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Why I Don’t Think Ride Or Die Should Have Been Cancelled (And What Company Should Save It...)
(Welcome to my weekly streaming ratings report, the single best guide to what’s popular in streaming TV and what isn’t. I’m the Entertainment Strategy Guy, a former streaming executive who now analyzes business strategy in the entertainment industry. If you were forwarded this email, please subscribe to get these insights each week.) So…I recently came across a Reddit thread, talking about films on streaming, wondering why there are no reliable sources out there for streaming ratings data. Sigh. Honestly, as annoyed as I am that so many still don’t realize that we have streaming ratings, I somewhat get it. Until now, there was such a long delay between when a show or film came to streaming and when we got its viewership data; I understand why people were confused. (But, as you know, this just changed.) Also, even back in the day, how many people knew how well films did on television? Luckily, as a reader, you’re in the know. Okay, on to this week’s issue. I want to take a look at Prime Video cancelling Ride or Die and whether I agree with that decision. Overall, we didn’t have any breakout hits (no TV shows landed over 20 million hours according to Nielsen) but we have a lot of steady performers on the streaming charts. Plus, we’ll look at where $50 million in missing box office dollars went. (Spoiler: straight-to-streaming.) All that, plus new episodes of The Secret Lives of Mormon Wives, Supergirl heads to streaming, a new YA show does well on Netflix, the viewership for the Daily Wire’s $50 million fantasy show, what TV show hit-maker can’t make streaming hits, CD sales, all the flops, bombs and misses, and a whole lot more. Let’s dive right in! (Reminder: The streaming ratings report focuses on the U.S. market and compiles data from Nielsen’s weekly top ten viewership ranks, Luminate’s Top Ten Data, JustWatch and Reelgood interest data, Samba TV household viewership, company datecdotes, Netflix hours viewed data, Google Trends, and IMDb to determine the most popular content. While most data points are current, Nielsen’s data covers the weeks of September 7th to September 13th, 2026. You can find a link to my terminology here.) Subscribe Television - Ride or Die Is a Hit…But It Got Cancelled? What The Data “Says” I hate the phrase “here’s what the data says”, even though sometimes I find myself using it. If data just told us everything, we data folks would be out of a job! Data is often messy, complicated and nuanced. When it comes to strategy, many of the best decisions can’t actually use “data”, since it’s vastly too complicated to model. Anyways, I’ve been singing the praises of Prime Video’s Ride Or Die this summer, a show that did very well for them. And yet…it got cancelled. Now, usually when a show gets cancelled, a bunch of websites say “a hit show got cancelled”... Here’s the thing, though: in this case, they’re right! The data “says” that this show was a hit. Specifically, out of 522 first seasons to make a week on the Nielsen charts since 2020, it’s the 75th biggest. On Amazon, Ride or Die is eighth out of 41 first seasons: That’s top 15th percentile all time, almost exactly, which is my definition of a “hit”! I mean, outside of Reacher, Amazon needed a hit this summer! (Admittedly, Off Campus did well for Amazon in the spring, but Ride or Die performed even better.) So what happened? Why did Amazon cancel one of their rare 2026 bright spots? Well, Deadline reported a reason—which I’ll get to—but I’d break it down into three relevant questions: What is a given streamer’s reasoning? Is that reasoning sound? Could the stated reason not be the real reason? According to Deadline, Amazon felt the show “over-indexed” in middle-aged women. (This was based on leaks from within Amazon.) The logic is this: Amazon already reaches this demographic because of unlimited two-day shipping bundled with Prime, so they don’t really need more shows like this. Now, it’s my job to ask if that’s a good reason, and I’ll be honest, in this case, I don’t think it is. Sure, this show may “over-index” in middle-aged women—I’ll just assume that’s the case here—but I think folks often oversell how important over-indexing actually is. When a show is a “hit”, it isn’t a bit bigger than its rivals; it’s usually multiples bigger. For example, Elle only made the charts for two weeks at 8.3 million hours each. So Ride or Die was 80% bigger in its first two weeks, and likely had a much stronger hold, with its terrific 13 million hours in week three. Ride or Die was nearly three times bigger than Sterling Point through three weeks too. And that means that _Elle, Sterling Point a_nd