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Psychedelics Herald New Era of Mental Health
By Macarena Cortina, Psychology ‘21
Author’s Note: As a psychology major who used to be a plant biology major, I’m very interested in the arenas where these two fields interact. Such is the case with psychoactive plants and fungi that produce significant alterations in brain chemistry and other aspects of the human psyche. That is why I chose to write about psychedelics and their rebirth in both research and culture. In the past few months, I have seen increasing media coverage of new scientific findings about these substances, as well as legal advancements in their decriminalization, making this a relevant topic in the worlds of psychology and ethnobotany. The history of psychedelics is a long and complicated one, but here I attempt to cover the basics in hopes of demystifying these new powerful therapeutic treatments and informing readers about the latest horizon in mental health.
After decades in the dark, psychedelic drugs are finally resurfacing in the world of science and medicine as potential new tools for mental health treatment. Psychedelics, otherwise known as hallucinogens, are a class of psychoactive substances that have the power to alter mood, perception, and cognitive functions in the human brain. They include drugs such as LSD, magic mushrooms, ayahuasca, MDMA, and peyote [1]. The US has a long and complex history with these drugs, and the resulting criminalization and stigma associated with them have kept psychedelics in the shadows for many years. However, a major shift in society’s opinions of psychedelics is taking place, and a reawakening is happening in the scientific community. Researchers from various disciplines are becoming increasingly interested in unlocking the therapeutic powers of these compounds, especially for those who are diagnosed with mental disorders and are resistant to the treatments that are currently available for them. Whether or not the world is ready for it, the psychedelic renaissance has begun.
Psychedelics have been used by Indigenous communities around the world as part of their cultural, spiritual, and healing traditions for thousands of years. In the Western world, psychedelics were rediscovered in the 1940s by Swiss chemist Albert Hofmann, who accidentally absorbed LSD through his skin while conducting tests for a potential medicine [2]. What followed was an “uninterrupted stream of fantastic pictures, extraordinary shapes, with intense, kaleidoscopic play of colors” [7]. Once LSD was disseminated throughout the world, psychologists began to experiment with it as a psychotomimetic, or a drug that mimics psychosis, in hopes of gaining a better understanding of schizophrenia and similar mental disorders [2, 3]. In the 1950s, as a result of the US government’s fear that communist nations were using mind control to brainwash US prisoners of war, the CIA carried out the top-secret project MK-Ultra, drugging even unwitting subjects with psychedelics in an attempt to learn about potential mind control techniques [4]. Recreational use of psychoactive substances proliferated in the counterculture movement of the 1960s, eventually leading to their criminalization and status as Schedule 1 drugs [5]. This classified them as substances with no medical value and a high potential for abuse—two descriptors we know are not factual [6].
Now, people seem to be reevaluating their outlook on these formerly demonized drugs and are instead looking for ways to harness psychedelics’ medicinal properties for mental and physical improvement. Momentum is building quickly. Clinical trials are beginning to show real potential in the use of psychedelics for the treatment of depression, anxiety, post-traumatic stress disorder (PTSD), addiction, eating disorders, and emotional suffering caused by diagnosis of a terminal illness. The US Food and Drug Administration (FDA) has already approved the use of ketamine for therapeutic purposes with MDMA and psilocybin set to follow [7]. Psilocybin has also been decriminalized in cities across the US and was completely legalized for medical use in the entire state of Oregon in November 2020. Entrepreneurs and investors are flocking to startups such as MAPS Public Benefit Corporation and Compass Pathways, which are currently developing psychedelic drugs for therapeutic application. Research centers have been cropping up across the country as well, even at prestigious institutions like John Hopkins School of Medicine and Massachusetts General Hospital.
