Interoception and Anxiety

My friend Philip has alerted me to this fascinating presentation by Professor Sarah Garfinkel from Sussex University on YouTube – “interoception and anxiety in autistic adults” –

Professor Garfinkel introduces the term “interoception ” as the ability to be aware your internal body functions and status – e.g. breathing, heartbeat etc. even feelings and emotions; i.e. sensations that are internal to your body.  In her presentation she shows how tests can measure the accuracy of an individual’s interoception .

Now it turns out that those will good interoception are also more likely to experience emotional reactions to situations – almost as if they are more aware of such emotional responses… which fits with having  good interoception .  It has also been demonstrated that folk with poor interoception tend experience less emotional responses and to be more prone to anxiety.

Professor Garfinkel’s research and experiments also demonstrate that those on the autism spectrum tend  (but not always) to have poorer interoception … yet increased anxiety.

So, Professor Garfinkel’s team demonstrated that they could train autistic subjects to increase their interoception (in comparison with a control group) by using exercises or rest to vary their heart rates and to have them focus upon their heart rates.   The research showed that along with better introspection the subjects also reported better emotional regulation – feeling less ambushed by their emotions.

I have written separately about  theory of mind and autism – yet here I want to focus on the link between poor interoception and anxiety – in all, not just those on the autism spectrum – and the good news that interoception can be improved through training leading to less anxiety.

Having watched this lecture, I wonder if mindfulness – where we practice by focusing on the breath and develop an objective awareness of “emotional first wave reactions” – enhances interoception .  When mediating we focus on the breath as it is a simple function taking place within us… so that we are able to learn to avoid a wandering mind and to improve our ability to observe the feelings or thoughts that arising within in us… sounds like interoception ?

It would be interesting to see if training in mindfulness increases interoception – we already know that mindfulness can reduced our proness to anxiety just as well as antianxiety drugs… yet without the side effects.

MBCT reduces the cost of cancer treatment and improves quality of life

Patients  diagnosed with some type of cancer face an anxious time.  They may be fearful about their own survival or worry the the impact that their death could have on their family members.  They may have concerns about their treatment including their ability to deal with pain, nausea or surgery; or relating to the impact on their appearance, on their body,  on their career, on their finances, on their relationships or on their family.  They may feel overwhelmed or unable to control their emotions; and they may feel anxious as they await tests or scans to clarify their situation. It’s quite a list.  And most all of the 3650,000 people diagnosed with cancer in the UK every year will have most of these worries.  And so too will their loved ones.

Besides anxiety, as they await medical professionals to make perhaps life changing decisions, patients may feel helplessness or have low mood.  Some may fear the worst or start to anticipate a poor outcome.  In fact those admitted as in-patients are nearly twice as prone to depression related to their cancer in comparison with those who are treated as out-patients.

Now,  there are many studies that show just how effective Mindfulness Based Cognitive Therapy (MBCT) is in reducing depression and anxiety within cancer patents.  I have posted before about a study involving 245 cancer patients: “Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial” (2019 published in Journal of Clinical Oncology).  Each of the cancer patients taking part in the study was categorised as experiencing “psychological distress” — i.e. demonstrating a score ≥ 11 on the Hospital Anxiety and Depression Scale (HADS).  The study compared patients treated with the usual psychological support  with those receiving an eight week course in either “therapist lead” MBCT or self-help (internet based) eMBCT. The results demonstrated that both face-to-face and internet-based self-help mindfulness based cognitive therapy significantly reduced psychological distress in patients with cancer – reducing fear of cancer recurrence and improving mental health–related quality of life. See here

The results showed:

  • “Usual treatment” produced a small change in mean HADS score from 17.04 at baseline to 16.37 at post-intervention
  • Yet “Face to face MBCT” achieved a change from 18.81 to 13.25
  • and the “eMBCT group” achieved a change from 17.24 to 11.87 – almost eliminating  “psychosocial distress”

So, both MBCT and eMBCT significantly reduced fear of cancer recurrence and rumination; thereby increasing mental health–related quality of life, mindfulness skills, and more positive mental health compared with usual treatment. The investigators concluded, “Compared with treatment as usual, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.”

As you may be aware we are currently working on a version of our Rezl app to provide information, advice and support to those diagnosed with cancer and those close to them.

