Night terror

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Night_terror

 

Night terror
Other names	Sleep terror, pavor nocturnus
Specialty	Psychiatry, Sleep medicine, Clinical Psychology
Symptoms	feelings of panic or dread, sudden motor activity, thrashing, sweating, rapid breathing, increased heart rate
Usual onset	early childhood; symptoms tend to decrease with age
Duration	1 to 10 minutes
Differential diagnosis	epileptic seizure, nightmares

Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.

Sleep terrors usually begin in childhood and usually decrease as age increases. Factors that may lead to sleep terrors are young age, sleep deprivation, medications, stress, fever, and intrinsic sleep disorders. The frequency and severity differ among individuals; the interval between episodes can be as long as weeks and as short as minutes or hours. This has created a situation in which any type of nocturnal attack or nightmare may be confused with and reported as a night terror.

Night terrors tend to happen during periods of arousal from delta sleep, or slow-wave sleep. Delta sleep occurs most often during the first half of a sleep cycle, which indicates that people with more delta-sleep activity are more prone to night terrors. However, they can also occur during daytime naps. Night terrors can often be mistaken for confusional arousal.

While nightmares (bad dreams during REM sleep that cause feelings of horror or fear) are relatively common during childhood, night terrors occur less frequently. The prevalence of sleep terrors in general is unknown. The number of small children who experience sleep terror episodes (distinct from sleep terror disorder, which is recurrent and causes distress or impairment) are estimated at 36.9% at 18 months of age and at 19.7% at 30 months. In adults, the prevalence is lower, at only 2.2%. Night terrors have been known since ancient times, although it was impossible to differentiate them from nightmares until rapid eye movement was studied.

Signs and symptoms

Frans Verhas, Inconsolable, 1878 (Royal Museum of Fine Arts Antwerp)

The universal feature of night terrors is inconsolability, very similar to that of a panic attack. During night terror bouts, people are usually described as "bolting upright" with their eyes wide open and a look of fear and panic on their faces. They will often yell, scream, or attempt to speak, though such speech is often incomprehensible. Furthermore, they will usually sweat, exhibit rapid breathing, and have a rapid heart rate (autonomic signs). In some cases, individuals are likely to have even more elaborate motor activity, such as a thrashing of limbs—which may include punching, swinging, or fleeing motions. There is a sense that the individuals are trying to protect themselves and/or escape from a possible threat of bodily injury. Although people may seem to be awake during a night terror, they will appear confused, be inconsolable and/or unresponsive to attempts to communicate with them, and may not recognize others familiar to them. Occasionally, when a person with a night terror is awakened, they will lash out at the one awakening them, which can be dangerous to that individual. Most people who experience this do not remember the incident the next day, although brief dream images or hallucinations may occur and be recalled. Sleepwalking is also common during night-terror bouts, as sleepwalking and night terrors are different manifestations of the same parasomnia. Both children and adults may display behaviour indicative of attempting to escape; some may thrash about or get out of bed and begin walking or running around aimlessly while inconsolable, increasing the risk of accidental injury. The risk of injury to others may be exacerbated by inadvertent provocation by nearby people, whose efforts to calm the individual may result in a physically violent response from the individual as they attempt to escape.

During lab tests, subjects are known to have very high voltages of electroencephalography (EEG) delta activity, an increase in muscle tone, and a doubled or faster heart rate. Brain activities during a typical episode show theta and alpha activity when monitored with an EEG. Episodes can include tachycardia. Night terrors are also associated with intense autonomic discharge of tachypnea, flushing, diaphoresis, and mydriasis—that is, unconscious or involuntary rapid breathing, reddening of the skin, profuse sweating, and dilation of the pupils. Abrupt but calmer arousal from NREM sleep, short of a full night-terror episode, is also common.

In children with night terrors, there is no increased occurrence of psychiatric diagnoses. However, in adults with night terrors there is a close association with psychopathology and mental disorders. There may be an increased occurrence of night terrors—particularly among those with post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). It is also likely that some personality disorders may occur in individuals with night terrors, such as dependent, schizoid, and borderline personality disorders. There have been some symptoms of depression and anxiety that have increased in individuals that have frequent night terrors. Low blood sugar is associated with both pediatric and adult night terrors. A study of adults with thalamic lesions of the brain and brainstem have been occasionally associated with night terrors. Night terrors are closely linked to sleepwalking and frontal lobe epilepsy.

Children

Night terrors typically occur in children between the ages of three and twelve years, with a peak onset in children aged three and a half years old. An estimated 1–6% of children experience night terrors. Children of both sexes and all ethnic backgrounds are affected equally. In children younger than three and a half years old, peak frequency of night terrors is at least one episode per week(can also be more up to 3-4 in rare cases). Among older children, peak frequency of night terrors is one or two episodes per month. The children will most likely have no recollection of the episode the next day. Pediatric evaluation may be sought to exclude the possibility that the night terrors are caused by seizure disorders or breathing problems. Most children will outgrow sleep terrors.

Adults

Night terrors in adults have been reported in all age ranges. Though the symptoms of night terrors in adolescents and adults are similar, the cause, prognosis and treatment are qualitatively different. These night terrors can occur each night if the individual does not eat a proper diet, get the appropriate amount or quality of sleep (e.g. sleep apnea), is enduring stressful events, or if he or she remains untreated. Adult night terrors are much less common, and often respond to treatments to rectify causes of poor quality or quantity of sleep. Night terrors are classified as a mental and behavioral disorder in the ICD. A study done about night terrors in adults showed that other psychiatric symptoms were prevalent in most patients experiencing night terrors hinting at the comorbidity of the two. There is some evidence of a link between night terrors and hypoglycemia.

When a night terror happens, it is typical for a person to wake up yelling and kicking and to be able to recognize what he or she is saying. The person may even run out of the house (more common among adults) which can then lead to violent actions. It has been found that some adults who have been on a long-term intrathecal clonidine therapy show side effects of night terrors, such as feelings of terror early in the sleep cycle. This is due to the possible alteration of cervical/brain clonidine concentration. In adults, night terrors can be symptomatic of neurological disease and can be further investigated through an MRI procedure.

