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Can An AI Program Deliver Useful Psychotherapy?

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There are increasing numbers of AI-based chat programs that boast the convenience of a therapist in your pocket, always ready to listen.

So far, things have not gone entirely without incident, as (for example) the tendency of such chatbots to be agreeable in the things they say, can worsen some people’s mental health, if the chatbot uncritically believes everything they say. This has been a big problem for people using OpenAI’s ChatGPT as a therapist (something its makers, to their credit, do not claim it is qualified to do), when ChatGPT has encouraged and exacerbated paranoia and delusions, due to its tendency to give agreeable “yes, and…” responses.

But, it’s been worse than that, too. Some chatbots have inadvertently encouraged users to kill themselves, in a (technically successful) attempt to be encouraging, in inappropriate response to users expressing uncertainty on the topic.

This is a problem with applying a large language model (LLM) approach without sufficient failsafes in place, because a LLM AI will hear, after a discussion of previous suicidal ideation, “Maybe I’ll really do it this time, I don’t know” and will check its database for a huge number of instances of those words, and determine that an appropriate response is “I believe in you, you will succeed if you put your mind to it”, for example.

A sensible middle ground?

Researchers have tried to boundary those potential pitfalls, to provide an AI that can help a user to manage some of the most common mental health concerns (e.g. depression, anxiety, etc), while raising the alarm (rather than overextending its reach) when it comes to serious risks such as those associated with suicidal ideation:

❝While these results are very promising, no generative AI agent is ready to operate fully autonomously in mental health where there is a very wide range of high-risk scenarios it might encounter.

Therabot is not limited to an office and can go anywhere a patient goes. It was available around the clock for challenges that arose in daily life and could walk users through strategies to handle them in real time. But the feature that allows AI to be so effective is also what confers its risk—patients can say anything to it, and it can say anything back.

This trial brought into focus that the study team has to be equipped to intervene—possibly right away—if a patient expresses an acute safety concern such as suicidal ideation, or if the software responds in a way that is not in line with best practices. Thankfully, we did not see this often with Therabot, but that is always a risk with generative AI, and our study team was ready.

We still need to better understand and quantify the risks associated with generative AI used in mental health contexts.❞

Dr. Heinz, quoted above, was a lead researcher on a study testing “Therabot”, and his colleague and fellow lead researcher Dr. Nicholas Jacobson boasts,

❝Our results are comparable to what we would see for people with access to gold-standard cognitive therapy with outpatient providers. We’re talking about potentially giving people the equivalent of the best treatment you can get in the care system over shorter periods of time.❞

You can read their paper here: Randomized Trial of a Generative AI Chatbot for Mental Health Treatment

Lower-tech smartphone options

When it comes to more basic things, such as Cognitive Behavioral Therapy (CBT), advanced AI may not be necessary, as CBT by its very nature lends itself well to being presented in a way that’s scarcely more complicated than a flowchart, with relatively little that can go wrong even when done by an app. For example:

Cognitive behavioral therapy skills via a smartphone app for subthreshold depression among adults in the community: the RESiLIENT randomized controlled trial

Perhaps the lowest-tech way (that still involves tech) is journaling, using an app that provides journaling prompts. We discuss several of the options for that, here:

The Easiest Way To Take Up Journaling

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  • “Recovery is possible when we replace judgment with compassion”: How this mother turned pain into service for others

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    This is the second installment in a series about Pennsylvanians in recovery from substance use disorder and how stigma affected their recovery. The series is a collaboration between Public Good News, Centro Integral de la Mujer Madre Tierra, and Life Unites Us. If you’d like to share your story, contact us at mailto:[email protected]

    [Editor’s note: The contents of this interview have been edited for length and clarity. This interview was originally conducted in Spanish.]

    Carmen Albrecht, 58

    Outreach bilingual coordinator at Peace and Harmony House in Berks County 
    Reading, Pennsylvania

    I am a mother of five children. I have 22 grandchildren, six great-grandchildren, and I have been married for 16 years. I came to the United States from Puerto Rico in 1979, when my parents separated. My father struggled a lot with alcohol and was abusive toward my mother.