other Amazon YA shows need to not just over-index a little with younger women (assuming that’s who Amazon prefers over middle-aged women), but massively over-index. Otherwise, more people in that demo (and a bunch more besides) likely watched Ride or Die. (I’ll try to explore this concept more in a future article.) And don’t get me started on how Ride or Die did compared to a certain (very, very popular, possibly the world’s most popular) YouTuber’s reality show…which didn’t make the charts after its first week and likely cost much, much more than Ride or Die. All to say, Amazon-MGM Studios/Prime Video can tell reporters that this show didn’t reach the right audience, but that excuse feels weak to me. So this leads to the third question: could other reasons have come into play? Yes! Renewal or cancellation decisions rarely (I’m tempted to say “never”) boil down to one variable. At its simplest, it’s two things: budget versus viewership. But often factors like critical acclaim, ownership and, yes, personal opinion come into play. In this case, Amazon has a new executive running things, and this show isn’t owned by Amazon-MGM Studios (unlike Elle). And yes, it may not have indexed with the right target viewers, too. Likely all of those factors came into play.1 My guess is ownership ended up mattering most. Amazon doesn’t own Ride or Die. It’s actually produced by another major studio. Fortunately/allegedly, this show is being shopped around. I can think of one brand new CEO who should consider it for one of his two major streamers…especially if he wants to rebuild goodwill in Hollywood. His name is on this list of exec producers of Ride or Die… If David Ellison needs some goodwill—and he does—rescue this female-led show tomorrow and grab some good headlines for a day. The data justifies it. Quick Notes on TV We’re just getting started with this issue, but the rest is for paid subscribers of the Entertainment Strategy Guy, so if you’d like to find out… How The Secret Lives of Mormon Wives latest season did on Hulu, post-controversy... Whether Supergirl soared on HBO Max... Why the box office is losing money due to the streamers... The viewership for the Daily Wire’s $50 million fantasy show... Updates on The Gentlemen, Lanterns, Outer Banks, King of the Hill and more... What former hit-maker has three streaming flops in a row... Whether The Mandalorian and Grogu popped in week two... All the flops, bombs and misses... And a whole lot more... ...please subscribe! We can only keep doing this great work with your support. If you want an idea of just how much content you’d get in a full issue, check out this older issue. Coming Soon! Oh man, we’re almost caught up! We just have two more issues, then the streaming Ratings Report will be coming out just two weeks after a TV show premieres! Next issue, I’ll be looking at the first two weeks of the NFL Thursday night games on streaming, a huge new spinoff, Reacher’s Neagly on Prime Video, and the latest edition of Monster: The Lizzie Borden Story on Netflix, the return of Slow Horses on Apple and MobLand (quietly one of their biggest shows) on Paramount+, and Dancing with the Stars on both ABC and Disney+. Plus I’ll take a look at animation for adults in 2026. The week after, a ton of movies are coming to streaming: Toy Story 5 on Disney+, Backrooms on HBO Max, Jackass: Best and Last on Paramount+ and The Breadwinner on Netflix, plus a Unabomber film on Netflix and a romcom on Prime Video. Woody Harrelson and Matthew McConaughey have a show on Apple, along with a game show inspired by Willy Wonka that everyone seems to hate. Long term, some crazy (but hopefully crazy like a fox) IP news. FX ordered a new Sons of Anarchy show from Charlie Hunnam, but it’s not about the biker gang. No, it features the show’s cast playing themselves in a new “meta-thriller”. Huh. And a lot of the cast is coming back. Next, Ryan Gosling is producing a Flintstones movie about a “grown-up Bamm-Bamm Rubble”. Also, huh. This one is in “early development” so we’ll see what happens. Both projects are based on IP, but also seem to have crazy takes on the IP, which I like.
James Gunn dispels Wonder Woman casting rumors while roasting Frank Grillo
James Gunn addressed the Adria Arjona-Wonder Woman casting rumors by roasting DC star Frank Grillo. ‘You don’t believe he doesn’t know anything? Exhibit A.’
Poor leaders can tank employees’ mental health (and the company); his business summit puts workplace culture
“I’m a big believer in human to human connection because there’s so much loneliness and isolation happening,” explained Ebrima “Abraham” Sisay, host of the You Gotta No! Podcast (YGN) and its annual YGN Summit. “That’s because we’re getting further away from what we are meant to do as humans.”