As part of building the justification-case for the use of MBCT within cancer clinics I spotted this paper from the Netherlands:  “Cost‐utility of individual internet‐based and face‐to‐face Mindfulness‐Based Cognitive Therapy compared with treatment as usual in reducing psychological distress in cancer patients” (April 2019 by  Compen et al).

The study was an random controlled trial tracking three groups of patients: one given MBCT; one given access to an online MBCT programme (eMBCT); and a control group given treatment as usual (TAU). The paper investigated the “societal costs” (loss of employment earnings, cost of psychological treatment and “quality of life” measures)  through-out treatment and through to nine months post-treatment.

The results showed:

  • The MBCT and eMBCT patients both demonstrated a  40% reduction in  the cost of the psychiatric/psychological care required in comparison with the TAU group;
  • The MBCT and eMBCT patients both demonstrated a 70% reduction the earnings lost in comparison with the TAU group;
  • The MBCT and eMBCT patients both reported significantly higher quality of life than the TAU group

The researchers concluded that “Results indicate that eMBCT and MBCT are cost‐saving treatments whilst simultaneously improving quality of life for distressed cancer patients.”

It seems to me that that healthcare insurers would benefit from the reduced treatment costs;  and disability income or income protection scheme providers would see reduced claims – maybe they should consider the provision of MBCT/eMBCT to reduce their costs (and their premiums) and to increase the “quality of life” of their customers.


So how do the brains of men and women differ?

In the words of the late Caroline Aherne’s Mrs Merton character: “Let’s have a heated debate.”

Twenty five years ago  John Gray’s book told us how  “Men are from Mars, Women from Venus” – well not literally, but the concept was that by understanding each other’s thinking and likely reactions to events then we could all be more understanding of each other.

As a guy, I have often surprised myself that I can focus on work or even on watching soccer at a time when other parts of my life present real challenges… and I notice how my girlfriend can find it difficult to focus on anything other than whatever is troubling her.  John Grey’s book taught me to stop trying to respond to her problems by trying to fix them;  but to just be empathetic and supportive. Thanks John.

So, while sitting in my “man cave”  (and in joke for those who read the book) I started to wonder about how good or bad men and women are at compartmentalisation.

Compartmentalization is a defence mechanism in which people mentally separate conflicting thoughts, emotions, or experiences

I found a great blog post on Jennifer Crumb Perez   here.   It explains how women may see men as “distant” because men are often focusing elsewhere or avoid serious issues of the here and now.

“Men tend to compartmentalize their feelings and thoughts about, well, pretty much everything. If you were to look inside a woman’s brain, you might find a comfy quilt made from her thoughts and feelings, all stitched together. Women naturally process thoughts and feelings and integrate them into one cohesive ‘thing’.”

It turns out that back when we were all living in hunter gather communities, men and women played different roles. Women were responsible for raising healthy and functioning members of society; so they needed to be able to think and feel at the exact same time – to multi-task and to avoid neglecting any current “family raising issues”.   While Men were tasked with hunting and fighting; so to keep focused they needed to avoid any distracting emotions or “issues”. It would not have been helpful to think and feel at the same time.   The guys needed to focus to stay alive and to complete their current tasks. So, compartmentalization of thoughts and feelings would be very helpful for the men… yet unhelpful for the women.

Today, being compartmentalised may not be so important (how much focus do you need int the  store?); and it can apparently be a barrier in relationships – unless your partner has read John Gray’s book.  The advice to men is to begin to integrate their thoughts and feelings. As a start, Crumb Perez suggests, men should admit they have them!

A piece on “The Mind of a Man” highlights how strange women may find guys’ apparent inattentiveness to important issues or their distractednesss (code for not listening).  The piece quotes Michael Gurian, author of the book “What Could He Be Thinking?” who explains how our hormones have caused our brains to develop differently.  This difference can be seen on MRI scans:
“If you line up PET scans of 50 male brains and 50 female brains, you’ll see more colors lighting up in the female brain because there’s about 15% more blood flow, on average, in the female brain. If you show those 100 men and women a picture of someone looking sad, you’ll notice that less of the male brain lights up as the men try to figure out the emotion involved. There’s less involvement of the emotive centers and less going on in the hippocampus, where memory storage is.” Says Gurian.  So women are more sensitive to emotions.

