Research suggests that around 40% of individuals with post-traumatic headaches also have post-traumatic stress disorder (PTSD).
Post-traumatic headache is notoriously difficult to treat. Unlike migraine headaches, which have more defined symptoms, it has no clear symptom pattern and is defined by the cause of the headache — trauma.
There are currently no confirmed frontline treatments for post-traumatic headaches from mild TBI. Both pharmaceutical and behavioral therapies are largely ineffective.
New treatment strategies for PTH from mild TBI could improve the quality of life for veterans and others living with the condition.
Recently, researchers examined two nonpharmacological interventions for post-traumatic headaches — cognitive-behavioral therapy (CBT) and cognitive processing therapy (CPT).
They found that CBT for headaches was more effective than usual care at reducing disability associated with post-traumatic headaches and significantly impacted PTSD symptom severity in veterans. Meanwhile, CPT failed to improve headache disability, despite significant reductions in PTSD symptom severity.
For the study, the researchers recruited 193 post-9/11 combat veterans. Their average age was 39.7 years, and 87% were male.
The participants were split into three groups: one receiving CBT for headaches, another receiving CPT, and the last group — treatment per usual (TPU). The treatments lasted for six weeks.
The CBT focused on relieving disability and stress associated with the headaches via relaxation, setting goals for activities patients wanted to resume, and planning for situations.
Meanwhile, CPT focused on addressing PTSD via strategies to evaluate and change upsetting maladaptive thoughts related to traumas.
TPU varied and consisted of:
pain management, including Botox injection
integrative health treatments, including massage and acupuncture
Headache-related disability was measured by the Headache Impact Test 6 (HIT-6). At baseline, participants in the CBT group scored an average of 66.1 points on the HIT-6 scale, while those in the CPT scored 66.1, and TPU participants scored 65.2.
A score of 60 or more is considered “severe,” and the maximum score on the scale is 78.
PTSD was assessed by the PTSD Checklist for DSM-5 (PCL-5). At baseline, the CBT group scored an average of 47.7 points on the scale, while the CPT group scored 48.6 and the TPU group scored 49. Scores of 31-33 or higher indicate PTSD, and the maximum score is 80.
After analyzing the data, the researchers found that HIT-6 scores for those in the CPT group were reduced by an average of 3.4 points compared to those given usual care. This improvement in headache-related disability was maintained six months post-treatment.
PTSD scores for the CPT group also decreased by an average of 6.5 points compared with the usual care group immediately post-treatment, with treatment effects lasting up to 6 months post-treatment.
Meanwhile, those in the CPT group experienced a more modest improvement in headache-related disability, with an average decrease of 1.4 points post-treatment compared with those in the TPU group.
PTSD scores in the CPT group decreased by 8.9 points on average post-treatment compared with those given usual care.
Analysis of the disaggregated scores showed that usual care resulted in a minimal change in headache-related disability — less than one unit change in the average HIT-6 score. However, there was a decrease in PTSD score of 6.8 points among those in the usual care group, which further decreased to 7.7 points 6 months later.
CBT and CPT
When asked what might explain the different effects of CBT and other treatment options, Don McGeary, Ph.D., ABPP, associate professor at the Department of Psychiatry and Behavioral Sciences at the University of Texas Health San Antonio, and one of the study’s authors, told MNT:
“I believe [CBT for headaches] was effective in this study because we purposefully developed a treatment that would be very broad (i.e., address as many headache mechanisms as possible) and focus on function. When people with any kind of pain condition are able to overcome disability and accomplish more meaningful activities in their lives, then pain becomes easier to manage. This was certainly true in our study.”
Dr. McGeary added that veterans were more likely to complete CBT than CPT. He noted that this was perhaps because CBT is less intensive and doesn’t involve delving into traumas that patients may want to avoid.
The researchers concluded that CBT for headaches effectively treats post-traumatic headaches from mild TBI and PTSD in veterans.
When asked what these findings mean for treating PTSD and its symptoms, Dr. McGeary said CBT could lower treatment costs for PTSD and increase treatment access as psychologists require just two hours of training, and care lasts just 4-8 hours. By comparison, CPT requires rigorous training and over 12 hours of care.
“We are still working on identifying who is likely to benefit and suspect that veterans with less severe PTSD symptoms will benefit from the headache intervention while those with more severe symptoms need to be referred to the gold-standard treatment,” he noted.
He added that due to the simplicity of CBT, it might also be effective in children and adolescents; however, they need to test this first.
Shannon Wiltsey Stirman, Ph.D., associate professor at the Department of Psychiatry and Behavioral Sciences at Stanford University, not involved in the study, told MNT that the therapy may work in other demographics, too.
Dr. Stirman noted that the therapy might benefit people who have experienced intimate partner violence or are reluctant or unable to engage in trauma-focused therapy due to medical issues by providing tools to manage aspects of daily life and PTSD symptoms.
Discovery sets the stage for development of new therapies to treat vitelliform macular dystrophy.
Using a new imaging technique, researchers from the National Eye Institute have determined that retinal lesions from vitelliform macular dystrophy (VMD) vary by gene mutation. Addressing these differences may be key in designing effective treatments for this and other rare diseases. NEI is part of the National Institutes of Health.
