Improvements In Mental Well-being Research Articles

Self-Rated Effectiveness of Ayahuasca and Breathwork on Well-Being, Psychological Resilience, Self-Compassion, and Personality: An Observational Comparison Study

Background: In recent years, there has been a growing interest in the therapeutic potential of classical psychedelics like ayahuasca for mental health improvement. Naturalistic studies at ayahuasca retreats have shown (short-term) improvements in mental well-being but understanding the psychological mechanisms is crucial. We are interested in psychological processes such as resilience, self-compassion, and personality traits. Additionally, it is unclear whether changes are solely due to ayahuasca or influenced by the social setting. To address this, a control group participating in a breathwork session, similar to ayahuasca retreats, was included. Methods: In this observational study, individuals who attended an ayahuasca retreat (n = 69) and individuals who participated in a breathwork session (n = 30) completed an online survey one week before (baseline) and one, six, and twelve weeks after they entered the retreat/session. The survey included a series of questionnaires, i.e., the World Health Organisation-Five Well-Being Index, 14-item Resilience Scale, Self-Compassion Scale–Short Form, and Big Five Inventory-10. A linear mixed model (LMM) was used to analyze the outcome data. Results: It was shown that well-being, resilience, and self-compassion increased and remained stable over 12 weeks compared to baseline, regardless of group (ayahuasca or breathwork). Older participants generally reported higher resilience and self-compassion. Self-compassion was also higher in the ayahuasca group overall. Neuroticism decreased in both groups, with lower scores in the ayahuasca group. Agreeableness increased over time, also not influenced by group membership, while there were no changes in extraversion, conscientiousness, or openness. Discussion: Both interventions improved well-being, aligning with prior research. Importantly, this study unveils a novel finding: both interventions enhance resilience and self-compassion for up to three months, offering promise for conditions marked by low well-being, resilience, and self-compassion like depression and anxiety-related disorders. While acknowledging its limitations (e.g., self-selected sample, no specific information of the ayahuasca brew or the breathwork technique), it emphasizes the need for controlled studies with control groups, attention to social contexts in research on these interventions, and to assess other variables like depth of altered states of consciousness that might explain improvement in psychological processes and wellbeing.

Training-related improvements in mental well-being through reduction in negative interpretation bias: A randomized trial of online socio-emotional dyadic and mindfulness interventions

BackgroundEffects of online contemplative practices, especially partner-based practices, on psychological well-being remain mixed, with sparse understanding of potential affective-cognitive mechanisms. The study aimed to assess the efficacy of two online contemplative interventions in improving depression, anxiety, emotion regulation (ER), and resilience, and to evaluate the mechanistic role of negative attention and interpretation biases. MethodsEmploying a randomized controlled design (n = 285), we compared the efficacy of 10-week online mindfulness-based and partner-based socio-emotional dyadic interventions, both supported by weekly coaching sessions. Mental health aspects were assessed using validated self-report measures and negative biases using the mouse-contingent Scrambled Sentences Task. ResultsBoth interventions, compared to waitlist control, led to reductions in depression and ER difficulties, while trait anxiety decreased only after mindfulness training. Increases in multidimensional resilience were observed only after socio-emotional training and in stress recovery only after mindfulness-based training, both compared to waitlist control. Socio-emotional training led to significant reductions in negative interpretation bias and this mediated reductions in depression and trait anxiety. Neither training led to reductions in state anxiety or negative attention bias. LimitationsThe subclinical nature and overrepresentation of females in the sample limits generalizability. ConclusionsFindings indicate that online mindfulness-based and socio-emotional partner-based interventions, supported by online coaching sessions, can reduce depression and ER difficulties. Though mindfulness practice reduced trait anxiety and enhanced stress recovery, socio-emotional training increased multidimensional resilience. Socio-emotional training reduced negative interpretation bias, which emerged as an intervention-specific mechanism. These findings highlight the potential benefits of online contemplative intervention approaches for psychological well-being.

The Effects of Australia's First Residential Peer-Support Suicide Prevention and Recovery Centre (SPARC).

