The Wellbeing Magazine
In this issue: Which “you” makes the decisions? The myth of the pseudo-therapies News Round-up A SAD time of year 6 unhealthy “healthy” foods Food for Mood: SAMe, folate & vitamin b12 Food for Mood Recipe Five myths about sleep
1
2
Which “You” Makes the Decisions? We like to think of ourselves as rational thinking beings. But many psychologists say that in fact we are three different minds inside a single body. And this insight explains a great deal about why we struggle to give up our unhealthy lifestyles in favour of things that improve our wellbeing. These three minds might be thought of as habit-mind, emotional-mind and thinkingmind. Each corresponds to a different part of the brain - the primitive reptile brain, the limbic brain, and the neo prefrontal cortex. And the way they interact determines whether we succeed or fail in our goals.
But willpower has been shown to be in short supply for all of us - like a muscle, it gets tired when you overuse it. No matter how strong your willpower, sooner or later you will crack unless you can change the way your three minds interact. This means consciously changing the model of the world projected by our habit-minds.
Imagine that you just stepped off the weighing scales, having discovered that you are a stone overweight. Your thinking mind says “I need to get down to the gym.”
What if we made going to the gym rewarding. We might arrange to go with a friend. We might stop and have a coffee and a chat after we have worked out. So when the emotional mind asks, “What do we think about gyms?” Habit mind replies, “We like them, we get to have a coffee and a chat with Jane.”
But the emotional mind turns to the habit mind and asks, “How do we feel about gyms?” To which habit mind replies, “Yuk, we hate them.” So emotional-mind says to thinking-mind, “Not now, but we could go tomorrow.” ”So thinking-mind says, “Yes, it’s getting dark, and there’s a film I wanted to see on TV. I’ll set the alarm clock for 6.00am.”
Of course, in the long-term the feel-good effects of exercise, healthy eating, relaxation and all the other things we can do to improve wellbeing will make them habits in their own right. But the key to making the transition is to consciously change the internal movie that our habitminds show to our emotional-minds so that we can begin to feel good about things we used to dislike.
But, of course, when the alarm goes off, the whole process of putting it off occurs again. Our need to improve our long-term wellbeing is always put off by our short-term habitual desire to feel good immediately. At this point, most arrogant people who still believe they are entirely rational (nobody is) will claim that the reason people are overweight, unfit, or have poor general wellbeing is simply a sign of their personal weakness. They “lack willpower”.
This means consciously adding rewards to change our habits so that we feel positive about the things that promote health and wellbeing.
3
The Myth of the Pseudo-Therapies
It used to be that if you were stressed, anxious or depressed, they gave you pills. Then came the scandals around the antidepressant Seroxat - which suggested that antidepressants could do more harm than good. More recently, it has emerged that the manufacturers of antidepressants have been systematically hiding the results of clinical trials that had no - or negative results. At the same time, they have been recycling and republishing any positive trials so that these appear much more important.
managers to roll-out CBT as a one-size-fitsall therapy.
The result has been a short-term increase in sales at the cost of growing patient cynicism and distrust. One manifestation of this has been a desperate search for alternatives. Most obviously, in the wake of the Seroxat scare, people turned to the only other mainstream form of treatment for depression counselling and psychotherapy.
This has led to a quest for new alternatives that may have an impact on stress, anxiety and depression. At the severe end of the clinical depression spectrum, there has been renewed interest in Electro-Convulsive Therapy and the closely related (although much safer) Trans-Cranial Magnetic Stimulation. There is also growing interest in several psychoactive drugs such as ketamine and psilocybin (the chemical found in magic mushrooms).
Unfortunately, CBT, as configured in the NHS England Improving Access to Psychological Therapies (IAPT) programme has proved to be an expensive failure. Waiting times are long, “therapists” are often poorly trained and lack experience, the programme is limited to 6 sessions (often delivered over the phone), and the programme is too rigid.
However, since many of these “talking therapies” lacked a solid evidence base, much of the focus turned to the one talking therapy that had been subject to a sizeable number of studies - Cognitive Behavioural Therapy (CBT). Although there is little evidence that CBT is any better than any other talking therapy - and many researchers and practitioners argue that the “cognitive” elements are no better than placebo - it suited politicians and NHS
At the mild-moderate end of the spectrum we have witnessed the wholesale development of pseudo-therapies such as: bibliotherapy, ecotherapy, gardening therapy, exercise on prescription, sewing therapy, surfing therapy and choral singing therapy to name but a few. These “therapies” cannot attract the kind of funding that is needed to run full clinical
4
trials. As a result, many rely on “before and after” studies that lack appropriate controls. The results are almost always moderately positive - people are better off engaging with the “therapy” than having “treatment as usual”. The problem is that “treatment as usual” often amounts to being given a packet of pills, a sick note, and a long spell on a waiting list for CBT - Almost anything is likely to be better than this!
