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Key Takeaways Adolescents' intentional overdose attempts are more frequent at night and linked to recent screen use. Both prescription and over-the-counter medications are commonly used in these suicide attempts. Limiting screen time before bed and securing medications are recommended to mitigate risks. The study aims to inform strategies to reduce youth suicide and self-harm, with findings to be presented at a psychiatry conference. Preliminary data from a recent study shows intentional overdose suicide attempts by individuals aged 12 to 17 are significantly more likely to occur during the night and in context of recent digital screen use. Investigators collected data from patients aged 12 to 17 who were admitted to a child and adolescent psychiatry unit after a suicide attempt by intentional overdose. Researchers focused on the time of day, screen use, and type of medication related to overdose suicide attempts in adolescents. The data showed intentional overdose attempts by adolescents to be more likely during the nighttime and in relation to recent use of screens. The study also found that both prescription and over the counter medications were used in these intentional overdose suicide attempts. There was also no significant difference in number of suicide attempts by intentional overdose between prescription drugs or over the counter drugs. Leader of this study, Abhishek Reddy, MD, a child and adolescent psychiatry physician at the Carilion Clinic, noted that “Researchers have previously found links between screen use, suicidal behaviors, sleep problems, and mental health challenges in children. We wanted to examine the combination of those factors as well as the availability of prescription and OTC medications when it comes to overdoses.” Previous studies found high or increasing rates of use of addictive screen time were associated with suicidal behaviors and ideation. In a press release, Reddy added, “The main goal in identifying these factors is to help develop ways to reduce the number of suicides and self-harm among children and adolescents.” Reddy provided clinical recommendations related to factors of screen time, medication access, and sleep health. Limiting children’s and adolescents’ access to screens, particularly in the hour before bedtime, can be beneficial, he explained. Reddy pointed out that disconnecting from screens is essential, especially before sleeping, and allowing screen time can also be used as a positive reward for behaviors parents would like to encourage. “Children who struggle with bullying at school can end up taking it home with them and seeing messages at night, when they are at their most vulnerable,” Reddy added. Good sleep hygiene is also important; it is useful to help children develop a routine to relax before bedtime, and refraining from treats with high sugar content or caffeinated beverages in the evening can also help improve sleep. Reddy specifically noted access to prescription and over the counter medications should be monitored if a child is exhibiting struggles with their mental health. Parents can secure medications in the household to ensure they are not being misused. Reddy emphasized that the study’s preliminary “findings support clinical recommendations related to these factors” of sleep, screen time, and medication access. This research will be presented at the American Academy of Child and Adolescent Psychiatry annual meeting in Chicago at the end of October. Note: This article originally appeared on Psychiatric Times .

Key Takeaways Dr. Sarah Oreck refutes the FDA's claim, citing a 2024 meta-analysis showing no link between acetaminophen use during pregnancy and autism or ADHD. The narrative around acetaminophen and autism stigmatizes neurodivergence and distracts from the need for better support systems for autistic individuals. Misinformation about acetaminophen can increase medical mistrust and harm maternal mental health, emphasizing the importance of evidence-based guidance. Dr. Oreck advocates for trusting mothers to make informed decisions and calls for a healthcare system that supports maternal well-being and evidence-based care. CLINICAL CONVERSATIONS On September 22, the US Food and Drug Administration (FDA) announced a label change for acetaminophen (Tylenol and similar products) that reflect supposed evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and attention-deficit/hyperactivity disorder (ADHD) in children.1 In response to this announcement, Psychiatric Times connected with a reproductive psychiatrist and expert, Sarah Oreck, MD, MS, to discuss these claims. Psychiatric Times: The FDA has issued a statement that acetaminophen use during pregnancy causes neurological conditions like autism and ADHD in children. Can you share your thoughts on this announcement or provide any helpful data? Sarah Oreck, MD, MS: Let me be crystal clear: this statement is simply not true. A February 2024 meta-analysis showed that acetaminophen use during pregnancy does NOT increase ADHD or autism risk.2 The earlier studies suggesting a link? Poor quality research that never should have made headlines. People take acetaminophen for fevers, chronic pain, migraines—conditions that themselves could impact fetal development. You cannot separate these factors. It is like blaming umbrellas for rain—the research shows correlation, not causation. Acetaminophen remains one of the safest pain relief options in pregnancy when used appropriately and the evidence supports its use. PT: Do you believe this announcement increases stigma surrounding autism and other such disorders? Oreck: This narrative is deeply problematic, and frankly, infuriating. This is not about protecting children—it is about finding someone to blame while pathologizing autism as something that needs to be eradicated or cured. The premise that autism is something to prevent or eliminate is fundamentally flawed. Individuals with autism have made extraordinary contributions to science, technology, art, and every field imaginable. We are talking about neurodivergence, not a disease to be wiped out. Many autistic adults advocate powerfully for acceptance and accommodation, not cure. Here is what is actually happening: while we shame pregnant people over acetaminophen, children with autism are waiting months for essential services. Families are bankrupting themselves to access therapies. Schools lack basic resources for neurodivergent students. The real scandal is not Tylenol, it is our fundamentally broken support system. If this administration truly cared about outcomes for children with autism, we would invest in early intervention programs, educational support, and family resources. Instead, we are creating fear around one of the few safe medications available during pregnancy. That is not science-based medicine; it is scapegoating. PT: How does medical mistrust put mothers in particular at risk? What impact will news like this announcement have on maternal mental health as a whole? Oreck: The message is always the same: your pain does not count. Maternal suffering does not matter, just endure for the baby. Medical mistrust is already a crisis for mothers, but misinformation like this will cause real harm. Pregnant people will endure dangerous fevers because they are terrified, which, untreated, can cause neural tube defects, among other avoidable outcomes. These are real, immediate risks, not theoretical ones from flawed research. PT: What advice can mental health clinicians offer mothers who are afraid? How can mental health clinicians combat misinformation or reduce fear in patients? Oreck: Validate their fear—it is understandable given the irresponsible reporting. Then walk them through the actual science and remind them: correlation does not equal causation. We will never have perfect data on pregnancy medications because we cannot ethically run controlled trials on pregnant people. If you took Tylenol for fever, you protected your pregnancy. If you took it for pain, you took care of yourself so you could take care of your baby. The risk of untreated conditions is often far greater than theoretical medication risks. Maternal suffering is not a virtue. You made the best decision with the information available. Your child's outcomes are not a referendum on your worth as a parent. PT: Anything else you would like to share? Oreck: This is medical gaslighting on a massive scale. At Mavida Health, we do things differently. We believe our patients when they tell us something is wrong. We do not dismiss maternal pain as "just hormones" or say "you seem fine" when you are struggling. Evidence-based care means trusting the research, but it also means trusting mothers to make informed decisions about their own bodies. That is the standard of care we should all be fighting for. PT: Thank you!