Causes

There is some evidence that a predisposition to night terrors and other parasomnias may be congenital. Individuals frequently report that past family members have had either episodes of sleep terrors or sleepwalking. In some studies, a ten-fold increase in the prevalence of night terrors in first-degree biological relatives has been observed—however, the exact link to inheritance is not known. Familial aggregation has been found suggesting that there is an autosomal mode of inheritance. In addition, some laboratory findings suggest that sleep deprivation and having a fever can increase the likelihood of a night terror episode occurring. Other contributing factors include nocturnal asthma, gastroesophageal reflux, central nervous system medications, and a constricted nasal passage. Special consideration must be used when the subject with narcolepsy, as there may be a link. There have been no findings that show a cultural difference between manifestations of night terrors, though it is thought that the significance and cause of night terrors differ within cultures.

Also, older children and adults provide highly detailed and descriptive images associated with their sleep terrors compared to younger children, who either cannot recall or only vaguely remember. Sleep terrors in children are also more likely to occur in males than females; in adults, the ratio between sexes is equal. A longitudinal study examined twins, both identical and fraternal, and found that a significantly higher concordance rate of night terror was found in identical twins than in fraternal.

Though the symptoms of night terrors in adolescents and adults are similar, their causes, prognoses, and treatments are qualitatively different. There is some evidence that suggests that night terrors can occur if the individual does not eat a proper diet, does not get the appropriate amount or quality of sleep (e.g., because of sleep apnea), or is enduring stressful events. Adults who have experienced sexual abuse are more likely to receive a diagnosis of sleep disorders, including night terrors. Overall, though, adult night terrors are much less common and often respond best to treatments that rectify causes of poor quality or quantity of sleep.

Diagnosis

The DSM-5 diagnostic criteria for sleep terror disorder requires:

• Recurrent periods where the individual abruptly but not completely wakes from sleep, usually occurring during the first third major period of sleep.
• The individual experiences intense fear with a panicky scream at the beginning and symptoms of autonomic arousal, such as increased heart rate, heavy breathing, and increased perspiration. The individual cannot be soothed or comforted during the episode.
• The individual is unable or almost unable to remember images of the dream (only a single visual scene for example).
• The episode is completely forgotten.
• The occurrence of the sleep terror episode causes clinically significant distress or impairment in the individual's functioning.
• The disturbance is not due to the effects of a substance, general medical condition or medication.
• Coexisting mental or medical disorders do not explain the episodes of sleep terrors.

Differential diagnosis

Night terrors are distinct from nightmares. In fact, in nightmares there are almost never vocalization or agitation, and if there are any, they are less strong in comparison to night terrors. In addition, nightmares appear ordinarily during REM sleep in contrast to night terrors, which occur in NREM sleep. Finally, individuals with nightmares can wake up completely and easily and have clear and detailed memories of their dreams.

A distinction between night terrors and epileptic seizure is required. Indeed, an epileptic seizure could happen during the night but also during the day. To make the difference between both of them, an EEG can be done and if there are some anomalies on it, it would rather be an epileptic seizure.

Assessment

The assessment of sleep terrors is similar to the assessment of other parasomnias and must include:

• When the episode occurs during the sleep period
• Age of onset
• How often these episodes occur (frequency) and how long they last for (duration)
• Description of the episode, including behavior, emotions, and thoughts during and after the event
• How responsive the patient is to external stimuli during the episode
• How conscious or aware the patient is, when awakened from an episode
• If the episode is remembered afterwards
• The triggers or precipitating factors
• Sleep–wake pattern and sleep environment
• Daytime sleepiness
• Other sleep disorders that might be present
• Family history for NREM parasomnias and other sleep disorders
• Medical, psychiatric, and neurological history
• Medication and substance use history

Additionally, a home video might be helpful for a proper diagnosis. A polysomnography in the sleep laboratory is recommended for ruling out other disorders, however, sleep terrors occur less frequently in the sleep laboratory than at home and a polysomnography can therefore be unsuccessful at recording the sleep terror episode.

Treatment

In most children, night terrors eventually subside and do not need to be treated. It may be helpful to reassure the child and their family that they will outgrow this disorder.

The duration of one episode is mostly brief but it may last longer if parents try to wake up the child. Awakening the child may make their agitation stronger. For all these reasons, it is important to let the sleep terror episode fade away and to just be vigilant in order for them not to fall to the ground.

Considering an episode could be violent, it may be advisable to secure the environment in which the child sleeps. Windows should be closed and potentially dangerous items should be removed from the bedroom, and additionally, alarms can be installed and the child placed in a downstairs bedroom.

There is some evidence to suggest that night terrors can result from lack of sleep or poor sleeping habits. In these cases, it can be helpful to improve the amount and quality of sleep which the child is getting. It is also important to have a good sleep hygiene, if a child has night terrors parents could try to change their sleep hygiene. Another option could be to adapt child's naps so that they are not too long or too short. Then, excessive stress or conflicts in a child's life could also have an impact on their sleep too, so to have some strategies to cope with stress combined with psychotherapy could decrease the frequency of the episodes. A polysomnography can be recommended if the child continues to have a lot of night terror episodes.

Hypnosis could be efficient. Sleepers could become less sensitive to their sleep terrors.

One technique is to wake up just before the sleep terrors begin. When they appear regularly, this method can prevent their appearance.

Psychotherapy or counseling might be helpful in some cases.

If all these methods are not enough, benzodiazepines (such as diazepam) or tricyclic antidepressants may be used; however, medication is only recommended in extreme cases. Widening the nasal airway by surgical removal of the adenoid was previously considered and demonstrated to be effective; nowadays, however, invasive treatments are generally avoided.

Research

A small study of paroxetine found some benefit.

Another small trial found benefit with L-5-hydroxytryptophan (L-5-HTP).

Time preference

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Time_preference

In economics, time preference (or time discounting, delay discounting, temporal discounting, long-term orientation) is the current relative valuation placed on receiving a good or some cash at an earlier date compared with receiving it at a later date.

Time preferences are captured mathematically in the discount function. The higher the time preference, the higher the discount placed on returns receivable or costs payable in the future.

One of the factors that may determine an individual's time preference is how long that individual has lived. An older individual may have a lower time preference (relative to what they had earlier in life) due to a higher income and to the fact that they have had more time to acquire durable commodities (such as a college education or a house). As future is inherently uncertain, risk preferences also affect time preferences. 

Example

A practical example: Jim and Bob go out for a drink but Jim has no money so Bob lends Jim $10. The next day Jim visits Bob and says, "Bob, you can have $10 now, or I will give you $15 when I get paid at the end of the month." Bob's time preference will change depending on his trust in Jim, whether he needs the money now, or if he thinks he can wait; or if he'd prefer to have $15 at the end of the month rather than $10 now. Present and expected needs, present and expected income affect one's time preference.

