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Stress and mental illness account for 57% of workdays lost in UK

When I talk to people about the impact of building resilience through mindfulness I like to emphasise its value to all – how mindfulness can increase the resilience in all of us to deal with pressure and with change; and make all of us more able to focus and to make better decisions; and to increase our productivity, our open-mindedness, our empathy and our life satisfaction… and there is evidence to show that teams with mindful members are more effective that those without such members.

Yet it is also important to look at how resilience can help people to deal with stress and to avoid becoming anxious or depressed – especially as  my recent work has shown that many people overestimate their reserve of resilience and so that are shocked when they suddenly start to experience problems.  And this happens to many people…

I recently noticed that the HSE (The UK’s Health and Safety Executive) have released figures for 2017/18 that show that work related stress and mental illness (anxiety and depression) accounted for over half of work place absences: 57%. (See here )

So nearly 600,000 employees now suffer from such conditions; and the data shows that the growth such problems has yet to plateau; growing by 13% from the previous year. The cost of this absence is now £8Billion per year.

A spokesperson from HSE commenting on the figures said: “The fact that work-related stress, anxiety and depression is estimated to be responsible for 57 per cent of the working days lost to ill health shows how important it is for employers to take action.”

At Carina Sciences we are working with employers to use our Rezl app to build the resilience of employees – to pre-empt such problems, to reduce the impact on those with such problems… and to enable all employees to boost their performance and life satisfaction.

Obsession with social media fuels anxiety in teenage girls

A study published in The Lancet Child & Adolescent Health suggests that obsessive social media usage is casing teen age girl to exhibit high levels of stress and anxiety.  Yet the anxiety of boys does not demonstrate a similar relationship with their social media usage.

The study of nearly 10,000 British schoolchildren aged 13-16 found that girls who checked social media multiple times a day had a 38 per cent greater risk of suffering psychological distress; it recommends that parents encourage teenagers to leave their phones downstairs when they go to bed and to get plenty of physical exercise.

The causes seem to be related both to the exposure to anxiety inducing content such as comparisons or exposure  to cyberbullying – even if it is to others – and that the time spent on social media reduces the time spent on more positive or support activities including sleeping.

The Times quoted Russell Viner, the lead researcher from the UCL Great Ormond Street Institute of Child Health: “Our results suggest that social media itself doesn’t cause harm, but that frequent use may disrupt activities that have a positive impact on mental health such as sleeping and exercising, while increasing exposure of young people to harmful content, particularly the negative experience of cyberbullying.”

Dasha Nicholls from Imperial College London, who co-authored the report, adds: “The clear sex differences we discovered could simply be attributed to girls accessing social media more frequently than boys, or to the fact that girls had higher levels of anxiety to begin with. Cyberbullying may be more prevalent among girls, or it may be more closely associated with stress in girls than in boys.”

Now all this makes sense to me – from my own experience as a parent it seems that the use of social media by girls is much more tied up with their self-representation, self-image and self-worth; while teenage boys seems to communicate “superficial drivel” – a bit like the way that guys, in a new social situation, will chat about their car journey or football rather than their current hopes and worries.

Yet these result chime with the results shown in the UK Adult Psychiatric Morbidity shows that 26 % of young women, aged between 16 and 18, have a common mental health disorder (depression, generalised anxiety, phobias or obsessions etc) compared with only 9% of men.

Now it could be that young women face different challenges to young men or it could be that something in the way we bring girls up means that they develop less resilience than boys – but I think this report on the impacts of social media usage on the lives of young girls is real food for thought.

Burnout – it’s official

A 2018 study found that 40% of U.S. adult workers were so “burnt-out” at their jobs that they considered quitting.

So now The World Health Organisation (WHO) has recognised the growing issue of corporate burnout as a medical condition, meaning that as of 2020, it will officially be identified in the International Classification of Diseases. (See here )

The WHO identifies “burnout” specifically as a “workplace issue”:  officially described as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”:

“It 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. Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

“The new WHO classification means that workers experiencing burnout will be able to receive a medical diagnosis. Along with mental illness, workers have historically felt discouraged from discussing such issues within the workplace; yet now, due to the classification, workers may well feel emboldened to open up about the issue, therefore preventing a culture of taboo.

Key symptoms of burnout include fatigue; increased anxiety; Lack of motivation; lack of self-care and the emergence of severe health issues: typically symptoms may start with back pain, migraines and eye-strain or feeling like you’re drowning in your workload and have led to strokes and even heart attacks for some business professionals who refused to seek help.