TOPLINE: A substantial proportion of teens who identified as sexual and gender minorities were exposed to suicidal behavior and ideation by friends and family members and reported experiencing more suicidal thoughts and behaviors than their cisgender and heterosexual peers. METHODOLOGY: Adolescents between ages 14 and 21 years filled out surveys identifying themselves by gender identity (nonbinary, genderqueer, transgender, etc.) and sexual orientation (queer, pansexual, gay, lesbian, etc.) Researchers ran the survey between December 2022 and May 2023 to find out if these adolescents who were exposed to others’ suicidal behavior were more likely to experience suicidal thoughts or actions themselves Sexual and gender minority status was determined by asking each adolescent their sex assigned at birth, current gender identity, and sexual orientation Adolescents completed the Paykel Suicide Scale and Suicide Capacity Scale to assess suicidal thoughts and behaviors, evaluate past-year suicidal thoughts and attempts, and disposition to feeling low fear of pain or death, among others. Exposure to suicidal behavior of friends and family was assessed by asking adolescents whether any friends or family members had attempted suicide or died by suicide. The teens also reported their experiences of racial or ethnic discrimination in the previous 30 days. TAKEAWAY: They included 1126 students (mean age, 16.2 years; 55% assigned female sex at birth; 51% African American or Black individuals; 35% White individuals) from four public high schools in one US county. Overall, 50.2% of sexual and gender minority adolescents reported being exposed to a suicide attempt by a friend, and 36.3% reported exposure to a suicide attempt by a family member. These adolescents reported higher levels of suicide capability (t, -4.0; P < .001) and more frequent suicidal ideation (t, -6.3; P < .001) and attempts (t, -6.9; P < .001) than their cisgender and heterosexual peers. Sexual and gender minority adolescents reported higher levels of peer, school, and institutional racial or ethnic discrimination than cisgender and heterosexual youth (P < .05 for all). Sexual and gender minority status was associated with exposure to suicide attempts by friends and family members (P < .05 for both); this exposure, in turn, was associated with increased suicide capability and suicidal thoughts and behaviors (P < .05 for all). IN PRACTICE: “[The study] findings suggest that existing models of suicide risk among [sexual and gender minority] adolescents should be expanded to include social network factors, particularly exposure to others’ suicide attempts,” the authors wrote. “Peer-engaged interventions may be one strategy to address and disrupt the potential for suicide contagion within SGM [sexual and gender minorities] adolescent peer networks.” SOURCE: This study was led by Kirsty A. Clark, PhD, of the Department of Medicine, Health, and Society at Vanderbilt University in Nashville, Tennessee. It was published online on August 20, 2025, in Journal of Adolescent Health. LIMITATIONS: Information on network size, density, member demographics, and the nature of exposure (online or in person) was missing. The cross-sectional design of this study limited the assessment of cause-and-effect relationships. DISCLOSURES: This study was supported by a grant from the US CDC. One author reported receiving funding from the National Institute of Mental Health. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

"The history of psychiatry is a history of fads in theory, diagnosis, and treatment. Such rapid shifts in conceptualization—such as the emergence of the concept of adult ADHD—almost always warrant informed critical examination." COMMENTARY As recently as 2 decades ago, the consensus view in American academic psychiatry was that attention-deficit/hyperactivity disorder (ADHD) rarely, if ever, persists into adulthood. 1,2 For decades, ADHD was considered a disorder of childhood; adult cases were seen uncommonly and the diagnosis was rarely made. DSM-IV-TR, published in 2000, describes a condition existing in children and makes only scant reference to adults. 3 Fast-forward to 2023, and adult ADHD is the diagnosis du jour ; rates of diagnosis are skyrocketing at an alarming rate as are prescriptions for psychostimulants, the drugs that purportedly treat the condition. The history of psychiatry is a history of fads in theory, diagnosis, and treatment. Such rapid shifts in conceptualization—such as the emergence of the concept of adult ADHD—almost always warrant informed critical examination. In the case of a novel psychiatric disorder, it is either true that (1) psychopathologists and psychiatric nosologists have missed the disorder for more than a century, or (2) that the disorder is a case of disease mongering, when a condition that has never been observed is suddenly made popular overnight as a result of social, cultural, and economic reasons. We argue that the latter is true for adult ADHD. How did adult ADHD get its wheels? The rise in diagnosis of adult ADHD fully coincides with marketing by the pharmaceutical industry when Eli Lilly and Company got the first US Food and Drug Administration indication for this label with atomoxetine (Strattera) in 1996. Since that date, many academics have been promoting the concept of adult ADHD. The adult ADHD market has become a multibillion-dollar industry, with the rise of digital companies specializing in online diagnosis and treatment—some of which have come under legal scrutiny. Does ADHD Persist Into Adulthood? Findings from commonly cited retrospective studies suggest that approximately 50% to 60% of childhood ADHD persists into adulthood. These studies look backwards to attempt to determine which childhood cases continue into adulthood. However, these data are disproven by prospective studies, which repeatedly show that about 80% of children with ADHD do not continue to have that diagnosable condition, followed prospectively either into young adulthood or even for 33 years into their fourth decade of life ( Figure ). 4,5 A total of 20% of cases persist, whereas 80% do not. In other words, most children with ADHD do not continue to meet the criteria for the diagnosis into adulthood. Construct Validity and Diagnostic Hierarchy When we argue that adult ADHD is not a scientifically valid diagnosis, we do not mean, of course, that the symptoms so attributed do not exist. Clearly, adult human beings can exhibit problems with attention, concentration, focus, memory, and related abilities. What we mean is that these symptoms have not been shown to be the result of a scientifically valid disease (adult ADHD) and are better explained by more classic and scientifically validated psychiatric conditions, namely diseases or abnormalities of mood, anxiety, and mood temperament. A major problem with the DSM system as currently constituted is that it fails to take into account the concept of diagnostic hierarchy, a fundamental diagnostic principle used across medicine. In sum, diagnostic hierarchy refers to the idea that not all diagnoses are created equal—that some are more important or more primary than others. Failure to adhere to the concept of diagnostic hierarchy has resulted in epidemics of polydiagnosis (assigning multiple diagnoses to the same patient) and polypharmacy (the use of multiple psychiatric medications, often across classes). What Causes the Symptoms Attributed to Adult ADHD? Plenty of other psychiatric disorders exist that can cause ADHD-like symptoms, and in current practice, individuals with these symptoms receive misdiagnoses of adult ADHD. For example, 84% of patients with symptoms meeting criteria for adult ADHD also have symptoms that meet criteria for mood illnesses.6 Using the concept of diagnostic hierarchy, poor attention is a symptom of depression, mania, and anxiety; thus, the occurrence of inattention while a patient has mood symptoms does not mean the patient has both an attention disorder and a mood disorder. This would be like saying every person with pneumonia also has a fever disorder. It is common to find that someone who thinks they have adult ADHD has another illness, such as a mood or anxiety condition, that causes the symptom of inattention. Another underappreciated consideration is the concept of mood temperament. Unlike the symptoms of major mood disorders, mood temperaments do not come and go; they are present all the time as part of one’s personality. Conditions such as cyclothymia, hyperthymia, and dysthymia