Neoclassical views

In the neoclassical theory of interest due to Irving Fisher, the rate of time preference is usually taken as a parameter in an individual's utility function which captures the trade off between consumption today and consumption in the future, and is thus exogenous and subjective. It is also the underlying determinant of the real rate of interest. The rate of return on investment is generally seen as return on capital, with the real rate of interest equal to the marginal product of capital at any point in time. Arbitrage, in turn, implies that the return on capital is equalized with the interest rate on financial assets (adjusting for factors such as inflation and risk). Consumers, who are facing a choice between consumption and saving, respond to the difference between the market interest rate and their own subjective rate of time preference ("impatience") and increase or decrease their current consumption according to this difference. This changes the amount of funds available for investment and capital accumulation, as in for example the Ramsey growth model.

In the long run steady state, consumption's share in a person's income is constant which pins down the rate of interest as equal to the rate of time preference, with the marginal product of capital adjusting to ensure this equality holds. It is important to note that in this view, it is not that people discount the future because they can receive positive interest rates on their savings. Rather, the causality goes in the opposite direction; interest rates must be positive in order to induce impatient individuals to forgo current consumptions in favor of future.

Austrian Economics

Time preference is a key component of the Austrian School of economics, it is used to understand the relationship between saving, investment and interest rates. According to the Misesian branch of the school: In acting, an actor invariably aims to substitute a more satisfactory for a less satisfactory state of affairs and thus demonstrates a preference for more rather than fewer goods. Moreover, he invariably consider when in the future his goals will be reached, i.e., the time necessary to accomplish them, as well as a good's duration of serviceability. Thus, he also demonstrates a universal preference for earlier over later goods, and for more over less durable ones. This is the phenomenon of time preference. Every actor requires some amount of time to attain his goal, and since man must always consume something and cannot entirely stop consuming while he is alive, time is always scarce. Thus, ceteris paribus, present or earlier goods are, and must invariably be, valued more highly than future or later ones. In fact, if man were not constrained by time preference and if the only constraint operating on him were that of preferring more over less, he would invariably choose those production processes which yielded the largest output per input, regardless of the length of time needed for these methods to bear fruit.^[6]

To enjoy greater consumption, man must extend his productivity first. Since acquiring the increased productivity comes with a cost—namely, time spent away from using the old method of production and consumption—there must be some means of paying that cost. This is the role of savings. Some people have refrained from consumption in the past so that others can be sustained and create the new structure.

Savings remain key to this process of capital construction, and it is the time preference, that manifests itself in savings. Time preference is the extent to which people value current consumption over future consumption. If people enjoy current consumption so much, that the promise of an increased future consumption cannot bring them to save (and sacrifice the current level of consumption), the production will not be improved.

The thrust of the Austrian Business Cycle Theory is that credit inflation distorts this process, by making it appear that more means exist for current production than are actually sustainable. Since this is in fact an illusion, the endeavors of entrepreneurs to create a structure of production not reflecting actual consumer time preferences (as manifested in available savings for the purchase of producer goods) must end in failure.

Time-Preference Theory of Interest

The Austrian school rejects the classical view of capital, which says interest rates are determined by the supply and demand of capital. The Austrian school holds that interest rates are determined by the subjective decision of individuals to spend money now or in the future. In other words, interest rates are determined by the time preference of borrowers and lenders. For example, an increase in the rate of saving suggests that consumers are putting off present consumption and that more resources (and money) will be available in the future.

Austrian economist Eugen von Böhm-Bawerk, who expounded on the theory in his book Capital and Interest, believes that the value of goods decreases as the length of time needed for their completion increases, even when their quantity, quality, and nature remain the same. Böhm-Bawerk names three reasons for the inherent difference in value between present and future goods: the tendency, in a healthy economy, for the supply of goods to grow over time; the tendency of consumers to underestimate their future needs; and the preference of entrepreneurs to initiate production with materials presently available, rather than waiting for future goods to appear.

Temporal discounting

Temporal discounting (also known as delay discounting, time discounting) is the tendency of people to discount rewards as they approach a temporal horizon in the future or the past (i.e., become so distant in time that they cease to be valuable or to have additive effects). To put it another way, it is a tendency to give greater value to rewards as they move away from their temporal horizons and towards the "now". For instance, a nicotine deprived smoker may highly value a cigarette available any time in the next 6 hours but assign little or no value to a cigarette available in 6 months.

Regarding terminology, from Frederick et al. (2002):

We distinguish time discounting from time preference. We use the term time discounting broadly to encompass any reason for caring less about a future consequence, including factors that diminish the expected utility generated by a future consequence, such as uncertainty or changing tastes. We use the term time preference to refer, more specifically, to the preference for immediate utility over delayed utility.

This term is used in intertemporal economics, intertemporal choice, neurobiology of reward and decision making, microeconomics and recently neuroeconomics. Traditional models of economics assumed that the discounting function is exponential in time leading to a monotonic decrease in preference with increased time delay; however, more recent neuroeconomic models suggest a hyperbolic discount function which can address the phenomenon of preference reversal. Temporal discounting is also a theory particularly relevant to the political decisions of individuals, as people often put their short term political interests before the longer term policies. This can be applied to the way individuals vote in elections but can also apply to how they contribute to societal issues like climate change, that is primarily a long term threat and therefore not prioritised.

Assessing temporal discounting

Offered a choice of $100 today and $100 in one month, individuals will most likely choose the $100 now. However, should the question change to having $100 today, or $1,000 in one month, individuals will most likely choose the $1,000 in one month. The $100 can be conceptualized as a Smaller Sooner Reward (SSR), and the $1,000 can be conceptualized as a Larger Later Reward (LLR). Researchers who study temporal discounting are interested in the point in time in which an individual changes their preference for the SSR to the LLR, or vice versa. For example, although an individual may prefer $1,000 in one month over $100 now, they may switch their preference to the $100 if the delay to the $1,000 is increased to 60 months (5 years). This means that this individual values $1,000 after a delay of 60 months less than $100 now. The trick is to find the point in time in which the individual values the LLR and the SSR as being equivalent. That is known as the indifference point. Preferences can be measured by asking people to make a series of choices between immediate and delayed payoffs, where the delay period and the payoff amounts are varied.