Barkov Timeline Throws Cold Water on Dylan Larkin Trade
Barkov's 10-to-12-week timeline gives Florida only temporary cap relief, cooling the Dylan Larkin trade talk. #RedWings
How a controversial camera system is monitoring mental health patients
The Lampard Inquiry started back in September 2024 and I remember going to the first hearing in Chelmsford. Subscribe The bereaved families made placards of their loved ones, they stood outside in silence and then laid flowers to mark the moment. Now, two years on, in a process meant to last another two years, there’s been a development. Last week, we were told the chair, Baroness Lampard, pictured below, could be looking at making interim recommendations. Throughout the process, she has remarked that although this inquiry is looking at almost 2,000 people who were under the care of Essex mental health services from 2000-2023 when they died, the findings could have national implications for other trusts. ‘Records 24 hours a day in patient’s bedroom’ So why has this happened? One system that the inquiry is going to take a closer look at is a controversial monitoring system called Oxevision. It monitors some vital signs of patients remotely by using a camera placed in a room. It’s used by 40% of NHS mental health trusts. But campaigners, particularly the group Stop Oxevision, have asked for this technology to be removed from mental health wards as soon as possible. I spoke to a member, Hat Porter, today and they described to me what they thought this technology did and explained their concerns: “It records 24 hours a day and it’s located in a patient’s bedroom, which is obviously somewhere you’d usually expect to be a private place. “Our concerns are that the use of the technology has been has been kind of implemented as a substitute for proper in-person support, that it’s kind of over relied on and that there’s a lot of misunderstandings and that the presence of a camera, which has often been used without people’s consent, sometimes without even their knowledge, that that has a really big impact on privacy, dignity and human rights.” ‘Not sufficient’ I put it to them that the company behind Oxevision would dispute their claims about consent and in videos I’ve seen online from NHS trusts, they make it clear that the technology is complementary to trained staff and not a replacement. [ ](https://channel4news.substack.com/p/the-nottingham-inquiry-what-lessons) [ How the Nottingham inquiry shines a spotlight on other key mental health care failings ](https://channel4news.substack.com/p/the-nottingham-inquiry-what-lessons) Victoria Macdonald · Feb 12 [ Read full story ](https://channel4news.substack.com/p/the-nottingham-inquiry-what-lessons) A team of lawyers has been working on the inquiry and with bereaved family members who have concerns about this technology. I spoke to solicitor Priya Singh, from Hodge Jones & Allen, who made the point that questions usually asked by nurses would be missing from using devices like this. “It’s not sufficient to say, oh, the patient is moving around. Somebody must go in and say, are you okay? Are you distressed? Do you want help? Is there anything I can do? Share Channel 4 News “How are you spending your time? So I think a lot of our families cannot see the function of it when ultimately the patient should only really be observed when they’ve been prescribed to be observed, they can be observed more, but that more should really be happening face to face.” The Chair will hear evidence over the next two weeks and then a decision made after that, which could have national impact if she does decide this technology should be investigated or even removed. The Department of Health and Social Care said: “The Government is committed to ensuring that lessons are learned from the Lampard Inquiry to improve patient safety. “We are confident that the Inquiry will play an important role in identifying wider learnings for the health system following the tragic events in Essex and will contribute to improvements in patient safety.” We approached LIO Health, which runs Oxevision, for comment. Subscribe Share Channel 4 News Leave a comment
Roundtable Ravens Episode 42 - Breaking Down Week 4 Win
Roundtable Ravens crew James Brizuela and Billie Melissa break down the Baltimore Ravens' Week 4 win against the Tennessee Titans.
Wyoming Business Hit A 5-Year Enrollment High. Its Dean Isn't Satisfied
Scott Beaulier once pictured a McDonald's franchise as his ceiling. Now he wants national recognition for a Wyoming college up 18% since 2021
Congressional candidates discuss expanding executive power and need for political will
Congressional approval ratings are in the tank. By some measures this is one of the least productive sessions of Congress in living memory. WGLT's Charlie Schlenker reports those things may not change much any time soon.
St. Louis Prehistoric Life Show brings free fossil fun to the Science Center
The inaugural St. Louis Prehistoric Life Show invites families to crack open rocks, identify fossils, meet paleontologists, and more.
Dennis Hastert, speaker disgraced by sex abuse, dies at 84
Dennis Hastert, whose rise to U.S. House speaker in 1999 was as unexpected as the criminal conviction that sullied his reputation and sent him to prison years later, has died.
After school programming, birthday parties and day camps at Brooklyn Science Spot in Carroll Gardens (sponsored) | Brooklyn Bridge Parents - News, Events and Family Services
Brooklyn families, get ready for a fall experience that goes beyond worksheets, screen time, and ordinary after-school programs and camps. At Brooklyn Science Spot, we are opening the door to a whole new way for children to learn, explore, and fall in love with science through hands-on discovery, creative thinking, and real-world STEM fun. Opening
AZ-ALBERTSONS
Returning for her third year, actress, director and mom Haylie Duff will host a special cooking demo from 1:15 p.m. to 2 p.m.
10 cool and cozy books for fall - Entertainment
Temperatures are cool, the couch is cozy, and the season’s greatest reads are calling your name. Here are 10 books to curl up with this fall.
OPINION: Pay for performance, not for politics
The North Carolina General Assembly approved substantial pay increases for public schoolteachers earlier this year. If a bipartisan commission has its way, teacher compensation will soar over …
Italy’s Meloni follows pop stars in seeking to trademark her voice to combat AI deepfakes
Italian Premier Giorgia Meloni has applied to trademark her voice with the European Union intellectual property office in a bid to bolster protections against AI-generated deepfakes | KNSS Radio
Davids Fights Washington Healthcare Cuts with Plan to Lower Costs, Protect Kansas Hospitals
WASHINGTON, D.C. — Today, U.S. Representative Sharice Davids (KS-03) introduced a comprehensive package of healthcare legislation that directly counters Washington’s recent healthcare rollbacks, which are increasing monthly costs and closing rural hospitals. Davids’ efforts would protect Kansas families from rising medical costs, block new federal red tape, and keep local hospitals and health clinics open.