Aim: This paper reports preliminary evidence of the impacts of Australia's first residential peer-support service for people at risk of suicide. Methods: Psychological distress was measured preintervention, postintervention, and after 3 months and analyzed using paired t tests. Interviews were held postintervention and were analyzed using thematic analysis. Results: Psychological distress significantly improved from preintervention to postintervention (n = 16, d = 1.77) and at follow-up (n = 5, d = 1.12). Interviews (n = 10) indicated that participants experienced improvements in mental well-being and feelings of connectedness, respite, and confidence to engage with other services. The peer-support workers were key. Some participants felt that the location was too remote, too little information was given, and a longer stay would have been preferable. Limitations: The study did not include a control group, the sample was relatively small, and participants may have been subject to socially desirable answers. Conclusions: These findings indicate that residential peer-support services potentially offer a valuable alternative to conventional inpatient treatment for people at risk of suicide.

Occupational burnout and public stigma associated with employee mental well-being: A multi-industry, cross-sectional study during COVID-19.

While mental illness (e.g., depression, anxiety) has been examined frequently in the workplace, the COVID-19 pandemic has only increased the attention towards mental illness. Mental well-being views mental health as a continuum from ill health to thriving. Few studies have examined factors associated with mental well-being in the workplace. Public stigma for mental illness, the general population's negative attitude towards mental illness, and occupational burnout are examined. The purpose of this study was to examine the relationship between burnout and public stigma on mental well-being in a sample of employees across industries in the United States. Employees surveyed from 16 companies from various industries were assessed. Room Here, a non-profit organization whose goal is to improve employee mental fitness, gathered data from these companies located in the western mountain region of the U.S. Data were collected during the pandemic. Across this portfolio of companies, 259 employees were included in the sample. Survey assesses respondents' mental well-being, stigma towards mental illness, and occupational burnout. Ordinary least squares (OLS) regression was used in this cross-sectional study on secondary data. Results suggested occupational burnout was associated with a decrease in mental well-being, while public stigma was associated with an improvement in mental well-being. This study sought to examine the relationship between mental well-being, burnout, and public stigma. Employee burnout and public stigma were related to mental well-being. Implications for burnout and stigma reduction programs are discussed as well as future research.

Tū tangata: Culturally encompassing physical activity and its impact on the mental well-being and academic achievement of Pacific talavou

As part of their kaupapa of catering for the whole child, Pacific Advance Secondary School in Ōtāhuhu has implemented an innovative programme called Tū Tangata to get their talavou physically active. This has led to improvements in mental wellbeing and academic achievements. Tū Tangata is an expression well known to Māori and means “stand tall”. It is based on a philosophy that encourages young people to stand up and be counted and take responsibility for their futures.

Prospective associations between adherence to 24-hour movement guidelines and mental well-being in Chinese adolescents

ABSTRACT Most evidence regarding the relationships between adherence to 24-hour movement guidelines and adolescent mental health have been derived from cross-sectional studies or have ignored positive mental health indicators. The current prospective study examined the associations between adherence to 24-hour movement guidelines and changes in mental well-being among Chinese adolescents over three months. 816 Chinese adolescents (M age = 14.76 years; SD = 0.81) completed baseline and follow-up scales of 24-hour movement behaviours, mental well-being, and covariates. Linear mixed-effects models were used for data analyses, with adjustments for covariates and mental well-being at baseline. There was a significant improvement in mental well-being across the three months, and the improvement in mental well-being was positively associated with meeting any single guidelines and both physical activity and sleep guidelines but not adherence to all three guidelines. Meeting both physical activity and sleep recommendations appears to exert more significant benefits on mental well-being than meeting one or two other recommendations. An integrative approach to mental health promotion by focusing on 24-hour movement behaviours (at least physical activity and sleep) may be more effective than focusing on a single behaviour alone.

Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals.

Transgender individuals often face elevated mental health challenges due to gender dysphoria, but gender-affirming treatments such as surgery and hormone therapy have been linked to significant improvements in mental well-being. The potential influence of time and circadian rhythms on these treatments is prevalent. The intricate interplay between hormones, clock genes, and fertility is profound, acknowledging the complexity of reproductive health in transgender individuals. Furthermore, risks associated with gender-affirming hormonal therapy and potential complications of puberty suppression emphasize the importance of ongoing surveillance for these patients and the need of fertility preservation and family-building options for transgender individuals. This narrative review delves into the intricate landscape of hormone therapy for transgender individuals, shedding light on its impact on bone, cardiovascular, and overall health. It explores how hormone therapy affects bone maintenance and cardiovascular risk factors, outlining the complex interplay of testosterone and estrogen. It also underscores the necessity for further research, especially regarding the long-term effects of transgender hormones. This project emphasizes the critical role of healthcare providers, particularly obstetricians and gynecologists, in providing affirming care, calling for comprehensive understanding and integration of transgender treatments. This review will contribute to a better understanding of the impact of hormone therapy on reproductive health and overall well-being in transgender individuals. It will provide valuable insights for healthcare providers, policymakers, and transgender individuals themselves, informing decision-making regarding hormone therapy and fertility preservation options. Additionally, by identifying research gaps, this review will guide future studies to address the evolving healthcare needs of transgender individuals. This project represents a critical step toward addressing the complex healthcare needs of this population. By synthesizing existing knowledge and highlighting areas for further investigation, this review aims to improve the quality of care and support provided to transgender individuals, ultimately enhancing their reproductive health and overall well-being.