    I stayed in the United States with my father, and during that time, I decided to start a family at a very young age. By the age of 21, I already had five children. Very shortly after having my children, I was introduced to cocaine. Less than a year later, I was completely addicted.

    By 1996, I had lost my five children to social services because I had become consumed by my addiction.

    It controlled me completely—not only mentally, but also physically and emotionally. It numbed so much of the sadness, pain, and loneliness I had back then as a single mother.

    There were many times I tried to leave it behind because people wanted me to change so I could get my children back and move forward. I was a young person, only 27 years old. With addiction, I didn’t just lose my dignity—I lost my pride and my faith.

    There were many blows along the way because my own people looked at me differently and no one respected me anymore. The stigma crushed me completely, and I kept going with that pain.

    I was treated badly. People called me “drug addict,” “dirty,” and told me I was worthless. They said, “They took your children away because you deserved it,” and, “Your family will never accept you like that.” There was a time in 2002 when I sought help, and my children were returned to me—but about a year and a half later, or less, I lost them again.

    This is something I wrote:

    “During the struggle with addiction for more than 10 years, one of the deepest wounds did not come only from the drugs, but from the stigma that surrounded me. People who called me an ‘addict’ looked at me with contempt, as if I were less than human. Over time, those words began to feel like the truth. I felt useless. I felt worthless, convinced that this was the only future waiting for me. Stigma doesn’t just hurt—it completely crushes you. It makes you believe you don’t deserve help. It makes you hide from people, hide like a worm all tangled up, making you think there is no way out. And when you are already at your lowest point, that judgment can push you even deeper—and it does. It wasn’t until I went through many jails and institutions that I was able to slow down enough to see what I could do and realize that there was hope for me. There, I received structure and support and the opportunity to begin to rebuild myself.”

    When I left prison, I had already met someone—and that person did not judge me for who I was. That person supported me. I remember thinking, “That can’t be real because nobody loves me.” But he was the only one who stayed there, standing strong with me. That’s how my recovery began.

    A man and a woman pose for a picture in front of a large banner that has logos for two organizations: Hope Rescue Mission and Lighthouse. There are gold, black and grey balloons hanging around the banner. The man and the woman are wearing formal clothes.
    Carmen with her husband. Courtesy of Carmen Albrecht.

    I had to go to court, see the judge, report to parole, deal with social services, take care of my mental health, keep a job, and maintain a home—and for me, that was overwhelming. But with the support of the person who is now my husband, and the support of the job I had, I was able to complete all those programs in 18 months.

    Then I said to myself, “I have to make a change in my life. I have to help those who are where I once was.” If I don’t help them, they won’t find a way out because this is incredibly hard.

    So I set aside all the things that hurt me so much. Those names people called me and the ways they hurt me, that was the addiction, that wasn’t who I truly was. I am different. I am a strong person, and I can do this. Little by little, I kept going. I started studying and went back to school. I earned my GED. I completed an 18-month program in drug and alcohol counseling and got my first job serving people with mental health needs. By 2008, I was working as an assistant to social workers in a halfway house.

    I had a deep hunger to keep moving forward and to keep learning more about what drugs do to people, about the damage I had done to myself, and how I was able to overcome the stigma of how people treated me and how they saw me. I had to learn to walk with my head held high, not look back, and give myself the pride of knowing that I am not that person anymore. I had to look at myself in the mirror every morning and say, “Wow, I am beautiful.”

    So I kept studying. I also graduated as a Certified Recovery Specialist. I have a diploma in drug and alcohol counseling, and I also have more than 200 certificates related to working with addiction, alcohol, mental health, and homelessness because I went through all of that myself.

    Until recently, I worked at the Hope Rescue Mission with people struggling with addiction, homelessness, and mental health. And now I am working as a bilingual community outreach coordinator at Peace and Harmony House in Berks County.

    Even at the age I am now, I want to keep going forward. I want to help in every way I can. I have been able to help thousands and thousands of people, and I have helped send many people to rehabilitation centers who trust me deeply. I have a family that loves me unconditionally. My grandchildren love me. And by the grace of God, today I have been sober for 21 years.

