Richard G. Petty, MD

Work, Stress, Vacations and Exotic Drinks with Little Umbrellas in Them

Your humble reporter has often spoken about his brush with burnout. 

Even though I was a recognized expert on stress – and a former meditation teacher, no less! – I got perilously close to the edge. Fortunately someone noticed and I was packed off on vacation. It was remarkable that just a week in the Caribbean followed by an unforgettable one-week retreat in the Catskills was enough to cure me. My resting pulse rate fell from 68 to 48, where it stayed for more than a year, and I never again had any symptoms. The key point was that the short break was enough to interrupt the downward spiral and provoke the cognitive shift that prevented me from ever again making the mistakes that lead to the trouble in the first place.

I still work hard, but trust me when I say that working 16-17 hours a day, seven days a week is preposterous. Neglecting your emotional health and social life is bad enough. But the last straw was to stop engaging in spiritual practices that I had followed since childhood.

For a long time now I have been teaching that most people can make phenomenal changes in a very short period. It may take you a long time to prepare, but once you are ready change can be extremely quick. If you think about it, the actual physical business of an egg and a sperm joining to make a new life takes less than a minute. But the preparation for the event may take half a lifetime. At least I hope for your sake that it takes a lot longer than a minute…

And that’s all that I am going to say about that…

I was thinking about all this the other day when a stressed executive was telling me that he all he wanted was to spend six months sitting on a beach. In fact that would probably be a thoroughly bad idea.

It is not the time; it is the quality of the time, and the energy that you bring to it.

I cannot stress enough that for most people energy management is far more important than time management.

When it comes to beating burnout, the kind of vacation is likely more important than its length.

A summary of ten years of research by a team lead by Dov Eden, an organizational psychologist from Tel Aviv University's Faculty of Management, was presented at last year's meeting of "Work, Stress and Health" in Miami. The event is sponsored by the American Psychological Association and what Professor Eden had to say really supports what we have been talking about.

For the past ten years the team has been studying "respite effects," which measure relief from chronic job stress during and after vacations away from the workplace. They have also been looking at the impact of constant contact: the revolution in telecommunications has kept some people permanently wired into the office while they are supposed to be away putting their feet up and drinking exotic concoctions with little umbrellas in them. So we are losing true "respite relief," and that in turn is a cause of chronic job stress.

One recent study involved 800 professors from eight Universities in Israel, the United States, and New Zealand. The researchers measured stress levels before, during, and after a sabbatical leave of a semester or a whole year. They compared them with people who stayed home, and others who just took a long weekend or a one-week vacation. They found that those who took a long sabbatical break experienced about the same amount of stress relief as people who had taken either a week off or just a long weekend or long-weekend vacation. And all three groups returned to pre-sabbatical stress levels in about the same amount of time: approximately three weeks.

Some of Eden’s other studies have indicated that people who best succeed in uncoupling from work and detaching form its demands, get the most benefit from their vacations and they probably less likely to experience job burnout. It's the ones who cannot detach from the constant flow of job-related demands that are most likely to suffer from burnout.

The key to a refreshing vacation is to create as much space as possible between you and your work life. I once knew someone who spent a week on Tioman Island in the South China Sea. It is reputed to be one of the most beautiful places on earth, which was one of the reasons why it was selected for the filming of South Pacific. For the whole week she spent all day every day working, and every day the hotel’s fax machine got jammed with the 60-70 pages that she sent out. That is not a recipe for a refreshing, life affirming vacation.

This body of research confirms what most sensible managers have worked out for themselves. When someone goes on vacation they should leave their cell phones behind and not check their email. People who feel attached to the office 24/7 are setting themselves up for long-term stress-related illnesses.

I get a lot more email and phone calls than most normal mortals, yet many years ago I made a remarkable discovery.

I had been out of contact for a week, and even after disposing of the spam and junk mail, there were still well over a thousand messages “demanding” my immediate attention. But during that week away, events had moved on, most no longer needed any input from me at all. Matters had been resolved and solutions found. We lost no business, and I have it on good authority that the earth did not fall into the sun.

I came back rested and restored, and firing on all cylinders: everyone benefited.

Quite obviously it is not a good idea to be completely un-obtainable. I have had two friends, one of whom lost her mother and another his wife, and neither heard the sad news for more than a week. So even when I am in some far flung part of the planet I make sure that there is a way for me to be contacted, But only three people know how.

And I am no longer an electron junkie.

Try it the next time that you have a chance. It really is easier than you think.




“Let all bitterness, and wrath, and anger, and clamor, and evil speaking, be put away from you, with all malice; and be ye kind to one another, tenderhearted, forgiving one another, even as God, for Christ's sake, hath forgiven you.”
--The Bible, Ephesians 4:31-32

“Detach yourself from all that makes your mind restless. Renounce all that disturbs its peace. If you want peace, deserve it.”
--Sri Nisargadatta Maharaj (Indian Spiritual Teacher and Exponent of Jnana Yoga and Advaita Doctrine, 1897-1981)

“You must have been warned against letting the golden hours slip by, but some of them are golden only because we have let then slip by.”
--Sir James Matthew (J.M.) Barrie (Scottish Writer and Playwright, 1860-1937)

The Looming Crisis of Alzheimer’s

For those of us who lobby for resources, it is no overstatement to say that Alzheimer's disease has reached crisis proportions in the United States.

As we are getting older, the incidence, prevalence and mortality of Alzheimer’s disease are all rising.

The 2007 Alzheimer's Disease Facts and Figures report by the Alzheimer's Association makes sobering reading. Here are some of the headline facts:

• Alzheimer's disease is the most common cause of dementia
• At the present rate, one in 85 people will have the disease in 40 years
• There are now more than 5 million people suffering from Alzheimer's disease, and the report projects an increase of 16 million cases by 2050 unless preventive measures are taken and/or science is able to come up with a prevention or cure
• One person is now diagnosed with dementia every seven seconds
• One in every four American families is affected by dementia
• The incidence of dementia is one in 1,000 before age 65 and one in 20 after age 65.
• More than $100 billion is spent per year on dementia, which is about 10 percent of all healthcare expenditures

As we have discussed before, the symptoms of dementia may be delayed for 3 to 5 years through healthy lifestyles and behavior modification, and there are many new treatment approaches in the pipeline.

The huge issue is that statistic about one in four families being affected by the disease. And it is a disease: it is not part of normal aging.

Caregivers can suffer terribly.

The Alzheimer’s Association also has some information for those who care for people with Alzheimer’s.

There is also some food information here concerning caregiver stress.

I would also like to direct you to some of the things that I have written here about the wellness of caregivers.

And for everyone, don’t wait until you are thirsty before you dig that well. Work on building you personal resilience and follow the simple lifestyle guidelines that may significantly reduce your risk of developing Alzheimer’s disease.

Integrated Medicine with Heart Surgery

The movement to treat the whole person is a lot more developed in Europe than tit is in the United States. So it is always gratifying to see research on integrated medicine on this side of the pond. Even if there are critics who call anything holistic “woo woo,” the fact is that patients like the approach, and there is a developing research base.

A new study from the Mayo Clinic indicates that massage therapy decreases pain levels for patients after heart surgery. During a five-month period in 2005, 58 patients undergoing surgery participated in a pilot study to examine the effect of massage on pain after surgery. Of the 30 who received massage, the mean pain scores were less than 1 on a scale of 1 to 10, with 10 as the most painful.

Before the massage therapy, these patients rated their pain at an average of 3 on a 10-point scale. In the control group of 28, pain levels remained the same over the same period, according to findings published in the current issue of Complementary Therapies in Clinical Practice. 

As a result of the pilot study, Mayo now has a full-time massage therapist available for patients after heart surgery, and a larger, randomized study is under way.

The reason for the study was that patients often report that tension, stress, pain and anxiety get in the way of their recovery after cardiac surgery. Therefore apart from massage, the researchers are also exploring the use of stress management, music therapy and guided imagery as adjuncts to the best of modern medicine.

This makes good sense, and I shall keep you posted as more information is published.

Meditation, Stress and Self-Regulation

There is progressively more evidence that meditation can have measurable effects on behavior and the brain. The trouble is that some of the results have conflicted, mainly because of the different types of meditation and different measurement protocols. So I was very interested to see some new research in this week’s issue of the Proceedings of the National Academy of Sciences, by a team of researchers from China collaborating with renowned experts at the University of Oregon, who have developed an approach for neuroscientists to study how very brief meditation training might improve a person's attention and response to stress.

The study itself was done with undergraduate students in China. The experimental group received five days of meditation training using a technique called integrative body-mind training (IBMT), which was developed in China n the early 1990s.

IBMT is a rapid mental training method that aims at inducing a state of alert restfulness using breathing and guided imagery.

The control group received five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress.

The experimental group showed greater improvement a test of attention that was designed to measure peoples’ ability to resolve conflict among stimuli. Subjects were stressed by doing mental arithmetic.

At the beginning of the experiment both groups showed an elevated release of cortisol following the mathematical task, but after training the experimental group showed less cortisol release. This probably indicates an improvement in stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than the control group.

The next stage in the research will involve direct measurements of brain function.

Although IBMT is described as a form of meditation, it may be inducing something slightly different from, say, Zen meditation. The important point is that it is possible to produce measurable physiological changes in just five days, and this will make it much easier to examine the dynamic effects of hypnosis, relaxation and this technique on brain function.

I would also be grateful for any readers who have more information abut the precise details of IBMT, and whether training in the precise techniques is available outside China.

I shall keep you posted as new data emerge.

“Peace can be reached through meditation on the knowledge which dreams can give. Peace can also be reached through concentration upon that which is dearest to the heart.”
--Patanjali (Indian Philosopher said to be the Compiler of the Yoga Sutras, Dates Unknown)

“Through meditation and by giving full attention to one thing at a time, we can learn to direct attention where we choose.”
--Eknath Easwaran (Indian-American Spiritual Teacher, Professor and Author, 1910-1999)

“Meditation is not to escape from society, but to come 
back to ourselves and see what is going on. Once there is 
seeing, there must be acting. With mindfulness, we know 
what to do and what not to do to help.”
--Thich Nhat Hahn (Vietnamese Buddhist Monk, 1926-)

“A meditator keeps his mind open every second. He is constantly investigating life, investigating his own experience, viewing existence in a detached and inquisitive way. Thus, he is constantly open to truth in any form, from any source, an at any time.”
--Henepola Gunaratana (a.k.a. Bhante G., Sri Lankan Buddhist Monk, 1927-)

T’ai Chi Chih and the Sympathetic Nervous System

One of the problems about getting older is that the activity of the sympathetic nervous system may increase, bringing with it an increased risk of metabolic problems such as insulin resistance, hypertension and cardiovascular disease.

