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A recent piece in the FT highlighted the increase in burnout amongst junior staff in professional services companies: “Junior lawyers and consultants are warning they are suffering burnout after working longer hours in isolation during the pandemic, sparking fears of an exodus from the biggest global law and advisory firms.  Soaring demand for legal and corporate advice during the Covid-19 crisis and a global shift to remote working have resulted in a growing mental health problem among younger professional workers, according to senior partners.” (Here)

We are talking about the big audit firms, management consultancies, corporate lawyers and investments banks – where there is often a culture of working to deadlines – whatever it takes.  The FT mentions that recently, a group of first-year analysts at Goldman Sachs told management they had been working an average of 95 hours per week and suffering from insomnia and anxiety. More widely, this trend is causing fears of an exodus from the biggest global law and advisory firms.

The key signs of “approaching burnout” are insomnia and anxiety along with irritability, emotional swings and restlessness.  Yet many junior workers in these organisations may feel unable to say that cannot meet deadlines – and it is worth noting that internally, such organisations are often very competitive: if you get the promotion, then I don’t.

Let’s be curious and stand back.

The World Health Organisation 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.”

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.

It is no surprise that studies on burnout often identify a lack of autonomy as being a feature of environments with a lot of burnout.

Worse – burnout can creep up on you. 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 Rezl Toolbox has a tutorial and a mediation to help people to deal with stress in a mindful way:

“I am able to pause, to take stock and to set aside intractable issues   …such as thoughts of unresolvable situations or of anxieties about the future – as these are not helping me right now! I can set aside low priority issues for now. I can show myself self-compassion and understanding.   I can say that this is my experience right now – yet it won’t always be so”.

“I am self-confident… so that I can seek the views and support of others.”   This is so important. Better to be open and to seek support; and for expectations to be reset… giving a feeling of relief.

“I can prioritise the things that require my focus – which may include getting help or resetting expectations…. so that I have the time to resolve the current situation; so that I have a clear way forward and so that I can focus on each task ahead.  All these actions are available to me.   Some involve sharing.  In most cases, the instinct to keep things “bottled up” or hidden just makes things worse and ensures that the situation may be repeated over and over. “

Please get in contact if you would like to try it.

I noticed some recent newspaper reports suggesting that MDMA (aka the recreational drug Ecstasy) is effective in helping alcoholics to reduced their drinking.  The research was conducted at University College London by Professor David Nutt.  You may recall Professor Nutt was previously the government’s “Drugs Tsar” as chairman of the Advisory Council on the Misuse of Drugs.  He was fired from this post in 2009 after speaking out to suggest that there was a mismatch between lawmakers’ classification recreational drugs – suggesting that illicit drugs should be classified according to the actual evidence of the harm they caused.  To this end he presented an analysis which revealed that alcohol or tobacco were more harmful than LSD, ecstasy or cannabis.  Further, I have heard Professor Nutt talk about the opportunity to repurpose some drugs that are currently controlled in order to effectively treat mental illness and addictions.

The recent news reports centred on a study by Professor Nutt and his team at University College London showing that Ecstasy can be used to treat alcoholism – as it seems to enable addicts to confront their pasts.

In a trial, addicts were given doses of the Class A drug MDMA during two of eight psychotherapy sessions.  Before the therapy, they had been drinking an average of about 130 units a week – yet nine months later, 79 per cent of those who had taken the MDMA therapy were still consuming less than 14 units of alcohol per week, compared with just 25 per cent of people who had sought standard NHS care.

Prof Nutt’s work made me wonder about trials investigating the possibility of using Mindfulness to help people with substance abuse and addiction problems.

In fact, there are many published papers detailing research into the effectiveness of Mindfulness interventions to help reduced addictive behaviours – alcoholism, binge drinking smoking and drug addictions – to reducing cravings and dependency… and as a mollifiers for stress.  It took me a little longer to find studies looking at the long-term effect (where the effects lasted beyond the period of the study interventions) – but pleasingly there are a number of excellent random controlled trials that show such lasting impact.

One typical example is this 2014 paper “Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders A Randomized Clinical Trial (Sarah Bowden et al – from the Addictive Behaviors Research Center, Seattle, Washington – published in JAMA Psychiatry). (Here).

