.”

NEDA’s leadership denies the decision had anything to do with the unionization but told NPR and KFF Health News it became necessary because of the covid-19 pandemic, when eating disorders surged and the number of calls, texts, and messages to the help line more than doubled.

The increase in crisis-level calls also raises NEDA’s legal liability, managers explained in an email sent March 31 to current and former volunteers, informing them that the help line was ending and that NEDA would “begin to pivot to the expanded use of AI-assisted technology.”

“What has really changed in the landscape are the federal and state requirements for mandated reporting for mental and physical health issues (self-harm, suicidality, child abuse),” according to the email, which NPR and KFF Health News obtained. “NEDA is now considered a mandated reporter and that hits our risk profile — changing our training and daily work processes and driving up our insurance premiums. We are not a crisis line; we are a referral center and information provider.”

Pandemic created a ‘perfect storm’ for eating disorders

When it was time for a volunteer shift on the help line, Meta usually logged in from her dorm room at Dickinson College in Pennsylvania.

Meta recalled a recent conversation on the help line’s messaging platform with a girl who said she was 11. The girl said she had just confessed to her parents that she was struggling with an eating disorder, but the conversation had gone badly.

“The parents said that they ‘didn’t believe in eating disorders’ and [told their daughter], ‘You just need to eat more. You need to stop doing this,’” Meta recalled. “This individual was also suicidal and exhibited traits of self-harm as well. … It was just really heartbreaking to see.”

Eating disorders are common, serious, and sometimes fatal illnesses. An estimated 9 percent of Americans experience an eating disorder during their lifetimes. Eating disorders also have some of the highest mortality rates among mental illnesses, with an estimated death toll of more than 10,000 Americans each year.

But after covid hit, closing schools and forcing people into prolonged isolation, crisis calls and messages like the one Meta describes became far more frequent on the help line.

In the U.S., the rate of pediatric hospitalizations and ER visits surged. On the NEDA help line, client volume increased by more than 100 percent compared with pre-pandemic levels.

“Eating disorders thrive in isolation, so covid and shelter-in-place was a tough time for a lot of folks struggling,” explained Abbie Harper, who has worked as a help line associate.

Until a few weeks ago, the help line was run by just five to six paid staffers and two supervisors, and it depended on a rotating roster of 90-165 volunteers at any given time, according to NEDA.

Yet even after lockdowns ended, NEDA’s help line volume remained elevated above pre-pandemic levels, and the cases continued to be clinically severe. Staffers felt overwhelmed, undersupported, and increasingly burned out, and turnover increased, according to multiple interviews.

The help line staff formally notified NEDA that their unionization vote had been certified on March 27. Four days later, they learned their positions were being eliminated.

“Our volunteers are volunteers,” said Lauren Smolar, NEDA’s vice president of mission and education. “They’re not professionals. They don’t have crisis training. And we really can’t accept that kind of responsibility.” Instead, she said, people seeking crisis help should be reaching out to resources like 988, a 24/7 suicide and crisis hotline that connects people with trained counselors.

The surge in volume also meant the help line was unable to respond immediately to 46 percent of initial contacts, and it could take six to 11 days to respond to messages.

“And that’s frankly unacceptable in 2023, for people to have to wait a week or more to receive the information that they need, the specialized treatment options that they need,” Smolar said.

After learning in the March 31 email that the helpline would be phased out, volunteer Faith Fischetti, 22, tried out the chatbot on her own, asking it some of the more frequent questions she gets from users. But her interactions with Tessa were not reassuring: “[The bot] gave links and resources that were completely unrelated” to her questions, she said.

Fischetti’s biggest worry is that someone coming to the NEDA site for help will leave because they “feel that they’re not understood, and feel that no one is there for them. And that’s the most terrifying thing to me.”

A chatbot can miss red flags

Tessa the chatbot was created to help a specific cohort: people with eating disorders who never receive treatment.

Only 20 percent of people with eating disorders get formal help, according to Ellen Fitzsimmons-Craft, a psychologist and associate professor at Washington University School of Medicine in St. Louis. Her team created Tessa after receiving funding from NEDA in 2018, with the goal of looking for ways technology could help fill the treatment gap.

NEDA said Tessa was supposed to be a “rule-based” chatbot, meaning one that is programmed with a limited set of possible responses. It is not ChatGPT and cannot generate unique answers in response to specific queries. “So she can’t go off the rails, so to speak,” Fitzsimmons-Craft said.

The plan was for Tessa to guide users through an interactive, weeks-long course about body positivity, based on cognitive behavioral therapy tools. Additional content about bingeing, weight concerns, and regular eating was under development but not yet available to users.

There’s evidence the AI approach can help. Fitzsimmons-Craft’s team did a small study that found college students who interacted with Tessa had significantly greater reductions in “weight/shape concerns” than a control group at three- and six-month follow-ups.

But even the best-intentioned technology can carry risks. Fitzsimmons-Craft’s team published a different study looking at ways the chatbot “unexpectedly reinforced harmful behaviors at times.” For example, the chatbot would give users a prompt: “Please take a moment to write about when you felt best about your body?”

Responses included: “When I was underweight and could see my bones.” “I feel best about my body when I ignore it and don’t think about it at all.”

The chatbot seemed to ignore the troubling aspects of such responses — and even to affirm negative thinking — when it would reply: “It is awesome that you can recognize a moment when you felt confident in your skin, let’s keep working on making you feel this good more often.”

Researchers were able to troubleshoot some of those issues. But the chatbot still missed red flags, the study found, such as when it asked: “What is a small healthy eating habit goal you would like to set up before you start your next conversation?”

One user replied, “Don’t eat.”

“Take a moment to pat yourself on the back for doing this hard work, <>!” the chatbot responded.

Massachusetts Institute of Technology assistant professor Marzyeh Ghassemi has seen issues like this crop up in her own research developing machine learning to improve health.

Large language models and chatbots will inevitably make mistakes, but “sometimes they tend to be wrong more often for certain groups, like women and minorities,” she said.

If people receive bad advice or instructions from a bot, “people sometimes have a difficulty not listening to it,” Ghassemi added. “I think it sets you up for this really negative outcome … especially for a mental health crisis situation, where people may be at a point where they’re not thinking with absolute clarity. It’s very important that the information that you give them is correct and is helpful to them.”

And if the value of the live help line was the ability to connect with a real person who deeply understands eating disorders, Ghassemi said, a chatbot can’t do that.

“If people are experiencing a majority of the positive impact of these interactions because the person on the other side understands fundamentally the experience they’re going through, and what a struggle it’s been, I struggle to understand how a chatbot could be part of that.”

Tessa goes ‘off the rails’

When Sharon Maxwell heard NEDA was promoting Tessa as “a meaningful prevention resource” for those struggling with eating disorders, she wanted to try it out.

Maxwell, based in San Diego, had struggled for years with an eating disorder that began in childhood. She now works as a consultant in the eating disorder field. “Hi, Tessa,” she typed into the online text box. “How do you support folks with eating disorders?”

Tessa rattled off a list of ideas, including resources for “healthy eating habits.” Alarm bells immediately went off in Maxwell’s head. She asked Tessa for details. Before long, the chatbot was giving her tips on losing weight — ones that sounded an awful lot like what she’d been told when she was put on Weight Watchers at age 10.

“The recommendations that Tessa gave me were that I could lose 1 to 2 pounds per week, that I should eat no more than 2,000 calories in a day, that I should have a calorie deficit of 500-1,000 calories per day,” Maxwell said. “All of which might sound benign to the general listener. However, to an individual with an eating disorder, the focus of weight loss really fuels the eating disorder.”

NEDA blamed the chatbot’s issues on Cass, the mental health chatbot company that operated Tessa as a free service. Cass had changed Tessa without NEDA’s awareness or approval, said NEDA CEO Liz Thompson, enabling the chatbot to generate new answers beyond what Tessa’s creators had intended.

Cass’ founder and CEO, Michiel Rauws, said the changes to Tessa were made last year as part of a “systems upgrade,” including an “enhanced question-and-answer feature.” That feature uses generative artificial intelligence — meaning it gives the chatbot the ability to use new data and create new responses.

That change was part of NEDA’s contract, Rauws said.

But Thompson disagrees. She told NPR and KFF Health News that “NEDA was never advised of these changes and did not and would not have approved them.”

“The content some testers received relative to diet culture and weight management, [which] can be harmful to those with eating disorders, is against NEDA policy, and would never have been scripted into the chatbot by eating disorders experts,” she said.

Complaints about Tessa started last year

NEDA was aware of issues with the chatbot months before Maxwell’s interactions with Tessa in late May.

In October 2022, NEDA passed along screenshots from Monika Ostroff, executive director of the Multi-Service Eating Disorders Association in Massachusetts. They showed Tessa telling Ostroff to avoid “unhealthy” foods and eat only “healthy” snacks, like fruit.

“It’s really important that you find what healthy snacks you like the most, so if it’s not a fruit, try something else!” Tessa told Ostroff. “So the next time you’re hungry between meals, try to go for that instead of an unhealthy snack like a bag of chips. Think you can do that?”

Ostroff said this was a clear example of the chatbot encouraging “diet culture” mentality. “That meant that they [NEDA] either wrote these scripts themselves, they got the chatbot and didn’t bother to make sure it was safe and didn’t test it, or released it and didn’t test it,” she said.

The healthy-snack language was quickly removed after Ostroff reported it. But Rauws said that language was part of Tessa’s “pre-scripted language, and not related to generative AI.”

Fitzsimmons-Craft said her team didn’t write it, that it “was not something our team designed Tessa to offer and that it was not part of the rule-based program we originally designed.”

Then, earlier this year, “a similar event happened as another example,” Rauws said.

“This time it was around our enhanced question-and-answer feature, which leverages a generative model. When we got notified by NEDA that an answer text it provided fell outside their guidelines,” it was addressed right away, he said.

Rauws said he can’t provide more details about what this event entailed.

“This is another earlier instance, and not the same instance as over the Memorial Day weekend,” he said via email, referring to Maxwell’s interactions with Tessa. “According to our privacy policy, this is related to user data tied to a question posed by a person, so we would have to get approval from that individual first.”

When asked about this event, Thompson said she doesn’t know what instance Rauws is referring to.

Both NEDA and Cass have issued apologies.

Ostroff said that regardless of what went wrong, the impact on someone with an eating disorder is the same. “It doesn’t matter if it’s rule-based or generative, it’s all fat-phobic,” she said. “We have huge populations of people who are harmed by this kind of language every day.”

She also worries about what this might mean for the tens of thousands of people turning to NEDA’s help line each year.

Thompson said NEDA still offers numerous resources for people seeking help, including a screening tool and resource map, and is developing new online and in-person programs.

“We recognize and regret that certain decisions taken by NEDA have disappointed members of the eating disorders community,” she wrote in an emailed statement. “Like all other organizations focused on eating disorders, NEDA’s resources are limited and this requires us to make difficult choices. … We always wish we could do more and we remain dedicated to doing better.”

This article is from a partnership that includes Michigan Radio, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The brain is the most complex part of the human body. To keep our heads running smoothly,  more than 100 types of neurotransmitters must shuttle messages across multiple regions of white and gray matter. It’s difficult for researchers to track the immense number of connections that these chemical messengers make—Google recently created one of the most detailed maps of neuronal connectivity patterns, but even the tech giant could only focus on a small section of the brain. 

While it may take decades until someone fully maps out the human brain, there are ways to trace different aspects of connectivity. A new study published today in Science Advances used mind-altering drugs, such as ketamine and the surgical anesthetic propofol, to follow which neurotransmitter systems those pharmaceuticals activate. The findings help identify associations between these drugs and unexpected neurotransmitters. They could also help identify new treatment options for certain conditions and diseases, as the authors found that brain regions commonly altered by different drugs were often similarly affected by various neurological disorders.

Pharmacological agents such as mind-altering drugs have powerful uses in medicine, says Andrea Luppi, a postdoctoral researcher of network neuroscience at the Alan Turing Institute in the United Kingdom. “Anesthetics are extremely useful for surgery. Modafinil and methylphenidate are used to treat certain conditions,” Luppi says. “So it’s important to know how they act on the brain to exert their effects.”

But these types of chemicals can be tricky to understand, because they activate more than one neurotransmitter receptor. Knowing how they work in the brain can improve how they are used in clinical practice in the future. But it’s not enough to predict a drug’s mechanism based purely  on its clinical effects. There is also a chance these drugs could influence other neurotransmitters beyond their main targets. 

[Related: If you grow a brain in a lab, will it have a mind of its own?]

To address these questions, Luppi and his coauthors analyzed two sets of neuroimaging data from past studies to map out the ways the human brain changes when taking 10 mind-altering drugs. These drugs fell under three categories: psychedelics (psilocybin, DMT, LSD, MDMA, ayahuasca, and ketamine), anesthetics (propofol and sevoflurane), and cognitive enhancers (modafinil and methylphenidate). The first data set, based on the PET scans of 1,200 people, helped the team sketch out 19 types of molecules in the brain: all neurotransmitter receptors and transporters.

The second dataset used the fMRI scans of 224 people who had acute exposure to one of the 10 drugs. According to the authors, this is the largest fMRI study to date that has plotted a detailed map of the neurotransmitter landscape when under the influence.

Brain mapping showed that mind-altering drugs work with multiple neurotransmitter systems. The mapping showed expected relationships, such as the link between MDMA and its well-known target, the serotonin 2A receptor. However, the team noticed some mind-altering drugs, like anesthetics and psychedelics, can affect other neurotransmitters beyonds their main molecular targets. For example, anesthetics at the lowest dose primarily target molecules in the brain called GABA_A receptors. But the molecules that the drugs bind to changes as doses increase, the authors found, activating a more diverse group of neurotransmitters. 

[Related: How your brain conjures dreams]

“We are used to thinking that many drugs have a single or few molecular targets. What we see suggests that even when a drug exerts its effect through a specific receptor, it can have downstream consequences on many neurotransmitter systems. This reinforces the idea that the brain is a complex system,” Luppi says. 

According to the study authors, their mapping provides new opportunities to explore how each of these mind-altering drugs affects the neurotransmitter landscape. It could also help vet certain drugs for neuropsychiatric treatments. The changes in activity caused by mind-altering drugs are similar to the changes seen in the brains of patients with conditions such as autism, depression, and schizophrenia, the authors say. Administering mind-altering drugs that rewire the connections in functionally impaired brain areas could be another treatment option for people who live with these conditions. 

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Picture this: you text your romantic partner in the middle of the day, inquiring about dinner and after-work plans, but the message goes unanswered for an hour. Or your manager pulls you aside to offer some constructive criticism on a project or task you thought you were doing well with. If these or similar situations would leave you feeling anxious, incredibly unsettled, or angry, you may have high rejection sensitivity.

According to board certified behavioral analyst Reena Patel, high rejection sensitivity is an emotional response pattern characterized by an intense fear of rejection and an excessive need for approval from others. In less-clinical terms, it causes people to interpret uncertain or ambiguous social cues as signs of humiliation. As a result, rejection is not just a temporary sting or setback, but a devastating blow that affects self-confidence and can lead to social anxiety.

Importantly, high rejection sensitivity is not a diagnosable condition, but a pattern of thoughts, feelings, and behaviors that can be observed and acknowledged by medical professionals, according to Darren Aboyoun, a clinical psychologist.

“It is more commonly observed in individuals who have experienced significant rejections or who have a history of interpersonal difficulties, such as those with insecure attachment styles,” Aboyoun explains. “Sensitivity to rejection can trigger physiological changes, including the fight-or-flight response, and heightened activity in areas of the brain that influence blood pressure, decision-making, and emotions.”

Aboyoun emphasizes that people who exhibit this trait aren’t just feeling bad about a situation they can easily “move on” from, but rather their feelings toward rejection are so deeply ingrained and overwhelming that they can lead to social withdrawal and isolation.

“In professional settings, high rejection sensitivity can disrupt one’s ability to collaborate with others, concentrate effectively, and ultimately hinder productivity and career advancement,” Aboyoun says. “In family and interpersonal relationships, it can contribute to miscommunication, difficulties in cultivating open, supportive relationships.”

Coping mechanisms and steps to move forward 

High rejection sensitivity is not currently categorized as a mental condition or illness, but as a behavioral trait. There is no proven cure or medication to manage it on its own, though certain types of therapy and coping mechanisms can help.

If you’re feeling up to it, you can also try to be clear with the people in your life about what you need from them. For instance, if you need validation or acknowledgment of your emotions and experiences without judgment, consider asking for it. Aboyoun suggests working with others to help them choose their words carefully when speaking with you and to ask others for reassurance when appropriate. The idea is to foster open lines of communication so that others can understand your perspective without minimizing your experiences.

Practicing mindfulness and relaxation techniques such as deep breathing exercises or meditation may also help manage anxiety and emotional reactivity triggered by perceived rejection, but Aboyoun suggests other coping strategies too.

For one, it’s important to acknowledge and accept that high rejection sensitivity is a vulnerability. If you are exhibiting a chronic heightened reaction to certain feelings or interactions, it’s good to self-reflect, Aboyoun says. Self reflection will require a deeper insight into why you reacted a certain way and whether that feeling is limited to something you said or did, or something else, he explains. 

“High rejection sensitivity is a very treatable condition,” Aboyoun says. “Effective treatment can positively change one’s life by increasing confidence and developing improved social skills that will cultivate more fulfilling relationships.”

This access to treatment is why he recommends therapy or counseling and working with a trained therapist to identify your patterns of rejection and increase your capacity to adapt to your thoughts and feelings.

Rejection sensitivity can be a challenging behavioral pattern to overcome, and unfortunately it has been the subject of very limited research. Until more studies can be done, learning to cope may involve a fair amount of trial and error. But once you find an approach that works, you should see improvement in previously troublesome areas of your life.

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If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

CHARLESTON, S.C. — Melanie Gray Miller, a 30-year-old physician, wiped away tears as she described the isolation she felt after losing a beloved patient.

“It was at the end of a night shift, when it seems like bad things always happen,” said Miller, who is training to become a pediatrician.

The infant had been sick for months in the Medical University of South Carolina’s pediatric intensive care unit and the possibility that he might not improve was obvious, Miller recalled during an April meeting with physicians and hospital administrators. But the suddenness of his death still caught her off guard.

“I have family and friends that I talk to about things,” she said. “But no one truly understands.”

Doctors don’t typically take time to grieve at work. But during that recent meeting, Miller and her colleagues opened up about the insomnia, emotional exhaustion, trauma, and burnout they experienced from their time in the pediatric ICU.

“This is not a normal place,” Grant Goodrich, the hospital system’s director of ethics, said to the group, acknowledging an occupational hazard the industry often downplays. “Most people don’t see kids die.”

The recurring conversation, scheduled for early-career doctors coming off monthlong pediatric ICU rotations, is one way the hospital helps staffers cope with stress, according to Alyssa Rheingold, a licensed clinical psychologist who leads its resiliency program.

“Often the focus is to teach somebody how to do yoga and take a bath,” she said. “That’s not at all what well-being is about.”

Burnout in the health care industry is a widespread problem that long predates the covid-19 pandemic, though the chaos introduced by the coronavirus’s spread made things worse, physicians and psychologists said. Health systems across the country are trying to boost morale and keep clinicians from quitting or retiring early, but the stakes are higher than workforce shortages.

Rates of physician suicide, partly fueled by burnout, have been a concern for decades. And while burnout occurs across medical specialties, some studies have shown that primary care doctors, such as pediatricians and family physicians, may run a higher risk.

“Why go into primary care when you can make twice the money doing something with half the stress?” said Daniel Crummett, a retired primary care doctor who lives in North Carolina. “I don’t know why anyone would go into primary care.”

Doctors say they are fed up with demands imposed by hospital administrators and health insurance companies, and they’re concerned about the notoriously grueling shifts assigned to medical residents during the early years of their careers. A long-standing stigma keeps physicians from prioritizing their own mental health, while their jobs require them to routinely grapple with death, grief, and trauma. The culture of medicine encourages them to simply bear it.

“Resiliency is a cringe word for me,” Miller said. “In medicine, we’re just expected to be resilient 24/7. I don’t love that culture.”

And though the pipeline of physicians entering the profession is strong, the ranks of doctors in the U.S. aren’t growing fast enough to meet future demand, according to the American Medical Association. That’s why burnout exacerbates workforce shortages and, if it continues, may limit the ability of some patients to access even basic care. A 2021 report published by the Association of American Medical Colleges projects the U.S. will be short as many as 48,000 primary care physicians by 2034, a higher number than any other single medical specialty.

A survey published last year by The Physicians Foundation, a nonprofit focused on improving health care, found more than half of the 1,501 responding doctors didn’t have positive feelings about the current or future state of the medical profession. More than 20% said they wanted to retire within a year.

Similarly, in a 2022 AMA survey of 11,000 doctors and other medical professionals, more than half reported feeling burned out and indicated they were experiencing a great deal of stress.

Those numbers appear to be even higher in primary care. Even before the pandemic, 70% of primary care providers and 89% of primary care residents reported feelings of burnout.

“Everyone in health care feels overworked,” said Gregg Coodley, a primary care physician in Portland, Oregon, and author of the 2022 book “Patients in Peril: The Demise of Primary Care in America.”

“I’m not saying there aren’t issues for other specialists, too, but in primary care, it’s the worst problem,” he said.

The high level of student debt most medical school graduates carry, combined with salaries more than four times as high as the average, deter many physicians from quitting medicine midcareer. Even primary care doctors, whose salaries are among the lowest of all medical specialties, are paid significantly more than the average American worker. That’s why, instead of leaving the profession in their 30s or 40s, doctors often stay in their jobs but retire early.

“We go into medicine to help people, to take care of people, to do good in the world,” said Crummett, who retired from the Duke University hospital system in 2020 when he turned 65.

Crummett said he would have enjoyed working until he was 70, if not for the bureaucratic burdens of practicing medicine, including needing to get prior authorization from insurance companies before providing care, navigating cumbersome electronic health record platforms, and logging hours of administrative work outside the exam room.

“I enjoyed seeing patients. I really enjoyed my co-workers,” he said. “The administration was certainly a major factor in burnout.”

Jean Antonucci, a primary care doctor in rural Maine who retired from full-time work at 66, said she, too, would have kept working if not for the hassle of dealing with hospital administrators and insurance companies.

Once, Antonucci said, she had to call an insurance company — by landline and cellphone simultaneously, with one phone on each ear — to get prior authorization to conduct a CT scan, while her patient in need of an appendectomy waited in pain. The hospital wouldn’t conduct the scan without insurance approval.

“It was just infuriating,” said Antonucci, who now practices medicine only one day a week. “I could have kept working. I just got tired.”

Providers’ collective exhaustion is a crisis kept hidden by design, said Whitney Marvin, a pediatrician who works in the pediatric ICU at the Medical University of South Carolina. She said hospital culture implicitly teaches doctors to tamp down their emotions and to “keep moving.”

“I’m not supposed to be weak, and I’m not supposed to cry, and I’m not supposed to have all these emotions, because then maybe I’m not good enough at my job,” said Marvin, describing the way doctors have historically thought about their mental health.

This mentality prevents many doctors from seeking the help they need, which can lead to burnout — and much worse. An estimated 300 physicians die by suicide every year, according to the American Foundation for Suicide Prevention. The problem is particularly pronounced among female physicians, who die by suicide at a significantly higher rate than women in other professions.

A March report from Medscape found, of more than 9,000 doctors surveyed, 9% of male physicians and 11% of female physicians said they have had suicidal thoughts. But the problem isn’t new, the report noted. Elevated rates of suicide among physicians have been documented for 150 years.

“Ironically, it’s happening to a group of people who should have the easiest access to mental health care,” said Gary Price, a Connecticut surgeon and president of The Physicians Foundation.

But the reluctance to seek help isn’t unfounded, said Corey Feist, president of the Dr. Lorna Breen Heroes’ Foundation.

“There’s something known in residency as the ‘silent curriculum,’” Feist said in describing an often-unspoken understanding among doctors that seeking mental health treatment could jeopardize their livelihood.

Feist’s sister-in-law, emergency room physician Lorna Breen, died by suicide during the early months of the pandemic. Breen sought inpatient treatment for mental health once, Feist said, but feared that her medical license could be revoked for doing so.

The foundation works to change laws across the country to prohibit medical boards and hospitals from asking doctors invasive mental health questions on employment or license applications.

“These people need to be taken care of by us, because really, no one’s looking out for them,” Feist said.

In Charleston, psychologists are made available to physicians during group meetings like the one Miller attended, as part of the resiliency program.

But fixing the burnout problem also requires a cultural change, especially among older physicians.

“They had it worse and we know that. But it’s still not good,” Miller said. “Until that changes, we’re just going to continue burning out physicians within the first three years of their career.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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Love it or hate it, sleeping naked hits different. Not only is it less laundry to wash, but taking off those pajamas can do wonders for your health. While you may feel self-conscious at first, the openness of resting in the nude can actually boost your confidence and help you look your best self. 

There’s no right or wrong way to get ready for bed—it’s all a matter of preference. And while nakedness won’t miraculously cure all your sleep problems, experts say there are some modest benefits to going au naturel.

1. Younger-looking skin 

James Walker, a medical advisor for the healthcare platform Welzo, says sleeping without clothes gives your skin an opportunity to breathe, allowing for better airflow. He explains that clothes, especially tight-fitting ones, can restrict blood circulation, making it harder for your skin to receive vitamins and minerals needed for collagen production. Certain materials also might add to your discomfort in bed. Aditya Kashyap Mishra, a sex educator and relationship expert for Lustyboy, says synthetic fibers like spandex and nylon trap moisture in your skin—the added heat can make it hard to fall asleep. Other synthetic fabrics and pajamas with dyed cotton may cause skin irritation and acne from the fabric rubbing against you.

[Related: 5 surprising beauty benefits of running]

Tossing and turning from wearing the wrong clothing can affect your quality of sleep and your skin. The body makes collagen during sleep, which is essential for supple and younger-looking skin. Research shows that getting less than the recommended seven hours of sleep for adults increases skin aging and slows down recovery from sun damage.

2. A cooldown for your body

As you might expect, sleeping with your skin exposed helps regulate your temperature at night, says Walker. The drop in body temperature can prevent overheating—a real concern in summer and in places where winter is virtually non-existent. Research shows that feeling extremely hot at night increases wakefulness. Even if you manage to land some shut-eye, it will likely be less restorative with shorter cycles of slow-wave sleep and REM sleep. 

Feeling colder, on the other hand, can also help you fall asleep faster. Your body temperature is synced up with the light-dark cycles outside; it normally falls when the sun goes down. A lower body temperature from sleeping nude tells your biological clock it’s time to shut down.

3. Fewer fungal infections

Fungi and bacteria thrive in warm and damp areas like your nether regions. Mishra explains that trapped sweat from moisture-wicking clothing increases the risk of microorganisms building up, resulting in yeast infections and jock itch. Jock itch can also come from constant friction from clothes. Stripping down to nothing will allow more air circulation and keep your intimate parts from getting overheated.

4. Better emotional intimacy

Skin-to-skin contact between partners can strengthen your relationship. Research shows touching among consenting adults releases the “love hormone” called oxytocin. This chemical reduces stress and encourages openness and social bonding with others. One US marketing poll of more than 1,000 adults found that 57 percent of couples who regularly snoozed in the nude were happy in their relationship compared to 48 percent of pajama wearers. Getting used to baring it all in front of a partner can counteract self-consciousness of how you look in bed. Mishra says this openness is a huge stress reliever, and the added relaxation can help you sleep better.

What if you want to sleep in clothes?

If you’re still not convinced about sleeping naked, there are other ways to improve your slumber. Avoid tight or constricting apparel that would restrict your movement, irritate your skin, or otherwise cause discomfort. Walker recommends going to bed in loose-fitting and breathable fabrics like cotton or bamboo, or one simple layer like an oversized T-shirt and shorts to avoid overheating.

[Related: 11 ways to sleep better in unbearable heat]

There’s nothing wrong with slipping on a pair of socks before bed, Walker adds. Some people find it comforting and helpful in keeping their feet warm, especially during colder seasons. However, he warns against sleeping in socks that are too tight as they could restrict circulation. 

Whether you go to bed nude or in clothes, you should always remove your makeup and any heavy jewelry. Snoozing with makeup on can clog pores and lead to future breakouts. “It’s best to cleanse the face thoroughly before sleeping to allow the skin to breathe and regenerate,” advises Walker. Additionally, laying down in chunky necklaces, bangles, and other jewelry can be painful and might even leave abrasions on the skin.

“Ultimately, the key is to prioritize comfort and choose sleepwear that allows for optimal relaxation,” Walker says. “It’s always a good idea to listen to your body and make choices that help you feel comfortable and at ease during sleep.”

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In the past few years, 10,000 to 20,000 apps have stampeded into the mental health space, offering to “disrupt” traditional therapy. With the frenzy around AI innovations like ChatGPT, the claim that chatbots can provide mental health care is on the horizon.

The numbers explain why: Pandemic stresses led to millions more Americans seeking treatment. At the same time, there has long been a shortage of mental health professionals in the United States; more than half of all counties lack psychiatrists. Given the Affordable Care Act’s mandate that insurers offer parity between mental and physical health coverage, there is a gaping chasm between demand and supply.

For entrepreneurs, that presents a market bonanza. At the South by Southwest conference in March, where health startups displayed their products, there was a near-religious conviction that AI could rebuild health care, offering apps and machines that could diagnose and treat all kinds of illnesses, replacing doctors and nurses.

Unfortunately, in the mental health space, evidence of effectiveness is lacking. Few of the many apps on the market have independent outcomes research showing they help; most haven’t been scrutinized at all by the FDA. Though marketed to treat conditions such as anxiety, attention-deficit/hyperactivity disorder, and depression, or to predict suicidal tendencies, many warn users (in small print) that they are “not intended to be medical, behavioral health or other healthcare service” or “not an FDA cleared product.”

There are good reasons to be cautious in the face of this marketing juggernaut.

Decades ago, Joseph Weizenbaum, a professor at the Massachusetts Institute of Technology and considered one of the fathers of artificial intelligence, predicted AI would never make a good therapist, though it could be made to sound like one. In fact, his original AI program, created in the 1960s, was a psychotherapist named ELIZA, which used word and pattern recognition combined with natural language programming to sound like a therapist:

Woman: Well, my boyfriend made me come here.

ELIZA: Your boyfriend made you come here?

Woman: He says I’m depressed much of the time.

ELIZA: I am sorry to hear that you are depressed.

Woman: It’s true. I am unhappy.

ELIZA: Do you think coming here will help you not to be unhappy?

Though hailed as an AI triumph, ELIZA’s “success” terrified Weizenbaum, whom I once interviewed. He said students would interact with the machine as if Eliza were an actual therapist, when what he’d created was “a party trick,” he said.

He foresaw the evolution of far more sophisticated programs like ChatGPT. But “the experiences a computer might gain under such circumstances are not human experiences,” he told me. “The computer will not, for example, experience loneliness in any sense that we understand it.”

The same goes for anxiety or ecstasy, emotions so neurologically complex that scientists have not been able pinpoint their neural origins. Can a chatbot achieve transference, the empathic flow between patient and doctor that is central to many types of therapy?

“The core tenet of medicine is that it’s a relationship between human and human — and AI can’t love,” said Bon Ku, director of the Health Design Lab at Thomas Jefferson University and a pioneer in medical innovation. “I have a human therapist, and that will never be replaced by AI.”

Ku said he’d like to see AI used instead to reduce practitioners’ tasks like record-keeping and data entry to “free up more time for humans to connect.”

While some mental health apps may ultimately prove worthy, there is evidence that some can do harm. One researcher noted that some users faulted these apps for their “scripted nature and lack of adaptability beyond textbook cases of mild anxiety and depression.”

It may prove tempting for insurers to offer up apps and chatbots to meet the mental health parity requirement. After all, that would be a cheap and simple solution, compared with the difficulty of offering a panel of human therapists, especially since many take no insurance because they consider insurers’ payments too low.

Perhaps seeing the flood of AI hitting the market, the Department of Labor announced last year it was ramping up efforts to ensure better insurer compliance with the mental health parity requirement.

The FDA likewise said late last year it “intends to exercise enforcement discretion” over a range of mental health apps, which it will vet as medical devices. So far, not one has been approved. And only a very few have gotten the agency’s breakthrough device designation, which fast-tracks reviews and studies on devices that show potential.

These apps mostly offer what therapists call structured therapy — in which patients have specific problems and the app can respond with a workbook-like approach. For example, Woebot combines exercises for mindfulness and self-care (with answers written by teams of therapists) for postpartum depression. Wysa, another app that has received a breakthrough device designation, delivers cognitive behavioral therapy for anxiety, depression, and chronic pain.

But gathering reliable scientific data about how well app-based treatments function will take time. “The problem is that there is very little evidence now for the agency to reach any conclusions,” said Kedar Mate, head of the Boston-based Institute for Healthcare Improvement.

Until we have that research, we don’t know whether app-based mental health care does better than Weizenbaum’s ELIZA. AI may certainly improve as the years go by, but at this point, for insurers to claim that providing access to an app is anything close to meeting the mental health parity requirement is woefully premature.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Forging strong social relationships can help mitigate the effects of traumatic childhood events in human adults, but also in baboons. A study published May 17 in the journal Science Advances drew on 36 years of data from almost 200 baboons in southern Kenya and found that even though early adversity can take years of their lifespans, stronger social bonds in adulthood can help get these years back. 

[Related: Baboon poop shows how chronic stress shortens lives.]

“It’s like the saying from the King James Apocrypha, ‘a faithful friend is the medicine of life,’” co-author and Duke University biologist and evolutionary anthropologist Susan Alberts said in a statement.

Studies have consistently found that people who go through more bad experiences growing up, such as neglect or abuse,  are more likely to die early. However, the mechanisms behind how early adversity leads to a premature death has been harder for researchers to pin down, according to Alberts. Some of the limitations to earlier research is the reliance on self-reported memories which can be imprecise and subjective. 

Enter our primate cousins. Baboons share more than 90 percent of their DNA with humans and researchers have followed individual baboons near Amboseli National Park in Kenya since 1971. 

In this new study, the researchers analyzed how early life experiences and adult social connections affected long-term survival in 199 female baboons between 1983 and 2019.

Baboon childhood is certainly different from human childhood, but young baboons still face hardships. The team in the study tallied up each female’s exposure to six potential sources of early adversity, including whether she had a low-ranking or socially isolated mother or if her mother died before she reached maturity. It was also noted if she was born in a drought year or into a large group, and if she had a sibling close in age, which could contribute to more competition for both maternal attention and resources.

The team found that stressful experiences are very common for the baboons growing up in the semi-arid and unpredictable landscape of Amboseli. Of the 199 baboons in the study, 75 percent suffered through at least one stressor, and 33 percent had two or more.

Their results confirm previous findings that the more hardship a female baboon faces, the shorter her lifespan. Monkeys who experienced more upheaval at a young age were also more socially isolated as adults.

[Related: Monkeys with close friends have friendlier gut bacteria.]

However, the researchers showed that 90 percent of the dip in survival was due to the direct effects of early adversity, not to the weakened social bonds that continued into adulthood.