The sympathetic nervous system  is a branch of the autonomic nervous system. It is always active at a basal level, which is called sympathetic tone. It becomes more active during times of stress. Its actions during the stress response comprise the classical fight-or-flight response.

There is a very interesting study from the Norman Cousins Center for Psychoneuroimmunology at the UCLA Semel Institute for Neuroscience & Human Behavior in Los Angeles.

There were 32 people in the study aged 60 or over. There were 19 people who were T’ai Chi Chih (TCC) practitioners and 13 who were not. The practitioners had completed a 25-week training in TCC the 13 others just had health education classes. T'ai Chi Chih is a simplified  type of T'ai Chi that emphasizes the development of qi, a.k.a. chi.

TCC practitioners performed the breathing and movements for 20 minutes, while HE participants passively rested for the same time. Investigators measured various cardiovascular parameters before and after the task. A subsample of participants returned for a second evaluation and performed videotape-guided stretching for 20 minutes to evaluate the cardiovascular effects of slow-moving physical activity. TCC performance was found to significantly decrease sympathetic nervous system activity as measured by cardiac pre-ejection, blood pressure and heart rate. In contrast, there was no change in sympathetic activity following passive rest or slow-moving physical activity.

This shows us that there is something different about T’ai Chi. Practicing it leads to a decrease in activity of the sympathetic nervous system to levels that are not achieved by performing comparable physical activity alone.

Rescue Remedy and Acute Anxiety

I have been using the Bach Flower Essences since the 1970s and they can be very helpful. Since living in the United States I have added the American Flower Essences to my repertoire. We have even helped cats, dogs and horses with them. The whole idea that soaking a flower in water and exposing the infusion to sunlight could have any therapeutic benefit seems absurd. Except that the remedies so often work. The trouble is that there is so little decent research on them.

A new study conducted by researchers at the University of Miami School of Nursing in conjunction with The Sirkin Creative Living Center has suggested that Rescue Remedy, a mixture of five of the Bach Essences, may be effective for the treatment of anxiety.

Rescue Remedy, manufactured by Nelsons, contains five flower essences, each of which is said to have a specific psycho-spiritual action:

• Rock Rose to alleviate terror and panic
• Impatiens to mollify irritation and impatience
• Clematis to help with inattentiveness
• Star of Bethlehem to ease shock
• Cherry Plum is said to calm irrational thoughts

The study examined the product for the reduction of acute situational stress. A double-blind clinical trial comparing a standard dosage of Rescue Remedy against a placebo of identical appearance was conducted in a sample of 111 individuals aged 18 to 49. The Spielberger State-Trait Anxiety Inventory (STAI) was administered before and after the use of Rescue Remedy or placebo. The results suggest that Rescue Remedy may be effective in reducing fairly high levels of situational anxiety. The results were just published in the latest edition of Complementary Health Practice Review. The abstract should be available  online in the near future.

It will be interesting to see if this result can be replicated with this kind of acute anxiety, as well as other types of stress or anxiety. The STAI is a good choice for a first study: it is simple and attempts to capture the key features of the acute anxiety as well as the long-term propensity to it. It can be hard for people to give reproducible answers when they are acutely anxious, and it is important to know about the inter-rater reliability of the people dong the evaluations.

Recently the Rescue remedy has been produced as a spray as well as the original drops, and we have been making extensive use of it in combination with other approaches to treatment.

As I explain in Healing, Meaning and Purpose, there are good reasons for thinking that different types of treatment work at different levels of an individual. The flower essences seem to work at the level of the Informational Matrix of the body: it is an "information medicine," that can act very quickly. We have seen scared horses - and people - calm down within seconds after being given the right remedy.

When it works, it can be remarkable.

Evaluating Sense of Coherence

Yesterday we began to look at Aaron Antonovsky's concept of Sense of Coherence.

Here is one of the most widely used sets of questions to determine an individual’s Sense of Coherence, derived from Antonovsky's The Sense of Coherence Quest.

The questions concern a number of aspects of our lives.

Each question has seven possible answers. The person doing the evaluation marks one number from 1 to 7 for whichever one most closely corresponds to their beliefs or  feelings.

1. When you talk to people, do you have the feeling that they don’t understand you?
    Never     1 2 3 4 5 6 7     Always have this feeling

2 In the past, when you had to do something that depended upon cooperation with others, did you have the feeling that it:
    Surely wouldn't get done     1 2 3 4 5 6 7     Surely would get done

3. Think of the people with whom you come into contact daily, aside from the ones to whom you feel closest. How well do you know most of them?
    You feel that they're strangers     1 2 3 4 5 6 7     You know them very well

4. Do have the feeling that you don't really care about what goes on around you?
    Very seldom or never     1 2 3 4 5 6 7    Very often

5. Have you in the past ever been surprised by the behavior of people whom you thought you knew well?
    Never happened     1 2 3 4 5 6 7     Always happened

6. Have you ever had people that you counted on, ended up disappointing you?
    Never happened     1 2 3 4 5 6 7     Always happened

7. Life is:
    Full of interest     1 2 3 4 5 6 7     Completely routine

8. Until now your life has had:
    No clear goals or purpose at all     1 2 3 4 5 6 7     Very clear goals and purpose

9. Do you have the feeling that you're being treated unfairly?
    Very often     1 2 3 4 5 6 7     Very seldom or never

10. In the past ten years your life has been:
    Full of changes without your knowing what will happen next     1 2 3 4 5 6 7     Completely consistent and clear

11. Most of the things you do in the future will probably be:
    Completely fascinating     1 2 3 4 5 6 7     Deadly boring

12. Do you have the feeling that you are in an unfamiliar situation and don't know what to do?
    Very often     1 2 3 4 5 6 7     Very seldom or never

13. What best describes how you see life:
    One can always find a solution to painful things in life     1 2 3 4 5 6 7     There is no solution to painful things in life

14. When you think about your life, you very often:
    Feel how good it is to be alive     1 2 3 4 5 6 7     Ask yourself why you exist at all

15. When you face a difficult problem, the choice of a solution is:
    Always confusing and hard to find     1 2 3 4 5 6 7     Always completely clear

16. Doing the things you do every day is:
    A source of deep pleasure and satisfaction     1 2 3 4 5 6 7     A source of pain and boredom

17. Your life in the future will probably be:
    Full of changes without your knowing what will happen next     1 2 3 4 5 6 7     Completely consistent and clear

18. When something unpleasant happened in the past your tendency was:
    "To beat yourself up" about it     1 2 3 4 5 6 7 to say,     "Ok that’s that, I have to live with it " and go on

19. Do you have very mixed-up feelings and ideas?
    Very often     1 2 3 4 5 6 7     Very seldom or never

20. When you do something that gives you a good feeling:
    It’s certain that you'll go on feeling good     1 2 3 4 5 6 7     It's certain that something will happen to spoil the feeling

21. Does you have feelings inside you would rather not feel?
    Very often     1 2 3 4 5 6 7     Very seldom or never

22. You anticipate that your personal life in the future will be:
    Totally without meaning or purpose     1 2 3 4 5 6 7     Full of meaning and purpose

23. Do you think that there will always be people whom you'll be able to count on in the future?
    You're certain there will be     1 2 3 4 5 6 7     You doubt there will be

24. Does it happen that you have the feeling that you don't know exactly what's about to happen?
    Very often     1 2 3 4 5 6 7     Very seldom or never

25. Many people - even those with a strong character - sometimes feel like sad sacks (losers) in certain situations. How often have you felt this way in the past?
    Never     1 2 3 4 5 6 7     Very often

26. When something happened, have you generally found that:
    You overestimated or underestimated its importance     1 2 3 4 5 6 7             You saw things in the right proportion

27. When you think of the difficulties you are likely to face in important aspects of your life, do you have the feeling that:
    You will always succeed in overcoming the difficulties     1 2 3 4 5 6 7             You won't succeed in overcoming the difficulties

28. How often do you have the feeling that there's little meaning in the things you do in your daily life?
    Very often     1 2 3 4 5 6 7    Very seldom or never

29. How often do you have feelings that you're not sure you can keep under control?
    Very often     1 2 3 4 5 6 7     Very seldom or never

There are no right or wrong answers, but the overall pattern of your scores will give you some useful insights. There is a large research literature in which scores on this scale have been related to everything from career choices to the risk of getting PTSD.

A Sense of Coherence

One of the central concepts of Integrated Health and Integrated Medicine is the idea of coherence. This is not a new idea, but was developed in new ways and formalized by the American/Israeli sociologist Aaron Antonovsky. It is such an important concept that I have mentioned something about it before

Antonovsky developed his theory of health and illness, which he termed Salutogenesis. This model was described in his 1979 book "Health, Stress and Coping", followed by "Unraveling the Mystery of Health" in 1987. I remember its publication, and the strong feeling amongst many of us interested in Integrated Health that it was a most important contribution to understanding the relationship between health and illness. A key concept in Antonovsky's salutogenic theory concerns the way in which specific personal dispositions serve to make us more resilient to the stressors that we encounter in daily life.

Antonovsky identified these characteristics, which he said helped a person better cope and remain healthy by providing "a sense of coherence" (SOC) about life and the challenges we all face. Measures of Sense of Coherence have been developed and tested in more than 30 countries.

The SOC is defined as: “The extent to which one has a pervasive, enduring though dynamic, feeling of confidence that one’s environment is predictable and that things will work out as well as can reasonably be expected.”

So it tries to capture our sense of optimism and control.

SOC has three components:

• Comprehensibility
• Manageability
• Meaningfulness

Comprehensibility is the extent to which events are perceived as making logical sense, that they are ordered, consistent, and structured. Manageability is the extent to which a person feels they can cope. Meaningfulness is how much one feels that life makes sense, and challenges are worthy of commitment.

Professor Antonovsky believed that a person with a strong SOC is more likely to feel less stress and tension, and to have confidence that he or she can meet the demand placed upon them. The SOC was developed to apply across cultures, and versions of the questionnaire have been used in over 30 countries.

The SOC is not the only factor in a predicting outcomes in a person’s life: it interacts with a person’s natural coping style, upbringing, financial assets, mood and social support. The strength and availability of each is a major determinant in the development of a strong or weak SOC.

Research in the growing field of psychoneuroimmunology has supported many of the basic assertions of the relationship between emotions and health contained in Antonovsky's theory of Salutogenesis.

I saw some research (NR691) at the 2007 Annual Meeting of the American Psychiatric Association in San Diego, California last month that was based on a sample of 976 working people in Denmark, found that people with a high sense of coherence perceive less stress and experience less psychological disturbance in the work place.

This all makes very good sense, and it also gives us yet another line of approach for helping people deal with the stresses of life and gain personal mastery.

I shall talk about using this information in the future.

