Monday, September 25, 2023

By Don Sapatkin

Good Monday morning! (Or good Monday night or Tuesday for our Jewish readers observing Yom Kippur.) MindSite News writer Denise Clay-Murray wanted to know how Philadelphia’s leading mayoral candidate planned to address the mental health needs of people impacted by gun violence. She pursued an interview and – much to her chagrin – became part of the story.

In today’s Daily: In a challenge to conventional wisdom, a study found that trying to kick negative thoughts out of your head can help your mental health. Some users of the weight-loss drug Ozempic are reporting mental health side-effects. And the White House continues efforts to push insurers to fully cover mental health treatment.

Suppressing negative thoughts may improve mental health, study finds, challenging psychiatric dogma

Image: Shutterstock

The notion that it’s counter-productive to try and push negative thoughts out of your head originated with Sigmund Freud and has become conventional wisdom. In the 1980s, psychologist Daniel Wegner’s “white bear” studies (as in: don’t think about the white bear!) only strengthened the CW: Telling psychotherapy patients to suppress negative thoughts will backfire and cause them to pop into their heads more often rather than less.

Now a small but detailed study is challenging that belief, NBC News reported. Researchers led by Michael Anderson, a neuroscientist at Cambridge University in England, asked 120 participants to imagine the future and identify 20 “fears and worries” they were afraid might happen, 20 “hopes and dreams” and 36 neutral events like going to the eye doctor. In each case, they needed to vividly imagine the scenario occurring and to create a single cue word to remind them of each scenario.

Then they took part in Zoom trainings. Half of the study subjects were told to look at their negative cue words – but to keep their minds from wandering into more negative thoughts as they did. The other half were asked to do the same thing with the neutral words. “You’re told: If something does pop into mind, even briefly, push it out,” Anderson said. “Moreover, don’t distract yourself. Don’t think about lunch.” The exercise was repeated 12 times a day for three days.

Immediately after the experiment – and again three months later – the participants who blocked out negative thoughts reported that those fears were less vivid, and they thought about the scary events less. They also reported that their mental health had improved compared to the group tasked with suppressing neutral thoughts.

One small study is hardly definitive. It will need to be replicated and tried in clinical (rather than research) settings. Still, it has gotten a lot of press:  Scientific American focused on Anderson’s co-author, an emigré member of the Uighur ethnic group whose people have been oppressed and traumatized by China’s government. She initiated the research after noticing how the most resilient members of her community suppressed their memories of Chinese atrocities.

The Independent of London headlined its story in the most British of ways: “Stiff upper lip might be better for mental health after all, study suggests.”

Reports of possible mental health side-effects accompany Ozempic’s rise

Ozempic, a medication approved to treat Type 2 diabetes, has in a short time attained near-mythic status as a weight-loss drug. In the mental health world, some psychiatrists are prescribing it off-label to counter the weight gain caused by some psychiatric medications. Others suggest that it might even treat addiction.

But there’s a problem, NPR reports: As more and more people take it, reports of users engaging in self-harm or experiencing suicidal thoughts are mounting. These side effects are not listed among the cautions on the drug’s label – perhaps because studies that led to approval of Ozempic excluded people with depression, anxiety and suicidal thoughts.

The European Medicines Agency said in July it was examining 150 reports of self-harm and suicidal thoughts in people using Ozempic and similar drugs. The FDA hasn’t gone that far. A spokesperson said that the agency is monitoring the situation, but she noted that Wegovy, which is approved for weight loss and contains semaglutide, the same active ingredient as in Ozempic, includes a warning about suicidal thoughts on its label.

The FDA has received 489 reports of patients experiencing anxiety, depression or suicidal thoughts while taking these drugs, according to an NPR analysis of the FDA Adverse Event Reporting System. Ninety-six of these reports were for suicidal thoughts by patients, five of whom died. This reporting system itself can’t establish a link between a problem and a drug but is grounds for continuing to monitor and investigate such cases.