Dennis Hastert, House speaker sullied by abuse case, dies at 84
Dennis Hastert, whose rise to US House speaker in 1996 was as unexpected as the criminal conviction that sullied his reputation and sent him to prison years later, has died. He was 84.
Senate Unanimously Passes the Health Care Cybersecurity and Resiliency Act
A bipartisan bill that seeks to improve healthcare cybersecurity and resilience has been unanimously passed by the U.S. Senate. The bill - The Health Care The U.S. Senate has voted unanimously to advance the Health Care Cybersecurity and Resiliency Act, which requires more robust cybersecurity measures for healthcare organizations and authorizes grants to help rural and under-resourced providers improve cybersecurity.
Scientists Created a Computer Inside a Water Drop Using Billions of DNA Molecules and It Worked
You won’t believe it, but DNA molecules can turn even a tiny drop of water into a computer.
Syracuse Football: How Do Oddsmakers Feel About Matchup with Virginia?
The Orange are back in action this weekend against the Cavaliers following a 42-41 win over UConn.
Memorial Health team highlights support, expanded services during Breast Cancer Awareness Month
October is Breast Cancer Awareness Month, and Memorial Health System is using the time to highlight breast health education, early detection and the support available locally for patients and families.
2026 Outstanding Women in Business
The 18th annual Outstanding Women in Business awards recognize a dozen well-accomplished professionals from across the region and in many industries who go above and beyond. The committee selected the winners from more than 80 nominations, all of whom were worthy. The criteria evaluated each nominee’s professional achievements, community impact, ability to break the glass ceiling and mentorship of other professionals, particularly women. In addition to profiling these women in the following pages, the Worcester Business Journal will celebrate this year’s Outstanding Women in Business at a special luncheon on Oct. 28 at the College of the Holy Cross. To join the celebration of these exceptional women, visit WBJournal.com and register. – Mark Conti, editor This Year’s Judges Worcester Business Journal considered 54 Central Massachusetts professionals for the 2026 Outstanding Women in Business awards, based on 83 nominations. These nominees were independently evaluated by two volunteer judges, who scored each on their professional achievements, community contribution and mentorship of young professionals. Samantha P. McDonald is a partner at Bowditch. She is an experienced, client-focused real estate lawyer, concentrating on business and real estate property law. She has been recognized as a WBJ Power 100 in the Class of 2026 and a “Top Women of Law” in Massachusetts Lawyers Weekly. Dr. Kavita Babu is chief medical officer and vice president of medical affairs at Heywood Healthcare, where she provides strategic and clinical leadership to advance high-quality, patient-centered care across the organization. She is also a member of the WBJ Outstanding Women in Business Class of 2025.
Dennis Hastert, Powerful Politician Disgraced by Child Sexual Abuse, Dies
The longest-serving Republican speaker of the House admitted in 2016 to abusing teenage boys decades earlier. He was 84.
Community health fair provides one-stop shop for Arlington families
Arlington's third annual community health fair brought crowds to Carlin Springs Elementary School over the weekend. From flu shots and eye exams to bike giveaways and tips for healthier eating, the event hosted by the Kiwanis Club of Arlington and VHC Health offered a one-stop shop for families. "It's a lot of fun on a
Neighborhood Intelligence Provides Business Update and Announces $45.5 Million Equity Financing with Participation from Management and a Single Institutional Investor
NASHVILLE, Tenn., October 05, 2026--Neighborhood Intelligence (NASDAQ: NXH) ("Neighborhood" or the "Company") today announced that it has entered into a definitive agreement for the purchase and sale of an aggregate of 16,485,508 shares of its common stock (or pre-funded warrants in lieu thereof) at a purchase price of $2.76 per share (or pre-funded warrant in lieu thereof) in a registered direct offering. In addition, the Company will issue warrants to purchase up to 16,123,189 shares of common
Why the creative brain feeds on movement
Movement and creativity go hand in hand. Scientists are working to discover why
DraftKings Rallies 5% as BoA Upgrades to Buy With $27 Price Target; Flutter Entertainment Ticks Up
A Wall Street firm that spent the past year avoiding DraftKings (NASDAQ:DKNG | DKNG Price Prediction) over prediction-market risk has lifted its view. DraftKings stock is up 5% to $19.46 in morning trading after Bank of America (NYSE:BAC) upgraded the shares to Buy from Neutral. Also, shares of Flutter Entertainment (NYSE:FLUT) are up 1%, a […]
Will Democrats’ midterm wave reach California’s Central Valley? Bernie Sanders rallies the vote
Bernie Sanders rallied hundreds in sweltering Bakersfield heat for Randy Villegas, a progressive long shot in one of the nation's most contested House races.