Gardening can be good for wellbeing - but is it really a therapy?
But the real problem concerns the way we have come to think about mental health. Because the pharmaceutical industry and the psychiatry profession have persuaded us to believe that conditions like depression are “brain disorders”, then anything that improves them must be having a “therapeutic effect” on the brain.
inactivity, over-eating, excessive and inconclusive worrying, poor diet, etc). On the other hand, people who recover and overcome depression usually engage in wellbeing-promoting activities that involve self-monitoring and forward planning, social engagement, physical activity, relaxation, healthy eating, daylight and fresh air.
If, however, one begins to see the impacts on the brain and body as symptoms rather than causes, then one forms an altogether different view of the benefits of all kinds of ordinary activities on conditions like stress, anxiety and depression.
From this perspective, it is no surprise that a host of pseudo-therapies have benefits, since they essentially involve helping people avoid behaviours that would serve to make them and/or keep them unwell, while simultaneously engaging them in activities that are known to promote wellbeing.
The best evidence available to us at present is that depression is caused by a combination of predisposing factors such as abuse or trauma in childhood, physical illness, poverty, etc, combined with one of two forms of triggering factor - those involving loss or change (homelessness, divorce, redundancy, etc) and/or those that involve a sense of being trapped (abuse, severe illness, debt, failed relationships, poor employment, etc). These factors are then either mitigated or exacerbated by the behaviours that people take in response to them.
Does this really matter? Yes, for two reasons: First, the “brain disorder” model is highly disempowering as it forces people to rely on experts who cannot provide effective treatments. Second, and more importantly, it prevents large numbers of people from understanding that, as with physical health, there is a great deal that we can all do to improve and protect our own mental health. Rather than waiting for a self-appointed “therapist” to tell us that social engagement, regular exercise, relaxation and a good diet are essential to our wellbeing, isn’t it time we just got on and did these things for ourselves?
Common to many (perhaps most?) people affected by depression is a range of unhelpful behaviours including some level of substance abuse (alcohol, drugs, sugar, coffee, etc), social withdrawal, physical
5
News round-up Failing to tackle depression is damaging UK productivity
Arrogance about sleep costs us dear
KPMG director Nick Baber has called on employers to address depression by changing workplace culture.
A large-scale study by Scientists from Oxford, Cambridge, Harvard, Manchester and Surrey universities has found that the macho attitude to sleep in many corporations is causing severe health problems to many employees.
Baber’s remarks follow a study of 500 businesses by Group Risk Development which found that 45% had serious problems with absenteeism as a result of mental health issues, and 36% cite mental health as their primary concern.
Sleep deprivation over long periods results in illnesses like cancer, heart disease, type-2 diabetes, depression, and a host of infections that are collectively too expensive to treat.
Stress and high workloads are damaging NHS Wales
Depression as deadly as smoking
Researchers at Oxford University have found that having depression reduces life expectancy by between 7 and 11 years, making it similar to smoking - which reduces life expectancy by 8 to 10 years.
A survey of NHS Wales Trusts has identified a large jump in absenteeism this year. The Wales Ambulance Service now loses more than 8% of staff time to sickness, with common mental illnesses like stress, depression and anxiety taking the biggest toll.
Figures for severe mental illnesses are even more worrying - bipolar depression reduces life expectancy by 9 to 20 years while schizophrenia reduces it by 10 to 20 years. The study’s authors say that on average, British people who have a mental illness have a life expectancy similar to people in some of the poorest places on Earth, such as Bangladesh and North Korea.
Sickness absence is putting an additional strain on services that were already stretched by financial cuts. Many more front-line NHS staff face greater workloads.
6
News round-up Wellbeing coaching improves quality of life
Wellbeing app benefits short-lived
Research by VTT Technical Research Centre of Finland has found that few people use wellbeing apps for more than a few weeks.
A study by the US Mayo Clinic has found that wellbeing coaching makes the difference between people expressing a wish to engage in a healthier lifestyle and their actually doing things like healthy eating, physical activity, relaxation and stress management which bring this about.