involve constant presence of mild manic and/or depressive symptoms. Since these manic and/or depressive symptoms are present all the time, they can produce inattention, poor concentration, and poor executive function all the time. One of us (NG) recently published with colleagues the first study on the topic of misdiagnosis of mood temperament on ADHD.7 We found that 62% of patients who received a diagnosis of adult ADHD actually have an affective temperament, most commonly cyclothymia (42%). In patients treated with amphetamine, mood symptoms predictably worsened. Why Do the Drugs Work? A common claim is that since psychostimulants improve the cognition of individuals diagnosed with adult ADHD, then they must be treating an underlying disorder. But this is faulty logic. Psychostimulants improve cognition for everyone, including normal patients without psychiatric illness. It is because they have this general effect that they are so widely abused; it says nothing about the existence of adult ADHD. Concluding Thoughts The history of psychiatry teaches us that the field has been vulnerable to a host of diagnostic fads. Adult ADHD is the latest of such fads, and a careful review of the scientific literature reveals that the range of ADHD-like symptoms in adults is more accurately explained by other empirically validated psychiatric disorders. This has significant ramifications for therapy, given the wide use of psychostimulants in the treatment of these patients. The opinions expressed are those of the authors and do not necessarily reflect the opinions of Psychiatric Times. Dr Ruffalo is an instructor of psychiatry at the University of Central Florida College of Medicine in Orlando and adjunct instructor of psychiatry at Tufts University School of Medicine in Boston, Massachusetts. Dr Ghaemi is director of the Psychopharmacology Consultation Clinic at Tufts Medical Center and a professor of psychiatry at Tufts University School of Medicine. Related Articles Attention Deficit Hyperactivity Disorder (ADHD) Nonstimulants: A Better Option for ADHD? Paying Attention to ADHD Prescriptions in Your Community Amid Shortages, Federal Agencies Ask Drugmakers to Boost Output of ADHD Meds ADHD Underappreciated in Older Adults

Generics are now approved for adults in the treatment of BED and for individuals aged 6 years and older in the treatment of ADHD. The US Food & Drug Administration (FDA) announced that it has approved several generics for the treatment of attention-deficit/hyperactivity disorder (ADHD) and binge-eating disorder (BED). The first generics of Vyvanse (lisdexamfetamine dimesylate) capsules and chewable tablets are now approved for the treatment of ADHD in patients aged 6 years and older and for the treatment of moderate to severe BED in adults. These approvals follow the FDA’s announcement of the shortage of an immediate-release formulation of amphetamine mixed salts (Adderall) on October 12, 2022. “The shortages of stimulants (largely generics) have been a nightmare to children, families, and their practitioners,” Timothy Wilens, MD, chief of the Division of Child and Adolescent Psychiatry and codirector of the Center for Addiction Medicine at Massachusetts General Hospital, told Psychiatric Times ®. “At a public health level, it is important for policy makers to understand their multifaceted nature and work together to help alleviate such severe, impactful shortages in the future.” With the approval of the lisdexamfetamine dimesylate generic for the treatment of ADHD, more patients with ADHD may have access to treatment. In addition to approving generics, the FDA has announced that it will continue to address the ongoing Adderall shortage by providing assistance to manufacturers, monitoring supply, and sharing updates and other information about the shortage. Related Article: Attention Deficit Hyperactivity Disorder (ADHD) Nonstimulants: A Better Option for ADHD? Stimulant Treatment for Childhood ADHD Not Linked to Adolescent, Young Adult Substance Use

Adults with greater adverse childhood experiences (ACEs) have higher attention deficit hyperactivity disorder (ADHD) symptom reporting than those with fewer ACEs, according to study findings published in the Journal of Attention Disorders . Yet, higher ACEs did not contribute to other psychological symptoms or worse neurocognitive performances. Studies that examine the relationship between objective cognitive performance and ACEs (early life experiences that may influence mental health outcomes) report conflicting results, and few studies have explored the relationship between objective cognitive performance and ACEs among individuals with self-reported ADHD symptoms. Therefore, investigators sought to characterize ADHD symptom reporting, neurocognitive performance, and other psychological symptoms among adults who experienced ACEs. The investigators conducted a cross-sectional study that began with 144 consecutive adults referred to an urban university academic medical center for neurological evaluation. Following the exclusion of 29 participants (primarily for invalid ADHD symptom reporting), a total of 115 individuals were included for analyses. On average, participants were aged 28.42 years (SD, 6.46), completed 16.47 years of education (SD, 1.99), and 65% (n=75) were women. Participants completed the ACE Questionnaire in which they self-reported ACEs, including emotional, physical, and sexual abuse along with neglect, and witnessing violence. Individuals were split into two groups based on these scores: the high ACEs group scored 4 or greater and the low ACEs group scored 3 or less. Participants also completed the Beck Depression Inventory-Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). These measures were self-reports of depressive symptoms, anxiety, and perceived stress, respectively. In addition, all individuals completed a battery of standardized neuropsychological tests. " [O]ur results and the growing body of literature demonstrating links between ADHD and ACEs highlight the need for clinicians to consider ACEs during ADHD diagnostic assessments and treatment planning." Compared with the low ACEs group, the high ACEs group had higher ADHD symptom reporting for childhood impulsive ( F =14.65; P <.001) and inattentive ( F =11.31; P <.001) symptoms, and also reported significantly greater ADHD childhood symptom severity ( F =11.31; P <.001). Similar results were found for the assessments of current/adulthood symptoms, with the high ACEs group reporting significantly higher levels of impulsive ( F =7.24; P <.001) and hyperactive ( F =4.62; P <.05) symptoms, along with greater symptom severity ( F =5.51; P <.05) than the lower ACEs group. However, despite these group differences in self-reported ADHD symptoms, psychological symptom reporting of depression, anxiety, and perceived stress did not differ between the high ACEs group and the low ACEs group. Further, neurocognitive functioning was similar across all tested domains between the groups. These results demonstrate that a heavier burden of ACEs resulted in higher ADHD symptom reporting, but did not impact other psychological symptoms or neurocognitive performance. The investigators concluded, “[O]ur results and the growing body of literature demonstrating links between ADHD and ACEs highlight the need for clinicians to consider ACEs during ADHD diagnostic assessments and treatment planning.” Study limitations include recall bias during childhood data reporting and the inability to investigate causative factors due to the cross-sectional study design. References: Alfonso D, Basurto K, Guilfoyle J, et al. The effect of adverse childhood experiences on ADHD symptom reporting, psychological symptoms, and cognitive performance among adult neuropsychological referrals. Related Topic: Paying Attention to ADHD Prescriptions in Your Community ADHD Underappreciated in Older Adults

