Aaron E. Carroll's Blog, page 11

Take this breath: mindfulness and public health

I’ve heard from several people that my story, A Sated Wind, was helpful to them. That is the point of sharing, so I am delighted. This morning, the following poem came to me, which can be read as related to that story, though can be read in other ways as well. So, I am sharing it in the same spirit as I shared A Sated Wind.

Take this breath as if it were the last
Seasons, cycled
Storms, ceased
Stillness
Begin again

The backstory and where it leads may surprise you.

Yesterday, it occurred to me during a seated (what I would call my “formal”) meditation session to breathe as if each breath were my last — to really commit to that possibility, to believe it. How would I spend my final breath?

If that doesn’t focus one’s mind, what does? I found it helped me reach … well I don’t know what or where. I just went. If you’re a meditator, give it a try.

When I wake each morning I spend ten minutes or sometimes tens of minutes in a lying, meditative state. This is less “formal” — as in less planned — but meditation can take many forms (e.g., swimming, jogging, walking, doing dishes can all be meditative). At this time my mind is dreamy and pliable. Like gifts, things of significance come to me, almost every day. Today, in that state, is when this poem emerged.

What has any of this, whether this poem or A Sated Wind, got to do with TIE, a blog about health care, health policy, health services research, etc.? First of all, there’s always been a trickle of content that’s just about life. I make no apology for what I post on a blog I co-edit. But there’s more.

This poem, and the story, stems from a mindfulness/meditation practice, which for me is both attention to the present and a vulnerable letting go into a creative, playful, personally relevant (not work!) mind-space. In that spirit, I will share that it’s beginning to dawn on me that there may be some role for mindfulness not just in personal health (that’s clear) but in public health. This may not be a novel thought, I imagine. In fact, I hope it is not.

I think most readers of this blog likely recognize a toxicity in our culture, institutions, environment, habits and, in general, relationships. Most things seem too fast, too harsh, too impersonal, too uncaring, too disconnected, too thoughtless.

A personal practice of mindfulness can, of course, assist with all that. But that’s like treating a single patient with pollution-induced asthma with medication when the problem is the pollution. Is there a public health approach to mindfulness? I don’t know. Perhaps others are thinking about this already. I’d like to find out, perhaps help where I can, to the extent my life and energy permit.

Please reach out if you see the path you think I’m seeking. It’s certainly of relevance to this blog.

The post Take this breath: mindfulness and public health first appeared on The Incidental Economist.

Follow-up to our email subscribers

You’d like to think that in 2024 it would not be hard to have a blog (which is, what, a 1990s technology?) that sends out emails (which is, what, a 1980s technology?). But, alas, it seems hard, and not all TIE posts are getting to email subscribers. Service may be spotty for a while.

So, here’s my suggestion: If you love TIE and have heretofore relied on our emails, make a habit to also check the site from time to time, perhaps once a week or so. Glance over the homepage to see if you missed anything of interest to you. Shouldn’t take long, but it’s up to you. I won’t bother you again about it. (I am very sorry for the inconvenience.)

Here, for example, is one post — a rare and very personal one by me — I know that did not go out by email. But I am sure there will be others that fail to do so until the Silicon Valley geniuses work how to reliably marry blogs to email. I figure that’ll be in 2055 or so.

The post Follow-up to our email subscribers first appeared on The Incidental Economist.

A sated wind

Positive and negative space. Is it the pile of heavy blankets that comforts or the warm cave beneath? Both and.

The night of November 30, 2019, within such a cave, the door of sleep blew open no sooner had it closed. Startled awake, yet nothing was amiss. Just the wind, as they say.

I reentered sleep, the door to waking consciousness gently closed only to be immediately blown open, again with no apparent cause.

These gusts of wind came from my central nervous system. They tormented throughout the night, waking me just as I fell asleep over and over and over. It happened the next night too. And the next. And the next.

It’s a rare sleep condition, unknown and misunderstood by many neurologists, with almost no research literature, no discernible cause, and no definitive treatment. With medications, mindfulness, meditation, breathing exercises, changes to work and lifestyle, many months can be fine.

But, it is a life remade, a being changed. Some parts of me have been lost, some given, some taken.