No matter how strong their bonds were with other baboons, each additional hardship translated to 1.4 years of life lost. Those who went through four bad experiences growing up died close to 5.6 years earlier than those who didn’t face any. Since the average female baboon lives to age 18, this is a large drop in lost years.

But an unfortunate start in life does not mean that a baboon will absolutely live a short life. 

“Females who have bad early lives are not doomed,” co-author and biologist at SUNY Oswego Elizabeth Lange said in a statement. “We found that both early life adversity and adult social interactions affect survival independently. That means that interventions that occur throughout the lifespan could improve survival.”

In baboons, strong social bonds are measured by how often they groom with their closest friends. Those with strong social bonds added 2.2 years to their lives, no matter what adversity they had faced in their earlier years. The baboons whose mothers died before they reached maturity and then forged strong friendships in adulthood showed the best ability to bounce back. 

However, the flip side is also true. Weak social bonds can magnify early life adversity, according to the study. 

It is not clear yet if these results can be translated to adult humans, but it suggests that early intervention is not the only way to overcome childhood trauma and its lingering effects. 

“If you did have early life adversity, whatever you do, try to make friends,” Alberts said.

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There are countless studies and copious amounts of research delving into how the internet can negatively impact your mind. But, new data indicates that there’s one way online time could actually benefit the brain. According to findings recently published in the Journal of the American Geriatrics Society from a team at NYU, it appears that regular internet usage may significantly reduce the risk of dementia in older populations.

As also highlighted by Gizmodo on Thursday, the study examined online habits of over 18,000 adults over the age of 50 for as long as 17 years (with a median of nearly 8 years) via data from the government’s biannual Health and Retirement Study. The dataset was subsequently broken down into two groups—those who were regular internet users, and those who were not. A second survey assessed their cognition at the study’s outset to use for reference over time. According to researchers, regular visitors to the internet “experienced approximately half the risk of dementia than non-regular users,” even when taking issues like pre-existing conditions into consideration. As Gizmodo also noted, those who reported using the internet in subsequent analysis displayed even lower risks of impairment.

[Related: How your daily screen time affects your wellbeing.]

But don’t take this as carte blanche to surf the web to your heart’s content just yet. When utilizing a smaller dataset of users that provided hourly usage rates per week, researchers discovered a potential U-curve situation between time and risk for dementia. Those who spend over six hours a day on the internet appear to possess a slightly increased chance to develop cognitive issues, much like those who rarely go online at all. This led researchers to hypothesize that “excessive online engagement may have adverse cognitive effects on older adults.” Despite the study’s caveats, however, the findings present an interesting look into the potential positives of online use, especially when people are often told to use the internet less.

The Goldilocks “not too much, but not too little” linkage between internet use and dementia falls in line with experts’ recent suggestions on how to best maintain cognitive health: lead an overall, decently healthy lifestyle, i.e. one with regular physical activity, a primarily plant-based diet, an aversion to bogus supplements, managing existing diseases, and reduced alcohol consumption. So, on top of all that, you can now possibly add a healthy hour or so of daily internet scrolling to the list. Just don’t fall too far down the rabbit hole.

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Is shyness something you feel, or is it something that defines you? Child psychologists are still not fully convinced one way or the other. A small study published April 25 in the journal Society for Research in Child Development found that timidness, fear and nervousness in social situations or being at the center of attention, is a fairly typical childhood experience, whether it is an emotion or personality. 

[Related from PopSci+: Can dogs be introverts?]

Some long standing theories about shyness believe that there are two types of coy behavior. “Temperamental” shyness remains roughly the same throughout development, whereas “state” shyness is felt during a social situation and manifests more like an emotion. 

In this new study, researchers examined the behavioral, affective, and physiological responses to a speech task in 152 Canadian children (73 girls and 79 boys) ages seven and eight. The children were told that they would be giving a speech that would be filmed and shown to other children. Their parents completed online questionnaires about their child’s temperament, while the children were given an echocardiogram to check for physiological indications of nervous behavior.

The children prepared a two-minute speech about their last birthday and recited the speech in front of a video camera and a mirror. The researchers monitored the children for behaviors coded as avoidance or inhibition, self-reported nervousness, and respiratory sinus arrhythmia.

The team found that temperamental shyness may exist in a distinct group of children over time, and a larger group of children may experience shyness as an emotion during certain situations. 

About 10 percent of the children had a high level of stress giving the speech in addition to relatively high levels of shyness over time, according to the questionnaires filled out by their parents. According to the team, this provides evidence that shyness may be part of these children’s temperament. Being the center of attention may be stressful across time and in various contexts in this group. Future research could examine the consequences on how this shyness affects academic, social, and psychological well-being since shyness could be measured across time. 

Roughly 25 percent of study participants were not reported to be shy, but demonstrated a higher level of stress from giving the speech. The authors believe that it is likely that state shyness in response to a speech task is a relatively common, normative experience for children at this age.

[Related: Little kids drew their grim—and hopeful—reality of COVID.]

“Our findings provide empirical support for the long-theorized idea that there may be a subset of temperamentally shy children who manifest heightened behavioral, affective, and physiological reactivity in response to a social stressor, as well as a subset of children who may experience only the affective component which may reflect state shyness,” co-author and Brock University post-doctoral fellow and psychologist Kristie Poole said in a statement. “This highlights the multiple components and developmental course of temperamental shyness and the features that distinguish temperamental and state shyness in middle to late childhood.”

This study provides some empirical evidence for long-standing ideas about shyness that were first made by the late psychologist Jerome Kagan. In the 1990s, Kagan argued that temperamental shyness may exist as a distinct category for some children and the features that define this category are relatively stable across time and context.

The authors also noted some limitations to the research, namely that the study only measured these behavioral, affective, and physiological components at one point in time and the sample size was relatively small. Future research should also include a more racially, ethnically, and socioeconomically diverse pool and focus.

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In 2013, Charlotte Figi made national news by becoming the youngest patient in Colorado to receive cannabidiol (CBD) therapy to soothe her seizures. The five-year-old had struggled with severe epilepsy since infancy, sometimes experiencing 50 or more episodes a day, with little relief from standard drugs and dietary tweaks. By the time her parents started consulting doctors about CBD extracts, she had difficulty walking, talking, and eating without help.

Figi’s neurologist put her on a low dose of a specially bred strain of medical cannabis, later dubbed “Charlotte’s Web.” The effects were almost immediate. The seizures slowed from daily to weekly events, and soon, the kid was living life almost normally. After close to two years of the oral treatment, the doctors decided to wean Figi off other epileptic medications.

Figi’s story represents one of the clearest, most well-documented cases of the healing potential of CBD. (The young pioneer died in 2020, due to complications of COVID-19.) Though people have used the plant-based chemical to treat migraines and other bodily aches for centuries, the science around its efficacy is still inconclusive because it’s tricky to study its direct effect on the nervous system. Regardless, the industry has boomed in the past decade. Today CBD can be found in a range of products—from lattes to bath bombs to dog treats—and is marketed as a cure-all for pain, anxiety, insomnia, and even AIDS.

So, what should a person who’s buying CBD expect? There’s plenty of information out there, but the bottom line is confusing. Here’s an overview of what medical experts say about the ingredient and whether it lives up to its hype.

What is CBD?

CBD is essentially cannabis, minus the strong psychoactive bits. The carbon-oxygen-hydrogen compound can be found in high concentrations in Cannabis sativa and less-potent hemp plants. Sometimes manufacturers mix it with traces of tetrahydrocannabinol (THC), the cannabis-based chemical that gets people high, but it generally doesn’t carry the same dopamine-heightening and possibly addictive properties.

Like THC, though, CBD works its “magic” by cozying up to the nervous system. From what molecular scientists know so far, it somehow changes proteins found all over the body that are responsible for managing pain, inflammation, mood, appetite, and even memory. It’s still unknown how extensively it affects that internal chemistry, especially when combined with other ingredients, says Johns Hopkins University food scientist Kantha Shelke.

Is CBD legal?

The Food and Drug Administration (FDA) recently updated its regulations to state that it supports further research on benefits, safety, and use of CBD products. For now, the extract is considered a controlled substance if it comes from cannabis plants. It’s treated more like a dietary supplement or food additive when harvested from hemp.

[Related: Cannabis poisoning is on the rise in pets]

That seems relatively straightforward, but throw local laws into the mix and the standards become a lot more unwieldy. CBD is legal to sell and buy in one form or another around the US, though it’s harder to hawk across state lines because of the federal regulations. In places where it’s lawful, the ingredient can be added to any product as long as it contains less than 0.3 percent THC and is marketed correctly. If it’s labeled as a drug it has to undergo clinical tests and win FDA approval before it’s available for public use. The agency has only approved one CBD medication so far: Epidolex, which is used to treat the same genetic syndrome that Charlotte Figi had.

At the beginning of 2023, the FDA announced that it would work with Congress on a new set of CBD regulations, citing potential long-term risks to people’s livers, the male reproductive system, livestock, and more. Once they are passed, the substance will be in a separate class from dietary supplements and food additives. In the meantime, the agency cautions against giving CBD products to children, pregnant and lactating people, and pets.

What are the proven benefits of CBD?

Some of the best research on CBD’s therapeutic effects comes from treating childhood epilepsy (thanks to the Figi family), schizophrenia, sleep deprivation, and anxiety disorders. The chemical has shown strong results in relieving all four of these conditions, with “a clear calming effect,” according to one 2019 analysis. That said, most of the studies exploring this connection don’t include a control group, or a baseline for comparison.

When it comes to looking at CBD for pain relief, the research is even more flimsy. Tests have shown that it can be effective against arthritis in rats, and that it might work as well as opioids for multiple sclerosis and cancer patients. But many of these treatments also included some amount of THC, so it’s hard to say if CBD was the primary cause of relief.

There’s also the question of which forms of CBD are safe enough for consumers but strong enough to make a difference. For neurological conditions like anxiety or apnea, the chemical needs to be absorbed into the bloodstream to have maximum impact. That means it needs to be ingested, inhaled, or rubbed in at high concentrations. But as health reporter Sarah Jacoby wrote in Self while vetting her own CBD buys, many of the proteins that trigger pain and inflammation are located between the skin and veins. So, any cream or gel that wants to counter aching joints and tight muscles needs to be able to get through the dermis but not as deep as the blood vessels. That’s a tall order for any drugstore formula.

Overall, doctors are reluctant to call CBD a pain panacea. But companies keep putting it in gels, goos, tinctures, massage oils, and roll-on creams, and people continue to snap them up. (One market report put CBD sales at nearly $5 billion sales in 2020.) It’s clear that the ingredient is somewhat beneficial to human health—science just needs to understand how much.

Does CBD have any bad effects?

Medical researchers haven’t pinpointed any deadly patterns with CBD use yet. A few case studies have mentioned respiratory failure, but in many of those instances, the patients also had THC in their system. People have complained about nausea and gastrointestinal issues after taking high concentrations of CBD. The Mayo Clinic also mentions fatigue, dizziness, and loss of appetite as possible complications.

[Related: Can you overdose on weed?]

There are concerns that CBD might interact negatively with other drugs, specifically blood thinners like warfarin. But there’s no specific guidance on which medications to avoid mixing with the extract.

How much CBD should people take?

Unfortunately, there’s no easy way to calculate safe and effective serving sizes for CBD. Dosing depends on body weight, desired effect, and the way a person is taking it. CBD products often come with suggestions, but those can be misleading, given that the FDA doesn’t test every supplement against its labels and claims. (The agency has issued warnings to dozens of companies who’ve listed incorrect information about CBD and THC levels in their products; see the full list here.)

“With CBD, dosage matters,” Shelke says, as over-indulgence has been associated with ill effects. But without a fundamental understanding of the chemistry of the ingredient, and how the cooking process changes it, it’s hard to come up with scientifically backed dosing recommendations. With the limited information available, Shelke advises to go the “less is better” route with any unregulated CBD products.

Why is CBD so hard to study?

Because CBD is one of hundreds of compounds in hemp and cannabis, it’s tricky to extract and standardize. If the chemical is tainted or alternated in any way during the process, it can have a different set of effects. The way it’s consumed also plays a big part in the reaction. As Figi’s neurologist wrote back in 2014, cooking or smoking CBD means adding heat, which could break down the chemical and make it less beneficial. Pills and edibles, on the other hand, need to be carefully engineered so that they don’t get neutralized by stomach acid.

All that variability, both in the plants and the products that are derived from them, makes CBD more challenging to test for medicinal purposes. It’s also often mixed with THC when treating chronic pain or life-threatening illnesses, so it take many extra layers of research to isolate the purely physical perks from the psychoactive ones.

Is CBD safe to cook with?

Plenty of food brands, restaurants, and cookbook authors are now folding CBD into their recipes. But does the ingredient have the same therapeutic effect when it’s baked in a brownie pan at 360 degrees Fahrenheit or seared in a skillet with sea bass and lemon rinds?

“There are many unanswered questions about the science, safety, quality, and physiological effects of CBD that need to be addressed before one can identify the effects of various chemical reactions on its efficacy,” Shelke says. Part of the issue with cooking with the extract is that the purity and the concentration is often unknown. This makes it even harder to know how it will interact with other ingredients, and whether that combination will help or harm a person. Bottom line: It’s better to avoid highly processed products or prepared meals with CBD, especially if you’re new to the compound.

What’s the best way to see if CBD works for me?

If you’re looking for a supplement to help you go to sleep at night, relieve a light migraine, or unwind after a stressful event, try a low-stakes gummy or topical oil. Be sure to choose a well-reviewed and reputable product, Shelke says: Just because it says it contains CBD doesn’t mean it will live up to its promise.

To treat chronic pain, depressive disorders, or other serious illnesses, get your doctor’s recommendations first. They can take stock of the latest research specific to your needs and also track how CBD works with other prescriptions you’re taking.

[Related on PopSci+: The tasty chemicals flavoring the edible cannabis boom]

As you head into the experience, manage your expectations. Like most wellness products that are backed by tepid evidence, the results can be hit or miss. Stay within the recommended doses on the products’ labels and report any unexpected side effects to your primary-care physician.

The future of CBD seems full of potential, but in present times, there are more questions than answers.

This post was updated in 2023 with new regulatory information from the FDA.

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Picture this: You’re at your desk working on a project when your phone chimes. A quick glance tells you a friend sent over a video on TikTok. Convinced you’re due for a break, you click the link to find a new dance video from Charli D’Amelio. Fast forward an hour later, and you’re still on your phone, except now you’ve gone from viral dances to animal videos to fitness gurus raving about a weight loss hack. 

If this scenario hits too close to home, you’re not alone. Most people on social media check it daily, and younger people are likelier to return to their favorite platforms multiple times a day. TikTok is especially popular with teenagers: A 2022 survey from the Pew Research Center suggests 67 percent of teens use it, while 16 percent use it almost constantly. 

So why do people spend so much time online? One underlying reason is that platforms like TikTok promote infinite scrolling. You might start off in one video only for the page to continuously load a never-ending stream of content. Absent-mindedly scrolling through content might seem like an innocent activity and a great excuse to waste time. However, research suggests it can negatively influence the brain and mental health.

Anyone can fall prey to mindless scrolling. Younger people are especially vulnerable since the brain is not fully developed until age 25, says Lisa Pion-Berlin, a psychologist and president of Parents Anonymous, a child abuse prevention nonprofit. While limiting access to social media (like this Utah bill requiring parental permission is trying to do) is one option, learning how to be a more active user can help anyone stop infinite scrolling and still enjoy social media.

Why infinite scrolling is bad for you

Social media platforms like TikTok are not comprehensively bad for you. Several studies suggest social media can prompt feelings of connectedness and positive well-being. Further, they allow for personal expression, which fosters positive mental health.

Ultimately, how social media makes people feel depends on how they use it. For example, excess social media use is associated with feeling more anxious, lonely, and generally bad about yourself. 

“The more attached we are to our devices, the more problematic it becomes,” says Lisa Strohman, a psychologist and the founder of Digital Citizen Academy, an education program that teaches children and teens how to have a healthy relationship with technology. 

[Related: Do you never feel FOMO? Time to meet its twin, JOMO.]

Moreover, Strohman says watching pictures and videos of everyone living their best life might make you worried or sad that you’re missing out. Some research suggests that comparing yourself to others on social media can result in aggression and anxiety, while other studies suggest a link between negative comparisons on social media and suicidal ideation.

Meanwhile, mindless scrolling can result in a state of mind similar to being in a trance state, says Pion-Berlin. She’s concerned that “mindless scrolling is a way to tune out” or dissociate from reality. Some research suggests that overuse of social media can result in negative psychological impacts: A 2023 study in the journal JAMA Pediatrics found that middle schoolers who constantly checked their social media feeds showed changes in how their brains responded to feedback and criticism from peers.   

Infinite scrolling can also lead to disrupted sleep patterns in adolescents and adults. The screen’s blue light can make it difficult to fall asleep, and the constant content prevents your brain from shutting down for the night. 

When we sleep, the brain sorts through and categorizes the information from the day and commits the vital stuff into long-term memory, explains Strohman. But mindless social media surfing before bedtime keeps giving it more data for the brain to process throughout the night, “and that’s what tends to lead to that insomnia,” she explains.

How infinite scrolling can hijack the brain

Mindless scrolling helps make social media an addicting habit because it takes advantage of the brain’s reward system, says Strohman.

An enjoyable TikTok, for example, can trigger the brain’s reward pathway. Subsequently, this causes the brain to release a chemical called dopamine, which Strohman describes “as a hit or a high” for the brain. The dopamine surge tells the brain that scrolling through social media is pleasurable and that we should do it again. Because another attention-grabbing Tiktok plays immediately when the first is over, this process starts all over again immediately. 

“The brain is rewarded every time because of how the feeds and algorithms are set up so that anytime we’re not on the app, we think we’re missing something,” explains Strohman. “That makes us want to go back on it again.:

The same process applies to adolescents—possibly to a more significant effect. Pion-Berlin explains that because the prefrontal cortex is one of the last brain areas to mature fully, younger people are more impulsive and have less self-control than adults. With less self-control, it may be easier for teens to fall into this rabbit hole of social media content, she says. In addition, the limbic system—a part of the brain involved in behavioral and emotional responses—is also more sensitive during our teenage years, which makes them likelier to prioritize pleasurable and desirable activities.

What are some ways to stop infinite scrolling?

While infinite scrolling isn’t great, that does not mean you need to quit social media altogether. On the contrary, there are some benefits to staying on the apps, such as building communities among people with a shared hobby or interest, maintaining relationships with family who live miles away, raising awareness for a particular cause, and learning from credible experts.

[Related: All the ways you can reduce screen time across your devices]

To make the most of your time, you’ll want to become an active rather than a passive user. Active users interact with others— in practice, this could look like commenting on posts or creating content. The high engagement gives you a specific purpose for being on the app, allows you to nurture and maintain online friendships, and is associated with improved well-being. 

Meanwhile, infinite scrolling is a passive activity because you’re socially disconnected from others and lurking in the background. Of course, sometimes you just want to take a break from life and watch some mind-numbing videos. In these situations, you’ll want to set a timer to limit the time you spend online and know when it’s time to log off, Strohman says. 

Another suggestion from Strohman is turning off notifications. People often fall into mindless surfing when notified or tagged in something. And while you might start out looking at the relevant post, you can easily find yourself lost in a comment thread or other recommended videos. 

“Have a clear purpose when accessing social media,” Strohman says. If a friend shares a post, tell yourself you will only watch this one video and not spend the next two hours on TikTok. 

“The more you scroll, the less settled you’ll be,” advises Strohman. “Be mindful, recognize your part in it, and try to do what you can to manage yourself in those online worlds.”

The post How to break your toxic infinite scroll habit on TikTok appeared first on Popular Science.

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When it comes to tackling the opioid crisis in America, there is no single solution. Public health officials have taken measures to prevent future overdoses by reducing the number of opioid prescriptions, curbing the flow of illicit drug trafficking, and raising awareness of the dangers of opioids. But for the three million people already addicted to this class of drugs, the emphasis has turned to a quick-working treatment: naloxone.

It’s possible to reverse an opioid overdose with an injectable or single-dose nasal spray called naloxone (also known by the brand name Narcan). Street drugs and prescription painkillers like heroin, morphine, and codeine target opioid receptors in the brain to induce a pleasurable high. But they can also affect neurons that control respiration, causing a person to stop breathing if they overdose. Naloxone blocks the brain receptors so that the drugs can’t reach them, preventing this deadly side effect. “There are very few things I would call a perfect antidote, but, in this case, Narcan is one of them,” says Ryan Marino, a medical toxicologist and addiction medicine specialist at the Case Western Reserve University School of Medicine. He adds that naloxone works against synthetic opioids like fentanyl.

[Related: At-home test strips for fentanyl are just the first step to preventing overdoses]

In response to the growing number of opioid overdose deaths—75 percent of drug overdose deaths in the US in 2020 involved an opioid—the Food and Drug Administration (FDA) approved an over-the-counter version of naloxone. The decision makes the drug more accessible: People will be able to buy the nasal spray at places like their local pharmacy or gas station without a prescription. But while medical experts have lauded the FDA’s ruling, not everyone is happy with the news. There have been some concerns from the public about distributing naloxone and whether it encourages more drug use. PopSci spoke with medical experts on common misconceptions surrounding naloxone and its safety.

Myth 1: Naloxone encourages people to do more drugs

A common objection to expanding naloxone access is that it acts as a safety net for people with addiction to continue their drug habits with few repercussions. But Kathryn Cunningham, director of the Center of Addiction Research at the University of Texas Medical Branch, says research has shown no evidence that naloxone leads to more drug use. 

A well-known 2013 study in The BMJ journal found the number of opioid-related hospital visits did not increase in communities with programs distributing naloxone and those with less access to the nasal spray. Instead, naloxone helped in reducing the amount of risky drug activity in 19 communities that distributed it to residents.

Myth 2: Naloxone prevents users from getting treated for addiction

Think of naloxone as a fire extinguisher in your house, Marino says. You’ll likely use it if there’s a small blaze. But if you have repeated incidents or if your house becomes engulfed in flames, the fire extinguisher can only help so much. Eventually, you’ll have to call the fire department for help. Simply put, naloxone may actually convince people to find professional help because it gives them more opportunities to seek treatment and rehabilitation later in life. “You can’t seek medical services if you’re dead,” Cunningham explains. 

If there’s any deterrent to getting treatment, it’s the stigma surrounding substance use disorders. Research suggests laws hampering access to care and discrimination from medical professionals against patients with a history of drug use may discourage people from opening up about their addiction. Even when they seek out help, patients have reported being treated as if they were untrustworthy, intimidating, and immoral.

Myth 3: Only medical professionals can use naloxone safely

You do not need medical training to give naloxone to someone who’s overdosed. Marino says the over-the-counter nasal spray that the FDA approved was designed to be easy enough to be used by a child as young as 6. The box also has step-by-step instructions printed on the side. “It comes with this little nasal atomizer,” Marino adds. “You just take it out of the package, put it in someone’s nose, and press the pointer. That’s all there is to it.” If a person accidentally applies naloxone to someone who hasn’t overdosed, it will be benign.

[Related: How to break free of the bystander effect and help someone in trouble]

There is no age limit for being treated with naloxone. You can use it on a newborn with opioids in their system or even a toddler who’s exposed to fentanyl patches. The nasal spray expires after three years, and should be stored in temperatures between 77 and 104 degrees Fahrenheit. Naloxone freezes at temperatures below 5 degrees Fahrenheit, making it unusable until it thaws out.

Myth 4: Naloxone makes users violent

It’s been rumored that the sudden onslaught of withdrawal symptoms caused by naloxone might cause a person to become aggressive or lash out when they gain consciousness. That’s not typically the case. Cunningham says common side effects after treatment include headaches, disorientation, vomiting, and nausea—all of which are temporary, because it’s a short-acting drug. “Withdrawal is not life-threatening,” Cunningham notes. “Not breathing because of an opiate is life-threatening.”

Fact: Naloxone could save many lives if more people have it

The FDA’s decision (which doesn’t mention exact rollout dates) makes it so that anyone can be ready to jump in and prevent deaths from opioid overdoses. Marino says it’s best to think of naloxone as another item in your first aid kit in case of emergencies. “We might tell ourselves that no one in our life is using drugs or going to overdose, but you never want to have a situation where you need it and not have it.”

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Nothing prepared Linda C. Johnson of Indianapolis for the fatigue that descended on her after a diagnosis of stage 4 lung cancer in early 2020.

Initially, Johnson, now 77, thought she was depressed. She could barely summon the energy to get dressed in the morning. Some days, she couldn’t get out of bed.

But as she began to get her affairs in order, Johnson realized something else was going on. However long she slept the night before, she woke up exhausted. She felt depleted, even if she didn’t do much during the day.

“People would tell me, ‘You know, you’re getting old.’ And that wasn’t helpful at all. Because then you feel there’s nothing you can do mentally or physically to deal with this,” she told me.

Fatigue is a common companion of many illnesses that beset older adults: heart disease, cancer, rheumatoid arthritis, lung disease, kidney disease, and neurological conditions like multiple sclerosis, among others. It’s one of the most common symptoms associated with chronic illness, affecting 40% to 74% of older people living with these conditions, according to a 2021 review by researchers at the University of Massachusetts.

This is more than exhaustion after an extremely busy day or a night of poor sleep. It’s a persistent whole-body feeling of having no energy, even with minimal or no exertion. “I feel like I have a drained battery pretty much all of the time,” wrote a user named Renee in a Facebook group for people with polycythemia vera, a rare blood cancer. “It’s sort of like being a wrung-out dish rag.”

Fatigue doesn’t represent “a day when you’re tired; it’s a couple of weeks or a couple of months when you’re tired,” said Dr. Kurt Kroenke, a research scientist at the Regenstrief Institute in Indianapolis, which specializes in medical research, and a professor at Indiana University’s School of Medicine.

When he and colleagues queried nearly 3,500 older patients at a large primary care clinic in Indianapolis about bothersome symptoms, 55% listed fatigue — second only to musculoskeletal pain (65%) and more than back pain (45%) and shortness of breath (41%).

Separately, a 2010 study in the Journal of the American Geriatrics Society estimated that 31% of people 51 and older reported being fatigued in the past week.

The impact can be profound. Fatigue is the leading reason for restricted activity in people 70 and older, according to a 2001 study by researchers at Yale. Other studies have linked fatigue with impaired mobility, limitations in people’s abilities to perform daily activities, the onset or worsening of disability, and earlier death.

What often happens is older adults with fatigue stop being active and become deconditioned, which leads to muscle loss and weakness, which heightens fatigue. “It becomes a vicious cycle that contributes to things like depression, which can make you more fatigued,” said Dr. Jean Kutner, a professor of medicine and chief medical officer at the University of Colorado Hospital.

To stop that from happening, Johnson came up with a plan after learning her lung cancer had returned. Every morning, she set small goals for herself. One day, she’d get up and wash her face. The next, she’d take a shower. Another day, she’d go to the grocery store. After each activity, she’d rest.

In the three years since her cancer came back, Johnson’s fatigue has been constant. But “I’m functioning better,” she told me, because she’s learned how to pace herself and find things that motivate her, like teaching a virtual class to students training to be teachers and getting exercise under the supervision of a personal trainer.

When should older adults be concerned about fatigue? “If someone has been doing OK but is now feeling fatigued all the time, it’s important to get an evaluation,” said Dr. Holly Yang, a physician at Scripps Mercy Hospital in San Diego and incoming board president of the American Academy of Hospice and Palliative Medicine.

“Fatigue is an alarm signal that something is wrong with the body but it’s rarely one thing. Usually, several things need to be addressed,” said Dr. Ardeshir Hashmi, section chief of the Center for Geriatric Medicine at the Cleveland Clinic.

Among the items physicians should check: Are your thyroid levels normal? Are you having trouble with sleep? If you have underlying medical conditions, are they well controlled? Do you have an underlying infection? Are you chronically dehydrated? Do you have anemia (a deficiency of red blood cells or hemoglobin), an electrolyte imbalance, or low levels of testosterone? Are you eating enough protein? Have you been feeling more anxious or depressed recently? And might medications you’re taking be contributing to fatigue?

“The medications and doses may be the same, but your body’s ability to metabolize those medications and clear them from your system may have changed,” Hashmi said, noting that such changes in the body’s metabolic activity are common as people become older.

Many potential contributors to fatigue can be addressed. But much of the time, reasons for fatigue can’t be explained by an underlying medical condition.

That happened to Teresa Goodell, 64, a retired nurse who lives just outside Portland, Oregon. During a December visit to Arizona, she suddenly found herself exhausted and short of breath while on a hike, even though she was in good physical condition. At an urgent care facility, she was diagnosed with an asthma exacerbation and given steroids, but they didn’t help.

Soon, Goodell was spending hours each day in bed, overcome by profound tiredness and weakness. Even small activities wore her out. But none of the medical tests she received in Arizona and subsequently in Portland — a chest X-ray and CT scan, blood work, a cardiac stress test — showed abnormalities.

“There was no objective evidence of illness, and that makes it hard for anybody to believe you’re sick,” she told me.

Goodell started visiting long covid web sites and chat rooms for people with chronic fatigue syndrome. Today, she’s convinced she has post-viral syndrome from an infection. One of the most common symptoms of long covid is fatigue that interferes with daily life, according to the Centers for Disease Control and Prevention.

There are several strategies for dealing with persistent fatigue. In cancer patients, “the best evidence favors physical activity such as tai chi, yoga, walking, or low-impact exercises,” said Dr. Christian Sinclair, an associate professor of palliative medicine at the University of Kansas Health System. The goal is to “gradually stretch patients’ stamina,” he said.

With long covid, however, doing too much too soon can backfire by causing “post-exertional malaise.” Pacing one’s activities is often recommended: doing only what’s most important, when one’s energy level is highest, and resting afterward. “You learn how to set realistic goals,” said Dr. Andrew Esch, senior education advisor at the Center to Advance Palliative Care.

Cognitive behavioral therapy can help older adults with fatigue learn how to adjust expectations and address intrusive thoughts such as, “I should be able to do more.” At the University of Texas MD Anderson Cancer Center, management plans for older patients with fatigue typically include strategies to address physical activity, sleep health, nutrition, emotional health, and support from family and friends.

“So much of fatigue management is about forming new habits,” said Dr. Ishwaria Subbiah, a palliative care and integrative medicine physician at MD Anderson. “It’s important to recognize that this doesn’t happen right away: It takes time.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Update 04/06/2023: Comments from Monument’s CEO have been added to this article.

According to recent reports, two online alcohol recovery startups shared users’ detailed private health information and personal data to third-party advertisers without their consent. They were able to do so via popular tracking systems such as the Meta Pixel. Both Tempest and its parent company, Monument, confirmed the extensive privacy violations to TechCrunch on Tuesday. They now claim to no longer employ the frequently criticized consumer profiling products developed by companies such as Microsoft, Google, and Facebook.

In a disclosure letter mailed to its consumers last week, Monument states “we value and respect the privacy of our members’ information,” but admitted “some information” may have been shared to third parties without the “appropriate authorization, consent, or agreements required by law.” The potentially illegal violations stem as far back as 2020 for Monument members, and 2017 for those using Tempest.

Within those leaks, as many as 100,000 accounts’ names, birthdates, email addresses, telephone numbers, home addresses, membership IDs, insurance IDs, and IP addresses. Additionally, users’ photographs, service plans, survey responses, appointment-related info, and “associated health information” may also have been shared to third-parties. Monument and Tempest assured customers, however, that their Social Security numbers and banking information had not been improperly handled.

[Related: How data brokers threaten your privacy.]

Major data companies’ largely free “pixel” tools generally work by embedding a small bit of code into websites. The program then subsequently supplies immensely personal and detailed information to both third-party businesses, as well as the tracking tech’s makers to help compile extensive consumer profiles for advertising purposes. One study estimates that approximately one-third of the 80,000 most popular websites online utilize Meta Pixel (disclosure: PopSci included), for example. While both Tempest and Monument pledge to have removed tracking code from their sites, TechCrunch also notes the codes’ makers are not legally required to delete previously collected data.

“Monument and Tempest should be ashamed of sharing this extremely personal information of people, especially considering the nature and vulnerability of their clients,” Caitlin Seeley George, campaigns managing director of the digital privacy advocacy group, Fight for the Future, wrote PopSci via email. For George, the revelations are simply the latest examples of companies disregarding privacy for profit, but argues lawmakers “should similarly feel ashamed” that the public lacks legal defense or protection from these abuses. “It seems like every week we hear another case of companies sharing our data and prioritizing profits over privacy. This won’t end until lawmakers pass privacy laws,” she said.

“Protecting our patients’ privacy is a top priority,” Monument CEO Mike Russell told PopSci over email. “We have put robust safeguards in place and will continue to adopt appropriate measures to keep data safe. In addition, we have ended our relationship with third-party advertisers that will not agree to comply with our contractual requirements and applicable law.”

Tracking tools are increasingly the subject of scrutiny and criticism as more and more reports detail privacy concerns—last year, an investigation from The Markup and The Verge revealed that some of the country’s most popular tax prep software providers utilize Meta Pixel. The same tracking code is also at the center of a lawsuit in California concerning potential HIPAA violations stemming from hospitals sharing patients’ medical data.

Correction 04/06/2023: A previous version of this article’s headline stated Tempest and Monument “sold” user data. A spokesperson for the companies stated they “shared” data with third-party companies.

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Some adults who take prescription medication for attention-deficit/hyperactivity disorder are required to have their urine tested for drugs several times a year. Others never are tested.

Such screenings are designed to check if ADHD patients are safely taking their pills, such as Adderall, and not selling them, taking too many, or using other drugs.

Several doctors told KHN there are varying opinions and no national standards on the role of urine testing to monitor adults who take ADHD medication. So patients face dramatically different requirements, depending on their clinics’ and health insurers’ policies.

“There really isn’t much literature to guide you on how to do this,” said Dr. Margaret Chaplin, a Connecticut psychiatrist who treats patients with ADHD, mental illnesses, or substance use disorders.

Chaplin first noticed the lack of testing standards about eight years ago, when she and colleagues proposed ways to prevent stimulant misuse in adult ADHD patients.

Her team recommended urine tests only if patients exhibit “red-flag behavior,” such as appearing intoxicated, repeatedly reporting lost prescriptions, or frequently switching doctors. Some doctors and clinics make testing decisions on a patient-by-patient basis taking into account those red flags or patient history. Others apply universal policies, which may be aimed at preventing discrimination. Some insurance companies and state Medicaid systems also have testing requirements.

ADHD stimulants, opioid pain medications, and some other drugs are classified as controlled substances, which are tightly regulated because they can be addictive or misused.

ADHD patients subjected to frequent drug screens say the tests can be time-consuming and expensive. Some feel stigmatized.

A.C. Shilton felt relieved when she was diagnosed with ADHD in her mid-30s. The farmer and freelance journalist from rural Tennessee said the diagnosis explained why she felt so disorganized and forgetful, and as if her brain were a motor running all day. Shilton said her medication slows that motor down.

The 38-year-old Jamestown resident said her first doctor ordered urine tests once a year. That doctor eventually closed his practice, and Shilton said her next physician made her take a test at nearly every visit.