So how do psychedelics work? In truth, scientists still don’t know exactly what happens to neural circuitry under the influence of these mind-altering drugs. While more research is required to fully understand how psychedelics affect the brain, there are some findings that help clarify this mystery. For example, the major group of psychedelics—called the “classic psychedelics”—closely resembles the neurotransmitter serotonin in terms of molecular structure [8]. This group includes psilocin, one of the important components of magic mushrooms; 5-MeO-DMT, which is present in a variety of plant species and at least one toad species; and LSD, also known as acid [8]. What they all have in common is a tryptamine structure, characterized by the presence of one six-atom ring linked to a five-atom ring [8]. This similarity lends itself to a strong affinity between these psychedelics and serotonin receptors in the cerebral cortex, particularly the receptor 5-HT2A [8]. The implication of this is that psychedelics can have a significant and widespread influence on brain chemistry, given that serotonin is one of the main neurotransmitters in the brain and plays a major role in mood regulation [9].
What follows is a poorly understood cascade of effects that causes disorganized activity across the brain [10]. At the same time, it seems that the brain’s default-mode network gets inhibited. British researcher Robin Carhart-Harris recently discovered this by dosing study participants with either psilocybin or LSD and examining their neural activity with the help of fMRI (functional magnetic resonance imaging). Rather than seeing what most people expected—an excitation of brain networks—Dr. Carhart-Harris found a decrease of neuronal firing in the brain, specifically in the default-mode network. According to Michael Pollan, author of the best-selling book on psychedelics How to Change Your Mind, this network is a “tightly linked set of structures connecting the prefrontal cortex to the posterior cingulate cortex to deeper, older centers of emotion and memory.” Its function appears to involve self-reflection, theory of mind, autobiographical memory, and other components that aid us in creating our identity. In other words, the ego—the conscious sense of self and thus the source of any self-destructive thoughts that may arise—seems to be localized in the default-mode network. This network is at the top of the hierarchy of brain function, meaning it regulates all other mental activity [10].
Therefore, when psychedelics enter the system and quiet the default-mode network, suddenly new and different neural pathways are free to connect, leading to a temporary rewiring of the brain [10]. In many cases, this disruption of normal brain functioning has reportedly resulted in mystical, spiritual, and highly meaningful experiences. Psychedelics facilitate neuroplasticity, thereby helping people break negative thinking patterns and showing them—even temporarily—that it’s possible to feel another way or view something from a different (and more positive) perspective.
This kind of experience can be immensely helpful to someone who is struggling with a mental health disorder and needs a brain reset. While other techniques, such as meditation and general mindfulness, can help cultivate a similar feeling, they require much more time and effort, something that is not always feasible—and never easy—for those who are severely struggling with their mental health [10]. Psychedelics can help jump-start the process of healing, and their effects can be made even more powerful and long-lasting when coupled with psychotherapy [11]. Talking with a psychiatrist or psychologist after the drug treatment can help integrate and solidify a client’s newly acquired thinking patterns [11].
In a study published in The New England Journal of Medicine in April 2021, researchers found that psilocybin works at least as well as leading antidepressant escitalopram [12]. In this double-blind, randomized, controlled trial, fifty-nine participants with moderate-to-severe depression took either psilocybin or escitalopram, along with a placebo pill in both cases. After six weeks, participants in both groups exhibited lower scores on the 16-item Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR-16), indicating an improvement in their condition. The difference in scores between the two groups was not statistically significant, meaning that a longer study with a larger sample size is still required to show if there is an advantage to treating depression with psilocybin over conventional drugs [12]. However, one notable difference was that psilocybin seems to take effect faster than escitalopram [13]. As an SSRI (selective serotonin reuptake inhibitor), escitalopram takes a couple months to work, something that’s not helpful for those with severe depression. Psilocybin, then, is suggested to provide more immediate relief to people battling depression [13].