    I have spent 18 years working in the field of addiction, walking alongside people who are living what I once lived. Every day I see how stigma continues to be a huge barrier for those seeking help. That’s why I speak about this because no one should be defined by their worst moments. Recovery is possible when we replace judgment with compassion.

    If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

    If you’re looking for substance use disorder or mental health help in Pennsylvania, find a list of resources here.

    This article first appeared on Public Good News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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  • Stand Up For Your Health (Or Don’t)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    You may have heard the phrase “sitting is the new smoking”, and while the jury’s out on whether that’s accurate or not in terms of exactly how damaging it is, one thing that is universally agreed-upon is that sitting is indeed very bad.

    It’s especially bad for your spine (because of being folded in ways it shouldn’t be), your muscles and associated nerves of the lower back and hip area, your abdominal organs (because of being compressed in ways they shouldn’t be), and your heart (because of arteries and veins being squashed up in ways they shouldn’t be), and if you remember how “what’s good for your heart is good for your brain”, the inverse is true, and what’s bad for your heart is also bad for your brain, which won’t get nourished with oxygen and nutrients and which won’t have its detritus removed as efficiently as it should; that’ll be left to build up in the brain instead.

    First, elephant in the room: not everybody can stand, and of those who can, not everybody can stand for long. So obviously, work within what’s attainable for you.

    Also note that while sitting is the disease-bringer/worsener, standing isn’t the only solution, for example:

    • Walking is better than standing. You may be wondering: “who can’t stand but can walk?” and the answer is, a lot of people with certain kinds of chronic pain, for whom walking is less chronic-pain-exacerbating than standing, because the human body is built for movement and inactivity can worsen things even more than movement.
    • Lying down is better than sitting. One of the major problems with sitting is that your organs are all bunched up in ways they shouldn’t be. Lying down is, in this regard, closer to standing than sitting, because your body has a nice straight line to it.
    • Sitting can be made less bad! For example:
      • Sitting in a recliner chair in the reclined position is… Not great, if you’re then tilting your skull forwards to compensate, but if you’re just sitting back and relaxing, this is a lot better than sitting in the usual seated position, because again, it’s closer to lying down, which is closer to standing.
      • Sitting in seiza (the traditional Japanese kneeling position) is, provided you do it correctly and with good posture, better than sitting in the traditional Western manner. The reason for this is simple: instead of having your torso and legs at 90°, they are at 120°ish, give or take the size of your thighs and butt (bigger being better in this regard), and even that angle can be made even better if you use a meditation bench like this one ← we’re eyeballing it and didn’t get out a protractor, but if you look at the model’s torso and thighs, that’s about 135° difference, which is huge improvement over the 90° you get while sitting Western-style.

    For most of us a lot of the time though, we can stand to sit less. Think about the places you most often sit, and what can be done to reasonably minimize those, for example:

    • Car: minimize driving (or being a passenger in a car); walk where reasonably possible. Public transport, if available, may have standing options.
    • Office: a standing desk is, of course, the way to go. You can even use a standing desk converter, like this one. Just make sure to set it at the correct height, both in terms of where the keyboard and mouse go (the same height as your elbows are when your arms are dropped to your sides), and where the monitor goes (center of the monitor should be at eye-level).
      • Note: laptops will never be right for this, unless the natural resting distance between your elbows and your eyes is about 4½ inches, which will only be the case if your total height is approximately 1 foot and 2 inches. For anyone taller than that, laptops are still great to have when on the move and as a backup, but not great for ergonomics.
      • Workaround: if for some reason you must use a laptop for your day-to-day work, consider using a bluetooth keyboard so that you can still set them the appropriate height-distance apart and thus not have to hunch over them.
    • Dining room: sitting to eat a main meal is reasonable, but consider standing options for lighter bites; a standing-height “brunch bar” is great if you can arrange one.
    • Lounge: let it live up to its name, and actually lounge: if you’re not going to stand, then horizontal lounging is an improvement over sitting—as is sitting on the floor, and changing your position frequently. Who knew, kids had it right in that regard!
      • Note: if, like this writer, you do a lot of reading, the same applies regardless of which room you’re doing it in.
    • Bedroom: a culprit for many will be sitting while doing a beauty routine and/or possibly make-up. Easily avoided if you set a well-lit mirror at the correct height to use while standing.
      • Note: at the correct height though! While hunching up over a wall-mounted mirror is an improvement over hunching up at a seated vanity, it’s not a great improvement. You want to be able to stand with good posture and do it comfortably.
    • Bathroom: leave your phone outside—which is also a good approach for avoiding hemorrhoids! See also: Half Of Americans Over 50 Have Hemorrhoids, But They Can Be Prevented!