Origin of differences in time preference across countries

Oded Galor and Omer Ozak explore the roots of observed differences in time preference across nations. They establish that pre-industrial agricultural characteristics that were favorable to higher return to agricultural investment triggered a process of selection, adaptation, and learning that brought about a higher prevalence of long-term orientation. These agricultural characteristics are associated with contemporary economic and human behavior such as technological adoption, education, saving, and smoking.

Historical understanding of time preference theory in relation to interest rates

The Catholic scholastic philosophers firstly brought up sophisticated explanations and justifications of return on capital, including risk and the opportunity cost of profit forgone, associated with the discount factor. However, they failed to interpret the interest on a riskless loan and hence denounced the time preference discounter as sinful and usurious.

Later, Conrad Summenhart, a theologian at the University of Tübingen, used time preference to explain the discount loans, where the lenders won't profit usuriously from the loans as the borrowers would accept the price the lenders ask. A half-century later, Martin de Azpilcueta Navarrus, a Dominican canon lawyer and monetary theorist at the University of Salamanca, held the view that present goods, such as money, will naturally be worth more on the market than future goods (money). At about the same time, Gian Francesco Lottini da Volterra, an Italian humanist and politician, discovered time preference and contemplated time preference as an overestimation of "a present" that can be grasped immediately by the senses. Two centuries later, Ferdinando Galiani, a Neapolitan abbot, used an analogy to point out that just similar to the exchange rate, the interest rate links and equates the present value to the future value, and under people's subjective mind, these two physically non-identical items should be equal.

These scattered thoughts and progression of theories inspired Anne Robert Jacques Turgot, a French statesman, to generate a full-scale time preference theory: what must be compared in a loan transaction is not the value of money lent with the value repaid, but rather the ‘value of the promise of a sum of money compared to the value of money available now; in addition, he analyzed the relation between money supply and interest rates: If money supply increases and people with insensitive time preference receive the money, then these people tend to hoard money for savings instead of going for consumptions, which will cause interest rates to fall while prices to rise. This helps to explain why contemporary interest rates have tended to fall due to the European thrifty spirit.

Digital detox

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Digital_detox 

A digital detox is a time without digital devices, such as smartphones

A digital detox is a period of time when a person voluntarily refrains from using digital devices such as smartphones, computers, and social media platforms. This form of detoxification has gained popularity, as individuals have increased their time spent on digital devices and the Internet.

Background

See also: Digital media use and mental health, Problematic social media use, and Problematic smartphone use

A 2015 survey conducted by Deloitte found that around 59% of smartphone users check a social media platform in the five minutes prior to going to bed, and within 30 minutes of waking up.

Motivations

Motivations to start a digital detox include:

• Concern about developing addictive behavior that some identify as an Internet addiction disorder
• Aiming to reduce stress and anxiety caused by the over-use of technology
• Re-focusing offline social interactions and actions
• Re-connecting with nature
• Increasing mindfulness
• Improving one's learning ability by decreasing distractions and eliminating multi-tasking

Potential health effects

Smartphone usage can disturb sleep and cause vision problems

The extended overuse of technology has been found to reduce quality of sleep, cause eye strain and vision problems, as well as lead to the increased occurrence of migraine headaches. A previous research survey of over 7,000 participants found that approximately 70% of those who use technology with screens have experienced "digital eye strain as a result of the growing use of [screen possessing technological devices]".

Research on the effects of popular technological devices such as cellphones and computers on sleep has suggested that the light emitted from screens may suppress the production of the hormone melatonin, an important regulatory biochemical that controls the duration and character of sleep cycles.

Potential effects on relationships

A study of 145 American adults recruited through MTurk in 2016 suggested that marital satisfaction can be lowered if either partner "snubs" the other in favor of using a cellphone. The act was also associated with a higher incidence of depression and a reported lower satisfaction with life. The self-reported attachment styles of the participants were seen to have an effect such that individuals with attachment anxiety reported a higher degree of cell phone conflict.

Another study suggested that the visible presence of mobile devices during conversations may have a limiting effect on the sense of connection felt between those involved in the conversation as well as the overall quality of the conversation.

Social media detoxification

A subset of digital detox is social media detox, which is a period of time when individuals voluntarily stay away from social media. In academic research, social media detoxification is commonly referred to as the "non-use of social media", and falls under the umbrella of "Digital Detox", with a focus specifically on unplugging from social media.

A 2019 Pew Research Center study found that 69% of adults in the United States used Facebook, 73% used YouTube, and 37% used Instagram. A 2012 study found that around 60% of Facebook users have made a conscious effort to voluntarily take a break from Facebook for a time period of several weeks or more. This has been referred to as "media refusal", with non-users known as "social media rejectors" who once used social media but have now voluntarily given it up for various reasons.

Methods

A subset of a digital detox is a social media detox, in which an individual voluntarily keeps off of social media platforms. Motivations for performing only a subset of a digital detox could be attributed to the total time spent on social media platforms and the related psychological effects.  The use of social media can lead to internet addiction and decrease productivity which is why celebrities such as Ed Sheeran and Kendall Jenner have undergone a social media detox and influenced others to do one as well. Comedian Ari Shaffir gained attention for refusing to use a smartphone after concerns about spending too much time on it, especially on social media. Many social media users will also visit their platforms multiple times per day, with 68% of Snapchat users and 50% of Facebook users doing so. Based on a 2019 Pew Research Center study, 73% of adults in the United States use YouTube, 37% use Instagram and 69% use Facebook with around 60% of Facebook users making an effort to undergo a social media detoxification.

Most experts agree that moderation is a much more effective method of detoxification than fully forgoing technology. One way of curbing overuse of digital devices is to allocate some of the uses of a smartphone to non-digital means. In 2019 Google announced a "paper phone" which can contain daily agendas, directions, and other uses so that people rely less on their smartphone.

Designated 'sacred spaces' wherein smartphone usage is strictly prohibited can help.

Recently, the tourism industry has found a niche market for 'digital detox travel packages' where tourists are disconnected from their Information and communications technology by traveling to remote areas. A study from University of Nottingham Ningbo China found that the biggest motivators for embarking on a digital detox holiday include mindfulness, technostress, relaxation, and self-expression.