Pathways to mental well-being for graduates of mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR): A mediation analysis of an RCT

Objective To explore mediated effects of Mindfulness-Based Cognitive Therapy-“Taking it Further” (MBCT-TiF) on mental well-being through changes in mindfulness, self-compassion, and decentering. Method A secondary analysis of an RCT using simple mediation, with 164 graduates of MBCT and mindfulness-based stress reduction (MBSR), was implemented whereby MBCT-TiF (vs ongoing mindfulness practice; OMP) was the independent variable; changes in mindfulness, self-compassion, and decentering during the intervention were the mediators; and mental well-being at post-intervention, whilst controlling for baseline, was the dependent variable. Secondary outcomes included psychological quality of life, depression, and anxiety. Results Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: ab = 0.11 [0.03, 0.25]; decentering: ab = 0.16 [0.05, 0.33]; self-compassion: ab = 0.07 [0.01, 0.18]). A similar pattern was demonstrated for depression, but only mindfulness and decentering mediated effects on psychological quality of life and anxiety. Conclusion The findings provide preliminary support for all three mediators in driving change in mental well-being in a sample of MBCT/MBSR graduates. Future work must be theory-driven and powered to test all mediators in parallel and alongside other potential mediators (e.g., equanimity) to further understand independent contributions and interacting effects. Trial registration: ClinicalTrials.gov identifier: NCT05154266.

The impact of social media interventions on mental well-being: a systematic review

Abstract Background There is some evidence that problematic social media use is related to poorer mental well-being. To improve users’ mental well-being, social media interventions, e.g., abstinence from social media, have been recommended. However, there is limited understanding of their effectiveness. This systematic review aimed to synthesise literature on the effectiveness of social media interventions for improving mental well-being. Methods Three databases were searched (2004-June 2022). Experimental studies evaluating the impact of social media interventions on mental well-being in adults were included. Outcomes such as depression, and loneliness, were included. A narrative synthesis was completed to summarise effectiveness by outcomes and intervention type. The Quality Assessment Tool was used to measure quality. Results Of 2,785 results, 23 studies were included for analysis. Many studies (9/23, 39%) found improvements in mental well-being, seven (7/23, 30%) found mixed effects and seven found no effect on mental well-being. Therapy-based interventions, that used techniques from Cognitive Behavioural Therapy, were more effective (83%, 5/6 of studies showing benefit) than limiting use (20%, 1/5) or full abstinence from social media (25%, 3/12). Depression was the most improved outcome with 70% (7/10) of studies showing a significant improvement after the intervention. Quality was poor, 96% (22/23) of studies received a weak score, mostly due to selection bias, as most used convenience sampling of university students (16/23, 70%). Conclusions This review provides some evidence that social media interventions are effective in improving mental well-being, especially for depression and when using therapy-based techniques. Further research with representative samples is needed to understand who may benefit most from social media interventions. This will help to develop guidance for policymakers and clinicians on how to manage problematic social media use. Key messages • The relationship between social media and mental well-being is complex and experimental evidence overall does not show conclusively that less time spent on social media improves mental well-being. • Reflecting on why/when social can become problematic for our mental health can improve mental well-being, so policies/public health interventions should focus on how we use social media.

Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation.

Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap. Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods. To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative. This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction. At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M. COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas. Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change. This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.

Connections matter: Adolescent social connectedness profiles and mental well-being over time.