“You go in to get the standard of care, which is this medicine, and you’re kind of treated like you’re a bad person again; there’s some shame associated with that,” Shilton said.

She was also upset after learning office staffers were incorrect when they told her that urine testing was required by law — something that other ADHD patients posting on social media forums said had happened to them too.

Shilton said few doctors treat adult ADHD patients in her rural community. She now drives more than an hour to a different clinic, which doesn’t require her to take as many drug tests.

Travis Gordon, 47, of Charlotte, North Carolina, has gone to the same ADHD clinic for more than 10 years. Gordon said he wasn’t drug-tested in the first few years. Then, for several years, he had to give a urine sample every three months. During much of the covid-19 pandemic, he wasn’t tested. Now, he’s screened every six months.

“We shouldn’t have to feel like street criminals to get drugs that are needed for our daily success,” Gordon said.

Gordon said it would make sense for doctors to order tests more frequently as they get to know new patients. But he said he doesn’t understand why such testing should continue for people like him, established patients who properly take their medication.

Traci Camper, 50, of northeastern Tennessee, said she has “never even tried a cigarette,” much less used illicit drugs, but her doctor has required urine tests every three months for more than 10 years. Camper said the process can be inconvenient but she’s ultimately OK with the tests, especially since she lives in an area with high rates of drug abuse.

The clinics that Shilton, Gordon, and Camper went to did not respond to KHN’s requests for interviews about their testing policies.

Adults are diagnosed with ADHD if they have multiple, frequent symptoms so severe they interfere with work, relationships, or other aspects of life. Treatments include therapy and medication, most often stimulants.

ADHD patients have been affected by the response to the opioid crisis, which has led to more scrutiny for all controlled medications. Some have reported trouble filling their prescriptions as drug distribution companies limit sales to certain pharmacies. Some patients, especially rural ones, could face obstacles if the federal government reverts to pre-pandemic rules that require at least one in-person appointment to receive controlled drugs via telehealth.

Chaplin said doctors who treat ADHD may feel the need to be extra vigilant with drug testing because of this increased scrutiny, or due to the risk of misuse.

An estimated 3.7 million Americans 12 or older misused prescription stimulants in 2021, and 1.5 million had a prescription stimulant use disorder, according to the National Survey on Drug Use and Health. Americans are more likely to misuse or be addicted to prescription opioids, sedatives, and tranquilizers, the agency said.

Adults with ADHD are more likely to have a substance use disorder than those without the condition, according to the Substance Abuse and Mental Health Services Administration.

Although there aren’t formal standards, several health care organizations and professionals have made recommendations to prevent and detect adult ADHD stimulant misuse. Suggestions include requiring patients to sign prescription-agreement contracts and regularly checking databases that show all controlled medications each patient is buying.

Chaplin said there’s little research into how effective any method is at preventing medication misuse.

A recent survey found that 42% of family physicians and 21% of college health professionals who treat adult ADHD require their patients to submit random urine drug screens.

Gordon, Camper, and some ADHD patients on social media forums said their drug screens have come at predictable intervals, instead of random ones.

Dr. Sidarth Wakhlu, a psychiatrist who specializes in treating substance use disorders at the University of Texas Southwestern Medical Center in Dallas, said some of his patients also have ADHD. He suggests drug-testing most ADHD patients once or twice a year. For “someone who has no addiction history, has no red flags, every three months is an overkill,” he said.

The cost of drug testing is as variable as the frequency.

For example, Dr. Michael Fingerhood at Johns Hopkins University uses urine tests that cost as little as $60 before insurance. Fingerhood makes testing decisions case by case for patients who take controlled substances to treat ADHD, pain, or opioid addiction.

Gordon used to pay $110 for each of his tests when he had insurance his doctor did not accept. Shilton’s insurance was billed $545 for a test. Shilton said she complained to a nurse who said, in the future, she could use a less expensive test.

Shilton said she replied, “Well, why aren’t we doing that to begin with? Why are we doing this extremely fancy drug testing?”

Wakhlu said the more expensive urine tests can identify specific types and quantities of drugs. Such tests are usually used to confirm the results of initial, less pricey tests, according to the Centers for Disease Control and Prevention.

Wakhlu said that when test results show a patient might be misusing stimulants, doctors should initiate a non-accusatory conversation to discuss the results and, if needed, offer help. He also said it’s important to emphasize safety, such as how taking too much ADHD medication or combining it with other stimulants, such as methamphetamine, can be dangerous.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Consider three hypothetical women in their mid-70s, all living alone in identical economic circumstances with the same array of ailments: diabetes, arthritis, and high blood pressure.

Ms. Green stays home most of the time and sometimes goes a week without seeing people. But she’s in frequent touch by phone with friends and relatives, and she takes a virtual class with a discussion group from a nearby college.

Ms. Smith also stays home, but rarely talks to anyone. She has lost contact with friends, stopped going to church, and spends most of her time watching TV.

Ms. Johnson has a wide circle of friends and a busy schedule. She walks with neighbors regularly, volunteers at a school twice a week, goes to church, and is in close touch with her children, who don’t live nearby.

Three sets of social circumstances, three levels of risk should the women experience a fall, bout of pneumonia, or serious deterioration in health.

Of the women, Ms. Johnson would be most likely to get a ride to the doctor or a visit in the hospital, experts suggest. Several people may check on Ms. Green and arrange assistance while she recovers.

But Ms. Smith would be unlikely to get much help and more likely than the others to fare poorly if her health became challenged. She’s what some experts would call “socially vulnerable” or “socially frail.”

Social frailty is a corollary to physical frailty, a set of vulnerabilities (including weakness, exhaustion, unintentional weight loss, slowness, and low physical activity) shown to increase the risk of falls, disability, hospitalization, poor surgical outcomes, admission to a nursing home, and earlier death in older adults.

Essentially, people who are physically frail have less physiological strength and a reduced biological ability to bounce back from illness or injury.

Those who are socially frail similarly have fewer resources to draw upon, but for different reasons — they don’t have close relationships, can’t rely on others for help, aren’t active in community groups or religious organizations, or live in neighborhoods that feel unsafe, among other circumstances. Also, social frailty can entail feeling a lack of control over one’s life or being devalued by others.

Many of these factors have been linked to poor health outcomes in later life, along with so-called social determinants of health — low socioeconomic status, poor nutrition, insecure housing, and inaccessible transportation.

Social frailty assumes that each factor contributes to an older person’s vulnerability and that they interact with and build upon each other. “It’s a more complete picture of older adults’ circumstances than any one factor alone,” said Dr. Melissa Andrew, a professor of geriatric medicine at Dalhousie University in Halifax, Nova Scotia, who published one of the first social vulnerability indices for older adults in 2008.

This way of thinking about older adults’ social lives, and how they influence health outcomes, is getting new attention from experts in the U.S. and elsewhere. In February, researchers at Massachusetts General Hospital and the University of California-San Francisco published a 10-item “social frailty index” in the Proceedings of the National Academy of Sciences journal.

Using data from 8,250 adults 65 and older who participated in the national Health and Retirement Study from 2010 to 2016, the researchers found that the index helped predict an increased risk of death during the period studied in a significant number of older adults, complementing medical tools used for this purpose.

“Our goal is to help clinicians identify older patients who are socially frail and to prompt problem-solving designed to help them cope with various challenges,” said Dr. Sachin Shah, a co-author of the paper and a researcher at Massachusetts General Hospital.

“It adds dimensions of what a clinician should know about their patients beyond current screening instruments, which are focused on physical health,” said Dr. Linda Fried, an internationally known frailty researcher and dean of the Mailman School of Public Health at Columbia University.

Beyond the corridors of medicine, she said, “we need society to build solutions” to issues raised in the index — the ability of seniors to work, volunteer, and engage with other people; the safety and accessibility of neighborhoods in which they live; ageism and discrimination against older adults; and more.

Meanwhile, a team of Chinese researchers recently published a comprehensive review of social frailty in adults age 60 and older, based on results from dozens of studies with about 83,900 participants in Japan, China, Korea, and Europe. They determined that 24% of these older adults, assessed both in hospitals and in the community, were socially frail — a higher portion than those deemed physically frail (12%) or cognitively frail (9%) in separate studies. Most vulnerable were people 75 and older.

What are the implications for health care? “If someone is socially vulnerable, perhaps they’ll need more help at home while they’re recovering from surgery. Or maybe they’ll need someone outside their family circle to be an advocate for them in the hospital,” said Dr. Kenneth Covinsky, a geriatrician at UCSF and co-author of the recent Proceedings of the National Academy of Sciences article.

“I can see a social frailty index being useful in identifying older adults who need extra assistance and directing them to community resources,” said Jennifer Ailshire, an associate professor of gerontology and sociology at the University of Southern California Leonard Davis School of Gerontology.

Unlike other physicians, geriatricians regularly screen older adults for extra needs, albeit without using a well-vetted or consistent set of measures. “I’ll ask, who do you depend on most and how do you depend on them? Do they bring you food? Drive you places? Come by and check on you? Give you their time and attention?” said Dr. William Dale, the Arthur M. Coppola Family Chair in Supportive Care Medicine at City of Hope, a comprehensive cancer center in Duarte, California.

Depending on the patients’ answers, Dale will refer them to a social worker or help modify their plan of care. But, he cautioned, primary care physicians and specialists don’t routinely take the time to do this.

Oak Street Health, a Chicago-based chain of 169 primary care centers for older adults in 21 states and recently purchased by CVS Health, is trying to change that in its clinics, said Dr. Ali Khan, the company’s chief medical officer of value-based care strategy. At least three times a year, medical assistants, social workers, or clinicians ask patients about loneliness and social isolation, barriers to transportation, food insecurity, financial strain, housing quality and safety, access to broadband services, and utility services.

The organization combines these findings with patient-specific medical information in a “global risk assessment” that separates seniors into four tiers of risk, from very high to very low. In turn, this informs the kinds of services provided to patients, the frequency of service delivery, and individual wellness plans, which include social as well as medical priorities.

The central issue, Khan said, is “what is this patient’s ability to continue down a path of resilience in the face of a very complicated health care system?” and what Oak Street Health can do to enhance that.

What’s left out of an approach like this, however, is something crucial to older adults: whether their relationships with other people are positive or negative. That isn’t typically measured, but it’s essential in considering whether their social needs are being met, said Linda Waite, the George Herbert Mead Distinguished Service Professor of sociology at the University of Chicago and director of the National Social Life, Health, and Aging Project.

For seniors who want to think about their own social vulnerability, consider this five-item index, developed by researchers in Japan.

(1) Do you go out less frequently now than last year?

(2) Do you sometimes visit your friends?

(3) Do you feel you are helpful to friends or family?

(4) Do you live alone?

(5) Do you talk to someone every day?

Think about your answers. If you find your responses unsatisfactory, it might be time to reconsider your social circumstances and make a change.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

The post Social relationships are important to the health of aging adults appeared first on Popular Science.

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Scrolling through Instagram and TikTok on a Monday morning is an easy trigger for the dreaded fear of missing out–or FOMO. To push back against this need to never miss a party or fancy vacation, the term JOMO (joy of missing out) has been popularized for those who report a healthy level of enjoyment of solitude.

However, most people who also have high JOMO also report higher levels of social anxiety, according to a study published this month in the journal Telematics and Informatics Reports.

[Related: Seattle schools sue social media companies over students’ worsening mental health.]

For the study, a team from Washington State University looked at two 500-person samples of adults recruited through Amazon’s crowdsourcing platform MTurk. As a way to measure JOMO, they asked a slate of questions about enjoying spending time alone and experiencing disconnection. For example, whether subjects liked having time to self-reflect and if they were happy to see friends and family out enjoying themselves even if they weren’t there. Questions to assess loneliness, social media use, social anxiety, personality traits, and general life satisfaction were also included. 

The surveys revealed mixed results, with some evidence that there is actually some anxiety hiding behind the joy. 

“In general, a lot of people like being connected,” psychology professor and co-author Chris Barry said in a statement. “When trying to assess JOMO, we found that some people were enjoying missing out, not for the solitude or a Zen-like, calming experience of being able to regroup, but more to avoid social interaction.”

This avoidance might explain the correlation the team found between social media use and JOMO, which surprised the team. They anticipated that people who wanted to miss out on social gatherings would not care to check in to see what their friends or family were doing. Instead, they found that those who have social anxiety may find social media as a less intense way to connect instead of interacting in person. 

The study of the first sample group showed connections in those high in JOMO and social media and also general life satisfaction, but social anxiety actually had the strongest correlation.

[Related: Study confirms the obvious: youth have abandoned Facebook.]

After getting these mixed results, they designed a second study to see if there was a group of people high in JOMO, but without that anxiety. While they did find these blissful introverts, the group was small and represented only about 10 percent of the participants in the study. This group was not socially anxious, but still reported some moderate feelings of loneliness.

Previous studies have linked FOMO with low self-esteem and loneliness, but these findings indicate that the experience of JOMO is not as clear. The team believes that JOMO might be more of a momentary phase of needing to disconnect instead of a constant state of feelings. Other studies have also shown that continued exposure to anxiety triggers can help lessen stress later.

“There are a lot of unanswered questions like ‘what’s a good dosage of social interaction versus disengagement?’ I think that’s going to differ for everyone,” Barry said.  “The motives matter,” Barry said. “Why are people missing out? If it’s because they need to recharge, that’s maybe a good thing. If they’re trying to avoid something, that is probably not healthy in the long run.”

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Anxiety is the most common psychological disorder affecting adults in the U.S. In older people, it’s associated with considerable distress as well as ill health, diminished quality of life, and elevated rates of disability.

Yet, when the U.S. Preventive Services Task Force, an independent, influential panel of experts, suggested last year that adults be screened for anxiety, it left out one group — people 65 and older.

The major reason the task force cited in draft recommendations issued in September: “the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety” in all older adults. (Final recommendations are expected later this year.)

The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening entails evaluating people who don’t have obvious symptoms of worrisome medical or psychological conditions.

“We recognize that many older adults experience mental health conditions like anxiety” and “we are calling urgently for more research,” said Lori Pbert, associate chief of the preventive and behavioral medicine division at the University of Massachusetts Chan Medical School and a former task force member who worked on the anxiety recommendations.

This “we don’t know enough yet” stance doesn’t sit well with some experts who study and treat seniors with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the task force’s position “baffling” because “it’s well established that anxiety isn’t uncommon in older adults and effective treatments exist.”

“I cannot think of any danger in identifying anxiety in older adults, especially because doing so has no harm and we can do things to reduce it,” said Dr. Helen Lavretsky, a psychology professor at UCLA.

In a recent editorial in JAMA Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors with generalized anxiety disorder — intense, persistent worry about everyday matters — receive treatment. That’s concerning, they said, considering evidence of links between anxiety and stroke, heart failure, coronary artery disease, autoimmune illness, and neurodegenerative disorders such as dementia.

Other forms of anxiety commonly undetected and untreated in seniors include phobias (like a fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear of being assessed and judged by others), and post-traumatic stress disorder.

The smoldering disagreement over screening calls attention to the significance of anxiety in later life — a concern heightened during the covid-19 pandemic, which magnified stress and worry among seniors. Here’s what you should know.

Anxiety is common. According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety condition.

As many as half have symptoms of anxiety — irritability, worry, restlessness, decreased concentration, sleep changes, fatigue, avoidant behaviors — that can be distressing but don’t justify a diagnosis, the study noted.

Most seniors with anxiety have struggled with this condition since earlier in life, but the way it manifests may change over time. Specifically, older adults tend to be more anxious about issues such as illness, the loss of family and friends, retirement, and cognitive declines, experts said. Only a small fraction develop anxiety after turning 65.

Anxiety can be difficult to identify in older adults. Older adults often minimize symptoms of anxiety, thinking “this is what getting older is like” rather than “this is a problem that I should do something about,” Andreescu said.

Also, seniors are more likely than younger adults to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath, and gastrointestinal problems — that can be difficult to distinguish from underlying medical conditions, according to Gretchen Brenes, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

Some types of anxiety or anxious behaviors — notably, hoarding and fear of falling — are much more common in older adults, but questionnaires meant to identify anxiety don’t typically ask about those issues, said Dr. Jordan Karp, chair of psychiatry at the University of Arizona College of Medicine in Tucson.

When older adults voice concerns, medical providers too often dismiss them as normal, given the challenges of aging, said Dr. Eric Lenze, head of psychiatry at Washington University School of Medicine in St. Louis and the third author of the recent JAMA Psychiatry editorial.

Simple questions can help identify whether an older adult needs to be evaluated for anxiety, he and other experts suggested: Do you have recurrent worries that are hard to control? Are you having trouble sleeping? Have you been feeling more irritable, stressed, or nervous? Are you having trouble with concentration or thinking? Are you avoiding things you normally like to do because you’re wrapped up in your worries?

Stephen Snyder, 67, who lives in Zelienople, Pennsylvania, and was diagnosed with generalized anxiety disorder in March 2019, would answer “yes” to many of these queries. “I’m a Type A personality and I worry a lot about a lot of things — my family, my finances, the future,” he told me. “Also, I’ve tended to dwell on things that happened in the past and get all worked up.”

Treatments are effective. Psychotherapy — particularly cognitive behavioral therapy, which helps people address persistent negative thoughts — is generally considered the first line of anxiety treatment in older adults. In an evidence review for the task force, researchers noted that this type of therapy helps reduce anxiety in seniors seen in primary care settings.

Also recommended, Lenze noted, is relaxation therapy, which can involve deep breathing exercises, massage or music therapy, yoga, and progressive muscle relaxation.

Because mental health practitioners, especially those who specialize in seniors’ mental health, are extremely difficult to find, primary care physicians often recommend medications to ease anxiety. Two categories of drugs — antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — are typically prescribed, and both appear to help to older adults, experts said.

Frequently prescribed to older adults, but to be avoided by them, are benzodiazepines, a class of sedating medications such as Valium, Ativan, Xanax, and Klonopin. The American Geriatrics Society has warned medical providers not to use these in older adults, except when other therapies have failed, because they are addictive and significantly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairments.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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As a New Yorker, there’s a difference in whether it’s cold or “brick” outside. Cold weather is when you throw on a sweater before heading out. When it’s brick, you try to stay home as much as possible to avoid ending up like a human glacier. But the local lingo didn’t apply much this winter, with record-low snowfall and above-average temperatures across New York City.

A warm winter is more than just losing a few snow days. It’s knowing that the world will be dealing with more scorching heat waves and droughts, and natural disasters like the deadly flooding caused by Hurricane Ian in Florida and Cuba last year.

Climate change is only one of humanity’s long list of problems. This month we mark the third anniversary of the COVID pandemic, a disease that has killed millions worldwide and is becoming more chronic like the flu. On top of that, Turkey and Syria are still facing the aftershocks of a historically deadly earthquake, and soaring food prices from Russia’s invasion of Ukraine could worsen global hunger for years to come. 

[Related: How to manage your mental health as traumatic events pile up]

There seems to be no shortage of community-wide tragedies. Likewise, these events are taking a toll on people’s psyches. Whether conscious or subconscious, you might mourn a loss of safety and security, on top of the more obvious layers of sorrow. But these feelings can also help you be the change you need to move forward in this ever-evolving world.

Collective grief is both a shared and unique experience

Some tragedies, like a mass shooting or police brutality, resonate among an entire group of people. “Grief is a normal reaction to loss,” says Kriss Kevorkian, a thanatologist and founder of the counseling service, A Grieving World. “When it’s collective grief, we’re experiencing that on a larger scale with more people.”

Collective grief can take hold even if you don’t personally know the people directly affected. When the Uvlade school shooting occurred, there was a nationwide outpouring of anger and sorrow over the murders of the teachers and children. Violent events like these force you to rethink life and the safety of your family, says Kevorkian.

Younger generations have become the most vulnerable to collective grief, especially with environmental anxiety. Kevorkian says that government failure to stop climate change has caused children to become more helpless and apathetic. When young people like Greta Thunberg do speak out on climate change, they are mocked and subject to verbal abuse.

Your brain and body on grief

Grief doesn’t stay in one corner of your body—it consumes your entire being. You might feel more tired than usual from tossing and turning all night. Maybe you’ve lost your appetite or have trouble keeping food down. Research shows that the first few months of grief can affect your body’s immune system activity and increase your risk of blood clots.

When your mind is weighed down by sadness, anger, and loneliness, there is little space to focus on other matters. Having “grief brain” can make it feel like you’re in a fog. Everyday tasks such as watering the plants or taking out the trash become really challenging. As you try to process your loss, you might forget things like where you placed your keys or an important doctor’s appointment. 

Grief brain happens because your mind recognizes the stress and emotional trauma as a threat, triggering the entire body’s fight-or-flight response. Brain regions like the amygdala signal the alarm through stress hormones that elevate your heart rate and increase your blood pressure, upping your anxiety and panic to keep tabs on the stressor. 

When you don’t deal with the heavy emotion, your brain protects itself by going into constant survival mode. Believing it’s in danger, it allocates more energy and resources to fear centers like the amygdala. Your brain might also decide to escape the stressor by metaphorically running away. It might dissociate from daily happenings, for example, to give you a mental break from negative emotions. “Deciding how to approach your grief can foster healing as opposed to delaying it when we try to ignore or deny reality,” says Jasmine Cobb, a social worker specializing in grief and trauma at Visual Healing Therapeutic Services in Texas.

Consume your grief before it consumes you

The good news is that grief-related stress on the brain is reversible. Meditation and mindfulness can train you to focus on the present moment instead of reliving the past or dissociating from future threats. Going outside for a 30-minute walk instead of doom-scrolling or watching the news can help clear and calm the mind. Crying can also be a healthy release of stress as it releases feel-good hormones such as oxytocin and endorphins. 

There is no normal amount of time you’re supposed to grieve. You can spend months or years mourning, only for a news story or movie to trigger your pain all over again. “There are three words I really can’t stand, ‘get over it,’” says Kevorkian. “Grief never ends.” 

While time can help with the grieving process, it’s important that you’re actively working on your emotions and any unresolved issues related to the loss. Cobb says speaking with someone you can confide in is important, whether it’s a family friend, therapist, or a spiritual leader. There is also power in shared grief. People who have gone through a similar experience can help provide support in overcoming your grief. “Find your community who can hold a torch for you when you’re unable to do that for yourself,” advises Cobb.

Turning collective grief into collective action

Grief is one of life’s greatest teachers, says Kevorkian. It shows you how to live in the present and appreciate all that you have right now. Beyond acceptance, taking action can help you wrestle with some of the hopelessness you might feel when dealing with events out of your control, Kevorkian explains.

[Related: The biggest tool we have to fight climate anxiety is community]

One example of a group turning pain into lasting change is Mothers Against Drunk Driving (MADD). In 1980, 13-year-old Cari Lightner was killed by a drunk driver—a man who had just gotten out of jail two days after his fourth DUI arrest. For the next few years, Cari’s mother, Candace, used her daughter’s photo and story of her accident to raise awareness and change California traffic safety laws. Candace went on to form MADD, a political-advocacy group that gives other grieving parents the opportunity to feel like their tragedy was not in vain. 

“It’s easy for us to stay in bed under the covers and wallow in despair,” says Kevorkian. But finding the courage to take action can help you get out of your head and connect with others sharing similar distress. Hopefully, with time and work, the world will seem a little less bleak.

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The month of March brings with it the third anniversary of COVID-19 shutdowns beginning in the United States. The year 2020 became synonymous with change and fear, as major sporting events were canceled, thousands were infected with the novel virus and died, and work and school shifted online for millions. The world changed forever–especially for children.

In a survey of parents conducted in the fall of 2022 by Pew Research Center, 48 percent of parents with children in grades K-12 said that the first year of the pandemic had a very or somewhat negative impact on their children’s emotional well-being. Additionally, a 2022 review of survey studies by the National Institutes of Health (NIH) found that “the impact of the COVID-19 pandemic on mental health of children and adolescents is multifaceted and substantial,” and urged more well-designed studies looking at the mental health effects of the pandemic. 

[Related: COVID-19 vaccines are still essential in preventing death in children and teens.]

Now, a group of researchers in Sweden is turning to children’s drawings and their own explanation of what they drew to get a better sense of their feelings, beliefs, and ideas about COVID-19. A small study published March 2 in the journal Acta Paediatrica found that the common themes were detailed images of canceled activities, illness, and death, and the children had quite a bit of knowledge about the disease.

The team collected 91 drawings from kids between the ages of four and six years-old that were submitted to the Swedish Archive of Children’s Drawings between April 2020 and February 2021. The project was part of investigations into children’s voices in the public space during the pandemic.

“It was a very fun study to carry out. I was actually quite uncertain as to whether a medical journal would publish the article, but they did, including the children’s drawings and everything,” co-author Anna Sarkadi said in a statement. Sarkadi is a physician specializing in children’s health and social medicine from Uppsala University in Sweden

They analyzed the drawings using a type of visual analysis called semiotic visual analysis which looks at the image’s denotation (what images represent and how) and connotation (the associated meaning). The analysis also looked at the child’s own explanations accompanying the drawings.

The findings revealed that even the youngest children were strongly affected by the pandemic. In addition to canceled plans and images showing sick and dying people, fear, worry, and missing grandparents were common themes among them. Coronavirus was often described as a monster, while other children described how to protect themselves from the virus. One drawing even showed two children in a sword fight against a giant virus.

[Related: It’s harder for kids with food allergies to catch COVID.]

“The drawings were often covered in a lot of snot. On one drawing, a child wrote, ‘You throw up, then you cough, then you feel better or die,’ with extremely clear illustrations,” explained Maria Thell, a co-author and doctoral student at Uppsala University, in a statement. 

The study found that the children also know quite a bit about the virus, including how it spread and its symptoms. Out of 91 drawings, 14 showed hand washing, 17 showed symptoms like coughing, and 44 showed a depiction of the virus itself. 

“As a researcher with a background in child and youth science, I would love to develop this method further,” said Thell.

This team’s research will continue and the drawings from seven to 11 year old children will be studied next. 

“By encouraging young children to draw pictures using open prompts, such as how a disease feels, looks like or what is different now, it is possible to understand their interpretations of a situation and related emotions,” the authors write in the study. 

Additionally, they write that pediatricians can use children’s drawings to gage emotional response to COVID-19 in addition to other health issues and get a unique glimpse into their world. This can help adults have a better idea of what kids understand or don’t understand and detect any “unhelpful fantasies’ they may have conjured up. 

A survey of children in the United Kingdom found that seven to 11 year-olds were highly aware of the social restriction, illness, and death caused by the virus and similar reviews of children’s drawings have been conducted in Spain and Greece.

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If you’ve ever been pleasant to a rude customer while waiting tables, smiled through a friend’s wedding despite disliking their choice of spouse, or graciously received a truly ugly sweater as a gift, you’ve participated in a display rule. This is hiding a negative emotion usually to promote harmony between two individuals and the rules differ by culture. However, they can have negative consequences for the person suppressing a negative emotion or opinion. 

As daily interactions become increasingly virtual, display rules are changing. A group of researchers from the University of Tokyo in Japan set out to answer the questions of how emojis are used to reflect emotions in different contexts, if the same display rules apply to emojis, and how they affect a person’s well being. 

[Related: Meet the newest Apple emojis: a goose, a moose, and another pink heart.]

“As online socializing becomes more prevalent, people have become accustomed to embellishing their expressions and scrutinizing the appropriateness of their communication,” said Moyu Liu, a PhD student studying emotional management in online spaces at the University of Tokyo, in a statement. “However, I realized that this may lead us to lose touch with our authentic emotions.”

Liu is the co-author of a small study published March 3 in the journal Frontiers in Psychology, that found that emojis were used to both express positive feelings and soften the more negative ones–such as not liking a friend’s piece of art.

Earlier research established that emojis serve as functional equivalents of facial expressions, but it didn’t look at the relationships between emotions expressed and experienced. It’s here that display rules can be problematic—if there is too much of a dissonance between the emotions that you experience and the emotions that you express, it can lead to emotional exhaustion. 

To try to answer this question, Liu’s study observed 1,289 participants who use Simeji, the most-downloaded emoji keyboard in Japan, and how the emojis were used to either express an emotion or mask it. 

The participants provided demographic data, answered questions about their subjective well being, and rated how often they use emojis. They were also given messages with different social contexts and asked to respond to them as they would normally, and then rated the intensity of the expression of their emotions.

[Related: AI moderators can’t keep up with vaccine disinformation’s newest language: emojis.]

The study found that texters chose to express more emotions via emoji with people in a private context or with a close friend. The respondents expressed the least amount of emotion with higher-status individuals. The most intense expressions of emotion came with matching emojis, unless the respondents felt the need to mask their true feelings, such as using a smiling emoji to mask sadness. 

Only when negative feelings were very strongly felt did the respondents use a negative emoji. Additionally, using emojis to express emotions was associated with higher subjective well being compared to masking emotions.

Liu would like to expand this study with a larger and more varied sample, including more males since the Simeji keyboard is more popular among young women and from different cultural backgrounds.

“First, the highly gender-imbalanced sample may have led to stronger results. Future research should explore potential gender differences in emoji display rules and examine the structural issues surrounding the formation of these emotion cultures,” cautioned Liu. “Second, Japanese culture’s emphasis on interpersonal harmony and concealment of negative emotions may have influenced the results.”

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When the wintry mix makes going outside unpleasant, the couch and a good book are tempting. But think: if you start your spring cleaning now, you’ll be able to enjoy the first warm days of the season outside smelling flowers instead of inside scrubbing floors.

Untidy spaces in particular seem to have a harmful effect on your mood and health. As a 2017 article in Psychology Today noted, clutter can interrupt “both your ability to move and your ability to think.”

[Related: A complete guide to digital spring cleaning]

Plus, it turns out people who regularly tidy up are getting a fair amount of light physical activity. That’s good if one of your New Year’s resolutions was to decrease the number on the scale, but cleaning also offers the benefit of space in your home to do things like rolling out the yoga mat or firing up an exercise video, doubling down on the physical benefits of a tidier space.

And if you start your spring cleaning now, it’ll give you an edge when warmer weather rolls around. Nearly 80 percent of households in the US ring in the new season with spring cleaning, and tackling what you can now means there will be less to do when you’d rather be outside. Some tasks, though, like washing windows, should probably still wait until you’re in significantly above-freezing temperatures.

Next, consider what you’ve accumulated—gifts, trinkets, and toys—over the past year and pare down items that serve similar purposes. For example, if you got a new phone or computer for Christmas, donate the old one. Be sure to include any cords and chargers, and consider including a pre-paid minutes card if you can afford it.

That said, don’t declare this the weekend you finally scour all the stain off every tile in your kitchen. Break a big task into more digestible chunks and tackle those grout stains a row or two at a time. Taking smaller steps will also let you know what “clean” and “tidy” mean to you—your place doesn’t have to look like an apartment straight out of #cleantok to be functional for you.

Give yourself a flexible deadline and bend the scope of the task to accommodate. Instead of having that shelf in order and the books to be donated out the door by the first day of spring, set a steady, regular pace that you can pick up and put down as you need. Even if the big stuff isn’t complete by the time the robins come back, it’ll still be much closer to being done than it was before.

Finally, consider tackling multiple projects on a rotating basis. A 2015 survey conducted by Microsoft in Canada showed that our attention spans have dropped substantially in the past decades—from 12 seconds in 2000 to 8 seconds in 2013. But switching things up keeps us more productive for longer. For work that’s repetitive or doesn’t need your full attention, multitasking and doing it in “small bites” can also help.

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The death of Tyre Nichols at the hands of Memphis police earlier this year has set off new questions about what public safety really means in America. While the five former officers are being charged for Nichol’s murder, there’s been scrutiny over how EMS responders handled the victim’s injuries after arriving on the scene.

On the night of January 7, paramedics responded to a call of a person being pepper sprayed. Despite the man laying bloody and in distress against a police vehicle, they failed to make their own assessment of the patient beyond what the officers told them. It took another 19 minutes for the EMTs to bring a stretcher out for him. 

The mistreatment Nichols endured from people trained to save lives is a grave reminder that America is built on a system designed to treat minority communities differently. One in every 1,000 Black men in the US will be killed by law enforcement, estimates a 2019 criminal justice study. Among young Black men between 25 and 29, police brutality ranks as the sixth leading cause of death. And more than half of police brutality cases go unreported, especially when they involve Black people. 

[Related: Racism is undeniably a public health issue]

In the wake of Nichols’s murder, medical organizations like the Association of American Medical Colleges released statements condemning the violence. But they didn’t address the fact that fear of being harmed by figures of authority can also carry over to medical institutions and personnel. Sirry Alang, an associate professor of Black Communities & the Social Determinants of Health at the University of Pittsburgh School of Education, says police brutality must be considered a public health crisis. “Police brutality literally kills people. It causes death and disability and it shifts relationships with healthcare providers that make people less likely to seek care.”

The roots of medical mistrust

Medical mistrust is the belief that people working in the medical field want to harm you or don’t have your best interests at heart. Alang says it tends to come from the concern of being treated differently because you are affiliated with a specific racial or gender group. 

Medical mistrust has been justified through American history. From the 1930s to the 1970s, public health researchers with the Tuskegee syphilis study infected hundreds of healthy Black men and intentionally withheld treatment when penicillin became available. What’s more, the bogus science of eugenics promoted the forced sterilization of thousands of people of color in the 20th century. 

Mistrust has also arisen, in part, because of the prejudices workers at medical institutions hold against certain groups of people. For example, Black patients are less likely to be prescribed pain medication than white patients, even if they are experiencing the same level of pain, because of a deep-rooted stereotype that they have “thicker skin.” The US mortality rate among Black mothers from complications during pregnancy is also three times higher than that of white mothers, in part because of the failure of doctors to understand the pain of Black women.

“People don’t seek healthcare as individuals,” explains Alang—their choices are shaped by personal experience and the experiences of others in their community. “One bad experience can influence the expectations of others in that network and make it easy for medical distrust to spread.”

Cycles of violence, trauma, and more mistrust 

Experiencing police brutality creates traumatic racial experiences that can subvert a person’s belief on what to expect when dealing with a figure of authority. Think about the end of an abusive romantic relationship. Even if you moved on, you might always be wary of your new partner and whether they’ll behave just as badly. Similarly, a traumatic experience with the police keeps you on edge of being mistreated in other areas. 

“If people in authoritative roles have showed they don’t respect you, you’ll be more suspicious of other authority figures like healthcare providers,” says Georges Benjamin, the executive director for the American Public Health Association. What’s more, exposure to police violence can force survivors to develop feelings of hopelessness and worthlessness and further convince them to avoid care—even when they need it.

[Related: Teen girls and queer youth are facing a crisis of hopelessness]

Another issue is that healthcare institutions support a broken public-safety system that often works against those who need it. Take emergency medical dispatches, for example. First responders tend to talk to the officer at the scene first instead of speaking with the harmed individual to figure out what happened. “They then come to you like an object it has to fix instead of a person,” says Alang. 

Crumbling police-community relations

The stress and trauma that comes from the threat of police brutality can cause long-term stress that wears down the body over time. For example, a 2016 study of Black residents living in highly policed areas of New York City found they were more likely to have poor health outcomes such as high blood pressure, regardless of whether or not officers stopped them. Benjamin says that the perception that law enforcement is not actually there to protect you can create community stress that keeps your body in a constant fight-or-flight mode.