Recent research conducted by CEO Magazine found that  70% of polled CEOs were in a severely unhealthy fitness condition, whilst 100% claimed to be suffering from some sort of stress ailment including headaches, asthma, ulcers and backaches.

I guess this WHO recognition is the start to ensuring that employers and health services focus on the phenomenon of burnout; and that those suffering from burnout are supported by their employers in the same way as those with any other health issues.

Now I expect we all have friends and family who have suddenly suffered from  “adrenal breakdown” or from the symptoms listed above – and the onset of such symptoms can often come as a shock… and be bewildering for the sufferer.  Yet a previous post shows  (here) that many people significantly over estimate their current level of resilience and so a “burnout episode” can strike from “out of the blue”.  Worse,  I have watched friends in high performing jobs start to suffer from such symptoms and then compound the situation by adding anxiety as they start to experience self-doubt and wonder how that can continue to earn at their current rate given how they feel… what will be the impact on their lifestyle and loved ones.  For many, it may be the first time that that have to admit to themselves, let alone anyone else, that they are not invincible.

The way out for those effected is often to rethink their approach to their work… and to their lives. Yet for most of us who have yet to experience burnout is it not too late to think about our priorities (…our ego), our work life balance and to take care of our wellbeing and resilience.

The Rezl Toolbox includes a tutorial and a guided mediation to help those experiencing symptoms of pressure and stress.  Please get in contact if you would like to try it.

Focus in the midst of chaos- US Special Ops

 

The US special forces are using mindfulness to ensure that soldiers are better able to focus in chaotic situations – for instance, to avoid civilian harm.

Yet making better decisions when under pressure… and being able to calmly concentrate on the task in hand when there is a lot going on … are skills that would enhance the performance on all of us.

I have previously seen research showing how the US military has demonstrated that  mindfulness helps soldiers to “decompress” after difficult patrols and studies  showing how mindfulness helps soldiers overcome PTSD –  even when the training is given “post exposure to the traumatic experiences” it can reduce the brain activity expended on ruminating about such previous situations and emotions. So I was intrigued then I saw this article in the New York Times here.

The piece explains that Professor Amishi Jha from the University of Miami published a paper last December on the effectiveness of mindfulness among members of the US Special Operation units.  The research shows that the soldiers are “better able to discern key information under chaotic circumstances and demonstrate  increased working memory function”; plus the soldiers report making fewer cognitive errors than those who are not trained in mindfulness.  Prof Jha points  out that members of the special forces are chosen for their ability to focus and so the fact that they experience an improvement speaks to the power of the mindfulness training.

Professor Jha added: “They ‘re the best and what they are trying to do is the hardest. When the US Special Forces do something not only does the rest of the US military pay attention, the rest of the world’s militaries pay attention”.

I guess while we can see that in a chaotic situation a soldier has to focus upon the relevant information and the decisions to be made. So I am sure Prof Jha is right and other militaries will be implementing their own programmes.  Yet there are many other types of role where such an ability to focus is key…  The ability to set aside emotions and reactions, to take on board the relevant information,  to make operational decisions and to “focus on what need to be done” is a very transferable skill indeed.

Making better decisions when under pressure… and being able to focus on the task in hand… are skills that would enhance the performance of all of us.

One in six UK adults take antidepressants – yet mindfulness can help avoid the need to take them… and can help patients give them up

Each year one is six adults in the UK are being prescribed antidepressants… yet mindfulness is just as effective and research shows it can help people to give up the antidepressants without increasing their chance of a relapse.

A piece from The Guardian (here) sets out the  “one is six” figure.  Data released under the Freedom of Information Act shows that more than 7.3 million people were prescribed antidepressants in 2017-18, 4.4 million of whom also received a prescription for such drugs in both of the two previous years.

Yet mindfulness, and especial Mindfulness Based Cognitive Therapy (MBCT), is shown to be as effective as antidepressants – with the added advantages of helping people to become more able to focus and more empathetic yet without the downsides of the antidepressants or the longer-term problem of how to come of them.

A  piece from Forbes Magazine, explains a study published in The Lancet, to back this up. (Here).  The Forbes article says:

The results from the current study were impressive: MBCT was just as effective as staying on antidepressants over the next two years following treatment: 44% of people in the MBCT group relapsed, while 47% of those in the antidepressant group did.

So MBCT was slightly more effective as medication, which is good news for those who in principle would like to go off antidepressants.

The study brings some interesting and hopeful news for those who don’t want to take medication over the long term, or who can’t tolerate the side effects. And, the authors point out, some people just prefer psychosocial treatments over drug treatments for personal reasons.

