No Time to Panic – by Matt Gutman
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Matt Gutman is not a doctor or a psychologist. He’s a journalist, accustomed to asking questions and then asking more probing questions, unrelenting until he gets the answers he’s looking for.
This book is the result of what happened when he needed to overcome his own anxiety and panic attacks, and went on an incisive investigative journey.
The style is as clear and accessible as you’d expect of a journalist, and presents a very human exploration, nonetheless organized in a way that will be useful to the reader.
It’s said that “experience is a great teacher, but she sends hefty bills”. In this case as in many, it’s good to learn from someone else’s experience!
By the end of the book, you’ll have a good grounding in most approaches to dealing with anxiety and panic attacks, and an idea of efficacy/applicability, and what to expect.
Bottom line: without claiming any magic bullet, this book presents six key strategies that Gutman found to work, along with his experiences of what didn’t. Valuable reading if you want to curb your own anxiety, or want to be able to help/support someone else with theirs.
Click here to check out No Time To Panic, and find the peace you deserve!
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Lost for words? Research shows art therapy brings benefits for mental health
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Creating art for healing purposes dates back tens of thousands of years, to the practices of First Nations people around the world. Art therapy uses creative processes, primarily visual art such as painting, drawing or sculpture, with a view to improving physical health and emotional wellbeing.
When people face significant physical or mental ill-health, it can be challenging to put their experiences into words. Art therapists support people to explore and process overwhelming thoughts, feelings and experiences through a reflective art-making process. This is distinct from art classes, which often focus on technical aspects of the artwork, or the aesthetics of the final product.
Art therapy can be used to support treatment for a wide range of physical and mental health conditions. It has been linked to benefits including improved self-awareness, social connection and emotional regulation, while lowering levels of distress, anxiety and even pain scores.
In a study published this week in the Journal of Mental Health, we found art therapy was associated with positive outcomes for children and adolescents in a hospital-based mental health unit.
An option for those who can’t find the words
While a person’s engagement in talk therapies may sometimes be affected by the nature of their illness, verbal reflection is optional in art therapy.
Where possible, after finishing an artwork, a person can explore the meaning of their work with the art therapist, translating unspoken symbolic material into verbal reflection.
However, as the talking component is less central to the therapeutic process, art therapy is an accessible option for people who may not be able to find the words to describe their experiences.
Art therapy has supported improved mental health outcomes for people who have experienced trauma, people with eating disorders, schizophrenia and dementia, as well as children with autism.
Art therapy has also been linked to improved outcomes for people with a range of physical health conditions. These include lower levels of anxiety, depression and fatigue among people with cancer, enhanced psychological stability for patients with heart disease, and improved social connection among people who have experienced a traumatic brain injury.
Art therapy has been associated with improved mood and anxiety levels for patients in hospital, and lower pain, tiredness and depression among palliative care patients.
Studies suggest art therapy could support people with a range of health conditions. mojo cp/Shutterstock Our research
Mental ill-health, including among children and young people, presents a major challenge for our society. While most care takes place in the community, a small proportion of young people require care in hospital to ensure their safety.
In this environment, practices that place even greater restriction, such as seclusion or physical restraint, may be used briefly as a last resort to ensure immediate physical safety. However, these “restrictive practices” are associated with negative effects such as post-traumatic stress for patients and health professionals.
Worryingly, staff report a lack of alternatives to keep patients safe. However, the elimination of restrictive practices is a major aim of mental health services in Australia and internationally.
Our research looked at more than six years of data from a child and adolescent mental health hospital ward in Australia. We sought to determine whether there was a reduction in restrictive practices during the periods when art therapy was offered on the unit, compared to times when it was absent.
We found a clear association between the provision of art therapy and reduced frequency of seclusion, physical restraint and injection of sedatives on the unit.
We don’t know the precise reason for this. However, art therapy may have lessened levels of severe distress among patients, thereby reducing the risk they would harm themselves or others, and the likelihood of staff using restrictive practices to prevent this.
This artwork was described by the young person who made it as a dead tree with new growth, representing a sense of hope emerging as they started to move towards their recovery. Author provided That said, hospital admission involves multiple therapeutic interventions including talk-based therapies and medications. Confirming the effect of a therapeutic intervention requires controlled clinical trials where people are randomly assigned one treatment or another.
Although ours was an observational study, randomised controlled trials support the benefits of art therapy in youth mental health services. For instance, a 2011 hospital-based study showed reduced symptoms of post-traumatic stress disorder among adolescents randomised to trauma-focussed art therapy compared to a “control” arts and crafts group.
Artwork made by a young person during an art therapy session in an in-patient mental health unit. Author provided What do young people think?
