Unrepresented patients are individuals who lack decision makingcapacity and have no family or friends to make medical decisions for them. This population is growing in number in the United States, particularly within emergency and intensive care settings. While some bioethical discussion has taken place in response to the question of who ought to make decisions for these patients, the issue of how surrogate medical decisions ought to be made for this population remains unexplored. In this paper, we argue that standard (...) applications of surrogate decision making principles in health care are not well suited to many unrepresented patients with long-term mental health diagnosis. We argue that when applied to this population, the substituted judgment standard, designed to preserve patient preferences and values, may lead to the exclusion of their preferences. We argue further that the application of the best interest standard runs the risk of leading to harmful cases of overtreatment or undertreatment. We offer an alternative interpretation of the best interest principle that is better able to promote the well-being of unrepresented patients, especially for those who lack capacity because of mental disorders. This alternative is based on the practices and principles of harm reduction and includes three components: emphasis on considering the expressed preferences of unrepresented patients, a focus on reducing harm as well as the delivery of clinical benefits, and a recognition of the importance of promoting trust. (shrink)

BackgroundDeep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies hav...

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view (...) from this position, although not without challenge and internal discipline dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

Neurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

In my paper, I propose to investigate the philosophical underpinnings of representative indigenous Japanese psychotherapeutic approaches, particularly that of Morita and Naikan therapies, that have, at their foundations, distinctly Buddhist psychological tenets, and that offer to deal with mental health issues in a manifestly different way compared with their western counterparts. I offer a comprehensive account of how the characterizations of madness and mental illness have been shifting over the last two hundred years in Japanese society (...) and culture, and how this has affected mental health care in Japan. Finally, the ways in which modern day thinkers, such as Daisetz Teitaro Suzuki and Keiji Nishitani have been re-shaping the concepts of the self in Japanese religion and philosophy while, at the same time, taking care to remain faithful to the original East Asian sensibilities will also be expounded and connected to the themes of mental health and mental illness. (shrink)

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers’ self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic (...) neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers’ own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers’ knowledge of students’ social and emotional needs, and promoting educational improvement. (shrink)

Morality and mental health are now inseparably linked in our view of character. Alcoholics are sick, yet they are punished for drunk driving. Drug addicts are criminals, but their punishment can be court ordered therapy. The line between character flaws and personality disorders has become fuzzy, with even the seven deadly sins seen as mental disorders. In addition to pathologizing wrong-doing, we also psychologize virtue; self-respect becomes self-esteem, integrity becomes psychological integration, and responsibility becomes maturity. Moral advice (...) is now sought primarily from psychologists and therapists rather than philosophers or theologians. This book asks: are we replacing morality with therapy, in potentially confused and dangerous ways, or are we creatively integrating morality and mental health? According to the book, it's a little bit of both. It surveys the ways in which morality and mental health are related, touching on practical concerns like love and work, self-respect and self-fulfillment, guilt and depression, crime and violence, and addictions. Terming this integrative development “the therapeutic trend in ethics,” the book uses examples from popular culture, various moral controversies, and draws on line of thought that includes Plato, the Stoics, Freud, Nietzsche, and contemporary psychotherapeutic theories. The book develops some interesting conclusions, among them that sound morality is indeed healthy, and that moral values are inevitably embedded in our conceptions of mental health. In the end, the book shows how both morality and mental health are inextricably intertwined in our pursuit of a meaningful life. (shrink)

In this paper, we propose an Internet of Things to enhancing the experience of personal gardening as a method of therapy for mental-health patients, given a belief in its role in a person’s mood and general positivity, The proposed prototype continuously senses and monitors the state of an indoor plant through different sensors. The user is notified of the plant’s needs for water, sunlight, etc., through generated notifications from channels over cloud in-real time. Thus, we were able to (...) successfully create a humanised experience of recovery where the user can accessibly ‘talk’ with its plant through a smartphone. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on body responses to (...) threat and fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)