Criticism

In the 2010s, technology and social media became an integral aspect of everyday life, and thus the decision to refrain from using technology or social media has become a conscious lifestyle choice reflecting the desire for selective and reversible disconnection. In the digital age, social media plays a vital role in building social capital, maintaining connections, and managing impressions. Scholars have argued for the importance of maintaining a certain level of distraction that social media can provide for a balanced state of body and mind, and some scholars have even argued that social media is necessary and should not be completely cut out. That being said, many scholars believe that the moderation of social media is essential, primarily due to social media platforms' goal of encouraging constant use with likes, notifications, and infinite scrolling. To lessen the effects of these addictive features social media platforms such as Instagram have begun to explore alternative methods, such as making likes on a user's post invisible to the user, to shift the focus away from constant notifications and likes.

Some companies have even launched movements against technology addiction. For example, in October 2019, Google released Paper Phone, a Google product consisting of a printed piece of paper folded into eighths that contains relevant information to your day much like a daily planner. The motive behind the project was to provide the utility of a smartphone in a simplistic and less dynamic delivery. Other projects have focused on building second phones with less functionality, or putting human nature and design above technology. Some critics disagree with Google's approach to the digital detox phenomenon, however, and instead argue that harmony between technology use and well-being can be achieved. These critics suggest that the best way to digitally detox is to be mindful of the amount of time that is being spent on a digital device.

Psychologist

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Psychologist

 

Psychologist

Description
Competencies	Psychotherapy, psychological assessment and testing, depends on specialty
Education required	Differs by location and specialty, Bachelor's degree with honors in Psychology, Master's degree in Psychology, PsyD or PhD
Fields of employment	Clinical neuropsychology, clinical, Medical, community, counselling, educational and developmental, forensic, health, organisational or sport and exercise
Related jobs	Psychiatrist psychotherapist

A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how individuals relate to each other and to their environments.

Psychologists usually acquire a bachelor's degree in psychology, followed by a master's degree or doctorate in psychology. Unlike psychiatric physicians and psychiatric nurse-practitioners, psychologists usually cannot prescribe medication, but depending on the jurisdiction, some psychologists with additional training can be licensed to prescribe medications; qualification requirements may be different from a bachelor's degree and master's degree.

Psychologists receive extensive training in psychological testing, scoring, interpretation, and reporting, while psychiatrists are not usually trained in psychological testing. Psychologists are also trained in, and often specialize in, one or more psychotherapies to improve symptoms of many mental disorders, including but not limited to treatment for anxiety, depression, post-traumatic stress disorder, schizophrenia, bipolar disorder, personality disorders and eating disorders. Treatment from psychologists can be individual or in groups. Cognitive behavioral therapy is a commonly used, well studied and high efficacy psychotherapy practiced by psychologists. Psychologists can work with a range of institutions and people, such as schools, prisons, in a private clinic, in a workplace, or with a sports team.

Applied psychology applies theory to solve problems in human and animal behavior. Applied fields include clinical psychology, counseling psychology, sport psychology, forensic psychology, industrial and organizational psychology, health psychology and school psychology. Licensing and regulations can vary by state and profession.

Australia

In Australia, the psychology profession, and the use of the title "psychologist", is regulated by an Act of Parliament, the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008, following an agreement between state and territorial governments. Under this national law, registration of psychologists is administered by the Psychology Board of Australia (PsyBA). Before July 2010, the professional registration of psychologists was governed by various state and territorial Psychology Registration Boards. The Australian Psychology Accreditation Council (APAC) oversees education standards for the profession.

The minimum requirements for general registration in psychology, including the right to use the title "psychologist", are an APAC approved four-year degree in psychology followed by either a two-year master's program or two years of practice supervised by a registered psychologist. However, the Australian Health Practitioner Regulation Agency (AHPRA) is currently in the process of phasing out the 4 + 2 internship pathway. Once the 4 + 2 pathway is phased out, a master's degree or PhD will be required to become a psychologist in Australia. This is because of concerns about public safety, and to reduce the burden of training on employers. There is also a '5 + 1' registration pathway, including a four-year APAC approved degree followed by one year of postgraduate study and one year of supervised practice. Endorsement within a specific area of practice requires additional qualifications. These notations are not "specialist" titles (Western Australian psychologists could use "specialist" in their titles during a three-year transitional period from 17 October 2010 to 17 October 2013).

Membership with Australian Psychological Society (APS) differs from registration as a psychologist. The standard route to full membership (MAPS) of the APS usually requires four years of APAC-accredited undergraduate study, plus a master's or doctorate in psychology from an accredited institution. An alternate route is available for academics and practitioners who have gained appropriate experience and made a substantial contribution to the field of psychology.

Restrictions apply to all individuals using the title "psychologist" in all states and territories of Australia. However, the terms "psychotherapist", "social worker", and "counselor" are currently self-regulated, with several organizations campaigning for government regulation.

Belgium

Since 1933, the title "psychologist" has been protected by law in Belgium. It can only be used by people who are on the National Government Commission list. The minimum requirement is the completion of five years of university training in psychology (master's degree or equivalent). The title of "psychotherapist" is not legally protected. As of 2016, Belgian law recognizes the clinical psychologist as an autonomous health profession. It reserves the practice of psychotherapy to medical doctors, clinical psychologists and clinical orthopedagogists.

Canada

A professional in the U.S. or Canada must hold a graduate degree in psychology (MA, Psy.D., Ed.D., or Ph.D.), or have a provincial license to use the title "psychologist". Provincial regulators include:

• Alberta: College of Alberta Psychologists
• British Columbia: College of Psychologists of British Columbia
• Manitoba: Psychological Association of Manitoba
• Newfoundland and Labrador: Newfoundland and Labrador Psychology Board
• New Brunswick: College of Psychologists of New Brunswick
• Northwest Territories: Office of the Registrar, Northwest Territories (NWT) Professional Licensing
• Nova Scotia: Nova Scotia Board of Examiners in Psychology
• Nunavut: Registrar, Professional Licensing Kugluktuk
• Ontario: College of Psychologists of Ontario
• Prince Edward Island: Prince Edward Island Psychologists Registration Board
• Quebec: Order of Psychologists of Quebec
• Saskatchewan: Saskatchewan College of Psychologists

Dominican Republic

A professional psychologist in the Dominican Republic must have a suitable qualification and be a member of the Dominican College of Psychologists.

Finland

In Finland, the title "psychologist" is protected by law. The restriction for psychologists (licensed professionals) is governed by National Supervisory Authority for Welfare and Health (Finland) (Valvira). It takes 330 ECTS-credits (about six years) to complete the university studies (master's degree). There are about 6,200 licensed psychologists in Finland.