In previous research we found art therapy was considered by adolescents in hospital-based mental health care to be the most helpful group therapy intervention compared to other talk-based therapy groups and creative activities.
In research not yet published, we’re speaking with young people to better understand their experiences of art therapy, and why it might reduce distress. One young person accessing art therapy in an acute mental health service shared:
[Art therapy] is a way of sort of letting out your emotions in a way that doesn’t involve being judged […] It let me release a lot of stuff that was bottling up and stuff that I couldn’t explain through words.
A promising area
The burgeoning research showing the benefits of art therapy for both physical and especially mental health highlights the value of creative and innovative approaches to treatment in health care.
There are opportunities to expand art therapy services in a range of health-care settings. Doing so would enable greater access to art therapy for people with a variety of physical and mental health conditions.
Sarah Versitano, Academic, Master of Art Therapy Program, Western Sydney University and Iain Perkes, Senior Lecturer, Child and Adolescent Psychiatry, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cupping: How It Works (And How It Doesn’t)
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Good Health By The Cup?
In Tuesday’s newsletter, we asked you for your opinion of cupping (the medical practice), and got the above-depicted, below-described, set of responses:
- About 40% said “It may help by improving circulation and stimulating the immune system”
- About 26% said “I have never heard of the medical practice of cupping before this”
- About 19% said “It is pseudoscience and/or placebo at best, but probably not harmful
- About 9% said “It is a good, evidence-based practice that removes toxins and stimulates health”
- About 6% said “It is a dangerous practice that often causes harm to people who need medical help”
So what does the science say?
First, a quick note for those unfamiliar with cupping: it is the practice of placing a warmed cup on the skin (open side of the cup against the skin). As the warm air inside cools, it reduces the interior air pressure, which means the cup is now (quite literally) a suction cup. This pulls the skin up into the cup a little. The end result is visually, and physiologically, the same process as what happens if someone places the nozzle of a vacuum cleaner against their skin. For that matter, there are alternative versions that simply use a pump-based suction system, instead of heated cups—but the heated cups are most traditional and seem to be most popular. See also:
National Center for Complementary and Integrative Health | Cupping
It is a dangerous practice that often causes harm to people who need medical help: True or False?
False, for any practical purposes.
- Directly, it can (and usually does) cause minor superficial harm, much like many medical treatments, wherein the benefits are considered to outweigh the harm, justifying the treatment. In the case of cupping, the minor harm is usually a little bruising, but there are other risks; see the link we gave just above.
- Indirectly, it could cause harm by emboldening a person to neglect a more impactful treatment for their ailment.
But, there’s nothing for cupping akin to the “the most common cause of death is when someone gets a vertebral artery fatally severed” of chiropractic, for example.
It is a good, evidence-based practice that removes toxins and stimulates health: True or False?
True and False in different parts. This one’s on us; we included four claims in one short line. But let’s look at them individually:
- Is it good? Well, those who like it, like it. It legitimately has some mild health benefits, and its potential for harm is quite small. We’d call this a modest good, but good nonetheless.
- Is it evidence-based? Somewhat, albeit weakly; there are some papers supporting its modest health claims, although the research is mostly only published in journals of alternative medicine, and any we found were in journals that have been described by scientists as pseudoscientific.
- Does it remove toxins? Not directly, at least. There is also a version that involves making a small hole in the skin before applying the cup, the better to draw out the toxins (called “wet cupping”). This might seem a little medieval, but this is because it is from early medieval times (wet cupping’s first recorded use being in the early 7th century). However, the body’s response to being poked, pierced, sucked, etc is to produce antibodies, and they will do their best to remove toxins. So, indirectly, there’s an argument.
- Does it stimulate health? Yes! We’ll come to that shortly. But first…
It is pseudoscience and/or placebo at best, but probably not harmful: True or False?
True in that its traditionally-proposed mechanism of action is a pseudoscience and placebo almost certainly plays a strong part, and also in that it’s generally not harmful.
On it being a pseudoscience: we’ve talked about this before, but it bears repeating; just because something’s proposed mechanism of action is pseudoscience, doesn’t necessarily mean it doesn’t work by some other mechanism of action. If you tell a small child that “eating the rainbow” will improve their health, and they believe this is some sort of magical rainbow power imbuing them with health, then the mechanism of action that they believe in is a pseudoscience, but eating a variety of colorful fruit and vegetables will still be healthy.