How to make your resolutions a reality. Whether it's a New Year's resolution or a resolution for new you anytime of the year, sustained change can be difficult. One study found that 24 percent of people had dropped their resolutions by the time February rolled around, and, by six months, over half of people had given up. Luckily, it is not impossible to change your ways. And the best way to make that change? Drop the perfectionism and be better than perfect. Make Changes Perfectionism, or an all-or-nothing mentality, gets in the way of maintained changes. Perfectionism sounds something like this: “I had one cookie and ruined my diet, so I might as well eat the rest of the plate.” “I don't have time to meditate as long as I want to, so I'm not going do it at all.” “I can't afford a gym membership, so I can't work out.” This all-or-nothing mindset gets in your way of making progress. The antidote to perfectionism, however, is not to give up. Giving up is actually a symptom of perfectionism. Instead, be better than perfect. Being better than perfect means you focus on the change that you want and why you want it. You take steps toward that goal, celebrating each step in the right direction. What's more, you stop judging yourself when you make a mistake. Here are five ways to make sustained change by being better than perfect: 1. Focus on your why. Frequently, when people are making a change, they focus on what they don't like about it. If your resolution is to exercise, you may focus on how much you hate running or going to the gym. The secret, however, is to focus on why you want to make that change. What are the benefits of making this change? Consider psychological, physical, relationship, purpose/work, spirituality . For example, exercise has been shown to be a great way to release stress and decrease depression . That's good for your psychological health. Regarding your physical health, exercise can help you not only lose weight and tone up your body, but also help you fight infection by boosting your immune system. Socially, research shows that people who exercise together are happier together . Regarding your work, exercise can help boost creativity and productivity , which helps you be a better worker. Financially, you can save money by being healthier. And spiritually, because exercise helps reduce stress, it can allow you to focus more on what is important to you – your values – as opposed to being overwhelmed with stress. 2. It's not failure; it's data . People often give up on a resolution or change when they revert back to their old ways. Maybe your resolution is to be more organized, and yet you realize at the end of the week that your desk is just as messy as always. Instead of beating yourself up and proclaiming, “This will never work!” use the situation as data. By data, I mean information that you can learn from to make positive changes. For example, if your desk is a mess, you may want to set a reminder every afternoon for you to take five minutes and clean it up. You can learn from what didn't work to make it work. 3. Take – and celebrate – even small steps . People often bite off huge goals for New Year's resolutions. Perhaps it is to lose a significant amount of weight or to never eat sugar again or to never fight with your partner again. While these are certainly wonderful aspirations, they are significant changes. As I often tell my clients, the way to get to the top of the Empire State building is not in one big step. There are a lot of steps that go into it. For you, celebrate each step in the right direction. And if you revert to old ways, reread number 2, and apply it. Here are some ways to take steps in the right direction without having to have things be “perfect": Don't have time to do 20 minutes of meditation? Take five deep breaths. Hate going to the gym? Try an exercise video on YouTube. Don't have the money to only eat fresh organic vegetables? Choose one or two that you will incorporate into your diet. 4. Schedule it . Sure, it sounds great to have a goal of lessening your stress, but how can you actually do it? The key is to figure out actionable steps and then schedule them. Perhaps you choose to wake up 10 minutes early to meditate. Or maybe you set a reminder midmorning, when you tend to be more stressed , to stop and just take five breaths. You can also use an association method. For example, before I became a psychologist, I was a physical therapist. During my training, one of my clinical instructors pointed out what horrible posture I had. My goal was to have good posture, to sit up straight, but it was hard for me to make that change. So, what I ended up doing was associate every time I looked at my watch with sitting up straight. The more I did that, the more automatic it became, and then my posture got better. 5. Get an accountability partner . Choose someone to whom you will be accountable—whether it's your partner, a friend, or a coach. Sure, you may want to make the change, but when we are accountable to someone else, we are more likely to stick with that new behavior.

If you’re thinking of trying therapy, you might’ve already noticed the surprising amount of types available. Though some approaches work best for specific conditions, others can help with a range of issues. In therapy, you’ll work with a trained mental health professional. What you’ll do in each appointment depends on the preferred methods of your therapist and the issues you’re looking to address. You can expect to spend some time discussing how challenging situations, emotions, and behaviors affect your life. This will likely involve working through some negative events or distressing thoughts. It may be difficult in the moment, but the end result is usually a happier, more fulfilling life. Here’s a look at some common types of therapy and how to choose which one is best for you. Types of Therapy Psychodynamic therapy Psychodynamic therapy developed from psychoanalysis, a long-term approach to mental health treatment. In psychoanalysis, you can expect to talk about anything on your mind to uncover patterns in thoughts or behavior that might be contributing to distress. It’s also common to talk about your childhood and past, along with recurring dreams or fantasies you might have. How it works In psychodynamic therapy, you’ll work with a therapist to explore the connection between your unconscious mind and your actions. This involves examining your emotions, relationships, and thought patterns. Psychodynamic therapy can be a longer-term approach to mental health treatment, compared to cognitive behavioral therapy (CBT) and other types of therapy. Traditional psychoanalysis is an intensive form of treatment that people can go to for years. Research suggests many people continue to improve, even after they complete psychodynamic therapy. Cognitive behavioral therapy Cognitive behavioral therapy is a short-term approach to mental health treatment. It’s similar to behavioral therapy, but it also addresses unhelpful thought patterns or problematic thoughts. The idea behind CBT is that certain feelings or beliefs you have about yourself or situations in your life can lead to distress. This distress may contribute to mental health issues, occur alongside them, or develop as a complication of other mental health issues. How it works In CBT sessions, you’ll work on identifying patterns and learning more about how they might negatively affect you. With your therapist’s guidance, you’ll explore ways to replace negative thought patterns or behaviors with ones that are more helpful and accurate. Like behavioral therapy, CBT doesn’t spend much time addressing past events. Instead, it focuses on addressing existing symptoms and making changes. CBT often involves homework or practice outside the therapy session. For example, you might keep track of negative thoughts or things that trouble you between sessions in a journal. This practice helps to reinforce what you learn in therapy and apply your new skills to everyday situations. There are also some subtypes of CBT, such as: Dialectical behavioral therapy (DBT). DBT uses CBT skills, but it prioritizes acceptance and emotional regulation. You can expect to work on developing skills to cope with distressing or challenging situations. You may also learn how to accept and deal with difficult emotions when they arise. Rational emotive therapy. This approach helps you learn how to challenge irrational beliefs that contribute to emotional distress or other issues. The idea behind rational emotive therapy is that replacing irrational thoughts with more rational ones can improve your well-being. Behavioral therapy Behavioral therapy is a focused, action-oriented approach to mental health treatment. According to behavioral theory, certain behaviors develop from things you learned in your past. Some of these behaviors might affect your life negatively or cause distress. Behavioral therapy can help you change your behavioral responses. How it works In behavioral therapy, you won’t spend much time talking about unconscious reasons for your behavior or working through emotional difficulties. Instead, you’ll focus on ways to change behavioral reactions and patterns that cause distress. There are many subtypes of behavioral therapy, including: Systematic desensitization. Systematic desensitization combines relaxation exercises with gradual exposure to something you fear. This can help you slowly get used to replacing feelings of fear and anxiety with a relaxation response. Aversion therapy. In aversion therapy, you learn to associate the behavior you want to change with something that’s uncomfortable or unpleasant in some way. This association may help you stop the behavior. Flooding. This is similar to systematic desensitization, but it involves facing your fears directly from the start, rather than gradually. If you have a phobia of dogs, for example, the first exposure step might be sitting in a room of friendly, playful dogs. With systematic desensitization, on the other hand, your first exposure step might be looking at pictures of dogs. Source: A Guide to Different Types of Therapy