Constant stress contributes to a higher risk of heart disease, stroke, and diabetes, along with a number of mental health conditions. But when people are apprehensive about how they will be treated for “overreacting” to the constant threat of police brutality, Alang says they are more likely to skip out on seeing or talking to their doctor about the source of their stress and trauma. They might also be less likely to adhere to medication or treatment plan. “The relationship between a healthcare provider and a patient is one of fundamental trust,” Benjamin explains. “If you don’t trust that individual, you might have some suspicions on their advice or you may not believe what they told you.”

Building a safer public health system

Reducing police violence is just one part of fixing medical mistrust; hospital, EMS groups, and public health organizations need to actively build rapport with communities grieving the loss of their members. Alang says putting out anti-racist press statements after a violent incident does little to reassure the public. Instead, both she and Benjamin advise medical institutions to take action in ways that make people feel heard or supported. 

This can come from changes like hiring a healthcare workforce that represents the patient population it’s treating, and setting up accessible mental health programs focused on addressing trauma and stress. Benjamin adds that medical institutions can work with law enforcement to build out community-based policing, including teaching them how to interact with people under stress. “Public health is not going to [completely] solve this police violence problem,” he says. “But we are part of the solution.”

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For some workers, every weekend being a long weekend sounds like a dream. As it turns out, a  four-day work week trial from the United Kingdom analyzing nearly 3,000 workers across 61 companies is adding to the pile of evidence that demonstrates how a a reduction of hours is good for employees, the bottom line, and possibly the planet itself.

From June to December 2022, the studied employees worked 80 percent of their usual hours without a reduction in pay. In exchange, they promised to deliver 100 percent of their usual workload. According to 4 Day Week Global (4DWG) and 4 Day Week Campaign, the nonprofit organizations that organized the trial, this is the largest number of companies to participate in this kind of research. Researchers from the University of Cambridge, Boston College in Massachusetts, and workplace research group Autonomy oversaw data collection, interviews, and the analysis.

[Related: Essential tips and tools for working remotely—from anywhere.]

Employees were surveyed throughout the trial to gauge what an extra day of free time does for workers. The results were published today with 1,238 workers completing a final survey about their experience.

About 71 percent of employees reported lower levels of burnout, with 39 percent reporting less stress compared with the beginning of the trial. Sick days were reduced by 65 percent and there was a 57 percent drop in staff turnover compared to June to December 2021. 

Roughly 60 percent of employees found it easier to balance work and homelife. 62 percent of employees reported it easier to combine work with social life. 

“Before the trial, many questioned whether we would see an increase in productivity to offset the reduction in working time – but this is exactly what we found,” said sociologist Brendan Burchell, who led the University of Cambridge’s side of the research, in a statement. “Many employees were very keen to find efficiency gains themselves. Long meetings with too many people were cut short or ditched completely. Workers were much less inclined to kill time, and actively sought out technologies that improved their productivity.”

Company revenue barely changed, and even showed a marginal increase by 1.4 percent on average.

Additionally, male-identifying workers reported spending 27 percent more time taking care of their children, based on time diaries that were logged during the trial. Female-identifying  participants reported 13 percent increase in childcare.

“It is wonderful to see that we can shift the dial and start to create more balance of care duties in households,” Charlotte Lockhart, founder and managing director of 4DWG, told CNN.

[Related: Burnout is real. Here’s how to spot it—and recover.]

A day off in the middle of the week meant some savings on childcare expenses for some of the parents of young children. For parents with older children, it meant some more general free time. 

There were also some benefits for the planet. Simon Ursell, a founder of Tyler Grange, an environmental consultant group that participated in the trial, told the BBC, “On average we saw a 21 percent reduction in the number of miles traveled by car.” Tyler Grange cut out unnecessary meetings and travel and Ursell says some employees used additional days off to become more involved in volunteering.

The organizations that took part in the trial included a wide range of companies and sectors including online retailers, financial service providers, animation studios, housing, marketing firms, healthcare, and a fish and chip shop. About 92 percent of companies that took part in this pilot program said that they intend to continue a four-day work week and 18 companies confirmed the permanent change.

“We feel really encouraged by the results, which showed the many ways companies were turning the four-day week from a dream into realistic policy, with multiple benefits,” said David Frayne, a Research Associate at the University of Cambridge, in a statement. 

As calls for a shorter work week have increased, some lawmakers in the United States are  willing to put the state behind it to test its merits. Maryland legislators have proposed a bill (House Bill 181) that will encourage qualifying businesses that have at least 30 employees to implement a 4-day work week (without reduction in pay), as part of a 5-year pilot program. Companies would receive a tax credit to help maintain wages. If it passes, Maryland will be the first state to encourage a 32 hour work week.

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Adolescence and its raging hormones and major physical and emotional changes has always been a fraught period of time. Add onto that the threats of climate change, constant mass shootings, the COVID-19 pandemic, and continued societal injustice and it’s a hard time to be young in the United States. The data collected in the 2021 Youth Risk Behavior Survey is revealing just how “engulfed” in violence and trauma teens are, especially teenage girls.

Nearly one in three high school-aged girls reported 2021 that they seriously considered suicide in 2021. This is a huge jump of nearly 60 percent from a decade ago, according to new data released from the Centers for Disease Control and Prevention (CDC) on February 13. Teen girls additionally reported experiencing distress at twice the rate of teen boys. 

The YRBS also found increased rates of mental health issues and suicidal behavior among teens who identified as lesbian, gay, bisexual, or questioning.

[Related: Some teenagers’ brains have been aging faster during the pandemic.]

“High school should be a time for trailblazing, not trauma. These data show our kids need far more support to cope, hope, and thrive,” said Debra Houry, CDC’s Chief Medical Officer and Deputy Director for Program and Science, in a statement. “Proven school prevention programs can offer teens a vital lifeline in these growing waves of trauma.”

The YRBS is conducted every other year, but this survey done in fall of 2021 was an especially crucial one. It is the first iteration of the survey where the COVID-19 pandemic was a factor. The pandemic has taken a toll on teenagers, many of whom were already struggling with mental health issues before the pandemic began. Many were dealing with social media pressures, family turmoil, the deaths of family members to COVID-19, and isolation. “These data make it clear that young people in the U.S. are collectively experiencing a level of distress that calls on us to act,” the authors wrote.

The survey asks teens about substance abuse, mental health, sexual behaviors, among other topics. The 2021 survey was also the first to ask about the social determinants of health (housing stability, food insecurity, etc.) and protective factors including parental involvement and connections with classmates. 

Youth mental health has continued to get worse over the three decades that the CDC has been gathering data on adolescents and the American Academy of Pediatrics declared a national emergency in child and adolescent mental health in 2021 and 2022. This new survey found particularly stark increases in widespread reports of harmful experiences among teen girls.

The report found that about 18 percent of teenage girls reported experiencing sexual violence. a 20 percent increase from 2017. More than 14 percent reported being forced to have sex, a 27 percent increase since 2019. 

“If you think about every 10 teen girls that you know, at least one and possibly more has been raped, and that is the highest level we’ve ever seen,” Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, told The Washington Post. She also said that the the rise of sexual violence almost certainly contributed to the glaring spike of depressive symptoms. “We are really alarmed.”

[Related: Gender-affirming hormones can improve teens’ mental health and life satisfaction.]

Worsening levels of persistent sadness or hopelessness were found across all racial and ethnic groups, with an increase in suicide attempts among Black and White youth. However, Black and Hispanic students were more likely than their White or Asian classmates to avoid school due to safety concerns. White students were also more likely to experience sexual violence than Asian, Black, and Hispanic students, and they were the only group to see an increase in sexual violence. Alaska Native and American Indian high school students were more likely than other racial or ethnics groups to have been raped.

Close to 70 percent of LGBQ+ students reported feeling persistently sad or hopeless and more than one in five had attempted suicide in the past year. The 2021 survey did not have a question assessing gender identity and did not highlight data specifically on students who identify as transgender, so the  “T” commonly used in the acronym LGBTQ+ was not included when referring to the data. However, the authors believe that strategies to improve adolescent health should be inclusive of all youth who identify as LGBTQ+.

Some of the positive findings of the new survey were that teens experienced lower rates of certain risky sexual behaviors (including general sexual activity and having multiple sex partners), substance abuse, and bullying at school.

The researchers wrote that schools can play a major role in helping address these issues through offering programs and connections that can protect against adverse mental health issues, such as youth development programs and inclusivity efforts. They also said that schools can link students and families with community resources and provide more mental, physical, and sexual health education. 

Contact the 988 Suicide & Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support. Call or text 988. Chat at 988lifeline.org. Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365. Visit the 988 Suicide & Crisis Lifeline for more information at 988lifeline.org.

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When the COVID-19 pandemic shut down normal life in 2020, nature became a refuge for many people  cooped up inside. As pandemic related travel disturbances continued, the National Park Service saw record numbers of visitors, as spending time outdoors was safer in terms of virus spread.

Even when a pandemic isn’t raging, spending time outside reduces stress, improves cognition, and can help us sleep better. All of this can help people lead happy, healthy, and productive lives, which helps the economy and lowers healthcare costs. 

[Related: Nature saves us trillions of dollars in healthcare.]

Citizen science has been designed to use people power for the benefit of scientific knowledge, but it can also help the citizens doing the science as well. A study published February 9 in the journal People and Nature found that involvement in citizen science boosts wellbeing and connection to nature for participants. 

“People connect with nature in different ways, so it’s great to see nature-based citizen science can provide another form of active engagement that can strengthen the human-nature relationship,” said study co-author Miles Richardson from the Nature Connectedness Research Group at the University of Derby in the UK, in a statement. “When combined with noticing the positive emotions nature can bring, citizen science and help unite both human and nature’s wellbeing.”

The study was conducted during pandemic lockdowns in 2020 by the UK Centre for Ecology & Hydrology (UKCEH), the University of Derby, and the British Science Association. Five hundred volunteers from across the United Kingdom were randomly assigned to carry out a 10-minute nature-based activity at least five times over a period of eight days: a survey of pollinating insects, a butterfly survey, spending time in nature and jotting down three good things they noticed, or a combination of both. 

Researchers surveyed the participants both before and after the citizen scientists went out into nature, as a way to assess differences in connection to nature, well being, and pro-nature behavior. 

After completing their assignments, the researchers found that all volunteers showed increased scores in feeling connected to nature. 

“It gave me permission to slow down,” wrote one participant. 

“It made me more aware of nature in all aspects of the environment,” said another. 

“It reminded me that small things can make a big difference to my mood,” observed another volunteer.

[Related: Birders behold: Cornell’s Merlin app is now a one-stop shop for bird identification.]

The volunteers who wrote down the three good things they noticed while out in nature.Those who also combined those three positive things with nature recording activities (like counting pollinating insects) said that they were more likely to adopt more pro-nature behaviors beyond their involvement with this study. Some of those behaviors involved planting more pollinator friendly plants in their own gardens or helping build wildlife shelters. 

“Being in and around nature is good for our wellbeing, and we’ve shown that focused, active engagement with nature is just as important – whether that is ‘mindful moments’ in nature or taking part in citizen science,” said Michael Pocock, ecologist and academic lead for public engagement with research at UKCEH, in a statement. “This has been a valuable exercise for us in exploring how we can make citizen science even better. We now know that if we design future projects with additional nature-noticing activities, for example, we can enhance people’s own connection to nature, while still collecting valuable data.”

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County prosecutors charged former labor and delivery nurse Lindsay Clancy with first-degree murder and three counts of strangulation on Tuesday, after the alleged killing of her three children in Duxbury, Massachusetts. Clancy, who has pleaded not guilty, underwent a psychiatric evaluation before her arraignment. Clancy’s lawyer is arguing that the mother was not in the right state of mind at the time of the killing, citing “overmedication” for issues with maternal mental health.

Although there has been no official diagnosis yet, her defense attorney has suggested Clancy has a rare disorder called postpartum psychosis. A major symptom of the condition, which occurs once or twice among every 1,000 people who give birth, is that a person loses their sense of reality after pregnancy. 

People may develop postpartum psychosis quickly, immediately following the delivery or within the first week following birth, says Ariadna Forray, an expert in postpartum maternal mental health psychiatry at Yale School of Medicine. Although it can cause severe mental illness that, if left untreated, could potentially bring harm to the individual and others, Forray says “it’s rare for women to develop postpartum psychosis, and it’s even rarer to have women act out on their symptoms.” And while Clancy was reportedly taking treatments for postpartum depression, which is far more common, months before the killing, the condition itself is very different from postpartum psychosis.

What are the signs of postpartum psychosis?

People with the disorder show sudden mood fluctuations. One moment, they might feel jittery and highly energetic, and then the next moment, they may seem sluggish and more irritable than usual. “It’s your brain’s extreme reaction to having a baby,” explains Allison Lieberman, a marriage and family therapist who specializes in postpartum depression and psychosis at the online mental health platform Choosing Therapy. Chemical and hormonal shifts from childbirth, along with the stress of being a parent, can trigger a mother’s brain to have a “survival reaction,” she says.

Postpartum psychosis can be hard to recognize at first, because a mother’s physical and emotional changes often result from typical tasks like caring for a newborn baby. Parents rarely get much sleep in the first few months and often show dips in energy and appetite. 

[Related: Meditation isn’t always calming. For a select few, it may lead to psychosis.]

Specific risk factors associated with the condition are not well understood, because it’s so rare. But the most important symptoms to watch out for are confusion and disoriented thoughts that signal a loss of touch with reality. For example, parents may create delusions about the baby being sick when the child is perfectly healthy. They could convince themselves that the only way to help is to harm. “It’s the difference between knowing the intrusive thoughts are real versus not real,” says Lieberman. “Even if you think ‘I’m going to throw my baby down the stairs,’ that’s not necessarily psychosis if it disturbs you.”

However, both Lieberman and Forray stress that having postpartum psychosis does not automatically make you a violent person. In Lindsay Clancy’s case, the defense team is arguing she killed her children because a voice compelled her to do it. 

Is postpartum psychosis a symptom of postpartum depression?

No, they are unrelated to each other. The only connection is that both conditions occur after delivery. 

Postpartum depression is a medical condition where people who give birth experience intense feelings of sadness, hopelessness, and low mood within the first four weeks after delivery. Lieberman says it’s a longer and more intense version of the :baby blues,: because the condition interferes with a mother’s ability to care for themselves. “There’s this extra level of guilt that’s associated with not being able to be the parent you want to be and not enjoying parenthood,” Lieberman says. 

[Related: We don’t really know how many pregnant people are dying in the US]

Postpartum depression is common. It affects one in seven people who give birth, though many cases go undiagnosed because of the stigma and fear of being judged. Lindsay Clancy allegedly was taking 12 prescription drugs for multiple mood disorders, including postpartum depression. However, both Lieberman and Forray say it is not possible for postpartum depression to manifest into postpartum psychosis. 

While depression may cause new mothers to exhibit mood swings, postpartum psychosis is considered a type of bipolar disorder. “An estimated 70 to 80 percent of cases are related to bipolar disorder,” Forray says. Research suggests that having a history of the manic illness puts someone at a higher risk of developing postpartum psychosis after giving birth.

How is postpartum psychosis treated?

While delusions and hallucinations can take on many forms, the majority do not cause an individual to become violent. If there is evidence of postpartum psychosis in a patient, the best plan is to prevent the condition from worsening and avoiding escalation to acting out on these delusional thoughts. 

People with suspected postpartum psychosis need to be admitted to a psychiatric hospitalization where they can be assessed by a mental health expert, Forray says. Depending on the symptoms, they might then be prescribed medications such as a mood stabilizer or an antipsychotic. Another modern-day and safe alternative is electroconvulsive therapy. Research has shown the therapy helps to improve the severity of symptoms. “There’s a whole host of treatments that can be very effective,” Forray says. “And women start doing better as soon as treatment starts.”

With immediate medical intervention and the right support, it is possible to recover from postpartum psychosis. If you or someone you know is experiencing a mental health crisis, consider texting HOME to 741741 to reach the National Crisis Text Line or dialing 988 to the National Suicide Prevention Hotline. The services are free, confidential, and equipped with staff trained to get you the help you need.

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Over the past seven years, Allegheny County Department of Human Services workers have frequently employed an AI predictive risk modeling program to aid in assessing children’s risk factors for being placed into the greater Pittsburgh area’s foster care system. In recent months, however, the underlying algorithms behind the Allegheny Family Screening Tool (AFST) have received increased scrutiny over their opaque design, taking into account predictive AI tools’ longstanding racial, class, and gender-based biases.

Previous delving into the Allegheny Family Screening Tool’s algorithm by the Associate Press revealed certain data points could be interpreted as stand-in descriptions for racial groups. But  now it appears the AFST could also be affecting families within the disabled community as well as families  with a history of mental health conditions. And the Justice Department is taking notice.

[Related: The White House’s new ‘AI Bill of Rights’ plans to tackle racist and biased algorithms.]

According to a new report published today from the Associated Press, multiple formal complaints regarding the AFST have been filed via the Justice Dept.’s Civil Rights Division, citing the AP’s prior investigations into its potential problems. Anonymous sources within the Justice Dept. say officials are concerned that the AFST’s overreliance on potentially skewed historical data risks “automating past inequalities,” particularly long standing biases against people with disabilities and mental health problems.

The AP explains the Allegheny Family Screening Tool utilizes a “pioneering” AI program designed to supposedly help overworked social workers in the greater Pittsburgh area determine which families require further investigation regarding child welfare claims. More specifically, the tool was crafted to aid in predicting the potential risk of a child being placed into foster care within two years of following an investigation into their family environment.

The AFST’s black box design reportedly takes into account numerous case factors, including “personal data and birth, Medicaid, substance abuse, mental health, jail and probation records, among other government data sets,” to determine further investigations for neglect. Although human social service workers ultimately decide whether or not to follow up on cases following the AFST algorithm results, critics argue the program’s potentially faulty judgments could influence the employees’ decisions.

[Related: The racist history behind using biology in criminology.]

A spokesman for the Allegheny County Department of Human Services told the AP they were not aware of any Justice Department complaints, nor were they willing to discuss the larger criticisms regarding the screening tool.

Child protective services systems have long faced extensive criticisms regarding both their overall effectiveness, as well as the disproportional consequences faced by Black, disabled, poor, and otherwise marginalized families. The AFST’s official website heavily features third-party studies, reports, and articles attesting to the program’s supposed reliability and utility.

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Feeling flat or emotionally unavailable can be a common side-effect of serotonin reuptake inhibitors (SSRIs), a widely used class of anti-depressants. About 40 to 60 percent of patients taking SSRI’s are believed to experience limited enjoyment or feel emotionally dull.

A small study published January 22 in the journal Neuropsychopharmacology is shedding light on why this “emotional blunting,” or the dulling of both good and bad emotions, may happen. The study finds that the drugs affect reinforcement learning, which allows us to learn from our environment and actions.

[Related: The first new FDA-approved antidepressant in decades goes up your nose.]

“Emotional blunting is a common side effect of SSRI antidepressants. In a way, this may be in part how they work—they take away some of the emotional pain that people who experience depression feel, but, unfortunately, it seems that they also take away some of the enjoyment,” said Professor Barbara Sahakian, a co-author and professor of psychology the University of Cambridge, in a statement. “From our study, we can now see that this is because they become less sensitive to rewards, which provide important feedback.”

SSRIs target serotonin, a chemical in the brain called the “pleasure chemical” or the “happiness molecule” that carries messages between nerve cells. According to the National Health Service (NHS), more than 8.3 million patients in England received an antidepressant during 2021 and 2022. In the United States, prescriptions for anti-anxiety and antidepressants increased by an estimated 21 percent following the COVID-19 pandemic.

A team led by researchers at the University of Cambridge and the University of Copenhagen looked into the long term clinical use of SSRIs. They recruited 66 healthy volunteers and gave 32 of them an SSRI called escitalopram and the other 34 took a placebo. According to the team, this drug is known to be one of the best-tolerated antidepressants available on the market and the study participants took them over 21 days.

The participants completed self-reported questionnaires and were given a series of tests that assessed learning, inhibition, executive function, reinforcement behavior, and decision-making.

In terms of attention and memory (also called ‘cold’ cognition), there were no significant differences. There also weren’t any differences in ‘hot’ cognition, or the cognitive functions that involve emotions.

The key novel finding of the tests was a reduced reinforcement sensitivity on two tasks for the group taking escitalopram compared to those taking the placebo.

[Related: A link to depression might be in your gut bacteria.]

The team used a probabilistic reversal test, where a participant was shown two stimuli (A and B). If they chose A, they would receive a reward four out of five times. If they chose B, they would only get a reward one time out of five. The participants weren’t told this rule, but would have to figure it out themselves. At some point during the test, the probabilities would switch, forcing participants to learn a new rule.

Compared with those taking the placebo, the participants taking escitalopram were less likely to use both the positive and negative feedback to guide their learning of the task. The participants on the antidepressants were 23 percent less sensitive to this stimuli switch, which suggests that escitalopram affected sensitivity to the rewards and the individual’s ability to respond accordingly.

This could also explain one big difference the team found in the self-reported questionnaires: volunteers taking escitalopram had more difficulty reaching orgasm when having sex, a widely-reported side effect of the medication.

“Our findings provide important evidence for the role of serotonin in reinforcement learning,” said Christelle Langley, a co-author also from the Cambridge Department of Psychiatry, in a statement. “We are following this work up with a study examining neuroimaging data to understand how escitalopram affects the brain during reward learning.”

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Content moderation is a notoriously nasty job, and the burgeoning labor outsourcing industry surrounding it routinely faces heated scrutiny for the ethics of its approach to subjecting human workers to the internet’s darkest corners. On Wednesday, Time published a new investigative deep dive into Sama, a company that recently provided OpenAI with laborers solely tasked with reading some of the worst content the internet has to offer.

Although the endeavor’s overall goal was to develop helpful and necessary internal AI filters for the popular, buzzworthy ChatGPT program, former Sama employees say they now suffer from PTSD from their tenures sifting through thousands of horrid online text excerpts describing sexual assault, incest, bestiality, child abuse, torture, and murder, according to the new report.  Not to mention, the report states that these employees, largely based in Kenya, were paid less than $2 an hour.

[Related: Popular youth mental health service faces backlash after experimenting with AI-chatbot advice.]

OpenAI’s ChatGPT quickly became one of last year’s most talked about technological breakthroughs for its ability to near instantaneously generate creative text from virtually any human prompt. While similar programs already exist, they have been frequently prone to spewing hateful and downright abusive content due to their inability to internally identify toxic material amid the troves of internet writing utilized as generative reference points.

With already well over 1 million users, ChatGPT has been largely free of such issues (although many other worries remain), largely thanks to an additional built-in AI filtering system meant to omit much of the internet’s awfulness. But despite their utility, current AI programs aren’t self-aware enough to notice inappropriate material on their own—they first require training from humans to flag all sorts of contextual keywords and subject matter. 

Billed on its homepage as an “the next era of AI development,” Sama, a US-based data-labeling company that employs workers in Kenya, India, and Uganda for Silicon Valley businesses, claims to have helped over 50,000 people around the world rise above poverty via its employment opportunities. According to Time’s research sourced via hundreds of pages of internal documents, contracts, and worker pay stubs, however, the cost for dozens of workers amounted to self-described “torture” for takehome hourly rates of anywhere between $1.32 and $2.

[Related: OpenAI’s new chatbot offers solid conversations and fewer hot takes.]

Workers allege to Time that they worked far past their assigned hours, sifting through 150-250 disturbing text passages per day and flagging the content for ChatGPT’s AI filter training. Although wellness counselor services were reportedly available, Sama’s employees nevertheless experienced lingering emotional and mental tolls that exceeded those services’ capabilities. In a statement provided to Time, Sama disputes the workload, and said their contractors were only expected to review around 70 texts a shift.

“These companies present AI and automation to us as though it eliminates workers, but in reality that’s rarely the case,” Paris Marx, a tech culture critic and author of Road to Nowhere: What Silicon Valley Gets Wrong About Transportation, explains to PopSci. “… It’s the story of the Facebook content moderators all over again—some of which were also hired in Kenya by Sama.”

Marx argues the only way to avoid these kinds of mental and physical exploitation would require a massive cultural reworking within the tech industry, something that currently feels very unlikely. “This is the model of AI development that these companies have chosen,” they write, “[and] changing it would require completely upending the goals and foundational assumptions of what they’re doing.”

Sama initially entered into content moderation contracts with OpenAI amounting to $200,000 surrounding the project, but reportedly cut ties early to focus instead on “computer vision data annotation solutions.” OpenAI is currently in talks with investors to raise funding at a $29 billion valuation, $10 billion of which could come from Microsoft. Reuters previously reported OpenAI expects $200 million in revenue this year, and upwards of $1 billion in 2024. As the latest exposé reveals yet again, these profits frequently come at major behind-the-scenes costs for everyday laborers.

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Access to gender-affirming hormones significantly improves the mental health and overall life satisfaction of transgender and nonbinary teens, finds a new study published January 18 in The New England Journal of Medicine. In one of the longest and largest studies looking at psychological outcomes, the authors’ conclusions further support the idea of gender-affirming care as a life-saving treatment.

“The authors provide a compelling defense for maintaining access to gender-affirming care for adolescents,” says Melina Wald, a child and adolescent psychologist and clinical director of the gender identity program at Columbia University Medical Center who was not affiliated with the study. For instance, the team found teens felt more comfortable in their bodies, who they are as it relates to their gender, and their mental state when they took therapeutic hormones. 

A June 2022 report estimates 1.6 million people over the age of 13 identify as transgender in the US. Among the 13- to 17-year-olds identifying as transgender or nonbinary, the number has nearly doubled from previous estimates in 2017. A common experience transgender youth wrestle with is gender dysphoria—a feeling of discomfort and distress when your sex assigned at birth does not match your gender identity. Left untreated, gender dysphoria is associated with an increase in suicide attempts and self-harm among trans teens. A branch of the National Institute of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, funded the latest study to try to address the issue.

“There has been a lack of awareness in the past about the unique health needs and research opportunities for transgender and gender diverse populations,” a representative of the institute told Popular Science in an email. “Research in this area is important for expanding the evidence currently guiding the clinical care of transgender and nonbinary youth.”

One of the most effective ways to combat gender dysphoria is to make a person’s physical appearance more in line with their gender identity, and hormone therapy can help. Gender-affirming hormones—such as estrogen, testosterone blockers, progesterones—are a common medical path for transgender individuals to develop feminine or masculine features that help them feel more like their authentic selves. However, one long-standing complaint from critics against gender-affirming care is that it can cause “psychological mutilation” with some arguing hormone therapy “indoctrinates” children to continue treatment as adults, speculating that they would have been happier to not. The misinformation surrounding the dangers of gender-affirming care have fueled transphobic legislation that withholds medical care from adolescents.

[Related: Exploring the common misconceptions regarding trans and non-binary identities]

“Gender-affirmative care is safe, effective, and even lifesaving,” argues Michelle Forcier, a professor of pediatrics specializing in gender, sexual and reproductive health at Brown University not involved in the study. “Children should not be pawns of politicians [who hold] safe, effective healthcare hostage for political and personal goals. Most legislators are not qualified as medical experts in gender-affirming care and have no business inserting themselves in the clinical setting.” 

Forcier says that a patient’s decision to start and participate in gender-affirmative care is a personal and private one that should only be discussed with the child, caregivers, and their medical team. Popular Science reached out to multiple study authors for comment, but they had either declined or did not respond in time of publication.

The current study recruited 315 transgender and nonbinary youth between 12 to 20 undergoing gender-affirming hormone therapy from clinical sites in Chicago, Boston, San Francisco, and Los Angeles. About 60.3 percent of participants were transmasculine and 58.7 percent were non-Latinx white. The teens started gender affirming hormones at different stages of development, with 25 already on puberty blockers before the study. From July 2016 to June 2019, psychologists used several psychosocial tests from the National Institute of Health to track any depression or anxiety symptoms the teens experienced, as well as positive effects from treatment and their life satisfaction every six months.

During the two-year study period, teens who felt their appearance reflecting more of their gender identity after gender-affirming care reported more propensity towards positive emotions  and greater life satisfaction. Youths that initiated gender-affirming care earlier already came in with lower baseline levels of depression and anxiety than those who started hormone therapy in late puberty. 

[Related: LGBTQ+ health networks helped make urban neighborhoods more resilient against COVID]

Regarding race, non-Latinx white youth showed a more significant decrease in depressive symptoms than other ethnicities and mixed race groups. However, the results may not be generalized to reflect the Black community, as there was an underrepresentation of Black participants in the study. In addition, Wald says that tracking and comparing the outcomes of youth who did not pursue hormone therapy at the study clinics would help inform any differences across transgender youth who do not have access to this type of care.

One notable observation was that transmasculine, but not transfeminine teens, showed a significant reduction in symptoms related to anxiety and depression. The differences may lie in the hormones they are receiving. Gina Sequeira, the co-director of the Seattle Children’s Gender Clinic who was not involved in the study, says patients taking testosterone see physical changes congruent with their gender identity at a faster rate than people taking estrogen. Estrogen takes longer to reduce testosterone’s masculinizing effects on the body and develop feminine features. 

“A patient on testosterone, for example, would start noticing a deepening of the voice usually within the first six months,” describes Sequeira. “For estrogen, changes like breast development take years and my suspicion is that patients may not have achieved the breasts they wanted at the two-year mark.” 

Despite all the benefits observed with gender-affirming hormone therapy, it is not a cure-all for gender dysphoria. In the study, 11 participants disclosed that they experienced suicidal ideation and two had died by suicide during the two-year period. All experts say the findings emphasize the need for a multifaceted approach to care. 

“Gender-affirmative hormones offer some benefit and relief, but youth are still navigating a potentially hostile world around them,” says Forcier, who adds that after the treatment, people may still experience a body that is not aligned with their gender identity. 

Having support at home and in the local community “can’t be understated,” says Sequeira. She adds that the more spaces a young person is affirmed in their gender identity—in healthcare settings, school, sports—the better their mental health.

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This article was originally published on KHN.

Controlled substances became a little less controlled during the pandemic. That benefited both patients (for their health) and telehealth startups (to make money).

Some potentially addictive medications — like buprenorphine and Adderall — are now far more available online to patients because of regulatory changes. Given the scarcity of qualified doctors to treat some of the behavioral health conditions associated with these drugs, like opioid use disorder or attention-deficit/hyperactivity disorder, doctors’ new ability to prescribe online or, in some cases, by telephone is a huge change. But easier access to the drugs has both upsides and downsides, since they’re often dispensed without accompanying therapy that improves the odds of a patient’s success.

Pre-pandemic, patients sometimes traveled several hours for addiction care, said Emily Behar, director of clinical operations for Ophelia, a New York startup serving people with opioid addictions. Or patients might be struggling with multiple jobs or a lack of child care. Such obstacles made sustaining care fraught.

“How do you reach those people?” she asked.

It’s a question preoccupying much of the behavioral health sector, complicated by the reality that most patients with opioid use disorder aren’t in treatment, said Dr. Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration.

Increased access to telehealth has started to provide an answer. Behar, the startup executive, says its patients can see expert providers at their convenience. Missed appointments are dropping, say many in the industry.

The startup has secured solid funding — nearly $68 million, according to Crunchbase, an industry database — but addiction specialists and other prescribers of controlled substances online are a mixed group. Some are nonprofits; others are large startups attracting scrutiny from the news media and law enforcement for allegedly sloppy prescription practices.

The influx of new providers is attributable to loosened requirements born of pandemic-era necessity. To help patients get access to care while maintaining physical distance, the Drug Enforcement Administration and SAMHSA waived restrictions on telehealth for controlled substances.

But whether those changes will endure is uncertain. The federal government is working piecemeal to codify new rules for prescribing controlled substances, in light of the health care system’s pandemic experience.

On Dec. 13, SAMHSA issued a proposal to codify telehealth regulations on opioid treatment programs — but that affects only part of the sector. Left unaddressed — at least until the DEA issues rules — is the process for individual providers to register to prescribe buprenorphine. The new rules “get us at least a little bit closer to where we need to go,” said Sunny Levine, a telehealth and behavioral health lawyer at the firm Foley & Lardner, headquartered in Milwaukee.

Congress also tweaked rules around buprenorphine, doing away with a long-standing policy to cap the number of patients each provider can prescribe to. Ultimately, however, the DEA is the main regulatory domino yet to fall for telehealth providers.

In addition, pharmacies are taking a more skeptical stance on telehealth prescriptions — especially from startups. Patients were getting accustomed to using telemedicine to fill and refill their prescriptions for medications for some controlled substances, like Adderall, primarily used to treat ADHD. A shortage of Adderall has affected access for some patients. Now, though, some pharmacies are refusing to fill those prescriptions.

Cheryl Anderson, one Pennsylvanian with ADHD, said she sought online options because of her demanding schedule.

“My husband is frequently out of town, so I don’t have someone to reliably watch the baby to go to an in-person appointment,” she said. It was tough, with three kids, to find the time. Telehealth helped for about half of 2022. Previously, the DEA and state governments imposed tough rules on obtaining controlled substances from online pharmacies.

But in September, after her doctor wrote a refill prescription, she got a phone call saying her local pharmacy wouldn’t dispense medications if the prescription came through telehealth. Other local pharmacies she called took the same position.

Those denials seem to reflect a broader cultural shift in attitudes. Whereas patients and politicians hailed telemedicine at the beginning of the pandemic — first for its safety but also for its increased convenience and potential to extend care to rural areas and neighborhoods without specialists — hints of skepticism are creeping in.

The telehealth boom attracted shady actors. “You had a lot of people who saw an opportunity to do things that were less than scrupulous,” particularly in the behavioral health market, said Michael Yang, a managing partner at the venture capitalist firm OMERS Ventures. Skeptical media coverage has proliferated of startups that, allegedly, shotgun prescriptions for mental health conditions without monitoring patients receiving those medications. “It’ll settle down.”

The startups pose quandaries for local pharmacists, said Matt Morrison, owner of Gibson’s Pharmacy in Dodge City, Kansas.

Pharmacists have multiple obligations related to prescriptions, he said: to make sure incoming prescriptions are from legitimate physicians and that they’re connected to an actual health condition before filling the order. The sense around the industry, Morrison said, is that prescriptions from startups are tricky. They might come from a distant provider, whom the pharmacist can’t contact easily.

Those qualms pose difficulties for addiction treatment. Persuading pharmacists to fill prescriptions is one of the biggest administrative tasks for Ophelia, Behar said. Still, the shift online has been helpful.

“Telehealth picks up the gaps,” said Josh Luftig, a founding member of CA Bridge, a program based in Oakland, California, that helps patients in emergency departments initiate treatment for substance misuse. The supply of care providers wasn’t enough to meet demand. “Across the board, there’s been a lack of access to treatment in the outpatient setting. Now all they need is a phone and to get to a pharmacy.”

Treatment is more efficient for patient and provider alike, providers say. “The majority of our patients prefer to have a telehealth experience,” he said. “The telehealth appointments are more efficient. It increases the capacity of each person involved.”