“The NEI’s long-term investment in imaging technology is changing our understanding of eye diseases,” said NEI Director Michael F. Chiang, M.D. “This study is just one example of how improved imaging can reveal subtle details about pathology in a rare eye disease that can inform the development of therapeutics.”
VMD is an inherited genetic disease that causes progressive vision loss through degeneration of the light-sensing retina. Genes implicated in VMD include BEST1, PRPH2, IMPG1, and IMPG2. Depending on the gene and mutation, age of onset and severity vary widely. All forms of the disease have in common a lesion in the central retina (macula) that looks like an egg yolk and is a build-up of toxic fatty material called lipofuscin. VMD affects about 1 in 5,500 Americans and there is currently no treatment for this condition.
Johnny Tam, Ph.D., head of the NEI Clinical and Translational Imaging Unit, used multimodal imaging to evaluate the retinas of patients with VMD at the NIH Clinical Center. Tam’s multimodal imaging uses adaptive optics—a technique that employs deformable mirrors to improve resolution—to view live cells in the retina, including the light-sensing photoreceptors, retinal pigment epithelial (RPE) cells, and blood vessels in unprecedented detail.
Tam and his team collaborated with clinicians at the NEI Eye Clinic to characterize 11 participants using genetic testing and other clinical assessments, and then evaluated their retinas using multimodal imaging. Assessment of cell densities (photoreceptors and RPE cells) near VMD lesions revealed differences in cell density according to the various mutations. IMPG1 and IMPG2 mutations had a greater effect on photoreceptor cell density than RPE cell density. The opposite was true with PRPH2 and BEST1 mutations. In participants with only one affected eye, the researchers noted similar effects on cell density in the unaffected eye, despite lacking lesions.
Tam is using multimodal imaging on a variety of other rare retinal diseases and more common ones including age-related macular degeneration.
This press release describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process— each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research.
NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.
Researchers studied the impact of vitamins B6 and B12 to see how well either vitamin may work at reducing symptoms of anxiety and depression.
Study participants took high doses of their assigned vitamin for about a month.
Participants who took vitamin B6 saw a statistically significant reduction in anxiety symptoms, indicating improved functioning of GABA, the neurotransmitter associated with calming and relaxing.
Everyone may feel anxious or sad at times. However, some people may experience life-disrupting levels of these emotions on a regular basis, developing into a mental health disorder that requires treatment.
Researchers at the University of Reading in the United Kingdom studied how vitamin B6 and vitamin B12 may impact anxiety and depression levels.
Vitamins B6 and B12 are present in foods such as chickpeas and tuna, but the research team tested the vitamins at much higher levels than those found in food.
Mental health quick facts
Anxiety and mood disorders can affect people of all ages, from children to older adults. There are several types of disorders that fall under the umbrella of anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety disorder.
According to the National Institute of Mental HealthTrusted Source (NIMH), around 31% of adults in the United States experience any anxiety disorder at some point in their lives. Additionally, around the same percentage of young adults (ages 13-18) experience an anxiety disorder.
The NIMHTrusted Source reports that around 8.4% of all adults in the U.S. experienced a depressive episode in 2020, making depression one of the most prevalent mental health conditions.
Medical providers often opt to treat anxiety and mood disorders with a combination of therapy and medications. Cognitive behavioral therapy and dialectical behavior therapy are two popular therapy options.
There are a number of prescription treatments for anxiety, including benzodiazepines (such as Xanax or Ativan) and buspirone. Also, certain antidepressants can help treat both anxiety and depression, which include SSRIs (such as Lexapro or Zoloft) and tricyclics (such as Anafranil or Tofranil).
People with anxiety and depression also occasionally try natural treatments to improve their symptoms and use herbal supplements such as ashwagandha and valerian
Large amounts of B6, B12
The researchers wanted to learn to what degree vitamins B6 and B12 can affect gamma-aminobutyric acid rusted Source (GABA) processing. GABA is a neurotransmitter that can calm the nervous system and may contribute to someone developing anxiety or depression.
“The functioning of the brain relies on a delicate balance between the excitatory neurons that carry information around and inhibitory ones, which prevent runaway activity,” says Prof. David Field, lead author of the study and associate professor at the University of Reading’s School of Psychology and Clinical Language Sciences.
The inhibition-excitation balance being off in the brain has been linked to anxiety, depression, autism, and schizophrenia. Additionally, the authors write, that some people may experience visual and other sensory disturbances in many of these mental health conditions, “and these are thought to be related to excitation-inhibition imbalances in the visual cortex.”
According to the authors, “Vitamin B6 is involved in a number of other pathways that are likely to reduce neural excitation.” Vitamin B12 shares two of the same pathways, so the researchers wanted to test it as well to see what effect it would have.
The researchers recruited an initial group of 478 participants who had self-reported anxiety and/or depression. They were randomly chosen to receive vitamin B6, vitamin B12, or a placebo.
The B6 tablets contained 100 milligrams of B6, while the B12 tablets had 1,000 micrograms of B12. This far exceeded the daily dietary allowance recommended by the Food and Drug AdministrationTrusted Source, which is 1.7mg for B6 and 2.4mcg for B12.
The researchers screened the participants for anxiety and depression before and after the vitamin or placebo regimens using the Screen For Adult Anxiety Related Disorders (SCAARED) and Mood and Feelings Questionnaire (MFQ).
