FOCUS The Journal of Lifelong Learning in Psychiatry
January 1, 2010
Kathy M. Sanders
369 citations
Mindfulness, a natural mental state of present-moment awareness, can be trained through meditation techniques that cultivate a nonjudgmental focus. Integrating mindfulness meditation with standard psychotherapies, especially cognitive behavior therapies, effectively alleviates suffering in affective disorders such as anxiety, depression, and personality disorders while enhancing well-being. Early evidence also suggests a positive impact on therapy outcomes when the clinician practices mindfulness. Mindfulness-based interventions are an important tool for clinicians, though further research with larger samples and controlled conditions is needed to confirm their efficacy.
FOCUS The Journal of Lifelong Learning in Psychiatry
January 1, 2018
Albert Yeung, Jessie S. M. Chan, Joey C. Cheung et al.
166 citations
Qigong and Tai-Chi, traditional Chinese self-healing exercises combining coordinated posture, deep breathing, meditation, and mental focus, improve psychological well-being and reduce symptoms of anxiety and depression, according to clinical studies including randomized controlled trials and meta-analyses. These meditative movements, which share elements with mindfulness meditation, may work by anchoring attention to interoceptive sensations, enhancing nonreactivity to aversive thoughts. Slow movements and slowed breathing could alter the autonomic system, restoring homeostasis and shifting balance toward parasympathetic dominance, while also attenuating stress-related hypothalamus-pituitary-adrenal axis reactivity. Effects on emotion regulation may involve changes in prefrontal regions, the limbic system, the striatum, or gene expression linked to inflammation and stress pathways.
FOCUS The Journal of Lifelong Learning in Psychiatry
April 1, 2022
Jennifer B. Dwyer, Angeli Landeros‐Weisenberger, Jessica A. Johnson et al.
51 citations
A single intravenous infusion of ketamine (0.5 mg/kg over 40 minutes) significantly reduced depressive symptoms in adolescents with major depressive disorder 24 hours later compared with the active placebo midazolam. The treatment effects appeared to persist for 14 days on one depression scale but not another. A greater proportion of participants responded to ketamine during the first three days after infusion (76%) compared with midazolam (35%). Ketamine caused transient dissociative symptoms but no serious adverse events.
FOCUS The Journal of Lifelong Learning in Psychiatry
January 1, 2021
Collin Reiff, Elon E. Richman, Charles B. Nemeroff et al.
17 citations
A review of clinical trials on psychedelic drugs for psychiatric disorders found the strongest evidence for MDMA and psilocybin, both designated by the FDA as breakthrough therapies for PTSD and treatment-resistant depression, respectively. Evidence for LSD and ayahuasca is observational but suggests potential therapeutic effects for mood, anxiety, trauma, and substance use disorders, as well as end-of-life care. Of 1,603 articles screened, 14 well-designed trials were identified. The database remains insufficient for FDA approval of any psychedelic for routine clinical use, but continued research is warranted.
FOCUS The Journal of Lifelong Learning in Psychiatry
July 1, 2018
Gerard Sanacora, Rachel Katz
16 citations
Ketamine, originally used as an anesthetic, shows promise as a rapid-acting treatment for severe depression, including treatment-refractory cases. A single dose provides short-lived relief, but multiple infusions may offer sustained effects. Its quick onset could help prevent hospital stays, treat acute suicidal ideation, and facilitate medication changes. Combining ketamine with psychotherapy may enhance response and duration. Despite growing use for various psychiatric disorders, there is inadequate data on true clinical efficacy, safety, and mechanisms of action. This article reviews ketamine's history as an antidepressant, current hypotheses on its mechanisms, and existing evidence on safety and efficacy for clinicians.
FOCUS The Journal of Lifelong Learning in Psychiatry
July 1, 2024
Sasha Gorrell, Amanda E. Downey
3 citations
Medications have shown little success in improving eating disorder cognitions, and many patients do not benefit from evidence-based psychotherapies. Anorexia nervosa is becoming more common and remains difficult to treat. This article reviews early research into cannabidiol, psilocybin therapy, ketamine, the ketogenic diet, transcranial magnetic stimulation, and vagus nerve stimulation for anorexia nervosa. These pilot studies highlight the need for larger, more diverse clinical trials to move findings into clinical practice.