Germany

In Germany, the use of the title Diplom-Psychologe (Dipl.-Psych.) is restricted by law, and a practitioner is legally required to hold the corresponding academic title, which is comparable to a M.Sc. degree and requires at least five years of training at a university. Originally, a diploma degree in psychology awarded in Germany included the subject of clinical psychology. With the Bologna-reform, this degree was replaced by a master's degree. The academic degree of Diplom-Psychologe or M.Sc. (Psychologie) does not include a psychotherapeutic qualification, which requires three to five years of additional training. The psychotherapeutic training combines in-depth theoretical knowledge with supervised patient care and self-reflection units. After having completed the training requirements, psychologists take a state-run exam, which, upon successful completion (Approbation), confers the official title of "psychological psychotherapist" (Psychologischer Psychotherapeut). After many years of inter-professional political controversy, non-physician psychotherapy was given an adequate legal foundation through the creation of two new academic healthcare professions.

Greece

Since 1979, the title "psychologist" has been protected by law in Greece. It can only be used by people who hold a relevant license or certificate, which is issued by the Greek authorities, to practice as a psychologist. The minimum requirement is the completion of university training in psychology at a Greek university, or at a university recognized by the Greek authorities. Psychologists in Greece are legally required to abide by the Code of Conduct of Psychologists (2019). Psychologists in Greece are not required to register with any psychology body in the country in order to legally practice the profession.  Titles such as "psychotherapist" or "counselor" are not protected by law in Greece and anyone may call themselves a "psychotherapist" or "counselor" without having earned a graduate degree in psychology.

India

In India, "clinical psychologist" is specifically defined in the Mental Health Act, 2017. An MPhil in Clinical Psychology degree of two years duration recognized by the Rehabilitation Council of India is required to apply for registration as a clinical psychologist. This procedure has been criticized by some stakeholders since clinical psychology is not limited to the area of rehabilitation. Titles such as "counselor" or "psychotherapist" are not protected at present. In other words, an individual may call themselves a "psychotherapist" or "counselor" without having earned a graduate degree in clinical psychology or another mental health field, and without having to register with the Rehabilitation Council of India.

New Zealand

In New Zealand, the use of the title "psychologist" is restricted by law. Prior to 2004, only the title "registered psychologist" was restricted to people qualified and registered as such. However, with the proclamation of the Health Practitioners Competence Assurance Act, in 2003, the use of the title "psychologist" was limited to practitioners registered with the New Zealand Psychologists Board. The titles "clinical psychologist", "counseling psychologist", "educational psychologist", "intern psychologist", and "trainee psychologist" are similarly protected. This is to protect the public by providing assurance that the title-holder is registered and therefore qualified and competent to practice, and can be held accountable. The legislation does not include an exemption clause for any class of practitioner (e.g., academics, or government employees).

Norway

In Norway, the title "psychologist" is restricted by law and can only be obtained by completing a 6-year integrated program, leading to the Candidate of Psychology degree. Psychologists are considered health personnel, and their work is regulated through the "health personnel act".

South Africa

South African psychologist Pumla Gobodo-Madikizela

In South Africa, psychologists are qualified in either clinical, counseling, educational, organizational, or research psychology. As below, qualification requires at least five years of study, and at least one of internship.

To become qualified, one must complete a recognized master's degree in Psychology, an appropriate practicum at a recognized training institution, and take an examination set by the Professional Board for Psychology. Registration with the Health Professions Council of South Africa (HPCSA) is required and includes a Continuing Professional Development component.

The practicum usually involves a full year internship, and in some specializations, the HPCSA requires completion of an additional year of community service. The master's program consists of seminars, coursework-based theoretical and practical training, and a dissertation of limited scope, and is (in most cases) two years in duration. Prior to enrolling in the master's program, the student studies psychology for three years as an undergraduate (B.A. or B.Sc., and, for organizational psychology, also B.Com.), followed by an additional postgraduate honours degree in psychology; see List of universities in South Africa.

The undergraduate B.Psyc. is a four-year program integrating theory and practical training, and—with the required examination set by the Professional Board for Psychology—is sufficient for practice as a psychometrist or counselor.

United Kingdom

In the UK, "registered psychologist" and "practitioner psychologist" are protected titles. The title of "neuropsychologist" is not protected. In addition, the following specialist titles are also protected by law: "clinical psychologist", "counselling psychologist", "educational psychologist", "forensic psychologist", "health psychologist", "occupational psychologist" and "sport and exercise psychologist". The Health and Care Professions Council (HCPC) is the statutory regulator for practitioner psychologists in the UK. In the UK, the use of the title "chartered psychologist" is also protected by statutory regulation, but that title simply means that the psychologist is a chartered member of the British Psychological Society, but is not necessarily registered with the HCPC. However, it is illegal for someone who is not in the appropriate section of the HCPC register to provide psychological services. The requirement to register as a clinical, counselling, or educational psychologist is a professional doctorate (and in the case of the latter two the British Psychological Society's Professional Qualification, which meets the standards of a professional doctorate). The title of "psychologist", by itself, is not protected. The British Psychological Society is working with the HCPC to ensure that the title of "neuropsychologist" is regulated as a specialist title for practitioner psychologists.

Employment

As of December 2012, in the United Kingdom, there are 19,000 practitioner psychologists registered across seven categories: clinical psychologist, counselling psychologist, educational psychologist, forensic psychologist, health psychologist, occupational psychologist, sport and exercise psychologist. At least 9,500 of these are clinical psychologists, which is the largest group of psychologists in clinical settings such as the NHS. Around 2,000 are educational psychologists.

United States

Education and training

In the United States and Canada, full membership in each country's professional association—American Psychological Association (APA) and Canadian Psychological Association (CPA), respectively—requires doctoral training (except in some Canadian provinces, such as Alberta, where a master's degree is sufficient). The minimal requirement for full membership can be waived in circumstances where there is evidence that significant contribution or performance in the field of psychology has been made. Associate membership requires at least two years of postgraduate studies in psychology or an approved related discipline.

The University of Pennsylvania was the first institution to offer formal education in clinical psychology in the U.S.

Some U.S. schools offer accredited programs in clinical psychology resulting in a master's degree. Such programs can range from forty-eight to eighty-four units, most often taking two to three years to complete after the undergraduate degree. Training usually emphasizes theory and treatment over research, quite often with a focus on school or couples and family counseling. Similar to doctoral programs, master's level students usually must complete a clinical practicum under supervision; some programs also require a minimum amount of personal psychotherapy. While many graduates from master's level training go on to doctoral psychology programs, a large number also go directly into practice—often as a licensed professional counselor (LPC), marriage and family therapist (MFT), or other similar licensed practice, which varies by state.

