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.

Grit – perseverance – and deliberate practice…

I love this inspiring example of perseverance and “deliberate practice” (that stretches you beyond your current level).  I first read about Shizuka Arakawa in Geoff Colvin’s book: “Talent Is Overrated”:

A study of figure skaters found that sub-elite skaters spent lots of time working on the jumps they could already do, while skaters at the highest levels spent more time on the jumps they couldn’t do, the kind that ultimately win Olympic medals and involved lots of falling down before they’re mastered….Landing on your butt 20,000 times is where great performance comes from.

Shizuka Arakawa won gold at 24 – she had been training as a skater since age five.  Winning the gold requires flawless performance of moves that the rest of us would consider simply impossible. Arakawa’s specialty was something called a layback Ina Bauer – bending backward almost double with the feet pointing in opposite directions–leading into a three-jump combination. Perfecting such moves requires huge quantities of practice, and falling down during much of it. For Arakawa it took nineteen years….[and] at least twenty thousand derriere impacts on an unforgiving surface.

We can all applaud the dedication of Shizuka Arakawa – yet her example should make all of use reconsider what we are capable of.

 

Here’s a couple of links to give you more information:

Explanation of the special Ina Bauer move: https://www.youtube.com/watch?v=IC8t3nOgVtU

Shizuka Arakawa’s 2006 Olympic performance: https://www.youtube.com/watch?v=8g0ghQMLORI

Reinvest the Time Spent on Hustle Porn

A friend of mine is starting up a mentoring service for processionals who are chasing “career narratives” (i.e. seeking the next promotion, the car, the house, seniority, glory etc.) to the point where their lives are becoming wretched.  Sure it’s is good to aspire, but as Paul Dolan suggests in his new book “Happy Ever After: Escaping The Myth of The Perfect Life”, it may be that some people continue to pursue career success even when the returns are diminishing – and that  the extra workload and stress from chasing the incremental £10k can destroy a work-life balance or even impact on mental and physical wellbeing.

While researching this context, I came across “Hustle Porn”.  So what it “Hustle Porn”? Well it tends to be in the form of YouTube channels operated by “successful entrepreneurs” urging would-be followers to work like crazy… for all hours… to make their ventures a success.

Now of course some entrepreneurs do succeed because they have great perseverance in the face of challenges and setbacks – so that they outreach their competitors… yet blindly urging young people to exclude every facet of their lives other then the pursuit of their venture, so that they are working 80, 100 or 120 hour per week,  does start to cause problems.

Such “hustle focus” can cause burnout, adrenal problems and mental health problems – and in fact the work focus can destroy family and friendship support networks so that the impacts of such a lifestyle are accelerated.

Reddit founder Alexis Ohanian has recently highlighted the trend for entrepreneurs and employees within the high tech industry to overwork – resulting in deteriorating physical and mental health  – often drive by Hustle Porn.

And worse, it seems that Hustle Porn is addictive to its followers.  In this blog I am not going to mention the high profile “Champions of Hustle” – these guys are monetising their online followers well enough without my help.   But awareness of this phenomenon, and its downside, is at least a start – colleagues, friends and family who are hooked on Hustle Porn need to realise where this type of life is heading… and to change; and give up the Hustle Porn.

So, yes – put energy onto your business venture – but at the same time don’t define you success in just business terms – think about success in terms of the life you want to lead… and the time you want to spend on non-work experiences.  Always ensure you have time set aside for hobbies, exercise and socialising.  Put a priority on sleep.

You might consider introducing mediation into your routine – so that your time at work  will become more focussed; and  yet you are able to set that focus aside in other parts of your week.  You might find that 10 or 15 minutes each day will make a much bigger change to your effectiveness if you practice mediation  rather then watching Hustle Porn on YouTube. So reinvest the time spent on Hustle Porn.

Media: Self-Harming and Student Mental Health… the Solution is with the Government!

