Picture from our ‘Love Your Body’ Campaign. To see more, click here
Contents Editor’s Note
Change is in the Airbrush
Anorexia: the things that go unmentioned
Review of Caroline Horton’s ‘Mess’
ReCovering My Life
An Interview with Caroline Horton
Let’s Have “The Talk”
Accessing Professional Support: The NHS
The State of Student Mental Health The Digital Age of Therapy
The Importance of the Peer to Peer Support Group The Transition to University
Student Minds’ Christmas Card Competition
Coming Soon: Ask Ami
The Student Minds Calendar
Why are students vulnerable? The Kitchen
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EDITOR’S NOTE Student Minds is a charity that aims to work with and for students, providing the time, space and resources to help enable people to start talking about student mental health, in a safe, supportive environment. We work with over a hundred student volunteers up and down the country to provide support to students with mental health problems, running open access support groups at a number of universities where we provide informal peer-to-peer support when students need it. We think that encouraging students to talk to their peers is a positive thing, that conversation helps to break down stigma. Moreover, we believe that talking changes lives. Developing ReCover is an extension of this belief; it provides us with a platform to help us to keep both students and volunteers up to date with news, developments and musings in the field of mental health. Working alongside Students Against Depression and Mental Wealth, we would like to use this magazine to inform a wider audience about the work that we are doing with students and universites across the country. So far this academic year, our groups have been organising venues and times for group sessions to be run over this term, holding stalls at freshers fairs far and wide and generally publicising like mad! If you would like to see pictures of these events, read about how they went, learn more about our team or find out where and when sessions will be held, please visit our website - www.studentminds.org.uk - or look us up on Facebook or Twitter.
We hope you enjoy reading our magazine, please tweet us/ email us/ facebook us with your thoughts! It’s a real delight to be able to collect together pieces written by different people with different ideas all surrounding student mental health.
If you’re keen to help us with content for upcoming issues, please get in touch via email firstname.lastname@example.org
And keep your eyes peeled for the next issue, to be released next semester! Thanks for reading, The ReCover Team ReCover would like to thank a few people for their help in getting this issue together: All of our wonderful contributors for their time, effort and fabulous thoughts Caroline Horton Joanne Paul Eliot Ruocco-Trenouth The Student Minds staff and Executive Committee
Change is in the Airbrush
Change is in the Airbrush While we are, on the most part, aware that images used in advertising are heavily manipulated, we somehow end up comparing ourselves to the flawless and impossibly skinny women that stare out from glossy magazine covers. We are told that these women are the ideal and we seem to aspire to their unattainable dimensions, despite the fact that we know the women that we’re looking at are not real. This is, however, beginning to change. An increasing number of advertising agencies and magazines have recently taken a pledge to do away with the airbrush and show off their radiant, natural models. Beyoncé has recently spoken out in these debates, withholding the rights to her bikini-clad image from the major fashion retailer H&M unless they promise not to airbrush away her curves. The result? Stunning images, made all the more gorgeous (and let’s be honest, damn sexy) for being completely untouchedup. Let’s take a moment to compare these stunning images to the Robert Cavelli campaign, where Beyonce’s body has been erased and stretched beyond all recognition.
Debenhams, Beyonce, Dove and Seventeen Magazine get touchy about retouching.
Very recently, another retailer, Debenhams, announced its refusal to airbrush its lingerie models. Citing economic as well as ethical concerns, Debenhams insisted that its campaign was ‘all about making women feel fabulous…rather than crushing their selfesteem by using false comparisons’. This all follows the Dove ‘Campaign for Real Beauty’ which launched almost ten years ago (yep, that makes me feel old, too), and has since received both praise and condemnation for its overt rejection of the use of airbrushing and super-skinny models in advertising. Taking one step further, Dove have recently released a direct attack on retouching – creating a Photoshop Action that claims to ‘beautify’ the image, reverting any actions that have been taken to falsify the image in question and inserting the message, ‘Don’t manipulate our perceptions of real beauty’. You can watch the full video here.
There’s still a lot more to tackle
Julia Bluhm’s efforts are perhaps the most inspiring in the battle against the ’brush – Bluhm gathered 84,000 signatures which she presented in a petition against Seventeen Magazine, asking them to stop using airbrushed images in their tween magazine. She plans to tackle Teen Vogue next. She’s only 14. While these are all exciting, positive steps towards changing the way we view both our own bodies and those of other women, there’s still a lot more to tackle than this. These images stand alongside headlines and articles which promote equally unhealthy perceptions of body image, weight and food. But we’re certainly taking an unquestionably important step towards the recovery of the cover girl.
ReCovering My Life
ReCovering My Life There was no way I was suffering from anorexia. People were being over-dramatic. I wasn’t skinny enough. I was fine with isolating myself and going to the gym rather than spending days laughing with my friends and family.
Wrong. That was my eating disorder talking. I was unhealthy and unhappy. Admitting that was my first step into the daunting world of recovery. Just four weeks ago, I entered a day service treatment for eating disorders, an experience which takes top prize in the ‘scariest moments of my life’ competition. Everything about the place terrified me; the staff, the patients, the equipment used to check my health, the dietary plans and of course, meal times weren’t the most stress free environment. I found my first week a struggle. I was emotionally drained, full of anxiety about the changes I was being asked to make and completely unsure of whether I was going to be strong enough to make them. Recovery just felt like another 8 letter word rather than a concrete life choice. I was nervous and angry about what people were going to expect of me. Challenging my eating disorder was wading into new territory. Full of questions and insecurities, I worried that I was going to be judged by people for being there and I felt guilty for accepting help to recover. I worried I was going to say the wrong thing or wouldn’t be liked by the people there. But that’s all they ever were, worries. Worries fuelled by anorexia and not based on any evidence (something I’ve learned during my four weeks of treatment). The second week of treatment made me so focused on my motivation for recovery. I found myself writing lists of
a REAL-LIFE account of the process of RECOVERY
countless reasons that I want to recover. Completing my studies is a big one, because as much as I like to think I’m superwoman sometimes, starving my brain of nutrition is not going to get me a degree. I want to go on holiday with my friends and let my biggest concern be which factor of sunscreen to wear. I want to have a social life where I’m not too exhausted to do anything. I want to enjoy life with my family and friends without the constant intrusion of anorexic thoughts. In the short amount of time that I’ve been in treatment, I’ve never felt so accepted in my life. Staff and patients have been completely understanding and non-judgmental. I’ve learned that everybody has their own story, their own difficulties and their own reasons for recovering. As much as it is a daily struggle, I am finding myself more and more able to remind myself of all the reasons why I can and will recover. During my third week of treatment, we saw possibly the only days of sunshine the British Summer had to offer and after annoyingly having to move my deck chair every 5 minutes to avoid being in the shade, it hit me that this symbolised how I feel about my recovery process so far. Yes, the shadows are going to try and creep up on me and my anorexia will put up a persistent fight but as long as I keep moving forward, I can keep myself situated happily in the sun. Initially, one word I would have used to describe accepting treatment would have been ‘anxiety’ but now, after seeing what resources I have available to me for support, such as nurses, psychologists, occupational therapists and my family and friends, I’m feeling much more hopeful. I know that I’m going to have struggles and challenges but with the right help, I’ll be better equipped to deal with them. After watching one too many episodes of The Apprentice, I’m starting to see myself more and more able to channel Alan Sugar and tell my anorexia “you’re not very helpful, you aren’t a team player and you’re just not a smart choice. Eating disorder – you’re fired!”
Anorexia: The Things That Go Unmentioned
Anorexia: the things that go unmentioned Stretch Marks
Yep. You will get them. As your body regains its healthy weight, the skin will stretch leaving those lines we are taught to be so ashamed of. Of course, there is no need to be ashamed! Just like stretch marks during pregnancy, your body is filling with new life, and stretch marks are just a sign of that change!
Ah yes... the forbidden subject. We get so uncomfortable about being ‘uncomfortable’, and it can be difficult to ask for help or advice. But when incorporating new foods into your diet, your digestion will take time to catch up, and in the meantime you may find your belly doing all sorts of funny things, and your trips to the loo anything but consistent or regular. Think about it like changing your exercise regime – for the first little while your muscles will get sore, and everyday tasks will be difficult. But before long it will sort itself out!
As you increase your intake, your body’s appetite will kick into hyperdrive. You may find yourself constantly hungry, and in satisfying this hunger, you may go beyond your meal plan, and may eat more than friends and family. This can be terrifying and guilt-inducing, but the thing to remember is that this is normal and temporary. Your body is just trying to pull itself out of the danger starvation mode as quickly as possible, to minimize the dangerous side effects, and as soon as you have your healthy weight, it will only ask for what it really needs (promise). Think of appetite and weight as an elastic. You’ve pulled it so far and so tight to one side, there will be some snap-back before it settles. But it will settle. Or, if you’re like me, you may have underwatered a plant at some point in your life. The first few days it will need more water than usual to perk back up. But after that, it will absorb as much as it needs. Once again, there are ways to help your body find balance in the interim. Rather than eating foods that barely keep hunger at bay, go for meals and snacks that really satisfy (as scary as this can be). Proteins and carbs keep you fuller for longer, as well as replenishing the energy stores that your body is looking for. Meats, starches and oils will all help fill that tummy, but it will take time, so give your body permission to feed itself with what it really needs.