Dementia is a collective term used to describe neurodegenerative disorders of the brain that affect cognition. It is estimated that over 55 million people around the world have dementia. Alzheimer’s disease is the most common type of dementia (60-80% of cases) and affects 6.7 million Americans . In people with dementia, the impairment in cognition is different from the memory problems associated with normal aging. Dementia can impair their ability to take care of themselves and their daily affairs. Dementia In a person with dementia, the neurons in the regions of the brain that affect cognition progressively get damaged. Dementia is a clinical diagnosis made in individuals with a significant decline from their baseline level of cognitive performance. The decline can occur in one or more cognitive domains, including: Memory, including the ability to remember recent events and conversations. Learning new information and applying it. Ability to sustain attention on complex tasks. Language, including naming, speaking without grammatical errors and with appropriate use of words. Movement-related skills, including hand-eye coordination, body-eye coordination, and visual-auditory skills. Ability to focus attention, plan, organize and coordinate multiple tasks. Ability to perceive, understand, and judge others and one’s social behavior. The severity of the cognitive impairment can be quantified through a neuropsychological assessment or a clinical assessment. For a diagnosis of dementia, a person’s cognitive issues should be severe enough to affect their ability to perform their daily activities independently. This includes their ability to manage their finances and medications, dress appropriately, and maintain hygiene. The cognitive impairment should not be the result of another psychiatric disorder like depression or schizophrenia, or medical conditions like delirium (a temporary state of confusion occurring over a short time due to underlying medical conditions, medications, substances, or toxins). There are different types and causes of dementia. The most common types of dementia are: Alzheimer’s disease : the most common type of dementia. Alzheimer’s disease usually begins with lapses in memory for recent events, conversations, names, or faces. Vascular dementia: the second most common type of dementia. This type of dementia is caused by strokes or mini-strokes (also known as transient ischemic attacks). Each stroke or mini-stroke can cause problems in the blood supply of the brain. Individuals with vascular dementia have a progressive decline in cognition with each stroke or mini-stroke. The symptoms depend on the area of the brain being affected. Dementia with Lewy bodies : in individuals who have dementia with Lewy bodies, the main symptoms include hallucinations; sleep disturbances like nightmares; appearing sleepy or tired; and trouble with movements or balance like falls, tremors, slow movements, and difficulties in walking. Problems with memory usually occur later in the progression of the disease compared to Alzheimer's disease. Frontotemporal dementia: in frontotemporal dementia, individuals can experience personality changes (such as lack of interest or emotions, impulsive anger) and difficulties in organizing and planning daily activities like going to work and paying bills. They can also struggle with language, like difficulty naming things, making grammatical errors, using inappropriate words, and maintaining fluency of speech. Problems with memory usually occur later in the progression of the disease compared to Alzheimer's disease. Individuals can have dementia caused by more than one factor. This is called mixed dementia. Dementia can also be caused by other medical conditions, including traumatic brain injury, use of alcohol and other substances, HIV infection, Parkinson’s disease, and Huntington’s disease. In the initial stages of dementia, individuals may be able to work, drive, cook, and participate in their other daily activities with the help of friends and family. The progression of dementia and the abilities affected varies among individuals. As the disease progresses, they become increasingly dependent on their friends and family members to take care of their daily needs, like paying bills, buying groceries, and personal care, including bathing and dressing. They can also experience changes in mood, anxiety, paranoia, hallucinations, agitation, inappropriate sexual behaviors, and sleep disturbances. Individuals may wander from home and get lost or make mistakes while driving or cooking. This can cause significant concern for their safety. As the disease progresses to other parts of the brain, individuals with dementia can have problems with balance, falls, and swallowing. They may also eventually become bed-bound, requiring around-the-clock care. Treatment Currently, there is no treatment that can reverse the disease process of dementia. The U.S. Food and Drug Administration (FDA) has approved medications to slow down the progression of Alzheimer’s disease (but not other types of dementia). Some of these medications belong to the class of medications called cholinesterase inhibitors, which are prescribed for mild to moderate Alzheimer’s disease [Aricept® (donepezil), Exelon® (rivastigmine) and Razadyne® (galantamine)]. One medication, Namenda® (memantine), has been approved by the U.S. FDA for treating moderate to severe Alzheimer's disease. In 2021, Aduhelm® (aducanumab) was approved by the U.S. FDA for treating Alzheimer's disease. Several new medications are also being studied to target various processes related to dementia with the goal of one day developing medications that can stop or slow down the cognitive decline of dementia. Maintaining a healthy lifestyle can help prevent dementia from getting worse. Healthy lifestyle choices can include eating a balanced diet; being physically, socially, and mentally active; stopping smoking; cutting down alcohol consumption; getting regular health check-ups; and getting treatment for heart disease, hypertension, and diabetes. Individuals with dementia can also have related conditions like depression, anxiety, agitation, and psychosis. Primary care providers or mental health providers can help manage these conditions with psychiatric medications, non-pharmacological interventions (such as addressing the cause of distress in the patient), or making lifestyle changes (like maintaining an appropriate sleep-wake cycle). Behavioral therapists who have specialized in the care of dementia can use therapies like reminiscence therapy, validation therapy, reality orientation, and cognitive stimulation therapy to alleviate distress and related behaviors, provide comfort, and avoid boredom or loneliness. Individuals with dementia may have difficulty identifying or explaining their needs. Recognizing and addressing their needs (e.g., pain, hunger, constipation, infections, skin rash, ingrowing nails, full bladder, and appropriate room temperature) can help an individual become comfortable and decrease the risk of behavioral problems. A calm and non-stimulating environment can be helpful, especially for sleeping at night. When the individual is anxious or agitated, redirecting their attention can be helpful. Instructions should be provided in a simple manner and broken down at each step as individuals might have difficulty comprehending complex instructions. It is best to avoid being argumentative or confrontational with individuals with dementia, as they might not remember or understand the issues. As the disease progresses