One in three university students experiences mental health problems during their study. A similar percentage leaves higher education without obtaining the degree for which they enrolled. Research suggests that both mental health problems and academic underperformance could be caused by students lacking control and purpose while they are adjusting to tertiary education. Currently, universities are not designed to cater to all the personal needs and mental health problems of large numbers of students at the (...) start of their studies. Within the literature aimed at preventing mental health problems among students (e.g., anxiety or depression), digital forms of therapy recently have been suggested as potentially scalable solutions to address these problems. Integrative psychological artificial intelligence (AI) in the form of a chatbot, for example, shows great potential as an evidence-based solution. At the same time, within the literature aimed at improving academic success, the online life-crafting intervention in which students write about values and passions, goals, and goal-attainment plans has shown to improve the academic performance and retention rates of students. Because the life-crafting intervention is delivered through the curriculum and doesn’t bear the stigma that is associated with therapy, it can reach larger populations of students. But life-crafting lacks the means for follow-up or the interactiveness that online AI-guided therapy can offer. In this paper, we propose to integrate the current literature on chatbot interventions aimed at the mental health of students with research about a life-crafting intervention that uses an inclusive curriculum-wide approach. When a chatbot asks students to prioritize both academic as well as social and health-related goals and provides personalized follow-up coaching, this can prevent -often interrelated- academic and mental health problems. Right on-time delivery, and personalized follow-up questions enhance the effects of both -originally separated- intervention types. Research on this new combination of interventions should use design principles that increase user-friendliness and monitor the technology acceptance of its participants. (shrink)

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between (...) 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing. (shrink)

The aims of this study were to examine the effectiveness of a range of smartphone apps for managing symptoms of anxiety and depression and to assess the utility of a single-case research design for enhancing the evidence base for this mode of treatment delivery. The study was serendipitously impacted by the COVID-19 pandemic, which allowed for effectiveness to be additionally observed in the context of significant community distress. A pilot study was initially conducted using theSuperBetter app to evaluate the proposed (...) methodology, which proved successful with the four finishing participants. In the main study, 39 participants commenced, with 29 finishing the intervention phase and completing post-intervention measures. At 6-month follow-up, a further three participants could not be contacted. This study used a digitally enhanced, multiple baseline across-individuals single-case research design. Participants were randomly assigned to the following apps:SuperBetter,Smiling Mind,MoodMission,MindShift, andDestressify. Symptomatology and life functioning were measured at five different time points: pre-baseline/screening, baseline, intervention, 3-week post-intervention, and 6-month follow-up. Detailed individual perceptions and subjective ratings of the apps were also obtained from participants following the study’s completion. Data were analyzed using visual inspection, time-series analysis, and methods of statistical and clinical significance. Positive results were observed for all apps. Overall, more favorable outcomes were achieved by younger participants, those concurrently undertaking psychotherapy and/or psychotropic medication, those with anxiety and mixed anxiety and depression rather than stand-alone depression, and those with a shorter history of mental illness. Outcomes were generally maintained at 6-month follow-up. It was concluded that a diverse range of evidence-based therapies offered via apps can be effective in managing mental health and improving life functioning even during times of significant global unrest and, like all psychotherapies, are influenced by client features. Additionally, this single-case research design is a low-cost/high value means of assessing the effectiveness of mental health apps.Clinical Trial Registration: The study is registered with the Australian and New Zealand Clinical Trials Registry, which is a primary registry in the World Health Organization Registry Network, registration number ACTRN12619001302145p. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized (...) controlled effectiveness trial conducted across five school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the (...) basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field. (shrink)

We describe work in progress to conduct a systematic review of research on effects of arts-based programs for mental health in young people. We are at the stage of searching for relevant studies through major databases and screening extant systematic reviews for additional research which meet our inclusion criteria. At this stage, however, concerns have arisen regarding both the quality of existing primary studies and of recently published systematic reviews in this area of arts and health. As (...) a case in point, in this paper we focus on one research report on art therapy with adolescent girls and its inclusion in three systematic reviews. We demonstrate that the reviews fail to undertake a robust critique of the Bazargan and Pakdaman paper and that the paper and reviews are flawed. Drawing on recent criticisms of systematic reviewing, we consider the value of proceeding with our systematic review as initially planned. (shrink)