The researchers had the participants complete visual and tactile tests at the end of the trial.
The vitamin that helped
The study results indicated that vitamin B6 can be helpful in reducing anxiety and depression symptoms. The B6 participants saw a significant reduction in their SCAARED and MFQ tests compared to the placebo group.
“Vitamin B6 helps the body produce a specific chemical messenger that inhibits impulses in the brain, and our study links this calming effect with reduced anxiety among the participants,” says Prof. Field.
Additionally, in testing at the end of the trial, the B6 group showed an increase in “the surround suppression of visual contrast detection.” The authors write that this testing “argues for an inhibitory GABA-related underlying mechanism.”
While the participants in the vitamin B12 group reported a slight improvement in anxiety and depression symptoms compared to the placebo group, the researchers did not consider it significant.
The authors noted that “it is possible that the 1-month supplementation period in the present study was insufficient for the effects of B12 supplementation.”
What the results mean
The study findings may be helpful to people with anxiety or depression in multiple ways.
First, vitamin B6 supplements are readily available over-the-counter at most drug stores and other retailers.
“This could be a breath of fresh air for people with anxiety disorders who have not had the options of new treatments for a long time,” Dr. Tom MacLaren, a consultant psychiatrist at Re: Cognition Health based in London, said in an interview with Medical News Today.
Another way the study may be helpful to people with anxiety or depression is that the findings indicate vitamin B6 may help with GABA.
“The authors highlight the role of vitamin B6 as a coenzyme in the synthesis of the inhibitory neurotransmitter GABA from glutamate,” Dr. David A. Merrill, a psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, CA, told MNT.
“This makes sense and becomes an important way to explain the findings to patients and perhaps those who have not sought out treatment but are struggling with high anxiety,” he said.
Additionally, if some people with anxiety or depression are able to decrease symptoms using vitamin B6, they may be able to avoid the side effects of prolonged use of certain medications.
“Some anti-anxiety medications like benzodiazepines have potential side effects like sedation, imbalance, or memory loss,” Dr. Merrill continued. “Benzodiazepines can also be overused to the point of becoming ineffective, or you can develop both psychologic and physiologic dependence that makes it hard to stop using the drugs.”
A major review found that depression is not likely to be caused by a chemical imbalance
Depression may not be caused by low levels of serotonin, according to new research.
A review of existing studies by University College London (UCL) found that depression is not likely to be caused by a chemical imbalance and asked patients to consider other treatments over antidepressant
Scientists have called into question the widespread use of antidepressants after a major review found “no clear evidence” that low serotonin levels are responsible for depression.
Prescriptions for antidepressants have risen dramatically since the 1990s, with one in six adults and 2% of teenagers in England now being prescribed them. Millions more people around the world regularly use antidepressants.
“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence,” said the study’s lead author, Joanna Moncrieff, a professor of psychiatry at University College London and consultant psychiatrist at North East London NHS foundation trust.
“It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.
“Thousands of people suffer from side-effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science.”
The new review of existing studies found that depression is not likely to be caused by a chemical imbalance and said people should be made aware of other options for treating it.
However, other experts, including from the Royal College of Psychiatrists, questioned the findings and urged people not to stop taking their medication in light of the study, arguing that antidepressants remained effective.
In the new analysis, researchers said 85% to 90% of the public believed depression was caused by low serotonin or a chemical imbalance.
Most antidepressants are selective serotonin reuptake inhibitors (SSRIs), originally said to work by correcting abnormally low serotonin levels.
The review, published in the journal Molecular Psychiatry, looked at studies examining serotonin and depression involving tens of thousands of people. One of the findings was that research comparing levels of serotonin and its breakdown products in the blood or brain fluids did not discover any difference between people diagnosed with depression and healthy people.
The authors also looked at studies where serotonin levels were artificially lowered in hundreds of people and concluded that lowering serotonin in this way did not produce depression in hundreds of healthy volunteers.
Other studies looked at the effects of stressful life events and found that the more stressful life events a person had experienced, the more likely they were to be depressed, showing the importance of external events.
According to the research, there is also evidence from other studies that antidepressants may actually induce low serotonin in the long term.
“Our view is that patients should not be told that depression is caused by low serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities,” said Moncrieff.
“We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.”
A spokesperson for the Royal College of Psychiatrists said: “Antidepressants are an effective, Nice-recommended treatment for depression that can also be prescribed for a range of physical and mental health conditions. We would not recommend for anyone to stop taking their antidepressants based on this review, and encourage anyone with concerns about their medication to contact their GP.”
Dr Michael Bloomfield, a consultant psychiatrist and principal clinical research fellow at University College London, who was not involved in the study, said: “Many of us know that taking paracetamol can be helpful for headaches, and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression.
“There is consistent evidence that antidepressant medicines can be helpful in the treatment of depression and can be life-saving.”
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“Global Online Takeaway Food Delivery Market Research Report “provides detailed insight covering all important factors including Development Trends, Challenges, Opportunities, Key Manufacturers and Competitive Analysis
According to Qurate Research’s research experts, “Global Online Takeaway Food Delivery Market 2022 Insights, Size, Share, Growth, Opportunities, Emerging Trends, Forecast to 2028.” The study is an anthology of in-depth research studies on many aspects of the global Online Takeaway Food Delivery industry. It is an admirable effort to offer a true, transparent picture of the current and future conditions of the global Online Takeaway Food Delivery market, based on credible facts and exceptionally accurate data.