Of course if you do want to get rid of those lines, this is easily done by increasing the skin’s elasticity. There are lots of moisturizing products on the market, as well as bio and essential oils. Increasing your vitamin E and C intake has also proved useful, so add some sunflower seeds or almonds to your salads, and incorporate some oranges into your breakfasts and snacks!
In the meantime, there are lots of things that you can do to help stabilize your tummy. Integrating probiotics from yoghurts, pickles and (the best one!) dark chocolate will keep your digestive track functioning properly. If there are too many trips to the loo, keep to starchy foods and complex carbohydrates like potato, rice and bread. If food is sitting like an immoveable lump in your stomach, lots of water is the main thing, but also try snacking on prunes, popcorn and apples to get things going!
Anorexia: The Things That Go Unmentioned
But then, there’s the more pleasant side of things... Glorious glowing nails, hair and skin The number one compliment you’re going to get as you recover has nothing to do with weight or shape, but rather your beautiful glowing skin! And you’ll notice improvements as well in your hair and nails. Just like the rest of your body, these bits need nutrients to keep growing and glowing. Shampoos, moisturisers and nail polishes all advertise the benefits of essential oils and vitamins – they have a greater impact when they are in rather than on your body. Nuts and seeds with essential oils will have the greatest impact, along with staying well hydrated and eating lots of fruit and veg. Iron and protein will also keep those nails healthy and strong – eating your spinach and steak makes for a better mani!
Rediscovering your mojo By messing about with your self-perception and your hormones, anorexia can strip you completely of your inner vixen. Not only is the idea of stripping down terrifying, but the energy and deep down tingle is simply missing. But it does return! And good thing too, because you will be becoming more attractive and sexually desirable to those around you (everyone knows that strong is sexy! And girls, boobs and booty are worth flaunting!). If you want to heat things up even faster, once again chocolate is the key, as well as watermelon, avocado (also good for hair, skin and nails) and, believe it or not, garlic (just brush after, for courtesy’s sake).
An Interview with Caroline Horton
An Interview with
Caroline Horton is a performer, writer and director based in Birmingham. She is an associate artist at The Bush theatre, an artist-in-residence at the Oxford Playhouse and a member of The Optimists network of young theatre makers in the Midlands. Recently, Caroline wrote and performed a play about anorexia called ‘Mess’, which toured the UK, including the Edinburgh Fringe Festival and Battersea Arts Centre. Our News Editor sat down with Caroline to discuss this unique project, its development and its reception.
Can you tell me a little bit about ‘Mess’, for those who haven’t had the chance to see it? ‘Mess’ is a theatre show with songs about anorexia and recovery. It’s based on my own experiences of the illness and of recovery. It’s a three-hander, so the set up is that these two friends Boris and Josephine are putting on a show and they have a musician with them, who helps them do this. Various things go wrong along the way; some scenes are more upsetting then they expected, they change their minds about what should exactly happen in a scene, so along the way this is also the story about how to talk about, deal with and confront this sort of stuff because its painful and complicated and illogical, so that runs alongside the story that Josephine and Boris are trying to tell. It’s very funny in places because of the pickles that these three characters get themselves into in their efforts to tell this story. It’s also moving and realistic in terms of its look at the illness and recovery. The show started at the Edinburgh festival last August. And then we toured for about 10 weeks in the spring, mainly to studio theatres around the UK. Then we’re
We’re putting on a play. It’s about anorexia. But don’t let that put you off.
on tour again this autumn from 1 October through to December. This tour is slightly different, more varied. We are doing some more studio theatres, also some art festivals for young people, and some festivals that focus on work around mental health, it’s also going into some schools and universities which I’m really excited about and hope it will lead to more educational institutions becoming interested in the piece. Although it’s not your classic piece of “theatre in education”, it definitely has a place within those environments. We’ve been supported financially by the Wellcome Trust as well as the Arts Council and from the very beginning of the process I collaborated with experts on eating disorders - both researchers and clinicians from the Institute of Psychiatry and the Maudsley Hospital. We’ve also collaborated very closely with Beat. These collaborations have really brought us a broader audience - beyond the regular threatregoing audience. We’ve focused a lot on pre-show discussions, sometimes inviting the experts along to take part. Mess has had some really great press, and it won the Best Ensemble Stage Award in Edinburgh, an Argos Angel Award at the Brighton Festival and it’s just been nominated in the best new play in the ‘Off West End’ Awards. I’m really excited about getting it back out on the road and visiting new venues. We’re also touring a workshop designed to raise awareness around eating disorders. This is exciting for me, because I deliver theatre making workshops regularly, but this is the first time I’ve delivered a workshop that uses theatre techniques to raise awareness around an issue, so that’s a slightly different process. We’ve developed it with guidance from medical and outreach experts.
An Interview with Caroline Horton
You mentioned that the play is inspired by your own experience of anorexia and recovery, but was there a more specific experience that prompted you to create ‘Mess’?
and the director, they were a really crucial information source, enabling them to broaden from my personal experience. They were also, for me, a sort of informal ethics panel, helping us judge whether something was going too far, or whether we were hitting the right notes - especially because the play has comic elements.
Absolutely- after finishing 2 years at drama school in Paris, I came back to the UK, and the headmistress from my sixth form asked me to come back and talk about what I’d been up to since leaving. So I spoke for roughly 5 minutes about university, drama school, working out what I wanted to do, and I mentioned having been very ill with anorexia and starting to work out what recovery meant to me. I didn’t go into a lot of detail, and it was a very small part of the talk I gave, but I was really blown away by the response. I ended up chatting with students, parents and members of staff about their own experiences of being confronted with eating disorders or having their own problems. I think the staff in particular spoke about coming into contact with students struggling with eating disorders year on year. There seemed to be a huge relief in discussing the issue openly and in chatting to someone who was content to discuss their own experience.
Beat, have been amazing in terms of marketing to a non-theatre audience. We had a London run in May, with a BEAT gala performance attended by many of their supporters and young ambassadors.
What really stunned me was how difficult, still, it was to talk about eating disorders, even though we see so much coverage in the media. Perhaps it also suggests the coverage is in general unhelpful – too celebrity-focused or sensationalist, it’s so often about the ‘shocking’ weight loss. So that day had a big effect on me. I’d not yet started creating my own work, and I didn’t start working on ‘Mess’ for another 5 years (after I’d made my first show) but it was that day that I started seriously thinking about making something about anorexia.
You mentioned the experts you worked with. What was the specific effect of their collaboration on the creation of the play? I got in touch with the experts that I worked with at the Institute of Psychiatry before we started rehearsing and they were in the room with us from the start of the devising process. I think for the other performers
In addition, we worked with Professor Ulrike Schmidt (Institute of Psychiatry, King’s College London). She was extremely helpfully strategically in terms of connecting me with BEAT’s Susan Ringwood (Chief Executive). And also just in terms of giving her support to the show. She’s so renowned in her work that this was hugely valuable.
What were some of the most striking reactions you got to “Mess” – either in formulation or in performance? One of most memorable moments was when we hadn’t quite finished the show, we’d got it to the full first draft version and Susan Ringwood, invited us to perform it at the International Easting Disorder Conference. Still with tweaks to be made, the show was in quite a delicate place so for the company, that was an anxiety provoking experience, partly because work in progress shows tend to be in a theatre context, whereas we were going to do this at a BEAT conference that was full of people who devote their lives to trying to solve these problems. We were also aware that this would be one of the first times where a large proportion of the audience would have personal experience of an eating disorder. Also we were not in a theatre, it was a lecture hall. But it was an absolutely brilliant experience, really wonderful; the audience laughed and cried and we had some really fascinating conversations with them afterwards. This showing gave us a huge boost at the point when we were just going to the last stage before the Edinburgh Festival.
An Interview with Caroline Horton
One of the problems often faced by those wishing to share stories of anorexia to a large audience is that of ‘triggers’ – of images or behaviours more likely to bring about then prevent anorexic thoughts or feelings; how did you avoid these in your play? Other than using my own knowledge of what I find triggering, this was also something I gathered feedback about along the way. I’ve been adamant in interviews that I did not talk specifics about my own illness - no numbers, there are no specific details about food/exercise regimes . It was really important to me that that wasn’t a problem for people watching the show. The show focuses on the bigger picture rather than minutiae– what was happening to Josephine’s relationships and how the obsessive behaviours cut her off from the world.