Personal Mastery and the Wellness of Caregivers

Looking after aging relatives can be incredibly difficult, particularly if they have a chronic illness such as Alzheimer’s disease.

There is also evidence that the caregivers of people with Alzheimer’s disease have increased rates of cardiovascular disease and they die prematurely. It has been assumed that the cardiovascular problems are a result of stress causing overdrive of the sympathetic nervous system.

There was some interesting research (NR241) presented last month at the 2007 Annual Meeting of the American Psychiatric Association in San Diego. The investigators did not have to come far: they are from the University of California in San Diego.

The investigators looked at 70 spousal caregivers of people with Alzheimer’s disease and used an experimental task to measure the activity of their sympathetic nervous systems. They also measured the caregiver’s levels of “Mastery:” the belief that one is capable of handing one’s problems. Mastery is one of the components of resilience, a key characteristic of a person who can handle stress well.

What they found make very good sense: the caregivers with the highest levels of personal mastery had the lowest levels of sympathetic activity, suggesting that a sense of mastery may protect against the physiological effects of acute stress.

This provides us with yet more evidence that psychosocial interventions that increase mastery may reduce the risk of cardiovascular disease amongst the caregivers of people with dementia.

Dying of a Broken Heart

Some colleagues in London have discovered how intense stress may cause severe irregularities (arrhythmias) of the heart that could be fatal.

It has been known for some time that emotional trauma and psychological stress can precipitate cardiac arrhythmia and sudden death through over-activity of the sympathetic nervous system, the system usually associated with "Fight or flight." It has also been known that people with preexisting heart disease are particularly at risk. This is one stereotype that is true: if someone with heart disease gets a bad shock, they may indeed die. It has been known for centuries that suffering a sudden unexpected bereavement can be a fatal stressor.

It is extremely important to understand how stress can affect the heart, and researchers at the Wellcome Trust Centre for Neuroimaging at University College London and the Brighton and Sussex Medical School have made  an important breakthrough that has just been published in the Proceedings of the National Academy of Sciences. Measuring the electrical activity of the brain and heart at the same time, they discovered at the regions of the brain responsible for learning, memory and emotion can destabilise the cardiac muscle of someone who already has heart disease. These areas of the brain can participate in a "vicious cycle" with the heart.

The patients performed the task of counting backwards in sevens, which is for most people mildly stressful.

The researchers discovered that activity in "higher level" regions of the brain such as the cerebral cortex, not only reflected the responses of the heart to stress, but also became involved in a "feedback loop", often worsening the situation by making the heart muscle less stable.

The regions of the brain responsible for regulating heart function can be unbalanced by stress, and it can be fatal.

It is further evidence that there is a constant "conversation" between the heart and the brain.

It is also the best evidence to date that comprehensive care of people with heart disease must include stress management.

And why wait until it's too late?

Now is the time to start building your resilience to stress!

Blood Pressure and the Brain

We have known for almost a century that regions of the brain are involved in the control of blood pressure.

Yet over the last three decades most of the emphasis in research into hypertension (high blood pressure) has focused on blood vessels, the heart and kidneys.

Now research from Bristol University in England has been published in this month’s issue of the journal Hypertension, and it may put the brain back into the center of research into the causes and treatment of high blood pressure.

Working with rats, the researchers isolated a protein called JAM-1 (junctional adhesion molecule-1), that is located in the walls of blood vessels in the brain. It appears to trap white blood cells causing obstruction of blood flow in some of the smallest blood vessels. This can cause inflammation and result in poor oxygen supply to the brain, which may in turn trigger events that raise blood pressure.

Though this work is in its early stages, this is exciting stuff: if confirmed, it might be possible to treat hypertension with drugs that reduce blood vessel inflammation and increase blood flow within the brain.

It also ties in with other recent research from Imperial College, London and Oxford University, in which a team of neurosurgeons and physiologists discovered changes in blood pressure while fitting brain electrodes to 15 patients for pain control.

Deep brain stimulation involves placing very thin electrodes on very exact locations in the brain and is already used to relieve pain and to help Parkinson's disease patients with their movement.

The researchers found that they could make patients' blood pressure increase or decrease by stimulating very specific regions of the brain with the electrodes. Regions that have been associated with blood pressure control in the past. If they stimulated an area deep down in the midbrain called the ventral periventricular/periaqueductal gray matter, blood pressure went down, and if they stimulated the dorsal periventricular/periaqueductal gray matter it went up.

Nobody is suggesting that we should start sticking electrodes in peoples’ brain, but this chance observation may have profound implications, particularly for people who drop their blood pressure too far when they are treated with standard medicines.

These two pieces of research may also help explain why a balanced inflammation–reducing diet and relaxation may both reduce blood pressure.

Mindfulness and Eating Disorders

There is a very interesting report about a study that is going on at Griffith University in Brisbane, Australia.

They are using a psychological technique called "mindfulness" that is firmly rooted in Buddhist philosophy, in which a person becomes intentionally aware of his or her thoughts and actions in the present moment, non-judgmentally. Mindfulness is applied to both bodily actions and the mind's own thoughts and feelings.

The idea is  to help them understand and deal with the emotions that trigger their binges. Unlike many other therapies used in the treatment of eating disorders, there is less focus on food and controlling eating and more on providing freedom from negative thoughts and emotions.

Psychologists Michelle Hanisch and Angela Morgan said that women who binged were often high-achievers and perfectionists and  when they perceived that they didn't measure up to self-imposed standards or were not in control of situations, they indulged in secretive eating binges.

It is well known that many women with eating disorders develop elaborate methods of hiding the evidence of their binges. Some feel so guilty afterwards they also induce vomiting, overuse laxatives or exercise excessively to counteract the effects of the binge.

The researchers say, "Binge eating is largely a distraction - a temporary escape from events and emotions that nevertheless can cause long-term physical problems including electrolyte imbalances. Instead, women need to learn how to react in a different way... Women who have been through the program report less dissatisfaction with their bodies, increased self-esteem and improved personal relationships," and "They learn that thoughts and emotions don't have any power over us as they are just passing phenomena and aren't permanent."

Mindfulness involves techniques and exercises that are very similar to meditation. They could help people live more in the moment, and develop a healthy acceptance of self and become aware of potentially destructive habitual responses.

There is quite a large literature on the use of mindfulness in a variety of clinical situations including substance abuse, oncology, chronic stress, reducing symptoms after organ transplantation, chronic headache and perhaps anxiety.

It will be interesting to see the final results of this study: I shall keep you informed about this and other studies on mindfulness, meditation and acceptance and committment therapy (ACT).

“Peace can be reached through meditation on the knowledge which dreams can give. Peace can also be reached through concentration upon that which is dearest to the heart.”
--Patanjali (Indian Philosopher said to be the Compiler of the Yoga Sutras, Dates Unknown)

"Meditation is not to escape from society, but to come 
back to ourselves and see what is going on. Once there is 
seeing, there must be acting. With mindfulness, we know 
what to do and what not to do to help.”
Thich Nhat Hanh (Vietnamese Buddhist Monk, 1926-)

“Generosity is another quality which, like patience, letting go, non-judging, and trust, provides a solid foundation for mindfulness practice. You might experiment with using the cultivation of generosity as a vehicle for deep self-observation and inquiry as well as an exercise in giving. A good place to start is with yourself. See if you can give yourself gifts that may be true blessings, such as self-acceptance, or some time each day with no purpose. Practice feeling deserving enough to accept these gifts without obligation -- to simply receive from yourself, and from the universe.”
--Jon Kabat Zinn (American Mindfulness Meditation Teacher and Associate Professor of Medicine at the University of Massachusetts Medical School, 1944-)

Social Adversity and Schizophrenia

People who are interested in the interaction of genes, environment, brain and mental illness might be interested to look at a brief article posted over at the Psychiatric Resource Forum.

The article summarizes some very important new data on social adversity and the subsequent dvelopment of major mental illness. The research has been looking at a huge puzzle: why are serious mental illnesses so much more common in Afro-Caribbeans and Africans living in England and other parts of Western Europe? It was initially thought that it might all be due to over-diagnosis, but with deatialed work done in England, the Caribbean and Africa it has now become clear that that isn't it.

There may be a contribution from vitamin D deficiency: dark skinned people who are recent immigrants cannot make as much in their skin as they need. But that is not a cause but a potential contrbutor. That being said I am going to have something more to say about causality in medicine in a post in the next day or two.

A second line of research has identified some key brain structures that if abnormal, dramatically increase the change that a "high risk" person will develop schizophrenia. By "high risk" we mean a significant family history of the illness.

This is important material and represents a major step forward in our understanding of major mental illness and a move away from the medical model that has dominated so much of psychiatry over the last 30 years.

Stress and the Skin

You have probably noticed how stress can have an impact on some people’s skin. Increasing stress can initiate or worsen skin disorders such as psoriasis and atopic dermatitis. There has also been a lot of discussion about whether stress can also exacerbate acne and cause cold sores to erupt.

A new study published in the December issue of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology sheds important light on this association.

It is well known that one of the physical effects of stress is to increase levels of a range of steroid hormones called glucocorticoids. The best known glucocorticoid is cortisol or hydrocortisone. So the question was whether the missing link between stress and skin problems might be one or other of the glucocorticoids.

Researchers from the Veterans Affairs Medical Center, San Francisco and the University of California at San Francisco and Yonsei University Wonju College of Medicine, Wonju, Korea decided to study this possible connection.

You may have heard that the skin is the largest organ in the body and provides the critical barrier between the environment and the internal organs. Its most important function is providing a permeability barrier that prevents us from drying out. When we are healthy we are approximately 65-70 percent water. We are able to survive and function in dry environments because the skin forms a permeability barrier that prevents the loss of water.

The physical location of the permeability barrier is in the outermost layer of the epidermis that is known as the stratum corneum. The stratum corneum is composed of dead cells surrounded by lipid membranes. The stratum corneum layer continuously sloughs off, and therefore has to be constantly regenerated. The epidermal cells in the lower epidermis are continuously proliferating to provide new cells, which then differentiate, move toward the surface and ultimately die, to form a new the stratum corneum. This process is going on in your skin right now, though it can be disrupted by damage such as sunburn. If the process becomes overactive, it can lead to the development of thick, hardened skin.

It was already known that psychological stress disturbs this elegantly balanced system by decreasing the proliferation of epidermal cells and inhibiting their differentiation. As a result the function of the permeability barrier is impaired.

To test the hypothesis that glucocorticoids would have adverse effects on skin function, they stressed some hairless mice by putting them in small cages in constant light and forcing them to listen to the radio for 48 hours.