In fact our own NHS says Mindfulness (MBCT) is  “as good as drugs for preventing depression relapse”. (Here).

 

While apiece from Psychology Today suggests that Mindfulness (MBCT) training can assist patients who wish to avoid antidepressants and even better, it can help those who wish to give up the antidepressants.  (Here).

So The reasearch is clear:  before starting to take antidepressants patients should consider MBCT; and for those already taking antidepressants (the “one in six”) then may be MBCT can support them in giving up the pills.

Trial shows that MBCT reduces psychological distress in cancer patients

A cancer diagnosis is usually devastating for a patient and for their close family.  We can see that receiving such news is traumatic – leaving patients anxious about death and the impact upon loved ones; or fearful of the treatment or of being unable to control their emotions.  Yet the subsequent treatment phases can also be stressful, debilitating and challenging as patients may face the longer-term impact of surgery on their function and self-image…  and even the end of treatment – the “all clear” – can cause problems as families celebrate but the patients themselves are not feeling so positive as they try to process and adjust to the impact of their experience and the way in which they  have changed… and of course the anxiety of wondering if there will be a reoccurance. (See a previous blog post on this subject https://carinasciences.com/2019/04/05/remission-is-a-work-in-progress/ ).

Yet Mindfulness Based Cognitive Therapy can really help cancer patients to reduce distress.

This week I have been looking at a Dutch study on 245 patients using Mindfulness Based Cognitive Therapy  (MBCT) to reduce anxiety. 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).  See here.

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.

The result showed:

  • “Usual treatment” produced a change in mean HADS score from 17.04 at baseline to 16.37 at post-intervention
  • “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  “psychotically distress” as defined

So, both MBCT and eMBCT significantly reduced fear of cancer recurrence and rumination and increased 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.”

This research is exciting for us at Carina Sciences as we are currently working on a project to help cancer patients and their carers by providing a blend of information, advice and psychological support from diagnosis through treatment and beyond.  I will keep you posted.

Mindfulness for the Education Sector

A friend drew my attention to two new research reports from the charity “Education Support Partnership” on the wellbeing staff in universities.  A qualitative study found that academics are often isolated and anxious, in a system they feel is driven by financial targets – what one called a “treadmill of justification”.  A second survey, by YouGov for the charity, found that 55% of higher education professionals describe themselves as stressed and nearly four in 10 had considered leaving the sector in the past two years as a result of health pressures.

A piece in the Guardian quoted Dennis Guiney, an educational psychologist and co-author of the research:

“Lack of collegiality was a big concern for the academics we spoke to. Rather than focusing solely on money, they felt university managers should be building this. Academics need to feel valued. Praise is important.” His research found that academics felt under much more pressure to deliver within the competitive new market in higher education, and this meant a sense of loss of control over their job. The report quotes one academic saying: “You have to do all you can to keep student numbers high. Otherwise, next year one of your colleagues might lose their job.” [See here ]

It seems that the “target driven approach” to education is causing stress for staff at all levels of the education system.  From my own experience it seems that most working in education are continuously suspicious that all DOFE initiatives are specifically designed to case more stress and anxiety.  They may or may not do so… but it is undeniable that there is an ingrained belief that teachers are stressed and the high-ups don’t care.

Yet before we get too despondent, there is hope.  I can highlight two reports summarising the positive impact of mindfulness interventions on staff in education:

First, a  2014 Report by K Weare  of University of Exeter  summarised the evidence (from 13 studies published in peer reviewed journals ) on the impact of mindfulness on the wellbeing and performance of school staff:

  • reductions in stress, burnout and anxiety, including a reduction in days off work and feelings of task and time pressure,
  • improved ability to manage thoughts and behaviour, an increase in coping skills, motivation, planning and problem solving, and taking more time to relax.
  • better mental health including less distress, negative emotion, depression and anxiety.
  • greater wellbeing, including life satisfaction, self-confidence, self-efficacy, self-compassion and sense of personal growth.
  • increased kindness and compassion to others, including greater empathy, tolerance, forgiveness and patience, and less anger and hostility.
  • better physical health, including lower blood pressure, declines in cortisol (a stress hormone) and fewer reported physical health problems. 
  • increased cognitive performance, including the ability to pay attention and focus, make decisions and respond flexibly to challenges.
  • enhanced job performance, including better classroom management and organisation, greater ability to prioritise, to see the whole picture, to be more self-motivated and autonomous, to show greater attunement to students’ needs, and achieve more supportive relationships with them.