Many people relate strongly to the character Boris, the one who is trying to do the right thing to help this person that they love and who is very ill, and not knowing what to do and feeling like they always say the wrong thing or do the wrong thing. A lot of people who’ve not themselves had any particular problem with their mental health, have related to this character very strongly. It’s like BEAT’s tagline – ‘everybody knows somebody’. It’s also just a story about someone struggling to change and find their way of being ok in the world. In my book, that’s pretty universal.
Our experts also gave feedback if they sensed anything was triggering – however this didn’t really come up as a problem. I remember a BEAT young ambassador came to see it saying that she was nervous about seeing it, in case it was triggering. She said it had been like bumping into an old lover and feeling connected with them but not in danger of re-entering that relationship - I thought that was a really interesting way of describing it, and other people have said similar things.
You write in your profile that you like to write plays that start from a personal story to say something universal; what does a story about anorexia tell a wider audience? I think the elements of the condition like anxiety, avoidance behaviours, obsession, the need to disappear from the world because its too difficult to cope with, like relationships being put under strain are recognisable to many people. Our audience has been very wide and it’s really interesting to hear about the different ways that people connect and certainly people with problems in different areas of mental health find much to relate to. www.studentminds.org.uk
To find out more details about the tour of ‘MESS’ click here.
Review of Caroline Horton’s Mess
Review of Caroline Horton’s Mess After seeing Caroline Horton’s Mess at the Battersea Arts Centre with a fellow Student Minds volunteer, we left the theatre smiling from ear to ear; finally, someone had written a brilliant play about anorexia. Understandably, my attempts at putting the word out about the show were met with apprehension as to whether it may have triggering material, or be distressing for any audience members who are currently suffering, or have recently recovered from, an eating disorder. I relayed these fears to the writer who reassured me that the play had been created in conjunction with B-eat and the Royal Institute of Psychiatry, so with this in mind, I bought the tickets.
I was not disappointed. Josephine and her friends are putting on a play. It’s about eating disorders. It tracks Josephine’s road to recovery; the high and lows, the doctors’ appointments, the triumphs and the setbacks. Along the way, she is aided by her lovable friends; Boris – a cute, slightly awkward, kind-hearted friend (who wears a pilot’s hat for some reason) – and Sistal – Josephine’s diva accompanist with crazy hair and hilarious interjections. Boris’s role in the play was a fascinating one; during the Q&A session afterwards, the cast and crew said that they felt it was important to make the character both male and female in order to faithfully represent all friends and family who are holding the hands of their loved ones through every stage of recovery.
general so as to not discount the experiences of others, whilst looking at Josephine’s story in detail. The play dips seamlessly into important scenes which depict loneliness, frustration and fear, and is cushioned by its endearing humour. Yet it really revolves around one message: there is always hope. The production had me laughing aloud throughout, and even made me shed a tear or two – something which is uncommon for me, I promise – but ultimately left me with a wonderful, life-affirming feeling. Caroline will be touring the show this winter in the with workshops being put on to increase awareness of eating disorders. For more information and tour dates, click here.
This play is not one to miss!
Above all, I was astonished as to how well the play dealt with talking about eating disorders; the cast managed to tread a delicate line between being very
Let’s Have “The Talk”
Let’s Have “The Talk” “So, wanna talk about Eating Disorders?”… hardly a sentence that rolls off the tongue and definitely not the easiest conversation starter, but it might just be one of the most significant ones of your University years. I’m sure every student will have heard the words “the friends you make at Uni are the ones you keep for life” and although these friendships are often formed during the fun experiences student living has to offer (aka the nights out, the hung-over mornings and the mutual love of snoozing at the back of lecture halls), the real test of these friendships can be formed through tackling the hard times together. In the midst of debating when to turn the heating on and who’s turn it is to do the dishes, discussing eating disorders might seem like a conversational bombshell on par with discussing ‘the birds and the bees’ with your parents. However, this needn’t be the case. What better time is there to discuss your health than right now?
Opening up to your housemates could be considered as broadening your support system and, eating disorder or not, we all need an extra pair of hands to rely on every once in a while. Disordered eating can be isolating, especially at uni when you’re expected to ‘assert your independence’, however a problem shared really can be a problem halved. It really does help to have an understanding friend to be there when things get rocky. Whether your housemates are advising you, consoling you or simply being there to take your mind off things, a support system during university is a must! Getting a degree is no walk in the park and every student needs people around them to help wade through the messy world of essays, exams and figuring out what to do with life. Well, the same goes for eating disorders.
If you think ahead to graduation day, I’m sure many people will visualise collecting their degrees with their housemates and celebrating with each other. Share your success! Choosing recovery is being brave. You deserve a high five for every day you say no to living with an eating disorder and walking through the door to a ‘well done’ is a service your housemates can provide. Let’s face it, food is a massive part of university life, whether it is shared kitchens or socialising at meals and speaking to housemates about eating opens the door for a better understanding around all of these situations. By talking about eating disorders, we not only help others to help us, but it enables us to educate others about the real facts about EDs – after all, we’re students…. We love to learn!
The State of Student Mental Health: Student Minds’ Transition Report
The State of Student Mental Health:
Student Minds’ Transition Report
As a student mental health charity, we are completely immersed in the state of student mental health. The amount of students who fall through the gaps in university support is saddening and presents itself as a problem that needs to be solved sooner rather than later. According to the Association for University and College Counselling (AUCC) 3-10% of students visit the university counselling services at least once during their stay at university, indicating that a surprising amount of students require support for their mental health. As identified by the Royal College of Psychiatry, university is a volatile time; it can be the most important few years of a person’s life, and coupled with the pressures of university life, this is a time when mental health problems are likely to begin. However, there are few NHS services that are geared towards supporting the student lifestyle. Last year, Student Minds conducted a report investigating the state of student mental health. The report ‘University Challenge; Integrating Care for Eating Disorders at Home and at University’ looks at “the lack of integration, personalization and effective care provided by universities” to students who had suffered with an eating disorder during university. Student Minds collected data and testimonials from a number of students who had struggled with an eating disorder and found that there was a gap in student mental health services due to the transient nature of students. Most students choose to move away from home to go to university to perhaps gain more independence, or maybe there is a brilliant course that is offered over the other side of the country, or simply if there is not a university close by. This means that the average student spends over 25 weeks of the year at their university and the rest of the time back at home, which presents a big problem for the NHS. Currently students can only register with one GP surgery at a time, and considering students spend almost half a year away at university, the consequence of this is that for half of the year, students will not be registered with an NHS mental health service at all. It is also known, all too well, that the waiting lists for specialist services can seem never ending. Another problem arises when students reach the top of the waiting list; if the student is unable to attend an
appointment, maybe because they have gone home for the holidays or are bogged down with exams, they are dropped to the bottom of the waiting list. Student Minds’ report showed that the average waiting time for specialist services is 18 weeks in which time 39% of the respondents stated that their mental health deteriorated in this time. The report showed that 38% of respondents felt that access to treatment was disrupted by the move to and from university, whilst 88% of the respondents felt that they would have benefitted from being registered at their home and at university. One respondent commented that “transitions between home and university were also the most difficult times for me, when I was most likely to relapse irrespective of the difficulties in transitioning between treatment teams- so it seems like a really important point to address”. Not only can this be devastating for the individual but can also be a financial burden; the cost of treating inpatients is around £50 million per year whereas outpatients is £3 million showing that poor early intervention can be costly both to the individual and the economy. The other side of the coin shows the experiences of the health care professionals in the current state of services. Concerns were raised on the communications between different teams and how difficult it is to pass on information. Perhaps one answer is to utilise the internet’s benefits. Berkshire county council provide a great example of how online forums can help with supporting those with Eating Disorders; ‘SHaRON’ is an online forum supporting people with Eating Disorders, this is closely moderated by a team of people who have recovered from an Eating Disorder and by clinical professionals to ensure that it is a safe space. If more support networks like this were in place then students would be given the option of support without needing to be registered at their local GP clinic. In the meantime, this report has been passed on along with our recommendations of the steps that can be taken to help improve services at university. Watch this space... For more information on SHaRON’s forum, click here.