A worldwidemental health crisis is expected, as millions worldwide fear death and disease while being forced into repeated isolation. Thus, there is a need for new proactive approaches to improve mental resilience and prevent mental health conditions. Since the 1990s, art has emerged as an alternative mental health therapy in the United States and Europe, becoming part of the social care agenda. This article focuses on how visual esthetic experiences can create similar patterns of (...) neuronal activity as those observed when the reward system is activated. The activation of the reward structures could have a stress buffering effect, given the interdependence observed between the reward and stress systems. Therefore, could visual esthetic experiences stimulate mental resilience? And if this were the case, could art-based interventions be offered for mental health in the context of COVID-19 and beyond? (shrink)

After nearly three decades of scientific research, digital mental health (DMH) is having its moment. Millions of dollars of venture capital funding are entering this space (Shah and Berry 2021; Wan...

Emotion regulation is an umbrella term to describe interactive, goal-dependent explicit and implicit processes that are intended to help an individual manage and shift an emotional experience. The primary window for appropriate emotion regulation development occurs during the infant, toddler, and preschool years. Atypical emotion regulation development is considered a risk factor for mental health problems and has been implicated as a primary mechanism underlying childhood pathologies. Current treatments are predominantly verbal- and behavioral-based and lack the opportunity to (...) practice in-the-moment management of emotionally charged situations. There is also an absence of caregiver-child interaction in these treatment strategies. Based on behavioral and neural support for music as a therapeutic mechanism, the incorporation of intentional music experiences, facilitated by a music therapist, may be one way to address these limitations. Musical Contour Regulation Facilitation is an interactive therapist-child music-based intervention for emotion regulation development practice in preschoolers. The Musical Contour Regulation Facilitation intervention uses the deliberate contour and temporal structure of a music therapy session to mirror the changing flow of the caregiver-child interaction through the alternation of high arousal and low arousal music experiences. The purpose of this paper is to describe the Therapeutic Function of Music, a theory-based description of the structural characteristics for a music-based stimulus to musically facilitate developmentally appropriate high arousal and low arousal in-the-moment emotion regulation experiences. The Therapeutic Function of Music analysis is based on a review of the music theory, music neuroscience, and music development literature and provides a preliminary model of the structural characteristics of the music as a core component of the Musical Contour Regulation Facilitation intervention. (shrink)

Mental health-related data generated by app users during the routine use of Consumer Mental Health Apps (CMHAs) are being increasingly leveraged for research and product improvement studies. However, it remains unclear which ethical safeguards and practices should be implemented by researchers and app developers to protect users during these studies, and concerns have been raised over their current implementation in CMHAs. To better understand which ethical safeguards and practices are implemented, why and how, 17 app developers (...) and researchers were interviewed who had been involved in using CMHA data for studies. Interviewees discussed the impact on stakeholder interests, sufficiency thresholds and procedural alterations of informed consent, data protection, gathering app user perspectives and representing users in app design and study conduct, and ensuring adequate support. Although the reasoning behind how and why these ethical safeguards and practices should be implemented showed considerable variability and several gaps, interviewees converged on various general lines of reasoning. This allowed for the development of a coherent and nuanced account that could prove useful for future CMHA studies and which could stimulate further normative investigation of the role of ethical safeguards and practices in these studies. (shrink)