This study examined profiles of social connectedness among early adolescents in grade 7 before the COVID-19 pandemic was declared (Winter 2020), and in grade 8 during the second Wave of the pandemic (Winter 2021). Linked data from 1753 early adolescents (49% female) from British Columbia, Canada who completed the Middle Years Development Instrument survey in grades 7 and 8 were used. Participants reported on life satisfaction, depressive symptoms, and connectedness with peers and adults at home, school and in the community. We used Latent Profile Analysis to identify connectedness profiles at both time points, and Latent Transition Analysis to examine transitions in connectedness profiles over time. Multiple regression analyses examined the associations between profile membership in grade 7 and mental well-being in grade 8, and the associations between transitions in profile membership (i.e., increase vs. decrease in connectedness over time) and mental well-being. Connectedness in multiple domains in grade 7 was related to significantly higher levels of mental well-being in grade 8, controlling for demographics, well-being in grade 7, and COVID-related mental health worries. Well-being was highest when students felt highly connected in all domains and lowest when they felt lower levels of connection. Increases in connectedness were associated with improvements in mental well-being and decreases with a decline in well-being over time. Experiencing connectedness with peers and adults is critical for the mental well-being in early adolescence. Providing opportunities to connect is important in the context of major societal challenges such as the COVID-19 pandemic.

The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review.

There is some evidence that more social media use is related to poorer mental well-being and that social media use can become problematic when it starts to interfere with a person's daily life and mental well-being. To address this issue and improve users' mental well-being, social media use interventions (eg, abstinence from social media) have been developed and evaluated. However, there is limited understanding of the effectiveness of these interventions in improving mental well-being. This systematic review aimed to synthesize the literature on the effectiveness of social media use interventions in improving mental well-being in adults. A systematic search (January 1, 2004, to July 31, 2022) was completed across 3 databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Experimental studies evaluating the impact of social media use interventions on mental well-being in adults were included. Outcomes related to mental well-being, such as depression, anxiety, stress, and loneliness, were included. A narrative synthesis without meta-analysis was completed to summarize the study characteristics and effectiveness by outcome and intervention type. The Effective Public Health Practice Project Quality Assessment Tool was used to measure the quality of the studies. Of the 2785 studies identified through the systematic search, 23 (0.83%) were included in the analysis. Many of the included studies (9/23, 39%) found improvements in mental well-being, some (7/23, 30%) found mixed effects, and others (7/23, 30%) found no effect on mental well-being. Therapy-based interventions that used techniques such as cognitive behavioral therapy were more effective than limiting use of social media or full abstinence from social media, with 83% (5/6) of these studies showing improvements in mental well-being compared with 20% (1/5) and 25% (3/12), respectively. Depression was the most frequently investigated and improved outcome with 70% (7/10) of the studies showing a significant improvement in depression after the intervention, whereas other outcomes showed more varied results. Quality was poor, with 96% (22/23) of the studies receiving a weak global score, mostly for issues related to selection bias because most of the studies (16/23, 70%) used a convenience sampling of university students. This review provides some evidence that social media use interventions are effective in improving mental well-being, especially for depression and when using therapy-based interventions. Further experimental and longitudinal research is needed with representative samples to investigate who may benefit most from social media use interventions. This will help to develop guidance and recommendations for policy makers and clinicians on how best to manage problematic social media use.

A workplace wellness program protects against COVID-19 effects on mental wellbeing

The outbreak of the COVID-19 pandemic had deleterious effects on workers’ mental wellbeing. The current study investigated the impact of an online workplace wellness program on teacher mental wellbeing and mindfulness during the first four months of nation-wide quarantine in New Zealand. Longitudinal data at three time points were examined: baseline, end of program, and 3 months post-program in a sample of 32 teachers. Tests of paired data of baseline versus the later time points found statistically significant improvements in mental wellbeing (Warwick-Edinburg Mental Wellbeing Scale) and mindfulness (The Five Facets Mindfulness Questionnaire) with large effect sizes. Mindfulness scores were higher at 3 months follow up compared to end-of-program suggesting teachers’ mindfulness ratings continued to improve after program completion. Implications for research and workplace training are discussed.

From "surviving to thriving": Mood Lifters - a wellness program for parents of medically complex children.