Well-established organizations also report success: Geisinger, a large mid-Atlantic health system, said 94% of participants in one maternity-focused program were compliant, spokesperson Emile Lee said.

Ophelia, which started up just before the pandemic, expected to treat patients both in-office and online. “We have an office in Philadelphia we’ve never used,” she said. Now the company labors every few months — in anticipation of the end of state and federal public health emergencies — to make sure that the end of the associated looser rules doesn’t lead to disruptions in care for their patients.

More clarity on the future of online treatment could result from permanent regulations from the DEA. What the agency’s rule — which would create a registration process for providers interested in prescribing controlled substances online — will say is “anyone’s guess,” said Elliot Vice, an executive specializing in telehealth with the trade group Faegre Drinker. That rule has been pending for years. “To see this still not move, it is puzzling.”

The agency, which declined to comment specifically for this article, pointed to previous statements praising increased access to medication-assisted treatment.

“There shouldn’t be any change in the rules for telehealth,” Luftig said. “It would be the most horrific thing in terms of access for our communities. It would be an unmitigated disaster.”

[Correction: This article was updated at 10:30 a.m. ET on Jan. 11, 2023, to correct the location of Foley & Lardner’s headquarters.]

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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A free mental health service offering online communities a peer-to-peer chat support network is facing scrutiny after its co-founder revealed the company briefly experimented with employing an AI chatbot to generate responses—without informing recipients. Although they have since attempted to downplay the project and highlight the program’s deficiencies, critics and users alike are expressing deep concerns regarding medical ethics, privacy, and the buzzy, controversial world of AI chatbot software.

As highlighted on Tuesday by New Scientist, Koko was co-founded roughly seven years ago by MIT graduate Rob Morris, whose official website bills the service as a novel approach to making online mental health support “accessible to everyone.” One of its main services allowing clients like social network platforms to install keyword flagging software that can then connect users to psychology resources, including human chat portals. Koko is touted as particularly useful for younger users of social media.

[Related: OpenAI’s new chatbot offers solid conversations and fewer hot takes.]

Last Friday, however, Morris tweeted that approximately 4,000 users were “provided mental health support… using GPT-3,” which is the popular AI chatbot program developed by OpenAI. Although users weren’t chatting directly with GPT-3, a “co-pilot” system was designed so that human support workers reviewed the AI’s suggested responses, and used them as they deemed relevant. As New Scientist also notes, it does not appear that Koko users received any form of up-front alert letting them know their mental health support was potentially generated, at least in part, by a chatbot.

In his Twitter thread, Morris explained that, while audiences rated AI co-authored responses “significantly higher” than human-only answers, they decided to quickly pull the program, stating that once people were made aware of the messages’ artificial origins, “it didn’t work.” 

“Simulated empathy feels weird, empty,” wrote Morris. Still, he expressed optimism at AI’s potential roles within mental healthcare, citing previous projects like Woebot, which alerts users from the outset that they would be conversing with a chatbot.

[Related: Seattle schools sue social media companies over students’ worsening mental health.]

The ensuing fallout from Morris’ descriptions of the Koko endeavor prompted near-immediate online backlash, causing Morris to issue multiple clarifications regarding “misconceptions” surrounding the experiment. “We were not pairing people up to chat with GPT-3, without their knowledge. (in retrospect, I could have worded my first tweet to better reflect this),” he wrote last Saturday, adding that the feature was “opt-in” while it was available.

“It’s obvious that AI content creation isn’t going away, but right now it’s moving so fast that people aren’t thinking critically about the best ways to use it,” Caitlin Seeley, campaign director for the digital rights advocacy group, Fight for the Future, wrote PopSci in an email. “Transparency must be a part of AI use—people should know if what they’re reading or looking at was created by a human or a computer, and we should have more insight into how AI programs are being trained.”

[Related: Apple introduces AI audiobook narrators, but the literary world is not too pleased.]

Seeley added that services like Koko need to be “thoughtful” about the services they purport to provide, as well as remain critical about AI’s role in those services. “There are still a lot of questions about how AI can be used in an ethical way, but any company considering it must ask these questions before they start using AI.”

Morris appears to have heard critics, although it remains unclear what will happen next for the company and any future plans with chat AI. “We share an interest in making sure that any uses of AI are handled delicately, with deep concern for privacy, transparency, and risk mitigation,” Morris wrote on Koko’s blog over the weekend, adding that the company’s clinical advisory board is meeting to discuss guidelines for future experiments, “specifically regarding IRB approval.”

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Excerpted from Good Anxiety: Harnessing the Power of the Most Misunderstood Emotion by Dr. Wendy Suzuki with permission from Atria. Copyright © 2022 by Wendy Suzuki, PhD.

What does emotion regulation mean?

One expert on emotion regulation, James J. Gross, another psychology professor at Stanford University, defines emotion regulation as “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express them.” He also points out that regulation is a set of processes that exist on a “continuum from conscious, effortful and controlled regulation to unconscious, effortless, and automatic regulation.”

What does this mean in practice? The bottom line is this: Though anxiety might originate as some form of attention-getting signal to avoid danger, it doesn’t necessarily have to cause discomfort, distraction, or otherwise interfere with our natural drive toward well-being and balance. We can learn to use awareness to reframe a situation, remove the perception of danger, and reappraise it as an opportunity to overcome a challenge and create new responses. We have multiple options for managing both the attention to the signal and the anxiety (the feelings), and if it gets to that point, the response itself. Our brain is a wondrous thing!

[Related: Stress and anxiety wear down your brain. Here’s how to fight back.]

Our brain-body systems are in a constant drive toward homeostasis, that state of equilibrium between arousal and relaxation. Every system—from the nervous system to the digestive—is interacting and exchanging signals in order to respond to a stressor and then re-gain homeostasis. This is true of our emotional system as well. Our negative emotions arise to draw our attention to something that may be dangerous, and then make some sort of change or adaptation to feel better. In other words, they have a positive purpose. It is the same with anxiety: it’s the brain-body’s way of telling us to pay attention. Our built-in system for managing our negative emotions, of processing, responding to, and coping with negative emotions in particular, so we can maintain or return to homeostasis is called emotion regulation.

Let’s look at how emotion regulation plays out in real life. Say you are anticipating an important job interview after being let go from your former position six months prior. You are feeling pressure, self-doubt, and fear—fear of rejection, fear of failure, fear of not measuring up. The interview is four days away but you’re already feeling nervous. When you even imagine walking through the door of the building, your hands start to sweat, your heart ticks up, and your breath becomes a tiny bit shallow. Next, you begin to imagine every possible thing that could go wrong: you might forget to bring your résumé, you might wear mismatching socks, or you might forget everything you know about why you’re applying for the job in the first place.

Situation selection

One option is to avoid a situation that you expect will bother you or exacerbate your anxiety. Avoiding the situation (skipping the job interview) may alleviate the fear and stress in the near term; however, it clearly will not help you if, in the long run, you want or need the job in question. Gross calls this strategy situation selection.

Situation modification

Another option is to modify the current situation so that the anticipation or anxiety is made more tolerable or bearable. For instance, if you’re experiencing anxiety about the pending interview, you could modify the situation by asking to do the interview over the phone or video conference. This enables you to exert some control over your anxiety and puts you more in charge of the feeling that it’s bigger than you. Gross calls this situation modification. I call it a shift from bad to good anxiety. Your nervousness has not disappeared; it’s simply under your control and being channeled.

Attention deployment

A third option is referred to as attention deployment, which includes several ways you can avert your attention from the anxiety-provoking situation to something else that absorbs your attention. Parents use this technique frequently with their infants and toddlers. If the young child is afraid of dogs, for example, a parent could direct the child’s focus to a funny face while the scary dog walks away. This is a kind of intentional distraction.

[Related: How to keep your anxiety from spiraling out of control]

Cognitive change

The fourth and probably most sophisticated of the strategies for emotion regulation is referred to as cognitive change. In this case, you actively and consciously reappraise or reframe your mindset or attitude: instead of thinking about the job interview as a horrible way to spend your Friday morning, you reframe it as an opportunity to show yourself and your potential employer how much you know about the role and the company or organization; it also builds your confidence. The reframe acts as a mental suggestion that reshapes the feeling of anxiety from one of dread and feeling overwhelmed to one of excitement and challenge.

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Of the trillions of microorganisms that call your gut home, 13 bacterial species may contribute to depression. A pair of studies published on December 6 in the journal Nature Communications identified bacteria linked to depression and a possible explanation for how they’re promoting depressive episodes. 

Depression is one of the leading causes of disability worldwide. About five percent of adults live with the condition. If left untreated, a depressive episode can significantly impair your life, from constant hopelessness to a loss of interest in day-to-day activities. Understanding just how these microbes contribute to our mental health could shape gut-driven approaches for managing the condition.

Certain gut bacteria could be causing a chemical imbalance in the brain 

In one of the studies, the authors examined the microbiome composition of 1,539 adults in the Netherlands. “Our biggest surprise was the strength of the relationship between gut bacteria and depression,” Robert Kraaij, a senior research scientist at Erasmus Medical Center Rotterdam in the Netherlands and study coauthor, wrote in an email to PopSci. Of the 13 microbial taxa linked to depression, people with a higher abundance of Sellimonas, Eggerthella, Lachnoclostridium, and Hungatella reported more depressive symptoms. 

The 13 microbial species help produce chemical messengers—glutamate, butyrate, serotonin, and gamma amino butyric acid (GABA)—which the levels are typically altered during the depression. The findings from the current study could help identify people who are most at risk for depression, explains Najaf Amin, a senior researcher at Oxford University and senior study author. 

In the future, Amin plans to study the levels of the four chemical messengers in the blood of people with and without depression to see how they compare. Doing so may help get a better sense of how gut bacteria influence a person’s brain chemistry and how the brain regulates mood.

[Related: Magic mushrooms help cancer patients deal with depression]

Differences across ethnicities in the gut microbiomes of people with depression

The second study investigated fecal samples of 3,211 individuals who resided in urban Amsterdam. The participants belonged to one of six different ethnic groups—Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan. The microbiome assessments showed changes in bacterial species associated with depressive symptoms, including those species from the Christensenellaceae, Lachnospiraceae, and Ruminococcaceae families. One interesting observation, however, was that not everyone with depression had the same amounts of each microbial species. About 18 to 29 percent of differences in depression-related bacteria was due to ethnic differences.

“This is pivotal research with interesting data on gut-brain [interactions], a burgeoning area of science and medicine now,” says Harvey Hamilton Allen Jr., chief gastroenterologist at Mohawk Valley Endoscopy Center at St. Luke’s Hospital, who was not involved in either of the studies.

What we know about the gut’s involvement in depression

One of the reasons depression is difficult to treat is that there seems to be no single cause. Prior research has linked depression to stressful or traumatic life events, while others have observed depression manifesting after chronic substance abuse. Genetic factors might also be at play, as people with a family history of depression are three times more likely to have it too. The gut microbiome might be another contributor at play. 

While the idea had been tossed around for centuries, biologists have only recently unearthed physical evidence of a gut-brain connection in the past couple of decades. The theory goes that humans have a “bidirectional” line of communication between the emotional and cognitive centers of the brain, explains Hamilton Allen Jr. Imagine a telephone wire running from your central brain to your enteric nervous system—a collection of neurons in the wall of the GI tract that controls your digestive system. The enteric nervous system is often called the “second brain” for its influence on the rest of the body. 

One important piece of evidence that the gut likely plays a role in depression is that about 95 percent of serotonin—often labeled the “happy hormone” for its mood-regulating effects—is made from gut bacteria. Paxil and Zoloft, two commonly prescribed medications for depression, block the body from reabsorbing serotonin to avoid the hormone’s levels from falling too low. 

Treating depression through the microbiome

A deep understanding of the ins and outs of the gut microbiome could revolutionize how we approach medicine, including how we treat depression. “If certain bacteria are part of the cause of depression, we can design treatments to modulate these bacteria,” says Kraaij.

One potential approach is through fecal transplants. While such a treatment might seem ripe for bacterial infections, it could help promote healthy gut bacteria in people who are unable to produce them on their own (there have been reported deaths from fecal transplants among immunocompromised people). Transporting the poop from a person with a healthy gut microbiota to someone with  an unhealthy gut has already become the standard of care for treating Clostridioides difficile infections. The procedure restores healthy bacteria back into the lower intestines. Just last week on December 2, the FDA approved the first pharmaceutical-grade fecal transplant to treat difficult intestinal infections.

[Related: Autism shapes the gut microbiome, scientists report, not the other way around]

There is also some growing evidence that fecal transplants could help with depression. In a small case study published in February 2022, two people with major depressive disorder underwent poop transplants in addition to their current treatment plan. Both showed a reduction in depressive-live behavior four weeks after the procedure. One of the patients continued to show improvement in their depressive symptoms for up to eight weeks after treatment, along with improvement in other GI problems. 

The two studies could make the fecal transplant process more efficient by knowing which of the 13 bacteria species need to be transferred to make the gut healthy again. What’s more, Hamilton Allen Jr. speculates the findings could even help fecal transplants to be more personalized to different ethnicities in the future. 

Still, gut microbes are one of many factors linked to depression, Hamilton Allen Jr. says. Without an experiment that could manipulate the microbiome to see how people fared with and without these microbes, scientists cannot definitively say a gut imbalance is a primary cause of depression. But he says, “this is definitely one of the new treatment modalities, and as we learn more about this organ, we are going to see more research going into treating the microbiome.”

Correction (December 12, 2022): This story has updated the genus name Clostridium difficile to Clostridioides difficile to reflect changes in taxonomic classification of the bacteria.

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This article was originally featured on KHN.

Assisted living communities too often fail to meet the needs of older adults and should focus more on residents’ medical and mental health concerns, according to a recent report by a diverse panel of experts.

It’s a clarion call for change inspired by the altered profile of the population that assisted living now serves.

Residents are older, sicker, and more compromised by impairments than in the past: 55% are 85 and older, 77% require help with bathing, 69% with walking, and 49% with toileting, according to data from the National Center for Health Statistics.

Also, more than half of residents have high blood pressure, and a third or more have heart disease or arthritis. Nearly one-third have been diagnosed with depression and at least 11% have a serious mental illness. As many as 42% have dementia or moderate-to-severe cognitive impairment.

“The nature of the clientele in assisted living has changed dramatically,” yet there are no widely accepted standards for addressing their physical and mental health needs, said Sheryl Zimmerman, who led the panel. She’s co-director of the Program on Aging, Disability, and Long-Term Care at the University of North Carolina-Chapel Hill.

The report addresses this gap with 43 recommendations from experts including patient advocates, assisted living providers, and specialists in medical, psychiatric, and dementia care that Zimmerman said she hopes will become “a new standard of care.”

One set of recommendations addresses staffing. The panel proposes that ratios of health aides to residents be established and that either a registered nurse or a licensed practical nurse be available on-site. (Before establishing specific requirements for various types of communities, the panel suggested further research on staffing requirements was necessary.)

Like nursing homes and home health agencies, assisted living operators have found it hard to retain or hire staff during the covid-19 pandemic. In a September 2021 survey, 82% reported “moderate” or “high” level of staffing shortages.

Dr. Kenneth Covinsky, a geriatrician and professor of medicine at the University of California-San Francisco, witnessed staffing-related problems when his mother moved to assisted living at age 79. At one point, she fell and had to wait about 25 minutes for someone to help her get up. On another occasion, she waited for 30 minutes on the toilet as overworked staffers responded to pagers buzzing nonstop.

“The nighttime scene was crazy: There would be one person for 30 to 40 residents,” said Covinsky, the author of an editorial accompanying the consensus recommendations. Eventually, he ended up moving his mother to another facility.

The panel also recommended staffers get training on managing dementia and mental illness, on medication side effects, on end-of-life care, on tailoring care to individual residents’ needs, and on infection control — a weakness highlighted during the height of the pandemic, when an estimated 17% more people died in assisted living in 2020 compared with previous years.

“If I were placing my parent in assisted living, I certainly would be looking not just at staffing ratios but the actual training of staff,” said Robyn Stone, senior vice president of research at LeadingAge and co-director of its long-term services and supports center at the University of Massachusetts-Boston. LeadingAge is an industry organization representing nonprofit long-term care providers. Stone said the organization generally supports the panel’s work.

The better trained staff are, the more likely they are to provide high-quality care to residents and the less likely they are to feel frustrated and burned out, said Dr. Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health.

This is especially important for memory care delivered in stand-alone assisted living facilities or a wing of a larger community. “We have seen places where a memory care unit charges upwards of $10,000 a month for ‘dementia care’ yet is little more than a locked door to prevent residents from leaving the unit and not the sensitive and personalized care advertised,” wrote Covinsky and his University of California-San Francisco colleague Dr. Kenneth Lam in their editorial.

Because dementia is such a pervasive concern in assisted living, the panel recommended that residents get formal cognitive assessments and that policies be established to address aggression or other worrisome behaviors.

One such policy might be trying non-pharmaceutical strategies (examples include aromatherapy or music therapy) to calm people with dementia before resorting to prescribed medications, Kales said. Another might be calling for a medical or psychiatric evaluation if a resident’s behavior changes dramatically and suddenly.

Further recommendations from the panel emphasize the importance of regularly assessing residents’ needs, developing care plans, and including residents in this process. “The resident should really be directing what their goals are and how they want care provided, but this doesn’t always happen,” said Lori Smetanka, a panel member and executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy organization.

“We agree with many of these recommendations” and many assisted living communities are already following these practices, said LaShuan Bethea, executive director of the National Center for Assisted Living, an industry organization.

Nonetheless, she said her organization has concerns, especially about the practicality and cost of the recommendations. “We need to understand what the feasibility would be,” she said, and suggested that a broad study look at those issues. In the meantime, states should examine how they regulate assisted living, taking into account the increased needs of the residents, Bethea said.

Because the nation’s roughly 28,900 assisted living communities are regulated by states and there are no federal standards, practices vary widely and generally there are fewer protections for residents than are found in nursing homes. Some assisted living facilities are small homes housing as few as four to six seniors; some are large housing complexes with nearly 600 older adults. Nearly 919,000 individuals live in these communities.

“There are many different flavors of assisted living, and I think we need to be more purposeful about naming what they are and who they’re best suited to care for,” said Kali Thomas, a panel member and an associate professor of health services, policy, and practice at Brown University.

Originally, assisted living was meant to be a “social” model: a home-like setting where older adults could interact with other residents while receiving help from staff with daily tasks such as bathing and dressing. But given the realities of today’s assisted living population, “the social model of care is outmoded,” said Tony Chicotel, a panel member and staff attorney with California Advocates for Nursing Home Reform.

Still, he and other panelists don’t want assisted living to become a “medical” model, like nursing homes.

“What’s interesting is you see nursing homes pushing to get to a more homelike environment and assisted living needing to more adequately manage the medical needs of residents,” Chicotel told me, referring to the current pandemic-inspired reexamination of long-term care. “That said, I don’t want assisted living facilities to look more like nursing homes. How this all will play out isn’t at all clear yet.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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PSYCHEDELICS are having a moment. This past spring, Netflix’s How to Change Your Mind documentary series introduced the binge-watching masses to the concept of using trippy substances to reboot troubled brains. Numerous startups offer at-home ketamine therapy in glossy ads on Instagram. And in 2020, Oregon became the first state to vote to legalize psilocybin for therapeutic use.

The world of scientific research is buzzing too. Clinical trials on the use of MDMA to treat post-traumatic stress disorder have shown promising results and could lead to FDA approval in the next year or so. A recent study in the Journal of Affective Disorders suggested that administering ketamine before a cesarean section might mitigate postpartum depression in some patients. And in August 2022, a small study on substance use disorder in JAMA Psychiatry showed that when combined with therapy, two psilocybin sessions were associated with a sharp decrease in days of heavy drinking among participants.

While science is still homing in on why this works, we’re starting to form a preliminary understanding: Trippy compounds seem to affect how the brain regions responsible for mood, cognition, and perception respond to the neurotransmitter serotonin. Early research suggests this can lead to a boost in neuroplasticity—gray matter’s ability to learn things and adapt to change.

Though our clinical understanding of psychedelics is in its infancy, the drugs themselves are not. Even their therapeutic use is ancient. Mushrooms have been involved in the spiritual ceremonies of the Mazatec people in what’s now Oaxaca, Mexico, for thousands of years. Ibogaine, now touted as a therapy for substance use disorder, is derived from a plant that hunters in West Africa have long chewed for stimulation and focus while stalking game. Peyote has served as both a spiritual tool and a medicine in North America since at least 1000 B.C.E. And MDMA is derived from safrole, a compound in the oil of sassafras plants, whose recorded use by Native Americans dates to at least the 16th century.

Many Indigenous groups maintain an unbroken lineage of plant medicine use, while others now seek to reconnect with practices made difficult or impossible in the wake of colonization and other pressures. Federal drug policies in place since the 1970s, which many public health experts now agree to be misguided, have led to disproportionate punishment of BIPOC people and slowed or stopped research into the therapeutic benefits of compounds like LSD, mescaline, and psilocybin. Though decriminalization laws like Oregon’s are unwinding the war on drugs, some advocates also see trouble in the latest wave of enthusiasm.

They warn that psychedelic medicine’s renaissance, fueled by media hype and venture capital, could make the substances less accessible to the people who stand to benefit from them the most. That group includes Indigenous and other marginalized populations, who have disproportionately high rates of trauma and resulting illness but who lack equal access to basic treatment—let alone expensive clinics or drug tourism retreats.

The future of fair drug use in the US is a puzzle that will take many perspectives to solve. But these four visionaries—therapists, activists, educators, researchers, and entrepreneurs—are listening, learning, and changing minds.

Protecting resources during a boom

As a Newe—a member of the Shoshone-Bannock Tribes of Fort Hall, Idaho—Dawn D. Davis has many identities that share a common goal. As a researcher, educator, mother, farmer, fainting goat herder, and peyote user, she embodies a lifelong commitment to reciprocity with the substances that give us life. In her current postdoctoral work at the Idaho National Laboratory’s Energy Systems department, that means studying resource management, particularly as it pertains to water access and energy resilience in marginalized and rural communities. It has also meant laying the research groundwork for Lophophora williamsii, the squat cactus commonly known as peyote, to be treated with care both inside and outside Indigenous cultures.

The plant has recently caught the attention of psychedelics enthusiasts for containing the hallucinogenic compound mescaline, which studies suggest might help facilitate therapy for issues like addiction and trauma. But Davis’ ancestors and many other Indigenous North Americans have used it for spiritual ceremonies and general health applications, from soothing toothaches to treating wounds, for thousands of years. “It’s always been a part of my life,” she says.

As Davis grew up, however, she saw less and less available—and the cacti that were around appeared to be shrinking. L. williamsii also grows slowly, sometimes taking more than a decade to mature, and most of what is out there sits on private land. She and her family, like most traditional peyote users, access it through the ceremonies of a diffuse religious group called the Native American Church. After receiving degrees in museum studies and Native American studies, Davis began pursuing a doctorate in natural and water resources from the University of Idaho in 2013 to understand the scope of the problem. She’s since spent nearly a decade collecting data on where the plant grows to home in on its preferred vegetation and soil.

She hopes that her findings on peyote’s current distribution, which she earned a Ph.D. for in 2021, will help landowners and Indigenous users better understand the conditions in which the plant can thrive. While she’s still working to confirm and publish her data, it does indicate that the potential habitat for the slow-growing cactus in Texas and Mexico is “quite extensive,” suggesting that in situ conservation is entirely possible. But she cautions that bringing traditional knowledge into such efforts is key. In conducting her field research, she interacted with landowners and the earth in ways she didn’t learn in grad school: by sharing her intentions, introducing herself to the environment, and getting the permission of everyone and everything involved. To keep the plant’s population from dwindling further, she says, Western science will have to make room for people who engage with the earth in this way.

Conservation efforts may soon grow more pressing, as some psychedelics enthusiasts are pushing to have peyote widely decriminalized. Groups that include the Native American Church of North America, where Davis serves on the Legislative Committee, and the National Congress of American Indians, where she co-chairs the Peyote Task Force, argue that this will make the scant wild population even more vulnerable to outside parties, and have asked that peyote not be mentioned in any decriminalization efforts.

Some members of these and other advocacy groups have pointed out that there are other, faster-growing cacti, such as the San Pedro plant, that also produce mescaline and could be cultivated instead. While it is less potent, the tall cactus can grow all over the world. In the US, it’s a common sight on arid front lawns, where it’s legal to have but not legal to use for its mescaline. Davis, for her part, would prefer mescaline get left out of decriminalization bills entirely; she worries that such a loophole could mask peyote harvesting.

Davis emphasizes she’s one person from one tribe, so bringing many Indigenous voices into the conversation about psychedelic use is crucial. That’s as true for protecting a plant in peril as it is for respecting the reasons why tribes used specific flora and how they combine them. “I may be the only Native American peyote researcher,” she says. “I don’t know of any others. But that’s a hard space to be in, because I don’t consider myself a psychedelic researcher. I consider myself a medicine researcher. I see things from a very different perspective.”

Finding the sacred side of therapy

Danielle Herrera’s ketamine patients at Sage Integrative Health don’t get a very clinical experience. The Bay Area psychotherapist takes people for walks while they’re high, gives them sensory objects like feathers and bowls of water, and even sings with them. “That’s something that happens a lot in ayahuasca circles,” she says of the ceremonies involving the psychoactive South American brew. “Humming together can be really powerful.”

While Herrera, who identifies as mixed-Indigenous and part Filipino, tells people that her therapy is informed by traditional rituals, she doesn’t mean she treats every trip like a ceremony in the Amazon basin. She has at least two beliefs that buck the medical establishment: First, that every recreational drug has the potential to be beneficial, given the right therapeutic guidance and exploration. And second, that the process should look different for every patient—and for every therapist.

Her first work out of graduate school focused on treating children, though she was reluctant to turn her own childhood trauma, which stemmed from her parents’ struggles with substance use disorder, into a career. That is, until she found herself drawn to the Harm Reduction Therapy Center in San Francisco. The mobile clinics Herrera worked at would welcome people high on anything and give them whatever help they needed. Someone might be hungry, or have a wound that needed dressing, and she would also offer mental health support.

During that time, Herrera started training in ketamine therapy at the Sage Institute clinic. “Noticing what was happening in the intersection between harm reduction and psychedelic therapy allowed my relationship with my family to deepen,” she says. Her mother, who is now sober but used methamphetamines for years, opened up about her initial experiences with meth, which were intensely positive and spiritual. “Even drug counselors would just shame her,” Herrera says. “She told me, ‘If there was just one person who I could have talked to about my spiritual awakening on meth, I might not have fallen into the chaotic use and depression that followed.’”

Herrera has now facilitated integration—the thoughtful unpacking of insights gained while high—for “every drug you can think of.” And each session, she says, can be profound and unique. She pushes back against mainstream stereotypes of the psychedelic experience, which she feels can make patients think they should expect to find peace, that the drugs will calm their inner demons. Many of the people she treats, especially those who have endured lifelong racial aggression, actually become more in tune with their inner rage.

Perhaps most crucially, Herrera is always entirely herself. “When I was learning to become a therapist, I was really resistant to the colonialism I knew was entrenched in these systems,” she says of the perspectives that have typically informed modern psychiatry. “I was a real pot stirrer.”

Putting a new spin on pharmaceutical development

Jeeshan Chowdhury often reminds folks that his startup’s technology isn’t actually new. Mescaline, the compound Journey Colab recently synthesized, is best known as the psychedelic component of peyote. “While it feels like this is a new trend, it’s validated by thousands of years of use by Indigenous communities,” Chowdhury says.

The recent psychedelic boom has inspired a race to find—and patent—new chemical compounds that pack the same punch as ancient plant medicines. That sprint, of course, comes with the typical Big Pharma fears, from making treatments more expensive to leapfrogging traditional users by stamping trademarks. Journey Colab, which is exploring mescaline as a tool to treat substance use disorder, set itself apart from its beginnings in 2020: 10 percent of its founding equity is held in a perpetual trust overseen by representatives of Indigenous communities. “It’s actual ownership,” Chowdhury emphasizes.

Until about five years ago, Chowdhury, who was raised in a devout Muslim home, had never had much interest in drugs. But he eventually realized they could save him. “I was living these two very parallel lives,” he says. In 2017, he’d already earned an M.D. from the University of Alberta and a Ph.D. in health informatics as a Rhodes Scholar at Oxford and had dropped out of a medical residency to found, build, and sell his first startup—a digital platform to help coordinate care in hospitals.

But he was in the midst of a mental health crisis. “I felt like I was drowning,” he says. Offerings like antidepressants and talk therapy helped, but felt like life preservers. By the time he sold that first company, he says, “I wanted to let go and drown.”

Out of desperation, he tried psychedelic therapy for the first time. “In that state of consciousness, it was like the muddy waters I’d been drowning in my whole life cleared up,” he says. He decided to get training in psychedelic integration—the process of folding insights gleaned from the thoughts and feelings of a trip into one’s conscious, everyday life—and grew fascinated by how much work still needed to be done to marry centuries of tradition with new scientific insight.

Journey Colab’s focus on mescaline could help refine our understanding of why the compound works so well. Previous studies in mice have indicated that the substance increases neuroplasticity for around five or six weeks; ketamine’s effects, by comparison, taper off after a couple of days, and those of MDMA and psilocybin in a fortnight. Journey Colab now wants to quantify how mescaline could help grease the wheels of alcohol use disorder therapy specifically.

Despite such promising signs, Chowdhury prefers to call Journey’s offerings “psychedelic procedures” as opposed to straightforward therapy sessions. Given their risks, he thinks they should be taken as seriously as surgery—and that they require tailored support and therapy to be effective. “It’s incredibly important for us to learn from the people who successfully integrated these very powerful tools into their individual lives and cultures and societies,” he says. “It’s done with ritual, and it’s done with respect.”

Making ketamine accessible and sustainable

Courtney Watson is supposed to be working on her dissertation. But a chance encounter in 2018 sent her on a detour. A licensed marriage and family therapist, Watson was moderating a panel at a conference for BIPOC techies when a stranger—who’d shown up thinking the meetup was about techno—asked her if she’d like to be introduced to the psychedelic therapy community.

She was intrigued. Watson had learned about the practice in grad school around 2011, when the drugs had yet to see their modern resurgence. In a class about addiction, a professor had pointed out that many illicit substances had once been used as medicine, and that they’d even been studied by modern scientists, but the war on drugs had shut those inquiries down.

On the advice of her new techno-loving acquaintance, Watson attended a conference on psychedelics. She was interested in the cultural perspectives of BIPOC and marginalized communities, but was surprised to hear a lot of chatter about LSD and psilocybin. “Those are white people drugs,” she remembers thinking. “We don’t do that stuff.” But then presenters talked about the power of such medicines to help treat PTSD. Watson knew that research increasingly showed members of marginalized communities had higher rates of the condition—one 2016 study, for example, indicated that more than one-quarter of Black women with depression in Oakland, California, had PTSD—but no one onstage was talking about that. She signed up for psychedelic-assisted therapy training not long after the conference ended. “I was like, ‘There’s an opportunity for healing here, and no one that’s here is going to be able to do that.’”

She opened Doorway Therapeutic Services, a ketamine clinic in Oakland designed by queer and BIPOC people, in 2020. There she relishes opportunities to challenge the status quo of one-on-one therapy. For instance, she and many other practitioners point out that traditional use of mind-altering drugs, like an ayahuasca ceremony she participated in in South America, tends to involve whole families and communities who spend generations learning to facilitate the rituals together. She also wants to see more opportunities for traditional herbalists to get the same recognition and legal validation as mainstream therapists. “It might be a mess in the beginning,” she says of shifting the paradigm around drug use and access, “but I believe we can do it.”

Watson is quick to point out that psychedelics need a lot more change—from including more BIPOC leaders to taming the high costs of therapy—than one person can kick-start. Under the leadership of sci-fi author Ayize Jama-Everett and activist Kufikiri Imara, she participated in an inaugural plant medicine conference called A Table of Our Own in the hopes of helping address these and other issues. The program gathered a couple dozen Black artists, academics, clinicians, cultivators, and spiritual leaders to re-imagine how psychedelic spaces can look with Black people at the helm.

For now, she’s doing what she can with Doorway. She works to make the organization as collaborative as possible and prioritizes employee well-being. That means sustaining the clinic by charging market rate for ketamine therapy in the Bay Area: more than $5,000 out of pocket for a full course of treatment.

Understanding that high cost limits accessibility, Watson, who’s still a Ph.D. candidate at Widener University, started a nonprofit. Access 2 Doorways helps fund clinics run by and for BIPOC people to facilitate access to psychedelic therapy. “We need this,” she says. “And we’re not going to get it if we don’t offer it.”

This story originally appeared in the High Issue of Popular Science. Read more PopSci+ stories.

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This article was originally featured on The Conversation.

Imagine that a soldier has a tiny computer device injected into their bloodstream that can be guided with a magnet to specific regions of their brain. With training, the soldier could then control weapon systems thousands of miles away using their thoughts alone. Embedding a similar type of computer in a soldier’s brain could suppress their fear and anxiety, allowing them to carry out combat missions more efficiently. Going one step further, a device equipped with an artificial intelligence system could directly control a soldier’s behavior by predicting what options they would choose in their current situation.

While these examples may sound like science fiction, the science to develop neurotechnologies like these is already in development. Brain-computer interfaces, or BCI, are technologies that decode and transmit brain signals to an external device to carry out a desired action. Basically, a user would only need to think about what they want to do, and a computer would do it for them.

BCIs are currently being tested in people with severe neuromuscular disorders to help them recover everyday functions like communication and mobility. For example, patients can turn on a light switch by visualizing the action and having a BCI decode their brain signals and transmit it to the switch. Likewise, patients can focus on specific letters, words or phrases on a computer screen that a BCI can move a cursor to select.

Researchers are looking into ways to directly translate brain signals into synthesized speech.

However, ethical considerations have not kept pace with the science. While ethicists have pressed for more ethical inquiry into neural modification in general, many practical questions around brain-computer interfaces have not been fully considered. For example, do the benefits of BCI outweigh the substantial risks of brain hacking, information theft and behavior control? Should BCI be used to curb or enhance specific emotions? What effect would BCIs have on the moral agency, personal identity and mental health of their users?

These questions are of great interest to us, a philosopher and neurosurgeon who study the ethics and science of current and future BCI applications. Considering the ethics of using this technology before it is implemented could prevent its potential harm. We argue that responsible use of BCI requires safeguarding people’s ability to function in a range of ways that are considered central to being human.

Expanding BCI beyond the clinic

Researchers are exploring nonmedical brain-computer interface applications in many fields, including gaming, virtual reality, artistic performance, warfare and air traffic control.

For example, Neuralink, a company co-founded by Elon Musk, is developing a brain implant for healthy people to potentially communicate wirelessly with anyone with a similar implant and computer setup.

In 2018, the U.S. military’s Defense Advanced Research Projects Agency launched a program to develop “a safe, portable neural interface system capable of reading from and writing to multiple points in the brain at once.” Its aim is to produce nonsurgical BCI for able-bodied service members for national security applications by 2050. For example, a soldier in a special forces unit could use BCI to send and receive thoughts with a fellow soldier and unit commander, a form of direct three-way communication that would enable real-time updates and more rapid response to threats.