FOCUS The Journal of Lifelong Learning in Psychiatry
July 1, 2024
Samantha Shao, Tessa Gruen, Alexandra Babakanian et al.
2 citations
A single 25-mg dose of synthetic psilocybin, given with psychological support, was safe and tolerable for 10 adult women with anorexia nervosa. No clinically significant changes occurred in heart health, vital signs, or suicidality. Two participants had temporary low blood sugar that resolved within a day. All side effects were mild and short-lived. Participants' reports indicated the treatment was acceptable. These results suggest psilocybin therapy may be a safe approach for female anorexia, a condition with no approved medications and high medical risk.
FOCUS The Journal of Lifelong Learning in Psychiatry
July 1, 2026
Morgan S. Hardy, S. William Li, Samuel T. Wilkinson
Ketamine, a rapid-acting antidepressant for treatment-resistant depression, works by blocking NMDA glutamate receptors and inducing a temporary state of enhanced neuroplasticity and metaplasticity—the brain's increased capacity for future plastic changes. This creates a posttreatment window of heightened cognitive flexibility, making patients more responsive to other interventions. Combining ketamine with cognitive-behavioral therapy (CBT) may leverage these neurobiological changes to produce a more durable antidepressant effect and reduce relapse. This differs from ketamine-assisted psychotherapy, which emphasizes the drug's consciousness-altering experience. Early studies show promise, but evidence is limited and optimal timing and structure remain undefined. The review summarizes the theoretical rationale and emerging evidence for integrating ketamine or esketamine with cognitive therapies, evaluates recent clinical trials, and proposes a framework for interventional psychiatrists.
FOCUS The Journal of Lifelong Learning in Psychiatry
July 1, 2026
Lynnette A. Averill, Logan Neitzke-Spruill
Psychedelic-assisted therapies show promise for stress- and trauma-related conditions that have not responded well to existing treatments. Current explanations focusing on brain changes and neurotransmitter effects are insufficient to explain how healing occurs through preparation, altered states, relationships, meaning-making, and integration. The authors propose a multilevel framework that distinguishes mechanisms of action from mechanisms of change, describing how neuroplasticity, memory updating, relational processes, context, and meaning-making may interact to create time-limited windows for experiential relearning. Ethical considerations and the possibility of increased vulnerability when safeguards are inadequate are discussed, along with guidance for clinicians.
FOCUS The Journal of Lifelong Learning in Psychiatry
April 1, 2026
Shakila Meshkat, Manish K. Jha, Venkat Bhat
Psilocybin, a serotonergic psychedelic, is being studied as a potential treatment for several psychiatric conditions. Clinical evidence from early-phase and small-scale trials suggests rapid but variable reductions in depressive symptoms, with some studies reporting sustained effects. Preliminary benefits have been shown for anxiety related to life-threatening illness and for reducing alcohol and tobacco dependence. Limited evidence supports possible effects in obsessive-compulsive disorder, body dysmorphic disorder, anorexia nervosa, and posttraumatic stress disorder. Adverse events like headache, nausea, and short-lived anxiety are typically transient and mild, though notable adverse reactions have occurred in larger trials. The evidence base remains limited by small sample sizes, selective populations, and short follow-up durations.
FOCUS The Journal of Lifelong Learning in Psychiatry
January 1, 2026
Tyler Durns, Greg Iannuzzi
Psilocybin, LSD, and MDMA have regained attention for their potential psychiatric benefits, but their effects on aggression and violence are not well understood. This review examines the historical, medical, legal, and cultural contexts of these compounds, along with how substance type, dose, set and setting, psychiatric comorbidity, and environmental factors influence violence risk. It discusses prevention and response strategies such as harm reduction, risk assessment, and treatment. The article concludes that individual risk factors mediating violence for users of these substances require further research.