Acting on what started as a hunch, Dr. Francis Martin has cataloged well over 20,000 distinct approaches to counseling and psychotherapy that are advertised on the webpages of licensed, practicing mental health providers. No doubt some portion of them are harmful, but the sheer volume of advertised practices and techniques, often with names deceptively similar to actual evidence-based practices, should be cause for concern among all stakeholders in the helping professions - from educators and researchers to policy makers (...) and insurance companies and, especially, consumers. Based on this significant original study, and drawing from other research and supports, Therapy Thieves describes a near-universal crisis in the field and recommends ways to rescue mental health care from itself. The crisis is caused by declining competence among counselors and psychotherapists who have failed to regulate themselves and who, therefore, deliver inadequate - if not harmful - services. In presenting a simple, yet powerful indictment of the field, Dr. Martin advocates for major reforms in several areas of mental health care, including how prospective licensees are trained, supervised and licensed, a major reworking of professional ethics, and the need to establish regulations for mental health care providers. In short, the book calls for major, specific, and urgently needed reforms. (shrink)

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational (...) and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists. (shrink)

This book is a collection of papers presented at conferences by the author on topics related to Thomistic Psychology. Although not being a systematic exposition of it, its reading provides a comprehensive view of the psychological approach derived from the Works of St. Thomas Aquinas, complemented by the specific developments of each subject treated. Topics such as the process of human knowledge, emotions, the formation of opinions, certainties and decisions, the constitution of ethos and its plasticity, its relations with the (...) instinct of sociability, the repercussions of this dynamism on personality and behavior, as well as the contributions that Thomistic Psychology offers to mental health diagnosis and therapy are addressed. The teachings of St. Thomas elucidate these and several other questions of daily life that are not always answered by contemporary psychological currents. To facilitate comprehension, the necessary assumptions are presented in accessible language, with examples and applications to daily life, correlating them, when appropriate, with contemporary themes such as computer science, neuroscience and Cognitive-Behavioral Psychology. The common reader thus acquires a better knowledge of his own mind, that of others and of the psychological interaction in life in society. And to the specialized reader, the invitation is opened for new and thought-provoking studies on questions of surprising actuality. -/- . (shrink)

With the proviso that Spinoza's concerns were philosophical, not medical, we examine the Ethics with a view to bringing out those aspects of it which are of import for mental health. We find that the Ethics surrounds the idea that man can be egoless in the Buddhist sense of that term. This concept provides a criterion of mental health. Further, according to Spinoza's theory of the Affections, those which are passive include some which are based on (...) pain. These he 'enumerates among the diseases'. And for them he provides, in Part V, specific 'remedies'. This in turn leads him to equate 'Mental Freedom or beatitude' with a 'healthy Mind'. We thus have in Part V additional possible criteria of mental health. Finally, there is the suggestion that philosophy for Spinoza was a kind of therapy.' There is not a philosophical method, though there are indeed methods, like different therapies. — The philosopher's treatment of a question is like the treatment of an illness. — A main cause of philosophical disease — a onesided diet . . . Wittgenstein This doctrine of knowledge first and action later is not a minor disease . . . My present advocacy of the unity of knowledge and action is precisely the medicine for that disease. Wang Yang-ming When asked by two disciples which of the views of each was correct, Wang replied: both are. Which is used depends on the kind of person you are trying to help. Some persons need this one, others that. (shrink)

Most research on aboriginal mind and mental health has sought to apply or confirm preexisting European-derived theories among aboriginal people. Culture has been underappreciate. An understanding of uniquely aboriginal models for mind and mental health might lead to more effective and robust interventions. To address this issue, a core group of elders from five separate regions of North America was developed to help determine how aboriginal people conceived of mind, self, and identity before European contact. The (...) process utilized for this study is iterative and involves discussions of teachings, traditional stories, and elder's comments on conclusions drawn. The elders endorsed a relational theory of mind in which mind exists between people as a product of the stories told and created within and by that relationship. Mind is distinguished from consciousness which is without language and exists within the individual as awareness. Language immediately results in an "out there" orientation in which two or more individuals generate stories about their experiences. The community is the basic unit of study for mind and mental health, and mental "illness" is not distinguished from physical "illness," but rather all are seen as a continuum of suffering and pain. What emerged from this research is that North American theories of mind are more closely related to Daoist and Shinto theories than to the logical positivism which drives most of North America's conventional psychology and psychiatry. Within European traditions, however, the philosophy of Mikhail Bakhtin with his emphasis on a dialogical self coupled with system theory comes closest to resembling North American aboriginal theories. This model explains why ceremony and ritual, community interventions, talking circles, and family therapy are more compatible with aboriginal thought than conventional North American biomedicine and psychology. (shrink)