Accessing Professional Support: The NHS
Accessing Professional Support: The NHS One of the greatest difficulties with mental illness is that it inhibits our ability to communicate effectively how we’re feeling, which can make accessing treatment for our problems seem desperately out of reach. Fear and uncertainty about the consequences of speaking up and seeking help is, from my experience, one of the most powerful blocks that stop us from getting the care we deserve. The NHS offers upport for a wide range of mental health problems, and this short article hopes to clearly lay out what will happen when you approach the NHS for help with your mental health, drawing on my experiences as both an NHS worker and a service user. The first port of call will be your GP. GPs are the gateway to any health support, physical or psychological. I’ll discuss both of these routes below, but first I think it’s best to go through what will actually happen when we approach a GP about mental health difficulties. As usual, there’s probably only around ten minutes for the appointment, although you may be able to request a double appointment. The doctor will ask why you’ve come to see them, and after you indicate you’re feeling low or something similar, they’ll either ask you to complete a questionnaire or conduct it with you verbally themselves. They take the form of a series of questions – for example, “Have you found little interest or pleasure in doing things?” and “Have you had a poor appetite or been overeating?” and ask you respond in terms of how frequently or not you’ve experience the symptom from not at all, sometimes, over half the days, and every day over the last two weeks. They will then score this and use this score to help them diagnose
you with one of the following; no depression, mild depression, moderate depression or severe depression. I found this test very off-putting as it felt like it didn’t allow me to adequately express the depth of what I was feeling and came across as cold and impersonal. Unfortunately, because of the way short GP appointments work, this is a feeling that many people seem to share. It’s sometimes helpful to remind ourselves that the test needs to be succinct and relatively accurate, so that the doctor can refer us to other services that give us more space to explore and tackle the disease – a ten minute appointment would only scratch the surface if we were given the space to express ourselves more freely during the time. Let’s think about where our doctor can direct us once they’ve identified difficulties with our mental health. The most immediate option is for them to prescribe medication. Anti-depressants are usually given in cases of moderate to severe depression, and there are often a lot of misconceptions and concerns about them. There are a great many different ones on the market, but the type prescribed by British GPs in most cases is the SSRI, which stands for selective serotonin reuptake inhibitor. Serotonin is a chemical that mainly controls one’s mood – although it can affect things like appetite – and an imbalance with it is thought to be a cause of depression. What SSRI basically does is stop your body from eliminating it from the brain, raising the level of it in your body and therefore hopefully raising your mood. This takes a little time, though, as the drugs are www.studentminds.org.uk
cumulative, meaning that they build up in effectiveness as you take them over a period of time. People usually start to feel the effects within a couple of weeks to a month. There are side effects, which we will experience on different levels. The most noticeable ones are often sexual; a low sex drive, inability or difficulty achieving orgasm, and erectile dysfunction in men. These raise clear difficulties for young people at university. It’s up to us as individuals to decide on balance whether taking the medication is worth it, but I personally believe it’s certainly worth giving it a shot. As there are so many available, if one gives you particularly pronounced side-effects, you can always go back to your doctor and ask to try another. You shouldn’t, however, suddenly stop taking them as this will bring all the negative feelings crashing back very suddenly. Instead, your doctor will reduce the dose of the old one whilst introducing the new one. Taking medication can be intimidating. It certainly was for me and I tried loads before I found one that suited me. Though I like to think that people’s awareness of depression makes taking these medications more acceptable in the public eye, there can still be some stigma attached. The side effects can also be difficult to cope with, but if these side effects prove to be a big problem, other options are available. One important thing to remember is that there are many routes out of mental health problems, and while it can be extraordinarily crushing when one fails it is uplifting to remember that there is always another option waiting in the wings.
Accessing Professional Support: The NHS
The other main strand of treatment is talking therapy; commonly CBT (Cognitive Behavioural Therapy), counselling, and psychotherapy, although other forms do exist. Unfortunately, there will almost always be a wait for these and you may have to travel some way to get to them. Wait times are hopefully between two weeks to a month, but they vary considerably across the country. This can feel like an eternity when you’re in the stranglehold of the disease and so you might find that similar services provided by your university can see you quicker than this. I can’t emphasise enough, however, how valuable these services can be. They really are worth the wait, despite how painful that wait can feel. CBT helps us understand our thoughts and behaviours, and gives us tools to deal with how they affect us. It’s very presentorientated – it recognises that what might have happened in our pasts is important, but focuses on dealing with how things manifest in the here and now. It’s very much a practical therapy, and requires some effort to put the things taught into practice. It’s offered in several ways; one to one sessions with a specialist worker or psychologist, some places teach CBT in groups and it’s even available as an online course. The existence of the latter two methods really demonstrate its practicality quite clearly. It’s not really a space for us to explore our feelings or the causes of them in depth, instead it provides us with a set of absolutely invaluable tools to deal with the tangible effects of mental illness. If you’ll let me use a tired old cliche, CBT is like riding a bike – once you’ve learned what it has to offer, you’ll find it stays with you giving you the power to tackle destructive impulses headon, throughout your daily life. It’s conducted with six to eight sessions over a period of ten to twelve weeks.
Counselling, on the other hand, is a little more explorative. The counsellor will help us think about the problems faced in our lives, and guide us to trying new ways to deal with them. A counsellor won’t tell us what to do, but are there to listen to our issues, provide frameworks to help understand them and let us explore effective ways to utilise this understanding in dealing with them. Counselling is often recommended by doctors to deal with particular issues, such as bereavement, relationship issues, financial troubles or the onset of a serious physical illness, all of which could be a key element underlying our depression. Sessions will always be one to one and last about an hour, and six to twelve of them will be offered – although in some cases this can be extended
Finally, if you’re feeling so bad that you want to kill or harm yourself, don’t wait for a doctor’s appointment. Your immediate safety is too precious to wait. You can go to an accident and emergency department in a hospital, call 999, or if that doesn’t feel right call HOPELine on 0800 068 41 41. They’re a charity that will understand what you’re going through and know how to help you out.
Psychotherapy is the classic kind of therapy portrayed (often inaccurately!) in books, films and TV. It’s conducted by a psychologist, and is aimed towards unpacking deeper issues or events that can trigger depression in our past. The psychologist will encourage us to talk about, and come to terms with, things that can be very difficult and painful to express. Clearly, it can be a little more intense than other talking therapies, and will be recommended by doctors if we alert them to things like a troubled family history, domestic violence, sexual abuse, witnessing traumatic events, or if we have problems with the police. Like counselling the sessions are one to one, last about an hour, and usually six to twelve will be offered, although again this can be extended.
The NHS is here to help us, and have so much experience and knowledge to do so. Realising there’s a problem with our mental health and seeking help with it is one of the most difficult experiences life can throw at us, and the stigmas and stereotypes that entrench mental health problems can render going to a doctor tremendously off-putting and even frightening. Uncertainty is often what’s behind that fear, and I hope the above will take away at least some of that uncertainty. The NHS helped me so much, and I hope that, if you need it, they’ll be able to do the same for you.
I know how difficult it can be to seek professional help.If you’ve read this piece and spotted a treatment that appeals to you, all you have to do is ask your doctor to refer you to it. They’ll only say no if they have a very good reason to do so, such as if a SSRI interferes badly with a medication you already take.
the author of this article works for an NHS Trust in London
The Digital Age of Therapy: Counselling From Your Couch? by
The Digital Age of Therapy: Counselling From Your Couch? The university years can be a high-risk time for the development of mental health problems. For some, attending university away from home can be challenging; for many, it is the first time a wealth of their decisions will be self-made, including what to eat, or when to get out of bed. Although many studies have highlighted the prevalence of mental health problems among university students, universities still struggle to employ enough counsellors to meet the demand on campus. There is an additional secondary issue; not all students who need help will seek help. Reasons to neglect treatment are both numerous and various, such as convenience and/or fear of social stigma. In response to these shortcomings, psychologists are considering alternative ways treat the university demographic. New research is investigating ways to make treatment easier to access than ever before- with online counselling programmes, so students can access therapy from the comfort of their own laptops, tablets, and mobile devices. Data from a randomised, controlled, clinical trial by Day, McGrath, and Wojtowicz (2013) suggests that students experiencing mental health problems related to anxiety, depression, and/or stress at university responded positively to internet-based guided selfhelp programmes. Students from various Canadian universities, (69 in total)experiencing mild-tomoderate levels of anxiety, depression, and/or stress, were enrolled in the experiment. Participants were randomized into one of two conditions; an Immediate-Access Group, where participants started the online programme straight away, and a DelayedAccess Group, where participants were asked to wait 6 weeks before starting the programme. A self-report questionnaire was used to collect measures at the start of the trial, after 6 weeks (the point of programme completion for the Immediate-Access group and the point of waiting period completion for the DelayedAccess group), after completion of the programme for the Delayed-Access group, and a follow-up measure at 6 months after the programme. The programme was originally developed by Currie et al (2010) based on cognitive-behaviour therapy strategies. The programme addresses topics such as mood, motivation, thoughts, and feelings with various
online workbook activities, video clips, and real-life examples. Participants are assigned to a programme coach, a trained student, who contacts the participants via phone or email on a weekly basis. The role of the coach is to provide support and encouragement to the participants as well as to clarify information contained within the programme material that perplexed participants. For the purpose of the study, coaches were not to provide therapeutic advice, aside from reiterating content in the programme material. Participants who had Immediate-Access to the guided self-help programme showed significant improved in levels of self-reported anxiety, depression, and stress, as compared to participants in the Delayed-Access condition, who had not yet began the programme. The improvement in mental health was not only significant, but also sustained over time, even with the lack of face-to-face counselling with a certified therapist. With the online programme, students were responsible for their own recovery. In addition to the treatment of depression, anxiety, and stress, such online therapy courses have also been considered to address the rate of eating disorders at university. Some psychologists are now proposing a “populationbased model” for the identification, prevention, and treatment of disordered eating to reduce both the incidence and prevalence of ED cases across campuses (Wilfley, Agras, Taylor, 2013). The model uses a screening algorithm to allot a range of online intervention programmes to the student body, with differing levels of programme intensity to suit the various degrees of risk for developing poor body image and/or restrictive eating behaviours (Figure 1). This “population-based” model also tries to change environmental norms by implementing a communitywide cultural intervention that promotes healthful body image and well-being, decreases acceptance of risk behaviours for ED, and decreases the stigma associated with EDs and high body weight. Wilfley et al note the importance of the synergy of change in attitudes and behaviours on both the individual level and also the population level to truly create a healthier environment on university campuses.