Yet if the men and women were asked to do a math or science problem, the PET scan would show, on average, that women used more of their brain to get the answer than the men did. “The male brain tends to be more efficient to lateralize and compartmentalize, which has the advantage of making him more task-focused. The female brain has more [nerve] connections and constantly cross-signals and takes in more, so it tends to see and feel more than the male brain,” Gurian says.

Are these pictures showing compartmentalisation in actions? I think so.

So, there we have it – men’s brains are different from women’s brains… including by being more “compartmentalised” – which is helpful in some aspects of life but  not in others.  We can break to break free of these limitations by women becoming more compartmentalised  in their thinking or men becoming more focused on their emotions and feelings.

Or we can just understand each other… and cut each other some slack, maybe.

Mindfulness significantly improves attention for adults with ADHD

I recently came across a 2016 paper from  Germany reviewing the impact of MBCT for the treatment of ADHD in adults. The paper demonstrates how a mindfulness intervention makes functional changes in brain areas that are suggested to be impaired in adults with ADHD; and in addition, patients readily accept mindfulness meditation. The researchers concluded that:

There is promising preliminary evidence that mindfulness meditation employed as a neurobehavioral intervention in therapy can help ADHD patients to regulate impaired brain functioning and thereby improve self-regulation of attention and emotion control.

[See Mindfulness-Based Cognitive Therapy and the Adult ADHD Brain: A Neuropsychotherapeutic Perspective ( 2016 Bachmann et al)  here  ]

Bit  let’s step back – what is ADHD and how many adults are impacted by this condition?  Well,  ADHD is a neurobiological disorder described by symptoms of inattention, hyperactivity and/or impulsivity. According to the U.S. CDC, 7.8% of children aged between 4 and 17 years have been diagnosed with ADHD; and the National Comorbidity Survey says that, 4.4% of US adults aged between 18 and 44 years have matched the DSM-IV criteria for ADHD.  So it’s an issue for about 1 in 20 adults.

So I dug a bit further and found a meta review (i.e. a review of published trials of Mindfulness intervention to treat ADHD)  – “The effectiveness of mindfulness-based intervention in attention on individuals with ADHD: A systematic review” (2017 by Clara et al published in the  Hong Kong Journal of Occupational Therapy).

This review identified six studies investigating the impact of mindfulness based interventions for adults with ADHD. The results all “showed significant improvement in attention” in this age group.  Moreover, three of the studies were randomized control trials, providing strong evidence that the positive results were due to treatment effect.  The researchers said:

“For adults with ADHD, mindfulness-based intervention improves attention deficits significantly.”

Note also that it was found that mindfulness based intervention was popularly in adults with ADHD – previous studies have shown the reluctance to follow pharmaceutical based regimens.

So ADHD is significant problem for some adults – yet mindfulness is a very effective, low cost and low-risk treatment – so wouldn’t it makes sense to try it?

Finally, let me just add that the research on childhood ADHD is less clear – I wonder if this is a problem with the terminology and delivery of MBCT – there is a Chinese study that demonstrates the effectiveness of a mindfulness intervention specially designed for such children:

The Rezl Life Community

This is a short message to tell you about The Rezl Life Community – it’s a place where we can share ideas, information and experiences;  where we can help, encourage and learn from each other.

Our Rezl app uses something called “Mindfulness Based Cognitive Therapy” (or MBCT) – which was developed at the universities of Massachusetts and Oxford.  Scientific research shows that MBCT significantly reduces anxiety and low mood; it increases job satisfaction and life satisfaction; it improves concentration – increasing productivity and reducing mistakes; and it makes people more open to the views of others. For elite performers MBCT increases their level of performance and “flow”; and for leaders and aspiring leaders…. Rezl will develop the skills to manage in “challenging and disruptive business environments”.

Now we want to make it easier for Rezl users to share their ideas and experience.  If you have questions about Rezl, about mindfulness or about how others have succeeded in dealing with specific challenges…  then this is the place for you.

So whatever your situation, then you can benefit from the collective experience, knowledge and support of our community…  and you can help and encourage others too.