To our knowledge, these projects have not opened a public discussion about the ethics of these technologies. While the U.S. military acknowledges that “negative public and social perceptions will need to be overcome” to successfully implement BCI, practical ethical guidelines are needed to better evaluate proposed neurotechnologies before deploying them.

Utilitarianism

One approach to tackling the ethical questions BCI raises is utilitarian. Utilitarianism is an ethical theory that strives to maximize the happiness or well-being of everyone affected by an action or policy.

Enhancing soldiers might create the greatest good by improving a nation’s warfighting abilities, protecting military assets by keeping soldiers remote, and maintaining military readiness. Utilitarian defenders of neuroenhancement argue that emergent technologies like BCI are morally equivalent to other widely accepted forms of brain enhancement. For example, stimulants like caffeine can improve the brain’s processing speed and may improve memory.

However, some worry that utilitarian approaches to BCI have moral blind spots. In contrast to medical applications designed to help patients, military applications are designed to help a nation win wars. In the process, BCI may ride roughshod over individual rights, such as the right to be mentally and emotionally healthy.

For example, soldiers operating drone weaponry in remote warfare today report higher levels of emotional distress, post-traumatic stress disorder and broken marriages compared to soldiers on the ground. Of course, soldiers routinely elect to sacrifice for the greater good. But if neuroenhancing becomes a job requirement, it could raise unique concerns about coercion.

Neurorights

Another approach to the ethics of BCI, neurorights, prioritizes certain ethical values even if doing so does not maximize overall well-being.

Proponents of neurorights champion individuals’ rights to cognitive liberty, mental privacy, mental integrity and psychological continuity. A right to cognitive liberty might bar unreasonable interference with a person’s mental state. A right to mental privacy might require ensuring a protected mental space, while a right to mental integrity would prohibit specific harms to a person’s mental states. Lastly, a right to psychological continuity might protect a person’s ability to maintain a coherent sense of themselves over time.

BCIs could interfere with neurorights in a variety of ways. For example, if a BCI tampers with how the world seems to a user, they might not be able to distinguish their own thoughts or emotions from altered versions of themselves. This may violate neurorights like mental privacy or mental integrity.

Yet soldiers already forfeit similar rights. For example, the U.S. military is allowed to restrict soldiers’ free speech and free exercise of religion in ways that are not typically applied to the general public. Would infringing neurorights be any different?

Human capabilities

A human capability approach insists that safeguarding certain human capabilities is crucial to protecting human dignity. While neurorights home in on an individual’s capacity to think, a capability view considers a broader range of what people can do and be, such as the ability to be emotionally and physically healthy, move freely from place to place, relate with others and nature, exercise the senses and imagination, feel and express emotions, play and recreate, and regulate the immediate environment.

We find a capability approach compelling because it gives a more robust picture of humanness and respect for human dignity. Drawing on this view, we have argued that proposed BCI applications must reasonably protect all of a user’s central capabilities at a minimal threshold. BCI designed to enhance capabilities beyond average human capacities would need to be deployed in ways that realize the user’s goals, not just other people’s.

For example, a bidirectional BCI that not only extracts and processes brain signals but delivers somatosensory feedback, such as sensations of pressure or temperature, back to the user would pose unreasonable risks if it disrupts a user’s ability to trust their own senses. Likewise, any technology, including BCIs, that controls a user’s movements would infringe on their dignity if it does not allow the user some ability to override it.

A limitation of a capability view is that it can be difficult to define what counts as a threshold capability. The view does not describe which new capabilities are worth pursuing. Yet, neuroenhancement could alter what is considered a standard threshold, and could eventually introduce entirely new human capabilities. Addressing this requires supplementing a capability approach with a fuller ethical analysis designed to answer these questions.

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The World Cup is in full swing, with countries duking it out on the soccer field for the championship and, of course, bragging rights. This World Cup has been anything but predictable. Fans were in uproar after Saudi Arabia beat out Argentina’s powerhouse team—the kingdom held a national holiday the day after to celebrate the win—while German fans were in disbelief after losing to Japan. And in a major upset, Mexico’s team was eliminated from the group stage, a first since 1978.

Whether or not you’re a soccer enthusiast, it’s hard to deny the excitement of seeing your home country move closer to the gold. And while not everyone can travel thousands of miles to the games held this year in Qatar, psychologists say there’s good reason to tune into a match. PopSci asked experts about the top five health benefits that come from rooting for a team, even if you’re just on the couch.

[Related: All the ways you can tune in to the 2022 Soccer World Cup]

You feel less lonely

Humans are, by nature, social creatures. This makes the world’s most popular sport a great opportunity to bond with others and find community. Carrie Wyland, a social psychologist at Tulane University in New Orleans, says there are two main reasons why. The first reason is that cheering for a team allows you to feel connected to something bigger than yourself. “Cheering for our favorite teams gives us a sense of identity,” she explains. This social identity is built on the small groups you’ve formed or connected with throughout your life. When you are deeply bonded with a group, your personal self shifts to a greater whole, creating a deeper sense of connectedness with others, explains Wyland. 

The second reason is collective joy. Whether you watch with family or go solo to a bar, your body experiences high arousal emotions, such as happiness and excitement, when you witness an event like your team scoring a goal. “When we experience and share these positive feelings with other people also watching the game, that actually allows us to enhance those emotions and have a greater emotional experience.”

And this social bond is felt through ups and downs—triumph and defeat. When your team loses, you might feel down for a few days, but there is an upside. Wyland says losing a game is still a collective experience and can continue to foster stronger bonds with others—whether in person, through a group chat, or even on social media—as you lament the loss together and figure out what went wrong.

You have higher self-esteem

A 2019 study in the journal Communication and Sport found that fans of winning sports teams reported higher self-esteem two days after the game. While more research is needed to confirm this link, Wyland says the boost in self-esteem after spectating a game may be from a psychological concept called “basking in reflected glory.” It’s when you associate another person’s wins with your own because of your close ties with this group. This can also be seen in fans who rejoice when their favorite music artist wins a Grammy or in supporters of a political party when their preferred candidate gets elected. In this case, a fan’s social identity in soccer may make them feel like they’re part of the team. So when fans cheer or perform rituals like wearing “lucky” socks, they feel like their support aided in the team’s victory.

You increase your life expectancy

There is some indirect support that cheering could help increase your lifespan. But this depends on how you cheer. Are you glued to the couch passively watching or are you physically getting up to jump and down or wave your hands when cheering? While it’s not near an actual physical workout, Wyland says small movements and gestures matter because it gets your body moving.

[Related: How to work out for your mental health] 

Socializing also positively impacts longevity. Social relationships—building friendships or feeling part of a community through sports—have been long associated with good physical and mental health. Regularly watching sports has even been linked to fewer depressive symptoms, which has been previously associated with a 10 to 12-year shorter lifespan in older adults. When you have that social support, there is evidence of a decreased risk of early death.

You relieve stress 

Getting swept away in the action of a game can help immerse yourself in the moment, especially in times of celebration, like when team USA’s Christian Pulisic scored that final goal against Iran to advance the team to the knockout rounds. 

“Sports are a celebration of life, and you are totally in the present—away from the regrets of the past or the anxieties of the future,” explains Eric Zillmer, a neuropsychologist and former director of athletics at Drexel University in Philadelphia. 

Watching and celebrating sports teams allows for a temporary escape from present reality. Zillmer says a game like soccer has rules and boundaries that can be therapeutic and easy to digest for people dealing with the unpredictability of life. Sports can also have people return to a simpler view of life: a triumphant comeback of the underdogs or the fairy tale moment of a superstar player carrying their team to the finals. 

“We know from studies on mindfulness and yoga that living your life in the present is very therapeutic for your health,” Zillmer says. “Sports make us feel alive, and it can be a catalyst for finding things that we hope to find in ourselves.” Sports are all about overcoming obstacles, he says; if those beating challenges exist in sports, they could exist in real life. 

[Related: The complex physics behind bending it like a World Cup player]

You are more motivated to exercise

Wyland says that seeing players zoom across the field and launch soccer balls into the air could inspire kids to get out and play the sport as well. Children may be energized after an exciting game and may want to play outside and emulate their favorite players like Argentina’s Lionel Messi or France’s Kylian Mbappé.

Adults can get in on the action, too, by channeling their excitement from watching the World Cup into their next workout. Zillmer advises linking high-probability behaviors (activities you like or enjoy doing) with low-probability behaviors (things you don’t want to do and may actively avoid). So if you’ve been meaning to exercise but can’t find the motivation to do it, think about your next session as a means to a reward. For example, if there’s a good chance you’re going to watch the USA versus Netherlands game (a high-probability behavior), then force yourself to engage in a low-probability behavior such as a walk around the block as a way of “earning it.” 

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Almost three years into the pandemic, the spotlight isn’t just on COVID medicine anymore. While booster shots and take-home antiviral pills gave us new tools to fight the infectious disease, health researchers and drug makers regained momentum in other crucial areas, like organ transplants, STI prevention, and white-whale therapies for alopecia and HIV. At the same time, AI deepened its role as a diagnostic aid, while mental health services got an accessibility boost across the US. We know the pandemic isn’t over—and other pathogens and illnesses are likely lurking undetected—but the progress we make in medical labs, factories, and care centers can help nurse societies back to health before the next storm hits.

Looking for the complete list of 100 winners? Find it here.

Grand Award Winner

AuriNova by 3DBio Therapeutics: A replacement ear that’s made from ear cells

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About 1,500 people in the US are born each year with absent or underdeveloped external ears. Traditional reconstruction techniques might fix the cosmetic issue, but a new 3D-printed ear transplant, called AuriNovo, offers a living substitute. The implant is made with proteins, hydrogel, and a patient’s own cells, giving it far more flexibility than any constructed with synthetic materials; plus, the procedure is less invasive than, say, transplanting tissue from a patient’s ribs. To build the replacement, a surgeon first takes a sample of an individual’s ear tissue to separate and culture the cartilage-making cells. Then, based on a 3D scan of the fully formed ear on the patient, the part is printed with collagen-based “bio ink” and surgically inserted above the jaw. A 20-year-old woman from Mexico was the first to get the implant this June. 3DBio Therapeutics, the New York-based regenerative medicine company behind AuriNovo, hopes to use the technology to one day create other replacement body parts, like noses, spinal discs, and larger organs. 

Paxlovid by Pfizer: The first take-home treatment for COVID-19

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COVID therapies have come a long way since the start of the pandemic, and now include several antiviral drugs and monoclonal antibodies. But Pfizer’s Paxlovid was the first oral treatment for the disease to receive emergency authorization from the FDA, meaning it can be obtained with a prescription. It’s also highly effective: Clinical trials show it reduces hospitalization and death from the virus up to 90 percent more than a placebo. The remedy is a combination of two pills: nirmatrelvir, which prevents the novel coronavirus from replicating, and ritonavir, which causes the body to metabolize nirmatrelvir more slowly. The drug does have downsides—it can interact with other medications and sometimes causes a foul aftertaste. Plus, rare cases of rebound COVID symptoms and positive tests have occurred in people following Paxlovid treatment, although research indicates that the latter might be related to the immune system responding to residual viral RNA. Still, it represents a crucial new safeguard for healthcare providers and the public.

EVO Visian Implantable Collamer Lenses by STAAR Surgical: Combining the perks of contacts and laser surgery

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Most cases of nearsightedness and astigmatism, which is blurred vision caused by an irregularly shaped cornea, can be fixed with laser eye surgery. But the procedure requires some corneal tissue to be removed and often leaves recipients with lingering dry eyes. EVO ICL provides an alternative with a minimally invasive new way to correct or reduce both conditions. During the approximately hour-long procedure, a flexible collagen-containing lens is implanted between the iris and natural lens. The implant is meant to sit in the eye permanently, but can also be plucked out by an ophthalmologist if needed. In published clinical trial results, close to 88 percent of patients reported 20/20 or better and nearly all achieved 20/32 or better distance vision after six months. The lenses also block some UV rays for added protection.

Olumiant by Eli Lilly and Incyte: Long-term relief for severe alopecia

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More than 300,000 people of all ages in the US live with severe alopecia areata, a condition that causes the immune system to attack hair follicles, leading to patchy baldness on the scalp and elsewhere. Hair loss in the nose and ears can affect patients’ hearing and allergies, and a lack of eyelashes can leave people vulnerable to eye irritation from dust. Olumiant, the first medication to secure the FDA’s approval for severe alopecia, can help hair grow back over the entire body. It belongs to a group of drugs called JAK inhibitors, which block certain inflammation-promoting enzymes. It was originally greenlit by the agency in 2018 to treat some forms of rheumatoid arthritis, but in clinical trials for alopecia, it helped roughly a third of participants to regrow up to 80 percent of their hair by 36 weeks, and nearly half after a year. Other JAK inhibitors in development could provide alternatives for patients who don’t fully respond to Olumiant.

AIR Recon DL by GE Healthcare: Sharper MRIs in half the time

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Laying motionless for an hour or longer in a magnetic scanner can be a claustrophobic and sometimes nauseating experience. A next-level neural network by GE Healthcare reduces the stress on patients, while filtering out visual noise from movement or faulty processing. The software combs through raw radio-wave data from MRI machines and turns the most accurate bits into high-resolution 3D images. Originally, the AI-reconstructed images had to be stitched together—but the updated tech, which received FDA approval this September, delivers in one go. The speedy precision can cut exam times in half, help hospitals and clinics serve more patients, and possibly improve the rate of diagnosis by giving radiologists a much cleaner view of tissues, bones, masses, and more.

ONE Male Condom by ONE: Latex that works for anal sex

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At first glance this condom isn’t all that different from those by other brands. It’s made from natural latex, comes in three thicknesses, and has a wide range of sizes for best fit. But the contraceptive is the first to also be clinically tested for STI protection during anal sex—and has proven to be extremely effective. In studies involving 252 male-male couples and 252 male-female couples, the condoms had a less than 2-percent chance of breakage, slippage, discomfort, and adverse events (which included urinary tract infections and bacteria and viruses spread during sex). With such a healthy showing, the company earned the FDA nod to label the product as “safe for anal sex.” With widespread availability, there’s hope that the condom can help beat back a record rise in chlamydia, gonorrhea, syphilis, and other STIs.

Bivalent COVID-19 vaccines by Moderna and Pfizer-BioNTech: A one-shot-fits-all approach

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One of the niftiest features of mRNA vaccines such as Moderna and Pfizer-BioNTech’s COVID shots is that they can be tweaked and scaled up quickly to keep up with an ever-changing virus. This August, the FDA authorized the first bivalent COVID boosters, modified with new genetic data to target both the original version of SARS-CoV-2 and the Omicron sub-variants BA.4 and BA.5. Just how much added protection the bivalent shots offer against the latest versions of COVID remains to be seen, although in early results, the Pfizer-BioNTech booster increased antibodies against the BA.4 and BA.5 sub-variants by up to 11 times, while the Moderna booster did so by up to 15 times. Experts anticipate that the bivalent COVID vaccines, which are available to all adults and children ages 5 and older in the US, could save thousands of lives if the virus surges again this winter. 

Umbilical cord blood transplant for HIV by Fred Hutchinson Cancer Research Center and Weill Cornell Medicine: The right cells for viral resistance

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There are now three official cases of patients in long-term HIV remission—but this one might be the most promising for the millions around the world living with the virus. In 2017, an unidentified American received a blood transplant packed with genes that were resistant to the pathogen behind AIDS. More than four years later, her doctors at Weill Cornell Medicine confirmed that the procedure at Fred Hutchinson Cancer Research Center had indeed made her free of the disease. The miraculous sample was specifically taken from a relative’s umbilical cord blood cells, which were still in the process of maturing and specializing, making it easier for the transplant to take. Previous attempts to cure the disease depended on bone marrow donations that carry a mutated gene only known in Northern Europeans. This alternative treatment makes transplants more accessible for patients from other ethnic backgrounds, so their bodies can fight HIV in the long run as well.

988 Suicide and Crisis Lifeline by SAMSHA: Streamlining the call for help 

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When you have a general emergency, you might call 911. But for people experiencing a mental crisis, the number has been a lot less intuitive. This July, however, the Suicide and Crisis Lifeline, run by the US Department of Health and Human Services since 2005, fully switched over to a three-digit code that’s easy to punch in: 988. The shortcut was years in the making, but required major collaboration with the Federal Communication Commission to connect every phone service provider to the alternative number. Since it went live, officials have reported shorter hold times and a 45-percent increase in use compared to August 2021, including on a specialized veteran hotline. The service shakeup also came with $177 million for states and tribes to support the transition in different ways, like alleviating surcharges, setting up call centers, and integrating crisis relief with existing or new emergency responses.

eCoin Peripheral Neurostimulator by Valencia Technologies: A discreet implant for bladder control 

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Pads, vaginal seals, and skin patches can be a burden for anyone who has to deal with urinary incontinence on a daily basis. A new electrode device, about as small as a nickel and implanted above the ankle, nips the issue in the bud in a more private and convenient way. Incontinence typically occurs when the muscles in and around the bladder contract too often or too much. To prevent leaks and constant trips to the toilet, the eCoin sends low-key shocks through the tibial nerve, targeting the pelvic organs and relaxing the bladder wall. A doctor can control the intensity of the pulses with a remote, making the device more customizable for a broad range of patients. Neurostimulators have become a vanguard treatment for different nervous system conditions, including chronic back pain and even paralysis—but few are so adaptable as this.

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Between lockdowns, missing milestone events such as prom or graduation, and general worry over the state of the world in the past few years, times have been particularly tough on adolescents.

Reports of anxiety and depression in adults increased by more than 25 percent in 2020, and some new research suggests that mental health and the neurological effects of the pandemic on adolescents could be even worse than in their adult counterparts.

[Related: Neuroscientists are mapping all 100 billion cells in the human brain.]

Scientists are beginning to look at how the past two and a half years of pandemic life is affecting the brains of teens. A new study published today in the journal Biological Psychiatry: Global Open Science, suggests that stressors related to the COVID-19 pandemic have physically changed teen brains, causing their brain structures to appear multiple years older than the brains of comparable peers before the pandemic.

“We already know from global research that the pandemic has adversely affected mental health in youth, but we didn’t know what, if anything, it was doing physically to their brains,” said Ian Gotlib, study author and psychology professor at Stanford University’s School of Humanities & Sciences, in a statement.

Changes in brain structure occur naturally as we age. During early teenage years and in puberty, the hippocampus (which controls access to certain memories) and the amygdala (which helps moderate emotions), go through growth spurts like the rest of the body. The tissues in the cortex, which controls executive functioning, becomes thinner at the same time.

To get a closer look, Gotlib and his team compared the MRI scans of 163 children that were taken before and during the pandemic. The study showed that during the COVID-19 lockdowns, this developmental process in the brain sped up in adolescents. According to Gotlib, an accelerated change in “brain age” has typically appeared only in children and adolescents who have experienced chronic adversity (family neglect, violence, family dysfunction, etc.). These kinds of early adverse experiences can be linked to worse mental health outcomes later in life.

However, it is still unclear whether the changes in brain structure that this study observed will be linked to changes in mental health later on in life.

“It’s also not clear if the changes are permanent,” said Gotlib. “Will their chronological age eventually catch up to their ‘brain age’? If their brain remains permanently older than their chronological age, it’s unclear what the outcomes will be in the future. For a 70- or 80-year-old, you’d expect some cognitive and memory problems based on changes in the brain, but what does it mean for a 16-year-old if their brains are aging prematurely?”

The results of this study could have implications for some of the longitudinal studies that have spanned the course of the pandemic. Scientists will have to account for abnormal rates of growth in the brain for any research down the road involving this generation, if those who experienced the pandemic generally show this rapid brain change.

“The pandemic is a global phenomenon—there’s no one who hasn’t experienced it,” said Gotlib. “There’s no real control group.”

[Related: We shouldn’t disregard the ideas that come from teens’ developing brains.]

Co-author Jonas Miller, an assistant professor of psychological sciences at the University of Connecticut, added that results like this may have serious consequences for this generation later in life.

“Adolescence is already a period of rapid reorganization in the brain, and it’s already linked to increased rates of mental health problems, depression, and risk-taking behavior,” Miller said. “Now you have this global event that’s happening, where everyone is experiencing some kind of adversity in the form of disruption to their daily routines – so it might be the case that the brains of kids who are 16 or 17 today are not comparable to those of their counterparts just a few years ago.”

Gotlib plans to follow the same cohort of teens from this study through later adolescence and into young adulthood, looking to see if the pandemic changed the trajectory of brain development long term, alongside their mental health. He also plans to compare the brain structures of those who were infected with COVID-19 and those who weren’t infected with the virus, with the goal of identifying any differences in the brain potentially caused by infection.

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When’s the last time you looked away from your computer? If you’re anything like me, it’s been a while, which might be slowing both of us down. 

Taking regular breaks can vastly improve your focus, according to a University of Illinois Urbana-Champaign study published in March 2011, and that means you and I should really be stepping away from our screens more than we are. It doesn’t matter whether you’re working or in the middle of a gaming session—breaks will help you perform better. The problem: it’s hard to remember to take some time to regroup, so you may have to force the issue.

This advice will be even easier to follow if you make a habit out of it. You could take a walk every day at 10 a.m., or make yourself a cup of tea every afternoon at 2 p.m., and those are just two of countless examples I could list here. Build these breaks into a routine and you’ll find it’s easier to stick to. 

Try the Pomodoro Technique

Pomodoro, as you might know, is the Italian word for tomato. The Pomodoro Technique gets its name from the tomato-shaped kitchen timer used by its creator Francesco Cirillo when he started scheduling breaks into his day. The method is simple: decide on a task you want to accomplish, set a timer for 25 minutes, and get to work. When time’s up, take a five-minute break. After four such sessions, take a longer break, generally a half-hour or so. Then start over. A lot of people swear by this technique, which combines periods of intense focus with regular breaks—exactly why we mentioned it in our guide to overcoming procrastination.

You can use a regular kitchen timer for this, if you want, but most people today rely on apps. I recommend Pomodor for anyone who is curious. This simple application runs entirely within a web browser, meaning you won’t need to install anything. Hit the play button to start focusing on a task, then take a break when you get a notification to stop.

The reason I like Stretchly is that it pops up over whatever you’re doing, effectively forcing you to stop. Each time, the application also offers a suggestion for how to spend your break, like turning your head toward natural light or doing some basic stretching. 

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This article was originally featured on KHN.

As the covid-19 pandemic worsened a mental health crisis among America’s young people, a small group of states quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.

Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s Youth Risk Behavior surveys that reaches more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.

Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.

Some questions on the state-level surveys — which can also ask students about their sexual orientation, gender identity, sexual activity, and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.

The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse, and suicidal ideation, experts said.

“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”

The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity, and more.

The decisions by Colorado, Florida, and Idaho not to participate in the state-level questionnaires will not affect the CDC’s national survey or the local school district surveys in the states that have them.

Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the United States.

The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. But trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade.

“So we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”

The pandemic has further exacerbated the mental health problems young people face, said Angela Mann, president of the Florida Association of School Psychologists.

Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had had a negative impact on their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.

But the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example. And the sample of students from each state is so small that some state officials said their schools received little actionable data despite decades of participation.

That was the case in Colorado, which decided not to participate next year, according to Emily Fine, school and youth survey manager at the Colorado health department. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019.

Minnesota, Oregon, Washington, and Wyoming, which also have their own youth surveys, either never participated or decided to skip the previous two CDC assessments. At least seven states will not participate in the 2023 state-level survey.

Fine said the state-run option is more beneficial because schools receive their own results.

In Leadville, a Colorado mountain town, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher-than-average rates of substance use. They also learned that Hispanic students in particular didn’t feel comfortable sharing serious problems like suicidal thoughts with adults, suggesting that opportunities to flag issues early were being missed.

“I feel like most kids tell the truth on those surveys, so I feel like it’s a reliable source,” said high schooler Daisey Monge, who is part of the youth coalition, which proposed a policy to train adults in the community to make better connections with young people.

Education officials in Florida and Idaho said they plan to gather more state-specific data using newly created questionnaires. But neither state has designed a new survey, and what questions will be asked or what data will be captured is not clear.

Cassandra Palelis, a spokesperson for the Florida Department of Education, said in an email that Florida intends to assemble a “workgroup” to design its new system.

In recent years, Idaho officials cited the CDC survey data when they applied for and received $11 million in grants for a new youth suicide prevention program called the Idaho Lives Project. The data showed the share of high school students who had seriously considered attempting suicide increased from 15% in 2011 to 22% in 2019.

“That is concerning,” said Eric Studebaker, director of student engagement and safety coordination for the State Department of Education. Still, he said, the state is worried about taking up class time to survey students and about overstepping boundaries by asking questions that are not parent-approved.

Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.

But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education law, which bans instruction about sexual orientation and gender identity in kindergarten through third grade.

The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school curriculums are having a chilling effect on all age groups, said youth advocates like Mann, the Florida school psychologist. “Some of these discussions about schools indoctrinating kids has bled into discussions about mental health services in schools,” she said.

Since the law was adopted, some Florida school administrators have removed “safe space” stickers with the rainbow flag indicating support for LGBTQ+ students. Some teachers have resigned in protest of the law, while others have expressed confusion about what they’re allowed to discuss in the classroom.

With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends.

“It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.

KHN Colorado correspondent Rae Ellen Bichell contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Despite being a wealthy country, clean water crises continue to plague the US. Late last week, residents of Jackson, Mississippi filed a class action lawsuit over a major water crisis that left 150,000 people in the capital city without clean running water. The crisis started after major flooding in August, but follows years of neglect to the infrastructure in the majority-Black city. Simultaneously, an arsenic scare in New York City’s Jacob Riis Houses further sounded the alarm on critical updates to aging water infrastructure.

Arguably the biggest water wake-up-calls have come from the city of Flint, Michigan. On April 25th, 2014, the city government switched its water supply from Lake Huron and the Detroit River to the Flint River. The water supply then wasn’t properly treated to prevent lead and other elements from leaching out of the city’s old water pipes and into the drinking water. Virtually all Flint residents were consequently exposed to drinking water with unsafe levels of bacteria, disinfection byproducts, and lead (a neurotoxicant).

Now, a new study published in the journal JAMA Network Open reveals the serious mental toll that these water crisis can have on the residents affected. The study looked at data from the largest mental health survey of the Flint community. In the five years after the water crisis began, one in five adults (about 13,600 people) were estimated to have clinical depression, and one in four (about 15,000 people) were estimated to have post-traumatic stress disorder (PTSD) five years after the water crisis began.

[Related: Michigan health director charged with involuntary manslaughter due to Flint water woes.]

“The mental health burden of America’s largest public-works environmental disaster clearly continues for many adults in Flint,” said Aaron Reuben, a postdoctoral scholar at Duke University who led the research, in a press release.

The drinking water in Flint wasn’t declared lead-free until January 24, 2017, but residents were cautioned that it could take over a year for the water to be completely safe. Tens of thousands of children and adults developed high blood-lead levels, putting them at greater risk for cognitive deficits, mental health problems, and other health problems later in life.

“We know that large-scale natural or human-caused disasters can trigger or exacerbate depression and PTSD,” said Dean Kilpatrick, a psychiatry professor at the Medical University of South Carolina and senior author of the study, in a press release. Kilpatrick noted that there was evidence of high rates of mental health problems in the community during the first years of the crisis. “What we did not know until now was the extent to which Flint residents continued to have mental health problems at the clinical diagnosis level five years after the crisis began.”

Past year rates of depression and PTSD identified in Flint and today they are three to five times greater than national estimates among US adults overall, according to Kilpatrick. This is likely due to a combination of higher base rates of mental health problems in Flint (lower incomes and systemic poverty, for example) before the crisis and significant exacerbation of problems resulting from the crisis.

[Related: The devastating effects of childhood lead exposure could last a lifetime.]

“The vast majority of our respondents were never offered mental health services despite clear indication that the crisis was psychologically traumatic. Now that pipes are being replaced, the time is right to begin a second phase of recovery from the water crisis – one that focuses on providing additional resources to heal psychological wounds,” Reuben added.

The findings in this study suggest that more should be done to provide mental health treatment for residents of Flint. “There is a clear unmet need. Nearly 100 percent of surveyed Flint residents reported that they changed their behavior to avoid consuming contaminated water during the crisis, and the vast majority still worry that the exposures they had may cause future health problems for themselves or their family members,” concluded Reuben.

While this problem isn’t unique to Flint, the city and its people shone a glaring spotlight on a nationwide issue. One of the enduring faces of this Flint crisis is Mari Copeny aka Little Miss Flint. At eight years-old, she wrote a letter to then President Barack Obama to draw attention to the crisis. The president shared that “letters from kids like you are what make me so optimistic about the future” and he visited Flint in 2016. Now 15 years-old, Copeny has continued to advocate for environmental justice and even launched a GoFundMe to raise money for Jackson residents.

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For the first time ever, a panel of health experts recommends that all adults under the age of 65 should be screened for anxiety. The new recommendations from the United States Preventative Services Task Force (USPSTF) come in the wake of high stress levels in this population that were prevalent even before the COVID-19 pandemic. USPSTF aims aims for this new guidance to help clinicians identify mental health disorders earlier so that they do not go undetected. It made similar recommendations earlier this year for children and teens.

It is common for anxiety disorders to go unrecognized an undetected in a primary care setting. The task force cited a study from the World Health Organization (WHO) that found the median time for initiating treatment for anxiety is 23 years.

“To address the critical need for supporting the mental health of adults in primary care, the Task Force reviewed the evidence on screening for anxiety, depression, and suicide risk,” says task force member Lori Pbert a clinical psychologist and professor at the University of Massachusetts Chan Medical School, in a press release. “The good news is that screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety can help identify these conditions early so people can be connected to care.”

[Related: Mental health ‘first aid’ can give bystanders the skills to act in a crisis.]

The panel had been preparing the guidance since before the COVID-19 pandemic began, but Pbert called the guidance “very timely” given reports of an increase in mental health problems that are associated with pandemic isolation and stress. “COVID has taken a tremendous toll on the mental health of Americans,” Pbert told The Washington Post. “This is a topic prioritized for its public health importance, but clearly there’s an increased focus on mental health in this country over the past few years.”

According to a study from the Centers for Diseases Control and Prevention (CDC) cited by the task force, the percentage of adults experiencing recent symptoms of a depressive or anxiety disorder jumped to 41.5 percent from 36.4 percent between August 2020 to February 2021. Between 2013 and 2018, only a few years before the pandemic, 8.1 percent of American adults 20 and older had depression in a given 2-week period and the number did not increase.

Currently, the guidance is in draft form and the public has opportunity to comment until October 17. While recommendations from USPSTF are not mandatory, they greatly influence primary care physicians across the US.

Some mental health care providers emphasized that programs that screen for anxiety and depression are are useful only if they can lead patients to effective solutions. Jeffrey Staab, a psychiatrist and chair of the department of psychiatry and psychology at the Mayo Clinic in Rochester, Minnesota told The New York Times that at a time when the country is “short on mental health resources on all levels—psychiatrists, psychologists, and therapists—that’s a real concern. We can screen lots of people, but if that’s all that happens, it’s a waste of time.” Staab is is not on the task force.

According to the USPSTF, screening and followup care can help reduce the symptoms of anxiety and depression, but there there is limited evidence on the benefits and harms of screening adults over 65 for anxiety. It also called for more research into suicide prevention, which remains a leading cause of death in the United States, according to the CDC.

[Related: How to manage your mental health as traumatic events pile up.]

“The Task Force cares deeply about the mental health of people nationwide. Unfortunately, evidence is limited on screening adults 65 or older for anxiety and screening all adults for suicide risk, so we are urgently calling for more research,” said task force member Gbenga Ogedegbe, the inaugural and founding director of the Institute for Excellence in Health Equity at NYU Langone Health and a member of the National Academy of Medicine, in a press release. “In the absence of evidence, healthcare professionals should use their judgment based on individual patient circumstances when determining whether or not to screen.”

The panel also cited the “racism and structural policies” disproportionally affecting people of color. Black patients, for example, are less likely to receive mental health services compared to other groups, and more likely to be misdiagnosed.

The task force stressed that this is just a single step in addressing an urgent mental health crisis and the task force will read every comment during the comment period, according to Pbert. “We would like people to be honest, to provide their input and perspectives,” she told CNN. “It’s really important because it’s allowing us to hear from the public—and the public includes people who are specialists in these areas. We really value the input of other specialists who can give us their perspective and their comments.”

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A study published Monday in the Journal of Clinical Psychiatry found that some people who received intravenous ketamine across three private ketamine infusion clinics had “significant improvement” in symptoms of depression, anxiety and suicidal ideation.

Used primarily in hospital settings as an anesthetic, ketamine is a very powerful medication that also is used illegally by less than one percent of the US population. It can create intense highs, hallucinations, and distortions.

Ketamine has been emerging as a potential treatment option for several years, and the Food and Drug Administration (FDA) approved a nasal spray derived from ketamine called esketamine for people with treatment-resistant depression in 2019. However, the FDA still hasn’t approved other ways of using ketamine to treat depression, such as IV infusion, shots in the arm, or lozenges. Some treatments using the medication are considered “off-label” and are npt covered by health insurance.

“While it’s wonderful to have new drugs, we remain reliant on serendipitous observation,” Steven Hyman, a psychiatrist at the Broad Institute, which partners in depression research with MIT and Harvard, told Popular Science in 2019. “We will have really turned a corner when we understand the mechanisms.”

[Related: Can tripping on ketamine cure PTSD? I decided to try.]

For this study, the researchers looked at data on 424 people with treatment-resistant depression (when symptoms of depression do not go away with traditional anti-depressants). The patients were treated between November 2017 and May 2021 at three ketamine infusion clinics in Virginia. These unregulated clinics specialize in treating suicidal ideation, depression, or anxiety. The patients filled out physical and mental health surveys during visits, and were given six ketamine infusions within 21 days.

The researchers say that half of the participants responded to the treatment within six weeks of beginning infusions and 20 percent had depressive symptoms in remission. After 10 infusions, response rates were 72 percent and remission rates were 38 percent. The team also saw a 30 percent reduction in anxiety symptoms over the course of the treatment and half of the patients who experienced suicidal ideation were in remission after six weeks.

This new study adds to a growing body of research into the its use in treating these types of illnesses. However, there are still no direct directives on how the drug should be used and private ketamine infusion clinics remain highly unregulated. Reporting from Bloomberg last year highlighted the growing market for psychedelic drug therapy “schools” charging large sums with little to no regulation.

Gerard Sanacora, a psychiatry professor at the Yale School of Medicine (who did not conduct the study) told CNN that the paper, “gives some more real-world data, which is incredibly important” because it helps show its potential to work in a more general population. He also explained that this study leaves some “critical gaps, including data on adverse effects and direct comparisons to other options, that make it difficult to conclude how it should be used.”

[Related: Two radically new drugs bring hope for people with depression. But psychiatrists are skeptical.]