The Co-op of Batesville
Serving the community for more than a decade Locally owned and operated businesses are a staple of the Delta economy, providing personalized service to their customers. The Co-Op of Batesville is a prime example. For 11 years, owners Steve and Kay Nickle have provided outdoor- themed supplies and apparel to citizens of Batesville, […]
Are aliens real? Here’s what science can and can’t prove
Some scientists believe the sheer number of stars, planets and potentially habitable environments in space makes extraterrestrial life plausible. But plausibility is not proof. Despite decades of sear...
Phillies news: Bryce Harper, Bryson Stott, Kyle Schwarber
I’d like to see Munetaka Murakami hit another home run tonight
Jobs in health care. Jobs for women. The US labour market is segmenting. Chernobyl’s radiation and Lenin’s love of literature.
Thank you for opening your Chartbook email. Elmer Bischoff, Two Figures at the Seashore, 1957 The only really dynamic job-creator in the US economy is health care: The largest crunch has come in Federal government, which has shed 2.7 m jobs. Source: tchouvkov on Twitter Tech is struggling. [ Joey Politano 🏳️🌈@JosephPolitano The US tech sector continues bleeding jobs in official data released today—overall, employment decreased by 17k last month and is down 69k over the last year That's nearly as bad as the worst of the 2024 tech-cession, and much worse than the 2022 boom or even pre-2020 norms 12:42 PM · Oct 2, 2026 · 15.2K Views 15 Replies · 47 Reposts · 390 Likes ](https://x.com/JosephPolitano/status/2106001807847940232?s=20) The new jobs are all for women. [ Justin Wolfers@JustinWolfers I'm not sure who saw this coming, but so far nearly all the jobs created during the second Trump administration have gone to women. 1:09 PM · Oct 2, 2026 · 33K Views 70 Replies · 146 Reposts · 644 Likes ](https://x.com/JustinWolfers/status/2106008723533533601?s=20) Meanwhile, real wages are being eaten up by modest over-target inflation. [ Heather Long@byHeatherLong The financial pain is real: Wage growth fell to 3% (y/y) in September. That's the lowest in 5 years. Wage growth: 3% Inflation: ~3.4% Inflation has eaten up all wage gains for the average worker since April. Many people are having to make hard choices about what to buy and what … 1:24 PM · Oct 2, 2026 · 37K Views 24 Replies · 275 Reposts · 533 Likes ](https://x.com/byHeatherLong/status/2106012367712620728?s=20) HEY READERS, THANK YOU for opening the Chartbook email. I hope it brightens your day. I enjoy putting out the newsletter, but tbh, what keeps this flow going is the generosity of those readers who clicked the subscription button. If you are persuaded to click, please consider the annual subscription of $60. It is both better value for you and a much better deal for me, as it involves only one credit card charge. Why feed the payments companies if we don’t have to. Subscribe Elmer Bischoff, Bathers, 1960 Americans are disillusioned with higher ed. For contributing subscribers only. Subscribe Where the Chernobyl radiation went. h/t Simon Kuestenmacher aka simongerman600 How Lenin’s love of literature shaped the Russian Revolution - Tariq Ali This, then, was the intellectual atmosphere in which Lenin came of age. His father, a highly cultured conservative, was the chief inspector of schools in his region and much respected as an educationalist. At home, Shakespeare, Goethe and Pushkin, among others, were read aloud on Sunday afternoons. It was impossible for the Ulyanov family – “Lenin” was a pseudonym adopted to outwit the tsarist secret police – to escape high culture. At high school, Lenin fell in love with Latin. His headteacher had high hopes that he might become a philologist and Latin scholar. History willed otherwise, but Lenin’s passion for Latin, and taste for the classics, never left him. He read Virgil, Ovid, Horace and Juvenal in the original, as well as Roman senatorial orations. He devoured Goethe during his two decades in exile, reading and rereading Faust many times. Lenin put his knowledge of the classics to good use in the time leading up to the October revolution of 1917. In April of that year, he broke with Russian social-democratic orthodoxy and, in a set of radical theses, called for a socialist revolution in Russia. A number of his own close comrades denounced him. In a sharp riposte, Lenin quoted Mephistopheles from Goethe’s masterwork: “Theory, my friend, is grey, but green is the eternal tree of life.” Source: The Guardian Elmer Bischoff, The River, 1953 If you’ve scrolled this far, you know you want to click: Subscribe
Yale School of Medicine On the Science of Childhood Anxiety, Say, Anxiety Disorders Are the Most Common Mental Health Challenges In Youth
Credit: Matt Bradbury October 5, 2026 - By Isabella Backman - Anxiety disorders are the most common mental health challenges in youth. Left untreated, they can disrupt the lives of both children and their families. The good news is that with intervention, most children will overcome these conditions. Across Yale School of Medicine, scientists are working to understand anxiety at every level, from common anxious behaviors to molecular biomarkers in the brain. They are using their findings to develop and disseminate new evidence-based treatments for childhood anxiety. Today, the go-to treatment for childhood anxiety disorders is cognitive behavioral therapy (CBT). This is a form of psychotherapy that teaches children skills for confronting anxious thoughts and helps them practice managing situations that cause anxiety. While it is the gold-standard treatment backed by considerable scientific evidence, up to 50% of