The Digital Age of Therapy: Counselling From Your Couch?
Wilfley et al (2013) suggest that in two years, the application of this population-based model could reduce the incidence and prevalence of eating disorders at university by nearly 50%. This figure, though not yet proven, is promising. A digital age of therapy would certainly have its benefits, especially for university students. Access to the internet at university is universally found. Completing treatment programmes with guaranteed privacy, at one’s convenience, and at one’s personal pace, may increase the likelihood of students in need engaging in treatment programmes and completing all steps from start to finish. Because online programmes are more cost-effective, they can be employed in these population-wide models to create environmental change. This also allows for early intervention in cases where clinical status has not yet been reached. The online programmes can also be tailored to better suit certain subtypes of people, suit certain skills or needs, and can detect cases with high-risk for relapse or high-risk for comorbid disorders. The high-tech approach allows for students to download mobile apps with these treatment strategies in case of sudden impulse, and to communicate with a social network of individuals in the same condition they are experiencing. Also, as noted in Day et al’s (2013) follow-up measures, changing on one’s own accord can be a powerful type of recovery that has lasting effects. However, a digital age of therapy can also be concerning. Notably, in the study by Day et al (2013), participants were gathered on a volunteer-basis; subjects responded to adverts knowing the online, selfguided nature of the programme. In this populationbased model proposed by Wilfley et al (2013), the entire student body is forced into the programme; those uninterested or unwilling are unlikely to change their cognitions, whether or not they complete the programme. Additionally, mental health problems can be very lonely- staying behind a computer screen and not seeking contact, or creating a face-to-face network of support (like Student Minds!), can perpetuate the symptoms, instead of addressing them. It takes a certain type of individual to respond to this method; these programmes require an independent initiative and strong desire for recovery.
There is also the concern of quantifying people- can we trust an algorithm to “sort” individuals among the treatment they require? As adjustable as these programmes can be to fit unique individuals, there is still the risk of “falling through the cracks.” And though these programmes attempt to manage the symptoms of disorders, can they truly unlock the personal reasons for the development of poor mental health? Would you engage in online therapy programmes if they were offered at your university? What if your university used this population-based approach and sorted you to your counselling course in Fresher’s week? ReCover would like to hear your thoughts. Please email us at email@example.com or click the following to join the discussion on Facebook and Twitter. If you are interested in accessing online-self help resources for Depression, visit the Students Against Depression webiste, where you can access a fantastic set of resources with information and accompanying workbooks. References:
Currie, S. L., McGrath, P. J., & Day, V. (2010). Development and usability of an online CBT program for symptoms of moderate depression, anxiety and stress in post-secondary students. Computers in Human Behavior, 26, 1419-1426. Day, V., McGrath, P., Wojtowicz, M. (2013). Internet-based guided self-help for university students with anxiety, depression, and stress: A randomized controlled clinical trial. Behaviour Research and Therapy, 51, 344-351
Wilfley, D. E., Agras, W. S., Taylor, C. B., (2013). Reducing the Burden of Eating Disorders: A Model for Population-Based Prevention and Treatment for University and College Campuses. International Journal of Eating Disorders 2013, 46, 529-532.
Everything OCD It is normal for anyone to experience intrusive thoughts, which may be disturbing, at any point in life. These can include thinking about crashing a car or jumping on a train track (Theale). Recurring unwanted thoughts and repetitive actions and/or rituals are the main characteristics of obsessive-compulsive disorder (OCD). Repetitive behaviours are also a core presentation of autism-spectrum disorders. What separates OCD from other diagnoses is the anxiety aspect of the disorder, and the knowledge that the thoughts and actions are irrational. A person suffering with OCD may experience these intrusive thoughts, known as obsessions, regularly and accompanied with great anxiety. The sufferer will attempt to ‘neutralise’ this anxiety by actions and/or rituals, which can be mental and may not be related to the original thought. These are known as compulsions. The engagement with the fear, although reducing the anxiety at first, enables it to grow stronger and gradually worsens the obsession-compulsion cycle. It is not known what causes OCD, but it is thought that there is an interruption in communication across the brain in people with the disorder. OCD diagnoses can vary from mild to severe, with the majority falling under the moderate to severe category. OCD often leads to avoidance behaviour, similar to that seen with phobias. A diagnosis is made when the obsessioncompulsion cycle takes up a significant amount of time in every-day life, causes a lot of distress and interferes with daily functioning. Due to lack of understanding and awareness, it is not uncommon for sufferers to go years without a diagnosis. If you suspect yourself or someone you know to have OCD, it is advised to seek advice as soon as possible. OCD can ‘feed’ upon itself, growing stronger, so seeking immediate diagnosis and treatment is highly recommended. Contact a general practitioner or your local mental health team for the appropriate referrals. I think my experiences of living with a mum who has OCD have had both positive and negative effects on my educational studies. I have learnt a lot about OCD through living with someone who has it. It has taught me to be more understanding of people’s situations. As individuals, we all have different stories and issues so I feel I am less judgmental and more understanding towards people. I have learnt how to keep myself calm
in stressful situations and if something bad happens, it’s not the end of the world. On the other hand, living with someone with has OCD is extremely stressful – for relatives as well as sufferers –- and I do find myself hiding things so they don’t trigger an argument or horrible feelings for my mum. I feel I know a lot about OCD from my experiences as I have seen first-hand the damage it can do to a person. I think I could educate misinformed people that it is a serious condition and not the stereotypical perception of having to have things neat on a desk. In general, it is hard to live with someone with OCD. As a close relation without any professional knowledge, you’re not sure how to help them manage the condition. I would advise anyone living with someone with OCD to just to be there for the sufferer and let them know that there are millions of people with the same condition and they are not alone or unusual. Let them know that there are doctors and specialists out there who can give help and management for the condition. Hannah, a student from Cardiff whose mum suffers from OCD The unwanted thoughts can still occur following treatment (as it is not uncommon for anyone to experience intrusive thoughts at any one time) but the majority of the symptoms can be controlled with therapy alone or in adjunct with medication. Cognitive behavioural therapy (CBT) plus exposure and response prevention (ERP) are the popular methods of therapy used for treatment of OCD. Other relaxation techniques, such as meditation and the practice of mindfulness, are also recommended to gradually lessen the impact of the anxiety component. There are many different ‘sub-types’ of OCD, depending on the type of obsessions and sometimes compulsions. These include intrusive thoughts involving harm occurring to oneself or others, blasphemy, paedophilia, homosexuality/heterosexuality and relationships. OCD is a very diverse disorder, but the general method of treatment remains the same with perhaps some alterations depending on the individual.
When I see a person walk by, it pops out in my head that I’m going to kill him. I feel afraid, I don’t want to kill anyone, but I fear I’ll lose control. Feeling dreadful, I manage myself to take a walk outside, but as I see anything alive (even plants or bugs), I can see that they are going to die because I see it. It’s driving me crazy! I keep inhaling, hoping to take back the filthiness from me, but it’s not working. I don’t want to harm anyone, but I can’t control myself. How useless I am, I’m a total failure, I am a waste of the world… I want to die, so that no one will be hurt… This is what is happening to me, almost every day. This kind of obsession is really, really painful. It may come out anytime, anywhere. A simple obsession can ruin the whole day. When obsessions occupy my mind, I feel depressed, and I am not able to study. The unwanted thoughts just spin around and stop me from thinking logically. What’s worse, it happens every day so that I can’t catch up with school work. As a high school student preparing for university entrance exams, this is a serious problem. It’s a cruel fact that OCD may accompany me through my whole life and I am still struggling. Never give up. Where there is life, there is hope; where there is a will, there is a way. OCD does not only stand for Obsessive Compulsive Disorder, it also stands for Optimistic, Compassionate, and Determined. There are many aspects of life, we don’t need to hide the bad ones, but we can choose to start looking for the bright ones. Po Hsaun Lee, a student in Taiwan suffering with OCD It must be noted: research shows that people who suffer from OCD are actually less likey to commit violent crimes.