Additionally, one of the main limitations of this particular research is that that it was not conducted as a blind study with a control group. It relied on patient-reported surveys and didn’t take into consideration those who declined to have ketamine infusions. The team also acknowledge that they didn’t systematically assess adverse events or side effects of the treatment.

“It’s an epidemic, and it’s been going on forever,” said Patrick Oliver, the study’s lead researcher, the medical director of MindPeace Clinics, and a former emergency room physician, in an interview with The Washington Post. “And we’ve found a medication that literally costs pennies to make and is fixing these patients.” Oliver claimed that ketamine therapy could potentially become a mainstream solution to depression and potentially other mental disorders that have long been undertreated.

According to data from the National Center on Health Statistics, nearly 46,000 Americans died from suicides in the United States in 2020 and it is the second leading cause of death for Americans age 10-34 as of 2020.

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A study published this week in the journal BMJ Open finds a possible link between inhaled and systemic glucocorticoids, commonly taken for ailments like chronic obstructive pulmonary disease (COPD) or asthma, and structural and volume changes in brain gray and white matter. The medications, also sometimes known as corticosteroids, come in both an inhaled and systemic (pill or injection) form and are widely prescribed (their taken by roughly 1 percent of the general population). The Asthma and Allergy Foundation of America estimates that 25 million people (1 in 13 individuals) have asthma in the United States.

The study looked at data from the UK BioBank, a biomedical research center that followed half a million residents of the United Kingdom from 2006 to 2010. The researchers found 222 oral glucocorticoid users and 557 users of inhaled glucocorticoids (779 total) who did not have a previous diagnosis of any neurological, hormonal, or mental health disorder.

[Related: Your car’s exhaust is giving kids asthma.]

The team then performed cognitive and mental health testing on these 779 individuals and took diffusion MRIs of their brains. The team compared the MRI and cognitive findings with over 24,000 people in the database who did not use these steroids. They found reduced white matter integrity in the corticosteroid users, according to the study.

“This study shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity,” wrote study author Merel van der Meulen, a postdoctoral student at Leiden University Medical Center in the Netherlands. “The greatest amount of white matter damage was found in people who use oral steroids regularly over long periods of time, with inhalers having the smallest impact on brain matter.”

In the brain, white matter is a tissue that forms connections between brain cells and the rest of the nervous system. Less white matter in the brain can slow down its ability to process information, as well as attention span and memory. Some studies have connected lower levels of white matter with depression and irritability.

“This study shows that both systemic and inhaled glucocorticoids are associated with an apparently widespread reduction in white matter integrity, which may in part underlie the neuropsychiatric side effects observed in patients using glucocorticoids,” the team wrote.

Some of the neuropsychiatric effects patients using these steroids for a long term are anxiety, depression, mania, and delirium.

In an interview with CNN, Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke, who was also not involved in the study said that, “there’s no reason for alarm.” Nath said physicians have long known that, if you give patients steroids, “the brain does shrink, but when you take them off the steroids, it comes back.” White matter has the ability to regenerate, thankfully.

[Related: Why Western states have the worst air pollution.]

The team pointed to certain limitations in the study. Only a few indicators of mood change were assessed and only for the preceding two weeks. They also reported that the changes might have been related to the condition for which steroids were prescribed rather than to steroid use itself. They also weren’t able to differentiate between steroid tablets and infusions for systemic users, all of which may have influenced the findings.

“Although a causal relation between glucocorticoid use and changes in the brain is likely based on the present and previous studies, the cross-sectional nature of this study does not allow for formal conclusions on causality,” they wrote.

This is another example of how correlation does not equal causation. Just because two things correlate does not necessarily mean that one causes the other. So if you’re an asthmatic taking one of these medications, make sure to talk to your doctor before considering any changes to your regimen.

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Health monitoring tech like Google Fit and the Apple Health app rake in millions of dollars every year. But they are primarily limited to physical aspects like fitness and sleep quality. Recently, however, multiple companies are attempting to tackle the psychological aspects of consumers’ wellbeing, raising numerous questions regarding privacy, accuracy, and ethics.

Both Fitbit and Tinder cofounder, Sean Rad, are offering new products billed as tools to better keep track and improve users’ mental health. The former’s newest item, the Sense 2, is a wearable akin to the Apple Watch that attempts to monitor your stress levels in realtime, then react accordingly. Aside from already ubiquitous datapoints like heart rate and skin temperature, Fitbit’s Sense 2 constantly measures electrodermal activity, aka sweat levels.

[Related: A beginner’s guide to Google Fit and Apple Health.]

Meanwhile, Rad’s Happy Ring company is already taking preorders for its new wearable designed that checks in with users whenever it notices stress-indicating fluctuations in biometrics. “Happy Ring makes no claims of being a diagnostic tool. Rather, the company believes it has cracked the code of monitoring wearers’ progress, in a kind of mental health analog to fitness trackers like Apple Watch and Oura,” explains TechCrunch in a recent writeup. “Much like those products, it purports to be a method for monitoring those vital readings and presenting actionable data to help get the wearer back on track.”

There is no upfront hardware cost to the Happy Ring—instead, consumers will pay for one of three subscription tiers ranging between $20 and $30 per month on a contract basis. When paired with its app, Happy Ring will monitor wearers’ biometric data in real-time, alerting them when it detects spikes in stress or tension and directing them to aid like cognitive behavioral therapy and breathing exercises, meditation prompts, and educational articles.

[Related: Tinder and the metaverse are breaking up.]

Many consumers may be intrigued by the idea of having comparatively cheap, constantly available digital counselor at their side, but there are numerous caveats to new products like these. First, as always, is understanding how customers’ data will be stored, utilized, and potentially sold to third-parties. None of these services are purely altruistic, and consumer health data is a goldmine to countless companies looking to hone their markets.

Secondly, an app’s recommendations are rarely a perfect substitute for actual mental health services and aid. While access to counselors and psychologists remains a major barrier for a huge portion of the country, products like Fitbit and Happy Ring won’t always be suitable alternatives. Then there’s the question of accuracy—inner psychological workings are much more complicated than physical exercise routines. It could be ineffective, potentially even dangerous, to think these intersectional issues can be broken down by apps and wearables. This isn’t to write off the industry entirely, but a healthy degree of skepticism is necessary when approaching what appears to be an inevitably massive industry in the years ahead.

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Psilocybin, the psychedelic compound that causes the trippy effects of magic mushrooms, could help people with alcohol use disorder drink less and potentially quit altogether. A new clinical study published August 25 in JAMA Psychiatry found that two doses of psilocybin combined with psychotherapy reduced the amount people drank compared with people who only received psychotherapy. Psilocybin’s effects persisted for at least seven months after the second dose, suggesting it could be a potential long-term treatment for alcohol addiction. 

“The findings are promising and exciting,” says lead study author Michael Bogenschutz, director of the NYU Langone Center for Psychedelic Medicine. “We saw large and very persistent effects that could help us find out what place psilocybin will play in the treatment of alcohol use disorder and potentially co-occurring mood and anxiety disorders.”

Though it enrolled fewer than 100 people, the trial “represents the largest psilocybin study to date, and the relatively robust outcomes in both overall drinking, and drinking-related behaviors in a study of this size are therefore noteworthy,” says James Giordano, professor of neurology and biochemistry at Georgetown University Medical Center who was not a member of the research team.

The Food and Drug Administration does not approve psilocybin as a treatment for any disorder. But in the past decade, a growing scientific movement has explored possible mental health benefits of psychedelics. Psilocybin, most notably, has shown to provide immediate and long-term relief for people with depression. Research suggests psilocybin’s effectiveness increases when combined with therapy, especially for treatment-resistant depression. The current trial tested psilocybin’s health benefits towards another condition: alcoholism. 

About 14.5 million people in the US have alcohol use disorder; alcohol is the third-leading preventable cause of death among Americans. Heavy drinking rates have also soared during lockdown, with an increased 25 percent of alcohol-related deaths in the first year of the pandemic. While some medications and psychotherapy can effectively manage alcohol abuse, Bogenschutz says their effects are small. Only one person out of 60 with alcohol use disorder actually seek medical treatment.

The new randomized, double-blind clinical trial is based on the results of a 2015 pilot study led by Bogenschutz, in which his team tested the effects of two doses of psilocybin plus psychotherapy on 10 participants with alcohol dependence. While the previous study was not well-controlled, Bogenschutz observed that the treatment substantially decreased people’s drinking and there were no noticeable safety issues.

[Related: Is Dry January the best way to cut back on drinking?]

To build off those results, the researchers enrolled 93 men and women diagnosed with alcohol use disorder. Each person received 12 psychotherapy sessions for 12 weeks and was randomly assigned to receive either two doses of psilocybin (48 patients) or an antihistamine placebo (45 patients). The team tracked the participants’ health outcomes and their daily drinking patterns for eight months. After the eight months, every participant was offered a third session where they would knowingly receive psilocybin.

People in the psilocybin group drank significantly less than people in the placebo group during the first 32 weeks. The rate of heavy drinking–four or more drinks in men and three or more drinks in women in a single day–in people who took psilocybin was 9.7 percent. For people who had the antihistamine, it was 23.6 percent. The last follow-up showed psilocybin’s effects persisted for another seven months.

Twice as many people in the psilocybin group stopped drinking altogether compared with those who were abstinent in the placebo group (48 percent vs. 24 percent). “My greatest expectations for this were to be able to manage my cravings, and this surpassed that,” said John Costas, one of the first participants enrolled in the clinical trial, in a press conference about the study. “[Psilocybin] eliminated all my cravings to the point where it cured my alcoholism, and I don’t categorize myself as an alcoholic anymore.”

Paul Mavis, another study participant who received the placebo but then psilocybin in the optional third session, said he feels comfortable again going out to dinner with friends who are drinking in front of him. “No one would have thought that I would not be drinking, including myself… I haven’t had a drink or a craving, it was as if I never drank in my life.”

[Related: What is a hangover? And can you cure it?]

“This is a very encouraging preliminary study of psilocybin-assisted therapy for alcohol use disorder,” says Keith Heinzerling, an addiction medicine specialist and director of treatment and research in psychedelics at Providence Saint John’s Health Center who was not affiliated with the study. Not only were there improvements in heavy drinking, but Heinzerling noted taking psilocybin did not cause any serious side effects. He pointed out, though, that the study had trouble hiding who had the hallucinogen and who did not; participants quickly realized which group they were in. “This is a challenge in all psychedelic clinical trials and may have biased the results in favor of psilocybin.”

The study has the potential to expand psilocybin use to co-morbidities often associated with alcohol dependence, Giordano says. But it would have been helpful to observe how psilocybin affected people by gender, ethnicity, and age, he adds.

Bogenschutz and his team are planning to expand their findings into a three-year trial with more than 200 participants at 15 sites. If all goes well, the trial may be one step closer toward FDA approval of psilocybin, which Bogenschutz says would be “a real breakthrough in the treatment of alcohol use disorder.”

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This article was originally featured on The Conversation.

Taking oxycodone at the same time as certain selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed class of antidepressant, can increase the risk of opioid overdose, according to a study my colleagues and I published.

Doctors prescribe the opioid oxycodone to treat moderate to severe pain after surgeries and injuries or certain conditions like cancer. Opioids are also a common drug of abuse. In the U.S., over 70% of drug overdose deaths in 2019 involved an opioid.

Because many patients with depression also experience chronic pain, opioids are often coprescribed with antidepressants like SSRIs. Prior research has shown that certain SSRIs, namely fluoxetine (Prozac or Sarafem) and paroxetine (Paxil, Pexeva or Brisdelle), can strongly inhibit a liver enzyme crucial to the proper breakdown of drugs in the body, including oxycodone. The resulting increased concentration of oxycodone in the blood may lead to accidental overdose.

To see whether different types of SSRIs might affect a patient’s risk of overdosing on oxycodone, my colleagues and I examined data from three large U.S. health insurance claims databases. We included over 2 million adults who began taking oxycodone while using SSRIs between 2000 and 2020. The average age of the group was around 50, and a little over 72% were women. A little over 30% were taking the SSRIs paroxetine and fluoxetine.

We found that patients taking paroxetine or fluoxetine had a 23% higher risk of overdosing on oxycodone than those using other SSRIs.

About 30% of patients with chronic pain experience adverse drug interactions while taking opioids. Other types of drugs have been shown to increase the risk of overdose and other harmful interactions. These include some muscle relaxants commonly used to treat pain, benzodiazepines commonly used to treat anxiety or poor sleep and some antipsychotics commonly used to treat schizophrenia or bipolar disorder. Similarly, in 2019, the Food and Drug Administration required drugmakers to include new warnings on using gabapentinoids, a class of drugs commonly used to treat epilepsy and pain, concurrently with opioids and other drugs that suppress the central nervous system. This mandate was due to an increased risk of dangerously reduced breathing rates that can result in overdose and death when these drugs are taken together.

The findings from our study offer insight on which of the most commonly used antidepressants could most likely lead to opioid overdose. Further investigation of how other drugs interact with opioids could help doctors and patients better understand which drugs are safe to take at the same time.

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When you laugh, you can immediately reap the rewards—your mood improves and you relax. And it doesn’t stop there as in the long term, more chuckles can give your heart health a boost, and reduce stress. 

But with everything going on in the world, it can be hard to laugh. Spending time with the people, comedians, movies, or TV shows that make us laugh the most is a good start, but there’s an even easier way to get the benefits of some extra cackles: making yourself laugh through simulated laughter. 

Laughing is healthy

Neuroimmunologists, the scientists who study the interaction between our nervous and immune systems, have shown that laughter can help us get rid of stress faster. In a 1989 study published in The American Journal of the Medical Sciences, researchers took blood samples from 10 men watching a funny hour-long video and found that their levels of a stress hormone called cortisol decreased faster than those of the control group. A similar, larger study published in 2001 in Alternative Therapies in Health and Medicine, showed that people who watched a single, hour-long funny video had a significant boost in their immune response. This means laughter not only decreases stress but also has the potential to help fight other illnesses. 

[Related: Why does laughing feel so stinkin’ good?]

In the long term, minor drops in stress levels and an improved immune function can have a dramatic effect on your wellbeing. In 2016, public health researchers from Japan used data from the Japan Gerontological Evaluation Study—including self-reported data from 20,000 adults aged 65 years and older—to analyze cardiovascular risk. They found that even after controlling for other risk factors such as high cholesterol, high blood pressure, and body mass index, the prevalence of heart disease was 20 percent higher in those who said they rarely or never laugh, compared to those who reported laughing every day. 

You don’t need a joke to laugh

When we think of laughter, we normally think of spontaneous or stimulated chuckles. The former happens when we hear a funny joke, for example, while the second occurs when someone tickles us. But there are other types of laughter—it can be induced (with medications like laughing gas), pathologic (due to brain damage or certain psychiatric disorders), or simulated. 

That last one is different from other kinds of chuckles because you can generate it whenever you want, without any specific purpose. Unlike spontaneous laughter, simulated laughter allows you to retain total control of your body movements and the intensity and duration of your own cackle. The best part about simulated laughter is that it provides many of the benefits of spontaneous laughter, like lower blood pressure, improved sleep quality, and reduced chronic muscular pain.  

When it comes to mental health, simulated laughter may even be better than spontaneous laughter. In a 2019 meta-analysis published in Social Sciences & Medicine, researchers of behavioral psychology at Vrije University in the Netherlands examined 29 different studies that looked at both types of laughter. They found that simulated laughter was doubly effective at reducing depression and anxiety, compared to spontaneous laughter. 

If you want to start reaping the health benefits of simulated laughter, you can start now. Before you start, and whether you do it alone or in a group, there are a few things you should note to get the maximum benefit—laugh in sessions of at least three minutes, twice a week, or more, for a minimum of six to eight weeks. 

How to laugh on your own

It may sound completely silly, but simulated laughter can be fun to do by yourself. The easiest way to start is a fake laugh, which you can then try to turn into laughter that gradually becomes longer and louder. If you have trouble with this technique, begin with a loud “ha-ha-ha” or “ho-ho-ho”. With practice, you can slowly build yourself up to the recommended three minutes. 

If that doesn’t work for you, or you want some variety, there are a few other methods you can try. 

First, there is lion laughter. Start by looking in a mirror, opening your mouth wide, and sticking your tongue out. Continue by pretending your hands are paws by opening them up and swatting at the air. Then, roar like a lion, and in between roars, laugh as much as possible. 

A second technique is crying laughter. In this method, you repeatedly lean forward and pretend to cry, and then lean back and laugh as much as you can. 

Finally, you might want to try laughing with yourself. To do this, think about a silly mistake you made, acknowledge it, and just start laughing. 

If you need them, there are online videos and guides available for solo laughter sessions. Robert Rivest, a certified laughter yoga master trainer, has several YouTube videos that can guide you through a laughter yoga session if you want to chuckle and stretch at the same time. There are also many laughter meditation guides available online with different durations. One version by Melissa Eisler, is a simple 10-minute routine you can do on the go. 

Better to laugh as a group

As practical as solo laughter is, a lot of people like to get together and simulate chuckles in a guided group. 

But before you engage in collective laughter, experts recommend you follow some simple guidelines. First, make sure you’re comfortable at all times: wear comfy clothes and bring a cushion or mat if the group will be doing floor exercises. If any of the movements—or poses in the case of laughter yoga—are painful, it’s okay to skip them. Second, if the simulated laughter turns into spontaneous laughter or vice versa, that’s okay—it’s all beneficial. Third, maintain eye contact with those in the group, as it helps keep you present and transmit the laughter to others. Fourth, since the point is to laugh as much as possible, try to avoid talking unless it is part of the session. Finally, as much as possible, smile, laugh, and encourage laughter in others.

[Related: Laughter is a key part of play for many animals]

While laughter yoga is the most popular form of simulated laughter, there are other ways to do it in a group, such as laughter gymnastics or with music and other forms of art. 

Laughter is an expression of joy, and other than providing health benefits, it should help us be happier. Enjoy it. 

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Decades of environmental psychology research tell us that everything that surrounds us is crucial to our mental health, and nature has a particularly powerful role in making us feel good. Clinical studies suggest that natural light can significantly improve health outcomes for patients with depression and agitation. Likewise, cluttered spaces spike cortisol levels in the body resulting in stress and depression, but also make us more prone to making mistakes and giving in to our impulses. A 1984 study published in Science found that surgery patients recovered better in rooms with a view of trees rather than a brick wall. 

This all may seem obvious, but it’s easy to forget. Fields like architecture and design, whose main goal is to create pleasant and functional spaces for their inhabitants, haven’t always fully embraced these principles. 

There are, in fact, several easy and right-before-your-nose tweaks you can do to make your home a more hospitable space for your mental health. They are more than just scattering plants around, but they’re renter-friendly, and don’t require a large budget or the freedom to tear down walls.

Biophilic design is a novel understanding of the importance of natural elements in home design. Meaning “passionate love of life,” this architectural trend recognizes nature as the stage of our evolution as a species and incorporates that relationship into the spaces we inhabit. This, biophilic design scholars say, is one of the most effective ways to create spaces that are better for our mental health.

“In the last about 200,000 years, our brains haven’t changed much. Our bodies haven’t changed much—we are basically still the same species,” says Michal Matlon, an architecture psychologist who works with Olszewska on Venetian Letter, a mental health and design newsletter. He explains that our brains and bodies have developed to fit inside natural environments and we need to build spaces that reflect that. It’s not just about how they look aesthetically, but about how they stimulate our senses.

This is why light is one of the most important elements to keep in mind when designing our homes. Access to daylight improves sleeping quality and mental health, according to a study published in the International Journal of Environmental Research and Public Health. Another study published in 2020 by the same journal showed participants who had access to natural light scored 42 percent higher in cognitive assessments than those who didn’t.

If you own your home and have the resources, you could increase your daily dose of sunshine by adding some roof lights. But something as simple as opening the blinds or the curtains every day can make a huge difference, explains Ben Channon, an architect, and author of Happy by Design. Even just moving your desk under a direct source of natural light could do the trick of improving your performance and creativity.

“We know that we need natural light, but there has also been a lot of talk about circadian lighting,” Matlon says. 

Several studies have shown that avoiding artificial light as much as possible during the evenings, and blue lights, in particular, has a positive effect on our sleep cycle. This too, Matlon says, is an easy tweak. You can purchase smart light bulbs and set them to dim automatically as the evening comes, or you can seek out special blue-spectrum-reduced light bulbs to ensure the light around your home—especially in the bedroom and the living room—is warm. Introducing smaller task lights or zoned atmospheric lamps can help focus illumination only where you need it. Bouncing light off surfaces like walls or filters rather than pointing it directly at something, can also reduce the overall lighting in a room and get you ready for bed. 

You might also want to recreate the dynamism of light in the outside world. Olszewska recommends you try looking for lamps that mimic the effect of light traveling through a canopy, for example, or the reflection of moving water. Similarly, it makes sense that sunset lamps have been taking the internet by storm.

But Olszewska says it is not just about greens and blues to mimic the trees and the ocean. Since the idea is to bring the outdoors in, the colors you choose will depend on your home’s surroundings—this includes the urban design but also the geography of the place. 

“You want to have this kind of correspondence between the colors outside and the colors inside because you want to recreate a connection with the outside,” she says. 

Amber Dunford, a design psychologist at Overstock.com, says monochromatic color palettes can also help your surroundings remind you more of nature. And more nature means better mental health. In the design world, monochromatic palettes don’t mean just one hue, but families of colors that are close to each other, like orange going into yellow. 

“Monochromatic spaces elicit a calming effect on humans, as the transition in color changes are more subtle and easy to experience,” she says. “While contrasting colors such as red and green create an energizing effect, a monochromatic palette creates a soothing effect.” 

It’s not just the color that you paint the walls, but the tones of everything or at least the main elements in a room. Start with an anchoring piece like a rug or sofa, says Dunford, and then layer in smaller elements such as pillows, throws, and artwork in similar hues.

“There’s a need for visual complexity because we don’t like to be bored,” says Channon. 

Even just looking at pictures of nature can relax you as much as if you were looking at an actual nature landscape, according to a 2019 study published by the International Journal of Environmental Research and Public Health. And if you don’t want to straight-up hang pictures of the oceans and forests on your walls, one easy trick to satisfy your need for visual complexity and nature is to use leaf, wood, or water patterns.  

“Living around wood texture can provide the same stress-reducing response we would experience from being out in nature,” says Dunford. “These surfaces provide a sense of warmth and safety, and are often described as being cozier and more welcoming in relation to other textures and materials.” 

A study published in 2017 in the International Journal of Environmental Research and Public Health, showed touching wood grain can calm prefrontal cortex activity and activate our parasympathetic nervous system, which induces relaxation. 

If you already have wooden furniture at home, consider exposing the natural wood by sanding it down to remove paint or shiny finishes, Dunford says. She also recommends foraging wood and using it as decor throughout your space.

 “A simple branch arrangement in a vase or a large piece of bark can act as an accessory when paired with other objects on a shelf,” she explains. 

You can also introduce small pieces like a carved wood bowl, wood frames, or larger elements like a wooden coffee table or furniture with wood arms. 

“You could buy furniture like a coffee table or a side table that’s maybe curved like a stub,” says Channon.

Nice rounded shapes can do the trick as well. 

Large empty spaces with echoes can be distracting and alienating because there usually aren’t any in nature, says Matlon. Instead, use textures and acoustic materials, like carpets and upholstery, to absorb the echo. You should also consider incorporating natural sounds into your spaces—a small table fountain can easily provide the song of a babbling brook. 

Similarly, technology can now emulate natural acoustics. Recently Matlon noticed his air conditioning unit had an option to mimic a natural breeze as if the windows were open, pushing air in unevenly and at different angles. “The air feels much more natural and comfortable,” says Matlon. Not everybody’s air conditioning does this, of course, but you can try out white noise machines, or even online platforms or smartphone apps, to add a little bit of natural ambiance to your space.

But transition spaces, such as corridors or entrances, are important too. They are often forgotten and neglected, but can serve as important points to recover your attention and find peace in between areas of your home, says Olszewska. 

[Related: 5 great spots for LED strip lights around your home]

For example, transition spaces can help you move from your workday to a relaxing evening. 

“Corridors or passage spaces could be a great opportunity for us to recover our cognitive resources,” says Olszewska, who is pioneering the movement of bringing corridors to the center of architectural design. In her study published in the Journal of Science-Informed Design, she analyzes the role of Japanese gardens as transition spaces that serve as restorative areas for the mind.

The post 9 nature-inspired decorating tips to make your home a more relaxing space appeared first on Popular Science.

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Headlines appear in the news about the latest natural disaster tied to the effects of climate change nearly every day, such as Yellowstone National Park’s flooding and Lake Mead’s shrinking water levels. The impact of climate change is only expected to worsen, and large portions of the public report feeling distressed about their future. 

Studies have shown that about two-thirds of Americans experience “climate anxiety.” This form of anxiety, caused by climate change-related fears, is pervasive among younger people who will see many of the effects of climate change in their lifetimes. 

Traditionally, combatting anxiety can mean going to therapy, meditating, and exercising more, according to mental health experts. However, climate anxiety is a creature of its own. While conquering generalized anxiety is a personal journey, experts say communities must unite to defeat this mental health threat.

Sarah Jaquette Ray, a professor of environmental studies at California State Polytechnic University, Humboldt, tells Popular Science that climate anxiety isn’t the same as generalized anxiety. Climate anxiety connects to a threat that affects us all, though in unique ways.

She says one crucial way is for people to discuss their feelings about climate change cooperatively. One way communities can do this is through support groups. Several organizations, such as the Good Grief Network and Climate Awakening, have methods and programs that allow people to come together and work through climate-related anxiety. There are also online tools for starting your own climate support group for your workplace or community through the All We Can Save project. Resources also exist to connect people to climate-aware therapists. 

[Related: 4 new myths about climate change—and how to debunk them.]

“I would like to see collective therapy,” Ray says. “The causes of stress and the causes angst are in fact social and political, therefore the arena that the solutions need to happen in and the services need to happen in ought to be at the collective level as a way to get people to simultaneously address their emotional distress and also build the kind of structures that are going to be needed to adapt to and mitigate climate change.”

Ray authored a 2020 book called “A Field Guide to Climate Anxiety,” which goes in-depth on the causes and potential solutions to climate anxiety. She says that one of the best ways for people to handle their climate anxiety is to take climate action. Feeling like they’re part of a group doing something about the problem can provide relief to an anxious individual and build a community of similarly climate-minded individuals.

“The vast majority of Americans care about climate change and are worried about climate change but just don’t know what to do about it,” Ray says. “They feel like it’s such a big problem that they have no way of controlling it, and that can make them completely check out. A different story needs to be told that what you do matters, and you can get a sense of purpose from it. You can build community while you do it, and it’s happening all over the place.”

Research has shown that young people who engage in climate activism or join environmental organizations tend to be less anxious about climate change. Ray adds that people involved in these collective actions are more capable of helping fight climate change because they are experiencing less anxiety about it.

“The mental health of a populace is necessary for significant climate action and social change,” Ray says. “The fact that people are mentally despairing actually increases their ineffectiveness. If we’re going to be effective in dealing with this stuff, we need to actually have our mental health intact.”

If you aren’t feeling anxious about climate change but know someone who is, there are a few ways to be effective in helping them. First, Ray says, don’t tell those experiencing it that climate change is not a problem they can solve and to just not worry about it. This type of advice is called “toxic positivity,” when someone hears to stay positive regardless of their circumstances and feelings. Being told to “think positively” can have detrimental effects on anxiety patients. 

“I think there’s a real need to accept the fact that this is going to involve some pretty uncomfortable emotions and learn the skills needed for dealing with those emotions,” Ray says.

On a grander scale, governments and other big players can do two things to help with a climate anxiety crisis: do more to solve climate change and fund mental health programs. A significant source of this anxiety comes from people feeling like not enough is being done to address the issue. But considering the climate will continue to get worse no matter how quickly governments act, people will still need support. 

If you’re finding yourself depressed or anxious about climate change, you aren’t alone. Luckily, chapters of existing climate organizations like 350.org or the Sunrise Movement are worldwide. Getting involved, talking to other people struggling with climate anxiety, and using those emotions to push for real change can help heal and strengthen your mind. 

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After nearly three years of planning, the shortcut for the National Suicide Prevention Hotline, 988, is going live on every landline, smartphone, and online dial pad in the US. First recommended by the Federal Communication Commission (FCC) and other national agencies, including the Department of Veteran Affairs, the three-digit number is meant to make 1-800-273-TALK easier and more accessible to use for individuals of any age experiencing a mental crisis. After speaking to the experts on the hotline, they will be connected to local services that best fit their needs, whether it be in-person counseling centers, mobile emergency teams, or substance abuse therapists.

Those seeking help will be able to call or text 988 with any provider they have. Some larger companies, like Verizon Wireless and T-Mobile, adopted the shortcut within months of the FCC finalizing its plan in summer of 2020. July 16 is the deadline for every phone provider, including digital-only ones, to connect the three-digit code. The commission also allowed some buffer time for trained staff at more than 180 crisis centers around the country to gear up in case of an influx of messages.

[Related: How to manage your mental health as traumatic events pile up]

The streamlined number comes during a national mental health crisis and stark rise in suicide attempts among teenagers. While the hotline is still largely the same beyond the new 988 option (for example, veterans can still select “1” to be directed to more specificalized counselors), federal groups are pushing states to set aside funds so that callers and texters can get local medical support, therapy, and more. One way states and territories can generate revenue is by mimicking the small 911 fee (anywhere from a few cents up to $2) that most customers already have on their monthly phone bills. But so far, few governments have elected to add this surcharge or create a designated 988 funding pool. Among them, Washington, Nevada, Colorado, and Virginia have passed the most impactful hotline legislation, according to a tracker by the National Alliance on Mental Illness.

Mental health support groups are still concerned that public awareness around the 988 update is still low. As PopSci and others reported earlier this year, a survey conducted by the Trevor Project, a nonprofit that works on suicide prevention for LGBTQ+ youth, found that 70 percent of 2,000 adult respondents knew little to nothing about the shortcut. Still, the National Suicide Prevention Hotline has seen higher call and text volumes during the pandemic, and officials are expecting even higher numbers once 988 is available for everyone.

[Related: Mental health ‘first aid’ can give bystanders the skills to act in a crisis]

Other mental health and suicide hotlines continue to exist for people with specific needs. The nonprofit Crisis Text Line (741741 by SMS) has long provided a support system for teens and kids, but was recently criticized for sharing anonymized data with a customer service company. Other services provide help in different scenarios, like domestic abuse or PTSD after natural disasters; international crisis centers provide a better range of language options (988 is only available in English and Spanish).

“There is still much work to do. But what matters is that we’re launching,” US Department of Health and Human Services Secretary Xavier Becerra said during a press conference on July 1. “If you are willing to turn to someone in your moment of crisis, 988 will be there. 988 won’t be a busy signal, and 988 won’t put you on hold. You will get help.”

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The habit of doomscrolling—idly flicking through social media, consuming content that isn’t necessarily good for our mental health—is all too easy to fall into. At the back of our minds we know there are more productive ways to fill our time, and yet we keep on opening the same apps and refreshing them again and again.

Part of the problem is that our phones are always with us and easy to reach. Another issue is that there are many short intervals in the day, whether it’s waiting on a subway platform or getting ready to go to sleep, where we’ve got nothing better to do but to open up our apps and see what might be new. 

But it doesn’t have to be this way. There are apps that can bring us all kinds of benefits and positive vibes as an alternative to doomscrolling. And what’s more, you can use them in short snippets throughout the day, whenever you have a spare couple of minutes.

Invest a few minutes here and there throughout the day and they can quickly build up into hours of practicing your reading, writing, speaking, and listening skills in another language. At all times you can keep track of your progress and mix up the kinds of tests and challenges you’re doing.

The gold standard here is Duolingo (iOS, Android), because of its intuitive interface and its quick, simple lessons. You can use it for free or pay $7 a month to remove the ads and get more types of exercises. Babbel (iOS, Android) and Rosetta Stone (iOS, Android) are top quality alternatives.

If you’re on iOS you’ve got Apple Books, and if you’re using an Android phone there’s Google Play Books & Audiobooks. There are also third-party alternatives like the Amazon Kindle app (iOS, Android) to consider. All of these apps are free to download and use, and you’ll find plenty of free e-books, too—especially out-of-copyright classics.

When it comes to replacing doomscrolling, you might be surprised at how much reading you can get through with just a handful of minutes a day. At a glance, you can see how far through each e-book you are and how much reading you’ve got left.

Importantly for this particular list, most podcast players include a timer function that lets you set how long you want to listen to a particular episode for. So, if you know you’ve got a five-minute break or 10 minutes before bed, you can set the timer accordingly and forget about having to stare at the screen.

If you’re on an iPhone, the obvious podcast player choice is Apple Podcasts. For Android users, it’s probably Google Podcasts (which is also available on iOS, by the way). There’s a whole host of other podcast players available, too—we especially like the free Pocket Casts (iOS, Android).

You can save articles to Instapaper (iOS, Android) very easily from any web browser. The app cuts out ads, navigation bars, and other distractions, leaving you with a simplified reading interface. Even better, it shows you at a glance how long each article is, so you can pick and choose accordingly. For $3 a month you can get extra features such as full text search and no limits on the notes you add to articles.

Feedly (iOS, Android) is also worth considering. This RSS reader can collate new articles from your favorite sites, giving you a straightforward interface to read them on, and adding features such as tags and highlights. You can follow up to 100 feeds for free, and after that, paid plans start at $6 a month.

You could just put on a relaxing playlist, for example, and let your thoughts drift—a quick search on YouTube (iOS, Android) or Spotify (iOS, Android) will return plenty of options for you to pick from. YouTube can offer you lots of free guided meditations, too: Include a time limit in your search that matches how long you’ve got.

Then there are dedicated meditation apps you can turn to. One of the most well-known is Headspace (iOS, Android), which has hundreds of guided meditations to pick from—it costs $13 a month, but you can try it free for a week. Calm (iOS, Android) is also worth a look, with its own vast library and a choice of meditation lengths: A limited amount of content is available for free, with a premium subscription costing $15 a month.

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This article was originally featured on KHN.

When Pat Paulson’s son told her he was feeling anxious and depressed at college, Paulson went through her Blue Cross Blue Shield provider directory and started calling mental health therapists. No providers in the Wisconsin city where her son’s university is located had openings. So she bought a monthly subscription to BetterHelp, a Mountain View, California, company that links people to therapists online.

Her son felt uncomfortable with his first BetterHelp therapist. After waiting several weeks, he saw a second therapist, whom he liked. But she wasn’t available the following week.

Despite the switch and the wait, Paulson is grateful she was able to find her son help. “He was getting to the point where he was ready to give up trying to find someone,” she said.

Many U.S. adults aren’t able to find help because of a shortage of therapists. Nearly 40% are struggling with mental health or substance abuse issues, according to the Centers for Disease Control and Prevention.

So millions of people are turning to online companies like BetterHelp that have sprung up in the past several years, advertising quick access to therapy. Often backed by venture capital firms, these for-profit businesses offer a wide mix of services, including one-on-one and group video therapy visits with licensed professionals, supportive texting, coaching videos, and prescriptions for medications.

