Objectives: Flotation-REST is a treatment for deep relaxation, where a person is contained in a stimuli-restricted environment and floats in water with high salt content. The aim was to investigate the effects from flotation-REST on people with insomnia diagnosis, as previous studies of flotation-REST have demonstrated some effects on sleep but have limitations regarding sample selections and sleep measures. Material and Methods: Six participants were recruited through an outpatient psychiatry clinic and posters on a university campus. All participants fulfilled criteria for insomnia diagnosis and four fulfilled criteria for major depressive disorder. Using a single case experimental design, daily changes were investigated on sleep logs regarding sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency over the course of 12 sessions consisting of 45 min of flotation-REST. No other treatments were offered simultaneously. Questionnaire data on insomnia severity (the ISI) and depressive severity (the MADRS) were also collected. Results: Three participants improved on their most salient insomnia symptom (long SOL or WASO), and two improved on sleep efficiency. The improvements were maintained 2 months after treatment. Insomnia severity decreased for three patients, whereas depressive severity decreased for five. No changes in TST were found and two patients did not improve on any sleep measure. The two participants who benefitted the most were students in their 20s. Discussion: The results were mixed. Flotation-REST may be beneficial for young adults with sleep-onset insomnia but more research is warranted.

Background: Burnout is a hidden productivity killer in organizations. Finding a solution to efficiently measure and proactively prevent or rehabilitate employees with burnout is a challenge. To meet this unabated demand, companies and caregivers can focus on proactive measures to prevent "Burnout as an Occupational Phenomenon." Objective: We aimed to address effectiveness, reliability, and validity of the empowerment for participation (EFP) batch of assessments to measure burnout risk in relation to the efficacy of web-based interventions using cognitive behavioral therapy (CBT) and floating to improve mental health and well-being. We introduced three risk assessments: risk for burnout, risk of anxiety, and risk for depression. Methods: We used an interventional, empirical, and parallel design using raw EFP psychometric data to measure the effectiveness of web-based therapy to reduce the risk of burnout between a control group and web-based therapy group. A total of 50 participants were selected. The rehabilitation and control groups consisted of 25 normally distributed employees each. The rehabilitation group received therapy, whereas the control group had not yet received any form of therapy. IBM SPSS was used to analyze the data collected, and a repeated measures ANOVA, an analysis of covariance, a discriminant analysis, and a construct validity analysis were used to test for reliability and validity. The group was selected from a list of employees within the My-E-Health ecosystem who showed a moderate or high risk for burnout. All assessments and mixed-method CBT were web-based, and floating was conducted at designated locations. The complete EFP assessment was integrated into a digital ecosystem designed for this purpose and therapy, offering a secure and encrypted ecosystem. Results: There was a statistically significant difference between pre- and postassessment scores for burnout. The reliability of the burnout measure was good (Cronbach alpha=.858; mean 1.826, SD 3.008; Cohen d=0.607; P<.001) with a high validity of 0.9420. A paired samples 2-tailed test showed a good t score of 4.292 and P<.001, with a good effect size, Cohen d=0.607. Web-based therapy reduced the risk for burnout in participants compared with the control group. Tests of between-subject effects show F=16.964, a significant difference between the control group and the web-based therapy group: P<.001, with movement between the group variables of 0.261 or 26.1% for the dependent variable. Conclusions: This study suggests good reliability and validity of using web-based interventional mixed methods CBT to reduce the risk of burnout. The EFP batch of web-based assessments could reliably identify morbidity risk levels and successfully measure clinical interventions and rehabilitation with consistently reliable results to serve as both a diagnostic and therapeutic tool worthy of major research in the future.

Introduction: Some therapies described within alternative and complementary medicine are advertised as sleep-promoting, including flotation-REST (Restricted Environmental Stimulation Technique). Flotation-REST induces deep relaxation through sensory isolation in a water-filled tank and is plausibly reported to mitigate insomnia problems, which have consistently been associated with stress, worry and arousal. However, the effects of flotation-REST have not been previously summarised. The aim of this systematic review was to investigate the efficacy of flotation-REST on sleep in clinical and non-clinical samples. Methods: A systematic search for studies on flotation-REST, involving at least one sleep-related variable, was conducted in the databases PubMed, Google Scholar, Web of Science and PsychINFO. Thirteen full-text articles met the inclusion criteria and were considered for eligibility. Nine were included in the current review. The methodological quality of the studies was assessed using a structured checklist, and a standard data extraction sheet was used to summarize the ratings. Results: In all included studies, flotation-REST demonstrated beneficial effects on sleep, both in clinical and nonclinical samples. In two studies, the effects were maintained 4 or 6 months post-treatment. The quality of the sleep outcome measures were, however, low in most studies, particularly regarding the participants' nightly sleep habits, self-reported sleep problems and insomnia diagnosis. Conclusions: Flotation-REST may be a promising treatment for insomnia symptoms, but more controlled studies with established sleep measures, and on populations with clinically verified insomnia, are needed.

