Month: August 2018

Each week The Sunday Times publishes list of  the top ten selling books in the non-fiction and fiction categories (…hard and softback).  This week the total week’s sales for the top 10 fiction titles (hard and softback) is 187,000 while for non-fiction it is  about of third of that… 65,000.  Yet each week there are many more pages devoted to reviews  of non-fiction books than for fiction – this week non-fiction reviews cover 8 pages while fiction reviews only get 3 pages.

I’ve no idea why this is…  it doesn’t make sense.

Yet now we have audio books also – and it turns out that many books are selling more in audio format that in the combined hard and software back sales.  We are seeing renowned authors writing to go “straight to audio” – and audio rights  are often sold separately to the print rights… and for much larger sums.  Now this does make sense.  Generations Y and Z are  busy and on the move – and have never developed the habit of reading from the page.  They carry their phones… and so the audio library is always available to them. In a piece within the Sunday Times Review, Francesca Angelini writes that US audio book sales have risen by over 250% over the last three years.  The figures show the main group of consumers contributing  to this rise are men aged 25-44 who are tech savvy but not traditionally big print readers.

At Carina Sciences we are launching our self-help app to develop resilience thought mindfulness based cognitive therapy: REZL.  It delivers tutorials and guided meditations from your smartphone to your ears… when and where you wish.

When setting out on this journey I was wondering about the effectiveness of such self-help courses in comparison with attending  face to face sessions.

I was encouraged by  the following paper from 2014: “The effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial.”  (by Lever Taylor, Billie Lever, Strauss, Clara, Cavanagh, Kate and Jones, Fergal) published in “Behaviour Research and Therapy”( 63. pp. 63-69. ISSN 0005-796).  This study measured  the impact of “self-help” mindfulness based cognitive therapy intervention – up on measures of anxiety, depression, stress, life satisfaction, self-compassion and mindfulness in comparison with a control group.

The study showed: “significant decreases relative to controls in anxiety, depression and stress symptom severity and significant improvements in life satisfaction, mindfulness and self-compassion.”

In fact the study showed improvement effects in every measure that were greater than those which would be expected from therapist-led interventions.   And the effects were persistent – the improved levels were maintained at the subsequent follow-up measurements.

Now, all other thing being equal,  having a human tutor  probably isn’t a bad thing – although there will be some variance in the quality of your tutor and I suppose you have to like them – but I suspect this finding is  about participants being more able to find the right time and right place to properly engage with the training material… and to practice.  Who wants to reduce their stress by having to rush across London for a 18:00 meeting with a therapy group? Further… some people may find face-to-face sessions to be awkward and inhibiting … especially when in the presence of work colleagues (either familiar or not).

So, if you don’t have a good therapist… or if you’re on the move … or more likely, if you find committing to the lessons (or the time to come to town and travel to the sessions) a  problem ….then maybe an app REZL is better for you.

So the convenience of self-help  trumps the therapist,  Yet there are self-help programmes that provide a book and CD… but how many under 40’s will read a book or are able to listen to a CD?  I guess that just like the audio book phenomenon, it seems that self-help is more accessible if it is provided by audio… and on demand – so that busy people can engage within it when they are free from distractions and without introducing more hassle into their lives.

This week the UK media has been full of the disclosure by James O’Shaughnessy (a “health minister”)   that hospital admissions of teenage girls for self-harming have nearly doubled over the last 20 years – up from 7,327 in 1997 to 13,463 in 2017; the figures for boys were about static (2,236 in 1997 to 2332 last year).

As you can imagine there were many quotes about the inadequacy of the UK’s Child and Adolescent  Mental Health Services  (CAHMS) – and a government spokesperson was quoted as saying that they were putting in an extra £300 million to provide such help in schools. [Yet as a governor of a school myself, I know that that there are many initiatives to ask schools to spot children who are struggling with problems – but the school staff themselves are completely unqualified to provide the support the children need…]

“Heart-breaking,” was how the statistics were described by the charity, the National Society for the Prevention of Cruelty to Children (NSPCC).  “These heart-breaking figures are sadly unsurprising. We know from contacts to Childline that many children are being driven to self-harm as a way of dealing with the pressures and demands of modern-day life,” an NSPCC spokesperson said. “Young people are crying out for help and more needs to be done to prevent them from reaching crisis point.” The NSPCC said it gave 15,376 counselling sessions about self-harm last year, the equivalent to 42 per day.