Before being stressed one group of mice was treated with mifepristone, which you may know by its two other names, RU-486, or the “morning after” pill, which blocks the action of glucocorticoids. A second group was given a drug called antalarmin, which blocks glucocorticoid production. A third group was stressed but received neither drug and a fourth group remained unstressed in ordinary cages and without the continuous light and sound to which the other groups were exposed.

The mice that received mifepristone or antalarmin showed significantly better skin function compared to the stressed mice that did not receive either treatment.

The experiment demonstrated the important role that glucocorticoids play in inducing the skin abnormalities brought on by psychological stress. Although we hope that the study will lead to a way to treat people who suffer from these skin conditions, there is still a long way to go. It’s always difficult to extrapolate from mice to people. Second, there may be serious side effects of modulating glucocorticoid activity. Glucocorticoids are essential hormones that play many important roles. Blocking their action could have negative outcomes. This is one of the reasons why we are skeptical about advertisements that claim that some herbal concoction can “cure” cortisol-related obesity. If something could really modify the activity of cortisol or other glucocorticoids in the body, it would likely have many most undesirable effects.

The research team is now looking at the effect of psychological stress on the skin's production of antimicrobial peptides, which play a role in defense against infection. It has long been thought that psychological stress might also reduce the ability of the skin to protect from infections.

I never like to leave a report involving animal experiments without also saying a heartfelt thank you to the animals that participated in the experiments.

This research is interesting and may have a number of spin offs. But I have another rather obvious question: since we already know that there is a link between stress and some skin problems, why not focus on stress management techniques, rather than trying to find new medicines to help counteract the biochemical effects of stress?

Hostility and Insulin Resistance

Insulin resistance – a reduction in the body’s ability to respond to insulin – is something that should interest and concern all of us. Not only are a third of Americans insulin resistant, with much higher rates in people of African and Indian heritage, but also insulin resistance is the major predictor of the development of type 2 diabetes and of coronary artery disease.

We already knew that stress and certain personality factors, including hostility can be associated with insulin resistance. Now new research  from The Cleveland Clinic in Ohio has clarified the association.

The study involved 643 men with an average age of 63.1 years, and the findings are published in the current issue of Psychosomatic Medicine.

The researchers measured the subjects' urine levels of norepinephrine. Norepinephrine is one of the objective indicators of stress. The researchers used standard rating scale – the Minnesota Multiphasic Personality Inventory and the Cook-Medley Hostility scale - to measure hostility. Insulin resistance was measured using some highly validated methods: the homeostatic model assessment index; 2-hour post-challenge glucose and insulin levels. The study had to be large because some many things can influence insulin resistance: nine other common variables had to be factored in to the analysis.

The study found that there was a statistical interaction between hostility and stress level in predicting insulin resistance. More hostile people do not always have worse insulin resistance, but they do when they are under stress, particularly if it is high level and sustained stress.

The team also found that not all components of hostility are related to insulin resistance. For instance, cynicism is a personality trait that is strongly related to insulin resistance.

We do not know if stress management techniques can reduce the risk of developing insulin resistance in these high-risk people, but it is likely that they will.

Yoga, tai chi ch’uan, meditation, psychotherapy may all be helpful. The best results of all have been to combine one or other of these with homeopathy, flower essences and spiritual counseling. We have little empirical research for these combined approaches, but a great deal of clinical experience that they may be beneficial.

If you notice that you or someone around you has a hostile, cynical way of handling stress, let them know that they are at high risk of developing a physical illness, but that there is a great deal that they can do for themselves before they fall off the cliff.

Hidden Harbingers of Weight: Salt Intake and Obesity

In Healing, Meaning and Purpose, I discuss some of the evidence for four previously little recognized causes of obesity:

1. Stress
2. Salt intake
3. Pesticides
4. Viruses

Each of these has been widely discussed in the professional literature, but little has percolated out into the general population except in advertisements for agents like Cortislim. I remain skeptical about these products. Tinkering with just one of the 260 hormones and neurotransmitters implicated in the control of weight is unlikely to be crowned with success. And their ingredients may also have the potential for causing problems. Recent advertisements have also mentioned that one of these products may elevate mood. Sad to say, in the last year we have seen two people who developed manic symptoms after taking one of the supplements. We are urging colleagues to see if there are any other cases, or whether these two were just coincidental.

I recently mentioned some of the evidence for viruses as a cause of weight gain.

Now a new publication from the Universities of Helsinki and Kuopio is out in this month's journal Progress in Cardiovascular Diseases, that provides powerful support for the salt hypothesis.

The researchers report that an average 30-35 % reduction in salt intake during 30 years in Finland was associated with an extraordinary 75 % to 80 % decrease in both stroke and coronary heart disease mortality in the population under 65 years. During the same period the life expectancy of both male and female Finns increased by 6 to 7 years.

As expected, reducing salt intake has a beneficial effect on blood pressure.

But in my view the most interesting finding of the study is the close link between salt intake and obesity.

As bartenders, pub landlords and tavern owners have known since the beginning of time, increasing a person's intake of sodium produces a progressive increase in thirst. (You didn't think that those peanuts on the bar were put there out of the goodness of the establishment's heart did you??!)

The progressive increase in the average intake of salt explains the observed increase in the intake of sugar-containing beverages which, in turn, has caused a marked net increase in the intake of calories during the same period in the United States.

Here is an extraordinary statistic: Between 1977 and 2001, energy intake from sweetened beverages increased on the average by 135 % in the United States. During the same period, the energy intake from milk was reduced by 38 %. The net effect on energy intake was a 278 kcal increase per person a day. The American Heart Association has estimated that, to burn the average increase of 278 kcal a day and avoid the development or worsening of obesity, each American should now walk or vacuum 1 hour 10 minutes more every day than in 1977. As we all know, that has not happened.

In the decade from 1976-1980 to 1988-1994 the overall prevalence of obesity increased 61 % among men and 52 % among women. During 1999 to 2002, the prevalence of obesity was 120 % higher among men and 99 % higher among women as compared with the 1976 to 1980 figures. The increased intake of salt, through induction of thirst with increased intake of high-energy beverages has clearly made a significant contribution to the increase of obesity in the United States.

It is also of note that until 1983 the use of salt did not change or even showed a continuous decreasing trend in the United States. The prevalence of obesity was relatively low and remained essentially unchanged from early 1960s to early 1980s.

This new study suggests that a comprehensive reduction in salt intake, which would reduce the intake of high-energy beverages, would be a potentially powerful means in the so far failed attempts to combat obesity in industrialized societies.

There is now conclusive population-wide evidence that indicates that we could achieve powerful beneficial health effects simply by reducing our overall salt intake. These benefits include a decrease in obesity.

As an aside, the population-wide long-term experience from Finland indicated that a remarkable decrease in the salt intake has not caused any adverse effects.

A number of years ago we were engaged in some experiments in which we replaced regular table salt - sodium chloride - with potassium chloride. For the first three weeks food seemed rather tasteless. But then we all suddenly discovered a new universe of flavors that had previously been hidden under a thick coating of salt. So a dietary change does have a temporary effect on your taste buds.

Although the paper doesn't say so, there is also some data that salt may itself increase cortisol release.

The bottom line?

We now have clear, empirical data to support three out of the four points that I made in Healing, Meaning and Purpose, and there is some less robust data for the fourth.

I urge you to try gradually to reduce your personal intake or salt, and to encourage your family and friends to do the same. I mentioned that food may initially seem a little less flavorful, but then things change rapidly and for the better.

And your body will love you for the change!

Alexithymia

There is an important psychological symptom that can cause a great deal of distress, particularly in relationships. It is called alexithymia.

The Harvard psychiatrist Peter Sifneos originally coined the term in 1972 to describe people who had extreme difficulty in emotional cognition. The word “alexithymia” literally means “no words for mood.” People with this problem lacked the ability to understanding, processing or describing their feelings verbally. As a result, most people who have the problem are largely unaware of their own feelings or what they signify. As a result they only rarely talk about their emotions or their emotional preferences, and they are largely unable to use their feelings or imagination to focus and fuel their drives and motivations.

People with alexithymia seem unable to fantasize and many report multiple somatic symptoms. However, alexithymia is also associated with a number of other complaints, such as hypertension, irritable bowel syndrome, substance use disorders, and some anxiety disorders. Their speech is often concrete, mundane and closely tied to external events. So they will describe physical symptoms rather than emotions, and don’t understand that their bodily sensations are signals of emotional distress.

Alexithymia lies on spectrum: regular readers will remember some of our discussions about categorical and dimensional diagnoses. For some people it is little more than an inability to get in touch with their emotions. But at the other end of the spectrum are a number of illnesses in which alexithymia may occur, including schizoid personality disorder, posttraumatic stress disorder, anorexia nervosa or Asperger's syndrome. It is also much more common in victims of trauma.

Much has been written about alexithymia: a literature search earlier today generated over 8,500 publications.

It is still not clear what causes alexithymia. But this much is clear: in some people, there is a strong inborn predisposition to developing it, while in others it can develop in response to life events such as being raised in a low socioeconomic group with little social stimulation, trauma or chronic stress. For this reason we often talk about primary and secondary alexithymia.

Some neuropsychological studies have indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which usually plays a predominant role in processing emotions. Other studies show evidence that there may be a deficit in the transmission of information between the hemispheres of the brain, with emotional information from the right hemisphere not being properly transferred to the language regions in the left hemisphere. Other studies have suggested that alexithymia may be related to a dysfunction of the anterior cingulate cortex a region of the brain involved in the control of attention, empathy, emotion and the anticipation of rewards.

Alexithymia can have some serious consequences. Apart from making relationships very difficult, it is more common in people who have near-fatal asthma attacks or have poor diabetic control. People with a history of alcohol abuse who have alexithymia are more likely to relapse. Alexithymia may predispose people to developing the insulin resistance syndrome.

As you can see, alexithymia can be dangerous: we have to have words for our feelings, or the feelings will express themselves though our bodies. It can predispose us to just about every stress-related illness, and even some illnesses that we don’t normally think of as stress-related. Since alexithymia is all about an ability to express emotions, it can be thought of as a social or informational disease. If we cannot inform others about our wants and needs, and if our minds cannot send us signals to say that something is going wrong, there could be a catastrophe lying in wait for us.

People with extreme forms of alexithymia can be very difficult to help using conventional medicine.

However, many people have minor degrees of alexithymia, and these can be helped by therapies designed to help them express emotions:

1. First is to become aware of the problem: I’ve had good success with asking people to keep an emotions “log book:” if they are having odd symptoms, how good are they about having appropriate emotions? I ask them to keep a note of their emotions in response to normal interactions with other people, or while watching television or a movie. If the person feels nothing while watching something really emotional, that can help him or her see that there is a problem. Simply learning to be more expressive can help mild cases: there are an array of forms of psychotherapy that can help.
2. In mild cases, we have had some good results with flower essences. There’s not a shred of scientific proof that they help, but clinically they often do. The same goes for two other helpful approaches:
3. Homeopathy: there are over a dozen remedies that may help
4. Tapping therapies

Women, Asthma and the Brain

There’s been a longstanding puzzle in medicine. Well actually there are lots of them, but here’s one that may be a puzzle no more.