Social theory has much to gain from taking up the challenges of conceptualizing ‘mental health’. Such an approach to the stunting of human mental life in conditions of adversity requires us to open up the black box of ‘environment’, and to develop a vitalist biosocial science, informed by and in conversation with the life sciences and the neurosciences. In this paper we draw on both classical and contemporary social theory to begin this task. We explore human (...) inhabitation – how humans inhabit their ‘ecological niches’ – and examine a number of conceptual developments that ‘deconstruct’ the binary distinction between organism and environment. We argue that we must understand the neurological, ecological and social pathways and mechanisms that shape human (mental) life if we are to address the central concerns of our discipline with inequity and injustice as these are inscribed into the bodies and souls of human beings. (shrink)

The task of being oneself lies at the heart of human existence and entails the possibility of not being oneself. In the case of schizophrenia, this possibility may come to the fore in a disturbing way. Patients often report that they feel alienated from themselves. Therefore, it is perhaps unsurprising that schizophrenia sometimes has been described with the heideggerian notion of inauthenticity. The aim of this paper is to explore if this description is adequate. We discuss two phenomenological accounts of (...) schizophrenia: Binswanger’s account of schizophrenia as a form of inauthenticity and Blankenburg’s account of schizophrenia as a loss of common sense, which seems construable as a loss of inauthenticity. We argue that the accounts are highlighting aspects of the same underlying phenomenon, viz. schizophrenic autism. Moreover, we argue that Binswanger’s description of schizophrenia as a form of inauthenticity is inadequate and we discuss experiences of self-alienation in schizophrenia. (shrink)

Identifying biomarkers of developing mental disorder is crucial to improving early identification and treatment—a key strategy for reducing the burden of mental disorders. Cross-frequency coupling between two different frequencies of neural oscillations is one such promising measure, believed to reflect synchronization between local and global networks in the brain. Specifically, in adults phase–amplitude coupling (PAC) has been shown to be involved in a range of cognitive processes, including working and long-term memory, attention, language, and fluid intelligence. Evidence suggests (...) that increased PAC mediates both temporary and lasting improvements in working memory elicited by transcranial direct-current stimulation and reductions in depressive symptoms after transcranial magnetic stimulation. Moreover, research has shown that abnormal patterns of PAC are associated with depression and schizophrenia in adults. PAC is believed to be closely related to cortico-cortico white matter (WM) microstructure, which is well established in the literature as a structural mechanism underlying mental health. Some cognitive findings have been replicated in adolescents and abnormal patterns of PAC have also been linked to ADHD in young people. However, currently most research has focused on cross-sectional adult samples. Whereas initial hypotheses suggested that PAC was a state-based measure due to an early focus on cognitive, task-based research, current evidence suggests that PAC has both state-based and stable components. Future longitudinal research focusing on PAC throughout adolescent development could further our understanding of the relationship between mental health and cognition and facilitate the development of new methods for the identification and treatment of youth mental health. (shrink)

Ethics in Mental Health-Substance Use aims to explore the comprehensive concerns and dilemmas occurring from mental health and substance use problems, and to inform, develop, and educate by sharing and pooling knowledge, and enhancing expertise, in this fast developing region of ethics and ethical care and practice. This volume concentrates on ethical concerns, dilemmas, and concepts specifically interrelated, as a collation of problem(s) that directly or indirectly affect the life of the individual and family. Whilst presenting (...) a balanced view of what is ethically best practice today, this title challenges concepts and stimulates debate, exploring all aspects of the development in treatment, intervention and care responses, and the adoption of research-led best practice. (shrink)