children will not see sufficient benefit from CBT alone. Wendy Silverman, PhD, Alfred A. Messer Professor in the Child Study Center, co-directs the Anxiety and Mood Disorders Program alongside Eli Lebowitz, PhD, associate professor in the Child Study Center. One of their main interests is learning how to improve outcomes beyond CBT. “We’re developing cutting-edge, research-based knowledge that can reduce the suffering that anxiety causes children and their families,” says Silverman. Changing parent behavior YSM experts are investigating how to improve CBT outcomes for children by involving the parents. Silverman’s research has uncovered two main components of parent intervention that improve childhood anxiety: not enabling children to completely avoid the things that make them anxious and taking steps to enhance their autonomy. Parents may unintentionally reinforce their child’s anxiety by allowing them to avoid what makes them anxious. They also may unintentionally limit the children’s sense of autonomy by being overly intrusive. “One of the things that we take pride in is that we’ve focused on trying to understand what parents need to do, and to test our ideas and see if changing the parents’ behaviors is enhancing the effects of CBT,” Silverman says. “Our findings thus far suggest that they do." As much as CBT can be helpful, it can also be challenging to get one’s child to do the necessary steps for CBT to work. This is one important reason why Lebowitz created a novel intervention program for parents named Supportive Parenting for Anxious Childhood Emotions (SPACE). Existing intervention programs often teach parents to act as therapists for their child, such as training them on how to practice breathing exercises. “It makes sense, but this doesn’t work very well in practice,” says Lebowitz. “And part of the reason, I think, is that it’s not easy to get your kid to do things, especially if they’re not excited about doing it.” SPACE is unique because it focuses entirely on parent involvement and changing parental behavior—children are not involved in the sessions. For example, parents learn how to use supportive messages that convey confidence that their child can tolerate and manage distress. “It might sound like a parent saying to a child, ‘I get that this is really hard for you, but I know that you can handle it,’” Lebowitz says. The program also works with parents to identify the ways in which they are accommodating anxious behaviors. “We’ll pick one thing that parents are doing that is an accommodation and help them make a detailed plan for how they’re going to change that,” Lebowitz explains. Treating Anxiety in Children and Adolescents Much of the existing research on SPACE has focused on parents of children under age 14. Ongoing studies are now exploring its use with parents of older teens. “Both anxiety and accommodation can interfere with normative developmental shifts during the teen years, including increased autonomy and individuation from parents,” says Rebecca Etkin, PhD, associate research scientist in the Child Study Center. “In this sense, SPACE may be particularly well-suited for anxious teens and their parents. We want to see whether it is effective during this distinct developmental window.” Unfortunately, many families in need of CBT face barriers, including limited availability of services and geographic constraints. One way to improve access is digital interventions. Silverman and her team are developing an evidence-based digitized intervention program for parents that they can access directly from their computer or smart phone. “The work we’re doing will be one of the very few parent interventions that is digitized and importantly tested for effectiveness,” she says. Creating interventions for anxiety-related challenges Silverman and Lebowitz recently received a generous gift to develop and test other interventions that help parents reduce other child anxiety-related behavioral and emotional difficulties, such as restrictive eating and unexplained somatic symptoms. One of these projects in particular focuses on understanding the risks of social media and its potential benefits, including offering a sense of connection. “A lot of research has focused on the idea that social media is harmful and the less of it the better,” says Lebowitz. “But we actually see is that this is not quite right—there are negatives, but there are also positives. So, we’re trying to get a little bit more nuanced of a picture.” The team is working with teens with social anxiety and their parents over an extended period to better understand their social media habits and how their anxiety levels affect engagement with different platforms. The teens will answer questions sent to an app on their phones about mood and social media usage in an effort to capture emotional responses as they unfold. “We hope to develop interventions that can help make the best of social media while protecting against the more problematic effects,” Lebowitz says. The brain’s role in anxiety Researchers are also testing therapies to address anxiety at the neurological and molecular levels. In collaboration with Dylan Gee, PhD, professor of psychology in Yale's Faculty of Arts and Sciences, and Hilary Blumberg, MD, John and Hope Furth Professor of Psychiatric Neuroscience at Yale School of Medicine, Lebowitz and Silverman are using brain imaging to identify changes in a child’s brain before and after parents enroll in SPACE. In one study, children viewed anxiety-inducing images while undergoing magnetic resonance imaging (MRI); the researchers conducted scans with and without the children’s parents nearby. Before SPACE, children’s