Puncturing stretches of this new fine-ness, some nights the wind torments, tilts my world. I never know when or why.

This is, of course, the great truth. We never know. Life is uncertain, constant change, struggle, full of turmoil. Yet there is also joy, beauty, love. These are not incompatible with turmoil. I am only perhaps the 10 or 50 billionth person who has ever lived to feel or proclaim this.

The last few months, the diabolical wind has blown more strongly, more regularly. At times it’s beaten me down. But I have not been alone. My friends and family draw ever closer. Warmth in the wind.

Recently, after several challenging nights, I woke early. I was tired, frustrated, lost, done. It was not yet light, but I would not sleep — the early morning hours are particularly difficult. Awake, I waited. I schemed.

It was time to visit the wind on my terms. At the sign of approaching dawn I entered the woods with questions, demands.

Climbing a hill, far from houses, through tears and with a mix of vulnerability and an I-have-nothing-to-lose bravery, I yelled to it, “What more do you want from me? Just tell me and I will give it. I will give it all now. NOW!!!” I expected an answer.

(Yes, this sounds like a madman’s ravings. But I knew what I was doing. This was no hallucination but a one-man psychodrama of two characters who are also one. This is therapy.)

The wind answered, “I will take all of you.”

I yelled back, “Not good enough. Name the parts. Name what you are taking and each part will be yours.”

As if at a restaurant, the wind opened a menu and considered. Slowly, it hissed, “I will take: Focus. Concentration. Energy. Ambition. Attention. Drive. Willpower. Equilibrium. Comprehension. Memory. Reason. Mind. Identity.”

“Is that all?”

“That is all.”

That’s when I understood that the wind had already shifted in my favor.

Atop the hill at dawn, I delivered wind’s order upon platters — the most cherished parts of myself. I spread my arms wide in offering.

The wind rose. It started feasting.

What happened? Nothing and everything. The wind did what wind does. The condition takes what the condition takes. We all experience conditions, struggles, turmoil. The problem is not in the wind or the conditions we face, but in our resistance, our coveting, our hoarding, our yearning, our attachments. We’re so attached to ourselves. (Buddha’s been telling us this on social media for thousands of years.)

So, I let go. And the wind died without emptying a single platter. The pain of the wind’s fury was the tightness of my clutch to the bedsheets of my mind. The more I unclench and accept, the less power it has. What it is is bad enough. What I choose to make it out to be can be a horror, the second arrow.

Or it can be beautiful.

Departing the summit, I noticed the menu’s other side, as if a negative space hidden in plain sight. It listed the things the wind did not demand in its lust for what I once most coveted. It did not take: Vulnerability. Forgiveness. Love. Compassion. Connection. Curiosity. Joy. Hope. Creativity. Wonder. Awe. Insight. Acceptance. Renewal. Authenticity. Breath. Voice.

The post A sated wind first appeared on The Incidental Economist.

Does a non-VA emergency department visit lead to more non-VA care for Veterans?

The Department of Veterans Affairs (VA) operates one of the largest health systems in the United States, providing care to millions of Veterans each year. With the passage of the Choice Act in 2014 and the MISSION Act in 2018, Veterans who are unable to receive VA care because of distance, wait times, or availability of services are allowed to receive care in the community from non-VA providers.

While this improves access to care, it’s unclear if it improves care quality or coordination. In fact, studies have established that VA care is of exceptional quality and that using out-of-network providers can lead to care fragmentation. A better understanding of how the use of non-VA care affects future use of both VA and non-VA care will help VA leadership focus on providing high quality, cost-effective care to Veterans.

New Evidence

Evaluators at the Partnered Evidence-based Policy Resource Center (PEPReC) recently published a paper in Academic Emergency Medicine titled: “Community care emergency room use and specialty care leakage from Veterans Health Administration hospitals.” The goal of this paper was to add to the conversation about care leakage – when care is provided outside a health system – and its implications by studying whether non-VA emergency care utilization led to more subsequent non-VA specialty care utilization than VA emergency care utilization did.

