Natalie Jacewicz, Author at �鶹Ů�� Health News

Social Media Is Harming The Minds Of Our Youth, Right? Maybe Not.

Natalie Jacewicz — Wed, 11 Oct 2017 09:05:49 +0000

It was 1:30 a.m., and Anna was trying to keep her mind off her ex-boyfriend, with whom she had ended a painful relationship hours earlier. It was too late to call the therapist she was seeing to cope with low self-esteem and homesickness, and too late to stop by a friend’s house.

So, she turned to social media. “I’m having a really hard time right now,” Anna — who asked to be identified by a pseudonym — posted on Facebook. “Is there anyone I can call and talk to until I feel better?”

Almost immediately, three people responded with offers to talk. They were friends she had met playing Quidditch, a sport based on the Harry Potter fantasy books, and she kept in touch with them online. Anna talked to two of them until she was able to fall sleep.

“I used to be very shy about posting personal stuff on Facebook because I didn’t want people judging me,” said Anna, 26. “But that night, I was in such a bad place; I was desperate, and I thought anything would help.”

The negative effects of social media on young people’s mental health are well-documented by researchers and the press. Social media and depression, and .

But some academics and therapists are proposing a counterintuitive view: They have found that social media may also help improve mental health by and providing a source of . These benefits have attracted too little attention from journalists and parents, they say.

“Yes, social media is contributing to a new era of adolescent (and adult) social stress, but when we accept that it is here to stay, we can also see it as a new opportunity for connection and mindfulness,” according to an online advice column published by the University of California-Berkeley’s Greater Good Science Center.

“We need to think about social media as not being absolutely good or bad,” said , an assistant professor who studies social media and health at Indiana University’s Media School. “We need to think about how to come up with appropriate uses of this stuff.”

Social media have become integral to the lives of young adults and teens: say they use apps such as Facebook, Twitter and Instagram every day.

In research published by the National Center for Biotechnology Information, Gonzales found that college students who viewed their own Facebook .

By curating their online personas to reflect their best traits — choosing flattering pictures and sharing exciting experiences — users remember what they like best about themselves.

“It’s like the way you might feel good about yourself when you check yourself out in the mirror before a date,” Gonzales explained.

Other reveal that people feel more social support when they present themselves honestly on social media, and tend to feel less stressed after they do so.

“You get much broader affirmation by posting on social media than from calling a relative,” Anna said. “It’s one thing if you text a friend; it’s another thing if you have a bunch of people trying to help you out.”

, an assistant professor of adolescent psychiatry at Mount Sinai Hospital in New York City and a practicing therapist, said many of his patients find social connections online they could not find elsewhere. This is particularly true of marginalized teens, such as kids in foster homes and LGBT adolescents.

“I’ve seen some of the really big positives, which is that kids who are isolated can find a community,” Oransky said. “They’re often first able to come out to online friends.” In a 2013 survey, 50 percent of LGBT youth having at least one close friend they knew only from online interactions.

Young adults with serious mental illness such as schizophrenia and bipolar disorder can also via social media, according to a study published in 2016. “These people are openly discussing their illness online,” said , a research fellow at the Dartmouth Institute for Health Policy and Clinical Practice.

Social media postings can help of mental health problems. “It’s definitely real that there’s hostility online,” Naslund said. “But we’ve found that comments related to mental health are overwhelmingly positive. People can learn how to cope with symptoms and how to find the right support.”

But parents can and should help their children use social media wisely, experts say. Oransky suggests, for instance, that parents talk with kids about the privacy consequences of posting compromising material, such as revealing pictures or personal details that might affect their job prospects. Naslund recommends that people start cautiously on social media by using pseudonyms.

Anna uses filters to keep co-workers from seeing her mental health posts. But she views social media as a way to act on her therapist’s recommendation to reach out for support when she needs it. “If you trust your friends,” she said, “I don’t see why you shouldn’t embrace the social media option.”