In June 2020, a team of researchers at John Hopkins published a meta-analysis of nine clinical trials concerning psychedelic-assisted therapy for mental health conditions such as PTSD, end-of-life distress, depression, and social anxiety in adults with autism [14]. These were all the “randomized, placebo-controlled trials on psychedelic-assisted therapy published [in English] after 1993.” The psychedelics in question included LSD, psilocybin, ayahuasca, and MDMA. Following their statistical meta-analysis of these trials, they found that the “overall between-group effect size at the primary endpoint for psychedelic-assisted therapy compared to placebo was very large (Hedges g = 1.21). This effect size reflects an 80% probability that a randomly selected patient undergoing psychedelic-assisted therapy will have a better outcome than a randomly selected patient receiving a placebo” [14].
There were only minimal adverse effects reported from this kind of therapy and no documentation of serious adverse effects [14]. When compared to effect sizes of pharmacological agents and psychotherapy interventions, the effects of psychedelic-assisted therapy were larger, especially considering the fact that participants received the psychedelic substance one to three times prior to the primary endpoint, as opposed to daily or close-to-daily interventions with psychotherapy or conventional medications. Overall, results suggest that psychedelic-assisted therapy is effective—with minimal adverse effects—and presents a “promising new direction in mental health treatment” [14].
At UC Davis, researchers in the Olson Lab recently engineered a drug modeled after the psychedelic ibogaine [15]. This variant, called tabernanthalog (TBG), was designed to induce the therapeutic effects of ibogaine minus the toxicity or risk of cardiac arrhythmias that make consuming ibogaine less safe. TBG is a non-hallucinogenic, water-soluble compound that can be produced in merely one step. In an experiment performed with rodents, “tabernanthalog was found to promote structural neural plasticity, reduce alcohol- and heroin-seeking behavior, and produce antidepressant-like effects.” These effects should be long lasting given that TBG has the ability to modify the neural circuitry related to addiction, making it a much better alternative to existing anti-addiction medications. And since the brain circuits involved in addiction overlap with those of conditions like depression, anxiety, and post-traumatic stress disorder, TBG could help treat various mental health issues [15].
As the psychedelic industry begins to emerge, members of the psychedelic community are voicing their concerns about the risks that come with rapid commercialization [7]. Biotech companies, researchers, and therapists should be careful about marketing psychedelics as a casual, quick fix to people’s problems. Psychedelics can occasion intense and profound experiences and should be consumed with the right mindset, setting, and guidance. There are still many unknowns about psychedelic use, especially its long-term effects. Not all individuals should try treatment with psychedelics, especially those with a personal or family history of psychosis. It will also be important to move forward in a way that is respectful to Indigenous traditions and accessible to all people—particularly people of color—without letting profit become the main priority. Some advocates worry that commercialization and adoption into a pharmaceutical model might strip psychedelics of their most powerful transformational benefits and that they will wind up being used merely for symptom resolution [7]. As long as psychedelics’ reintroduction to mainstream medicine is handled mindfully, the world may soon have a new avenue for effective mental health therapy that honors its Indigenous heritage and is accessible to all.
References:
- Alcohol & Drug Foundation. Psychedelics. October 7, 2020. Available from https://adf.org.au/drug-facts/psychedelics/.
- Williams L. 1999. Human Psychedelic Research: A Historical And Sociological Analysis. Cambridge University: Multidisciplinary Association for Psychedelic Studies.
- Sessa B. 2006. From Sacred Plants to Psychotherapy:The History and Re-Emergence of Psychedelics in Medicine. Royal College of Psychiatrists.
- History. MK-Ultra. June 16, 2017. Available from https://www.history.com/topics/us-government/history-of-mk-ultra.
- Beres D. Psychedelic Spotlight. Why Are Psychedelics Illegal? October 13, 2020. Available from https://psychedelicspotlight.com/why-are-psychedelics-illegal/.
- United States Drug Enforcement Administration. Drug Scheduling. Available from https://www.dea.gov/drug-information/drug-scheduling.
- Gregoire C. NEO.LIFE. Inside the Movement to Decolonize Psychedelic Pharma. October 29, 2020. Available from https://neo.life/2020/10/inside-the-movement-to-decolonize-psychedelic-pharma/.