Methods

The authors used a retrospective cohort study design to assess the impact of non-VA emergency care utilization on subsequent non-VA specialty care utilization. They gathered VA administrative and claims data from the VA Corporate Data Warehouse. The study period was January 2021 to July 2021. They included Veterans who had at least one emergency department (ED) visit – VA or non-VA – in the first three months of the study period. After employing certain exclusion criteria, 330,547 Veterans were included in the sample.

They used Current Procedural Terminology (CPT) codes and provider taxonomies to identify to which specialties subsequent-to-ED-care visits belonged. In order to focus on specialty care that could likely be brought back in-house, the authors excluded visits in primary care, mental health care, inpatient settings, and various rehabilitation and extended stay specialties.

To estimate effects and conduct sensitivity analyses, the authors used two-stage least-square models, an instrumental variables approach, and ordinary least-square models. They controlled for a variety of factors, such as Veteran age, gender, VA priority status, comorbid conditions, race and ethnicity, rurality, drive time to closest VA medical center, VA medical center complexity, and VA medical center fixed effects.

Findings

Having a non-VA ED visit was associated with more subsequent non-VA specialty care visits within all timeframes studied (30, 60, 90, and 120 days) compared to a VA ED visit. The 30-day timeframe showed the biggest difference (45 percentage points higher).

For Veterans living within 60 minutes of VA specialty care, having a non-VA ED visit was associated with more subsequent non-VA specialty care. The average drive time to both primary and specialty care was higher for Veterans with a non-VA ED visit than those with a VA ED visit. The proportions of non-Hispanic White Veterans and rural Veterans were higher among those with a non-VA ED visit than a VA ED visit as well.

Lastly, the authors found that an increase in VA ED physician capacity was associated with a decreased likelihood that a Veteran would seek care at a non-VA ED.

Conclusion

One notable limitation of this study is the differences between VA and non-VA care systems. There are different data-generating processes and financial incentives for providers, making comparisons challenging.

Given how much VA spends on non-VA each year, policy changes that could reduce that financial footprint are important. For example, the authors found that shifting five percentage points of VA ED care to non-VA ED could result in a $769 million increase in non-VA care spending. One could assume that the same-sized shift in the opposite direction could result in $769 million in savings.

As such, the findings of this study shed light on how receiving care at a non-VA ED increases the likelihood that a Veteran will then also receive specialty care in a non-VA setting. Understanding care pathways provides VA policymakers with new ways to reduce spending. For example, if VA could provide more ED care in-house, it’s likely VA could save a significant amount of money on both ED care and specialty care follow-up visits. VA care is known to be both high quality and preferred by Veterans, so the incentives are strong to minimize unnecessary non-VA ED and specialty care. Not only will this produce financial savings, it will also leave more non-VA care available for Veterans for whom VA care is simply not an option.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Does a non-VA emergency department visit lead to more non-VA care for Veterans? first appeared on The Incidental Economist.

Alone in America: How Attitudes About Connection Have Impacted Older Adults for the Worse

As we forge through the dark, long days of winter, many older Americans feel increasingly lonely and isolated.

About one third of older adults reported being socially isolated in 2023, while nearly 40% reported a lack of companionship. They spent more than half of their waking hours alone each day, even more for older adults who live alone.

Loneliness and social isolation aren’t just “bad feelings.” Recognized in a 2023 Surgeon General report as threats to our mental and physical health, they contribute to conditions like high blood pressure, obesity, and Alzheimer’s disease.

Common suggestions to combat loneliness and social isolation include visiting with friends, video calling with family, or consulting a doctor. While these can be effective, we must also tackle the systemic issues that brought us to the doorstep of the loneliness epidemic in the first place.

Individualism has Killed Connection

First is the American ideal of individualism. This concept centers on self-reliance and the protection of personal freedoms. We internalize individualism from a young age: Teenagers report valuing personal success over caring for others. It played a huge role in the COVID-19 pandemic as well, fueling widespread rebuke by many against communal public health recommendations like masking.

We’ve started to view aging through the lens of individualism. Research suggests that we respect older adults more when they’re perceived as competent and self-reliant. In other words, we value them when they can take care of themselves, by themselves.

Older adults may also internalize the importance of self-reliance and freedom. Internalized ageism creates a cycle in which older Americans expect to be seen as a burden or don’t feel worthy of connection.