The research looked at how more than 200,000 people used stress management and weight loss apps, but found that less than 10 percent used them long-term.
The study found that not only was working with a coach effective during the research, but that participants were much more likely to continue with and build on their lifestyle changes afterward.
“Al-Desko” dining is damaging the health of Welsh workers
Want to overcome depression? Try losing weight
Businesses in Wales that encourage or permit employees to eat at their desks are seriously undermining health and wellbeing, according to the Chartered Society of Physiotherapy.
The 2-year Practice-Based Opportunities for Weight Reduction at the University of Pennsylvania (POWER-UP) trial in the US has unexpectedly discovered that losing weight results in less depression and more sleep.
The study found that just one in five of us takes a proper lunch break away from our work. Worryingly, 20 percent said they did not take a lunch break, while 43 percent said that they ate at their desks.
Losing 5% of your body weight, and maintaining the loss over 6 months resulted in significant improvements in depression scores and an extra 21 minutes’ sleep.
The long-term costs in ill-health will be felt both by a struggling NHS and on business productivity.
7
A SAD Time of Year to exterior windows enjoyed a full 46 minutes additional sleep per night compared to those with no access to natural light. It is likely that most of us experience some effects of less exposure to daylight during the autumn and winter months. And while people with SAD can tackle the problem with a combination of diet, medication and use of light-boxes (special bright lights, thousands of times more powerful than an ordinary light bulb) there is a great deal that all of us can do to increase our exposure to daylight.
Two in every 100 of us greet autumn with trepidation. This is the season where the nights start to draw in. And the loss of daylight triggers a form of depression known as Seasonal Affective Disorder (SAD).
Because we spend much of the daylight hours at work, it is all the more important that we take proper lunch-breaks that involve going out. It can also help to walk for at least some of the journey to and from work. For example, instead of parking immediately next to your work, park a mile away and walk the remainder of the journey. Similarly, if you use public transport, try getting off a few stops before your workplace and walking the remainder of the way. (Both of these can also save you money on fares or parking charges).
Since rates of SAD increase the further away from the equator you get, it seems fairly clear that it is related to sunlight. However, there is some debate as to whether SAD is a single condition that affects relatively few of us, or whether people who experience SAD are at the end of a continuum of a condition that affects us all to some extent. Anecdotally, many people report having less energy and less motivation around the time the clocks go back. But since this is seldom a major problem, and is far removed from the crippling depression experienced by people with SAD, we have tended not to take the matter seriously.
Being active on the weekends is particularly important during the autumn and winter, as these are often the only days when most of us are not cooped up in our workplaces. Just going for a walk for an hour can make all the difference.
But new research published in the Journal of Clinical Sleep Medicine into the impact of daylight on sleep, physical activity and mood suggests that we should take exposure to daylight far more seriously than we have been doing.
Diet can also help - making sure you continue to eat sufficient fresh fruit and vegetables while avoiding too many starchy foods is thought to help boost energy levels and mood at this time of year.
The study found that the further from a window employees worked, the less well they slept, the poorer their performance, and the lower their mood. Most surprisingly, employees whose workstations were next
So if you are someone whose mood and energy drops in the autumn, now is the time to start planning your response.
8
6 Unhealthy “Healthy” Foods industry from passing off high-sugar foods as “healthy”. Here are 6 such foods that you should avoid like the plague: 1. Most things labelled “low-fat” or “fatfree”, as these will inevitably contain a massive dose of added sugar to make them palatable. 2. Fruit juices, some of which are little more than flavoured sugar water. Even those made from real fruit often have the beneficial fibre removed, leaving just the unhealthy (albeit naturally occurring) fructose.
In the early 1970s, public health officials formed the view that heart disease was largely the consequence of too much fat in our diet. Unfortunately, this focus on fat came at the expense of any serious examination of the damage caused by sugar.
3. Margarine - think “chemical soup” here. This manufactured substance was created as an alternative to butter; which, in moderation, is now widely seen as healthier. 4. Commercial salad dressings are often made from unhealthy oils combined with a high dose of added sugar. So while the salad may be healthy, the dressing may cancel any benefits.
In fact, the fructose in sugar can only be processed by the liver and must be stored as additional fat (unlike the glucose, which can be used for energy immediately). Moreover, there is growing evidence that sugar is mildly addictive - affecting the same areas of the brain as cocaine - the more we eat, the more we crave.