This article contextualizes some of the more specifically focused articles in this Special Issue of ‘Women and Mental Health’ by reviewing general historical and political currents structuring contemporary discussions around questions of models, treatment and provision for women within British mental health services. We highlight some particularities of the current British context (in relation to other national scenes) in terms of the forms and expressions of feminist activity around mental or emotional distress. While not absolute (...) mirrors of each other, resonances between general trends in feminist debates and organizational forms within feminist mental health work give rise to a wide spectrum of sites of intervention. We discuss some of the conditions that gave rise to these forms of (visible) feminist intervention within mental health service provision, focusing particularly on women's counselling and therapy services, and we offer an analysis of the range and conceptual tensions within which such interventions may be situated, including contested perspectives on power and empowerment. We also consider ways in which women's political activity around mental health issues is likely not to be noticed as such, given women's prototypical positions as patients and practitioners. We end by identifying what we see as current challenges for feminist activism around distress and its links with the conditions of women's lives and oppression more generally, not only as instances of more general tensions and challenges within contemporary feminisms, but also as offering an arena of opportunity for broader alliance and coalition-building. (shrink)

Methods of ethical reasoning in psychiatry -- Psychiatric professional ethics and the social -- Communitarian ethics and the social -- Moral agency in psychiatry -- Involuntary psychiatric treatment -- Psychiatry across cultures -- Neoliberalism -- Psychiatry and popular culture -- Psychiatric ethics in the light of neuroscience -- Reappraisals -- Power and knowledge in psychiatry.

BackgroundMental health problems have emerged as a significant health complication in United States colleges during COVID-19, and as a result, they have been extensively investigated in the United States and internationally. In contrast, research on coping among the college population during the pandemic is scant. Hence, this study investigated coping strategies proposed by undergraduate students attending a Midwestern university.ObjectivesThe purpose of this preliminary study was to obtain college students’ feedback/opinions about coping strategies for mental health problems, (...) suicide ideation, and self-harm during COVID-19.MethodsIn December 2021, one-hundred and four undergraduate students completed an online survey on coping strategies using Qualtrics. Major topics included: Types of coping strategies/styles expressed by students for general mental health problems, Types of coping strategies for suicide ideation and self-harm behaviors, Preferred platforms for receiving coping therapy, and Reasons for accepting or refusing parent involvement with mental health problems.ResultsThe most beneficial coping strategies for mental health were ranked by college students as follows: a skills training development program, meditation, and mindfulness exercises, and physical education. The respondents’ best coping strategies for preventing self-harm and suicide ideation/behaviors during COVID-19 were ranked as: improving support from friends, building self-esteem, and addressing anger, depression, stress, and loneliness. Finally, a total of 50% of participants felt that parents should be involved in college student interventions. Students stated that the most important type of support that they received from their parents were: emotional support, direction and/or assistance with solutions, and problem-solving.ConclusionThis study identified potential avenues which could be implemented into action during future outbreaks. Specifically, employing interventions that: train undergraduate students to employ more effective skills training coping strategies or practicing mindfulness or meditation; integrate mental health, suicide, and self-harm prevention into the curriculum; offer more in-person campus services targeted toward the psychological and emotional effects of a pandemic, and involve support persons in students’ lives to enhance their well-being during and after COVID-19. (shrink)

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers’ perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied (...) mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway. (shrink)

Research on mental health and illness presents a variety of unique ethical challenges. This article argues that institutional review boards (IRBs) can improve their reviews of such research by including the perspectives of individuals with the condition under study either as members of the IRB or as consultants thereto. Several reasons for including the perspectives of these individuals are advanced, with the discussion organized around a hypothetical case study involving the assessment of a novel talk-therapy modality. Having made (...) this case, the article goes on to explain how to implement the idea by building on a recent proposal by Rebecca Dresser, who argues in a number of publications for the inclusion of former research participants in the IRB review process. Finally, concerns about protecting reviewer and consultant confidentiality are addressed. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring (...) rather than ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. (...) -/- First, we review recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