We Don’t Want to Volunteer Anymore

Our cultural emphasis on self has contributed to a decrease in volunteering, which can have significant impacts on older adults’ health. Older adults benefit greatly from the help of others, but they also reap benefits from volunteering themselves. Lately, the disinterest in volunteering across the country has been noticeable.

From September 2020 to September 2021, 23% of Americans formally volunteered. This is down from 29% in the early 2000s. Americans report disinterest in volunteering because they feel that they don’t have time, the roles aren’t interesting, or no one asked them to do it.

When fewer Americans volunteer for positions like hot meal delivery for aging neighbors, social isolation and loneliness increase. For example, forty percent of Meals on Wheels recipients say that they would have very little contact with the outside world without home meal delivery.

For older adults themselves, volunteering is a hugely beneficial activity. It has been directly associated with decreased loneliness, as well as improved physical and cognitive functioning.

While over 22 million Baby Boomers volunteered in 2018, older Americans are volunteering less. Research suggests this could be due to deteriorating health or a lack of training and institutional support. Others attribute this decline to the COVID-19 pandemic and a national shutdown of activity, as well as risk of infection for older adults.

Housing is a Crisis for Loneliness and Isolation, Too

While the divestment from volunteering is concerning, the housing crisis is catastrophic for older adults seeking connection and support.

In recent decades, many older adults have been forced to move to other areas of the country where housing prices are lower, cutting off lifelong social connections. Others may experience homelessness or depression and anxiety – all outcomes of a housing crisis in America.

Research shows that three quarters of renters aged 65 years and older spend half of their income on housing alone. Half of older home owners do the same, and many are currently stuck in homes that don’t serve their needs because they can’t afford to downsize. Plus, only a quarter of America’s housing inventory even meets accessibility standards for aging residents, such as no-step entry and hallways large enough to accommodate wheelchairs.

Solutions Are Available

We can’t immediately eliminate loneliness and social isolation but there are available solutions to make older adults feel more connected.

The United States would do well to emulate other countries’ efforts to promote volunteering and increase funding for volunteer initiatives. Some countries are even considering incentives like tax discounts for those who volunteer.

In addition to addressing the cost of living and remaining in one’s family home, we should also create more affordable housing for older adults. There are innovative local government solutions available, like zoning for in-law units or accessory dwelling units. Grants to promote accessibility modifications are affordable and popular as well.

Older adults increasingly face social isolation and loneliness as winter begins, exacerbated by systemic problems like individualism and a decrease in volunteers and appropriate housing. It’s time we use the tools we have available, like volunteer incentives and affordable housing solutions, to better connect aging Americans with their communities.

The post Alone in America: How Attitudes About Connection Have Impacted Older Adults for the Worse first appeared on The Incidental Economist.

Alone in America: How Attitudes About Connection Have Impacted Older Adults for the Worse

As we forge through the dark, long days of winter, many older Americans feel increasingly lonely and isolated.

About one third of older adults reported being socially isolated in 2023, while nearly 40% reported a lack of companionship. They spent more than half of their waking hours alone each day, even more for older adults who live alone.

Loneliness and social isolation aren’t just “bad feelings.” Recognized in a 2023 Surgeon General report as threats to our mental and physical health, they contribute to conditions like high blood pressure, obesity, and Alzheimer’s disease.

Common suggestions to combat loneliness and social isolation include visiting with friends, video calling with family, or consulting a doctor. While these can be effective, we must also tackle the systemic issues that brought us to the doorstep of the loneliness epidemic in the first place.

Individualism has Killed Connection

First is the American ideal of individualism. This concept centers on self-reliance and the protection of personal freedoms. We internalize individualism from a young age: Teenagers report valuing personal success over caring for others. It played a huge role in the COVID-19 pandemic as well, fueling widespread rebuke by many against communal public health recommendations like masking.

We’ve started to view aging through the lens of individualism. Research suggests that we respect older adults more when they’re perceived as competent and self-reliant. In other words, we value them when they can take care of themselves, by themselves.

Older adults may also internalize the importance of self-reliance and freedom. Internalized ageism creates a cycle in which older Americans expect to be seen as a burden or don’t feel worthy of connection.