In the case of cupping, its proposed mechanism of action has to do withbalancing qi, yin and yang, etc (for which scientific evidence does not exist), in combination with acupuncture lore (for which some limited weak scientific evidence exists). On balancing qi, yin and yang etc, this is a lot like Europe’s historically popular humorism, which was based on the idea of balancing the four humors (blood, yellow bile, black bile, phlegm). Needless to say, humorism was not only a pseudoscience, but also eventually actively disproved with the advent of germ theory and modern medicine. Cupping therapy is not more scientifically based than humorism.
On the placebo side of things, there probably is a little more to it than that; much like with acupuncture, a lot of it may be a combination of placebo and using counter-irritation, a nerve-tricking method to use pain to reduce pain (much like pressing with one’s nail next to an insect bite).
Here’s one of the few studies we found that’s in what looks, at a glance, to be a reputable journal:
Cupping therapy and chronic back pain: systematic review and meta-analysis
It may help by improving circulation and stimulating the immune system: True or False?
True! It will improve local circulation by forcing blood into the area, and stimulate the immune system by giving it a perceived threat to fight.
Again, this can be achieved by many other means; acupuncture (or just “dry needling”, which is similar but without the traditional lore), a cold shower, and/or exercise (and for that matter, sex—which combines exercise, physiological arousal, and usually also foreign bodies to respond to) are all options that can improve circulation and stimulate the immune system.
You can read more about using some of these sorts of tricks for improving health in very well-evidenced, robustly scientific ways here:
The Stress Prescription (Against Aging!)
Take care!
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Brain Health Action Plan – by Dr. Teryn Clarke
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The author is a physician and neurologist, and she brings a lot of science with her when she sets out to Alzheimer’s-proof our brains:
- She talks about brain nourishment, and what things in contrast sabotage our brains, and how.
- She talks intermittent fasting, and optimal scheduling when it comes to food, sleep, exercise, and more.
- She talks about how the rest of our health affects our brain health, and vice versa.
The “action plan” promised by the title includes all of those elements, plus such matters as ongoing education, cognitive stimulation, stress management, dealing with depression, and other mostly-brain-based factors.
As such, it’s not just a “for your information” book, and Dr. Clarke does outline suggested goals, tasks, and habits, advises the use of a streak tracker, provides suggested recipes, and in all ways does what she can to make it easy for the reader to implement the information within.
Bottom line: if you’d like to dodge dementia, this book is quite a comprehensive guide.
Click here to check out Brain Health Action Plan, and enact yours!
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Herbs For Evidence-Based Health & Healing
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Herbs have been used since prehistoric times to treat injuries and illnesses, but which ones actually work, as opposed to being “old wives’ tales”?
Even today, in pharmacies herbals products may come with a disclaimer “based on traditional use only”, which, in scientific terms, means it likely performs no better than placebo.
This is a “Saturday Life Hacks” edition, not a “Research Review Monday”, so we won’t be doing any deep-dives today, and will instead keep things short and snappy. We’ll also spotlight one main benefit, rather than trying to cover all bases, as we often have room to do on a Monday!
Basil
Helps boost immunity:
Chamomile
Significantly reduces symptoms of osteoarthritis:
(This one challenged your writer’s resolve as it does so many things, it was hard to pick just one. So, she went with one that’s less known that “settling the stomach” and “relieving PMS” and “relaxation” and so forth)
Echinacea
Significantly reduces the risk of catching a cold (but won’t help once you’ve caught it):
Echinacea for preventing and treating the common cold
Elderberry
Significantly hastens recovery from upper respiratory viral infections:
Evening Primrose
Fights neuropathy, along with many other benefits:
An updated review on pharmacological activities and phytochemical constituents of evening primrose
Fennel
Antinflammatory, along with many other benefits:
Ginkgo biloba
Antioxidant effects provide anti-aging benefits:
Advances in the Studies of Ginkgo Biloba Leaves Extract on Aging-Related Diseases
Ginseng
Combats fatigue:
Ginseng as a Treatment for Fatigue: A Systematic Review
Lavender
Enjoyed for its sedative effects, which is really does have:
Evidence for Sedative Effects of the Essential Oil of Lavender after Inhalation
Sage
Helps fight HIV type 1 and Herpes simplex type 2 (and probably other viruses, but that’s what we have the science for right now):
Aqueous extracts from peppermint, sage and lemon balm leaves display potent anti-HIV-1 activity
Valerian
Inconclusive data; “traditional use only” for restful sleep.
Can’t have everything!
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Mammography AI Can Cost Patients Extra. Is It Worth It?
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As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.
I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?
I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.
In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.
While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.
“I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”
The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.
Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.
Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”
But is the tech analysis worth the extra cost to patients? There’s no easy answer.
“Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.
Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.
“At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.
About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.
The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.
CMS didn’t respond to requests for comment.
Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.