5. Cholesterol Lowering Phytosterols have been marketed on the assumption that lower cholesterol means lower risk of heart attacks. However, NICE argue against their use because most studies show that they have no impact on risk, while a few studies suggest that they increase the risk of heart attacks.
Unfortunately, the “low-fat” and “fat-free” foods that we have come to think of as “healthy” turn out to be packed full of added sugar (which acts both as a sweetener and a preservative). As a result, far too many of us have gained excessive weight despite choosing the foods we thought were healthy.
6. Processed organic or vegan foods. While these sound healthier, they may still contain high amounts of sugar and fat. Just because they do not involve animals or pesticides is no guarantee that they will be good for you.
At present, politicians are edging slowly toward the introduction of fat and sugar taxes - there is a strong movement in favour of a tax on fizzy drinks in Wales but that has yet to prevent the food
9
10
Food for Mood
SAMe, Folate and Vitamin B12 SAMe (S-Adenosylmethionine) is a substance your body creates to work with folate (vitamin B9) and vitamin B12 to manufacture important brain chemicals including serotonin, melatonin and dopamine. It also plays an important role in the immune system.
neurotransmitters serotonin (which is involved in mood) and melatonin (which regulates sleep). Indeed, there is no food source for SAMe. However, there are many common foods containing folate and vitamin B12: Foods high in folate:
SAMe supplements have been shown to have benefits for people with osteoarthritis, fibromyalgia and liver disease. Several clinical trials have demonstrated that SAMe supplements are more effective than placebo in the treatment of mildmoderate depression. Moreover, SAMe supplements have the benefit of fewer side effects than antidepressant drugs. They may also have additional benefits when used in conjunction with antidepressants for people with severe depression.
○ Lentils ○ Chickpeas ○ Spinach ○ Kidney Beans ○ Asparagus Foods containing smaller amounts of folate include avocado, tropical fruits, lettuce, orange, broccoli and (wheat) bread. Foods high in vitamin B12:
This said, SAMe supplements can have dangerous interactions with a range of medicines including many antidepressants. They can also trigger episodes of mania in people affected by bi-polar depression. So - as with all supplements - it is important to seek medical advice before using them. Where the symptoms of low mood and depression are the result of poor diet, it is more commonly the result of insufficient folate and/or vitamin B12 - both of which work alongside SAMe to manufacture the
○ Mussels ○ Smoked salmon ○ Tinned sardines ○ Liver ○ Tofu Other foods containing vitamin B12 include skimmed milk, cheese, eggs and red meat. Some breakfast cereals are also fortified with vitamin B12.
11
Food for Mood Recipe
Tofu and Spinach Cannelloni Ingredients ○ 2 tbsp olive oil ○ 1 onion, chopped ○ 3 garlic cloves, finely chopped ○ 2 x 400g cans chopped tomatoes ○ 50g pine nuts, roughly chopped ○ 400g bag spinach ○ pinch grated nutmeg ○ 349g pack silken tofu ○ 300g pack fresh lasagne sheets ○ 4 tbsp fresh breadcrumbs
Method 1. Heat half the oil in a pan, add onion and one of the chopped garlic cloves and fry until softened. Pour in tomatoes, season and bring to the boil. Reduce heat and cook until the sauce thickens.
2. Heat half remaining oil in a frying pan and cook another of garlic cloves for a minute, then add half the pine nuts and the spinach. Wilt the spinach, then tip out excess liquid. Whisk the tofu until smooth, then stir through the spinach with the nutmeg and some pepper. Remove from the heat; allow to cool slightly. 3. Heat oven to 200C/180C fan/gas 6. Pour half tomato sauce into a 20 x 30cm dish. Divide spinach mix between lasagne sheets, roll up and lay on top of sauce. Cover with the remaining sauce. Bake for 30 minutes. 4. Mix the breadcrumbs with the remaining garlic and pine nuts. Sprinkle over top of dish, drizzle with the remaining oil and bake until the breadcrumbs are golden.
Serves 4-6 12
Five Myths About Sleep
Getting a good night’s sleep is essential to wellbeing. However, in our 24-hour society we have developed some unhelpful and potentially dangerous myths about sleep. Here are some of the most common: 1. Having an alcoholic drink (or several) before bed will help you sleep. Unfortunately, alcohol-induced sleep is poor quality sleep which results in your still being tired when you wake up. 2. You can catch up on sleep on the weekends. Sadly, no. If you miss out on sleep, you have missed out and you can never get it back. 3. There’s no such thing as too much sleep. In fact several recent studies have shown that adults sleeping for more than 9 hours experience poorer health and wellbeing than those who sleep for 6-8 hours a night.