We Don’t Want to Volunteer Anymore

Our cultural emphasis on self has contributed to a decrease in volunteering, which can have significant impacts on older adults’ health. Older adults benefit greatly from the help of others, but they also reap benefits from volunteering themselves. Lately, the disinterest in volunteering across the country has been noticeable.

From September 2020 to September 2021, 23% of Americans formally volunteered. This is down from 29% in the early 2000s. Americans report disinterest in volunteering because they feel that they don’t have time, the roles aren’t interesting, or no one asked them to do it.

When fewer Americans volunteer for positions like hot meal delivery for aging neighbors, social isolation and loneliness increase. For example, forty percent of Meals on Wheels recipients say that they would have very little contact with the outside world without home meal delivery.

For older adults themselves, volunteering is a hugely beneficial activity. It has been directly associated with decreased loneliness, as well as improved physical and cognitive functioning.

While over 22 million Baby Boomers volunteered in 2018, older Americans are volunteering less. Research suggests this could be due to deteriorating health or a lack of training and institutional support. Others attribute this decline to the COVID-19 pandemic and a national shutdown of activity, as well as risk of infection for older adults.

Housing is a Crisis for Loneliness and Isolation, Too

While the divestment from volunteering is concerning, the housing crisis is catastrophic for older adults seeking connection and support.

In recent decades, many older adults have been forced to move to other areas of the country where housing prices are lower, cutting off lifelong social connections. Others may experience homelessness or depression and anxiety – all outcomes of a housing crisis in America.

Research shows that three quarters of renters aged 65 years and older spend half of their income on housing alone. Half of older home owners do the same, and many are currently stuck in homes that don’t serve their needs because they can’t afford to downsize. Plus, only a quarter of America’s housing inventory even meets accessibility standards for aging residents, such as no-step entry and hallways large enough to accommodate wheelchairs.

Solutions Are Available

We can’t immediately eliminate loneliness and social isolation but there are available solutions to make older adults feel more connected.

The United States would do well to emulate other countries’ efforts to promote volunteering and increase funding for volunteer initiatives. Some countries are even considering incentives like tax discounts for those who volunteer.

In addition to addressing the cost of living and remaining in one’s family home, we should also create more affordable housing for older adults. There are innovative local government solutions available, like zoning for in-law units or accessory dwelling units. Grants to promote accessibility modifications are affordable and popular as well.

Older adults increasingly face social isolation and loneliness as winter begins, exacerbated by systemic problems like individualism and a decrease in volunteers and appropriate housing. It’s time we use the tools we have available, like volunteer incentives and affordable housing solutions, to better connect aging Americans with their communities.

The post Alone in America: How Attitudes About Connection Have Impacted Older Adults for the Worse first appeared on The Incidental Economist.

If you’re a TIE email subscriber or want to be one, read this

If you rely on emails for TIE content, you’ve missed a lot of posts. Our post-to-email functionality broke in mid-December. We’ve been struggling mightily to fix it and finally have. At the end of this post is a list of links to great content you may have missed. Give it a skim and click through to catch up.

Meanwhile, here’s what you need to know about new TIE email delivery. At the end of each email, including the email for this post, is a link to manage your email delivery preferences. Click on it and, create a WordPress account if you don’t have one, and then fiddle to your liking (e.g., you can get emails for each post separately by default, once per day for all the previous day’s posts, once per week, etc.).

If you are not an email subscriber and want to become one, look for the subscribe button in the upper right corner of any page on TIE, including the one for this post. Click it, add your email address, and follow the obvious steps.

What you may have missed:

Public Health and Climate Change —Much of the conversation around climate change centers on things like lowering carbon emissions, which is obviously critical, but we think the public health response to climate change should be a larger part of the conversation.

VHA’s Risk Prediction Model: Are There Prediction Disparities? — Discussing a paper exploring racial and ethnic differences in VHA’s opioid risk prediction model, STORM.

Even pro-vaxxers get worried sometimes. Why is that? — Vaccines work but some give even staunch supporters pause. These trends should not be ignored, and experts should modify their outreach accordingly.