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Writing Your Way Through Cancer

Natalie Jacewicz — Fri, 25 Aug 2017 09:05:15 +0000

Earth, wind, sky, clouds, rocks
Have me,
If you will.
This body — no longer young
Not quite old.
From the Earth we come, (capital E)
To the Earth we’ll return.

When Lynn Scozzari wrote the beginning lines of that poem, “The Offering,” in 2013, she was staring at a photo of a naked woman seated on a rock, her arms thrust open to a valley below. Scozzari herself was in a conference room of the cancer center at Scripps Green Hospital in La Jolla, Calif., seated at a table stocked with coffee and tissues.

The year before, Scozzari had finished treatment for stage 4 breast cancer. Now, she was meeting with other patients and survivors who were also writing about their cancer experiences. Their assignment was to pick a black-and-white photo from a collection of images spread out on the table and write about it.

“I remember I was very guarded because I had felt extremely vulnerable during my treatment,” said Scozzari, describing how she felt when she joined the writing group. “The whole experience of being shuffled from doctor to doctor and poked and prodded … left me self-conscious and very protective.”

But she quickly relaxed — and then she found her inspiration. She still keeps an electronic copy of the poem she wrote that day. “The photo spoke to me, and I was able to express something inside of me,” she said. “The group helped me open up.”

Scozzari credits the group’s organizer, Sharon Bray, for that. Bray, a woman in her early 70s with a soft, gray bob and glasses, has led cancer patients and survivors in “expressive writing” workshops for more than 15 years. She has founded writing programs at three health care facilities in California.

She shares with her students a passion for writing, as well as that more harrowing kinship: In 2000, she learned she had a preliminary, noninvasive form of breast cancer known as , in which abnormal cells appear in the breast milk ducts.

After writing throughout her radiation therapy, Bray now helps others write through their illnesses by leading workshops, authoring a and maintaining a .

During her time in radiation, “I was asking big questions like ‘Where do I want my life to go next?’” Bray said. “And I think that in the cancer groups that I lead, people are also asking, ‘What will my life be about if I survive this?’ and ‘What will my life be about if I don’t survive this?’”

The National Association of Insurance Commissioners approved guidelines for which insurance company expenses can be counted as medical costs under the new health law. The recommendations now go to HHS.

Bray believes writing can help people cope with these difficult questions.

Expressive writing is about emotional disclosure, said Dr. Adrienne Hampton, an assistant professor of family medicine and community health at the University of Wisconsin. “It can be trauma-focused, or it can be aspiration-focused,” Hampton said. “Really, the key is just that it involves either conscious or subconscious emotional processing around a given topic.”

Expressive writing gained the attention of psychologists and medical doctors in the 1990s, when psychology professor wrote a series of articles about the value of disclosure and writing in the healing process. Since then, multiple studies have on people who are combating illnesses.

In a of 107 patients with asthma or rheumatoid arthritis, participants were asked to write either about the most stressful event of their lives or their day-to-day experiences. The group that wrote about a traumatic experience had less severe symptoms four months later.

Researchers have found writing can reduce symptoms of , speed and improve the chances of after being laid off.

After her breast cancer diagnosis, Bray began reading about the work of Pennebaker. “All the light bulbs went off,” she said, “and I thought, ‘This is my work.’ It was like a calling.” She began by leading programs pro bono in 2001 at a Palo Alto nonprofit now known as .

In 2004, she founded a writing program at , and has since launched programs at Scripps Green and at the University of California-San Diego’s Moores Cancer Center. She has also published two books about writing and cancer.

Cancer was not the first challenge Bray tackled with writing therapy. In 1968, she left her native California for Canada to protest the Vietnam War and accompany her husband, Larry, during his doctoral studies. He drowned while swimming one night about 13 years later, leaving Bray alone with their two young daughters. She began seeing a therapist and, as a result of her sessions, started writing poetry about her marriage and her husband’s death.