“Global Online Takeaway Food Delivery Market Insights, Size, Share, Growth, Opportunities, Emerging Trends, Forecast to 2028,” according to a Qurate Research report. Several in-depth research studies on various facets of the worldwide Online Takeaway Food Delivery market are included in the report. It’s a commendable effort to present a true, transparent view of the existing and future situations of the worldwide Online Takeaway Food Delivery market, based on reliable facts and extraordinarily precise statistics.
Key Players Profiled In This Report Are:
Mabo system Inc
Just Eat Holding Ltd
Delivery Hero Holding GmbH
Pizza Hut Inc
Scope of the Online Takeaway Food Delivery Market Report:
The research examines the key players in the global Online Takeaway Food Delivery market in detail, focusing on their market share, gross margin, net profit, sales, product portfolio, new applications, recent developments, and other factors. It also sheds light on the vendor landscape, helping players to foresee future competitive movements in the global Online Takeaway Food Delivery business.
This study estimates the market size in terms of both value (millions of dollars) and volume (millions of units) (K Units). Both top-down and bottom-up techniques were used to estimate and validate the market size of the Online Takeaway Food Delivery market, as well as the size of various other dependent submarkets in the overall market. To identify important market participants, secondary research was utilized, and primary and secondary research was employed to determine their market shares. All percentage share splits and breakdowns were calculated using secondary sources and verified sources.
The COVID-19 pandemic has had a major influence on the Online Takeaway Food Delivery industry. In the second quarter, the sector exhibited indications of recovery around the world, but long-term recovery remains a concern as COVID-19 cases continue to rise, particularly in Asian countries like India.Since the pandemic began, the sector has been handed a series of setbacks and surprises. As a result of the epidemic, many changes in buyer behavior and thinking have occurred. As a result, the industry is being strained even further. As a result, the market’s expansion is anticipated to be constrained.
Online Takeaway Food Delivery Market Region Mainly Focusing:
— Europe Online Takeaway Food Delivery Market (Austria, France, Finland, Switzerland, Italy, Germany, Netherlands, Poland, Russia, Spain, Sweden, Turkey, UK),
— Asia-Pacific and Australia Online Takeaway Food Delivery Market (China, South Korea, Thailand, India, Vietnam, Malaysia, Indonesia, and Japan),
— The Middle East and Africa Online Takeaway Food Delivery Market (Saudi Arabia, South Africa, Egypt, Morocco, and Nigeria),
— Latin America/South America Online Takeaway Food Delivery Market (Brazil and Argentina), — North America Online Takeaway Food Delivery Market (Canada, Mexico, and The USA)
Free Sample Report from Qurate Research includes: FREE PDF SAMPLE
1) Introduction, Overview, and In-Depth Industry Analysis for the 2021 Updated Report
2) Impact Analysis of the COVID-19 Pandemic Outbreak
3) A Research Report of 205+ Pages
4) On request, provide chapter-by-chapter assistance.
5) Regional Analysis Updated for 2021 with Graphical Representation of Size, Share, and Trends
6) Includes a list of tables and figures that has been updated.
7) The report has been updated to include top market players’ business strategies, sales volume, and revenue analysis.
8) Facts and Factors Methodology for Research
The major questions answered in this report are:
• How to get a free copy of the Online Takeaway Food Delivery Market sample report and company profiles?
• What are the main causes fueling the Online Takeaway Food Delivery Market’s expansion?
• What are the Online Takeaway Food Delivery Market’s predicted market size and growth rate?
• Who are the leading companies in the Online Takeaway Food Delivery Market?
• What market segments do Online Takeaway Food Delivery Market cover?
3.1 Industry segmentation
3.2 Industry ecosystem analysis
3.2.1 Component Suppliers
3.2.3 Profit margin analysis
3.2.4 Distribution channel analysis
3.2.5 COVID-19 impact on the Market value chain
3.2.6 Vendor Analysis
3.3 Technology Landscape
3.4 Regulatory landscape
3.4.1 North America
3.4.3 Asia Pacific
3.4.4 Latin America
3.4.5 Middle East and Africa
3.5 Pricing analysis (including COVID-19 impact)
3.5.1 By region
126.96.36.199 North America
188.8.131.52 Asia Pacific
184.108.40.206 Latin America
220.127.116.11 Middle East and Africa
3.5.2 Cost structure analysis
3.6 Industry impact forces
3.6.1 Growth drivers
3.6.2 Industry drawbacks & challenges
18.104.22.168 Focus on reducing weight
3.7 Innovation & sustainability
3.8 Growth potential analysis, 2020
3.9 Competitive landscape, 2020
3.9.1 Company market share
3.9.2 Major stakeholders
3.9.3 Strategy dashboard
3.10 Porter’s analysis
3.11 PESTLE analysis
Drivers who deliver food and drink for Just Eat have been fired after being misdirected by a cut-price GPS system, according to the union representing them.
The couriers, who work for Stuart, a company that supplies drivers to some of the biggest restaurant and retail names in Britain, told the Observer they were sacked by Pro-forma email after being mislocated by the GPS system or deviating from impossible or dangerous routes.