brains were better able to activate the regulatory circuitry needed to turn off an anxious response when their parents were nearby. But after SPACE, children could activate this circuitry even without the parent around. “As parents work on gradually reducing some of their accommodations, you can see a child get better at regulating their own fear system in the brain,” Lebowitz says. “It’s remarkable.” Research into the molecular underpinnings of anxiety can also inform new childhood anxiety treatments. In a recent study, Lebowitz, Silverman, and Flora Vaccarino, MD, Harris Professor in the Child Study Center, discovered that a protein known as fibroblast growth factor 2 (FGF2) could be protective from the toxic effects of stress. FGF2 levels in children and their parents were linked to the children’s risk of developing anxiety and depression, the study showed. The findings could help explain why some children who are exposed to early life trauma such as poverty or abuse are more prone to developing mental health disorders. And FGF2 could be a target for treatment. “This is very novel because it starts to give a clue to what is the molecular chain that connects those lived experiences to the actual psychological outcomes,” Lebowitz says. New ways to study and treat childhood anxiety Michael Crowley, PhD, associate professor in the Child Study Center, collaborates with Silverman and Lebowitz to study the role that attention plays in development and maintenance of childhood anxiety. There is a large body of research that shows that anxious children, like anxious adults, are prone to focus on threatening stimuli such as angry faces compared with neutral faces. This has led to innovative interventions that involve attention retraining. The idea is that if experts train children to look away from threatening stimuli, it may reduce their anxiety—especially children with social anxiety who are most prone to attend to threats. The researchers have just completed a clinical trial for attention retraining with 10- to 14-year-olds with social anxiety disorders and are currently analyzing the findings. Besides this innovative attention retraining research, as Crowly notes, “I like to design tasks that are engaging to kids,” Crowley says. “My goal is to assess something without the kids knowing what we are assessing.” With this goal in mind, Crowley has created a virtual game, named Boom, to study threat processing in children with anxiety disorders. The game is similar to that of hot potato—the child and three digital players take turns virtually passing a ball to each other’s gloves. At some point, the ball turns into a bomb, and as the bomb lands in each player’s glove, the outline of the glove turns yellow. The goal is to avoid having the bomb go off in your glove. What isn’t obvious is that the game is designed to measure different types of threatening stimuli, both ambiguous and direct. In the game, the direct threat occurs as the bomb is traveling towards your glove. The ambiguous threat is the yellow outlined glove as it is unknown where the bomb will travel next. While children play the game, Crowley’s team measures their brain activity using electroencephalography (EEG). The researchers have discovered that in kids with anxiety, the brain reacts more strongly to ambiguous threats than it does in their peers, but less strongly to direct threats. They believe that the initial abnormally large brain response to not knowing where the bomb is going impairs the brain's ability to properly respond when the threat is actually traveling the child’s way. “The brains of children with anxiety are unable to differentiate between threats you need to do something about and those that are not your problem.” Michael Crowley, PhD, develops innovative games for studying anxiety in children and adolescents.Credit: Matt Bradbury Based on these insights, Crowley hopes to study whether interventions like attention training could restore appropriate threat processing. Crowley’s team is also working on a test called the Balloon Risk Avoidance Task, which evaluates risk-taking and avoidance behaviors. It features a digital balloon that is full of air and about to burst. Kids have six seconds to let air out of the balloon. The more air they let out, the less risk they face that the balloon will pop. But at the same time, the balloon becomes less valuable as it deflates. “The more air you keep in the balloon, the more points you get,” Crowley explains. So far, the researchers have found that when the balloons pop unexpectedly, teens with social anxiety show distinct brain responses. Studying these responses can help psychologists understand the underlying pathways driving the various manifestations of anxiety. The genetics of anxiety When Thomas Fernandez, MD, associate professor in the Child Study Center and of psychiatry, was still in training, there was a lot of excitement about understanding the genetics associated with autism spectrum disorder. Since then, scientists have identified around 250 genes associated with autism. The genetic contribution to anxiety disorders, on the other hand, has historically received less attention. Anxiety is less heritable than autism, but the genetic contribution for anxiety disorders that emerge in childhood may be higher than for anxiety disorders overall. While scientists estimate the heritability of anxiety disorders in general to be around 30% to 50%, some studies suggest higher heritability for certain childhood-onset anxiety presentations. “I saw firsthand how researchers in the field went about finding vulnerability genes for autism,” Fernandez says. “So, we’re using a very similar