For many years now, it’s been known that asthma is more common in women, and also that psychological stress can cause flare ups of asthma.

Many women experience “menstrual flaring:” a worsening of asthma around the time of their menstrual period. There is also a strange paradox: some women with asthma wheeze less if they take an oral contraceptive, while some non-asthmatic women begin to wheeze when they take it. In some women pregnancy makes asthma worse, and in others it affords months of relief of symptoms. Women who are obese are more likely to get asthma, presumably because their intra-abdominal fat stores are churning out inflammatory mediators.

Researchers from the University of Wisconsin have shed  some important light on this link between asthma and the brain. In research published in the Proceedings of the National Academy of Sciences. In the study, six patients with mild asthma were exposed to ragweed or dust-mite extracts. The subjects were shown three different categories of words: asthma-related (e.g., "wheeze"), non-asthma negative ("loneliness") or neutral ("curtains").

Using functional magnetic resonance imaging, they showed that activity in two regions, known as the anterior cingulate cortex and the insula showed increased activity when the asthma-related words were heard compared with the other types. What is more, this enhanced activity was specifically linked to physiologic signals from the ragweed and dust-mite extracts. So being exposed to asthma-relevant emotional stimuli is associated with markers of inflammation and airway obstruction in asthmatic people exposed to an asthma-producing antigen.

In people with asthma and other stress-related conditions, these brain regions may be hyper-responsive to disease-specific emotional and physiologic signals. Taken together, these could contribute to problems that worsen the asthma, such as inflammation.

And one of the ways of making these regions of the brain hyper-responsive? Bathe them in estrogen.

That still does not explain why pregnancy and the oral contraceptive makes some women’s asthma better, and does the opposite in others. But it may just have to do with the “set point” of the cells in these regions of the brain. In the same way that we might set the thermostat in out house. An already hyper-responsive brain might be normalized and an under-active one stimulated to be over-active.

We need to do some more experiments, but these are a great start.

If you ever wheeze, have a look to see if there are stressors or hormonal events that trigger you. Whether you are being treated with homeopathy, herbals or conventional therapy, knowing when to expect trouble gives you the power to adapt you treatment when you are entering a risky time in your life.

Banquo’s Ghost

“Chess is the game which reflects most honor on human wit.” -- Voltaire (a.k.a. François-Marie Arouet, French Writer and Philosopher,  1694-1778)

For anyone with even a passing interest in chess, a re-unification match for the World Championship is currently taking place in Elista, the capital city of Kalmykia, a small region of the Russian Federation that is Europe’s only Buddhist country. Though I’m sure that some would quibble about whether it should be in Europe or Asia.

The beginning of the match between two of the world’s top Grandmasters - the aggressive Bulgarian gambler Veselin Topalov and the conservative Russian, Vladimir Kramnik - has led to and 2-0 score in favor of the Russian.

So why am I mentioning this is a blog dedicated to Personal Growth, Healing and Wellness? Because the current one-sided score line has a lot to do with each of these topics. This match is not just about chess playing ability: it is also about psychological and emotional strength, character and resilience.

There was a time when chess masters were unfit, often over-weight and the majority smoked. When I first started playing in tournaments in England, it was quite normal to have ashtrays beside most of the boards.

Oh how things have changed!

Now the players prepare physically, psychologically and some even spiritually with prayer and meditation:

1. Very few players smoke, not just because of long-term health risk, but because the deleterious effects of lowered oxygen levels on cognition outweigh the short-term improvement in attention caused by nicotine.
2. Aerobic exercise is essential to ensure that the brain is perfused with oxygen, and if you are physically unfit you cannot expect to survive a number of games that may each last for five or six hours.
3. Strength training is also essential to overall fitness and physical and the maintenance of psychological resilience. Topalov is going to need that now.
4. Posture is extremely important. According to Chinese and Ayurvedic physicians and chiropractors, bad posture results in a restriction in the flow of Qi, Prana, or blood. Whether or not you believe in the flow of Qi in the body, it is easy to demonstrate that bad posture has bad effects on cognition.
5. Flexibility is also an essential part of physical wellness that affects you psychologically as well as physically. Daily stretching should be part of everyone’s life.
6. Relaxation and meditation: one or other or both are essential tools for maintaining your balance while under stress, and for building resilience.
   
7. Diet: a carefully balanced nutritious diet rich in omega-3 fatty acids (without any added mercury!) and fiber is essential for optimum mental functioning.
8. Fluid intake: the current recommendations are for a healthy person to drink between 80 and 120 fluid ounces of pure water each day.
9. Avoid alcohol: A former World Champion – Alexander Alekhine – lost his title after turning up drunk on a number of occasions during a match to defend his title.

Looking at the pictures from the match, in both games Topalov looked intense and Kramnik far more relaxed. It could have been an illusion: I would need to be in proximity to be sure. In the first game Topalov took a needless risk in a dead level position. In the second, he had an absolutely won game. I’m no grandmaster, but even I spotted a win in three moves. How could he have failed to find it and then lost?

What is the explanation? Chess players have to play a certain number of moves in a specified time, so not only are they playing their opponent, they are also playing against the clock. The biggest prize in the game is on the line, for which both players have been preparing since childhood. And there are hundreds of thousands of people who are watching and analyzing their every move.

I know from personal experience that it can be hard enough to be interviewed on a television show being watched by millions of people, where any false statement would haunt me forever. Imagine having a battle of wits with one of the finest chess players in the world in the knowledge that every move will be analyzed for the next century, and computers are already analyzing every permutation of every move that the two players have made.

The stress on the players is unbelievable. Both have prepared for it, but it is also a matter of who has prepared best: that is a mixture of temperament and training. Just today I read an article talking about ways of avoiding stress. This is silly: stress is part of life and it can provide the motor in motivation. The trick is how we learn to respond to stress.

There is also another stressor that has only been felt by world championship contenders on two or three previous occasions. This match is being played in the shadow of the retirement of Garry Kasparov, who, in the opinion of most people, is the strongest player who ever lived, with the possible exception of Bobby Fischer. The difference is that Bobby became World Champion all by himself, with little help and by inventing a new approach to chess. It is a great tragedy that his life has apparently been blighted by mental illness, and that he has played only a few recorded games in the last 34 years.

By contrast, Garry was the strongest player in the world for twenty years, and in the opinion of most experts would probably still beat both of the current contenders. So whoever wins wants to prove himself a worthy champion. Garry’s specter remains like the ghost of Banquo in the Scottish play.

The final essential is that both players have to detach from the results of the first two games. Kramnik will obviously have his tail up now, but he is too smart and too experienced to give in to complacency. Topalov has to completely forget about the first two games and focus on what lies ahead: I’m sure that he has someone on his team working on simple techniques to stop the past from populating his psychological present.

Whatever lies ahead for these two men in the next few weeks, we shall see that chess is a microcosm of life in general.

“What is needed, rather than running away or controlling or suppressing or any other resistance, is understanding fear; that means, watch it, learn about it, come directly into contact with it. We are to learn about fear, not how to escape from it.” --Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)

Fibromyalgia and Childhood Abuse

There is a small and growing literature about a link between fibromyalgia and a history of abuse, primarily in childhood or early adolescence.

A new study has shown that people with fibromyalgia who had experienced physical abuse in childhood did not have the normal daily fluctuations in the stress hormone cortisol. They also had sudden surges in the hormone as soon as they were woken up, which can be a good stressor. People who had been sexually abused also had this odd cortisol response on being awakened. These findings suggest that severe traumatic experiences in childhood may be a factor in causing hormonal disturbances in people suffering from fibromyalgia. This adds to the growing body of evidence that in women having pain early in the day, there is a high likelihood that the entire stress hormone system does not function normally.

Colleagues from the Department of Psychiatry, UMDNJ-New Jersey Medical School in Newark, New Jersey have reported that women who have been raped are ten times more likely to experience chronic pelvic pain as well as generalized pain.

Another study has found close correlations between childhood abuse and the subsequent development of chronic pain. The link between rape and the subsequent development of fibromyalgia seems to be mediated by chronic stress, in the form of posttraumatic stress disorder.

What this means is that professionals need to consider this:

1. It is important careful to inquire about any history of past or present abuse or other severe trauma
2. That empathy and constructive validation of disease and suffering can be very helpful
3. That dysfunctional pain behaviors and personality traits may be a consequence of abuse together with a lack of resilience
4. That multidisciplinary treatments including psychotherapy may be the best approach to helping people. Using the methods of Integrated Medicine is often far better than reliance on potentially habit-forming medications.

If we remember that there is more and more evidence of inflammation and other physical problems in fibromyalgia, and that stress and maltreatment in early life can alter the structure and function of specific regions of the brain, what this all shows us is that abuse in childhood can have a long term impact on the way in which both the body and the brain functions.

Combat Stress

The British Ministry of Defense has announced that it is going to pardon all 306 soldiers shot for cowardice during the First World War.

This is the culmination of a campaign that has been going on for years, after it was discovered that most of these soldiers were actually suffering from “shell shock.” From the historical records it seems highly likely that this was actually post traumatic stress disorder (PTSD). Some people have said that there’s no point in issuing posthumous pardons ninety years after the events.

I don’t agree. It’s virtually impossible for us to imagine the horrors of trench warfare, and I think that it’s important to recognize the terrible psychological consequences of it.

Hospitals in the United States are already beginning to see a great many cases of PTSD from the current conflicts in Iraq and Afghanistan. We know that there are some predictors of who will suffer from PTSD, but that given enough trauma, it can likely happen to anyone.

People Dangerous to Your Health

I found a terrific blog with the title “Warning: Bores and buffoons may endanger your health.”

Our ability to self-regulate is a limited resource that fluctuates markedly, depending on our prior use of willpower, tiredness, stress and our personal resilience.

A new study by a team lead by Professor Eli Finkel of Northwestern University has shown that poor social coordination impairs self-regulation. What does this mean? If you are forced to work or interact with difficult individuals you may be left mentally exhausted and far less able to do anything useful for a significant period of time. In other words, draining social dynamics, in which an individual is trying so hard to regulate his or her behavior, can impair success on subsequent unrelated tasks.

In the research, volunteers were asked to work in pairs to maneuver an icon around a computer maze, with one volunteer giving the instructions, the other moving the joystick. Those operating the joysticks were actors, primed to respond to instructions in slow, stupid, inefficient and generally irritating ways. What was interesting was that the effects were not mediated through participants' conscious processes: they were almost entirely going on below the level of conscious awareness.