Radiology practices don’t handle payment for AI mammography all in the same way.
The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.
Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.
Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.
Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.
Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.
“The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.
In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine.
The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.
“CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”
Smith said he found it “troubling” that radiologists would charge for the AI analysis.
“There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Protein: How Much Do We Need, Really?
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Mythbusting Protein!
Yesterday, we asked you for your policy on protein consumption. The distribution of responses was as follows:
- A marginal majority (about 55%) voted for “Protein is very important, but we can eat too much of it”
- A large minority (about 35%) voted for “We need lots of protein; the more, the better!”
- A handful (about 4%) voted for “We should go as light on protein as possible”
- A handful (6%) voted for “If we don’t eat protein, our body will create it from other foods”
So, what does the science say?
If we don’t eat protein, our body will create it from other foods: True or False?
Contingently True on an absurd technicality, but for all practical purposes False.
Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize and absolutely must get from food. Normally, we get those amino acids from protein in our diet, and we can also supplement them by buying amino acid supplements.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
However, to get the requisite amino acid amounts, without consuming actual protein, would require gargantuan amounts of supplementation (bearing in mind bioavailability will never be 100%, so you’ll always need to take more than it seems), using supplements that will have been made by breaking down proteins anyway.
So unless you live in a laboratory and have access to endless amounts of all of the required amino acids (you can’t miss even one; you will die), and are willing to do that for the sake of proving a point, then you do really need to eat protein.
Your body cannot, for example, simply break down sugar and use it to make the protein you need.
On another technical note… Do bear in mind that many foods that we don’t necessarily think of as being sources of protein, are sources of protein.
Grains and grain products, for example, all contain protein; we just don’t think of them as that because their macronutritional profile is heavily weighted towards carbohydrates.
For that matter, even celery contains protein. How much, you may ask? Almost none! But if something has DNA, it has protein. Which means all plants and animals (at least in their unrefined forms).
So again, to even try to live without protein would very much require living in a laboratory.
We can eat too much protein: True or False?
True. First on an easy technicality; anything in excess is toxic. Even water, or oxygen. But also, in practical terms, there is such a thing as too much protein. The bar is quite high, though:
❝Based on short-term nitrogen balance studies, the Recommended Dietary Allowance of protein for a healthy adult with minimal physical activity is currently 0.8 g protein per kg bodyweight per day❞
❝To meet the functional needs such as promoting skeletal-muscle protein accretion and physical strength, dietary intake of 1.0, 1.3, and 1.6 g protein per kg bodyweight per day is recommended for individuals with minimal, moderate, and intense physical activity, respectively❞
❝Long-term consumption of protein at 2 g per kg bodyweight per day is safe for healthy adults, and the tolerable upper limit is 3.5 g per kg bodyweight per day for well-adapted subjects❞
❝Chronic high protein intake (>2 g per kg bodyweight per day for adults) may result in digestive, renal, and vascular abnormalities and should be avoided❞
Source: Dietary protein intake and human health
To put this into perspective, if you weigh about 160lbs (about 72kg), this would mean eating more than 144g protein per day, which grabbing a calculator means about 560g of lean beef, or 20oz, or 1¼lb.
If you’re eating quarter-pounder burgers though, that’s not usually so lean, so you’d need to eat more than nine quarter-pounder burgers per day to get too much protein.
High protein intake damages the kidneys: True or False?
True if you have kidney damage already; False if you are healthy. See for example:
- Effects of dietary protein restriction on the progression of advanced renal disease in the modification of diet in renal disease study
- A high protein diet has no harmful effects: a one-year crossover study in healthy male athletes
High protein intake increases cancer risk: True or False?
True or False depending on the source of the protein, so functionally false:
- Eating protein from red meat sources has been associated with higher risk for many cancers
- Eating protein from other sources has been associated with lower risk for many cancers
Source: Red Meat Consumption and Mortality Results From 2 Prospective Cohort Studies
High protein intake increase risk of heart disease: True or False?
True or False depending on the source of the protein, so, functionally false:
- Eating protein from red meat sources has been associated with higher risk of heart disease
- Eating protein from other sources has been associated with lower risk of heart disease
Source: Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women
In summary…
Getting a good amount of good quality protein is important to health.
One can get too much, but one would have to go to extremes to do so.
The source of protein matters:
- Red meat is associated with many health risks, but that’s not necessarily the protein’s fault.
- Getting plenty of protein from (ideally: unprocessed) sources such as poultry, fish, and/or plants, is critical to good health.
- Consuming “whole proteins” (that contain all 9 amino acids that we can’t synthesize) are best.
Learn more: Complete proteins vs. incomplete proteins (explanation and examples)
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