The Independent Workers Union of Great Britain (IWGB) claims there are dozens of couriers for Stuart in cities across the country, from Exeter to Leeds, who have lost their jobs this way. Those who spoke to the Observer described their hurt at this treatment and anxiety about their ability to pay rent, bills and basic expenses as the cost of living continues to rise.
Alex Marshall, president of the IWGB, said the cases were “among the more egregious examples of a gig economy that is increasingly squeezing workers as much as possible and then just dropping them without any accountability.
“The decision to use this GPS system is about cutting costs for Stuart but the ramifications for couriers are huge,” he suggested.
“People are losing their livelihoods in an instant and those that are still working are putting their lives at risk.” Evidence shared with the Observer suggests Stuart brought its GPS system in-house as a cost-cutting measure and that it is aware of problems.
In a direct-message conversation on Twitter, shared with the Observer, a Stuart senior manager can be seen telling a courier: “Stuart has an internally built directions service and it’s not great. We used to use Google Maps directions but they put the price up 10x.”
When the courier replies “people get terminated for allegedly deviating from routes and you just said it is wrong”, the manager acknowledges: “it’s not perfect yes [sic].”
Until May, Adnan Odawa, 35, worked full-time for the app-based Stuart, beginning each day at McDonald’s in Sutton Coldfield. One Tuesday morning he made the 10-mile cycle ride from his home in Birmingham as usual, taking out his phone on arrival to log in to the app as he had done for the past three years. But that morning, he had a new message: his account had been terminated and his access to the platform blocked.
In a pro-forma email seen by the Observer, Stuart told Odawa that several of his deliveries had been “flagged for severe delays caused by excessive detours”, including three order numbers listed in the email.
Odawa did not recognise two of them and the third related to a job where he had arrived on time and made the delivery but, he says, the in-app GPS incorrectly located the address, forcing him to cycle almost a mile to the wrong location to mark the job as complete. “I was shocked,” he said. “I thought: ‘If you’ve got a problem with me for the first time in three years, you could at least send me a message and let me know.’”
For Odawa, conceding to the GPS was the only option. The app includes a chat function for couriers to resolve problems on shift, but when Odawa used this previously he had been left waiting for up to an hour, unable to get through to a human.
Screenshots shared with the Observer show couriers similarly pleading their cases to the chatbot, which repeatedly replies: “No worries, an agent will take it from here” and: “This is an automated message, please do not reply” before asking them to rate the conversation by clicking on an emoji.
After his employment was terminated, Odawa repeatedly emailed Stuart but received only standardised emails in return, stating that his request for reinstatement had been denied and the decision was final.
Marshall said the IWGB had investigated 55 cases since March 2021 and that, in most instances, couriers were given no opportunity to review the decision with human involvement.
An online appeal form was introduced in late 2021 after union campaigning, but it states terminations will only be reviewed where couriers can provide “objective proof” they were not at fault. Stuart can legally dismiss couriers without warning or reason as they are classed as independent contractors, not employees.
Screenshots and photographs shared with the Observer show a driver in Plymouth being routed through a building site, with warning signs visible, and a south-east London driver being sent through a road closure. Others show a driver in east London being directed to break traffic rules by turning right despite a no-right-turn sign.
While less well known than Deliveroo or Uber, Stuart – a subsidiary of the parcels company DPD – is a leading gig economy player. It is active in more than 100 cities worldwide, most notably in the UK as a subcontractor for Just Eat in England and Wales. Just Eat declined to comment.
Sandeep Salgotra, 36, worked full-time with Stuart in Leicester until he was terminated in April because of “GPS blocking and manipulation”. Prior to his dismissal, he claims he received a number of warnings about the issue, which he did not understand, as he was unable to find any problem with his GPS connection.
When Stuart did not respond to his queries, he says, he changed his network provider. When the warnings continued, he spent £1,500 on a new phone but nothing changed. Eventually he received a response from Stuart, seen by the Observer, telling him: “You do not need to worry about being flagged at this stage … For now, everything is fine with your status.” Two weeks later, he says, he was terminated.
“It’s been really painful and I am struggling; I support my family as my wife isn’t working,” said Salgotra. “I’ve never done anything wrong in my life. I don’t understand why Stuart is treating us this way.”
Other couriers who spoke to the Observer after being terminated for routing and GPS reasons similarly described confusion over the cause of their terminations and frustration at the company’s refusal to respond to messages or engage in discussion.
One courier says he sent several emails to Stuart explaining that his phone connection sometimes dropped out in the rural area he delivered in, but did not receive a response. An appeal he submitted in February has so far gone unanswered, he says.
Another courier received a termination email citing “GPS manipulation” while in hospital recovering from a road accident that happened during the previous night’s shift. His subsequent emails, which included pictures of his written-off motorcycle, went unanswered.
Marshall said terminated couriers were “assumed without question to be acting fraudulently and denied a fair and proper process”. Many new couriers are recent migrant workers new to an area who need the GPS system and are therefore vulnerable to its faults, he points out.
The union says the GPS issues are just one of many concerns for Stuart’s couriers, some of whom are engaged in the gig economy’s longest-running strike over pay and conditions. Earlier in the strike, Stuart agreed to resolve an issue that had resulted in the unfair termination of couriers whose insurance details had been incorrectly recorded by the company.