  Second, a 2019 paper from Bristol University demonstrated that mindfulness-based interventions contribute to the overall educator wellbeing and this may increase students’ sense of connectedness to teachers without themselves undergoing any intervention:

  • lower levels of perceived stress
  • reduced sleep difficulty
  • higher levels of mindfulness
  • increased self-compassion
  • better emotion
  • Improved students’ sense of connectedness to teachers.

So mindfulness really can help to address the stress and anxiety of education workers.  Of course there are many research papers that show how mindfulness can help people in many professions to be less stressed and less prone to anxiety and depression – but surely these results will convince colleges and schools to introduce such initiatives asap.  They make fiscal sense, educational sense and fulfill the moral obligation to their stressed-out staff.

The drugs do work – but are hard to give up.

Today I heard Sarah Vine – a columnist for the Daily Mail – on the BBC Radio Five Emma Barnett Show.  The Royal College of Psychiatrists has recognised the problems encountered when patients try to come off long-term anti-depressant or anti-anxiety drugs and has called for NICE to provide guidance on the medical, social and psychological support that such patients should be given.  Right now the problem is not recognised and so patients  may be given no support at all.  Sarah Vine was talking to Emma about her own seven year use of anti-depressant and her inability to give them up.

So whatever we think of Sarah’s political views it is to her credit that she has written about this subject form a personal point of view and appeared on the  show.

It seems Sarah’s journey has been typical – she described her symptoms leading to being prescribed the drugs… how they helped her with her problems … and then how, although she reduced her dosage, she had failed on each occasion she had tried to come off the drugs.  She explained that the drugs reduced her mood swings – and while this  removed the major lows it also meant that she was “emotionally anesthetised” – so that she failed to enjoy the things in life that she should – hence her desire to move on from the drugs.  All sounds pretty typical.

So the drugs do work- but the price is that they are hard to come off.  I have previously written about the level of prescribing of such drugs especially to under sixteens.

What grabbed my attention was Emma’s question asking if Sarah would have started out on the anti-depressants if she had known what she knows now.  Sarah said the drugs had really help her … pause… but perhaps knowing what she knows now she might have tried other solutions before resorting to the drugs.

Yet studies have shown that mindfulness based cognitive  therapy  (MBCT) is at least as effective as anti-depressants pills – yet without the longer-term problems it would seem.  At Carina Sciences we would like to investigate at ways to make Rezl available to those who would like to try MBCT before reporting to drugs.  If you are in such apposition then please contract us.  If you are a healthcare or support organisation who would like to engage with us then please  contact us also.

 

What if you thought you had a full tank of petrol?

I was recently looking at some survey data collected from Generation Z participants.  As you might expect these twenty-somethings were quite open and realistic about their wellbeing  – rating their stress, anxiety and low mood objectively.  What was a surprise was their response when asked to rate their own resilience in contrast with an actual measurement of their resilience… they were way too optimistic.  Over half of them thought their resilience was high – while the tests showed only around one sixth of them had high resilience.  Worse, only about one sixth thought that their resilient was low – yet the actual measurements showed that one third had low resilience.  This suggests that at all levels of resilience they tended to overestimate their capacity to be resilient.

It’s like they’re getting close to the edge without realising just how close they are.

We can think of our reserves of resilience as being like a  kind of “tank of resilience” inside ourselves – and as we encounter challenges this resilience is used up; and then when we are “on empty” we can no longer cope with challenges or setbacks. So if someone is low on resilience and they should face a further set back or challenge – even a very small one – then they can find that they don’t have enough resilience left in the tank and so they may become overwhelmed with anxiety, depression or stress related symptoms.

Now, just to digress a little… the problem with conditions like stress, anxiety and depression is that when people experience such an episode they establish “thought pathways” that spiral downwards… …and then, in the future, when they encounter another “trigger” situation, they slide down the same pathway reinforcing it… and so on, making further episodes more and more likely.  And again, when resilience is low, the trigger doesn’t have to be something big or catastrophic – it could be some relatively minor setback or stressful situation  that triggers thoughts leading to stress symptoms or even anxiety or depression

I expect we all know people who have suddenly developed such symptoms – perhaps experiencing crippling anxiety or feeling they are exhausted or feel too low to get up one morning.  Looking back, in most cases, we can identify a succession of events and situations that have developed over time to consume the available resilience and we may also be able to see how lifestyle has not afforded the opportunity to replenish resilience – yet the sudden onset of disabling symptoms is often a real shock.

So it seems these young adults have a “resilience gauge” telling them they have “plenty in the tank” – yet in reality they are  about to “hit empty”.  The truth is none of us really know how much resilience we have in the tank – yet a gauge that tells us we have plenty may mislead us… until it is too late.