So CAHMS and the admirably proactive NSPCC are struggling to keep up – buy why has there been such a rise?

Well I am pleased to say that the most thoughtful piece in this debate written by Lauren Bell and published in The Sun: https://www.thesun.co.uk/fabulous/6952830/teenage-girls-self-harming-doubled-online-sites-tv-shows-glamourising/

Here Ms Bell highlights the “normalisation” and even the “glamorising” of self-harm: Fashion brands have used models with self-harming scars; and TV shows have made self-harming  seem a reasonable choice – almost as if “everyone is doing it”.  Worse, some online resources (…Tumblr and Instagram posts) can provide first hand accounts of how self-harming  feels – or even secret codes (- sounds exciting) for the sharing harming pictures.  One self-harmer has spoken of how a TV “teen soap” was “triggering” for her – as, like the character, she came to see self-harm as  an antidote to problems, a way of asserting control or even a method to gain relief for “pain”.

Netflix recently paid for research to show that their programme with a self-harming plot  might provoke empathy rather than encouraging girls to self-harm; or to be  “triggering”.  So TV makers may argue about “triggering” (- being directly responsible for precipitating acts or causing copycat acts etc) – and I am sure their script editors will take measures, and seek out advice,  to ensure their output is responsible.

Nevertheless it seems that the “normalisation of self-harm” means that it is seen by many teenage girls as “an option”– and the availability on the internet of “how to” information, plus the self-representation to be gained by sharing such thoughts or even pictures, seems to be supporting the rise in figures.

I think we have to acknowledged that web services that allow the promotion of self-harming – the sharing of justifications, of “how to guidance” and even testaments or photographs should be irradiated.  Similarly advertising should avoid the promotion of self-harm.

Yet, the figures cause me to believe that responsible programme makers of material aimed at teens have a real dilemma  – as even with even best intentions,  plotlines involving self-harming  can suggest that the behaviour is commonplace… and for some, a normal response to the pressures of life.  The usual reason for running such plots is that they help to gain understanding for those involved… and these plots often introduce the issue to a wider audience who may not be aware of the issue. However, these plots can also normalise the behaviour and even encourage interest from teen girls seeking ways to gain control in their lives or to redirect themselves  from other painful issues.  I think we have to be more concerned with the reduction of self-harming rather than providing community support for harmers.  It seems that even educating teens about the dangers of self-harming… or where they might seek help… can be counterproductive! Support for harmers must come  from the government funded services (which must improve)  –  the rest of us should work on reducing the problem.

Jesse Sostrin is a director at PwC’s U.S. Leadership Coaching Center of Excellence – I enjoyed reading his piece about developing your “adversity quotient” here.

Jesse suggests that people can progressively become resilient though “personal acts of defiance”:

A moment of resilience is your chance to face adversity and say: “No, not today. You will not stop my momentum or reduce my potential to make the most of this opportunity.”   Unfortunately, for many leaders besieged by the constant change, rising ambiguity, and intensifying complexity of today’s business world, it is adversity — a big or small problem rising from your experience — that does most of the talking: “Yes, I will change your plans. I will undo your progress. I will cause you to question your goals and I’ll be sure to mess with your confidence along the way.”

He suggests that to become practiced it is important that we should “Leverage every micro-adversity”:  

The big issues often grab the spotlight. E.g. “Our company was just sold… Our competitor landed the client… A close colleague was diagnosed with a serious illness”. Although these major adversities have the potential to reshape the landscape of a life, they aren’t necessarily the best starting point to build resilience. The better strategy is to leverage everyday micro-adversities to steadily increase your resilience and place yourself in a stronger position to respond when the big one shows up. E.g. “I shared an idea during a conference call but it didn’t get the response I wanted… My boss just assigned me a project that I’m not excited about… I tried to give a colleague some feedback, but it backfired and now there’s tension between us”.