in severity, the medications used to treat dementia or related behavior problems can become less effective. After discussing the risks versus benefits of the medications with the treating clinician, they can be discontinued to reduce the burden of taking inappropriate and unnecessary medications. Caregiver Stress Caring for individuals with dementia can be very stressful for family and friends, especially as the severity of dementia progresses and caregivers spend more effort and time caring for the individuals. Caregivers can struggle with accepting the severity of dementia or become angry and frustrated. As caregiving takes more time and energy, the caregiver can become socially isolated and lonely. They may experience anxiety, depression, and sleeplessness as they worry about the care of the individual with dementia and their future. The chronic stress of caregiving can also have a toll on the physical health of caregivers. It’s important for caregivers to take care of themselves and to seek help when needed. If possible, caregivers should find time in the day for themselves to pursue activities that they enjoy, relax, and exercise. They should ask for help from family and friends to take turns in caring for the individual with dementia. Respite care or adult day care centers can also be considered (see the U.S. Administration on Aging’s Eldercare Locator ). Caregivers should also try to not take problematic behaviors of individuals with dementia personally, as they are symptoms of the disease. Caregivers should consider psychotherapy/counseling or see their mental health provider if they feel anxious or depressed about caring for their loved ones. Attending caregiver support groups for individuals with dementia can also be helpful. Information about caregiver support groups and other caregiver resources can be obtained from local chapters of the Alzheimer’s Association. If the care for the individual with dementia is beyond the caregiver’s capabilities, long-term care facilities like assisted living facilities or memory care centers should be considered as they have nursing staff skilled in the care of individuals with dementia. Source: Alzheimer's Association

Key Takeaways CBT's cultural adaptations help Black clients manage racism's psychological impacts, such as internalized racism and negative core beliefs. Clinicians should engage in race discussions, using CBT strategies to address discomfort and enhance therapeutic relationships. Expanding treatment to include racial empowerment and pride mitigates racism's effects and fosters psychological well-being. THE BECK INSTITUTE CLINICAL CONVERSATIONS When my father, Aaron T. Beck, MD, developed cognitive behavior therapy (CBT) in the 1960s and 1970s, most research in the social sciences was being conducted on college students—who were overwhelmingly male, middle- to upper-class, and of European descent. Since then, it has been rightly observed that much additional work was needed to adapt CBT not only for a range of psychiatric disorders and psychological problems, but for a range of populations including individuals from diverse cultures, backgrounds, and racial identities. Over the last 6 decades, much work has been done to make CBT more widely applicable—and Janeé M. Steele, PhD, has contributed significantly to the literature with her book Racism and African American Mental Health: Using Cognitive Behavior Therapy to Empower Healing. I recently sat down with Dr Steele to learn more about how clinicians from all backgrounds can not only address issues of race in session, but empower Black clients with a sense of personal pride in their identities. Judith S. Beck, PhD: Research shows that Black Americans who have been exposed to racism often experience depression, anxiety, trauma, and low self-esteem. How is CBT particularly well-suited to empowering Black Americans to overcome these challenges? Janeé M. Steele, PhD: A growing body of research documents the effectiveness of CBT for racially diverse populations, including Black Americans. Yet CBT has historically been viewed as somewhat limited in its applicability to people of color. For example, one limitation of traditional CBT when working with Black clients who have experienced racism may be inadequate attention to oppressive systems and other societal influences that contribute to the client’s problems. This is limiting because without attention to these influences, clients may feel as though they are being blamed for their problems, leading to negative outcomes including worsened symptoms, dissatisfaction with therapy, or early termination. However, with appropriate cultural adaptations, CBT may significantly benefit clients who are dealing with the psychological impact of racism by helping them see the ways they are internalizing negative messages they receive about their racial identity and teaching them strategies to manage this and other harmful effects of racism such as depression, anxiety, and trauma. In my recent book, Racism and African American Mental Health: Using Cognitive Behavior Therapy to Empower Healing, I describe a case that illustrates this point. Michelle was a 37-year-old Black woman with performance anxiety. As the only person of color at her job, she worried excessively, and often experienced worsened task performance while being observed by her supervisor and coworkers. Early in therapy, I was intentional in asking questions about the impact of race on her situation and she confirmed that some of her concerns were about being falsely labeled by negative racial stereotypes. In response, I approached CBT with the goal of being sensitive to Michelle’s lived experience as a racial being. I enhanced psychoeducation to include information about culture-specific factors of anxiety such as stereotype threat, which refers to worsened performance due to the fear of negative stereotypes about one’s social group. I was careful to avoid questioning that would imply Michelle’s concerns about being the only person of color at work were irrational or distorted. I also helped Michelle modify the negative self-appraisals she developed in response to her situation, and she learned how to engage in feared situations while affirming her racial identity and attributing her anxiety to stereotype threat rather than personal deficits. As shown in the case of Michelle, with appropriate cultural sensitivity, CBT may offer clients insights into specific ways racism contributes to their problems. It may also help them gain new strategies to cope with or even challenge racism and its psychological effects. Beyond this, other aspects of CBT make this form of therapy especially useful in addressing the psychological distress, sense of powerlessness, and internalized anti-Black attitudes that may occur as a result of racism. These include CBT’s emphasis on personal empowerment, its attention to client strengths and support systems, and affirmation of one’s own sense of identity. The active, problem-focused, and time sensitive nature of CBT also furthers its usefulness. Beck: What are some of the ways that providers need to adapt CBT to help Black clients address negative core beliefs that have resulted from experiences of discrimination or racism? Steele: One manifestation of racial oppression I frequently encounter during therapy is internalized racism. Internalized racism refers to self-hatred that develops because of one’s conscious or unconscious belief in the inferiority of their racial group. From a CBT perspective, this equates to hurtful and stigmatizing core beliefs in which individuals devalue themselves or other members of their race. In Racism and African American Mental Health, I highlight several themes I have seen reflected in core beliefs associated with internalized racism. These themes include inferiority, inadequacy, personal blame, powerlessness, and belief in a just world. Following a longitudinal conceptualization of cognitions, these core beliefs often result in maladaptive rules for living and are frequently associated with avoidance or numbing coping strategies to compensate for the perceived deficits reflected in each core belief. Let’s return to the case of Michelle once more to illustrate what negative race-related core beliefs might look like in a client experiencing internalized racism and how a clinician might address these beliefs using CBT. Recall that Michelle experienced performance anxiety on her job due to fears of confirming negative racial stereotypes about Black individuals. Recognizing