There is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2–5% are not uncommon). Clinical psychologists in the U.S. undergo many years of graduate training—usually five to seven years after the bachelor's degree—to gain demonstrable competence and experience. Licensure as a psychologist may take an additional one to two years post-PhD/PsyD. Some states require a 1-year postdoctoral residency, while others do not require postdoctoral supervised experience and allow psychology graduates to sit for the licensure exam immediately. Some psychology specialties, such as clinical neuropsychology, require a 2-year postdoctoral experience regardless of the state, as set forth in the Houston Conference Guidelines. Today in America, about half of all clinical psychology graduate students are being trained in PhD programs that emphasize research and are conducted by universities—with the other half in PsyD programs, which have more focus on practice (similar to professional degrees for medicine and law). Both types of doctoral programs (PhD and PsyD) envision practicing clinical psychology in a research-based, scientifically valid manner, and most are accredited by the APA.

APA accreditation is very important for U.S. clinical, counseling, and school psychology programs because graduating from a non-accredited doctoral program may adversely affect employment prospects and present a hurdle for becoming licensed in some jurisdictions.

Doctorate (PhD and PsyD) programs usually involve some variation on the following 5 to 7 year, 90–120 unit curriculum:

• Bases of behavior—biological, cognitive-affective, and cultural-social
• Individual differences—personality, lifespan development, psychopathology
• History and systems—development of psychological theories, practices and scientific knowledge
• Clinical practice—diagnostics, psychological assessment, psychotherapeutic interventions, psychopharmacology, ethical and legal issues
• Coursework in statistics and research design
• Clinical experience
  • Practicum—usually three or four years of working with clients under supervision in a clinical setting. Most practicum placements begin in either the first or second year of doctoral training.
  • Doctoral internship—usually an intensive one or two-year placement in a clinical setting
• Dissertation—PhD programs usually require original quantitative empirical research, while PsyD dissertations involve original quantitative or qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis or clinical application and analysis. The dissertation typically takes 2–3 years to complete.
• Specialized electives—many programs offer sets of elective courses for specializations, such as health, child/adolescent, family, community, or neuropsychology.
• Personal psychotherapy—many programs require students to undertake a certain number of hours of personal psychotherapy (with a non-faculty therapist) although in recent years this requirement has become less frequent.
• Comprehensive exams or master's thesis: a thesis can involve original data collection and is distinct from a dissertation.

Psychologists can be seen as practicing within two general categories of psychology: health service psychology, which includes "practitioners" or "professionals" and research-oriented psychology which includes "scientists" or "scholars". The training models (Boulder and Vail models) endorsed by the APA require that health service psychologists be trained as both researchers and practitioners, and that they possess advanced degrees.

Psychologists typically have one of two degrees: PsyD or PhD. The PsyD program prepares the student primarily as a practitioner for clinical practice (e.g., testing, psychotherapy), but also as a scholar that consumes research. Depending on the specialty (industrial/organizational, social, clinical, school, etc.), a PhD may be trained in clinical practice as well as in scientific methodology, to prepare for a career in academia or research. Both the PsyD and PhD programs prepare students to take the national psychology licensing exam, the Examination for Professional Practice in Psychology (EPPP).

Within the two main categories are many further types of psychologists as reflected by APA's 54 Divisions, which are specialty or subspecialty or topical areas, including clinical, counseling, and school psychologists. Such professionals work with persons in a variety of therapeutic contexts. People often think of the discipline as involving only such clinical or counseling psychologists. While counseling and psychotherapy are common activities for psychologists, these health service psychology fields are just two branches in the larger domain of psychology. There are other classifications such as industrial and organizational and community psychologists, whose professionals mainly apply psychological research, theories, and techniques to "real-world" problems of business, industry, social benefit organizations, government, and academia.

APA-recognized specialties

• Clinical psychology
• Clinical neuropsychology
• Clinical child and adolescent psychology
• School psychology
• Behavioral and cognitive psychology
• Couple and family psychology
• Clinical health psychology
• Geropsychology
• Police and public safety psychology
• Sleep psychology
• Rehabilitation psychology
• Group psychology and group psychotherapy
• Forensic psychology
• Industrial and organizational psychology
• Psychoanalysis
• Counseling psychology
• Serious mental illness psychology
• Clinical psychopharmacology

Clinical psychologists receive training in a number of psychological therapies, including behavioral, cognitive, humanistic, existential, psychodynamic, and systemic approaches, as well as in-depth training in psychological testing, and to some extent, neuropsychological testing.

Services

Clinical psychologists can offer a range of professional services, including:

• Psychological treatment (psychotherapy)
• Administering, scoring, and interpreting psychological tests
• Prescribing medications (in some States)
• Conducting psychological research
• Teaching
• Developing prevention programs
• Consulting
• Program administration
• Expert testimony
• Supervision of students or other mental health professionals

In practice, clinical psychologists might work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, community mental health centers, schools, businesses, and non-profit agencies.

Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field.

Prescriptive Authority for Psychologists (RxP)

Psychologists in the United States campaigned for legislative changes to enable specially-trained psychologists to prescribe psychotropic medications. Legislation in Idaho, Iowa, Louisiana, New Mexico, and Illinois has granted those who complete an additional master's degree program in clinical psychopharmacology authority to prescribe medications for mental and emotional disorders. As of 2019, Louisiana is the only state where the licensing and regulation of the practice of medical psychology by medical psychologists (MPs) is regulated by a medical board (the Louisiana State Board of Medical Examiners) rather than a board of psychologists. While other states have pursued prescriptive authority, they have not succeeded. Similar legislation in the states of Hawaii and Oregon passed through their respective legislative bodies, but in each case the legislation was vetoed by the state's governor.

In 1989, the U.S Department of Defense was directed to create the Psychopharmacology Demonstration Project (PDP). By 1997, ten psychologists were trained in psychopharmacology and granted the ability to prescribe psychiatric medications.

Licensure

The practice of clinical psychology requires a license in the United States and Canada. Although each of the U.S. states is different in terms of requirements and licenses (see and for examples), there are three common requirements:

1. Graduation from an accredited school with the appropriate degree
2. Completion of supervised clinical experience
3. Passing a written and/or oral examination

All U.S. state and Canada provincial licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e., mental health law) examination or an oral examination. Nearly all states also require a certain number of continuing education credits per year in order to renew a license. Licensees can obtain this through various means, such as taking audited classes and attending approved workshops.