In their ads, some of the companies feature testimonials from celebrities like Olympic athletes Simone Biles and Michael Phelps. But veteran therapists and officials from leading mental health professional associations say there’s limited evidence of the new online providers’ effectiveness.

“There are fundamental questions about what these companies are doing and whether they are reaching people who really need help,” said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston and chair of the American Psychiatric Association’s Health Information Technology Committee. “They may be doing wonderful work, but it’s hard to know when we don’t have that data.”

Dr. Varun Choudhary, chief medical officer at Talkspace, an online and mobile-based therapy provider, said online companies can help patients who face financial, cultural, and accessibility barriers to traditional therapy. He said clients may want the convenience of getting care online at home.

“By bringing together patients on a teletherapy platform, Talkspace expands capacity to deliver treatment,” he said. The company, headquartered in New York, says it has served more than a million people with 3,000 providers across all 50 states, and it charges $400 or more per month for four weekly live sessions.

Research suggests therapy delivered online can be effective and, spurred by the covid-19 pandemic, many individual therapists are offering sessions with their patients online. But the rapid proliferation of the online commercial therapy industry worries some traditional mental health professionals who have raised concerns about aggressive advertising for online services and whether patient care is compromised by inadequate training and pay for therapists working at some digital companies. In addition, news reports have detailed questionable prescription protocols, after which federal law enforcement launched probes of one company.

“Online companies inundate the internet with appealing ads that make promises about treating depression and anxiety,” said Marlene Maheu, a clinical psychologist and founder of the Telebehavioral Health Institute, who trains practitioners in best online practices and evaluates services for employers who may want to offer them as benefits to workers. “But can you trust them with your kid who’s in trouble?”

Therapy via text

Studies have found face-to-face video psychotherapy visits and other mental health sessions to be just as effective as in-person encounters. But veteran mental health professionals are skeptical of some online providers’ texting practices and services that do not involve real-time video therapy. Research support for the efficacy of texting and similar services is scarce. On its own sites and publications, the American Psychological Association has barred advertising from one online mental health company on the grounds that its services do not meet the APA’s criteria for evidence-based therapy.

“Our concern there is that a patient will leave a text and it might be hours before the therapist responds,” said Vaile Wright, senior director for innovation at the American Psychological Association. “We don’t have peer-reviewed research to support that this is effective.”

Psychologist Bradley Boivin, who worked as an independent contracting therapist with BetterHelp for three months last year, said he had such strong concerns about the extensive use of texting for therapy that he told his clients he wouldn’t do it.

Boivin, who now works for a private practice in Scottsdale, Arizona, said other BetterHelp therapists told him they felt pressured to reply to client texts at all hours of the day. A BetterHelp compensation sheet obtained by KHN shows therapists get paid by the number of text words they read and write.

Alon Matas, founder and president of BetterHelp, which spent more than $7 million in December to advertise on 556 podcasts, defended the use of texting, saying his company’s therapists are not expected to respond immediately to clients’ texts. Each therapist uses professional judgment to decide when is the right time to use messaging and “how it’s best suited for each individual member,” he said.

Many therapists working at online companies are independent contractors, with no liability insurance or health insurance from the company, according to officials at associations for mental health professionals.

The online companies often attract therapists who are less experienced because the pay is typically lower than what therapists in private practices generally earn, according to Laura Groshong, director of policy and practice for the Clinical Social Work Association. “This is a way for new clinicians to get a foot in the door, and that’s something people should know,” she said.

The BetterHelp compensation sheet shows that the company pays therapists on a sliding scale based on how many hours per week they work — $30 per hour for the first five hours, $35 for the next five, etc., topping out at $70 per hour for any hours in excess of 35. That’s less than the typical $100 to $200 per session that private-practice therapists around the country charge clients.

Matas said the sheet does not reflect that therapists’ base hourly compensation by his company may be supplemented with monthly stipends, payments for group sessions, bonuses, and caseload incentives. BetterHelp has more than 25,000 therapists in its network, and Matas said it effectively pays up to 60% more than the median compensation for licensed therapists in every metropolitan area where it has therapists.

A virtual pharmacy

There also are concerns about online companies whose clinicians prescribe psychiatric drugs — either controlled substances that are potentially addictive such as Adderall, or antidepressants such as Zoloft that are not addictive but have potentially dangerous side effects.

Federal law requires doctors to see a patient in person before prescribing controlled drugs, which are those tightly regulated by the government because they can be abused. The federal government waived that provision under public health emergency rules issued early in the covid pandemic. Officials are considering whether to extend that waiver whenever the public health emergency period is over.

That review has been roiled by recent law enforcement actions following news reports in March. The Justice Department and the Drug Enforcement Administration are investigating Cerebral, a San Francisco online-prescribing company, for possible violations of the Controlled Substances Act for its prescribing of Adderall. The company told news organizations it has not been accused of violating the law and it would pause prescribing Adderall and other controlled drugs for attention-deficit/hyperactivity disorder. In a statement to KHN last month, it said, “Cerebral is fully cooperating with the Justice Department investigation.”

The DEA declined to comment on the probe, and the Department of Justice did not respond to KHN.

In a letter to the editor responding to a Bloomberg News article describing practices at Cerebral that included short patient appointments, aggressive advertising, and pressure on providers to prescribe drugs, Cerebral’s founder and CEO, Kyle Robertson, said his company did not give quotas or targets to clinicians to prescribe drugs. Cerebral “follows clinical prescribing guidelines based on the latest research,” he wrote.

The company’s directors removed him from his position in May.

The Cerebral allegations are “a wake-up call to everyone in the industry,” said Thomas Ferrante, an attorney at Foley & Lardner, which represents some online companies. “It’s a reminder that health care is a highly regulated space.”

“Companies like Cerebral are wrecking telemedicine for everyone,” said Piper Buersmeyer, a psychiatric nurse practitioner who is the majority owner of Med Rx Partners, an online and in-person service that evaluates patients and prescribes medications in Vancouver, Washington. “They are destroying trust.” She said she was concerned that some companies do not adequately evaluate patients’ mental health issues before prescribing medicines.

Other companies also advertise directly to consumers about aid in obtaining medication. For instance, Hims & Hers, another San Francisco telehealth firm, has run ads offering to provide “medication for anxiety and depression in less than 24 hours” after clients fill out a short form and connect online with a Hims & Hers provider. A spokesperson for the company, Sam Moore, said providers prescribe drugs only after following “evidence-based clinical protocols.”

Dr. Bob Kocher, president of Lyra Clinical Associates in Burlingame, California, said the optimal treatment pairs talk therapy with medication when needed. That generally works better than medication alone, he said. But he is concerned that some online therapy providers may not perform an adequate clinical evaluation of patients before and after they prescribe, may rely too much on patients’ self-diagnosis, and may not provide enough talk therapy.

“It’s not always clear it’s depression,” said Kocher, a practicing internist. Prescribing medications without adequate diagnostic work or continuing talk therapy, he added, would be “worrisome, because antidepressants are not without their own serious risks, including suicide.”

Based on her experience reviewing some online companies for employers and training therapists in online settings, Maheu is concerned that companies may not give their therapists training in how to deliver safe, effective, and ethical therapy online. As a trainer of online providers herself, she teaches therapists how to de-escalate suicidal or other crisis situations over the video screen. Meanwhile, there’s little government or professional regulation to protect consumers, she added. “What’s happening is a corporate takeover of behavioral health care by digital entrepreneurs,” Maheu warned. “This industry is a catastrophe waiting to happen.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Fireworks and Independence Day are synonymous for many—the pyrotechnic shows that reverberate across the nation on and around the Fourth of July are often one of the most anticipated events of the holiday. Yet they can also be difficult for people who suffer from some types of PTSD.

The loud noises, bright flashes, and pungent scent of gunpowder that accompany fireworks can be a trigger for people who have served in the military, are refugees of war, participated in protests, or survived a natural disaster, to name a few of the groups who may struggle this weekend. For some, these aerial explosions can trigger a full-body response, ranging from heightened anxiety to complete dissociation and hallucinations.

This doesn’t mean that somebody with PTSD cannot or will not be able to enjoy life during firework season. Avoiding the ubiquitous pyrotechnics altogether, after all, isn’t a long-term solution. What will make it easier is if they and those around them take a couple extra steps to ensure the long weekend is more pleasant than not. 

Hoff also recommends looking at the National Center for PTSD’s website, which has a wealth of information for the public, including screening questions you can bring to your doctor if you think you might have undiagnosed PTSD.

You can also try to practice some deep breathing. “Just doing five slow deep breaths will do wonders for calming, and you don’t need any fancy gizmos or instruction,” says Hoff. Other helpful grounding techniques include the 5-4-3-2-1 exercise: in your head, list five things you can see, four things you can hear, three things you can feel, two things you can smell, and one positive thought, she explains. 

Even a simple phone call can be a positive coping mechanism—Weiss specifically recommends making a list of friends and family members you can dial up during the day for emotional support.

Heck, maybe just hang out with your dog in the bathtub. “Having a friendly animal around in a safe space may be just the ticket, and if you are calming your dog down, you might be a little distracted from your own anxiety,” says Hoff.

“As you might expect, there are no easy or simple tricks that friends or family should try,” says Black. “Because PTSD symptoms are complex and can be unpredictable, little tricks can—and often will—backfire.” You can help by asking your loved one how much or how little they want to be involved in fireworks-related festivities, by listening without judgment even if you can’t fully understand their needs, and by respecting and supporting their choices about how much or how little they want to do, says Black. Let them take the lead. 

And as always, if you or someone around you is experiencing a crisis or is feeling suicidal, contact the national suicide hotline or the Veterans Crisis Line for Veterans at 1-800-273-8255. Telephone, text, and chat options are available 24/7.

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The message of spending time in nature to elevate our mental health pops up everywhere: self care books, blogs, and even on some of the most authoritative medical websites. But like so much data, the information we have on nature’s role in human well-being is incomplete.

New research out last week in the journal Current Research in Environmental Sustainability found that out of 174 expert-reviewed studies on nature and mental health benefits published between 2010 and 2020, 95 percent occurred in high-income countries across North America, Europe, and East Asia. Research based in the Global South was more or less absent—and only 4 percent of studies took place in medium-income countries, with none in low-income nations. Additionally, 62 percent of the studies didn’t report participant ethnicity.

“I can’t say that we were hugely surprised,” says Rachelle Gould, a professor at the University of Vermont’s Rubenstein School of Environment and Natural Resources and an author of the new paper. “Unfortunately, we anticipated that this might be the case.”

The skew in mental health research is notable, primarily because most people live in parts of the world that aren’t in the Western Hemisphere, formally educated, industrialized, rich, and democratic, otherwise known as WEIRD zones. Still, a huge number of universal conclusions are based on data collected from inhabitants of these areas. And when it comes to our relationships with nature, the cultures around us play a heavy factor.

“It is really important to know the details of how nature impacts us in intangible ways,” Gould says. “There’s some of it that probably is universal, but there are also maybe some that are culturally specific.”

Cultural differences can be as simple as what we perceive nature to be. In Western traditions, people may associate nature with forests or parks. But for others, including lead study author Carlos Andres Gallegos-Riofrío, the connection can look very different. Gallegos-Riofrío is from Ecuador, and his vision of nature includes the high-altitude grasslands of the Andes that provide water for millions of people. But this landscape is incredibly unique to his region. Denizens of other parts of the world might have desert landscapes as part of their “nature,” in stark contrast to the greenery that’s typically considered “natural.”

[Related: Nature saves us trillions of dollars in healthcare]

“All the time it’s forest and parks,” Gallegos-Riofrío explains. “[It’s] another sign of how dominant the cultural mark of [Western culture] is in this type of work.”

Additionally, the way that we see nature in relation to ourselves varies greatly by how we’re raised. While most everybody can enjoy a walk in the park, for some cultures, particularly in non-Western ones, the relationship with nature can be familial, adds Gould. For Indigenous groups, nature might represent more than a physical part of the world: It is kinship, she says, and often a “profound experience”.

“I see it in my regular world when I’m working with Indigenous populations, what people call Pachamama, which is Mother Nature,” says Gallegos-Riofrío. “In Ecuador, they are referring to something that is so fundamental to their existence. Pachamama is everything, including people. Pachamama is your field, where you grow the food. Pachamama is your whole territory.” 

This research also matters in the context of climate change, which is already directly harming people of color and poorer nations the most. Climate anxiety is a burgeoning field of assessing how people are responding to the destruction of the environment: Within that, it’s crucial to understand how different cultural factors play into the anxiety. So far the field of study is mostly a “largely white phenomenon,” Gould says.

Gallegos-Riofrío says that environmental destruction can bring about extremely different responses in different cultural groups. For example, he worked with an Indigenous population that had to be relocated due to a volcanic eruption, and found that they were distressed because they could not stay with the land, even in its last livable moments. 

“Especially the elders, they said, ‘no, I prefer to stay here and die here rather than to move, because this is me. These spaces are all me, these animals. How can I leave them behind?’” he says. “It was so cruel, so sad. We are not capturing these things in [nature and well-being research], but we must.”

[Related: We can’t truly protect the environment unless we tackle social justice issues, too]

Our relationship with nature is far from static, Gould adds; especially in times when the climate is changing rapidly, it’s crucial to know how different people feel and react to their own natural surroundings. While a landscape being destroyed can be disheartening for most people, it might take on a whole new meaning of grief for those who have lived there for centuries. 

“Part of it is that it’s sort of looking at the flip side that yes, nature is really good for our mental well-being. But when nature is being degraded and with climate change, it hurts,” says Gould. “I think understanding the diversity and variation in that hurt is just as important as understanding the diversity and variation in the positives that nature gives us.”

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There may be some truth to the common saying that magic mushrooms will open up your mind. New research shows that psilocybin, the psychedelic compound naturally found in some fungi, can help patients with depression by changing their brain-wave patterns.

Researchers in the United Kingdom told patients with major depressive disorder that they would receive some dosage of psilocybin. Those 43 patients were randomly assigned to receive two doses of either 25 mg or 1 mg—an amount that is considered negligible—of psilocybin. The doses were spaced three weeks apart, and patients did not know which dosage they received. After the first dose, each patient was told to take daily capsules for six weeks. Those who got the 25 mg psilocybin dose received placebo pills each day, while those who got just 1 mg of psilocybin received pills of escitalopram, a common antidepressant drug. 

Participants given escitalopram reported mild improvement in their symptoms at the end of the six-week treatment. By contrast, those who were given the high dose of psilocybin reported rapid improvement in their depression. Their fMRI scans showed heightened brain connectivity—and those improvements persisted for weeks. Psilocybin creates a liberating effect in the brain, the study authors write, breaking it out of the rut of depressive thinking. The findings were published on Monday in Nature Medicine. 

Healthy individuals tend to have highly connected brains, but in people with depression, “we sort of see the opposite of that—a brain characterized by segregation,” first author Richard Daws, a doctoral student at Imperial College London at the time of the study, told Live Science. Their study supports psilocybin use as a potential therapy for depression by way of boosting connectivity between different brain networks.

[Related: Oregon just voted to legalize magic mushrooms. Here’s what that actually means.]

But other experts who study neurocognitive effects of psychedelics say there are many more questions to be answered, especially given this new report’s small sample size and limited time frame. 

“This is an important contribution though I’m more interested in what happens in three months or six months,” Stephen Ross, associate director of the NYU Langone Center for Psychedelic Medicine, who studies psilocybin’s antidepressant effects in cancer patients, told The New York Times. “It’s a little bit like looking out into the universe with a telescope and seeing interesting things and then starting to build theories based on that.”

Depression remains one of the most common and most challenging mental health concerns in the US—an estimated 21 million adults (8.4 percent of all US adults) reported a major depressive episode in 2020, according to the National Institute of Mental Health. The COVID-19 pandemic has also triggered a 25 percent rise in anxiety and depression worldwide, according to the World Health Organization. While widely used antidepressants are a boon to many, they do not work for everyone and often have significant side effects. As many as one third of patients have “treatment-resistant” depression. 

Researchers have turned to unconventional, mind-altering drugs as potential alternate therapies for the patients for whom antidepressants fall short. Psilocybin, as well as LSD and MDMA, are major research targets of interest for psychiatric disorders including PTSD, anxiety, and eating disorders.

The study authors caution that while their findings are encouraging, people with depression should not attempt to self-medicate with psilocybin.

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Sarah Hellewell is a Research Fellow at the Faculty of Health Sciences and the Perron Institute for Neurological and Translational Science at Curtin University. This post was originally featured on The Conversation.

Far from the respiratory disease it seemed at first, COVID can impact almost all parts of the body, including the brain. For a small number of people, COVID infection may be accompanied by an episode of post-COVID psychosis, a break from reality which can be frightening for the patient and their loved ones.

Psychosis is a condition characterised by confused thoughts, delusions, and hallucinations. People with psychosis can struggle to tell what’s real from what isn’t. Psychosis occurs in “episodes” which may last for days or weeks. Since the start of the COVID pandemic, reports of post-COVID psychosis have come from all over the world.

Post-COVID psychosis is different to psychosis seen in other brain illnesses and diseases. So-called “first episode psychosis” is usually seen in teens or young adults in the development of schizophrenia, or alongside dementia in elderly people.

But people experiencing post-COVID psychosis are typically in their 30s, 40s and 50s, and are experiencing psychosis for the first time. They usually do not have any family history of psychosis. People with post-COVID psychosis also frequently have insight into the way they are feeling. They can recognize this is not normal for them, and something has changed in the way they are thinking.

Features in common

Based on the small number of reports so far, the start of psychosis has been days, weeks or even months after COVID diagnosis. While the symptoms of post-COVID psychosis can be varied, there are some commonalities: people usually have problems sleeping, followed by paranoid delusions and hallucinations. Some people feel compelled to hurt themselves or others.

The scientific evidence of post-COVID psychosis comes mostly from “case reports”, which are research papers describing symptoms and recovery of individual patients.

In the first and most widely reported case, a 36-year-old American woman developed psychosis approximately four days after she started having mild COVID symptoms. She became delusional, thinking that her partner was trying to kidnap her children. She was convinced she was being tracked through her mobile phone.

After trying to pass her children through a fast-food restaurant drive-through serving counter to protect them, she was taken to hospital for care. After one week of in-patient care to treat her psychosis, she was discharged. Her delusions did not return.

In another case, a 43-year-old Bulgarian man began experiencing psychois two days after he was discharged from hospital for severe COVID.

He believed the doctors had faked the results saying his COVID illness had resolved. He also had delusions that he had already died and his organs were rotten. He became a danger to his family, believing he should kill them to “spare them the same slow suffering”. After two weeks of treatment in hospital, his psychotic symptoms resolved and did not return.

Other case studies have reported people having delusions that patients in the hospital were actors and medical staff were trying to harm them, hearing voices speaking in foreign languages or telling them to take on grand tasks, like saving the earth.

Changes in the brain

The cause of post-COVID psychosis is not well understood. Some scientists think it could be due to persistent inflammation in the brain, prolonged inflammatory signals in the body or due to changes in blood vessels in the brain.

There is new evidence that brain areas undergoing change in mild COVID infection may also be areas that change in people who are at risk of, or who are experiencing, first-episode psychosis (that is, not after COVID infection). These areas are the orbitofrontal cortex at the front of the brain, and the parahippocampal gyrus–a key memory region deep in the brain. These regions may shrink in both mild COVID and psychosis.

However, more research is needed to understand this link.

Not the first time

COVID is not the first virus to be linked to psychosis. During the “Spanish flu” influenza pandemic of 1918 there were reports of post-viral psychosis.

Psychosis has been reported after infections with the other human coronaviruses, like those that cause Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Links between coronaviruses, immune system activation and psychosis have also been found, suggesting COVID may not be the only coronavirus capable of causing psychosis.

Just how common is post-COVID psychosis? The evidence to date suggests it is rare, occurring in about 0.25% of COVID cases who are not hospitalized (and likely have a mild infection), and 0.89% of people who are hospitalized for COVID.

Because there have been so many cases of COVID worldwide, isolated reports of post-COVID psychosis may stand out more. The frightening nature of what people might experience means we might hear more and more about them on social media and in the news.

Although the risk of post-COVID psychosis is low, people who have had COVID and their families should look out for any sudden changes in personality, paranoia or delusions in the days, weeks and months following infection.

If these signs are noticed, seeking medical help is vital. Most cases of post-COVID psychosis resolve quickly with proper psychiatric care and treatment with medication.

If you or someone you know are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting HOME to 741741.

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Perhaps you find yourself caught in an endless scroll on social media, or closing apps just to immediately reopen them. Perhaps you pick up a book only to put it back down shortly after because none of the words are registering. Perhaps you have so much on your plate that your mind keeps jumping from thought to thought without actually finishing any of them. 

If any of that resonates, you’re not alone. The ongoing, prolonged pandemic has unbalanced our health and wellbeing in every sense, including our ability to focus and pay attention. The good news is that this damage is (for the most part) reversible. 

Stress and anxiety are among the most well-understood factors influencing memory. When we experience immense or chronic stress, it’s normal for our brains to stay in survival mode, says Carmen Sandi, a neuroscientist at the École Polytechnique Fédérale de Lausanne in Switzerland. It’s an evolutionary adaptation where as soon as our nervous system senses danger, it prioritizes the areas of the brain in charge of keeping us alive, to detriment of other processes, such as critical thinking. Also a result of going into “survival mode” is our instinct to dart our attention around, as we must be hyper-aware of incoming threats. 

[Related: How to manage your mental health as traumatic events pile up]

But that doesn’t mean that any amount of stress is bad—“to perform well, to learn and to be efficient, a bit of stress is quite good,” says Sandi. Small doses of stress put your nervous system slightly on alert, heightening your focus and attention. But it works in an inverted “U” shape—once stress levels pass a certain threshold, the effect reverses and your nervous system starts to only pay attention to basic survival needs rather than complicated thought processes. Anything that causes you acute or chronic stress and anxiety—like being a parent, or suffering from a physical or mental health condition—can worsen your ability to remember things or pay close attention to the world around you. 

People with long-COVID often have difficulty concentrating. What’s worrying is that not every source of stress is controllable on an individual level. The pandemic, Russia’s invasion of Ukraine, inflation, and other economic stressors all pile on top of the persisting pressures of everyday life. This makes bouncing back and recovering our mental functions a difficult task, but there are small things we can do to get there.

An important first step is noticing any changes in yourself, says Shishir Baliyan, a doctoral student in psychobiology at the Universidad Nacional de Educación a Distancia in Spain who studies stress and empathy. But being aware of your own stress levels is harder than you might think. 

“The amount of stress that you feel, and the amount of stress that your body is going through are two different things,” says Baliyan. One is physiological stress, which is the mix of stress hormones and other sensory input occurring in your body, he explains. The other is psychological stress, which is the perception you have of how well you’re doing. The problem is that they rarely match up perfectly.

Take stock of your condition by stopping and asking yourself some questions: Is your memory worsening, and if so, how quickly? Did the onset of this decline coincide with stressors in your life? Being mindful of your own condition is important, Baliyan adds—you can’t fix a problem you’re not aware of. 

Memory is something that you can, actually, improve, but it’s important to know that it may take time. If they don’t see results fast enough, says Sandi, some people may start feeling a lack of control or a sense of failure, which can be problematic if it turns into a cycle. When that happens, the feeling of hopelessness adds more stress and worsens the problem. 

“Memory and working memory require practice,” she says. “One can train them.”

For example, research shows that mindfulness exercises like meditation can theoretically help attentional control, though there is not enough data to definitively say whether these practices directly improve attention span. There is mixed evidence on the effectiveness of games and exercises designed to improve working memory and attention, generally, the consensus is that our memory and attention spans are not fixed—they can be improved through discipline. 

Training your attention and memory has other benefits, too. In one study in the Journal of Social and Clinical Psychology, psychologists found that those with greater attentional control developed fewer symptoms of depression and anxiety during the onset of the pandemic. 

Finding ways to live with a shorter working memory and attention span is just as important as working towards improvement. Rather than beating yourself up for forgetting things, go easy on yourself and find workarounds. Strategies like writing notes to yourself, setting up more frequent reminders, and practicing different approaches, like the Pomodoro technique, can help you stay on top of things without straining your brain.

Feeling good can sometimes mean thinking well: “emotional and cognitive processes, they go hand in hand,” Baliyan says. If you’re feeling emotionally bogged down, that may be a sign you’re also not in the best cognitive state, and vice versa. 

Friends, family, and community can help by taking things off your plate—perhaps by taking your kids for a day, or cooking a meal when you don’t have the time. They can also provide emotional support for the stresses you are currently experiencing, and preemptively build up your sense of resilience in anticipation of future stresses. 

Improving your attention span and working memory is a journey with no guaranteed results, especially if stressors in your life do not change. But take comfort in the knowledge that your attention span and memory are plastic. Just as you may have seen them shorten and decline, it is possible to build them back up again with discipline and patience. They are not fixed in stone.

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This article was originally featured on Undark.

When Randy Jones got his start as an emergency medical technician in the 1970s, he wore a smock and a clip-on tie that reduced the chances a patient would grab hold and strangle him. With few job prospects in the tiny Kansas town where he grew up, the rush of running to emergencies in an ambulance felt like God’s work. Jones remembers wearing blood on his shirt like a badge of pride.

Then, in the early hours of New Year’s Day 1979, he plowed through a snowstorm to a call he can’t forget. Jones says he heard screaming a block away. A young couple had returned home after a night out and found their child unresponsive. A fireman passed the baby to Jones. He did mouth to mouth. The parents’ wailing continued, but there would be no resuscitation, no reviving, no heroic lifesaving. That night, he replayed the call, trying to figure out where he might have gone wrong. Later, after seeing other infants die with seemingly no explanation, Jones began having nightmares about running code blues on his own children.

So much of Jones’ life was inextricably wrapped up in his career, but he no longer trusted he could do what he’d felt called to do. For a time, he says he contemplated suicide. Death seemed preferable to calling for help, he says, and having his colleagues know he had broken. “There’s so much shame involved in it—to admit you can’t take it,” he says, adding that “co-workers lose faith in your ability to handle emergencies, and their lives depend on you.”

Today, there is also the threat of losing one’s livelihood. Many physicians fear that state boards could suspend their license or revoke its renewal if they seek mental health care. The threat of formal sanctions can reinforce a workplace culture that stigmatizes mental health. Seeking treatment may be seen as a career-ending decision—that a person is unfit for duty, both in the eyes of their colleagues and their profession.

By March of 2020, Jones had switched careers. At the time, he worked as a chaplain at a hospital in Greeley, Colorado. When the first reports of what would become the Covid-19 pandemic began filtering in, he was reminded of the old emotions he felt as an EMT. The virus seemed poised to exacerbate an invisible epidemic—the emotional repercussions of witnessing trauma, as well as the moral distress of being unable to do what’s best for every patient. Worse: Some physicians seemed to think they could handle anything. “That’s where doctors crack,” Jones says. “You look at the world in black and white and, you know, how much of human tragedy can you take?”

In the months that followed, Jones says he and ICU staff would wear the same masks, 12-plus hours a day. He consoled colleagues with sweat-slicked hair. Jones watched nurses cry. Patients died without having their loved ones at their bedside. One day, he says, a man with Covid-19 requested to see him. He borrowed a pair of goggles and ventured into the patient’s room—a forbidden zone. The man was about to be intubated, Jones says, and didn’t know whether he would wake up again. He wanted to make a confession. Jones is not a Catholic priest, but he agreed to hear what seemed like they might be the patient’s last words. He would later be reprimanded, he says, and had to promise never to do it again. But he wished he could put his palm into patients’ hands as they passed over. And Jones could sense that he wasn’t alone in feeling like he was unable to do his job.

Then, in March 2021, Jones quit. He joined First Responder Trauma Counselors, an organization in Colorado launched by Ed and Joanne Rupert, a husband-and-wife team. The Ruperts see themselves as providing a 911 for 911 workers’ wellbeing. FRTC offers counseling and mental health services for workers in the emergency response system: dispatchers, police officers, EMTs and paramedics, and nurses. In addition to offering 24-hour support, the Ruperts have a decked-out black Sprinter van that serves as a mobile response unit.

The Colorado group aims to address a crisis that predated the pandemic: In failing to care for caretakers, some say, the emergency response system in the U.S. has, in effect, created an exploited workforce, where those on the front lines confront daily the gap between demand on the ground and what they can feasibly provide. FRTC’s approach also reflects a growing interest in what is broadly known as peer support—help from people who share a similar lived experience. (All of FRTC’s clinical staff members, for instance, have professional experience working as first responders or in the military.) Keely Phillips, who manages peer support programs at a branch of the Canadian Mental Health Association, writes in a book chapter that peers are uniquely positioned, using their experience “like a lantern on a dark path. The lantern is loaded with strategies, new perspectives, and hope for the person who is struggling.”

The concept has resonated with administrators and staff alike. But sources say that, in part because it is predicated on patients’ trust, and in part because of its ambiguous definition, peer support lags in one key respect: Research on its effectiveness is limited. Proponents also caution that these programs cannot necessarily replace reform that addresses systemic problems plaguing the workforce.

Peer supporters are nonetheless forging ahead. In recent years, the U.S. Health Resources and Services Administration has invested millions in peer support programs. Leading medical organizations and practicing physicians have called for implementation in health care settings, where a staggering number of workers have quit since the pandemic began. All in all, experts are suggesting: Who better to care for caretakers than one of their own?

In the early 1970s, psychiatric clinicians borrowed hippie-era drug slang to describe the physical and mental burnout associated with “helping” professions, such as social work and teaching. The term eventually evolved, becoming a vague catchall for exhaustion. Another related, but more narrowly defined, concept emerged in the 1990s: Providers who found themselves running low on empathy were experiencing a symptom of “compassion fatigue.” By 2013, with the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association recognized that “experiencing repeated or extreme exposure to aversive details” of a traumatic event could qualify someone for a post-traumatic stress disorder diagnosis, provided they experienced other distressing symptoms as well—as can be the case with first responders, where vicarious trauma is a routine part of the work.

One concept that has gained considerable ground in recent years is called moral injury. In the 1990s, Jonathan Shay, a clinical psychiatrist, described moral injury in the context of war: Post-traumatic stress not only stemmed from what someone had done on the battlefield, but also what they had failed to do. Wendy Dean, a psychiatrist, applied the concept to health care in a 2018 essay she co-authored in STAT. First responders witness trauma, and these events can have a stacking effect. But Dean’s critique had a more systematic bent: The U.S. health care system forces workers to carry out orders that transgress deeply held moral beliefs. “What health care workers have said on a regular basis,” she told Undark, “is that, even before the pandemic: ‘I can’t get what I need to do my job. And I can’t get patients what they need.’”

“There’s so much shame involved in it — to admit you can’t take it,” Jones says, adding that “co-workers lose faith in your ability to handle emergencies, and their lives depend on you.”

Randy Jones

The Covid-19 pandemic intensified these issues. The virus has, so far, killed nearly 1 million Americans. For some health care workers, the politicized resistance to public health interventions, along with other on-the-job pressures, also seemed to be killing their sense of purpose. By some estimates, nearly one out of five health care workers quit their jobs.

While there is no clear way to measure mental, emotional, or moral injuries, data nonetheless suggests that leaving these issues unaddressed can have serious and widespread consequences. One 2015 survey of more than 4,000 EMS providers found that 37 percent had contemplated suicide. Suicides appear to be significantly higher than the general population for law enforcement officers, nurses, and physicians. Last month, the U.S. Senate passed the Dr. Lorna Breen Health Care Provider Protection Act, which is named for a New York City physician who died by suicide during the Covid-19 pandemic. The legislation, which went to President Biden’s desk on March 11, would establish grants for more programing to promote mental health. But the law would do little to reform professional licensing boards, which can effectively end a career. (Breen’s family has said these fears were among the reasons she felt she could not get help.)

Without top-down reform to respond to the ongoing psychological crises, several initiatives sprang up in recent years, particularly as Covid-19 swamped health care facilities. Many turned to the same form of expertise: Peers, the people who lived through it.

At age 26, Joanne Rupert, who grew up in England and South Africa, responded to a newspaper ad for a volunteer firefighter. Rupert worked for Head, a sports equipment company, in Boulder, and took flying lessons on the side. Improbably, the first 911 call she ever went on with the fire department was to the scene of a plane crash. Joanne instantly recognized the plane: It was her instructor’s. Drawing closer, she could see that he had a terrible head injury. But she had no medical training, and just had to stand there and watch. “At that point,” she says, “I said, ‘Wow, I never want to feel this way.’ That I can’t help, and I really wanted to help.”

Joanne went on to become an EMT and eventually took a job as a victim advocate for a local sheriff’s office, assisting those affected by crime or abuse. While working there, she learned about an accident involving a rock crusher at a quarry, and went to check in on the firefighters who had taken the call. They showed her graphic photos of the scene, Joanne says, “as if it was another day of the week.” But not long after, she got a call at four in the morning from one of the firefighters. He was not OK, she says, and he asked her: “Can you come out?” It felt a bit like encountering the plane crash all over again. Joanne wasn’t a licensed counselor at the time, and her job with the sheriff’s office didn’t involve assisting first responders. She couldn’t help him—no matter how much she wanted to. “I can’t just self deploy and be a vigilante and take care of everyone,” she says. The incident was a catalyst for going back to school for clinical psychology and eventually starting the organization that is now First Responder Trauma Counselors.

FRTC offers cognitive behavioral therapy, a type of talk therapy commonly used for PTSD, as well as eye movement desensitization and reprocessing, a technique where patients recall traumatic experiences while following sensory cues, such as tracking a therapist’s finger back and forth. (The exact mechanism by which EMDR works has been the subject of some controversy, though the American Psychological Association conditionally recommends it as a treatment for PTSD.) The Ruperts also offer alternative therapies with less robust evidence, including hypnosis, brainspotting (an offshoot of EMDR), and vibroacoustic resonance therapy that involves audible sound vibrations. But the core of their practice is predicated on having culturally competent clinicians—that is, their staff has worked as first responders. “Unless you’ve been at the dirty end of an arterial bleed, a weapon, or a hose line, you really don’t get what the feeling attached with the circumstance you’re in” is, Ed says, “and the hypervigilance that it creates over time.” Joanne says she emphasizes a pragmatic no-bullshit approach. “I’m not a touchy-feely therapist,” she says. “When people come in to see me, they don’t need me just to shake my head and go, ‘Uh-huh, mm-hmm, mm-hmm.’ That’s not going to work for a first responder. So I’m very much knees in the dirt, blood on the shirt as a therapist.”

One evening about a year ago, the Ruperts received a call. Joanne shared a summary of the conversation with Undark. “Everything was going fine on the phone. And then the person,” Joanne pauses. “I was in the middle of a sentence, and the person hung up on me.” She’d never met the caller, and so she looked at Ed, and said, “Uh-oh.” The couple picked up a paramedic and drove to the caller’s house at 11 p.m. Joanne says, “They were just like, ‘I can’t believe you’re here. I can’t believe you’re fucking here.’” The caller, who was intoxicated, had plans to die by suicide. The Ruperts say they stayed until the person sobered up and went to bed. (Data suggest that people who attempt suicide usually consider it for less than 24 hours before acting.)