There is extensive literature on the consequences of social conflict. But until now, very little research has been conducted on the effects of ineffective social coordination. That has been a big gap in the research literature, particularly given the fact that most of the higher systems in our brains are dedicated to social functions, and since the earliest days of our hunter-gatherer ancestors, tasks requiring social coordination have been the norm. In our day-to-day activities we have to cooperate with other people. Ineffective social coordination consumes a great deal of mental resources and has high costs for subsequent self-regulation. This is so important, because self-regulation is essential to living life well. It is also essential to the existence of a well functioning society.

What to do with this new information?

Identify people who drain you. If you need to work with them, do it in short bursts, and give yourself plenty of time outs.

And continue to build your resilience.

There's also one other piece, that we'll look at another time. Some people may also drain your energy directly. You may have come across "energy" or "psychic vampires." They really do exist, though there is nothing supernatural about them, and they don't have fangs or an aversion to garlic. In another post I'll show you some techniques for dealing with those people as well.

The researchers have done us a great service by putting the entire paper on the departmental website. Access is free.

Beating Burnout

I have been getting a number of requests to re-post some of my materials about burnout.

This is a summary of some of the information that we cover in our corporate wellness seminars. For people who are interested, we have also created a Powerpoint slide set, together with reference materials which are available for purchase from our website.

So let us begin at the beginning and ask:

What is Burnout?
This may seem such an obvious question, since the term “burnout” has become part of everyday language, but it is still the topic of a great deal of research.

The best definition of burnout is “a prolonged response to chronic physical, emotional and interpersonal stressors at work.” It is defined by three dimensions:

1. Exhaustion
2. Cynicism
3. Inefficacy

It is more than just an individual experience of stress: it has to be seen in the larger organizational context of people’s relationship with their work.

It is often the case that individuals miss all the signs in themselves.

So what are the main symptoms of burnout?

1. Worrying, particularly at night
2. Trouble sleeping
3. Feeling unappreciated or “used” at work
4. Feeling less effective or competent than you used to
5. Easily angry or irritated
6. Dread of going to work
7. A feeling of being overwhelmed
8. Recurrent stress-related physical symptoms like headaches, or back pain
9. Watching the clock and counting down toward the end of the work day
10. Rigidly applying riles without considering more creative solutions
11. Automatically expressing negative attitudes
12. Finding excuses to be absent from work
13. Alcohol or substance abuse

We need to ask questions about conditions at work. For instance whether individuals are asked to work extra long shifts, go without breaks and lack clear guidelines.

Who is at greatest risk?
Helping professionals and people who have great responsibility for others, such as  airline pilots and air traffic controllers.

Although there are some psychological predictors for who are more likely to suffer from burnout, with enough stressors just about anyone can become a victim of it. Some people have claimed that burnout is a physical illness resulting from exhaustion of the adrenal glands, but the research doesn’t show that. Burnout is primarily a problem of the system in which you work, interacting with your body and your mind. So now let’s look at how to transform yourself from victim to victor.

The major risk factors are:

1. Feeling powerless
2. Being caught in conflict
3. Having inadequate information
4. Lack of central visions
5. Incoordination of the team
6. Overload
7. Boredom
8. Alienation
9. Ambiguity
10. Conflict of values

What are the Solutions?
Dealing with burnout needs the help of all workers and the organization as a whole. Sometimes it also needs the help of an outsider. I was once working in a very unhappy place, in the days long before I realized that I had the power to change things myself. A psychologist friend working in the then new field of systems theory, told me that the problem was not with individuals, but that the whole system was “sick” and disorganized and what was needed was a system overhaul.

The opposite of job burnout is job engagement. If you feel that you are engaged in doing something valuable, for which you are appreciated, you are far more likely to have a satisfying life and enjoy doing your job well. There is good evidence that participation, engagement and autonomy are powerful predictors of health outcomes.

First, at the personal level:

The keys to preventing burnout are represented by the acronym REAP:

Resilience
Engagement
Autonomy
Participation

1. Evaluate your personal goals and priorities: what do you really want to get out of life, and even more importantly, what do you want to put in to life
2. Ensure that you have established your own core values, your purpose and your meaning. (My book and CD series Healing, Meaning and Purpose spends a lot of time on helping you do exactly that.)
3. Attend to your own health, through exercise, nutrition and sleep. (I have worked with countless individuals with burnout, whose problems largely evaporated once they were diverted from the coffee, soda and snack machines. Remember the close relationships between food and mood.)
4. Make sure that you have some outside interests. Not just things that further drain your energy, but something that you enjoy.
5. Learn some specific stress reduction techniques. (I also have some suggestions for doing so in my book.)
6. Are you a micromanager who has to do everything yourself? If so, then it is a really good idea to learn to delegate. And don’t take on responsibilities that are not yours. (It took me years to learn that one: I was such a slave to perfectionism, that I always thought that I had to everything myself. Bad mistake)
7. If your find yourself expressing negativity, work on substituting a positive word for every negative one.
8. Learn to forgive yourself if things are not going well, and use reversals as the fuel to power you to achievement: it’s what I call “silver-lining:” How to find the positive in any negative situation.
9. Try to form a support group or see if you can arrange for an outsider to some in and help you.
10. Are there some specific skills that you need to build and develop?
11. Can you tailor or change your job?
12. Develop detachment

Second, at the organizational level:

1. Evaluate overall work performance: if it declining, it may be an early sign that staff members are being afflicted by burnout.
2. Consider changes in managerial practices, to move away from the dominator to a partnership model.
3. Research has indicated that there are six key areas in which mismatches may lead to burnout: workload; personal control; appropriateness of rewards; sense of connection; sense of fairness and a conflict of values. So it is a good idea to break down any analyses and interventions along these lines.
4. All the evidence suggests that a combination of managerial change and education are the best way to head off and to deal with burnout.
5. There is also some research showing that a values-based spiritual program to prevent and deal with burnout. The recommendations include a short time for silence, visualization, reflection, active listening, appreciation creativity and playfulness.

What is very clear is that burnout is not just a personal problem; it is something that can affect an entire organization, and has to be tackled as an organization. If it is not, then in these difficult times in health care, we are going to have ever more tired and disillusioned people trying to care for sicker and sicker patients, and just not having the resources to do so.

Transcending Overload and Burnout
There is an important notion that is rarely even talked about. Why does stress and burnout exist? Is it simply bad overloaded wiring in the brain and bad overloaded wiring in our relationships and in our places of work? Well, yes, that is of course correct. But there is also something else: burnout occurs because multiple sets of systems are failing. Nature abhors a vacuum, so from the ashes of these failed systems a new and improved you can emerge. Remember the ancient story of the Phoenix that emerges from the flames. And you might know the statement by Richard Bach: “What the caterpillar calls the end of the world, the master calls a butterfly.”

We need to discard broken systems so that our true self can emerge.

I would like you to think about burnout as a state of consciousness that you are ready to outgrow. You can practice the psychological band-aids, or you can accept the invitation to grow.

There will inevitably be some transition pains, but that is to be expected as the new you is being born. This is also a good time to do an exercise that I recommend in Healing, Meaning and Purpose, and it is to establish where each part of you - Physical, Psychological, Social, Subtle and Spiritual – lies in terms of the Memes of Spiral Dynamics. If you do this exercise every few months, and at times of transition, it can provide powerful proof that the burnout is actually presenting you with a unique opportunity to grow.

Stress, Depression and Resilience

“Patience in calamity, mercy in greatness, fortitude in adversity; these are the self-attained perfections of great saints.”
--The Hitopodesa (Sanskrit fable from the Panchatantra, the “Five Chapters,” Translated as the “Good Advice” c.1100 A.D.)

We are all different in the way that we respond to emotional and physical stress. It is not enough to focus on one single reason why one person handles it and another does not. I have often made the point that we need to consider the physical, psychological, social, subtle and spiritual contributions to any illness or challenge.

New research is shedding light on the interaction between two of these: genes and environment. A multinational research effort assessed the impact of stressor on mood in 275 pairs of female twins. 170 sets of twins were identical: they have exactly the same genetic makeup.

The research indicates that only 12% of individual differences in reactions to stress can be attributed to genetic influences. This is stunning, and should have been reported far more widely: 88% of the differences in the way a person reacts to stress are not genetic, but personal and environmental. This is of great importance in problems such as depression. If genetic factors play such a small role, then paying attention to the development of personal resilience - as well as dealing with social factors – is more likely to be effective than anything else. And, as has been discussed elsewhere one of the ways in which some medicines help people with depression, bipolar disorder and schizophrenia is probably by increasing their resilience.

I have already started showing you some of the techniques for improving psychological resilience and in a future publication we are also going to start work on physical, subtle and spiritual resilience and how to develop more resilient and dynamic relationships.

"Never allow anyone to rain on your parade and thus cast a pall of gloom and defeat on the entire day. Remember that no talent, no self-denial, no brains, no character, are required to set up in the faultfinding business. Nothing external can have any power over you unless you permit it. Your time is too precious to be sacrificed in wasted days combating the menial forces of hate, jealously, and envy. Guard your fragile life carefully. Only God can shape a flower, but any foolish child can pull it to pieces."
--Og Mandino (American Motivational Speaker and Author, 1923-1996)

Technorati tags: Resilience Depression Stress Environment Genetics

Temporomandibular Joint Dysfunction

The temporomandibular joint (TMJ) is the hinge joint that connects your mandible or lower jaw to the temporal bone at the side of the skull.

The joint can be affected by many disease processes including osteoarthritis, rheumatoid arthritis, the arthritis associated with psoriasis and infectious arthritis. There’s a whole ragbag of other illnesses and injuries that can affect the joint. But it is more commonly affected by muscular tension, problems with the bite, or tooth grinding (bruxism). I’ve been interested in TMJ problems ever since my days working in the Princess Margaret Migraine Clinic in London, where I saw a great many people with chronic headaches due to problems at the joint. A dental colleague helped many of them. Once I had been trained in acupuncture, I found that this is one condition in which I’ve always had good rates of success, both in humans and in horses.

So I was pleased to see an audit of 60 patients with TMJ dysfunction was compiled from the practices of 15 dental practitioners in the United Kingdom who were applying to become members of the thriving British Dental Acupuncture Society. Simple acupuncture was used at local points around the joint, on the neck, and on a point on the hand that is linked up with the joint, and tends to relax muscles and improve blood flow. This was a simple study, and in hindsight, it could have been improved. But the conclusions were encouraging: 85% of patients benefited, and the intensity of the pain was reduced by an average of 75%. This is remarkable since the patients were only receiving acupuncture and not any of the “extras” that I normally recommend as a matter of course.