The real danger here is that if we are not aware that we are low on resilience or if we are blind to the possibility that it may run out… then this can cause us make decisions that will actually make things worse:

  • Despite being low on resilience we could opt to take on more responsibility or tasks – i.e. we are “over reaching” what we are capable of at that moment… Jumping from roof to roof is a dangerous game if we overestimate our jumping ability!
  • We fail to find a way to change our workload and/or reframe our pressures and anxieties to that we consume less resilience – a bit like driving more efficiently when we are low on petrol.
  • We do not adopt the lifestyle habits to recharge or rebuild our resilience
  • We do not ask for help and support – as we are unaware of how critical the situation is becoming

So cruising through life with an overinflated estimate of our own resilience can mean that when we hit problems we are shocked at the sudden impact… and by the  realisation that we are unable to proceed as we expected – and this in turn can add to the anxieties around such an episode as we start to question if we are “as good as we thought we were” or if we might lose our career (with all the fiscal implications that this might carry).

To avoid such situations we should all be aware of the drains on our own resilience and of the possibility of our resilience becoming low.  We should take care not to use it too freely and adopt habits to top-up our reserves of resilience on a regular basis. At Carina we are using Rezl to build-up the resilience of our users… and to adopt a mindful approach to life that will be less reliant on the needless consumption of our precious resilience.

“All-clear” is a Work in Progress

At Carina, we’re currently working on a project to provide a version of our Rezl app to deliver support to people diagnosed with cancer.  It will be a mix of psychological support and mindfulness – tools to deal with the “emotional roller-coaster” – and also detailed practical advice and suggestions.  I mention this work because as we have started to investigate and develop our ideas there have been a number of learnings that, for me, were unexpected.

Of course we could see that receiving a diagnosis of cancer is traumatic. Patients tell us that when they are given a diagnosis of some kind of cancer they experience many strong emotions. Many patients say that they feel overwhelmed … that they feel “it is not real” or that they are “unable to take anything in”.  Such reactions are very common and are normal. Each year 360,000 people in UK are diagnosed with Cancer – and almost all of these patients will experience some fear, disbelief, anger and anxiety …for themselves and for the impact on those close to them.

  • Patients describe the diagnosis as “the worst news imaginable“; that they feel shock, numbness, and feel “it’s not fair”, “why me?” or “I am doomed”; they feel blame; regret; guilt; and make comments such as “it’s inside me?”,  “What if it spreads?” and “ I want it out now”.
  • Patients express fears: of death, and its consequences for loved ones, pain, therapy, how will loved ones cope?…of being a source of upset or a burden.
  • Patients are anxious – impact on family, finances, pain, nausea, hospitals; surgery, loss of function, hair, loss of control, and being unable to tell people without losing control of emotions.

This is traumatic. Yet I was surprised to discover that more patients are referred for psychological support at the end of their treatment than at the start.  It may be that the process of moving quickly from diagnosis to the treatment phase brings many challenges and the need for practical adjustments so that a patient can be scooped along – obscuring any emotional issues.  Yet “the end of treatment” clearly brings significant challenges for patients – and there is often a lot of free time to become low or anxious about the future.

So when someone being treated for cancer gets the “all clear” their family and friends will be relieved… and usually celebrating – yet the patient may not feel that way.  They are often living with the effects of surgery or the longer-term impact of their therapy…  including “chemo-brain”. They may feel exhausted; they may miss the routine of their treatment and even experience “separation anxiety” on being parted from their treatment team.  They may feel alone – and under pressure to return to their “old life”.  They may experience “adjustment disorder” and struggle with anxiety and or depression.

So what can help people in this situation? – well insight, normalisation (an understanding that these feeling are to be expected  and common…) and the knowledge that time and space are required to adjust – it is not about returning to their “old life” but it’s about becoming comfortable with their new life and the person that they have become.

It’s a transition. .. and it will take time to adjust… emotionally and physically.  We are all changed by our experiences… a little every day …but especially by major events.

Patients may find that they have become more introspective… or see the world as a less certain place: revising values… beliefs… priorities … or reactions … perhaps deciding to change their lifestyle and the things they wish to focus up on.  Some may have been decisive previously but may now become more empathetic; while others may become more assertive or less patient …. or even experience a change in their level of self-confidence.

A mindful approach would be to become more aware of when they behave as before or when they seem to behave or react differently from their old self… so that they can decide on the reactions that they feel most appropriate for how they feel… now. Recording these observations, of different feelings and reactions, will help them understand the way that they have been changed by their experience.