It helped that her therapist looked like Robert Redford, Bray mused. But she especially appreciated a ritual they developed, in which she would write a poem and read it aloud at the beginning of a session, after which the therapist would say “thank you.”

Bray found that simple response unobtrusive and affirming. She would later adopt it in her own workshops.

In 1989, eight years after Larry’s death, Bray remarried and moved back to California with her new husband — also a native Californian.

Writing seems like a natural fit for Bray, who has some of an essayist’s peculiarities. She begins an interview by warning that she may “wax eloquent ad infinitum” about her work, and she responds to bullet-pointed emails with long, narrative paragraphs in a fanciful Candara font.

But it took a while for Bray to become a full-time writer. She went through a string of occupations first: elementary school teacher, doctoral student in applied educational psychology and employee at an international career transition firm.

Most of Bray’s workshops have 10 to 12 participants, run from two to three hours per session and last for 10 weeks. Participants learn about the groups in different ways, including online searches, physician referrals and fliers Bray puts up around the hospital.

People undergoing any kind of cancer treatment are welcome to attend, as are survivors up to five years out of treatment. The only people Bray discourages from participating are the newly diagnosed, because they are usually too overwhelmed with the immediate decisions confronting them to focus on a writing group.

Bray starts each meeting with a short, guided meditation and a quick warmup writing exercise. Then, the participants engage in a longer writing session based on a prompt. Afterward, Bray invites volunteers to read aloud what they’ve written and picks out one thing she especially likes about each person’s work. Then she says “thank you.”

Bray uses a wide variety of prompts: childhood memories, what you want most in a doctor, how you would approach cancer if it were a country. For the first class, the prompt is always the same: Write about the moment you learned you had cancer.

Tom Friedman, a licensed clinical social worker at Scripps who worked with Bray, said participants often told him how much they loved her program.

“It’s not just a support group; she has a real curriculum that she’s developed,” Friedman said. “It requires a high degree of sensitivity and professionalism.”

Sometimes workshop participants write essays, and sometimes they turn to verse. “I’ve had some of the most extraordinary poetry from people who are dying,” said Bray. “When they read aloud, it brings the entire group to tears.”

Some participants publish their . One of them, Ann Emerson, was in The American Poetry Review a few weeks before she died.

Bray’s sessions often enhance the physical and emotional well-being of the participants. Cathy, a patient with breast and bladder cancer who asked to go by a pseudonym to protect her medical privacy, said she slept better on nights after the writing sessions. Scozzari said she felt more comfortable opening up to people about her cancer than she had throughout her treatment.

Cathy and Scozzari say the members of their respective groups have stayed in touch.

This summer, Bray moved from California back to Canada to be close to family. Friedman said Scripps Green has been unable to find a suitable substitute to lead its writing program.

Bray hopes to start a similar program in Toronto, helping new groups of patients and survivors explore their feelings about the most challenging — and in some cases, the last — chapter of their lives.

Ann Emerson, in the opening lines of one of her poems, summed up the grim yet hopeful perspective of many cancer patients:

I stand at the window where
the world ends, barely breathing,
reciting a poem to myself:
I believe in this ordinary day,
a day I can still make it outdoors alive.

This story was produced by , which publishes , an editorially independent service of the .

KHN’s coverage of end-of-life and serious illness issues is supported by .

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Teaching Future Doctors About Addiction

Natalie Jacewicz — Tue, 02 Aug 2016 09:00:16 +0000

Jonathan Goodman can recall most of the lectures he’s attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.

But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.

“I wasn’t tested on it,” Goodman said, with a note of surprise.

Americans are overdosing at epidemic rates on opioids such as heroin and prescribed painkillers, and the nation’s doctors are inadequately prepared to help, according to some public health experts. They say the shortfall begins in medical school.

A in 2012 by the National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed , quadrupling from 1999 to 2014.