In the last few weeks there have been some thought provoking issues in the media – from the role of social media in causing self-harming to the prevalence of mental health problems in students.

NHS Digital has released figures to show that the number of children (aged 9 to 17) admitted to hospital with self-harming injuries rose by 12% in just one year. We have blamed social media for  interfering with elections, radicalising impressionable young people and reducing our self-worth  (as users compare themselves with the idyllic profiles of others) – yet social media seems it is playing a clear role in driving the growth in self-harming also.

The Daily Mail quoted Dr Hayley Van Zwanenbug from the Priory’s Oxford Wellbeing Centre as saying that social medial was leaving children feeling physically and socially inadequate.  Psychotherapist Julie Lynn-Eves wrote “Every day I see young patients left  in torment by images on social media.” Julie linked the rise in teenage self-harming to the phenomenon of social media and its emphasis on perfection and access to images of self-harming.

Now there are many complex issues here – including low self-esteem, and need to have some control or even a feeling of being successful at something. Yet, reading through the pieces it seems that the failure of the government and NHS to properly resource CAMHS (the child and adolescent mental health service) to address the teenage mental health tsunami is now being repeated by the inadequate provision of services to address self-harming.

In other media pieces there was news that the number of freshers arriving at university who declare a mental illness is up by 73% over  the last four years.  Of course, as I previously wrote in “Mental health in education – specialist and complex  infrastructure required!”, not only is this a sign of an increase in such problems, but it is also a sign that young people are more open about such issues and that the associated stigma is reducing.  Further, it is now clear that Universities have a duty to support such students;  and must not discriminate against them or allocate assignments in a way that exacerbates such problems.  The response to this news must be that is essential for our universities engage with the new frameworks and standards being set in pace… and we should look at the reasons why our young people are demonstrating such conditions… and the role of social media?

Finally, I noticed that the University of Reading had published results from a study to show that teenage depression impacts adversely memory.  It’s like a quadruple whammy – we know that depression reduces motivation, increases absence and make concentration difficult – and now it turns out that the ability to memorise learning is also impacted. Tasmin Ford of the Royal College of Psychiatrists was quoted in The Times as saying that a single year of depression in the years from 14 to 18 can completely swing a person’s life trajectory.  While Tom Madders from Young Minds said that it was still far too hard for young people to access the mental health support from the NHS.

So with regard to support for adolescent mental health problems or support for those who are self-harming… it looks like we must press the government to do more.  I realise that no political party wants to head in to an election promising tax rises – but the news that our public services are so underfunded is not unrelated to the fact that income tax rates are lower than at any point in my working life.

A Trial of Mindfulness in Schools – yet don’t forget to analyse academic achievement and the impact of social media.

Back in December I wrote “Mindfulness for school pupils – improved wellbeing and better grades”. (Here)

So, I was delighted to see that education secretary Damian Hinds has announced a trial to teach mindfulness within 370 schools . The trial is being led by the Anna Freud National Centre for Children and Families in partnership with University College London and it will run until 2021. The trial will involve pupils being taught muscle relaxation techniques, breathing exercises and mindfulness.

“As a society, we are much more open about our mental health than ever before, but the modern world has brought new pressures for children,” says  Hinds.

It’s also worth noting that recent research conducted by University College London discovered that teenage girls are twice as likely as teenage boys to exhibit symptoms of depression due to social media.

At the time of writing I have not been able to check out the outcome measures to be used  in the trial – but I while I am sure the trial will investigate the impact of mindfulness upon levels of mental health problems… I hope that it will seek to measure the impact of the trial on academic results also.

Further, it would be very interesting to see if the level of social media usage is reduced – or if the negative impact of social media is reduced by mindfulness  (…I would imagine it might – but this trial could enable us to find out).  If social medial use is causal in the development of anxiety and depression;  then such research would start to give us a real steer on how we can control social media and reduce its impact on the mental health of young people.