Background: New troublesome drug trends constitute a challenge for public health. Sweden has the second highest drug-related mortality rate in Europe. This calls for an investigation into the help-seeking attitudes of young adults to early middle-aged individuals asking how they would act in acute drug-related emergency or overdose situations. Methods: In total, 1232 individuals com- pleted an online survey promoted on Sweden’s largest discussion forum Flashback.org. Their free- text responses were analysed according to inductively generated categories. Results: Around 60% of the sample would act as expected and contact emergency care without hesitation. However, approximately 32% of the sample showed palpable resistance and would put off seeking help and use emergency care only as a last resort due to, for example, fear of legal repercussions and stigma. Moreover, 8% displayed a total lack of confidence in public healthcare and would avoid it at all costs or entirely disregard it as an option due to the alleged risk of negative consequences and expe- rienced restrictions on their personal freedom. Conclusions: While the inevitable criminalisation and stigmatisation associated with Sweden’s “zero tolerance” drug policy putatively serve as deterrents to drug use, our results demonstrate that these measures may also contribute to attitudes which discourage help-seeking. Such attitudes may at least partly explain the growing and comparatively high number of drug-induced deaths. Therefore, attitudinal and structural barriers to acute help-seeking in drug-related emergency situations should be acknowledged and investigated further in order to minimise harm.

Background: Psychedelic microdosing is the trending practice of using tiny repeated doses of psychedelic substances to facilitate a range of supposed benefits. With only a few published studies to date, the subject is still under-researched, and more knowledge is warranted. Social media and internet discussion forums have played a vital role in the growing visibility of the microdosing phenomenon, and the present study utilized YouTube contents to improve comprehension of the microdosing practice as well as the social interactions and discussions around microdosing. Methods: Microdosing self-disclosure in YouTube videos and their following comments were qualitatively analyzed by inductive thematic analysis. Various software was utilized to enable gathering and sorting relevant data. Results: Microdosing of psychedelic substances, primarily LSD and psilocybin, was used for therapeutic and enhancement purposes, and predominantly beneficial effects were reported. Many different applications and outcomes were discussed, and therapeutic effects for depression appeared especially noteworthy. Intentions for use were recognized as an influencing factor for the progression and outcomes of microdosing. The function of social interactions was mainly to discuss views on the microdosing phenomenon, strategies for optimal results, minimize risks, and share emotional support. Conclusions: Potentially, microdosing could provide some of the same benefits (for certain conditions) as full-dose interventions with less risk of adverse reactions related to the sometimes intense experiences of higher doses. Microdosing may well also mean additional benefits, as well as risks, through the repeated exposure over extended periods.

Background

The increasing number of legally ambiguous and precarious Novel Psychoactive Substances (NPS) constitutes a challenge for policy makers and public health. Scientific and more in-depth knowledge about the motivations for using NPS is scarce and often consist of predetermined, non-systematic, or poorly described reasons deduced from top-down approaches. Therefore, the aim of the present study was to explore and characterize the users’ self-reported reasons for NPS use inductively and more comprehensively.

Methods

The self-reported reasons of a self-selected sample of 613 international NPS users were collected via an online survey promoted at the international drug discussion forum bluelight.org and later analyzed qualitatively using inductive thematic analysis.

Results

The analysis showed that the participants used NPS because these compounds reportedly: 1) enabled safer and more convenient drug use, 2) satisfied a curiosity and interest about the effects, 3) facilitated a novel and exciting adventure, 4) promoted self-exploration and personal growth, 5) functioned as coping agents, 6) enhanced abilities and performance, 7) fostered social bonding and belonging, and 8) acted as a means for recreation and pleasure. The consumption of NPS was also driven by 9) problematic and unintentional use.

Conclusion

The present study contributed to a more comprehensive understanding of the users’ own and self-reported reasons for using NPS, which needs to be acknowledged not only in order to minimize drug related harm and drug user alienation but also to improve prevention efforts and reduce the potentially counter-intuitive effects of strictly prohibitive policies.