    Want to know more?

    We reviewed this book recently, which goes into all of the above in much more detail than we have room for here, plus also discusses a lot of social reframes that can be used (since a lot of sitting is a matter of social expectations, not actual need). It’s a very useful read:

    Death by Sitting: The Hidden Health Risks of a Sedentary Life and How to Stand Up for Your Well-Being – by Carolyne Thompson

    Take care!

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  • Caffeine For Memory Loss Reversal!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    There’s a lot of popular confusion about coffee (and/or caffeine)’s health benefits and risk, a good number of which we’ve cleared up here:

    The Bitter Truth About Coffee (or is it?) ← this is a mythbusting edition, focussing on coffee specifically, rather than caffeine in general.

    …as well as here, focussing on caffeine rather than coffee: Caffeine: Cognitive Enhancer Or Brain-Wrecker?

    When it comes to the brain, usually the benefits are considered to come more from coffee (or tea)’s antioxidant strengths, rather than the caffeine, aside from that yes, it’s a stimulant and so it will boost your brain in the short term, just like the rest of your body.

    And as for sleep? Well, coffee doesn’t have a good reputation, even if its negative effects have been greatly overstated:

    How Much Does Caffeine Affect Sleep, Really?

    But it turns out, there’s another side to the coin…

    Memory problems? Caffeine to the rescue!

    Researchers (Dr. Lik-Wei Wong et al.) investigated how caffeine affects memory deficits caused by sleep deprivation, focusing on a specific brain circuit, not just general alertness.

    First, the damage: five hours of sleep deprivation impaired a certain part* of the hippocampus, weakening synaptic plasticity and reducing the ability to recognize familiar individuals (social memory). This happened because sleep deprivation increased adenosine signaling, which dampens neural activity and disrupts proteins critical for learning and memory.

    *Lest this be too mysterious: it was the CA2 region

    Now, caffeine’s effect: caffeine is an adenosine blocker, so (of course) it blocked adenosine receptors and thus restored synaptic plasticity in the CA2 region, reversing both neural deficits and social memory impairment. Notably, the recovery was pathway-specific rather than global, meaning caffeine didn’t overstimulate the brain in non-sleep-deprived subjects.

    In other words: sleep deprivation selectively disrupts memory circuits, and caffeine can reverse these disruptions at both molecular and behavioral levels

    You can read the paper in full, here: Caffeine reverses sleep deprivation-induced synaptic and social memory deficits via adenosine receptor modulation in the male mouse hippocampal CA2 region

    You may be thinking: “Oh, it’s a mouse study! Male mice at that! What if I am not male, and/or not a mouse?”

    And in this case, that’s not too much of a concern. Yes, there are differences between a mouse brain and human brain, and yes, there are hormone-mediated sex differences in the brain, but neither of those two differences should impact this, as memory storing and retrieval, and adenosine signalling, is the same regardless, so far as research currently shows.

    This caffeine benefit is particularly worthy of note, because generally speaking, as we get older and we might worry about our memory failing us, this is exactly the kind of memory loss that most people fear most. People don’t fear being unable to memorize pi to n places, they fear not recognizing their loved ones, or even on a lesser level, just getting confused in social settings.

    See also: Is It Dementia?

    Want to learn more?

    If you’d like to improve your memory without caffeine, then consider:

    How To Boost Your Memory Immediately (Without Supplements)

    Enjoy!