Technorati tags: Temporomandibular joint Arthritis Acupuncture Migraine

Revisiting Resilience

“I don't measure a man's success by how high he climbs, but how high he bounces when he hits bottom.”
--General George S. Patton (American General, 1885-1945)

Resilience is the process of being able to adapt and to thrive in the face of adversity, stress, trauma, tragedy or threats. A resilient person is les likely to succumb to any of these life events and is less likely to develop mental illness. But resilience is more than a passive strength or resistance to the slings and arrows of outrageous fortune: it is a dynamic capacity that not only protects us, but enables us to turn adversity into strength and an opportunity for growth.

Despite our extraordinary health care system and a multi-billion dollar antidepressant industry, the rates of depression are increasing throughout the Western world. A recent book has suggested that boredom was unknown before about 1760: the beginning of the Industrial Revolution. All this tells us that something is seriously wrong with our resilience.

“The measure of a man is the way he bears up under misfortune.”
--Plutarch (Greek Biographer and Priest to the Oracle at Delphi, A.D. 46-c.120)

In Healing, Meaning and Purpose, I pointed out some of the incredible changes that have taken place over the last one hundred years, and their impact on health. To try and apply the principles of the past to the problems of the present and future is unlikely to be crowned with success. We need to adapt. Buddhists do not normally eat meat. Except for Tibetan Buddhists, who need to eat some meat in order to survive at the high altitudes of the Himalayas. I have a good friend who created the finest integrated medicine clinic in the world, the Hale Clinic in London. Normally an abstemious vegetarian, when she was embroiled in business meetings, she would often take some meat to remain grounded. I have done the same thing myself for years. I prefer not to eat meat. I have not had a steak in more than thirty years. But if I am to do a lot of traveling and need to work with politicians and business people, a bit of chopped up fish or poultry can be essential.

The changes in our lifestyles over the past century have dramatically reduced the level of physical activity necessary to provide life's basic resources: our effort-based rewards that are intimately involved in the regulation of mood. If you think about it for a moment, if your great-grandparents wanted to eat, there was probably a lot of effort involved. Our brains still contain a huge number of circuits that evolved to play roles in sustaining the kind of continuous effort that would be critical for the acquisition of resources such as food, water and shelter. So what happens when we suddenly on longer need much physical activity to obtain those resources? What happens to those parts of the brain that have millions of years evolving? There will be reduced activation of those brain regions essential for reward, pleasure, salience, motivation, problem-solving, and effective coping strategies. The practical consequence of that is that these systems will not sit there idling: if under-stimulated, since these systems are so heavily involved with our emotions, we would expect to see people becoming depressed. And we know that depression has been increasing throughout the Western world. Of course, many people need to stimulate these regions of the brain artificially, as with drugs, pornography or extreme sports.

Effort-based rewards are an essential component of resilience to life's stressful challenges. Purposeful physical activity is important in the maintenance of mental health. It therefore makes sense to put more emphasis on preventative behavioral and cognitive life strategies, rather than relying solely on psychopharmacological strategies. Our strategy is geared toward protecting people from developing depression, and compensatory behaviors. One of the very interesting new ideas in pharmacology is that antidepressants and antipsychotics may act to enhance resilience at both the cellular level and in the whole person. This is a very different concept from thinking of medicines as chemicals that simply block symptoms.

Our aim is to improve resilience and gradually to increase activation of all those under-used systems of the brain to treat and then to prevent problems. All the things that mother always said were good for you: healthy exercise, meditation, a balanced diet, charity and kindness, and actions aimed at fulfilling your personal and Higher Purpose have already been shown to treat and to protect.

Here are some proven methods for improving resilience:
1.    Learn to be adaptable: the heart of resilience is the ability to take things in your stride and to be able to surf the ocean of change, rather than trying to hold the hold it back.

2.    Be aware of the blockages in your mind or in the subtle systems of your body that are preventing you from bouncing back form adversity

3.    Attitude: avoid seeing a challenge as an insurmountable problem

4.    Accept that change is part of life: you can do little about it, but you can do a great deal about how you react to change

5.    Ensure that you have meaningful goals that are consistent with your core desires and beliefs, and that you are moving toward them

6.    Do all that you can to work on establishing your own Purpose in life. You can create a purpose for your life, but also be aware that there is a Higher Purpose in you life

7.    Take decisive actions: even if the first action may not be the best one. Any action is usually better than denying that problems exist, and hoping that they will evaporate while you are asleep or watching television

8.    Develop and maintain close relationships. Even if you are not a sociable person, relationships are one of the most potent way of protecting yourself from life’s ups and downs

9.    Look for opportunities to learn more about yourself, and how you react to situations. This doesn’t mean becoming an introvert or a rampant narcissist, but it does mean taking a moment each day to review where you are and what you can learn form things that are or have happened in your life. This is a big subject, but there are many good ways to answer the question, “Why is this happening to me  again?” and from preventing habitual problems and routine self-sabotage. (I shall be publishing an eBook and CD about this crucial topic in the very near future)

10.  Work on developing a positive self-image. I have had some harsh things to say about the excesses of the self-esteem movement, but it has now been replaced by something far more valuable: the science of positive psychology. We have a great deal of empirical data on how to improve a person’s happiness and resilience. Again, we can speak about that some more if you are interested.

11.  Maintain hope for the future. We have done research that has shown that one of the best ways of predicting a positive outcome with major mental illness, or of reducing the risk of recurrent substance abuse is to instill hope. Again, there are techniques for doing this, even when the whole world seems to be against you.

12.  Maintain perspective: do not blow things out of proportion, and remember that this too shall pass.

13.  Take care of yourself, physical, emotionally and spiritually. Listen to yourself: what does your body need? What do you need emotionally? What do you need from a relationship? What do you need spiritually?

14.  Are you giving others what they need from you? If you have a nagging sense that you are not giving a child or a spouse that they need and deserve, it can dramatically reduce you resilience.

15.  Rather than just thinking about and worrying over your problems, or problems that may turn up in the future, get into the habit of thinking of yourself not just as an individual who is going through problems, but as a boundless spiritual being who is learning a lesson.

16.  Never forget to think about the legacy that you are going to leave. Not just to your family, but to the world at large. If you can’t think of one, this is a good time to begin to create one. That is an enormously  powerful perspective on the world and on your problems.

“I am an old man and have had many troubles, most of which never happened.”
--Mark Twain (a.k.a. Samuel Langhorne Clemens, American Humorist, Writer and Lecturer, 1835-1910)

Technorati tags: Resilience Life event Life balance Legacy Stress management

Sick Building Syndrome

Sick building syndrome (SBS) was first recognized in 1982, and is a combination of symptoms associated with an individual's place of work - most often an office building -though there have also been instances of SBS in residential buildings. A 1984 World Health Organization report into the syndrome suggested up to 30% of new and remodeled buildings around the world might be linked to symptoms of SBS.

Many symptoms have been associated with SBS, including:

• Headache
• Dry or itchy skin
• Chronic fatigue
• Irritation of the eyes nose or throat, sometimes with a dry coughs
• Dizziness
• Nausea
• Difficulties in memory and concentration
• Extreme sensitivity to smells or bright lights

For SBS to exist, these symptoms must disappear soon after the occupants go outside.

There have been many explanations for these symptoms, primarily related to environmental pollutants. But I have something to add to that list. Some time ago I spent a happy year working at the Charing Cross Hospital in London during which I made an odd observation. On days that I worked in the laboratory on the tenth floor, I would be exhausted by the middle of the day, while on days when I worked in the outpatient clinic in the basement, I could easily get through a 5 hour clinic without difficulty. I mentioned it to a neurophysiologist friend who told me something very interesting: it had been discovered that on days when the wind blew at 5-10 miles an hour, the building began to vibrate like a giant tuning fork, and that the vibration was at its worst between the tenth floor and the top of the hospital. The vibration was imperceptible to most people, but I clearly had the misfortune to be sensitive to it. Yet without this experience, I might never have known of the potential adverse effects of vibration of the human body.

I have been consulted by a number of corporations and government organizations that have had trouble with people getting sick in certain buildings. Until now we have thought that it was all environmental, and that it could be anything from vibration to poor ventilation, chemicals, molds and many things in between. So I was very surprised to see a report published in the journal Occupational and Environmental Medicine from a first rate research group at University College London.

The British Inland Revenue Service demolished an entire 19-storey building in Bootle, Merseyside, after almost half of the employees had developed illnesses compatible with SBS. In a study published two and a half years ago, it was claimed that adding ultraviolet light to ventilation systems to kill microbes could vanquish the symptoms of SBS. But this new research suggests that the cure may actually be better management.

The new study included 4,052 civil service workers between the ages of 42 and 62 who were enrolled in a larger general health study. The men and women in the study worked at 44 different office buildings around London. The workers completed surveys designed to assess their general health and whether they had symptoms linked to SBS. They were also asked questions about the physical properties of the offices that they worked in and the stresses associated with their jobs.

As in earlier studies, women tended to have more symptoms associated with SBS than did men. Younger workers also had more of the symptoms than older workers. Almost one in five women and one in seven men reported five or more symptoms associated with sick building syndrome.

Now here was the surprise: the authors found little association between physical work environment and the symptoms. But there was a strong association between the symptoms and feelings of having high job demands and little support in the workplace. They also found that the more control people have over their workstation, the fewer symptoms were reported.

Though the findings fail to support "sick buildings" as a common cause of worker illness, the study should not be interpreted as meaning that the physical quality of the workplace is unimportant. It is most likely that we are dealing with a combination of physical and work related factors.

As I was reading the report and reviewing the rather vague but often quite severe symptoms, I was reminded of some recent work that I have been doing on burnout: I’ve just published an article about it. My interpretation of this study is that many cases of SBS are likely a form of burnout that is partially modulated by physical factors in the environment.

Technorati tags: sick building syndrome, workplace, occupational medicine, burnout, Stress

Using your Core Values for Rapid Stress Management

“The cyclone derives its powers from a calm center. So does a person.” -- Norman Vincent Peale (American Cleric, Writer and Self-Help Expert, 1898-1993)

As a professional speaker, I often forget that glossophobia - fear of public speaking – is the most common phobia in America today. I have a whole toolkit of techniques that I use for helping people with this problem, but I am always interested in new methods that can work quickly.

A study of 80 UCLA undergraduates published in the journal Psychological Science suggests that taking a few minutes to contemplate your personal values (Click here to take an online assessment of your personal values) in the moments before a tense situation, like making a speech, an examination or a visit to the dentist, can keep stress levels low.

People in the study who affirmed their values before delivering a speech had significantly lower levels of one of the stress hormones – cortisol – than did the control group, and psychological measures also indicated that they were less stressed.