To access the Rezl Life Community you can just tap the community button on the navigation bar at the bottom of each Rezl page – it looks like a small crowd of people -or,  you can use a browser on any PC or phone. Just go to

And remember that the Rezl Life “Conversations feature” enables you to set up a “group chat” for you and your friends so that you can exchange ideas as you journey with Rezl together.

We hope that you’ll join us… To help yourself – and to help others. Try it now. See you there.

The effect of becoming more mindful.

Many research projects have looked at the impact of mindfulness upon Resilience and upon other cognitive characteristics.  Besides building up your resilience, mindfulness is shown to have other positive benefits. All for just 10 minutes on four days per week.  What have you started to noticed about yourself?

Mindfulness builds resilience so that people are better able to deal with stress and pressure. There are many reasons why people can feel stressed – too much work, slipping behind, feeling that we are not as good as our colleagues or feeling that we are unable to produce work to the quality we want.  Some are particularly stressed by feeling that they are letting people down or not reaching the expectations of others or not reaching their own expectations.  Yet a mindful approach can allow us to pause, to avoid becoming overwhelmed by such feelings or by the anxieties that may be generated in such situations and so that we are more able to decide on a sensible way forward.

If you are experiencing any of these issues then please access the Pressure and Stress sessions within the Rezl toolbox.

Mindfulness is shown to increase concentration so that we are not distracted and this increases productivity and reduces mistakes.  Studies have shown a significant reduction in errors by people trained in mindfulness.

Mindfulness makes people more open to the views of others so that ideas are not dismissed or ignored and mindful people are more prepared to consider the ideas and concerns of others. Research has shown that teams with mindful team-members are more effective and more likely to collaborate towards achieving team goals.

Mindfulness increases empathy.  Mindful people are more likely to respond to others with compassion and understanding meaning that mindful team members are more supportive of their colleagues leading to better outcomes.

Many studies show that mindfulness improves self-esteem. We can see that self-compassion is an import trait and being more able to avoid becoming overwhelmed by our emotions increases self-confidence and builds our self-esteem.

Mindfulness can increase life satisfaction with an outlook that is less driven by ego. We are less likely to compare ourselves with others and end up feeling negative about our lives, our jobs etc.

A study showed that the three measures of Job satisfaction were improved by an average of 18% as a result of a mindfulness programme.

Mindfulness based congestive therapy has not only been designed to help everyone improve their resilience but also help those experiencing anxiety and depression.  It helps avoid emotional responses to situations that may trigger episodes of anxiety or depression and helps people to remain objective when such reactions arise.

Similarly the techniques of mindfulness have been shown to be effective in those dealing with chronic pain or even conditions like tinnitus.

Studies of change management situations, involving jobs, systems and processes – have shown that mindfulness significantly increases people’s capacity to deal with stress and change positively. Where “no change” is not an option, it is important to embrace the change process….positively.


Go fast – Go slow – use Rezl like Paracetamol

I recently took some time to talk with a number of our Rezl users.

Amongst the insights I gained was that some users are “binging” the tutorials and meditations – to learn the secrets quickly.  However, they did recognise (…it’s one of the secrets) that knowing how Mindfulness Based Cognitive Therapy can help you to avoid emotional reactions or to avoid being overwhelmed by depression and anxiety is one thing – but practicing, through meditation, to gain such benefits is another.  So I am pleased to report that the “bingers” went on to regularly practice their mediation with Rezl.

There were two groups of users who immediately seize on Rezl as offering an instant remedy to challenging episodes – people with anxiety (including those experiencing panic attacks) and those with problems getting to sleep.  These users tend to reach for Rezl and the relevant toolbox meditations whenever they had need of them.  Kind of like having paracetamol handy… always available whenever they need it.

Mindfulness provides long-lasting protection from burnout

Recently published results show that the benefits of Mindfulness, to reduce burnout in employees, are long-lasting.  That’s good for employees… and cost effective for employers.

I have written about burnout before: here.  Burnout is characterised by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.

The Ohio State University Wexner Medical Center  has publish data showing the long lasting nature of the benefits to healthcare professionals gained from their eight-week “mindfulness in motion” (MIM) training course.