Tips for managing and coping with OCD When struggling with intrusive thoughts and feelings, it is important to keep yourself safe. People with OCD find intrusive thoughts so anxietyprovoking and disturbing because they go against everything you believe. If you self-harm as a means of coping there are many alternatives, including purposefully walking or staying away from potential
objects you could use to harm yourself. If you’re worried that you can’t control yourself, go somewhere where you will be surrounded by other people. You may not feel at ease, but at least you will be safe. It may be worth trying another method of distraction from the thoughts, such as clapping or using an elastic band to stimulate the pain without causing harm. Learn how to accept the obsessions and the accompanying anxiety. Don’t try to reason with it, and don’t try to fight it. This lessens the emotional impact the thoughts and feelings have. Learn to live along with it and accept that it’s a part of you at this time of life. Mindfulness: try meditation at least once a day for 10 minutes to help you relax and accept the thoughts and anxiety. Distracting activities such as watching TV, playing video games and speaking to friends can help you pass through an episode safely and with more ease. Recognise and accept when you have an intrusive thought by telling yourself “that is an intrusive thought”.
The Butterfly Project If you feel like self-harming, take a marker or pen and draw a butterfly wherever the self-harm occurs. Name the butterfly after a loved one, or someone that really wants you to get better. NO scrubbing the butterfly off. If you self-harm before the butterfly is gone, it dies. If you don’t, it lives. If you have more than one, then self-harming kills them all. Another person may draw them on you. These butterflies are extra special, so you must take good care of them. Even if you don’t cut, feel free to draw a butterfly anyways, to show your support.
To read more about the Butterfly project, click here.
I have suffered from OCD since I was about 6 years old. It has taken many forms and affects all aspects of my life. I hate going food shopping. I examine every packet to see whether it is open, how it looks inside. I ask myself: is it cold enough? Is it too spicy? Picking a sandwich for my lunch is extremely challenging and sometimes the easiest way is to throw it away, which I have done many times. Contamination worries me a lot. I don’t like dirt, touching dirty things, the rubbish bins, washing from the previous day, raw meat, and the list goes on. I have had times where I have touched these, washed my hands about 10 times and still felt dirty. The main part of my OCD is having intrusive thoughts, which also started when I was young. I used to count numbers, I wasn’t able to stand on cracks in the pavement and I often made people repeat sentences and words. These rituals developed into more hateful thoughts and worries, so bad I can’t even bring myself to write them down. I also have to carry out rituals and routines – when I am going to bed, for instance, to ensure it feels right and that I have successfully banished the intrusive thoughts from my mind. The thoughts are so draining and frustrating; people talking to me day-to-day do not know I am having a battling conversation in my head, trying to outweigh the negativity. These thoughts have left me with anxiety issues; I have terrible panic attacks when I worry too much about things. OCD dictates my life, including how I communicate, what I do, what I wear and what I eat. This leads me on to why I decided to create the documentary ‘Living With Me And My OCD’.
I am a freelance filmmaker, I studied Contemporary Film and Video at Manchester Metropolitan and I run a social enterprise, E.D.E.N Film Productions. I decided to turn the camera on myself, recording my struggles, thoughts and what it felt like to be living with the thoughts in my head. The main reason for doing this was due to the desperately low level of awareness, understanding and acknowledgment of how serious OCD is. The idea grew and grew; I was able to interview a member of OCD-UK, members of my family and sufferers of OCD. From there I released a trailer that OCD-UK placed on their YouTube channel. I was overwhelmed by the positive response; currently the trailer is reaching 25,000 views. The documentary is still in production. It has interviews with over 29 individuals across the world and diary entries from myself. Its main aim is to raise awareness of OCD and to rid the stereotypical misconception of OCD. It is not just about being clean, tidy or ‘a little bit OCD’. Hopefully this documentary can help get OCD more talked about. Claire, a former student from Sheffield who suffers from OCD If you are interested in Claire’s documentary progress, then please either visit her website, or her YouTube channel. Click the following links to look at the resources used to compile this article; OCD-UK, OCD Action or the International OCD Foundation.
In January 2011, I suffered from a serious breakdown due to my OCD and struggled with everyday activities such as work, going out and eating without worrying.
The Importance of the Peer to Peer Support Group
The Importance of the Peer to Peer Support Group At Student Minds (formerly SRSH) we believe that discussing the thoughts and feelings associated with an eating disorder with a peer group can be beneficial for recovery. We therefore offer recovery-focused self-help groups for students with eating disorders. Our reasoning is supported by a recent review on psychosocial risk factors in eating disorders, in which Keel and Forney (2013) concluded that peer-based interventions might be key in tackling eating disorders. Keel and Forney (2013) argued that personality traits, such as perfectionism, might influence the development of eating disorders indirectly, by increasing the susceptibility to the beliefs of peers. These beliefs can include the Western beauty ideal of thinness. For instance, the idealisation of thinness for women has increased during the 20th century (van Son et al., 2006). A meta-analysis by Keel and Klump (2003) suggests that during the same period of time, the prevalence of both anorexia nervosa and bulimia nervosa has also increased. Although the direction of causality cannot be
established firmly, this suggests that cultural ideals are related to eating disorders. However, the increased prevalence could, at least in part, be due to better effectiveness in diagnosing eating disorders (Keel & Forney, 2013). Another limitation of cultural ideals causing eating disorders is that a disturbance in body image is part of the diagnostic criteria for eating disorders (American Psychiatric Association, 2000). Thus an increase in eating disorders would automatically involve an increase in body image disturbance and could thus influence the amount of thinness ideal within a culture. On the other hand, the thinness ideal could influence the way that people judge their own body and thus their risk for an eating disorder Overall, cultural beauty ideals and eating disorders could influence each other reciprocally. Evidence for a link between the two (but not the direction of causality) comes from cross-cultural studies. For example, in contrast to European countries, the traditional beauty ideal in Fiji favours fuller figures. In a cross-sectional study, Becker et al. (2002) compared the www.studentminds.org.uk
prevalence of eating disorders among approximately 17-yearold girls in 1995 and 1998. While in 1995, only about 40% of girls had a television at home, 70% of girls had a television in 1998, thus increasing the availability of Western TV shows demonstrating the thin ideal. Becker et al. (2002) found that the proportion of girls scoring above the pre-chosen cutoff on the Eating Attitude Test26 increased from 12.7% in 1995 to 29.2% in 1998. Even though this data is only correlational, it suggests that the views held by other people influence eating disorder prevalence (whether through direct or indirect contact via the media). Moreover, when interviewed, 77% of the Fijian girls in 1998 reported that they noticed that watching TV influenced their body image. Nonetheless, Keel and Forney (2013) pointed out that peopleâ€™s personality traits also influence their choice of watching TV, travelling abroad, or who they become friends with, so that, to a certain extent, they chose the culture and peer group that could later go on to influence them. Once again, this means that the influence could be reciprocal. ďƒ¨
The Importance of the Peer to Peer Support Group
In their recent literature review, Keel and Forney (2013) posited that many psychosocial risk factors for eating disorders have been examined but that only a few of them remained significant in longitudinal studies. One such factor is the influence of peer groups. In a university student sample including 566 women, Keel et al. (2013) found that the dieting frequency of roommates during university predicted the bulimic symptoms, and drive for thinness of women ten years later, as well as doubling the likelihood of purging (self-induced vomiting, diuretic or laxative abuse) ten years later. Conversely, women whose roommates dieted rarely or never showed the greatest decrease in their drive for thinness and bulimic symptoms over the ten-year period. This powerfully demonstrates the influence of peer groups. Keel and Forney (2013) argued that during university life, adult personalities form, so that the ideals of the peer group can become entrenched and influence the rest of adulthood, even if social circumstances change. They therefore argued that peer groups might either be a risk factor or a protective factor for eating disorders, depending on the peersâ€™ attitudes and behaviours. Consequently, Keel and Forney (2013) believe that peer-based interventions should be used to prevent the onset of eating disorders in adolescents. In line with this, Stice, Becker and Yokum (2013) reviewed evidence suggesting that peer-based interventions utilising cognitive dissonance are effective in preventing the internalisation of the thin ideal.