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  • Healing Spices – by Dr. Bharat Aggarwal & Debora Yost

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is exactly what the subtitle promises it to be, and more. It’s actually herbs and spices, but definitely mostly spices, and includes the kinds found in even the smallest supermarket, to some you might not have heard of, and might need to order online.

    We are treated to an explanation of the health-giving properties of each (and any potential contraindications), as well as the culinary properties, many tables of what goes with what and how and why, and even recipes to use them in. For the more adventurous, there’s even advice on how to grow, prepare, and store each of them.

    An extra benefit is that everything is cross-linked such that you can look things up by spice or by health condition or by flavor profile, and find what you need and what’ll go with it.

    The style is simple and informational, clearly laid-out in encyclopedic form.

    Bottom line: this book should be in your kitchen (or related nearby kitchen-book-place).

    Click here to check out Healing Spices, and advance your culinary repertoire!

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  • 6 Signs Of A Heart Attack… A Month In Advance

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    Many people know the signs of a heart attack when it’s happening, but how about before it’s too late to avoid it?

    The signs

    • Unusual fatigue: persistent tiredness that doesn’t improve with rest
    • Shortness of breath: unexplained breathlessness during light activities or rest, which can be caused by fluid buildup in the lungs (because the heart isn’t circulating blood as well as it should)
    • Chest discomfort: pain, pressure, tightness, or aching in the chest due to reduced blood flow to the heart muscle—often occurring during physical exertion or emotional stress
    • Frequent indigestion: means that heartburn could be heart-related! This is about persistently reoccurring discomfort or pain in the upper abdomen
    • Sleep disturbances: difficulties falling asleep, staying asleep, or waking up abruptly
    • Excessive sweating: unexplained cold sweats or sudden sweating without physical exertion or excessive heat, can be a response to the decreased oxygen levels caused by less efficient blood flow

    Note: this is a list of warning signs, not a diagnostic tool. Any or even all of these could be caused by something else. Just, don’t ignore the signs and do get yourself checked out.

    For more details on each of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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  • Always Tired? Here’s The Physiology Of Why

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    Dr. Ashley Froese explains what’s going on inside you, because understanding it is the first step to fixing it:

    When every cell is stressed…

    Cortisol normally tells your immune system to reduce inflammation because immune responses require large amounts of energy that the body prioritizes for immediate survival during danger (immediate survival = immediately right now, e.g. escape the tiger, not worrying about tomorrow’s health because first we must survive the next few minutes, if we want to see tomorrow at all, so everything else is expendable).

    However, constant cortisol exposure can cause your cells to downregulate cortisol receptors, making them less responsive to cortisol signals.

    This is a problem, because when immune cells stop responding properly to cortisol’s anti-inflammatory signal, they continue releasing inflammatory cytokines even when no real threat exists.

    Persistent immune activation can produce fatigue, body aches, pain, brain fog, bloating, and a general sense of feeling unwell.

    And as for what’s going on to cause that, there are several mechanisms of action, including:

    • Stress alters blood sugar regulation: cortisol activates gluconeogenesis in your liver, raising blood glucose so your body has fuel available for a fight-or-flight response.
    • Unused fuel leads to insulin resistance: if the body releases glucose during stress but you’re not physically active, repeated spikes in glucose and insulin can cause cells to become less responsive to insulin.
    • Excess glucose becomes stored fat: chronically elevated blood sugar is eventually stored as fat, often in organs such as your liver, contributing to conditions like fatty liver.
    • Cortisol interferes with other hormone systems: prolonged stress can reduce thyroid hormone activation (T4 to T3 conversion) and suppress sex hormones, leading to fatigue, cold sensitivity, low libido, poor sleep, and low mood.
    • Muscle breakdown slows metabolism: cortisol is catabolic and can break down muscle tissue for fuel, which reduces muscle mass and worsens metabolic control.

    So, if you’re tired all the time, and/or are generally experiencing these symptoms through no known other cause, then consider whether chronic stress could be the culprit:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like:

    How To Reduce Chronic Stress

    Take care!

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