This book takes Edmund Husserl's phenomenology and applies it to help psychotherapy practitioners formulate complex psychological problems. The reader will learn about Husserl's system of understanding and its concepts that point to first-person lived experience, and about the work of Husserl scholars who have developed a way to be precise about the experiences that clients have. Through exploring the connection between academic philosophy of consciousness and mental health, themes of biopsychosocial treatment planning, psychopathology of personality and psychological disorders, (...) and the treatment of complex psychological problems become clear. The author shows that Husserlian phenomenology can be used in the design of interventions for clients in a process called formulation. Once the intentionality of consciousness is understood, by asking simple questions, it becomes possible to define problematic experiences. This is a means of creating informed consent for treatment and it makes it clear to clients what is happening for them, so helping them understand themselves and how they see the world. We also see how Husserl's phenomenology is a vehicle for psychotherapists to present their knowledge about the research literature of what has been found to be effective care. This volume applies the concepts and practices of phenomenology in a concrete way, relating them to the practice of therapy and showing the value of a qualitative approach to understanding mental processes and the nature of human beings as motivated by values, meanings and other conscious experiences. This is a readable text in simple language that condenses key aspects of Husserl's thinking in relation to the theory and practice of psychotherapy, and it is suitable for philosophers and practitioners of psychology, psychiatry, and the psychotherapies, including psychoanalysis. (shrink)

BackgroundEmotional regulation is important for adolescents’ adaptive development. Preventive interventions for anxiety and depression are necessary for reducing the development of disorders later in life, and emotional regulation is a potentially relevant factor.ObjectiveWe investigated the effects of a mindfulness-based psychological education and prevention program [the Mindfulness and Awareness Program ] on the mental health of junior high school students in Japan.MethodsOur MAP primarily focused on mindfulness meditation to improve emotional regulation, thereby reducing depression and anxiety. The MAP comprised (...) eight sessions administered by a school counselor in a school setting. All participants were 12–13-year-old adolescents from nine classes in two Japanese schools. The program was provided to the intervention group, wherein students were educated on emotional expression, emotional cognition, and emotional regulation. The control group received regular school counseling services.ResultsCompared with the control group, the intervention group showed significant improvement in emotional regulation and a decrease in depression and generalized anxiety. The effect was greater at the follow-up assessment than at the immediate post-intervention assessment, and greater in female students.ConclusionOur mental health prevention program exhibited efficacy in reducing depression and anxiety and enhancing emotional regulation in early adolescence. Further, it appeared to be more effective for female adolescents. (shrink)

Mental health problems start early in life. However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients. In this study, we interviewed 12 young people who entered mental health care reluctantly at the initiative of others before the age of 18. (...) Their journeys through mental health care varied significantly despite sharing the same starting point. Our analyses resulted in a model of three trajectories. We describe relational and structural facilitators and obstacles within each trajectory and have formulated narratives highlighting core experiences differentiating them. Trajectory 1 was characterized by a rapid loss of hope, leading the adolescents to conclude that mental health care was not worth the investment. Trajectory 2 was characterized by a lingering hope that never materialized into a constructive therapeutic process despite prevailing efforts by both therapists and adolescents. Trajectory 3 was characterized by genuine meetings, allowing the therapist to transform from an unsafe stranger into a safe, competent, and benevolent adult. We discuss how our results have implications for understanding agency displayed by adolescent clients in therapy, therapist flexibility and authenticity, service organization, and attributional processes influencing clinical judgment and therapeutic processes when adolescent psychotherapy has a difficult starting point. (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were interviewed. The (...) interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

The Science and Religion Forum (SRF) seeks to be the premier organization promoting the discussion between science and religion in the United Kingdom. Each year, the SRF holds a conference tackling a topical issue, and in 2017 focused on mental well‐being, neuroscience, and religion. This article introduces the thematic section which is made up of five papers from that conference. As a new field within the science and religion academy, these articles are both wide‐ranging and detailed. This introductory article (...) locates this section within the academy and argues that its place is not only valid but vital, given the increase of mental health problems and the need for medicine, church, and society to answer this problem and present ways to help. (shrink)