Parents of medically complex children juggle unique demands associated with caring for chronically ill children, many of which negatively impact their mental wellbeing. Despite this, parents of medically complex children often forgo mental health support due to concerns with costs, time, stigma, and accessibility. There is limited research on evidence-based interventions addressing such barriers for these caregivers. We piloted an adapted version of Mood Lifters, a peer-led wellness program, to equip parents of medically complex children with evidence-based strategies to manage their mental health while also reducing barriers to support. We hypothesized parents would find Mood Lifters to be feasible and acceptable. Further, parents would experience improvements in mental wellbeing upon program completion. We conducted a single-arm prospective pilot study to assess Mood Lifters for parents of medically complex children. Participants included 51 parents in the U.S. recruited from a local pediatric hospital providing care for their children. Caregiver mental wellbeing was assessed through validated questionnaires pre-intervention (T1) and post-intervention (T2). Repeated-measures analysis of variance was conducted to evaluate change between T1 and T2. Analyses from T1 and T2 (n=18) revealed improvements in parents' depression (F(1,17) =7.691, p=0.013) and anxiety (F(1,17)=6.431, p=0.021) after program completion. Improvements in perceived stress and positive and negative emotion were significant at p<0.0083. Parents of medically complex children experienced improved mental health upon participating in Mood Lifters. Results offer preliminary support for the feasibility and acceptability of Mood Lifters as an evidence-based care option that may also alleviate common barriers to care.

Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature-A Pilot Study.

In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals' connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered.

Smartphone-based ecological momentary assessment reveals mental health benefits of birdlife

The mental health benefits of everyday encounters with birdlife for mental health are poorly understood. Previous studies have typically relied on retrospective questionnaires or artificial set-ups with little ecological validity. In the present study, we used the Urban Mind smartphone application to examine the impact of seeing or hearing birds on self-reported mental wellbeing in real-life contexts. A sample of 1292 participants completed a total of 26,856 ecological momentary assessments between April 2018 and October 2021. Everyday encounters with birdlife were associated with time-lasting improvements in mental wellbeing. These improvements were evident not only in healthy people but also in those with a diagnosis of depression, the most common mental illness across the world. These findings have potential implications for both environmental and wildlife protection and mental healthcare policies. Specific measures, aimed at preserving and increasing everyday encounters with birdlife in urban areas, should be implemented.

SP2.2.4 Structured prehabilitation reduces physical deconditioning and improves emotional and physical well-being during neo-adjuvant chemotherapy prior to surgery for oesophageal cancer

Abstract Introduction Neo-adjuvant chemotherapy (NAC) prior to oesophagectomy is associated with a decline in cardiovascular fitness, sarcopenia and reduced health related quality of life. This study aimed to determine if a structured exercise programmed mitigated these effects. Methods A prospective non-randomised trial compared a standard care pathway to a structured prehabilitation exercise programme undertaken before and during NAC and surgery for oesophageal cancer. Cardiopulmonary Exercise Testing (CPEX), body composition analyses and Health Related Quality of Life questionnaires were performed at multiple time points. Results Comparison of the Intervention (n=22) and Control (n=20) groups demonstrated a decline in patient fitness following NAC, measured by VO2peak. This was blunted by 7.86% in patients undergoing the structured exercise prehabilitation program (-21.40% Control vs -13.54% Intervention p=0.02). Fat Free Mass increased (intervention 16.1 vs. 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056) and Fat Mass Index to Fat Free Mass Index ratio (-5.51% Intervention, 10.74% control p=0.043) decreased in the treatment group. An overall improvement in Mental Wellbeing and Cognitive and Emotional function in HRQL after neo-adjuvant chemotherapy was seen in the intervention group. Conclusion A structured exercise programme prior to neoadjuvant chemotherapy blunts cardiopulmonary deconditioning, reverses sarcopenia and improves the quality of life in patients undergoing a highly debilitating treatment regimen. Further studies will be needed to validate these findings.

Brief, structured, group art therapy for women with breast and/or gynaecological cancer