- Pollan M. How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. New York: Penguin Press; 2018.
- Bancos I. Hormone Health Network. What is Serotonin? December 2018. Available from https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/serotonin#:~:text=Serotonin%20is%20the%20key%20hormone, sleeping%2C%20eating%2C%20and%20digestion.
- Pollan M, Harris S, Silva J, Goertzel B. December 11, 2020. Psychedelics: The scientific renaissance of mind-altering drugs. YouTube: Big Think. 1 online video: 20 min, sound, color.
- Singer M. 2021. Trip Adviser.Vogue. March issue: 198-199, 222-224.
- Carhart-Harris R, Giribaldi B, Watts R, Baker-Jones M, Murphy-Beiner A, Murphy R, Martell J, Blemings A, Erritzoe D, Nutt DJ. 2021. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med [Internet]. 384:1402-1411. doi: 10.1056/NEJMoa2032994.
- Lee YJ. Business Insider Australia. A landmark study shows the main compound in magic mushrooms could rival a leading depression drug. April 14, 2021. Available from https://www.businessinsider.com.au/psilocybin-magic-mushroom-for-depression-takeaways-from-icl-report-nejm-2021-4.
- Luoma JB, Chwyl C, Bathje GJ, Davis AK, Lacelotta R. 2020. A Meta-Analysis of Placebo-Controlled Trials of Psychedelic-Assisted Therapy. Journal of Psychoactive Drugs [Internet]. 52(4):289-299. doi: 10.1080/02791072.2020.1769878.
- Cameron LP, Tombari RJ, Olson DE, et al. 2020. A non-hallucinogenic psychedelic analogue with therapeutic potential. Nature [Internet]. 589:474–479. https://doi.org/10.1038/s41586-020-3008-z.
The Mental Health Crisis of the COVID-19 Pandemic
By Aditi Venkatesh, Cognitive Science ‘21
Author’s Note: I wrote this piece for a UWP 104E assignment to explain the psychological consequences of the COVID-19 pandemic. I chose to focus on mental health because it holds personal value to me and addresses an often overlooked aspect of this pandemic. I support the creation of more accessible mental health services and hope to encourage people to reflect on their own mental well-being during these unprecedented times.
Recall your life just a few months ago. Hanging out with friends at a restaurant. Working in an office and chatting with coworkers. Sitting in a classroom with hundreds of classmates. Visiting family members. Buying groceries without worrying about wiping everything down. Going for a walk with neighbors.
Now, life looks a lot different. Zoom meetings all the time. FaceTime calls just to talk to friends and family. Paranoia about whether masks and gloves are covering your face and hands properly. Constantly checking social media for news. Using laptops every hour to communicate with classmates, coworkers, teachers, and pretty much anyone. The same routine repeated over and over again.
Undoubtedly, the COVID-19 pandemic has created a much different world. The consequences of this pandemic are primarily examined from a medical and economic perspective, but more attention needs to be brought to the psychological impacts of this pandemic. Mental health disorders have become increasingly prevalent in society; data from Active Minds, a mental health awareness organization, states that 50% of the United States population will experience a mental health condition at some point during their lifetime [1]. These statistics become even more concerning for young adults, with 75% of all cases of mental health issues beginning by the age of 24 [1]. With new layers of stress, anxiety, and isolation stemming from the pandemic, mental health issues are more widespread than before. Through the remainder of this piece, I will articulate outcomes of COVID-19 including the general effect of a pandemic on mental health, specifically focusing on younger populations at risk for anxiety and depression. I discuss alternative positive outcomes in people who normally thrive in times of limited social interaction and contrast this with the harmful impact of drastic isolation. I examine the benefits and consequences of increased technology use during COVID-19. Lastly, I have provided a few helpful mental health resources for students, and I urge everyone to assess their own mental health during these difficult times and advocate for better mental health services.