There are professions whose scope of practice overlaps with the practice of psychology (particularly with respect to providing psychotherapy) and for which a license is required.

Ambiguity of title

To practice with the title of "psychologist", in almost all cases a doctoral degree is required (PhD, PsyD, or EdD in the U.S.). Normally, after the degree, the practitioner must fulfill a certain number of supervised postdoctoral hours ranging from 1,500 to 3,000 (usually taking one to two years), and passing the EPPP and any other state or provincial exams. By and large, a professional in the U.S. must hold a doctoral degree in psychology (PsyD, EdD, or PhD), and/or have a state license to use the title psychologist. However, regulations vary from state to state. For example, in the states of Michigan, West Virginia, and Vermont, there are psychologists licensed at the master's level.

Differences with psychiatrists

Further information: Mental health professional § Psychiatrists and clinical psychology

Although clinical psychologists and psychiatrists share the same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often different. Perhaps the most significant difference is that psychiatrists are licensed physicians, and, as such, psychiatrists are apt to use the medical model to assess mental health problems and to also employ psychotropic medications as a method of addressing mental health problems.

Psychologists generally do not prescribe medication, although in some jurisdictions they do have prescription privileges. In five U.S. states (New Mexico, Louisiana, Illinois, Iowa, and Idaho), psychologists with clinical psychopharmacology training have been granted prescriptive authority for mental health disorders.

Psychologists receive extensive training in psychological test administration, scoring, interpretation, and reporting, while psychiatrists are not trained in psychological testing. In addition, psychologists (particularly those from PhD programs) spend several years in graduate school being trained to conduct behavioral research; their training includes research design and advanced statistical analysis. While this training is available for physicians via dual MD/PhD programs, it is not typically included in standard medical education, although psychiatrists may develop research skills during their residency or a psychiatry fellowship (post-residency). Psychologists from PsyD programs tend to have more training and experience in clinical practice (e.g. psychotherapy, testing) than those from PhD programs.

Psychiatrists, as licensed physicians, have been trained more intensively in other areas, such as internal medicine and neurology, and may bring this knowledge to bear in identifying and treating medical or neurological conditions that present with primarily psychological symptoms such as depression, anxiety, or paranoia (e.g., hypothyroidism presenting with depressive symptoms, or pulmonary embolism with significant apprehension and anxiety).

Mental health professions

Comparison of mental health professionals in the US
Occupation	Degree	Common licenses	Prescription privilege	Mean 2020 income (USD)
Clinical psychologist	PhD/PsyD/EdD	Psychologist	Varies by state	$89,290
Counseling psychologist (doctorate)	PhD/PsyD/EdD	Psychologist	No	$65,000
Counselor (master's)	MA/MS/MEd	MFT/LPC/LHMC/LPA	No	$47,660
School psychologist	PhD/EdD/MS/EdS	School psychologist	No	$74,000
Psychiatrist	MD/DO	Psychiatrist	Yes	$217,100
Clinical social worker	PhD/DSW/MSW	LCSW	No	$51,760
Psychiatric nurse	MSN/BSN	RN	No	$75,330
Psychiatric and mental health nurse practitioner	DNP/PhD/MSN	APRN/APN/PMHNP	Yes (varies by state)	$117,670
Expressive/Art therapist	MA	ATR	No	$55,900

• Marriage and Family Therapist (MFT). An MFT license requires a doctorate or master's degree. In addition, it usually involves two years of post-degree clinical experience under supervision, and licensure requires passing a written exam, commonly the National Examination for Marriage and Family Therapists, which is maintained by the American Association for Marriage and Family Therapy. In addition, most states require an oral exam. MFTs, as the title implies, work mostly with families and couples, addressing a wide range of common psychological problems. Some jurisdictions have exemptions that let someone practice marriage and family therapy without meeting the requirements for a license. That is, they offer a license but do not require that marriage and family therapists obtain one.
• Licensed Professional Counselor (LPC). Similar to the MFT, the LPC license requires a master's or doctorate degree, a minimum number of hours of supervised clinical experience in a pre-doc practicum, and the passing of the National Counselor Exam. Similar licenses are the Licensed Mental Health Counselor (LMHC), Licensed Clinical Professional Counselor (LCPC), and Clinical Counselor in Mental Health (CCMH). In some states, after passing the exam, a temporary LPC license is awarded and the clinician may begin the normal 3000-hour supervised internship leading to the full license allowing to practice as a counselor or psychotherapist, usually under the supervision of a licensed psychologist. Some jurisdictions have exemptions that allow counseling to practice without meeting the requirements for a license. That is, they offer a license but do not require that counselors obtain one.
• Licensed Psychological Associate (LPA) Twenty-six states offer a master's-only license, a common one being the LPA, which allows for the therapist to either practice independently, or, more commonly, under the supervision of a licensed psychologist, depending on the state. Common requirements are two to four years of post-master's supervised clinical experience and passing a Psychological Associates Examination. Other titles for this level of licensing include psychological technician (Alabama), psychological assistant (California), licensed clinical psychotherapist (Kansas), licensed psychological practitioner (Minnesota), licensed behavioral practitioner (Oklahoma), licensed psychological associate (North Carolina) or psychological examiner (Tennessee).
• Licensed behavior analysts

Main article: Professional practice of behavior analysis

Licensed behavior analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness. This profession draws on the evidence base of applied behavior analysis and the philosophy of behaviorism. Behavior analysts have at least a master's degree in behavior analysis or in a mental health related discipline, as well as having taken at least five core courses in applied behavior analysis. Many behavior analysts have a doctorate. Most programs have a formalized internship program, and several programs are offered online. Most practitioners have passed the examination offered by the Behavior Analyst Certification Board The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

Employment

In the United States, of 181,600 jobs for psychologists in 2021, 123,300 are employed in clinical, counseling, and school positions; 2,900 are employed in industrial-organizational positions, and 55,400 are in "all other" positions.

The median salary in the U.S. for clinical, counseling, and school psychologists in May 2021 was US$82,510 and the median salary for industrial-organizational psychologists was US$105,310.

Psychologists can work in applied or academic settings. Academic psychologists educate higher education students, as well as conduct research, with graduate-level research being an important part of academic psychology. Academic positions can be tenured or non-tenured, with tenured positions being highly desirable.