the need to deconstruct the role of race in her thinking, I used Socratic questioning to learn more about the negative racial stereotypes to which she had been exposed and her reactions to these stereotypes. Some examples of the questions I asked included, “What are the stereotypes associated with being Black?” and “How do these stereotypes affect the way you see yourself and people in your racial group?” I then continued this dialogue asking questions such as, “How did you learn these stereotypes?” and “Where did these stereotypes come from?” to learn more about salient life and cultural experiences that brought these stereotypes into her awareness. Michelle shared that she was primarily concerned about being viewed negatively because of stereotypes that Black individuals are lazy and unintelligent. She reported learning about these stereotypes mostly through her elementary school experience, where she and other Black children were isolated and subjected to insensitive comments. Michelle added that Black individuals are also frequently portrayed according to these stereotypes on TV and in the media. Upon learning about the significance of Michelle’s elementary school experiences, we examined one specific situation from this time in her life, and I used a traditional CBT intervention, the downward arrow technique, to uncover one of her negative race-related core beliefs: “Black people don’t fit in.” We then worked on modifying this belief to reflect something that would be more functional. Acknowledging that Black individuals who live in their authentic selves often do not fit into dominant cultural standards, I was careful to approach this task in a way that honored her experiential reality. This meant that I did not ask Michelle to examine the evidence for and against her core belief, as this might have invalidated her experience and potentially led to a cultural rupture in the therapeutic relationship. Instead, Michelle and I focused on developing a new core belief that was as absolute as the old belief and would allow her to feel confident despite demeaning messages received from society. She eventually arrived at the new core belief, “Black people are valuable,” which she strengthened using strategies such as a positive data log and a historical review of experiences leading to the old belief. Beck: Some providers may feel hesitant to discuss racial issues in session, especially if they have not personally experienced racism. How can providers of European descent approach issues of race and racism with Black clients? Steele: New directions in psychology suggest that in addition to cultural humility, taking opportunities to discuss racial issues in a therapeutic setting that feels safe to the client is a critical feature of a multicultural orientation in therapy.3 Unfortunately, many clinicians, especially providers of European descent, may experience challenges while discussing issues of race and racism. One major challenge is discomfort due to feelings of apathy, guilt, and vulnerability that arise while discussing race. Another challenge is fear of offending clients when initiating these discussions, especially if one has been socialized to believe that discussions about race are rude or embarrassing. Use of CBT strategies during supervision, consultation, or through one’s own reflective practice can help clinicians become more comfortable approaching issues of race and racism with Black clients. For example, applying the cognitive model can help clinicians target the central thoughts interfering with their ability to initiate discussions about race, ethnicity, and culture. This may be done by asking oneself questions such as, “What is going through my mind, what am I thinking?” “What is upsetting about this thought?” and “What emotions do I feel?” Clinicians may also use a strategy such as the sideways arrow technique4 to explore their thoughts at a deeper level, asking questions such as “What am I worried will happen?” “If that were to happen, what am I concerned would happen?” and “If that were to happen, what is so bad about that?” A clinician working with Michelle, for example, might be worried about broaching race and saying something upsetting. The clinician might then think that this, in turn, could produce a rupture in therapeutic relationship that would cause Michelle to have negative feelings, limit her disclosure, or in a worse-case scenario, lead to premature termination. The clinician might worry that this, in turn, would cause negative feelings like embarrassment or guilt. Once the clinician has identified thoughts that interfere with approaching issues of race and racism with Black clients, they can work with them using CBT strategies such as advantage/disadvantage analysis to explore the advantages and disadvantages of holding onto vs changing their beliefs about discussing race. They could also use decatastrophizing questions such as “What’s the worst that could happen?” and “What could you do then?” or questions to gain distance such as “What would you tell another clinician in this situation?” to address these beliefs. There are also strategies clinicians can use to more skillfully approach the actual task of addressing race during therapy. For example, clinicians can use a tool such as the Cultural Formulation Interview5 during the intake process to learn more about how the client believes race influences their problems and ways of coping. To facilitate safety in the relationship, clinicians can also verbalize cultural differences and power differentials within the therapeutic relationship and acknowledge limitations in understanding due to their cultural worldview. Beck: What are some important considerations in developing a strong therapeutic relationship with Black clients? Steele: When working with Black clients, the clinician’s ability to build strong therapeutic relationships is critical to the process of change—given stigma contributing to the underutilization of mental health services in the Black community, the sensitive nature of race and racism, and the amount of vulnerability required to discuss these topics. Because of the historical legacy of racism in formalized systems of help, some Black individuals are reluctant to attend therapy. Moreover, due to spiritual beliefs which interpret the use of therapy as a lack of faith in God and familial strictures against the public airing of one’s dirty laundry, personal fortitude and reliance on prayer or the church when external help is needed may be preferred methods of coping compared with professional help-seeking. Therefore, at a minimum, clinicians should use basic counseling techniques throughout therapy to develop a bond that is perceived as secure, warm, and friendly to establish safety in the therapeutic relationship. This includes use of encouragers such as head nods and facial gestures, as well as skills such as empathy, probes, reflection of feeling, and open-ended questions. Clinicians should also be proactive in addressing race during therapy, as failure to do so may be viewed as a racial microaggression. In addition to use of the counseling techniques, clinicians working with Black clients on issues related to racism should also be intentional in their use of validation. Validation refers to the clinician’s ability to communicate that they understand the client’s reactions and that these reactions make sense given their life context or current situation. Within society, denial of racism is one of the ways anti-Black attitudes and discriminatory practices are covertly promoted and upheld. Denial also adds to the psychological distress Black individuals experience as a result of negative race-based encounters, contributing to confusion about what occurred, and later on, shame for not standing up for oneself. Accordingly, taking the time to validate Black clients’ perceptions of these events can be cathartic because it confirms that their experiences are real and that their reactions are reasonable. In the case of Michelle, for example, I sought to validate her experience by acknowledging that we live in a society where racist events occur, with a statement such as “It makes sense that you would experience anxiety as a result of these stereotypes; they are common and they are unfair,” and recognizing the difficult emotions that arise in the face of her experiences with another statement such as, “Thank you for trusting me enough to share something so painful.” Beck: What is the importance of expanding the focus of treatment beyond symptom