Schools have been so slow to change that some medical students, like the ones at Harvard University, have started conducting their own training on how to buy and administer drugs that reverse the effects of an overdose, according to Kelly Thibert, the national president of the American Medical Student Association. The to educate themselves about these medications because it was not part of the school’s curriculum.

Now, Stanford’s medical school may offer an example of what faculty-driven change can look like.

The school began retooling its curriculum after the director of its addiction medicine fellowship, Dr. Anna Lembke, expressed concern about its meager offerings in that field.

Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit, relevant to future doctors in any subspecialty, Lembke said. And that training will continue when the students leave the classrooms for clinical rotations.

“We’re at the very bottom of a very long uphill road,” said Lembke, who gave the lecture Goodman missed.

Medical faculties have traditionally eschewed teaching about addiction, in part because many physicians viewed the subject as a personal vice, not a disease. Some consider it difficult – sometimes impossible – to treat in a medical setting.

“Clearly, if you’ve got an addiction, you’ve been making a lot of bad choices,” said Dr. Joe Gerstein, a retired clinical assistant professor at Harvard Medical School and founding president of SMART Recovery, which emphasizes positive thinking to help people beat addiction. “I’ve spent 30 years in the medical community,” Gerstein said, “and I don’t know of any disease where you can get up in the morning and say, ‘That’s it.’”

Those who advocate medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addiction in their practices. In March, the American Board of Medical Specialties addiction medicine as a subspecialty.

The onus now is on medical schools to change, said Dr. Kelly Pfeifer, director of high-value care at the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)

In a March , the foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.

But many medical schools resist outside direction with regard to their curriculum. Pfeifer noted that more than 60 medical schools signed a , issued in February by the Obama Administration, promising to teach their students about responsible opioid prescription. However, several prestigious medical schools, including Harvard and Stanford, did not sign the pledge.

“I think that people don’t like to be told what to do,” Pfeifer said. Opting out of such pledges, she added, lets their curriculum fall through the cracks. “If there’s no accountability, nobody on the outside can say, ‘you promised to do this.’”

Stanford and Harvard signed an alternative, nonbinding statement issued by the Association of American Medical Colleges that acknowledges the role of medical schools in treating the epidemic. As recently as April, however, Lembke had been unaware of concrete plans to change Stanford’s curriculum.

But in late spring, she met with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is drawing up plans to expand the teaching of addiction medicine from the lone lecture she gives on opioids each year to a series of lectures.

She said she will recommend that doctors suggest alternate treatments, such as acupuncture or massage, before prescribing opioids.

Lembke is also seeking approval from the Accreditation Council of Graduate Medical Education to accept medical residents — doctors getting specialized training — into her addiction medicine fellowship. Before addiction medicine became an official subspecialty, fellowship programs devoted to it could not be ACGME accredited and could not apply for the additional funding available to accredited programs.

Lembke’s colleague Jordan Newmark, who directs education in Stanford’s pain division, is seeking to increase opioid training for medical students in their third and fourth years. He plans to ask actors to portray patients with opioid addictions in clinical training sessions.

Some challenges remain, even if training at medical schools dramatically improves, said Emily Feinstein, director of health law and policy at the National Center on Addiction and Substance Abuse. As of 2013, she noted, only 1,200 of the roughly 1 million active physicians in the United States had pursued a certificate in addiction medicine — the highest level of training available prior to the topic’s designation as a subspecialty.

One of the challenges is getting doctors interested in the field, Feinstein said, citing low insurance reimbursement rates as a deterrent to young physicians. “And the patients can be difficult to work with,” she added. “Addiction is a disease that affects your brain … and can make people angry.”

Goodman, the Stanford medical student, believes his peers are generally disinclined to blame patients in most branches of medicine. “Going into the mechanisms of addiction on the brain” could help students view it as a disease rather than a choice, he said.

Lembke agreed, saying it’s best to reach doctors at the start of their careers, before they’ve established a practice and get set in their ways.

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