This research contrasted the use of “Mindfulness-based relapse prevention” (MBRP) with a “cognitive-behavioural relapse prevention program“ (RP)  and  also with “treatment as usual” (TAU)  – a 12 step counselling program. A total of 286 eligible individuals who had successfully completed initial treatment for substance use disorders were randomized to MBRP, RP, or TAU and attended eight weekly sessions for their given program.  They were then monitored for 12 months.

The trail showed that in comparison with TAU, both MBRP and RP significantly reduced risk of relapse risk to drug use and heavy drinking at 6 months; and at the 12-month follow-up, MBRP was more effective than both RP and TAU in reducing drug use and heavy drinking.  The researchers commented:

“Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skilfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes.”

This is just one example of many such research projects to show that Mindfulness interventions really can support people to reduce heavy drinking and drug use over the long term.

It will be interesting to see if Professor Nutt’s “ecstasy treatment” requires “maintenance sessions” to continue the progress made – my hope and expectation is that most of his subjects will have changed their habit for the long-term as a result of his program.

One final comment: most of the research I found was centred on the use of drugs, alcohol and/or tobacco – it would be interesting to look at the effectiveness of Ecstasy on other addictive behaviours like gambling, self-harm, eating disorders etc which have also shown a positive response to mindfulness interventions.

I have written before about social anxiety: Social Anxiety Disorder is more than just shyness or nervousness.  While many people get nervous or self-conscious on occasions, Social Anxiety Disorder involves an intense fear of certain social situations — especially situations that are unfamiliar or in which people feel that they will be judged by others; and where they are afraid that they won’t “measure up” or that they will be exposed as inferior.  Just thinking about such situations may cause them to get anxious and they may go to great lengths to avoid them, disrupting their lives in the process.

And it is not unusual, nor confined to adults. Social anxiety is one of the most common psychological disorders amongst children and adolescents – and it has profound effects on their psychological states and academic achievements. The lifetime prevalence of Social Anxiety Disorder is 9.5% in females and 4.9% in males; the six-month prevalence rate is about 2% – 3%; yet and among high-school adolescents this rate increases to 5% – 10%.  Children and adolescents diagnosed with social anxiety are prone to academic problems, drug abuse, long periods of disability, and considerable pathologies in their daily lives and social relationships.

In summary, it’s a significant problem for adolescents… and especially for girls.

So, I was encouraged to read of a paper published in 2016 investigating the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) to reduce social anxiety and to increase self-esteem in adolescent females diagnosed with social anxiety disorder. (Here.)

The research identified high school girls (mean age 14) as subjects by using the established  (DSM-VI-TR-Axis) criteria for Social Anxiety Disorder; and then randomly accolated them to an “intervention group” and a control group.  The Intervention group were given eight weekly MBCT sessions and asked to work on MBCT mediations at home.  The two groups were assessed before and after the intervention:  the Social Phobia Inventory was used to assess social phobia and social anxiety; and Rosenburg’s Self Esteem Scale was used to measure the self-esteem of the participants.

Social Phobia Inventory (SPIN) questionnaire was developed in order to assess social anxiety or social phobia. This inventory is a self-assessment scale with 17 items including three subscales of phobia (6 items), avoidance (7 items), and physiological distress (4 items). Rosenberg’s Self-Esteem Scale (RSES) is a 10-item scale is to measure self-esteem. Originally, the scale was designed to assess the self-esteem of high school students. However, since its development, the scale has been used with a wider variety of groups including adults.

So, what did the study show?  The results showed that the social anxiety scores of the intervention group showed a significant decrease compared to their pre-test results, and the mean of the self-esteem scores of the intervention group members showed an increase compared to their pre-test results. These changes were not observed in the control group.  For the intervention group the mean SPIN score was reduced from 26.07 to 21.50 and the RSES scored increased from 0.89 to 2.58.

The researchers concluded: “The results revealed that the MBCT sessions significantly decreased social anxiety and increased self-esteem among the female adolescents suffering from social anxiety.”

So, if you are o someone you know is feeling anxious in social situations and have low self-esteem then MBCT may well be beneficial.  Try it.