Among the anxiety disorders Generalized Anxiety Disorder (GAD) is currently the most treatment resistant, suggesting that treatment protocols could be enhanced. A promising treatment of GAD is flotation-REST (Restricted Environmental Stimulation Technique), which in earlier studies has been shown to alleviate symptoms in GAD. Although, research on flotation-REST as a treatment of GAD has shown promising results no study has explored how the treatment is experienced. By applying a phenomneological perspective the present study aims to characterize the experience of undergoing flotation-REST treatment while suffering from GAD. Nine participants with GAD, as defined with self-report measures, participated. Data was collected by semi-structured interviews that were conducted after the completion of a twelve session treatment profram with flotaiton-REST. The Empirical Phenomenological Psychological (EPP) method was usedfor gathering and analyzing the data. The analysis resulted in six themes that characterize the experience of undergoing a flotation-REST treatment while having GAD: (1) obstacles in treatment, (2) a relaxed and safe vantage point, (3) non-ordinary states of consciousness, (4) connecting with oneself, (5) new attitudes and coping strategies, (6) enhanced life-quality. The results highlights that flotation-REST treatment of GAD was experienced as a comprehensive processes that were both challenging and pleasant. The results indicated that the method positively affected symptoms and the core issue associated with GAD on an experiential level. The present study also genereated some initial understanding regarding potential mechanisms that migh mediate and maintain positive treatment effects when flotation-REST is applied as an intervention of GAD. 

Background: Treatment resistant cluster headache and migraine patients are exploring alternative treatments online. The aim of this study was to improve comprehension regarding the use of non-established or alternative pharmacological treatments used by sufferers of cluster headaches and migraines.

Methods: A qualitative thematic analysis of the users’ own accounts presented in online forum discussions were conducted. The forum boards https://shroomery.org/, http://bluelight.org, and https://clusterbusters.org/ met the inclusion criteria and were used for the study.

Results: The analysis resulted in six themes: a desperate need for effective treatments; the role of the forum—finding alternative treatments and community support; alternative treatment substances; dosage and regimens; effects and treatment results; and adverse effects. The results provide an insight into why, how, and by which substances and methods sufferers seek relief from cluster headache and migraines.

Conclusions: These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives. The forum discourse mainly revolved around maximizing treatment results and minimizing potential harms. 

Aim: The purpose of this qualitative study was to investigate the effects experienced by users of a novel psychoactive substance, the benzodiazepine flubromazolam, by analysing users' own accounts on the Swedish forum Flashback.org. Method: A thematic analysis of anonymous self-reports published on the forum was performed and generated five general themes describing effects and experiences by flubromazolam users. Results: The themes which emerged were: Onset and duration, Desired effects, Adverse effects and addiction, Loss of control, General estimations and evaluations. The main reported characteristics of flubromazolam were heavy hypnotic and sedative effects, long-lasting amnesiac effects and the rapid development of tolerance. Flubromazolam was also anxiolytic and acted as a muscle relaxant for many users. Some users experienced euphoria or intense wellbeing. Other prominent characteristics were loss of control (leading to poor choices and actions, with unpleasant consequences) and long-lasting, often severe withdrawals. There were also serious incidents where users had been admitted to hospital, acute psychiatric treatment or taken into custody by the police. Conclusion: Flubromazolam appears to be a highly addictive and precarious benzodiazepine with many, possibly severe, side effects. The substance is generally described as very potent and with long-lasting effects. Memory loss and loss of control are common adverse effects, and withdrawals appear to be severe for many users

Several hundred new synthetic drugs, novel psychoactive substances (NPS) or “legal highs” have in recent years appeared on the drug market. These can effortlessly be obtained from on-line vendors, offering an easy access to a plethora of new and untested substances, often with unknown or dangerous effects. Several different attempts to reduce the availability of NPS and to prevent accidents and fatalities have been applied by governments around the world. Nonetheless this complex and constantly evolving situation provides palpable dilemmas and challenges to legislators and prevention strategists. One unintended consequence from prohibition and current drug policies occurs when possibly more precarious substances are used to substitute older and more well-known illicit drugs; so called “substance displacement”. We have performed extensive research on the use of NPS, by analyzing Internet resources (drug discussion forum, on-line questionnaires), and published several NPS studies. During our research we observed how substance displacement is a common issue, with implications for both clinical practices, drug prevention strategies, as well as for legislators. In the present review we discuss two common themes of substance displacement: 1) Synthetic cannabinoids replace herbal cannabis, and 2) Different attempts for self-medication using NPS. Incitements for substance displacement, that exposes the user to possibly more harmful substances, are founded both in legislation (availability of substances and fear of legal repercussions) as well as from certain policies or cultural perceptions of various medical conditions. We offer no obvious solutions to these complications, but would like to contribute to awareness of how these factors effects drug users and how measures intended to reduce harm in many cases have the opposite effects. Further studies on the divergent motivations and different groups of NPS users are highlighted as imperative to find new and realistic solutions going forward.