Subscribe to future issues of The Wave… Free!
We hope that you have enjoyed reading this issue of The Wave magazine. If you would like to receive copies of future issues of The Wave at no cost to you, please contact Life Surfing with your name and a postal address. Our mailing list is only used to distribute The Wave magazine. However, if you would like to be kept up to date with other news from Life Surfing, please visit our website and sign-up for our e-news. Thank you!
www.life-surfing.com
4. Some people can survive on 5 hours a night (famously Margaret Thatcher). But only at the cost of serious illness in later life. 5. The new sleep apps will help you sleep. Although these can help you understand what is happening during the night, studies have shown that they do not improve the quality or quantity of sleep.
Freephone
0300 321 4514 Or 07922 537 646
info@life-surfing.com 13
Life Surfing publications Life Surfing has a growing range of wellbeing and self-help guides for anyone who is struggling with life’s ups and downs, and anyone who wants to do more to help. Our publications are available from Amazon in paperback and Kindle formats - see the Life Surfing website for details.
New for 2014 No More Panic - A Guide to overcoming panic attacks and recovering from panic disorder Half of us will experience a panic attack at some time in our lives. For those who do, the experience can be quite literally terrifying. For many the experience is so unpleasant that they avoid similar situations in future. Some develop disabling panic disorders and agoraphobia. In this book, we set out what we - and others - have learned about panic attacks, and how anyone can overcome them... permanently.
Helping Hands: How to Help Someone Else Cope with Mental Health Problems Worried about
the wellbeing of a relative, friend, colleague or client? Not sure what to do or worried you might say or do the wrong thing? Helping Hands will provide you with an understanding of wellbeing and knowledge of mental illness, and will show you how you can help and support someone who has, or is at risk of developing, a mental health problem.
Other titles
Depression Workbook: 70 Self-help techniques for recovering from depression This book provides you with 70 tried and tested self-help techniques covering the seven key areas of your personal wellbeing.
Beating Anxiety: A Guide to Managing and Overcoming Anxiety Disorders This Life Surfing guide explains what anxiety is, how it is treated, and - crucially - what steps you can take to help yourself recover and sustain your personal wellbeing.
Getting to sleep: A guide to overcoming stress-related sleep problems With 1 in 3 of us experiencing stress-related insomnia, this important Life Surfing guide will give you a good understanding of sleep and the steps you can take to improve the quality and duration of your sleep. How to Help: A guide to helping someone manage mental distress In this Life Surfing guide, we explain what mental health and mental illness are, and the steps that you can take to help someone experiencing mental health problems or mental illness.
Depression: A guide to managing and overcoming depression This Life Surfing Guide to depression provides you with an introduction to what depression is, how it is treated, and the many things you can do to help yourself overcome the condition and create longterm personal wellbeing. Distress to De-stress: Understanding and managing stress in everyday life This Life Surfing guide explains what stress is, and - crucially - what healthy steps you can take to manage stress and promote long-term personal wellbeing. The guide includes 30 stress management techniques.
www.life-surfing.com
Food for Mood: A guide to healthy eating for mental health In this Life Surfing guide we explain how mental health problems can impact on diet and how you can improve your diet by using foods from the helpful lists of good mood foods set out in the guide.
Freephone 0300 321 4514 Or 07922 537 646 14
info@life-surfing.com
Listings Beth Whelan, Duopody Reflexology (illness, injury, stress, fatigue) in tranquil St Hilary, near Cowbridge. Tel 07504982623. Email: barefootbeth1@gmail.com
YogaMobility provides specialist accessible yoga classes for disabled and less able adults. Classes are held at Sbectrwm Community Centre, Fairwater, Monday and Thursday (10.30-12.30) and Roath Church House, Wednesday (6.00-7.20pm). www.yogamobility.org
If you would like to advertise in The Wave please contact Julia or Tim at Life Surfing. Freephone 0300 321 4514 - mobile 07922 537 646 - info@lifesurfing.com The Wave is designed and printed by Waye Forward (design) Ltd - www.design.wayeforward.com
Cover photographs: Nick Kaye
15
“You can’t stop the waves… … but you can learn to surf”
The Wave is published by Life Surfing a Community Interest Company limited by guarantee (07399335) registered in England 16 & Wales