This week Bill Michael, the UK boss at KPMG, lost his job. He stood down after his comments on a video conference with staff caused a stir. Australian Bill told 500 of the firm’s staff that they should “stop moaning” about the impact of the pandemic on their lives after they raised concerns about potential bonus and pay cuts; and he suggested they should stop “playing the victim card”. For some reason he then went on to describe “unconscious bias training” as “complete and utter crap”.

So, given his largely Gen Y and Gen Z audience what should Bill have done?

Well, Bill is known for saying it like it is – which is a very valuable characterise in business (the alternative is being in denial or failing to focus on key issues).  His point was that these employees had not been furloughed… and that many industries and people have had a much tougher time.  But maybe it was his tone – he needed to use more empathy (as both Gen Y and Gen Z staff expect to have “a voice” and to be considered) and to acknowledge that some employees would be disappointed to not to have been able to make their growth targets (for which you can read “bonusses”) through no fault of their own.  He also needed to let them know that he was aware that some of his staff may feel that that so many things are outside of their control; and may be starting to experience depression and or anxiety.

A more mindful approach would have been to recognise the issues on the minds of his staff… even those issues that don’t seem merited… and maybe to think about why staff may have those views… and to acknowledge their emotions while helping them to focus more positively on the future. Maybe something like this:

“I know that many of you will be frustrated and disappointed that the pandemic has prevented us from hitting our growth targets – those opportunities were taken from us… they weren’t there for us – but as a company we are in a great place and we will be able to make progress as the world opens up.  And while this pandemic has shown us that there are things we cannot control – it is important that, right now, we focus on the things that we can impact…  so that we are ready for the challenges ahead.”
“Let’s recognise that the company has been able to keep everyone working – so none of us has faced the financial worries that staff in other sectors have had to deal with.  Yet, I am sure there will be those of you, or maybe within your families, who have found the last year challenging from a mental health point of view.  If this is you then reach out for the resources, we have available and try to avoid ruminating about the past or feeling anxious about the future…  simply focus on the tasks before us today.”

So it’s is not about arguing about the logic or the validity of staff concerns – its acknowledging that the past has gone and about refocussing everyone on the way forward.

By the way, it is always useful to be aware of our unconscious biases (otherwise we may miss things or make poor decisions… repeatedly) – maybe Bill needed to be aware of his own biases when addressing the emotions and needs of his staff.

This whole episode seems to be about tone and culture – right at the top of KPMG.

A piece on this story form Bloomberg (here), make the point that the culture of listed companies are cutinised by shareholders – but the big audit  companies like KPMG are not listed. Their own governance code says such firms should promote an appropriate culture principally through “the right tone from the top.” They should maintain “a culture of openness which encourages people to consult and share problems.”   There’s that tone world together with a need to encourage openness and sharing.

Bloomberg suggests that: “The Big Four audit firms talk a lot about the strength of their audit culture. They could go further to evidence this, say by annually disclosing the results of staff surveys, including questions about the strength of the leadership and the commitment to diversity and inclusion, and outlining in general terms usage of speak-up hotlines. Call it a culture audit.”

A few weeks back, I was listening to the BBC Radio Four programme “All in the Mind”. The program included a curious piece on Hypermobility – the ability to bend your joints or fingers much further than normal – what we sometimes call being “double-jointed”.

Yet it tuned out that people who are Hypermobile are seven times more likely to experience anxiety or panic attack then the average!

You can listen the programme here – https://www.bbc.co.uk/sounds/play/m000q8z7 the item on Hypermobility can be heard from 17:30.

So why are some people hypermobile… and what has this got to do with anxiety?

Well, it turns out that folk who are hypermobile have connective tissue is more stretchy than normal.  Connective tissue is what binds a person together… quite literally.  This stretchiness is caused by a variation on the Collagen within the body.

I found a piece in Scientific American which provides a possible link to anxiety (here):

Joint hypermobility may be associated with an exaggerated fight-or-flight reaction. Jessica Eccles, a psychiatrist and researcher at the University of Sussex, and her colleagues uncovered a simple yet powerful mechanism behind the link: the collagen abnormalities that make joints especially flexible seem to affect blood vessels, making patients prone to an accumulation of blood in the veins of the legs. This pooling may lead to exaggerated cardiovascular responses to maintain the output of blood from the heart. When the heart has to work extra hard just to circulate blood, it brings the entire body to the verge of a fight-or-flight reaction, requiring very little to set off panic.