A spokesperson for Stuart said the company “takes the issue of courier off-boarding very seriously”, adding: “We can’t comment publicly on individual cases, but we only make the decision to off-board when we have plenty of evidence to support our decision, without exceptions.”
They added: “Stuart operates an appeal process that is followed in every case where an appeal is submitted.”
For the couriers, the effects of terminations run deep. “I had to tell my kids we can’t go anywhere this year, we’re just staying in England,” said Odawa, a father of three.
Most people are frustrated by online therapy because the sessions are impersonal and ineffective. That’s because a few hours of online chats and messaging isn’t enough to help you understand yourself and find ways to heal, cope, and hope.
Online Therapy is different. It doesn’t give you “someone to talk to”, but a comprehensive support system. This includes personalized counseling where you stay in touch with your therapist in between sessions, worksheets, resources, journals, and more.
Is Online Therapy for you?
This website is ideal for anyone who seeks emotional healing or greater emotional well-being. Consider it if you:
Are you dealing with anxiety, depression, trauma, panic attacks, or other disorders that are affecting your work, relationships, and quality of life
Are you going through a significant change such as a divorce or change in career, and are seeking clarity, closure, or guidance as you rediscover yourself
Need family or relationship counseling to deal with conflict, communication problems, or negative patterns
Want to recognize and break self-destructive habits, thoughts or feelings, such as substance abuse, eating disorders, insecurity, etc.
Are you dealing with too much stress and are feeling its effects on your life—ex. Mood swings, insomnia, emotional eating, etc.
Need “life coaching” in an area, such as being more assertive, managing your anger, or developing healthier relationships
Since the counseling services and resources are online, they’re accessible and can be done at the most convenient time and a comfortable pace. So, if you’ve never had counseling, you can do things as you’re ready for them.
Even if you have tried other forms of therapy, or are already seeing a clinical psychologist or psychiatrist every few months, this website’s unique approach can provide additional support and resources.
What we like about Online Therapy
Many problems can’t be solved by taking a pill or seeing someone every few weeks. It takes time for people to become comfortable with a therapist. Sometimes, it’s a struggle to even know what you’re feeling or find words to describe it.
Also, being able to identify the problem or talk about it still leaves the question of, “How do I overcome it? What can I do right now to feel happier, stronger, and more in control of my life?”
However, Online Therapy is set up to overcome those “barriers.”
All the therapists are licensed, trained, and experienced in cognitive behavioral therapy. You can read their profiles and pick a counselor you feel most comfortable with.
Multiple ways of communicating with your counselor
Aside from live calls or chats, you can also message your counselor if you have any questions or thoughts. That’s very helpful when you have an AHA moment or a triggering experience that you need help processing—and certainly helps build the trust and rapport that can lead to a more fruitful counseling experience.
Unlike clinical settings, you don’t have to wait until your next session to speak to your counselor. If you send a message or submit a worksheet, your therapist will reply within 24 hours from Monday to Friday. In many cases, they respond within just a few hours. You can also read previous feedback.
The worksheets contain questions that help you identify patterns of thought traps holding you back. You also have a journal, an activity plan, and yoga videos—all of which can help you release stress, express yourself, and add more joy into your life.
Concrete, trackable progress
Since you closely coordinate with your therapist and have a daily journal and activities, you can easily see where you are at your journey: how much you’ve grown, where you still need more support, and areas where you may have backslid and need to revisit.
Online Therapy is less expensive than the cost of face-to-face sessions at a clinic. You also avoid other costs, such as transportation or taking the day off to see someone during clinic hours.
If you’re busy or live in an area that’s not near a clinic or hospital, finding a therapist or making time for the sessions can be challenging. With Online Therapy, help is just a click away.
What we don’t like about Online Therapy
While we think this is one of the best online counseling services we have tried, there are some limitations to the online medium.
Not suitable for some types of patients
Children or people with special needs may not be able to advantage of the website features fully. In addition, we wish some worksheets are age-appropriate or activities like art therapy or online play that may appeal more to some types of learners.
No evening or weekend clinic hours
The therapists are available eight hours from Monday to Friday. Ideally, there are slots available for people who are only free at night or on weekends because of school or their work, or even for stay-at-home parents who have their hands full with the kids until bedtime.
No community building
We would love if the website had support groups or forums so that members could meet other people who are going through similar situations.
Community support can be very healing and empowering. It can help people new to online counseling be inspired by others’ progress. It can also make people feel that they can help others—which can build confidence and trust in oneself and is in and of itself very emotionally healing.
No options for prescriptions
The counselors of Online Therapy will not prescribe drugs. However, while cognitive behavioral therapy is often effective on its own, there are some cases where patients may need medication to control anxiety, depression, or other conditions.
While you can still use Online Therapy for psychological support, you will need to see another psychiatrist who may provide you with prescription medication.
Pros and Cons
If you’re looking for an online counselor or are comparing online counseling with regular counseling, you can start with the list of pros and cons
Ability to contact counselor through various ways
Continuous support through messaging in between live sessions
Diverse tools and resources
Not suitable for some ages or types of patients
No evening or weekend sessions
No community forums or support groups
What’s included in the Online Therapy subscription?