reduction to cultivate racial empowerment and a sense of pride in one’s racial identity, and how can providers create opportunities for clients to strengthen positive beliefs related to race? Steele: Empowerment and pride in one’s racial identity are essential components of healing from the effects of racism. Empowerment, which broadly consists of critical consciousness and committed social action, helps individuals view their experiences as part of a collective struggle, which in turn, promotes a greater sense of connectedness to the community, resistance, and agency. Similarly, racial pride, which refers to a sense of self-confidence derived from admiration of the history, strengths, and accomplishments of Black individuals, serves as a protective factor against the effects of racism, contributing to less race-based stress and greater overall psychological well-being. Accordingly, expanding the focus of treatment to include the cultivation of racial empowerment and pride in one’s racial identity actually aids the reduction of symptoms by mitigating the sense of powerlessness clients feel in response to racism and lessening the internalization of demeaning, anti-Black messages they receive from society. In Racism and African American Mental Health, I describe several interventions clinicians may use to increase critical consciousness, encourage social action, and facilitate racial pride. Bibliotherapy using the structured approach developed by Hynes and Hynes-Berry,6 for example, is one strategy clinicians may use to help clients expand insight into their experiences with racism by providing opportunities to explore what was learned from passages within the book and the personal feelings that arise. With guided discovery, CBT clinicians can also use this exploration to uncover maladaptive beliefs that can be modified using information learned from the book to influence future beliefs, attitudes, actions, and ways of being. Some of the questions I provide in Racism and African American Mental Health to guide this process include, “Which passages helped you gain a deeper understanding of yourself and/or the world around you?” “When have you experienced situations similar to the situation connected to the passage you identified?” “What beliefs or ideas are challenged by the passage you identified?” and “How do these insights change how you see yourself/the world around you?” Beck: Thank you so much Dr Steele for your time and for your tireless work in advancing and advocating for culturally adapted CBT with Black clients. There is no doubt that your work will benefit many! Dr Beck is president of Beck Institute for Cognitive Behavior Therapy in Bala Cynwyd, Pennsylvania, and a clinical professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia. Dr Steele is a licensed professional counselor and certified CBT therapist, as well as a member of the core faculty at Walden University. She is also the co-author of the book, Black Lives Are Beautiful: 50 Tools to Heal From Trauma and Promote Positive Racial Identity, and author of the book, Racism and African American Mental Health: Using Cognitive Behavior Therapy to Empower Healing. Note: This article originally appeared on Psychiatric Times .

Sleep disturbances predict increased risk for suicidal symptoms, study finds FROM PSYCHIATRY RESEARCH Several features of sleep disturbance , including nightmares, sleep onset latency, and sleep quality, were associated with a significantly increased risk of suicidal ideation (SI) , based on data from 102 individuals. Suicide remains the second leading cause of death in young adults, but factors that may predict increased suicide risk have not been characterized, wrote Rebecca C. Cox, PhD , of the University of Colorado Boulder, and colleagues. “Sleep disturbance is a promising modifiable risk factor for acute changes in suicide risk,” they noted. “Previous research has found multiple aspects of sleep disturbance are linked to elevated SI, including insomnia symptoms, both short and long sleep duration, nocturnal wakefulness, and nightmares.” However, data on the impact of nightly sleep disturbance on suicide risk are limited, the researchers said. They hypothesized that use of ecological momentary assessment (EMA) to assess daily variability in sleep might offer more insight into the relationship between various components of sleep disturbance and changes in suicide risk. In a study published in Psychiatry Research , the investigators recruited 102 young adults aged 18-35 years who had a history of suicidal behavior; 74.5% were female, 64.7% were White. Participants completed seven semi-random surveys per day for between wake and sleep schedules over 21 days. Each survey asked participants to report on whether they had experienced suicidal ideation (SI) since the last survey. The researchers examined within-person and between-person sleep variables including bedtime, sleep onset latency, sleep onset, number of awakenings, wake after sleep onset, sleep duration, sleep timing, sleep quality, and nightmares. Overall, nightmares had a significant, positive effect on passive SI at both within- and between-person levels, but no significant effect on active SI. Sleep latency showed a significant, positive effect on passive and active SI at the between-person level, meaning that “participants who took longer to fall asleep on average were more likely to experience passive and active SI during the sampling period,” the researchers noted. In addition, days following nights of more time awake between sleep onset and offset were days with increased likelihood of passive and active SI . Similarly, days following nights of worse sleep quality than normally reported for an individual were days with increased likelihood of passive and active SI. Sleep timing and duration had no significant effects on SI at the within- or between-person level. “Notably, tests of reverse models found no relation between daily passive or active SI and any component of the subsequent night’s sleep, suggesting a unidirectional relation between sleep disturbance and subsequent SI,” the researchers wrote in their discussion. If future research replicates the study findings, the results could support the inclusion of sleep difficulties on standard risk assessments as a way to identify risk for SI and initiate prevention approaches, they said. The findings were limited by several factors including the potential for unmeasured variables impacting the associations between sleep and SI , the researchers noted. Other limitations included the lack of data on more severe levels of SI such as planning and intent, and on suicidal behaviors such as preparatory behaviors, aborted attempts, and actual attempts. The findings also may not generalize to other age groups such as children, adolescents, or older adults, they said. More research is needed to determine which sleep disturbance components are acute risk factors for which suicide-related outcomes, the researchers said. However, the study is the first to provide evidence for daily sleep disturbances as a near-term predictor of SI in young adults, they concluded. The study was supported in part by the National Institutes of Health. The researchers had no financial conflicts to disclose.

What is dialectical behavior therapy (DBT)? Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely. Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors. “Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors. Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist. What is dialectical behavior therapy (DBT) used for? Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions. DBT has proven to be effective for treating and managing a wide range of mental health conditions, including: Borderline personality disorder (BPD). Self-harm. Suicidal behavior. Post-traumatic stress disorder (PTSD). Substance use disorder. Eating disorders, specifically binge eating disorder and bulimia. Depression. Anxiety. It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope. DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include: Mindfulness : This is the practice of being fully aware and focused in the present instead of worrying about the past or future. Distress tolerance : This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors. Interpersonal effectiveness : This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others. Emotion regulation : This means understanding, being more aware of and having more control over your emotions. Source: Cleveland Clinic