Cancer is not a random assault of genetic bad luck — Environmental factors, not genetics, is more likely the driver of the escalation of cancer prevalence for the last 80 years.

Ways We Can Mitigate Climate Change — We’ve spent a bunch of time this year examining the many, many health effects of climate change. We’re going to dig into what look like some of the most promising mitigation strategies at the moment.

Antidepressants, Weight Loss Drugs, and Stigma — Drugs that do a pretty good job of easing symptoms of depression and drugs that really help people struggling with obesity have a couple things in common.

SNAP, WIC, and HIP: Programs of Benefit — Government food assistance programs are lifelines shaping health, economy, and communities.

4 Ways Clinicians Can Address the Non-Physical Side Effects of Serious Illness — Serious illness has serious side effects, both physical and non-physical.

Telehealth Use and Availability in VHA Outpatient Mental Health Care — A recent policy brief examines telehealth use within the Veterans Health Administration.

Artificial Sweeteners and Cancer — When we released a recent episode about the artificial sweetener erythritol, many of you brought up questions about recent news on other artificial sweeteners, sucralose and aspartame, so we went to take a look.

We Need Caregivers’ Voices When Designing Effective Smart Home Technology — Smart home technology is increasingly being used to help older adults age in place, but we can’t forget to include caregivers as stakeholders for these products, too.

How Do Geographic Variations affect Wait Times and Veteran Access? — In order to improve access to health care, the Veterans Health Administration passed the Choice Act and MISSION Act to expand Veteran care coverage in the community. PEPReC researchers analyzed wait time differences across the United States to better understand Veterans’ experiences.

Navigating an Eating Disorder Crossover — Eating disorders are more severe than ever, and many people seem to shift between disorders. This crossover could be due to how we diagnose and treat them.

Payers of Long-Term Services and Supports for Veterans — More Veterans are seeking access to long-term services and supports, but the array of programs to pay for these services is complicated. A new policy brief seeks to summarize available options.

Do Food Dyes Make Kids Wild Out? — Avoiding certain food dyes to help improve a child’s behavioral issues is common advice, and not just on TikTok! Several doctors stand behind this recommendation.

How Neuroimaging Could Change Mental Health Care — Most mental health diagnoses are made without ever looking at the brain, but can brain imaging technology change that?

Home and Community-Based Services: Exploring Options to Control Costs and Expand Access to Long-Term Care — Veterans are seeking greater access to long-term services and supports. Research shows VHA and Veterans alike prefer those services to be home- and community-based.

Do Processed Foods Lead to Depression? — Healthcare Triage is no stranger to dissecting studies about processed foods, but we were recently alerted to a study linking them to depression.

EMDR: A Popular, Yet Controversial New Approach to Trauma Therapy — Most mental health conditions are treated with medication and talk therapy, however, one emerging approach attempts to heal traumatic memories without either.

The post If you’re a TIE email subscriber or want to be one, read this first appeared on The Incidental Economist.

EMDR: A Popular, Yet Controversial New Approach to Trauma Therapy

Estimates suggest that 70% of the world’s population experiences at least one traumatic event in their lifetimes, and we know how trauma can affect mental health and well-being. As rates of mental illness continue to grow, access to effective, quality mental health care is a priority. Traditionally, most mental health conditions are treated with medication and talk therapy, however, one emerging approach attempts to heal traumatic memories without either.  

Eye movement desensitization and reprocessing (EMDR) is an eight-phase treatment during which negative thoughts, images, and/or bodily sensations associated with trauma are reprocessed through bilateral stimulation such as eye movements, physical taps on the body, or by listening to audio. While EMDR has recently gained more popularity, debate remains on how excited we should be about it considering its controversial history, mixed research, and lack of understanding the mechanisms behind its success. 

Francine Shapiro developed EMDR in 1987 when she noticed how certain eye movements decreased her own negative emotions. It seems to work faster than other psychotherapies, typically completed in six to 12 sessions. It also doesn’t require any verbal discussion of the trauma itself, which can be one of the most exhausting aspects of traditional therapy.  

Today, EMDR is officially recognized as an effective treatment for posttraumatic stress disorder (PTSD) across several organizations including the United States Department of Veterans Affairs, American Psychiatric Association, and the World Health Organization. However, it’s also often used in therapeutic settings where traumatic events are associated with other mental health concerns (depression, anxiety, etc.).  