The coronavirus pandemic has created a mental health crisis across the world. Quarantining and shelter-in-place guidelines have isolated most people from family and friends, reduced social interactions drastically, and disrupted normal interpersonal interaction as shown in Figure 1 below, with data collected by the Kaiser Family Foundation towards the end of March 2020 [2]. People were already experiencing negative impacts on their mental health at the onset of the pandemic in early March, so undoubtedly, the duration of quarantine has exacerbated prior conditions. Individuals who are practicing shelter-in-place were more likely to report feeling mild or severe negative impacts on mental health than those who are not sheltering-in-place. Negative impacts include stress, anxiety, and general disruptions to life such as job loss, isolation, and income insecurity. These effects are particularly noticeable in individuals that were already at a higher risk for depression prior to the pandemic: younger adolescents, frontline healthcare workers, and individuals with chronic illnesses.
Figure 1:
Considering the isolation that comes with quarantining, we must recognize that levels of interpersonal dependence produce key vulnerabilities to depression and other comorbid mental health disorders. How much we depend on other relationships has strong implications on support systems, coping mechanisms to mental health issues, and willingness to seek treatment [3]. Prior research on psychosocial risk factors has shown that sociotropy and autonomy are two personality traits that predict depression. Sociotropy is the reliance on interpersonal relationships, while autonomy is related to independence and seeking self-control. A 2018 study conducted by Otani, et al. at the Yamagata School of Medicine in Japan found that sociotropy was associated with negative beliefs about oneself, but autonomy was associated with negative beliefs about others and short-lived positive beliefs about oneself [4]. These results highlight that dependence on others and an imbalance of self-esteem can be linked to depression. Since quarantining creates isolation, this isolation leads to an increased tendency to contemplate and overthink negative core beliefs about oneself, resulting in lower levels of confidence and self-esteem. We should be aware that certain personality traits are more vulnerable to depression during this pandemic and mental health needs to be prioritized more than ever before. However, one might wonder if autonomous individuals are thriving during this pandemic, since there is undoubtedly less social interaction than normal. For example, imagine a student that has mild social anxiety and does not enjoy their large classes in school. They might be relieved because they don’t have to have lengthy conversations with classmates and can independently complete their work. This very well may be the case for certain individuals. Previous studies have shown that autonomy can cultivate creativity, and introversion has been closely linked with autonomous tendencies [5]. Individuals that typically thrive in solitude and focus on hobbies, jobs, and other passions may find comfort in having more time to themselves due to COVID-19. Alternatively, extremely high levels of autonomy, such as complete disconnection from family and friends can be a factor that contributes to depression. This stresses the fact that a majority of individuals need some level of healthy social interaction to have a balanced life.
Despite the finding of a correlation between isolation and depression, since the onset of the pandemic, people are finding creative ways to socially interact and combat the loneliness COVID-19 has created. Many folks schedule weekly or monthly calls with family and friends to catch up. Organizations are holding virtual discussions about mental health and ways to practice self-care. Students across the world are creating online board games and holding virtual game nights.
However even with these alleviating factors, the magnitude and ongoing duration of the pandemic’s restrictions continue to foster unusually high levels of loneliness. Students who may have participated in many extracurricular activities (which are now canceled), can’t talk to their friends as much, feel out of the loop in their lives, and struggle to find ways to spend their free time. Loneliness is one feeling that can contribute to depression and anxiety. In Figure 2, among data collected by Healthline through a YouGov COVID-19 Tracker during April 2020, the age group most affected by depression and anxiety (33%) was adults younger than 35 years old [6]. Additionally, this younger population showed an increase of anxiety and depression over a two-week span from April 12th to April 26th. Lastly, 45% of the U.S. population tested showed anxiety and depression PHQ-4 values out of the normal range [6]. However, older populations reported a plateau or slight reduction, which may be due to less dramatic lifestyle changes or less technology use compared to younger generations. This is significant because it illustrates that younger adults, which includes most students, disproportionately face worsened mental health.
