The Nocebo Effect

The Placebo Effect: a psychological effect in which a treatment which contains no active medical substance causes an improvement in symptoms. For example, a participant in a trial takes a sugar pill believing it could be real medication and find their back pain goes away.

This effect has been well documented and is relatively well known (for more information read my blog post here). But what about the Nocebo effect? In this instance, the opposite happens. A participant in a trial takes a sugar pill, or receives a fake injection, and start to feel negative side effects of the medication. How is this possible when no active medication was received?

To begin to explain how this effect occurs, I’ll start by telling you a bit about how clinical trials are conducted. Before a participant consents to take part in the study, they have to read a participant information sheet which explains all the details of a trial and what will happen. In a drug trial, such as one testing a new medication to help persistent back pain, participants will also have to read a list of potential side effects, much like those you find on the leaflet that comes in the box with medication. When participants sign up, they are told that they might receive the real medication, or they might receive a sugar pill. Having the control group of those who receive fake medication is important in clinical trials, as it allows you to show that any improvement is due to the medication being tested and not other factors such as symptoms improving over time. The reason control groups are given fake medication instead of having no medication at all allows for researchers to see how much of the improvement of the real medication is due to it’s active ingredients, and to show that participants haven’t just got better because of the placebo effect.

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image from http://www.thehealthsite.com/diseases-conditions/mind-blowing-facts-about-the-nocebo-effect-k0517/

Even though participants have received the placebo medication they can still believe it is the real one – a placebo should be administered in exactly the same way as the real medication to be a true control. Therefore, it is this belief that they have taken the real drugs that can lead them to report side effects from it. One review of the evidence shows that around a quarter of participants taking a placebo drug experience adverse side effects from it, and that this can be higher than the participants taking the real medication! (Barksy et al, 2002). Visual cues can also induce nocebo effects: one study tested how participants rated the effectiveness and side effects of either branded or unbranded drugs (both in fact were placebos). Perhaps unsurprisingly, participants rated the branded drugs as more effective, and thought the unbranded drugs caused more side effects (Faasse et al 2013).

Several explanations have been put forward to explain the nocebo effect, including conditioned responses or participant’s expectations. For example, a doctor giving you an injection warns you that it might hurt, so you feel subjectively more pain than if they had been reassuring. Some studies investigating the neural basis of the nocebo effect in pain have hypothesised that the effect is caused by increased activity in certain areas of the brain such as the hippocampal network (which is involved in pain modulation) (Ploghaus et al, 2001). This activity is in turn caused by increased anxiety, brought on by the expectation of pain.

This brings a certain ethical dilemma for healthcare professionals and those running clinical trials. It is important the the patient or participant is given all of the information, in order to give informed consent. However, if giving someone more information would cause them to feel more pain, what would you do?

 

References:

Barsky, A.J., Saintfort, R., Rogers, M.P. and Borus, J.F., 2002. Nonspecific medication side effects and the nocebo phenomenon. Jama287(5), pp.622-627.

Faasse, K., Cundy, T., Gamble, G. and Petrie, K.J., 2013. The effect of an apparent change to a branded or generic medication on drug effectiveness and side effects. Psychosomatic medicine75(1), pp.90-96.

Ploghaus, A., Narain, C., Beckmann, C.F., Clare, S., Bantick, S., Wise, R., Matthews, P.M., Rawlins, J.N.P. and Tracey, I., 2001. Exacerbation of pain by anxiety is associated with activity in a hippocampal network. Journal of Neuroscience21(24), pp.9896-9903.

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Dialectical Behavioural Therapy

Talking therapies such as cognitive behaviour therapy (CBT) are well-known treatments for some mental illnesses including anxiety and phobias. Today’s post is about a type of CBT which isn’t as well known: dialectical behaviour therapy, or DBT.

CBT focuses on changing unhelpful thoughts and behaviours which cause the continuity of illness – for example changing the obsessive thoughts in OCD through talking and challenging beliefs in therapy (for more about CBT, read my post here). DBT also does this, but with an additional focus on accepting who you are as a person at the same time. ‘Dialectical’ just means to resolve differences and find a balance in patterns of behaviour. It has been developed to treat individuals who experience intense emotions, and is one of the recommended treatments for symptoms of Borderline Personality Disorder such as self harm, impulsivity, and unstable relationships (Mind, 2014).

The figure below from the Psychiatric Times shows the 4 sets of primary skills taught as part of DBT: mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. This training is usually in groups, in addition to 1 to 1 therapy sessions.

DBT

 

DBT has been shown to be more effective at reducing symptoms associated with borderline personality disorder than standard group therapy (Soler et al, 2009). In this experiment, participants were randomly assigned to either receive standard group therapy or DBT over 13 weekly sessions. The group who received DBT had greater improvement in depression, anxiety, emotion regulation, irritability and anger than the group who received standard therapy. It also showed almost twice as high retention rate of participants throughout the programme, suggesting it is an acceptable intervention for the treatment of borderline personality disorder.