“The bravest thing I’ve done so far in my life.” 

It’s not uncommon to hear testimony that EMDR was the only treatment to help some heal from their trauma. Several public figures have shared these kinds of experiences, such as Prince Harry who filmed an EMDR session for his new mental health docuseries, and Sandra Bullock who shared her story on Red Table Talk. 

One patient I spoke with emphasized that, after years of living at war with herself, EMDR provided the final piece to healing. Daniella said that it is strikingly clear to her how much EMDR changed her on a neurological level, greatly impacting her present and future self. The cognitive stability, perspective, peace, and control she now has, along with the seamless connection between her body and brain, continues to stay strong.  

A History of Controversy 

EMDR may be a promising therapy for those who have found little remedy with other treatments, but it has been controversial from the beginning. 

Since its conception, Shapiro has been widely scrutinized for how she disseminated EMDR. Early on, she claimed that EMDR was a breakthrough therapy and trained clinicians to use it for PTSD while it was still labeled “experimental.” 

EMDR then gained popularity in 1998 when the American Psychiatric Association listed it as a “probable efficacious treatment” for PTSD. This stirred more controversy, with some arguing that the Association’s decision was unjustified and better research was still needed. Early efficacy studies showed mixed results, although these publications were mostly case studies and researcher narratives.  

The rocky start complicated EMDR’s reception by the field. It’s still a newer intervention, and we don’t fully understand how it works. Current understanding relies on Shapiro’s information processing theory as its methodological rationale, which hasn’t been substantiated in explaining how EMDR works on a neurological level.  

Gaps in knowledge are common across most mental health therapies, however Shapiro had originally made claims explaining how EMDR worked that cannot be fully justified today. Bilateral eye movements were foundational to Shapiro’s original practice and served as a physiological explanation for how EMDR worked in the brain. However, some early studies found that they weren’t actually necessary. While more recent research has shown benefits, today most believe eye movements can be substituted for other forms of stimulation. 

Advocates have also prematurely claimed that EMDR can treat a range of mental health conditions beyond PTSD such as anxiety and personality and substance use disorders. There isn’t substantial evidence to support this yet, as research remains in its early stages. 

What To Make of EMDR Today 

The current state of EMDR research and its clinical use remains mixed. For example, a commonly referenced meta-analysis observed that, while EMDR has positive effects, the quality of existing research is still poor. Plus, when EMDR is compared to other treatments like cognitive behavioral therapy, it’s effective but not better.  

Some skepticism towards EMDR is fair: it has rapidly gained recognition while still having some unanswered questions. Resistance to new treatments is common, as are discrepancies early on between personal experience and research. Nonetheless, EMDR’s trajectory is hopeful, and it has helped those who felt like they had nowhere else to turn.  

The post EMDR: A Popular, Yet Controversial New Approach to Trauma Therapy first appeared on The Incidental Economist.

Do Processed Foods Lead to Depression?

Healthcare Triage is no stranger to dissecting studies about processed foods, but we were recently alerted to a study linking them to depression, and since we haven’t dissected that yet, that’s the topic of this week’s Healthcare Triage.

 



The post Do Processed Foods Lead to Depression? first appeared on The Incidental Economist.

Home and Community-Based Services: Exploring Options to Control Costs and Expand Access to Long-Term Care

As the proportion of older adults grows in the United States, providing long-term services and supports (LTSS) is a high priority, particularly for Veterans Health Administration (VHA). How LTSS are provided to aging Veterans or those with disabilities is a key component of serving this growing population. Veterans can access LTSS in an institution or in their home or community. For VHA, it turns out that Veterans may prefer home- and community-based services over institutional care, and there are significant potential cost-savings for VHA in administering LTSS in those preferred settings.

The Partnered Evidence-based Policy Resource Center (PEPReC) published a policy brief examining several distinct VHA programs available to Veterans and their caregivers for home- and community-based LTSS. Read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Home and Community-Based Services: Exploring Options to Control Costs and Expand Access to Long-Term Care first appeared on The Incidental Economist.