These are examples of micro-adversities. They’re not a big deal — except for the fact that they kind of are. … Such micro-adversities can weigh on your mind, making you feel powerless or stuck and tilting the inner game out of your favour by stealing attention from other important matters.

In his piece,  Jesse introduces the concept of  Adversity Quotient (AQ).  So what is AQ?

Many of us are familiar with Intelligence Quotient (IQ) and Emotional Quotient (EQ), yet in 1997, Paul Stoltz introduced a new yet interesting and intriguing concept – Adversity Quotient (AQ), which tells how well one withstands adversity and his ability to triumph over it… and research has shown that measurement of AQ is a better index in achieving success than IQ, education or even social skills.  By understanding the concept of AQ we can better understand how we and others react to challenge and adversity in all aspects of our lives. In fact, how people respond to adversity is a strong indicator of ability to succeed in many endeavours.

Dr. Paul Stoltz defines Adversity Quotient as “the capacity of the person to deal with the adversities of his life. As such, it is the science of human resilience.”

There is lots of great information about AQ on Dr Stoltz site here… and  I have borrowed much of the following explanation from the excellent piece “Adversity Quotient (AQ): An Emerging Determinant of Success and Superior Performance” on stitchesm.blogspot.com here:

To summarise: A person’s AQ can be measured. It is comprised of four CORE dimensions –

C for Control  – To what extent can you influence the situation? How much control do you perceive you have?  Those with higher AQs perceive they have significantly more control and influence in adverse situations than do those with lower AQs.

O for Ownership – To what extent do you hold yourself responsible for improving this situation? To what extent are you accountable to play some role in making it better?  Those with higher AQs hold themselves accountable for dealing with situations regardless of their cause. Those with lower AQs deflect accountability and most often feel victimized and helpless.

R for Reach – How far does the fallout of this situation reach into other areas of your work or life? To what extent does the adversity extend beyond the situation at hand? Keeping the fallout under control and limiting the reach of adversity is essential for efficient and effective problem solving. Those with higher AQs keep setbacks and challenges in their place, not letting them infest the healthy areas of their work and lives. Those with lower AQs tend to catastrophize, allowing a setback in one area to bleed into other, unrelated areas and become destructive.

E for Endurance  How long will the adversity endure? Can you see a time beyond the current situation?  Those with higher AQs have the uncanny ability to see past the most interminable difficulties and maintain hope and optimism. Those with lower AQs see adversity as dragging on indefinitely, if not permanently.

Of course our ability to feel empowered and “in control”… to be confident to take up ownership…. to be able to control our emotions so that current stresses and pressures do not impact on other parts of our lives… and our ability to see beyond the current “temporary situation”…. are all dependent on being able to avoid allowing previous difficulties or emotions or panics from influencing our performance today… and to be skilful to manage our instinctive emotions and our responses so that we can focus on the immediate solutions to be identified and implemented.

I guess that most of us would identify a “mindful approach” as assisting in limiting the reach of such problems.  Yet re-reading the above paragraph it seems that a mindful approach has much to contribute to improving each of our core dimensions in time of need.

So if you are working on your core responses – or if you are facing down micro adversities … or even if you are encountering  significant adversity… it important to remain objective and to be comfortable with pausing to consider the options available and their consequence… and then to  focus on the actions to be taken rather than reacting emotionally.  A knee jerk reaction may make things worse!

A more mindful approach will help you to become more resilient and who wouldn’t want that?

Last week The Times has published a report showing that last year 7.3 million people were given at least one antidepressant prescription in England. This figure includes more than 70,000 under 18s and almost 2,000 children of primary school age. Yet some experts think that such pills rarely work in children – with one saying that doctors were “medicalising adolescence”.   There was also a bias towards giving such pills to the elderly… and this was termed  “prescribing pills to combat loneliness”.