Successful completion of the MIM program had previously been shown to significantly decrease perceived stress and inflammation, as well as increase sleep quality and work engagement…

However, you could argue these results mean nothing for the organization if a month after the program ends, usual stress and burnout levels return to base levels,” said Maryanna Klatt, who is a professor in the Department of Family and Community Medicine at The Ohio State University College of Medicine.

“Demonstrating sustainability of the results of an intervention is nearly as important as demonstrating the effectiveness of the intervention, yet this is rarely done. Organizations need to be assured the return on their investment to reduce burnout and build resilience produces results that are maintained long after the intervention ends.” said Klatt.

A follow-up survey was sent via email to healthcare professionals (n = 220) who previously participated in the 8-week MIM intervention. Survey assessed burnout, perceived stress, resilience, work engagement. Average time since intervention end was 12.2 months. Results showed that there were significant differences from “pre-MIM” to  “12 months post-MIM”: ie less burnout, less perceived stress and improved resilience.

It’s been a stressful time for healthcare workers and this result demonstrates the lasting benefits of an eight week mindfulness programme.  Yet a 2018 study found that 40% of U.S. adult workers were so “burnt-out” at their jobs that they considered quitting – so maybe other sectors and employers should serious look at adopting mindfulness to reduce burnout.

What are our convictions and how strong are they?

Our personal convictions are our strongly held beliefs. A quick definition cut from Quorum says “Personal convictions are a special set of our beliefs, that determine (for you) what you believe to be right and wrong. They drive your behaviours and actions in every decision involving right and wrong. They determine your response to other people’s actions, including both your actions and your emotional response.”

I was wondering how the subject of personal convictions may change from generation to generation – as some topics heat up and some cool down; and if younger people now hold their personal convictions in a less strong or more fluid way than previous generations.

Convictions may centre around topics like political parties, or wealth redistribution, human rights, abortion, gun control, trans rights, fox hunting, LGBTQ+ equality, capital punishment, republicanism, national service, welfare payments, climate change, mass immigration, Islamophobia etc etc.

I will look at the types of personal convictions held by people over the coming months. Yet for now I make three points:

Many of us crave certainty – so we may prefer leaders with clear and strong convictions – as we will know what they are going to get.

Yet there is research that shows that we are often blind to evidence or arguments that disprove or undermine our convictions. Especially where our personal conviction form part of our self-representation. Once something is a personal conviction it seem one loses objectivity and balance. So there is a good and a bad side to holding strong convictions.

Finally, I wonder about the impact of becoming more mindful – does that reduce the strength of one’s convictions – or perhaps it make one more accepting of the convictions of others?

The Impact of Meditation

Research shows that meditating for just ten to 15 minutes per day can boost the brain’s ability to concentrate on tasks. A recent study of brain scans of students who took up meditation at Binghamton University in New York state revealed marked changes in their ability to switch between states of consciousness.

Scans from before and after an eight week meditation course for novices demonstrated  an improved ability to switch between the two general states of consciousness: the “default mode network”, when the brain is awake but not focused, such as in daydreaming; and the “dorsal attention network”, where the brain engages for demanding tasks.

The study was published in the journal Scientific Reports. When George Weinschenk was asked the teach as mediation class his colleague Weiying Dai, an assistant professor, was a little sceptical – especially about whether such a short amount of time spent learning how to meditate  would make any difference. Dai suggested it would be able to quantify any impact with modern technology. Dai had previously used MRI scans to track Alzheimer’s disease and suggested using the scans to look for differences in the brains of the meditation students.

Weinschenk says: “Tibetans have a term for that ease of switching between states — they call it mental pliancy, an ability that allows you to shape and mould your mind. They also consider the goal of concentration one of the fundamental principles of self-growth.”

Mediation is about practicing to be able to focus – to avoid internal distractions and also internal distractions such as thoughts of the past or of the future – and so the become more objective in a non-judgemental way.  The ability to concentrate on the moment (… to “be here now”) allows the sitter to become more aware of when the mind wanders and to refocus their thoughts.  Besides making sitters more effective in their tasks,  they may even experience the joy of “Flow states”.  Practice also enables meditators to gain authority over their emotional responses so that they are able to remains objective and avoid knee jerk or negative reactions.  All for just 10 minuet per days five times per week.