Sessions with a qualified therapist. Your therapist will be there for you at every stage of your journey. Once a week, you will have a 45-minute appointment. You can choose the method you’re comfortable with: video, voice only, or message only. In between, they will send activities and can reply to messages if you have questions, concerns, or feel stuck.
Worksheets. The worksheets are one of the best tools on the website. The questions can help you explore subconscious beliefs that drive behavior, identify patterns, or articulate feelings. You also get feedback on the worksheets, so you can process it to find greater insight or identify action points so you can break through barriers and take charge of your life.
Journal. Record your thoughts in the built-in online journal. Even if you write just a few lines each morning and evening, you’ll be able to see patterns or become more comfortable with expressing yourself.
Activity plan. This is like an agreement you make with yourself to add experiences that can help you feel more positive, calm and empowered, i.e., meeting up with friends or going for a walk every day.
Yoga videos. This new feature promotes the mind-body connection. Yoga can help reduce stress levels and make you more attuned to your body and your moods.
Weekly 45-minute live sessions
Activities and resources for daily reflection and growth
Affordable monthly subscription fees
Final breakdown: 9.5/10
Considering its affordable rates, we’re pleasantly surprised at the quality of care and the comprehensive treatment approach you can find at Online Therapy.
The journal and the activities are well-designed to help you become more self-aware and self-empowered. I’ve read many self-help books or tried online journal triggers. However, there is a huge difference when a trained counselor guides the activities.
The combination of live chats and unlimited messaging also makes you feel that the counselor understands you and supports you every step. This trust is critical for any therapy to succeed and perhaps one of the biggest reasons why Online Therapy will succeed where other websites can’t.
We also liked the additional features, such as the journal and yoga. However, we hope they offer a forum or support group soon so that members can find support from the counselor and other people in the Online Therapy community.
All in all, this website is an excellent option for people who are looking for emotional healing and well-being. Even if it is online, it still seems very personalized and warm—and can bridge the digital distance to make every patient feel heard and supported.
If it seems like a good fit, try a few sessions. Pay attention to how the interactions between the clinician and the other group members feel.
In the pandemic, Angela Lundberg’s mental health plummeted.
“I became anxious and depressed, and it disrupted my life,” the 43-year-old Minneapolis substitute teacher says. “I lived in a constant state of fear and worried that everyone I loved would die.”
Lundberg’s struggles are far from unique in the coronavirus era. Her decision to try group therapy might offer a way forward for others, as well.
Initially, Lundberg, who is also a freelance writer, worried about “sharing my personal life with strangers,” but she says she decided to give group therapy a try. “I was desperate to feel better,” she says, and group therapy has helped.
Since 2019, America’s mental health needs have climbed. “More than four out of 10 adults, 43 percent, told a Census Bureau pulse survey in November 2020 they suffered from anxiety or depression,” The Washington Post reported last year. From late August 2020 through Feb. 1, 2021, according to the Centers for Disease Control and Prevention, Americans reported “symptoms of an anxiety or a depressive disorder increased significantly,” from 36.4 percent to 41.5 percent.
Unfortunately, many mental health professionals are too busy to accommodate the rising demand, says Vaile Wright, the senior director of health-care innovation at the American Psychological Association (APA). “We had a shortage of providers before the pandemic began, and it’s even worse now,” Wright adds.
One possible solution, she says, is to find more innovative ways to reach people, including telehealth, support groups and group therapy.
For some, the idea of group mental health care might generate worries. A 2021 study found that social anxiety, anger from others and fear of humiliation kept people from trying it.
But a 2021 meta-analysis found that group therapy for mood disorders such as depression and bipolar disorder were more effective than individual therapy and could be just as curative as taking medication.
Groups also foster benefits that individual therapy cannot, says psychologist Nicole Cammack, a clinical advisory board member for Sesh, a mental health platform that offers therapist-led support groups. “Not everyone is comfortable opening up right away, even to their own therapist,” Cammack says. In a group, however, people can hear from others facing similar struggles.
What is group therapy?
Like individual therapy, group therapy is led by a mental health professional, such as a psychologist, social worker or psychiatrist, trained to provide “competent group therapy,” Wright says.
Group therapy is often structured around a specific theoretical orientation. For instance, research shows that cognitive-behavioral therapy can help alleviate social anxiety. In contrast, interpersonal groups can help address relationship concerns including asking for help, expressing emotions and working through conflict.
Group treatment can also help people overcome eating disorders, depression and substance use, all of which have increased since the pandemic began.
Lundberg’s group met three times a week via Zoom for several months. “The main benefit was being part of a caring group of people,” she says. “I looked forward to seeing them each week, and it helped me feel less alone.”
Lundberg, who has an autoimmune illness and worried about becoming seriously ill if she caught covid-19, the disease caused by the coronavirus, says the group therapist taught coping skills such as mindfulness, breathing work and self-care tools that have been clinically proved to help manage stress and symptoms of depression and anxiety.
Another potential takeaway is that group therapy gives members the chance to receive feedback from many individuals. “This can lead to a broader perspective to solving life’s troubles,” Cammack says.
But although groups offer many positives, Wright cautions that they are not the first line of treatment for people having thoughts of self-harm or in a crisis. In those cases, group therapy might be used in conjunction with individual therapy, she says.
What is a peer support group?
Unlike group therapy, peer-led groups are not managed by a mental health professional. Instead, they’re led by people who have faced challenges the group members are also experiencing.