This Times piece led to media discussions suggesting that GPs were either “lazy” in giving out such pills… or that they had no option given the wait for “talking therapies”.  At least two doctors wrote to The Times to explain that such drugs are mostly effective… and that 70,000 out of about 15 million children was not a big number (e.g. Asthma prescriptions were given to over 100,000 children.)

The BBC covered the follow-on news here  saying  – “The number of antidepressants prescribed to children in England, Scotland and Northern Ireland has risen over the past three years…In England, there was a 15% rise. Scotland saw a 10% increase. And in Northern Ireland the number rose by 6%.  …Experts have linked the rise to waits for specialist mental health services”

Now, it may be that that other therapies including Mindfulness Based Cognitive Therapy (MBCT) could offer a chance to reduce the level of prescribing (and addiction) – and ironically, the NHS often advises suffers to read the Mark Williams and Danny Pennman book “Mindfulness – a practical guide to finding peace in a frantic world” while waiting their turn for talking therapies;  yet such services are very stretched.  My advice to sufferers is to find a therapist and pay to get help asap… especially when it is your own child.  It is not right… but it is pragmatic to do so.

(In the interest of openness, I point out that we at Carina Sciences  are shortly to launch our REZL app to build resilience in all of us – so that we are better able to meet life’s challenges – by  using Mindfulness Based Conative Therapy.)

 

But, let’s go back and think about the 70,000 children given antidepressants last year. My own belief is that this number is, in fact, on the low side!

The 2014 UK Adult Psychotically Morbidity Survey  showed that 1 in 4 of us will suffer from a common mental disorder  such as anxiety and/or  depression in our lifetimes… and that in 3 out of 4  cases these problems begin in childhood or adolescence (<= 18 years).  So this suggests that 3/16 (about 18%) of children under 18 years old will have experienced the start of such problems.  Indeed the government’s statistics show that 10% of school children have a diagnosable common mental disorder .

So if we assume that these problems are entirely developed linearly between say 14 and 18  of which there are around 3.6 million young people in UK  ( – as the Times said only 2,000 of the 70,000 were of primary school age) … then we might reasonably  expect that there are about 350,000 under18s who have a “common mental disorder” problem.

Yet the piece in The Times says that ONLY 70,000 are being given drugs  in England …which can be scaled to about 80,000 across the UK… So we are using antidepressants for ONLY 80,000 of the 350,000 suffers. 

The real questions this raises are:  why are 18% of our children developing these problems?  What are we doing to help them? And, what are we doing to avoid such problems in the first place?

The simple answers are that:

• Ignorance and stigma  (…in parents as well as children) mean that many children will soldier on and fail to get early  help as their problems develop – and  it may be that domestic breakdown,  pressure from exams, unrealistic materialistic expectations or social media pressures are all making things worse for our children.
• We are doing little to help – the CAMHS (child and adolescence mental health services)  is a “silent catastrophe” say the Association of Child Psychotherapists (see The Guardian piece here)
• There are no preventative initiatives in place in UK.

So everyone is worked up about 70,000 children  and young people being given antidepressants – yet I am astonished the figure is not 5 times higher…  70,000? …it is the tip of an iceburg.

 The Guardian goes on to point out that not only are the CAMHS services scarce but they are often very poor: “This year, the NHS watchdog, the Care Quality Commission, rated 39% (26 services) of specialist Camhs as requiring improvement. Those surveyed by the Association of Child Psychotherapists were asked whether they could see any evidence of the government’s claim of making “one of the biggest expansion of services in Europe” – 93 % of respondents said they saw no evidence of this.”

…

Of course it is good that everyone is getting concerned about mental health problems in childhood…. (I wrote last month about the denial and lack of leadership shown by our  universities in failing to take responsibility for supporting students with problems  …yet it seems there is a similar lack of support for the under 18s.

IMO we should expect more from our government… we are long way from having CAMHS of the right scale and quality…  so sadly I expect we will have to wait until antidepressants are prescribed to our children at  a level where minsters will finally have to sort this out.