Figure 2:
At the same time in China, researchers found similar patterns of anxiety and depression and chose to analyze why this exacerbation was present in younger individuals. Many research studies in China, where the peak of COVID-19 has passed, are examining the psychological repercussions of the pandemic, with a focus on depression and anxiety. In a published study from April 2020, researchers in Wuhan, China measured that the prevalence of depression and anxiety in the general population was 35.1% and 20.1%, respectively [7]. Further analysis of the self-report questionnaire confirmed that individuals younger than 35 years old reported more severe symptoms of depression and anxiety. In fact, among the younger population, those that spent more than 3 hours per day thinking about the pandemic faced more severe anxiety than those that spent 0-2 hours. This result highlights that in addition to actual lifestyle changes, thoughts about COVID-19 induces anxiety in young populations. This begs the question, why are younger people thinking about COVID-19 more than older people?
The answer is technology. Even though everyone uses technology, younger ages rely on technology more, especially for school and interacting with friends. Of course, technology is not all bad. In fact, society is most likely only able to function during this pandemic due to advancements like video conferencing, telemedicine, and online social groups. However, another study conducted in Wuhan, China explored the use of social media during the recovery interventions placed after the peak of COVID-19 [8]. Researchers found that social media support groups slightly reduced depression. But more significantly, adults that spent more than 2 hours on COVID-19 news on social media had increased anxiety and depression. Another study in Chicago in May 2020 explored the role of mainstream media in coronavirus news and depression. Researchers found that greater exposure to COVID-19 news, through cable news channels like CNN, local news channels, and the New York Times, led to higher perceived vulnerability to COVID-19, and this was strongly correlated with depressive symptoms [9]. Social media and mainstream media sources can both produce an undue burden on individuals through a barrage of stressful information about COVID-19 and lead to greater anxiety and depression.
Another form of technology, while useful for work and school, has unintended negative consequences: video conferencing. People have started to refer to these downsides as “Zoom fatigue” [10]. Zoom fatigue is the phenomenon where people are more tired and stressed with online meetings compared to in-person ones. I am sure many readers have experienced the similar stresses of looking presentable, awkward silences when nobody is speaking, and simply, less fun meetings. During Zoom meetings, it is difficult to discern normal social cues, such as body language and eye contact, over a video. This nonverbal communication is crucial to making conversations run smoothly. Removal of many social cues makes video calls feel impersonal. It can make even a catch-up video call to your best friend seem stressful. Additionally, previous research has shown that when responding online, even delays of up to 1.2 seconds can make a person seem unfocused and unfriendly [10]. These slight technological delays can dramatically contribute to greater stress and anxiety. Zoom fatigue can be especially taxing on younger populations that are still in school and are constantly in and out of Zoom meetings for courses.
As the COVID-19 pandemic continues, society finds itself at crossroads. How do we balance the positive and negative impacts of the technology use? Obviously, we cannot simply get rid of Zoom meetings and online classes; however, this pandemic gives us a crucial opportunity to expand online mental health services. Past research on mental health effects during the 2003 SARS epidemic in China showed similar prevalence of worsened mental health, with 48% of the participants reporting deteriorated mental health because of the SARS epidemic through anxiety and depression; this is very similar to the 47% found in the 2020 KFF study [11, 2]. If mental health issues are just as exacerbated in our pandemic 15 years later even with greater technological advancements, it accentuates the disparities in accessible online mental health care. Increasing virtual therapy appointments, online support groups, and videos for stress-relieving techniques like meditation, breathing exercises, and self-reflection are some starting points.