playbook for childhood anxiety.” “I saw firsthand how researchers in the field went about finding vulnerability genes for autism. So, we’re using a very similar playbook for childhood anxiety.” Thomas Fernandez, MD Associate Professor In the Child Study Center and in Psychiatry Now, Fernandez and Emily Olfson, MD, PhD, assistant professor in the Child Study Center, are studying children and their parents to identify genetic changes that are present in the child but not the parents, known as “de novo mutations.” “All of us have some de novo mutations—maybe about 50 to 100 sprinkled throughout the genome,” Olfson says. “But when they occur within the coding regions of genes, they can be really disruptive.” Previous research shows that people with autism have higher rates of damaging de novo mutations than the general population. In 2022, Olfson, Lebowitz, Silverman, and Fernandez published a study on 68 children and their families that found that children with anxiety had similarly high levels of these mutations. Studying de novo mutations can help point the researchers to where they should be looking for genes associated with anxiety. “The end game is using the genes to steer us toward the right part of biology that we can then target to come up with better treatments,” Fernandez says. Building on those findings, the team is now studying more families to better understand how these de novo mutations, along with other genetic and environmental factors, shape pediatric anxiety disorders. They recently received a National Institutes of Health grant to enroll 750 new families over the next five years. Olfson is the principal investigator, with co-investigators Lebowitz, Fernandez, Silverman, and Shuangge Steven Ma, PhD, department chair and professor of biostatistics at Yale School of Public Health. Neurodevelopment, Risk Genes, and Mental Health Conditions - The Olfson Lab Joel Gelernter, MD, Foundations Fund Professor of Psychiatry, is interested in how different anxiety disorders differ genomically. “We are studying social phobia, panic disorder, and generalized anxiety disorder, working to understand why people differ in their risk to these specific anxiety disorders and evaluating various risk factors,” he says. Gelernter was recently involved in one of the largest studies to date of the genomics underlying anxiety disorder. The study included around 122,000 people with anxiety disorders and around 730,000 without. It found that some genetic differences associated with anxiety were linked to signaling that helps reduce overactivity in the nervous system. Many anxiety medications available today work by targeting this process. “It’s nice when the biology that you get out of a large genome-wide study ratifies things that we already know because that can help increase confidence in further findings from the study,” Gelernter says. Uncovering the neurobiology of psychiatric disorders John Krystal, MD, Robert L. McNeil, Jr. Professor of Translational Research and chair of the Department of Psychiatry, is interested in the neurobiology of psychiatric disorders, including post-traumatic stress disorder (PTSD), of which anxiety is a major symptom. In the late 1980s, Krystal’s team discovered that the drug yohimbine activated symptoms in patients with PTSD. “This was the first time we could link a specific biological mechanism to the symptoms of PTSD,” Krystal says. At the time, he adds, this finding was highly controversial. “A lot of people felt that PTSD was a purely psychological syndrome that didn’t have an underlying biology.” Since then, Krystal has dived deep into understanding the neurobiology of PTSD to learn how to better treat it. His team is evaluating the use of ketamine and psychedelics. These would be among the first treatments to be developed specifically for PTSD. They may also be applicable for other disorders including anxiety disorders, Krystal adds. An important gap in PTSD treatment is the absence of biological tests that inform how to best help patients manage their PTSD symptoms. A doctor doesn’t diagnose cancer based on how they feel. Rather, they use tests of the biology of the cancer to determine the best course of treatment. “And we can’t do that in any psychiatric disorder other than Alzheimer’s disease,” Krystal says. “But now we are building a foundation for this approach to the treatment of anxiety disorders for the first time.” Source: Yale School of Medicine
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For patients living with chronic blood disorders, access to safe and reliable blood supplies is fundamental to their care journey. Marking the sixth edition of an impactful partnership, Bristol Myers Squibb proudly collaborated with the Emirates Thalassemia Society and Dubai Science Park, the region's leading science focused hub and part of TECOM Group PJSC, hosted the 'Help Save a Life' blood donation drive, bringing together community members and healthcare professionals to provide vital suppo
Driving Community Health: Bristol Myers Squibb, Emirates Thalassemia Society and Dubai Science Park Host the 6th 'Help Save a Life' Blood Donation Drive
/PRNewswire/ -- For patients living with chronic blood disorders, access to safe and reliable blood supplies is fundamental to their care journey. Marking the...
Driving Community Health: Bristol Myers Squibb, Emirates Thalassemia Society and Dubai Science Park Host the 6th 'Help Save a Life' Blood Donation Drive
/PRNewswire/ -- For patients living with chronic blood disorders, access to safe and reliable blood supplies is fundamental to their care journey. Marking the...
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