Given the influence of the peer group in university students, changing the beliefs in a peerbased discussion may be more effective than changing the views of each individual in isolation. However, the effectiveness of peerbased interventions still remains to be tested. While Keel and Forney (2013) only suggested peer-based interventions to prevent the onset of eating disorders, our self-help group approach tries to take it one step further: We try to productively use the influence of peer groups to challenge entrenched ideas and aid the recovery of students with eating disorders. ď Ž
References: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text rev.). Washington, DC: Author. Becker, A. E., Burwell, R. A., Herzog, D. B., Hamburg, P., & Gilman, S. E. (2002). Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. The British Journal of Psychiatry, 180, 509-514. Stice, E., Becker, C. B., & Yokum, S. (2013). Eating disorder prevention: Current evidence base and future directions. International Journal of Eating Disorders, 46, 478-485. Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 129, 747-769. Keel, P. K., & Forney, K. J. (2013). Psychosocial risk factors for eating disorders. International Journal of Eating Disorders, 46, 433-439. Keel, P. K., Forney, K. J., Brown, T. A., & Heatherton, T. F. (2013). Influence of college peers on disordered eating in women and men at 10-year follow-up. Journal of abnormal psychology, 122, 105. van Son, G. E., van Hoeken, D., Bartelds, A. I., van Furth, E. F., & Hoek, H. W. (2006). Time trends in the incidence of eating disorders: a primary care study in the Netherlands. International Journal of Eating Disorders, 39, 565-569.
The Scary, Exciting, Daunting, Opportunity-Laden, Petrifying, Amazing Transition to University
The scary, exciting, daunting, SOPHIE opportunity-laden, petrifying, NORTH amazing transition to university. by
(delete as appropriate) I’ve been struggling over how to word this article since I agreed to write it. The university experience is so different for everyone – the challenges it poses, the anxieties that arise and the coping mechanisms that it brings about range wildly from person to person – so how can that be summed up in one piece of writing? But my pondering over ‘the university experience’ proved there is one universal element – it is a massive change in your life, and more often than not, a pretty scary one too. I hope that, in documenting some experiences that range from one side of the university experience to the other, this piece of writing will help to dispel some of the anxiety that the transition to university creates. Because even though it can be a really hard time in your life, it can also be a really great one. As soon as I posted on an extremely popular social networking site asking people to share their experiences of the transition to university, an old school friend sent a message detailing how her preexisting depression and anxiety – which stemmed from pressure that she put on herself due to a fear of getting behind during her A-Levels
– affected her three year degree. She described that, once the initial buzz of moving to university wore off, she became more depressed during her first year and would spend days crying in her room while her flatmates struggled to know how to help. This stressinduced depression caused panic attacks, which in-turn made the process of dealing with the anxiety harder. After a less difficult period on anti-depressants, she found that her final year was the worst she had faced. The combination of increasing stress and a prolonged battle with depression caused her to stop going to university for a two month period at the start of her second term. She described how as a certain form of escapism, she ‘got in’ with the wrong crowd, made some bad decisions and became a bit wild. Eventually a concerned friend encouraged her to face up to her wild behaviour, along with her anxiety and depression and suggested that she went to see a doctor who prescribed her with medication. Her reason for sharing this story with me is because her coping mechanism was herself. Though she did have a support network of friends and family, essentially
she found a small part in her that decided not to give in and to battle through her anxiety. She found that her tutors were more than happy to remain ignorant of the reasons for her absence and she therefore went through a period of having no one checking on her. As a result, she feels strongly about speaking to those who find themselves in a similar situation, but have no one to turn to for support. Though her university has an active student services department, the support they offer is not well publicised to staff or students, meaning that she did not know about the help that was available for her to receive. I asked her, if she had to pinpoint the main thing which helped her to start the process of overcoming her difficulties, what would that thing be? She told me that it was her; that she’d done it on her own. That, with the support of a few people who knew, a stern talking-to from herself and a hell of a lot of work, that she managed to make the changes she needed to by herself. And just recently, she graduated with a fantastic mark, and looked beautiful while doing so.
The Scary, Exciting, Daunting, Opportunity-Laden, Petrifying, Amazing Transition to University
My story is much less turbulent, but at times, I did feel really lost. Before I went to university I’d taken a gap year and done some incredible things with my time, including volunteer work in Kenya, and a backpacking trip to South Africa. But I really struggled with the huge changes that year made to my life, and by the time I came back, my self-confidence was the lowest it had ever been. Added to some terrible choices in my social life, I was in a very delicate place at the beginning of my university career. When my parents left me in my first year, I sat in my room and cried for the rest of that day. I found being in a new place, with none of my old friends and very little familiarity extremely difficult
at first, but eventually, I found my way towards an old friend from school who had already been at UEA for a year, and became close with his existing friendship group. I think this was the turning point for me – these students studied Drama and there was a real sense of community between all the three years. In no time, I had a new social group of which I felt an integral part and even when I was struggling academically, or with self-confidence, I had a close group around me acting as my support network. They encouraged me to transfer courses; from straight English Literature, to English Literature and Drama, which provided me with a course that both stimulated me academically
and challenged me creatively, and I loved the change. I can honestly say that, had it not been for this group of people, I would not have been as happy or felt as safe as I did throughout my three years. Overall, from my experience, I would say that having a strong support network is absolutely crucial at university. Your friends are there to encourage you through university and it is vital that you are open to people to talk about things that are bothering you. Sometimes it can be hard, and sometimes it might feel like it’s never going to finish, but with friends and encouragement from university services, more often than not, it will all be a-okay!
Student Minds’ Christmas Card Competition This year for Christmas 2013, to celebrate our exciting new rebrand, we’re inviting all our wonderful supporters to design a Christmas card for Student Minds. The winning design will be used on our charity Christmas cards, and sold to raise money for Student Minds, allowing us to help support more students with their mental health. Plus the winning designer’s name will be printed on the back of our cards! So if you would like to enter, here are the rules: Designs can be sent in either paper or electronic format; please send any paper design(s) by post to: Student Minds Christmas Card Competition 16 - 17 Turl Street Oxford OX1 3DH
Please ensure that digital images are sent to us in jpeg format and 300ppi minimum quality. For either entry format, please include both your name and email address along with your design(s). Entrants may enter as many designs as they like. The deadline for entries is the 11th of November at midnight. Please send all entries before this date to ensure your work will be considered. If you have any questions about the competition or would like some more information, just drop us an email at the address above.
Electronic design(s) can be sent to info@studentminds. org.uk.
Why Are Students Vulnerable?
Why are students vulnerable? A report on the ‘Student Mental Health and Wellbeing Report’ by Sussex Student Union It is well known that 1 in 4 students will struggle with their mental health at at least one point in their life. A study conducted by Sussex Student Union uncovered that 46.2% of their survey respondents arrived at university with a mental health problem which means that 26% of the respondents developed a mental health problem at university. Part of the difficulty of understanding mental health is that it is hard to define, especially if your experience of it is limited. When asked this question, some focussed on ill mental health such as “Factors, which aren’t the individuals fault, that affects their ability to function properly”. Others focussed on mental well being; “feeling secure, feeling in control of one’s life, one’s thoughts, one’s emotions and actions”. So what make students so vulnerable? Sussex university’s report suggested that factors such as feeling homesick (57.8%) financial worries (55.1%) and personal problems (65.3%) were amongst the highest contributors to poor mental health, with dreaded coursework at the top of the list (72.1%). Other factors included drugs and alcohol use, housing worries, identity and sexuality. The added pressures of university can be overwhelming to the majority of students and, whilst the added independence is great, the responsibility that comes along with being a student is tricky. The survey showed that students with mental health issues recorded higher percentages of student stress factors than those without. This is unsurprising; there are many pressures that come along with becoming a student. I specifically noticed that the leap from school to university was a big shock to some people and a big adjustment of expectations was needed. For others, the workload, living away from home and fitting in is tiring, scary and often overwhelming.
On top of that, many felt that there was a stigma attached the talking about mental health to the point where 75.2% of students did not declare that they had a mental health problem on their university application form. Some felt that it was not relevant; “ I did not think having depression had anything to do with my university.” Others were concerned about the stigma that is attached with mental health and even believed that this would affect the decision to accept that person on their desired course; “I was told not to by my college incase it affected the decision to accept me”. In fact 90.4% of respondents who had had a personal experience with a mental health problem, felt that there was stigma attached to it. Perhaps this is because university is a microcosm; especially at smaller, campus based university it’s very easy to to bump into people you know, or easy to catch hold of information about certain people. What I found hard as a student was how easy it was to compare achievements, such as grades, with other peoples which is so much harder to obtain in the outside world. Sometimes, university can feel like a vacuum! Could this be an advantage though? In a relatively small community of students, could this be a starting point to getting others talking about mental health? When asked how to combat stigma surrounding mental health, the participants of the survey called for better understanding of mental health and more open discussions of mental health issues.
Why Are Students Vulnerable? / Coming Soon: Ask Ami
Comments included: “Most ignorance comes from a lack of understanding or fear and ensuring people are as educated as possible on the subject of mental health is one of the only ways to prevent this” “If everyone just spoke more openly, since coming to uni, i realise I’m not alone in the way I feel, I saw mental health issues as being weak, I was ashamed to say anything”. This shows that mental health is an issue that we, as a student population, need to hit head on. Some fantastic suggestions from the survey participants were: • •
Holding a Mental Health Pride event. Put together a “coming out” platform where students and staff can come out and talk about their mental health.