Eccles hypothesizes that these patients might benefit in particular from beta blockers, drugs that ease anxiety by reducing symptoms of the body’s fight-or-flight response.

It’s as if Hypermobile people become prone to frequent “apparent fight or flight sensations” and that this increases levels of anxiety.

So, what’s the takeway here?  Well, if you are hypermobile then be aware that you are more prone the feeling anxious, and that such feelings are completely normal for those with this condition.  You might also consider building up your resilience through mindfulness practice – so that you are able to observe such emotions and allow them to dilute rather than responding to them with panic or anxiety.

Mindfulness has many benefits – both for wellbeing and for performance.  In this post, I want to investigate how mindfulness can increase creativity.  To be clear, by “creativity” I mean the ability to generate original ideas or to solve problems in an efficient and novel way.

One of the most definitive studies on this subject was conducted in 2012 by Lorenza Colzato, a Dutch cognitive psychologist at the Institute for Psychological Research and Leiden Institute for Brain and Cognition at Leiden University. Here.

The research team had a small group of novices practice two forms of mindfulness meditation:
1) “open-monitoring”, which involves observing and noting phenomena in the present moment and keeping attention flexible and unrestricted,
and 2) “focused attention”, which stresses concentrating on a single object, such as breathing, and ignoring other stimuli.

Subjects took part in either “open monitoring mediation” or “focussed attention meditation” and were then assessed by each of:

• Remote Association Task (Convergent Thinking) – participants are presented with three unrelated words (such as time, hair, and stretch) and are asked to find a common associate (long).
• Alternate Uses Task (Divergent Thinking) – participants were asked to list as many possible uses for six common household items (brick, shoe, newspaper, pen, towel, bottle).

The responses from the assessments were assessed for Originality, Fluency, Flexibility and Elaboration.

Colzato and her team discovered that “Open-Monitoring Meditation” (observing and noting phenomena in the present moment and keeping attention flexible and unrestricted) was far more effective in stimulating divergent thinking…  a key driver of creativity.

Two years later, another Dutch psychologist, Matthijs Baas, expanded on Colzato’s work and demonstrated the importance of specific mindfulness skills in the creative process. (Here ) The skills were:

1. observation, the ability to observe internal phenomena (such as bodily sensations, thoughts, and emotions) and external stimuli (sights, sounds, smells, etc.);
2. acting with awareness, engaging in activities with undivided attention;
3. description, being able to describe phenomena without analysing conceptually; and
4. accepting without judgment, being non-evaluative about present-moment experience.

A major finding was that high observation scores were the only consistently reliable predictor of creativity. The skill of observation, is enhanced by “Open-monitoring Meditation”; which not only improves working memory, it also increases cognitive flexibility and reduces cognitive rigidity—all of which are critical to the creative process.

Matthijs Baas said “The ability to observe is closely related to openness to experience, a personality trait that several studies have shown to be one of the most robust indicators of creative success… A state of conscious awareness resulting from living in the moment is not sufficient for creativity to come about. To be creative, you need to have, or be trained in, the ability to observe, notice, and attend to phenomena that pass your mind’s eye.”

 

I think that this makes sense – it may be that to be creative we need to “glide” through the facts or the options that occur to us without becoming too connected to with them… so that we are able to consider different perspectives and the wider possibilities that may be available to us.  This is reminiscent of the mindfulness practice whereby we simple observe our emotions without judgement:

“We can imagine our thoughts and emotions as a river rushing through a stretch of rapids – and we may find ourselves being tossed around…  and pulled under or hitting rocks… yet ‘mindfulness’ is like being able to stand on the edge of the river bank and watch the currents and eddies within the river… without becoming overwhelmed.”

So, the research shows that our creativity is enhanced by an aptitude for “Open Monitoring” i.e. “to observe and note phenomena – external stimuli or internal thoughts and emotions – in the present moment yet keeping attention flexible and unrestricted”. The good news is that this can be developed through the practice of “Open-Monitoring Meditation”.