“People can't live with change if there's not a changeless core inside them. The key to the ability to change is a changeless sense of who you are, what you are about and what you value.” --Steven R. Covey (American Author and Businessman, 1932-)

Reaffirming your core values is one of the keys to the development of resilience, and that is what was happening in this study. For anyone who is interested in dealing with fear of public speaking or in developing personal resilience, we shall be putting new articles on my website in the next few days.

“Remain calm, serene, always in command of yourself. You will then find out how easy it is to get along.” --Paramahansa Yogananda (Indian Spiritual Teacher and, in 1920, Founder of the Self-Realization Fellowship, 1893-1952)

Technorati tags: stress, stress management, core values

Partial Attention

“To do two things at once - is to do neither.” -- Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)

Just yesterday I was counseling a successful young businesswoman who was telling me that she was planning to buy a Blackberry to add to her cell phone, laptop, PDA and pager. I strongly advised her not to buy one. Not because I have anything against Blackberries: they are wonderful pieces of equipment, and some people cannot do their jobs without them. My suggestion was based on something else entirely: Overload. Apart from being in business, she is also a mother of a young teething child and the last thing that she needs is yet another device to occupy her attention.

So I was delighted by the remarkable coincidence that this week’s Newsweek magazine is carrying an important article by Steven Levy, reporting on the recent emerging Technology Conference in San Diego that took "The Attention Economy" as its theme. He described an issue that has been worrying me for several years and which I shall be addressing when I am interviewed for Success.com in a couple of weeks time. A former Apple and Microsoft executive named Linda Stone described the epidemic of continuous partial attention.

We have all been multitasking since before our ancestors came down from the trees, but she discussed the way in which people’s attention is now constantly being distracted by a host of new inputs: email, text messaging, instant messaging and a hundred other things. And think of those news broadcasts that since 2001 have regularly had more than one item at a time on the screen. Many people have learned to give only partial attention to the task before them. The downside of this is that the appearance of competent multitasking (“Look mom, I can do ten things at once!”) is an illusion. If you are only working on a project with 10% of your attention, it is going to take much longer to get it done, and errors are far more likely to occur. What if needed is intense focus on one thing at a time.

In a speech, Linda Stone said that I prominent cause of continuous partial attention is "a desire to live as a node on the network." Some people can manage several inputs very well indeed. I often have more than one screen of input open at once, and Bill Gates is able to monitor four active screens at once. But when I’m really concentrating on producing high quality material for you, gentle reader, I turn off all the inputs until I am finished. In fact, checking my email is a reward for having finished the job at hand. While there are many advantages to being in perpetual contact, the balance has tipped more toward distraction, and, as Linda Stone put it, “a sense of constant crisis.”

I am also reminded of the phenomenon of “Flow” made popular by the psychologist Mihaly Csikszentmihalyi. We feel that we are in a state of flow state when we are engaged in self-determined, goal-related, meaningful actions that are moving in the direction that we desire. Having our attention and energy pulled away from the flow is likely to interfere without ability not just to be productive, but also to enjoy life. There is, of course nothing wrong at all with being in continuous contact and communication with others people. But in order to be productive or to enjoy the moment, at some point you need to actually stop the conversation and focus on what you are doing.

Professor David Meyer from the University of Michigan at Ann Arbor is a research psychologist who has demonstrated that multitasking, far from increasing our productivity, actually makes us less productive. Some data from Europe has influenced lawmakers, after research indicated that driving and talking on a cell phone is a particularly bad multitasking combination that has been shown to cause even more accidents than drunk drivimg.

Remember the old saying: “If you chase two rabbits, both will escape.”

Technorati tags: attention, multitasking, Productivity, Work, Stress

Hunger and Memory

It’s always a good idea to see how new findings fit in with previous knowledge, and also to see if they make sense. We have previously met the hormone leptin, which is involved in decreasing appetite. Its twin is the hormone ghrelin. Discovered in 1999, ghrelin comes from some of the cells lining the stomach and acts in the hypothalamus to increase appetite. When the stomach is empty it is released into the circulation and travels to the brain where it activates receptors in many different regions. Some research has indicated that one of the reasons why gastric bypass surgery may be effective is because it reduces levels of ghrelin and therefore reduces appetite.

Research published in December 2004 showed that in healthy young men, sleep deprivation caused a decrease in leptin levels and an increase in ghrelin levels, which, as expected, was associated with an increase in hunger and appetite. This is one reason why getting less sleep than you need may cause you to gain weight.

A new study published in the journal Nature Neuroscience, has found an intriguing link between ghrelin and memory. I noticed that the BBC also picked up on this interesting story. Researchers at Yale have discovered that ghrelin acts in an ancient part of the brain known as the hippocampus: so named because it is shaped like a sea-horse. (As an amusing aside, the old German pathologists thought it looked like a silk worm, so that’s what they called it!) The hippocampus has a number of functions, but is most of all essential for learning new material.

The researchers showed that mice who lack the ghrelin gene had 25% fewer synaptic connections between their hippocampal neurons. They then did the next step, and injected normal mice with ghrelin. They promptly increased the number and density of their synaptic connections, which correlated with significant improvements in the animals’ performance on several tests of learning and memory.

So that means that a hormone produced by the stomach can control some brain functions, and this may represent a link between metabolism and the ability to learn. The more that we discover, the more we see the intimate interactions between the brain, intestines and heart.

This link makes good sense: we know that memory can be switched on and off by a range of factors. In order to help us come up with options for handling the environment and for remembering things to avoid, memory is often switched on at times of stress. Hunger is a form of stress, and it makes good biological sense that we might be more alert and better able to remember and to recall information when hungry. It stands to reason that this has enormous survival advantage. If our early ancestors had not had this hunger/memory link, they might well have died out in the competition for food.

This gives some credence to the old advice that it is best not to try to study or to take an exam on a full stomach. Just have enough food to make sure that you have ample fuel, and that you are not distracted by hunger pains.

Technorati tags: hunger, memory, stress, study habits

Marital Conflict and Hardening of the Arteries

The Bible contains at least three references to the undesirability of hardening one’s heart:

“And the Lord said unto Moses, When thou goest to return into Egypt, see that thou do all those wonders before Pharaoh, which I have put in thine hand: but I will harden his heart, that he shall not let the people go.” -- Exodus 4: 21

The BBC is carrying a report of a paper presented to the American Psychosomatic Society meeting in Denver Colorado. Researchers from the University of Utah have added another piece of evidence that marital conflict bad for you. In a previous posting I discussed the evidence that marital conflict can compromise the immune system. Now we have confirmation that marital conflict can also have an adverse effect on the coronary arteries, leading to hardening and calcification of these crucial blood vessels.

The researchers studied 150 married couples, with at least one partner in their sixties. None of the people in the study had ever been diagnosed with cardiovascular disease. Each couple was asked to pick a topic that caused disagreements in their marriage: topics included money, disagreements about in-laws, children, vacations and household chores. They were then videoed while they discussed the topic, and the videos were watched by psychology students who coded comments as friendly or hostile, submissive, or dominant or controlling. Cardiac scans were then done to look for signs of disease.

Wives who made the most hostile comments during the discussion had a greater degree of calcification of their coronary arteries, indicating the build up of plaque in these crucial arteries. It is not just the behavior of one person: the highest levels of calcification were found in women who behaved in a hostile and unfriendly way and who were interacting with husbands who were also hostile and unfriendly. Husbands who were more controlling, or who were more dominating, or whose wives were controlling or dominating, were also more likely to have more severe hardening of their arteries than other men.

These findings are in line with everything that I have been writing about looking at all the five dimensions or domains of a person: physical, psychological, social, subtle and spiritual. If you ask most people what they are doing to protect themselves against heart disease, they will probably talk about not smoking, taking exercise and healthy eating. That response is correct, but inadequate. Toxic relationships are just as dangerous, as are certain psychological response styles. For many years it was thought that the so-called “Type A personality,” was a risk factor for coronary artery disease, but research has shown that it is just two aspects of this response style that are responsible for the increased risk of coronary artery disease: anger and hostility.

Disagreements are bound to come up in any relationship, but the way that we communicate gives us a great opportunity to do something healthier for both people. In my book Healing, Meaning and Purpose I discuss the wonderful work of Riane Eisler, and I talk a lot about methods of transforming relationships from an unhealthy dominator model into a healthy partnership model.

Particularly if you are in a relationship, I urge you to take some action today to move towards greater heart health.

Technorati tags: marriage, heart disease, Riane Eisler, bad relationships

Stressful Marriages Can be Damaging to Your Health

There is an extremely interesting article in the month’s Archives of General Psychiatry, which was picked up by the media that examined how marital stress effects healing.

Most people now accept that the mind has powerful effects on the body, though as recently as the 1970s this was still regarded as rank heresy by many in the medical community. This new study is important for our understanding of the relationship between stress and physical health, and gives us further insights into how we can help ourselves stay well.

The study was done at Ohio State University and examines 42 married couples. Each person was given small skin lesions, and the startling finding was that in hostile couples, the wounds healed 60% more slowly than they did in non-hostile couples. The investigators even identified an inflammatory mediator called interleukin-6 (IL-6), as the biochemical link between hostility and slow wound healing. IL-6 levels are linked to long-term inflammation, which is in turn implicated in a number of illnesses, including diabetes mellitus, arthritis and cardiovascular disease.

A thirty-minute disagreement with a spouse could push back wound healing for 24 hours. The skin is the largest organ in the body and is exquisitely sensitive to stress: just thing of blushing and getting zits when under stress. So it is difficult to extrapolate from these findings in the skin, to try and predict what would happen with healing of internal organs. But we do have enough information already to say the following:

1. Allowing yourself to become involved in an argument may have long-term physical effects on you.

2. Some years ago I worked with a group of fine people who did just one thing that I did not like: they were wedded to the idea that it is a really good idea to vent your feelings. They would go as far as allowing patients to hit walls and other inanimate objects. I was never keen on this, feeling that expressing a lot of negative emotion could be counter-productive. After a patient broke bones in his hand after striking the wall, I quietly put an end to the practice. This new research indicates that I was correct to do so.

3. If you are going to have surgery, it is a good idea to be in a calm and peaceful frame of mind.

4. Stress is often unpredictable so it is a really good idea to be engaged in some ongoing stress management practice, so that you are better able to deal with the "slings and arrows of outrageous fortune," as Shakespeare put it over four hundred years ago. Clearly this doesn’t mean that you have to walk around like a burned out hippy on Quaaludes. Unless you really want to…. The best techniques that I know of for dealing with stress are the Sixty Second Peace Technique, Qigong and Yoga Breathing. If you have your own method, then stick with it. Otherwise you may want to check out some of the materials that I have written and recorded.

Technorati tags: stress, marriage, arguments, healing