A CDC study conducted in June 2020, several months following the onset of the pandemic, found that people aged 18-24 years still face the highest prevalence of mental health conditions [12]. However, 30.9% of all participants showed anxiety and depression symptoms above normal PHQ-4 measurements; this illustrates a reduction compared to the finding of 45% measured in the April 2020 Healthline survey [12, 6]. Most importantly, I hope this shows that things are getting better. I especially encourage all readers to reflect on how to better take care of their own mental health. It is so important to practice self-care, which can be different for everyone! This can be exercising, seeing a therapist, hanging out with friends, getting more sleep, or setting boundaries for your own capabilities. It’s okay to prioritize your mental health when things get overwhelming. Therapy can be helpful for some folks, so here are some resources to be aware of. Student Health and Counseling Services offers on-campus counseling appointments for students (call (530) 732-0871 or visit hem.ucdavis.edu to schedule). Free tele-mental health and online counseling appointments are offered through Therapy Assistance Online (visit taoconnect.org and sign up with your UC Davis email). Text RELATE to 741741 to chat live with a crisis counselor, available 24/7 through the Crisis Text Line. Lean on your support systems and know that you are not alone! Mental health is just as important as your physical health. I hope we can take this time to acknowledge the mental health crisis this pandemic has created by improving available mental health services and making mental healthcare more accessible for at-risk populations.
References
- Statistics. (2020, June 24). Retrieved August 07, 2020, from https://www.activeminds.org/about-mental-health/statistics/
- Panchal, N., Kamal, R., Orgera, K., Cox, C. F., Garfield, R., Hamel, L., Muñana, C., & Chidambaram, P. (2020, April 21). The Implications of COVID-19 for Mental Health and Substance Use. Retrieved from https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
- Meissner, B. L., & Bantjes, J. (2017). Disconnection, reconnection and autonomy: four young South African men’s experience of attempting suicide. Journal of Youth Studies, 20(7), 781–797. doi: 10.1080/13676261.2016.1273512
- Otani, K., Suzuki, A., Matsumoto, Y., & Shirata, T. (2018). Marked differences in core beliefs about self and others, between sociotropy and autonomy: Personality vulnerabilities in the cognitive model of depression. Neuropsychiatric Disease and Treatment, 14, 863–866. doi: 10.2147/ndt.s161541
- Runco, M. A., & Pritzker, S. R. (1999). Encyclopedia of creativity. San Diego, CA: Academic Press.
- Healthline Mental Health Index: Week of April 26 – U.S. Population. (2020, May 14). Retrieved from https://www.healthline.com/press/healthline-mental-health-index-week-of-april-26-u-s-population
- Huang, Y., & Zhao, N. (2020). Mental health burden for the public affected by the COVID-19 outbreak in China: Who will be the high-risk group? Psychology, Health & Medicine, 1-12. Advance online publication. doi: 10.1080/13548506.2020.1754438
- Ni, M. Y., Yang, L., Leung, C., Li, N., Yao, X. I., Wang, Y., Leung, G. M., Cowling, B. J., & Liao, Q. (2020). Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey. JMIR Mental Health, 7(5). doi: 10.2196/19009
- Olagoke, A. A., Olagoke, O. O., & Hughes, A. M. (2020). Exposure to coronavirus news on mainstream media: The role of risk perceptions and depression. British Journal of Health Psychology. Advance online publication. doi: 10.1111/bjhp.12427
- Sander, L., & Bauman, O. (2020, May 22). Zoom fatigue is real – here’s why video calls are so draining. Retrieved from https://ideas.ted.com/zoom-fatigue-is-real-heres-why-video-calls-are-so-draining/
- Lau, J. T., Yang, X., Pang, E., Tsui, H. Y., Wong, E., & Wing, Y. K. (2005). SARS-related perceptions in Hong Kong. Emerging Infectious Diseases, 11(3), 417–424. doi: 0.3201/eid1103.040675
- Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M.W. (2020, August 13). Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24-30, 2020. Morbidity and Mortality Weekly Report 2020, 69, 1049–1057. doi: 10.15585/mmwr.mm6932a1