The problem with conditions like stress, anxiety and depression is that when people experience such an episode they establish “though pathways” that spiral downwards. …and then… in the future, when they encounter a “trigger” situation, they slide down the same pathway reinforcing it… and so on… making further episodes more and more likely. And in many cases 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.

Yet there is a way out of this cycle:  The good news is that our brains demonstrate the ability to make new connections and modify existing connections which can change the way that we think, and even change the way we react subconsciously. It just takes some training and ‘practice’.  This is called ‘neuroplasticity’, and it is an ability that we all have at any age.

For people prone to epoxides of depression, they are often consumed with negative thoughts of self-blame and low self-worth. Yet there are many studies that show that Mindfulness-based Cognitive Therapy (MBCT) is effective in enabling subjects to be more objective if such thoughts should arise – or more able to choose to focus on the current movement rather than on ruminations of the past or worries about a future that may never come to be.

I read this recent article on the www.psypost.org website describing research by Kate William and her team at the University of Manchester. Here

The research involved working with subjects prone to depression to help them to avoid a relapse. The subjects were trained in Mindfulness Based Cognitive Therapy (MBCT) which trains individuals to respond to negative self-thoughts with acceptance and compassion as studies suggest that the approach is effective. The team used tests to gauge any reduction in “self-blame” which is thought to be a key component in avoiding a relapse into depression. The researchers used fMRI brain scanning to examine activation in brain regions associated with self-blame before and after the MBCT training.

Sure enough, the impact of the MBCT training was to reduce the self-blame and also to increase self-compassion  in subjects –  so that subjects are no longer so hard on themselves when things don’t work out as hoped.

And Bingo; upon analysis of the brain activity during self-blame versus other-blame activities; they found a drop in activation of the bilateral dorsal anterior cingulate cortex (dACC) and the medial superior frontal region. The dACC has been previously linked to emotions related to self-blame such as guilt and embarrassment.  So here is a change to the wiring of the brain that demonstrated the reduced self-blame that the subjects experienced.

Interestingly, the researchers also demonstrated that the reduction in self-blame following MBCT was linked to greater “self-kindness” as measured by the Self-Compassion Scale. Their analyses showed that increases in self-kindness correlated with reduced activation in the posterior cingulate cortex.

The researchers commented: “These findings suggest that MBCT is associated with a reduction in activations in cortical midline regions to self-blame which may be mediated by increasing self-kindness”

This research is very encouraging – it demonstrates that not only does MBCT cause subjects experience less self-blame and more self-compassion; but it shows that the wiring in their brains has been changed by the training so that they will be less likely to experience a relapse.

A recent study – the largest ever analysis of research on the subject – demonstrated that Mindfulness Based Cognitive Therapy (MBCT) helps people just as much as commonly prescribed anti-depressant drugs… and yet there was no evidence of any harmful effects.

The study showed that people suffering from depression who received MBCT were 31 per cent less likely to suffer a relapse during the next 60 weeks – it was reported in a paper in the JAMA Psychiatry journal.

Lead author, Professor Willem Kuyken, said: “This new evidence for mindfulness-based cognitive therapy … is very heartening. While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term.”

For once the UK is “on it”. The NICE guidance for the treatment of depression recommends the use of MBCT – and indeed the NHS runs its own MBCT courses. Here.

I have written before about the journalist Sarah Vine who said that while antidepressants medicines worked well for her, she had found it very difficult to come of the drugs: https://carinasciences.com/2019/05/30/the-drugs-do-work-but-are-hard-to-give-up/.  MBCT has no such addiction legacy – other than the positive benefits of mindfulness.

An article on the website stylist.co.uk related the experience of journalist Alice Purkiss who was advised to try an NHS MBCT course: “During the course, I’ve realised just how much my brain has held me hostage in the past… I am so very, very grateful that my local NHS psychological service has offered me this incredible opportunity to tune back in with my life and take control of the way my brain has terrorised me in the past. “ https://www.stylist.co.uk/health/mental-health/depression-treatment-mindful-cognitive-behavioural-therapy-nhs-course-health/182010

The benefits of MBCT for those with either anxiety and depression are very well researched: For example, this paper from the Journal Consulting and Clinical Psychology (April 2010) “The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review” (by Stefan G. Hofmann, Alice T. Sawyer, Ashley A. Witt, and Diana Oh).