Background: Meditation is gaining recognition as a tool to impact health and well-being. Samyama is an 8-day intensive residential meditation experience conducted by Isha Foundation requiring several months of extensive preparation and vegan diet. The health effects of Samyama have not been previously studied. The objective was to assess physical and emotional well-being before and after Samyama participation by evaluating psychological surveys and objective health biomarkers.Methods: This was an observational study of 632 adults before and after the (...) Isha Samyama retreat. All participants were invited to complete surveys. Controls included household significant others. Surveys were completed at baseline, just before Samyama, immediately after Samyama, and 3 months later to assess anxiety, depression, mindfulness, joy, vitality, and resilience through validated psychometric scales. Voluntary blood sampling for biomarker analysis was done to assess hemoglobin, HbA1c, lipid profile, and C-reactive protein. Primary outcomes were changes in psychometric scores, body weight, and blood biomarkers.Results: Depression and anxiety scores decreased from T1 to T3, with the effect most pronounced in participants with baseline depression or anxiety. Scores at T4 remained below baseline for those with pre-existing depression or anxiety. Vitality, resilience, joy, and mindfulness increased from T1 to T3. Body weight decreased by 3% from T1 to T3. Triglycerides were lower from T2 to T3. Participants had lower HbA1c and HDL at T2, and lower CRP at all timepoints compared with controls.Conclusions: Participation in the Isha Samyama program led to multiple benefits. The 2-month preparation reduced anxiety, and participants maintained lower anxiety levels at 3 months post-retreat. Physical health improved over the course of the program as evidenced by weight loss and improved HbA1C and lipid profile. Practices associated with the Samyama preparation phase and the retreat may serve as an effective way to improve physical and mental health. Future studies may examine their use as an alternative therapy in patients with depression and/or anxiety.Clinical Trial Registration:www.ClinicalTrials.gov, Identifier: 1801728792. Registered retrospectively on 4/17/2020. (shrink)

_Therapy & the Counter-tradition: The Edge of Philosophy_ brings together leading exponents of contemporary psychotherapy, philosophers and writers, to explore how philosophical ideas may inform therapy work. Each author discusses a particular philosopher who has influenced their life and therapeutic practice, while questioning how counselling and psychotherapy can address human ‘wholeness’, despite the ascendancy of rationality, regulation and diagnosis. It also seeks to acknowledge the distinct lack of philosophical input and education in counselling and psychotherapy training. The chapters are rooted (...) in the Counter-Tradition, whose diverse manifestations include humanism, skepticism, fideism, as well as the opening of philosophy and psychology to poetry and the arts. This collection of thought-provoking essays will help open the discussion within the psychological therapies, by providing therapists with critical philosophical references, which will help broaden their knowledge and the scope of their practice. Therapy & the Counter-tradition: The Edge of Philosophy will be of interest to mental health professionals, practitioners, counselling and psychotherapy trainees and trainers, and academics tutoring or studying psychology. It will also appeal to those interested in psychology, meditation, personal development and philosophy. (shrink)

This book gives the reader an understanding of what consciousness is about, and of how to make conscious experiences more pleasant. It expands on a new theory that describes the evolutionary trajectory leading to conscious life forms. In short, the evidence suggests that consciousness first evolved some 300 million years ago as a consequence of the introduction of feelings. Feelings offer a strategy for making behavioural decisions. Besides playing a crucial role in the evolution of the human mind, they are (...) a key factor in regard to mental health and quality of life. Fortunately, the human brain is plastic. By exploiting available options for modulating the mind, it is therefore possible to impact on what sort of experiences the brain serves. More specifically, you can strengthen the capacity for positive feelings and reduce the sway of negative feelings. The text covers biological, neurological, psychological, and philosophical aspects of the mind. (shrink)

Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health care. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small provider's (...) practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice. (shrink)