Biden administration keeps pressure on health insurers to cover mental health treatment

For decades, federal and state laws have required insurers to cover mental health and substance abuse treatment on par with what they provide for physical health. Numerous reports have shown that they don’t. The Biden administration is the first with the tools (provided by Congress) and the will to take on the industry. Its Department of Labor proposed new rules in July intended to force insurers to comply.

The administration recently reminded the industry that parity remains a priority. “We always hope for collaboration, but the rule has sticks as well,” Neera Tanden, head of President Biden’s domestic policy council, told Politico. “We hope insurers will change their behavior going forward without the sticks, but we will continue to fully enforce the parity law.” The  public comment period for the proposed regulations will close on Oct. 2. Insurers say the proposal will hurt consumers and have requested an extension of the comment period.

Foley & Lardner LLP, a law firm that advises companies on health care regulations, last week posted explicit guidance for insurers on this issue, urging them to remove “red flag” language in health plans that the Labor Department has warned about in the past. These include provisions that exclude coverage for medication-assisted treatment for opioid use disorder and residential care or partial hospitalization for mental health and substance use conditions, as well as exclusion of a type of therapy used in treating autism. I wrote on MindSite News last year about a family’s struggle for reimbursement of their autistic son’s Applied Behavioral Analysis, the standard treatment for autism, which their Anthem Blue Cross Blue Shield Plan had flatly stated was not a covered benefit.

In other news…

A new tool to diagnose hikikomori a form of extreme physical and social isolation first recognized in Japan was developed by researchers at Oregon Health & Science University and published in World Psychiatry. A letter to the editor described the tool. Last month, MindSite News republished an in-depth story about Hito Refresh Camp in southern Japan, a place that is “past support home, past collective farm” where hikikomori can get support to overcome their isolation:

A Camp for Japan’s Social Recluses

In Japan, people who isolate themselves, rarely interacting with others, are know as hikikomori. As their numbers have grown, organizations have emerged to help them reintegrate into society.

Do puberty blockers impact the mental health of teens? A re-analysis of data from a small 2021 study suggests they might. The original study found that, overall, puberty blockers given to transgender children ages 12 to 15 had neither a positive or negative impact on their mental health. But a reanalysis of that same study produced a more nuanced result: 34% saw their mental health deteriorate, 29% improved and 37% had no change, the BBC reported. The study included only 44 children and the new analysis has not yet been published in a peer-reviewed medical journal. But it is sure to be cited by red-state lawmakers seeking to ban medical treatment for transgender children.

Illinois county requires pot dispensaries to post warnings about mental health risks. In what may be the first such action in the nation, Patrick Kenneally, McHenry County’s Republican state’s attorney, ordered dispensaries to display in-store warnings of marijuana’s potential link to “psychotic disorders such as schizophrenia, increased thoughts of suicide and suicide attempts, anxiety and depression,” Axios Chicago reported. With marijuana still illegal under federal law, regulations vary widely among the 40 states that allow medical marijuana and 22 (plus the District of Columbia) that have legalized recreational use. Illinois and other states already require warning labels for marijuana that are similar to nicotine warnings. The move was blasted by Democratic lawmakers who said Kenneally’s action “carelessly conflates cannabis use with the most complex societal issues.”

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

Recent MindSite News Stories

Philly’s Cherelle Parker, The Very Disrespectful Emails (and Me)

Our reporter in Philadelphia wanted to know how leading mayoral candidate Cherelle Parker planned to address the mental health needs of people impacted by gun violence. So she pursued an interview with Parker and got stonewalled – as the campaign’s own internal emails admitted. Public embarrassment for the Parker campaign followed.

Continue reading…

California’s Surgeon General Wants Schools to Be the Front Line Against Childhood Stress

California’s Surgeon General wants to give teachers tools to better support students grappling with Adverse Childhood Experiences – things like abuse, neglect, substance abuse in the home or community or domestic violence. These stressful events are a leading cause of self-sabotaging behavior at school, such as chronic absenteeism or fighting.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...