This review of many MBCT trials showed that improvements on depression scores and anxiety scores were robust (repeatable and consistent) and significant; both for those with the conditions and for those without these conditions. – i.e. Even for those who were not suffering from depression or anxiety their mood was raised and worry was lowered – it’s not about a return to the normal – it is an elevation in mood and ability to avoid worry.  The researchers said that “[MBCT] improves symptoms of anxiety and depression across a relatively wide range of severity.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848393/

Our Rezl app uses this same Mindfulness Based Cognitive Therapy (MBCT) to build resilience… and more.

We chose to work with MBCT for two big reasons: –

1. It is a formalised programme – an eight-step programme – as we knew that many people using mindfulness apps find them a little open-ended and so while these apps are relaxing… they can lack a sense of progress.
2. The impacts of MBCT have been extremely well researched over the last 25 years.  It was clear that the benefits were very significant.

In summary, from the user’s perspective, then working with Rezl’s MBCT programme will:

• increase your resilience – the signs that your resilience may be getting low include difficulty sleeping, irritability and mood swings, poor levels of concentration and restlessness
• improve ability deal with stress, pressure, challenges and uncertainty.
• make you more empathetic open to the views of others
• increase positivity and self-esteem – increase self confidence
• teams with mindful team-members are more effective and more likely to collaborate towards achieving team goals.
• increase job satisfaction and life satisfaction
• reduce absenteeism and staff turnover
• US special forces use mindfulness to help them to improve their decision making in high pressure situations
• boost your performance at work or in sport, increase your focus, your engagement and your ‘flow’.
• enable you to develop the skills to manage in challenging and disruptive business environments and to attain the objectivity, focus and emotional stability that are required.

There are a lot of benefits there – but it is important to stress that Rezl isn’t just about helping those with mental wellbeing issues – Rezl can help all of us to achieve more in our lives. It’s for everyone!

The ability to focus and to avoid distractions –  i.e. to “pay attention” – is key for us. We constantly receive so much stimulation and information from our environment that without an ability to focus we would never be able to think clearly and to be effective.

Further, we also have our internal thoughts and emotions competing for our attention; not only do we ruminate about the past – going over previous events and re-experiencing the emotions and thoughts around those events – our brains are also able to “travel forward in time”-  imagining possible futures  or catastrophising –  and even to “mind travel” so that we imagine what others are thinking.

So, without being able to “pay attention” we would never be able to get anything done or to make considered decisions. Plus, in any emergency situation, is it is vital that we remain focused on making the right decisions and taking the actions that are required – panicking, becoming overwhelmed or distracted will not help us!

This week I came across this podcast from the Oxford Mindfulness Centre in which Professor Amishi Jha talks about the brain’s ability to “pay attention”. Amishi Jha is an associate professor of psychology at the University of Miami. Her research on attention, working memory and mindfulness has investigated the neural bases of executive functioning and mental training using various cognitive neuroscience techniques. Here.

Professor Jha suggests that our “attention” is our ability to select information for consideration in pursuit of some current purpose or goal – that’s our ability to select from the available external information, our knowledge and our internal thoughts.  Interestingly, she suggests that our ability to pay attention develops late… and is only fully developed in our mid 20s (- note to self: cut the kids more slack).

The podcast explains the key cognitive subsystems that are involved in our ability to pay attention:

• Orientation System – like a flashlight that we shine on the information on which we wish to focus – and so to diminish the attention we pay to the other stuff.
• Alerting System – an ability to remain broadly vigilant for any “flashing light” that may require our attention or our caution.
• Executive Function – our management system to direct our thinking and attention – while also taking care to respond to any incoming or ongoing issues (“a juggler”).
• Working Memory – our short term memory – like a whiteboard that fades – that we use to keep track to the current issues that we are focusing on.