• • •
Encouraging more teaching in schools and beyond aimed at educating people about mental health problems, how to spot them and how’s it treated. Improving communication to students about mental health issues and where to go for support throughout the academic year and through a variety of mediums (e.g Facebook and Twitter). Providing training for key staff (e.g teaching staff), on mental health issues and how these affect people/ how best to support students who have them.
If you’re passionate about mental health, maybe you could think about implementing some of these ideas as the new academic year begins. If you do, let us know by either sending a tweet, getting in touch via facebook, or sending an email to firstname.lastname@example.org.
coming soon: ASK AMI We all have questions when working towards balance and healthy living. Sometimes knowing we can turn to a compassionate friend for answers and reassurance is all we need. Ask Ami allows you to put your questions out anonymously to such a friend. She is not a qualified health professional, but someone with some experience in mental health and eating disorders, who will answer those awkward or embarrassing questions. If you’re wondering about something, chances are a lot of others are too - even if you think you’re alone. So write in with your questions to
email@example.com and they will be answered in the next issue. For example: Dear Ami, I’ve currently in recovering for an eating disorder, and I’m wondering if I should get a scale? Now that I’m not seeing my nurse anymore I need to keep an eye on my weight myself, and I’m pretty sure that I can keep do only doing it once a week, but I’m a little afraid it will become an obsession. Do you have any ideas? - Afraid of Getting Scale-y in Manchester
Dear AoGS in Manchester, That is a very good question. As we start becoming responsible for our own recovery process and maintenance, it can become very scarey - like working without a net. And the scale is a perfect example. But we don’t have to get rid of the net altogether, just try to find ways to make our own! When it comes to the scale, try this trick. When you’re feeling at your healthiest, and perhaps with a trusted friend or on one of your last care visits, grab a pad of post-its and write encouraging messages to yourself. Maybe 5-7 of them. Things like ‘your beauty goes beyond numbers’, or ‘how you feel cannot be measured’. Put them over the display of your scale. If you get tempted to jump on the scales before a week is up, peel through them one by one. Hearing those messages will hopefully reinforce all the hard work you’ve done in recovery, and encourage you to breathe, step off, and focus on a beauty that cannot be quantified! Its hard work, and mistakes will happen, but that’s how we become strong! Very best of luck! And well done for how far you’ve come already!
~ Ami www.studentminds.org.uk
The Student Minds Kitchen
Embarking on a Culinary Adventure to Explore the Bigger Picture Around Food
All too often, we equate food with nutrition and focus on the functional role it plays in our lives, fuelling the body to carry out a range of daily activities. Yet the act of sharing food can fulfill a far deeper need: we use it to show love and hospitality, to celebrate and to share experiences. Why is this the case? Well, perhaps for two reasons. Firstly, eating is universal: no matter where you go, people will have their own customs and traditions around food and cooking. And secondly, eating is a deeply sensory experience, making it an extremely powerful way to relate to other people. By engaging all five senses - taste, sight, sound, scent and touch - we can use the act of sharing food to make any social situation both more intimate and more memorable. Think of a food that you haven’t tasted since childhood, or that you associate with a particular memory. You’ll probably find that recalling the taste and smell of that food also evokes a powerful memory of the experience itself. So when I think of cola-flavoured chewitts, I am reminded of weekly swimming lessons with my older brother, of the sun-drenched conservatory looking onto the pool and of the toastie-and-flapjack lunches that followed each morning of underwater adventuring. Somehow, the sensory experience of eating a food helps us to recall other details that our mind links together into a powerful string of interlinked memories. More than this, sharing food can be a way of breaking down barriers. During a two-month adventure through Nepal last summer, I spent some time staying with a wonderful host family in a remote hillside village in the Kathmandu Valley. They were immediately welcoming, showering my friends and I with dozens of homemade flower garlands. But even after a week’s intensive language tuition, my Nepalese was at best ropey, and our host family had barely a handful of English words. So inevitably, much of our interaction was through various sensory experiences that we could all relate to: painting each other’s nails, dancing and sharing meals together. In Nepalese culture, where the mother’s role is still deeply entwined with her ability to provide food for her family, cooking remains the most meaningful way for a woman
to show affection, and as a result each meal was a true labour of love. During our stay, we shared in the daily ‘dal bhat’ routine (rice, lentil soup and vegetable curry twice a day), learnt how to make chapatis (sort of) and enjoyed the most divine rice pudding I have ever tasted. We were invited to people’s houses for homegrown pineapple and freshly made lemon juice. Drinking tea (‘chiya’) was an institution all on its own. And as one of the girls proudly showed me the mango grove her grandfather had planted, I was reminded of just how much the lives of these families revolved around their ability to live off the land. So much so that every student I spoke to proudly declared that Nepal was their favourite country; their village alone had everything they needed, and many never even contemplated leaving. On my return to the UK, aside from the obligatory photo-sharing sessions, one of my favourite ways of relating my experiences was to cook some of the delicious food that I’d had out in Nepal. Having smuggled a bunch of spices and tea back home, cooking dal bhat for my family and catching wafts of vegetable curry and spiced cinnamon tea around the house was a great way to bring back memories of my trip. And of course, for those who have moved away from their home country, there is nothing better than having an authentic meal that serves as a reminder of home. I’ve never seem anyone so enthused by a meal out as when a lovely Japanese woman took me to a small family-run restaurant in Oxford called ‘Edamame’. It was phenomenal food, and all the while she was reminiscing about how her parents would cook the exact same recipes, gleefully sharing the intricacies of chopstick etiquette and, of utmost importance, explaining the correct way to eat edamame. So food is infinitely more than the nourishment it provides us with and it adds a whole new layer of richness to our social encounters. In the words of Cesar Chavez, “If you really want to make a friend, go to someone’s house and eat with him... the people who give you their food give you their heart”. Check out The Kitchen blog for recipes, tips, articles and more!
The Student Minds Kitchen
How to Cook Tofu For any non-vegetarians out there (and possibly some vegetarians too)… yes, I know that tofu has a bad repuatation for being a little bit bland and uninteresting. This really doesn’t have to be the case though (promise!) – tofu is a delicious and healthy way to add protein to your meal. Go try Wagamama’s ‘amai udon’ if you don’t believe me (udon noodles with prawns, egg, tofu, beansprouts & leeks, garnished with peanuts and lime… ridiculously good!) They always seem to get their tofu spot on: crispy and flavoursome on the outside, light and fluffy on the inside. What sort of tofu do I buy and where can I find it? Firm Tofu: used in most savoury dishes e.g. stir-fries, salads etc. For the recipe below I used Cauldron Original Tofu, which you can find in the veggie refrigerator section of pretty much any supermarket. If you prefer a firmer, ‘meatier’ texture, you might want to try ‘extra firm tofu’. Silken Tofu: finer and creamier, usually used in desserts. Can be a little elusive, but I’ve found silken tofu in the ‘world foods’ section of my local Tesco… you might need to ask! The basics: how to cook tofu 1. Remove the tofu from the packet and drain. 2. Wrap in kitchen towel and sandwich between two chopping boards. Weigh down with heavy cookbooks or weights and leave for at least 10-20 minutes. This helps remove moisture from the tofu so that it has a firmer texture and doesn’t disintegrate when cooked. Drain and remove the kitchen towel. 3. Dice the tofu into approximately 1-2cm chunks (I prefer mine on the small side so there is more surface area for the flavours to seep in) then pour over the marinade. 4. There are a handful of cooking possibilities: sautéed, grilled, microwaved… once cooked, press lightly with the back of a fork to check that the skin gives a decent amount of resistance, then add to your chosen recipe and enjoy!
Marinated Tofu with Brown Rice, Baby Spinach and Toasted Almonds Ingredients • • • • • • •
Firm tofu Brown rice Baby spinach Toasted almonds Soy sauce Olive oil Lime
Drain and press tofu as above. Dice into 1-2cm cubes.
Prepare a marinade with equal quantities of soy sauce, water and fresh lime juice. Combine with the tofu and leave for approximately 30 minutes.
Meanwhile, put some brown rice in a pan of boiling water and leave to cook for approximately 35-40 minutes.
Sautée the tofu in a little olive oil, then serve with the brown rice, chopped baby spinach and toasted almonds.
I made enough for two portions and put the leftovers in a little klippit box to have the next day – eaten either hot or cold with a little sweet chilli dipping sauce, this recipe is divine! www.studentminds.org.uk
The Student Minds Calendar
Student Minds is a national charity working to encourage peer interventions for student mental health. ReCover magazine provides an outlet f...
Published on Oct 22, 2013
Student Minds is a national charity working to encourage peer interventions for student mental health. ReCover magazine provides an outlet f...