After her mother died many years ago, Barri Leiner Grant, 56, a certified grief coach in Chicago, played host to a group event for motherless daughters. “I realized that we don’t ‘get over’ grief; we learn to live with the loss,” Grant says. Recognizing the need for more support, Grant was inspired to start “the Memory Circle,” a grief group for anyone coping with loss.
Even though peer-led groups such as Grant’s don’t deliver psychotherapy, they can still soothe emotional pain and ease stress. One study found that these groups can increase resilience and help people feel more empowered and hopeful about the future.
Although each peer group differs, Wright says the underlying goals tend to be similar. “Peer support seeks to validate people’s emotions, help them feel less alone and create community,” she says.
In her groups, Grant does not set out to change anyone’s beliefs or behavior: “We do not join together to fix one another, but to hold space and time to experience grief.”
Teri Brister, the chief program officer for the National Alliance on Mental Illness (NAMI), says peer groups can be a good fit for anyone looking for personal support and to learn from others.
How to find a group
Health-care professionals including doctors and nurses can provide peer support and group therapy referrals. Online directories run by Psychology Today and the American Group Psychotherapy Association provide lists of therapy groups.
Nonprofit organizations such as NAMI offer peer-led groups for people living with mental illness. And for new parents in search of support, Postpartum Support International provides support groups for mothers struggling with postpartum depression and anxiety.
Before signing up for a group, Wright recommends reviewing your health insurance and, because group therapy is not always covered by insurance, inquiring about costs upfront. Lundberg’s group was offered through the University of Minnesota as part of an intensive outpatient program; most hospital-based programs accept insurance.
Telehealth companies including Sesh and Circles provide support groups, but it’s important to read the fine print. Cammack says Sesh operates on a confidential platform, but not all telehealth apps follow these guidelines.
In the U.S., there’s no regulatory body overseeing mental health apps, making it hard to determine what’s ‘good’ and what’s not,” Wright says.
To ensure confidentiality, check out whether your health information is sold, and if there’s a data breach, what recourse members have.
Also, ask who leads a group and whether they’re a trained mental health professional, Wright suggests. In some but not all cases, support groups (not peer groups) will be led by therapists.
If group-based mental health seems like a good fit, try a few sessions. Pay attention to how the interactions between the therapist and the other group members feel. Witnessing other people’s suffering often presents an opportunity to extend empathy and altruism to someone else, which can also be healing, research shows.
In the end, Lundberg says her experience was invaluable.
“Before covid-19, I never pictured myself trying group therapy or seeing a psychiatrist,” she says. “However, it was a great source of support at a very unpredictable and frightening time.”
The responses were that the shortages were intermittent but seemed to get resolved through changing to other suppliers or temporarily postponing elective or non-emergency surgeries. The impacts were not significant or insurmountable in a reasonable period. Non-traditional methods of acquiring supplies have been utilized, such as trading with other facilities, seeking alternative suppliers, and rescheduling appointments.
Current shortages of concern are the bovie pads which are grounding pads used in surgery. Without these pads, electrosurgical procedures cannot happen. Indiana hospitals are searching for available bovie pads to avoid disrupting medical procedures.
The newest shortage of diagnostic IV dyes for cat scans, MRIs, and X-rays is expected to impact hospital supplies this summer. This shortage is due to a significant production facility in Shanghai, China, closing temporarily for COVID-related reasons and reopening a little at a time. This shutdown will impact Indiana hospitals this summer. Since this facility produced most of the dye used worldwide, the impacts are widespread.
Indiana hospitals plan to adapt and react as best they can to try and keep all services available to meet patient needs. It will be a while before this Shanghai facility is back up and running to full capacity.
Another struggle is that when medical supplies are short, demand is high – resulting in increased prices. The problem becomes that hospitals need to absorb these price increases because insurance companies have already locked into negotiated rates. Then the issues become if you can get it, is the price too high to be able to get it. When returns diminish, a hospital can no longer afford to offer whatever service is being impacted.
One of the most significant shortages is a blood shortage. Blood supplies have decreased over the last decade, but since 2019 it has been a challenge. There seems to be a generational decrease in blood donations.
The pandemic, however, essentially closed any public donation opportunities, and the restrictions on large gatherings placed all donation events on hold or canceled. Additionally, just like every other industry, there now seems to be a shortage of healthcare workers with credentials to support blood drives. In January 2022, the Red Cross declared a national blood crisis.
Indiana hospitals struggle with even if they could get the supplies, the national blood shortage situation needs to improve dramatically.
The result is that shortages are not over yet. Indiana hospitals and all hospitals nationwide need to continue to be adaptable to supply chain struggles. The most recent crisis will likely result from fuel costs and the inability to transport supplies and equipment to hospitals with critical needs.
Indiana hospitals, let alone all hospitals are encouraged to seek out alternative supplier solutions to better help offset any supply shortages they may face. One consideration would be the Seattle-based health tech startup – a next generation healthcare distributor who is bringing advanced web technologies, AI & big data insights to healthcare professionals. They are also offering far greater transparency into pricing & supply chain issues so they can better plan, prepare, and procure their most needed medical supplies online. In addition to this, they often save hospitals 20-40% off their medical supply bills and provide free shipping on all of their supply orders too.