So, what can go wrong?  Well research shows that attention is diminished by  stress, threat and mood.  It seems reasonable that threats can grab our attention, and of course mood and negativity can be a distracting ( – this is where mindfulness techniques like self-compassion and choosing to “live in this moment” can be so helpful). But how does stress impact our attention?

Well, stress can cause our flashlight to become preoccupied by negative thoughts (of failure and it’s implications; or also of our perceived inability to get things done… to be “good enough”);  it can cause our alerting system to become hypervigilant – distracting us with issues that are not urgent or helpful to us; and stress may cause our executive function to become diminished so that we are distracted and fail to focus on critical issues.

Besides stress, we also face a significant challenge from the brain’s ability to “mind wander” – thinking “off task thoughts” during some ongoing activity.

Mind-wandering may be due to ruminations about the past, anxiety about the future, negative thoughts or even “mind travel”.  Studies show that Mind-wandering can lead to performance errors, variable” speed of response” to incoming stimuli, perceptual decoupling (we fail to notice the thing that we should) and low mood (negative thoughts).

The good news is that Professor Jha explains that her research shows that Mindfulness is reliable and exclusively effective to bolster our performance.  It is the practice of reducing distractions and mind-wandering which enables us to improve our attention skills… to set aside unhelpful distractions, thoughts and emotions.  Studies upon those who are stressed or in high-pressure environments – e.g. business professionals, students, athletes and elite soldiers –  have demonstrated the impact of Mindfulness training such a MBCT and MBSR to improve attention and to facilitate better decision-making in pressured or chaotic situations.

Maybe we all need to pay more attention to our attention.

Pregnancy, childbirth and the first weeks of parenthood are times of change, challenge and, for some, anxiety. This is especially so for those prone to worry or prone to low mood.  It can also be an anxious time for those who have previously experienced a stressful childbirth… or even a stillbirth or miscarriage; while those suffering from “health anxiety”, may find the whole journey extremely challenging.

Further, it is common for those who have previously experienced difficult births to demonstrate symptoms of PTSD.  While after the birth, the pressures on a new parent may cause “post-natal depression” or anxieties about the health of the infant.

It’s quite a list of potential problems.  In response I have been thinking about how Mindfulness Based Cognitive Therapy (MBCT) can help prepare and support women (and their partners) through pregnancy, childbirth and early parenthood.

The good news is that there is solid research to show that for pregnant women MBCT can:

• significantly reduce anxiety
• significantly reduce depression
• increase self-compassion – to avoid negativity and remain positive about their capability as a mother
• and, reduce postnatal depression and anxiety.

Here is a 2014 paper from Boston, published in “Women’s Mental Health”, that monitored the impact of an MBCT  programme on expectant mothers who were assessed as “clinically anxious” by week 27 of their pregnancy or earlier. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107206/

The research shows that MBCT was very effective:

“Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 participants who met GAD criteria at baseline, only one continued to meet criteria post-intervention. Participants regarded their experience in the intervention to be overwhelmingly positive.

I would add that It is important to know that, in other trials, MBCT is shown to reduce worry – even for those who are not anxious – i.e. it is not a treatment that just helps those who are anxious – it reduces the level of worry in all participants.

 

Here is a further 2016 paper from University of Colorado that describes a randomised controlled trial to  demonstrate how MBCT can significantly reduce both the possibility and impact of postnatal depression… even within mothers who had suffered similar problems in the past.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718345/

“At-risk women randomly assigned to MBCT reported significantly improved depressive outcomes compared to participants receiving treatment as usual, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study.”

I reflect that while there is a lot of research to show the positive impact of MBCT for expectant mothers who previously experienced stillbirths there was no research to show how it could help mothers who had previously experienced difficult or traumatic births – this may be down to the difficulty of identifying or categorising such subjects,  but I wondered if there might still be a blindspot so that hospitals are not realistic about the damage that such experiences can cause.  Most of us have friends or relatives who have been traumatised by a birthing experience.

At Carina Sciences we believe that these trials, together with other encouraging studies, suggest that MBCT can address PTSD symptoms, anxiety and depression associated with pregnancy, childbirth and the postnatal period.  We are looking at how we can provide specific material for pregnant women and their partners.  Meanwhile, if someone you know would benefit  from trying our Rezl app then please get in touch with us.