ABSTRACT Background This paper describes a structured group approach for women vulnerable to psychological distress following treatment for breast and/or gynaecological cancer. Aims Set in Hong Kong, the aim was to develop and pilot a brief art therapy intervention sensitive to local concerns and the specific needs of service-users. Methods A mixed methods study was developed and piloted in two phases over six-years in collaboration with female service-users recovering from breast and/or gynaecological cancer treatment. Key therapeutic goals and core themes were identified in phase 1 leading to the piloting of a six-session structured intervention with six groups in phase 2. This was evaluated using qualitative and quantitative methods: through service-user feedback and reflections; informal feedback captured through the art therapy process; and pre and post assessment of emotional distress (Distress Thermometer) and mental wellness (C-SWEMWBS). Results A consistent six-session structure was developed addressing four therapeutic goals: stress release and relaxation; amelioration of psychological and emotional distress; exploration of self-image; promotion of self-acceptance and awareness. Six core themes relating to loss and readjustment were established through the art therapy process. Participants experienced statistically significant reductions in psychological distress and increased mental well-being. Conclusion A new brief, structured, group art therapy approach was developed for women recovering from breast and/or gynaecological cancer treatment. Implications for practice/policy/future research The study contributes to the evidence base for the efficacy of art therapy in psycho-oncology and highlights the importance of service-user involvement in the design of a tailored, culturally sensitive, intervention responsive to local concerns. Plain-language summary This paper describes a brief art therapy group approach for women in recovery from treatment for breast and/or gynaecological cancer who are finding it difficult to adjust to changes in their bodies and the way they see themselves in the world. The aim of the project was to explore the use of a participatory approach to develop and test a brief art therapy intervention designed to meet the specific needs of such women. The project took place in Hong Kong, in a community cancer service offering support with the emotional impact of a cancer diagnosis and treatment. The theme-based group model was developed in two phases over six years in collaboration with female participants, all of whom were over the age of eighteen and had received treatment for breast and/or gynaecological cancer in the previous two years. Four therapeutic goals were identified: relaxation, reduction of emotional distress; exploration of feelings about oneself in the world, and awareness and acceptance of various aspects of oneself and one’s situation. Common issues relating to feelings of loss and difficulties adjusting to bodily changes led to the further identification of six core themes. These were creatively explored through the art therapy process leading to the development of a consistent six-session structure. The themed group approach was evaluated through service-user feedback and reflections, informal feedback during the art therapy process, and established measurement tools for assessing emotional distress and mental wellness. Results suggest an overall reduction in emotional distress with improvements in mental wellbeing. This contributes to the evidence base for the efficacy of art therapy in cancer care. Positive outcomes also reflect the participants’ involvement in the design of a culturally sensitive intervention responsive to local needs.

How Level is the 'Cognitive Playing Field'?

In Philosophy of Psychedelics, Letheby provides a convincing basis for the idea that psychedelics primarily derive their therapeutic potential through mediating favourable changes to self-related belief systems. In this commentary, we take a closer look at the role that contextual factors (‘set’ and ‘setting’) play in Letheby’s two-factor account of psychedelic therapy. While Letheby acknowledges that psychedelic effects are highly context-dependent, the exact role that context plays in self-modelling during the acute experience is not entirely clear. We argue that context plays an essential role in shaping the ‘discovery’ of alternate self-conceptions during the acute experience. Specifically, users are more likely to experience alterations in self-conception that are consistent with context-dependent features, such as one’s prior mindset (‘set’) and aspects of the external environment (‘setting’). This is consistent with a REBUS model of psychedelic effects, where a corollary effect of relaxing high-level prior beliefs is that the system becomes increasingly sensitised to bottom-up information (‘prediction errors’) from lower-level intrinsic sources and the sensory periphery. Furthermore, it may explain why a positive well-intentioned state of mind and a supportive therapeutic environment are more likely to result in positive acute experiences and long-term improvements in mental wellbeing. We see this position as being largely compatible with Letheby’s proposal, but may shift some aspects of its emphasis and framing. In particular, it may conflict with Letheby’s notion that psychedelics lead to a ‘level cognitive playing field’, where self-related hypotheses are thought to be assigned more or less equal probability.

Access to health care and mental health—Evidence from the ACA preexisting conditions provision

This study evaluates the impact of the Affordable Care Act (ACA) preexisting conditions provision on mental health. The 2014 policy ensured individuals with preexisting health conditions the right to obtain insurance coverage. Using longitudinal data from the Panel Study of Income Dynamics between 2007 and 2017 and estimating difference-in-differences models, our study provides evidence that the policy reduced severe mental distress by 1.44 percentage points (baseline mean: 8.09%) among individuals with preexisting physical health conditions. Exploiting pre-ACA, state-level variation in policies providing insurance coverage options to people with preexisting conditions, we find that this improvement in mental well-being is highly associated with the presence of high-risk pools before 2014, which provided individuals with prior health conditions access to coverage. Specifically, we show that our main results are driven by individuals with preexisting health conditions living in the 16 states that did not have high-risk pools. Furthermore, gender-specific analysis shows that the reduction in mental distress is primarily observable among women. When examining potential mechanisms, our analysis provides evidence that increases in insurance coverage, reductions in healthcare expenditures, and improvements in physical health can explain the positive effects of the provision on mental well-being.