Another study which compared DBT to usual treatment for women with borderline personality disorder found that participants in the DBT group showed lower levels of self harm than those who received standard treatment (Verheul et al, 2003). The authors hypothesised that this result could be due to specific features of DBT such as monitoring of self-injury with early sessions focusing on modifying these behaviours, patients being encouraged to phone their therapist before carrying them out, and more support for the therapists themselves resulting in less burnout (and so improved patient outcomes).

Overall, this evidence shows the effectiveness of DBT in treating symptoms of borderline personality disorder. More recently, research has moved to test whether DBT is an effective treatment for other conditions such as traumatic brain injury, substance abuse, depression, eating disorders and conduct disorders. However, one recent review concluded that more evidence needs to be collected to establish whether it is the best treatment for other types of mental illness (Valentine et al, 2014).

Thanks for reading this overview of DBT, if you’d like to find out more then Mind have some great online resources – see the link below.

https://www.mind.org.uk/media/1594506/ms_dbt_2014.pdf

References:

Mind (2014) https://www.mind.org.uk/media/1594506/ms_dbt_2014.pdf

Soler, J., Pascual, J.C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M.J., Gich, I., Alvarez, E. and Pérez, V., 2009. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour research and therapy47(5), pp.353-358.

Valentine, S.E., Bankoff, S.M., Poulin, R.M., Reidler, E.B. and Pantalone, D.W., 2015. The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature. Journal of clinical psychology71(1), pp.1-20.

Verheul, R., Van Den Bosch, L.M., Koeter, M.W., De Ridder, M.A., Stijnen, T. and Van Den Brink, W., 2003. Dialectical behaviour therapy for women with borderline personality disorder. The British Journal of Psychiatry182(2), pp.135-140.

Resilience – innate or acquired?

Hi everyone, and Happy New Year! I’m back after having a few weeks off blogging, and plan to stick to my schedule of 1 post a week in 2018 (usually posted on Thursdays, 4pm GMT).

To start off this year, I thought I’d talk about a concept in psychology which is being applied more to mental health – resilience. Whilst the idea of something being resilient probably isn’t new to you, you may not be aware of how people can be resilient, and what the benefits are of this personality trait.

In psychology, resilience means that someone is able to cope and adapt to difficult life events or stressful situations such as serious health problems or losing their job. It is therefore able to protect against negative outcomes of the stressful event and enable individuals to ‘bounce back’ quicker.

The protective factor model of resilience states that a protective factor such as social support, or self-esteem, interacts with the stressor to reduce negative outcomes such as anxiety or depression (O’Leary et al, 1998). People who have higher levels of social support are more likely to cope with stressful situations, with one study showing that social support moderated the effect of stress on depression scores (Pengilly & Dowd, 2000). Another well-studied protective factor is hardiness, which was identified by Kobasa in 1979. He compared personality traits in executives, and compared who did or did not get ill after stressful life events. He found that those who did not get ill showed more hardiness, which he defined as having a ‘commitment to self’ – an active participation in activities and the outside world; an ‘internal locus of control’ – the idea that you are in control of events that happen to you; and a sense of meaningfulness.

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image from https://help4hd.org/on-being-resilient/

As resilience has been shown to have several protective factors on stressful life events, there has been some debate about whether resilience can be taught to improve how people cope, and therefore improve their mental health. One study carried out in college students compared scores on stress levels between a control group and a group who received a resilience intervention (Steinhardt & Dolbier, 2008). The intervention focused on teaching problem solving, coping strategies and awareness of the different responses to stress. Participants in this group were also encouraged to take responsibility and self-leadership (actions coming from the self). Results showed that the group that took part in resilience training had higher resilience scores and scores of protective factors such as self-esteem. They also showed more effective coping strategies and lower scores on tests assessing depression and stress than the control group who did not receive the intervention. This effect was found with only 4 2-hour teaching sessions, showing that resilience can be taught in a relatively short space of time.

Several other studies have shown that resilience can be taught, something which is now gaining in popularity and can be applied to several populations from students to soldiers. Healthcare professionals are also taught resilience techniques as a way of coping with long term stress in emergency situations (McAllister & McKinnon, 2009).

There are some things you can try if you want to improve your resilience. Taking a break, using your support network, and looking after your physical health are all things which could improve how you cope with pressure or stressful situations. For more information on these tips and more, check out Mind.org’s advice here.

 

References:

O’Leary, V.E., 1998. Strength in the face of adversity: Individual and social thriving. Journal of Social issues54(2), pp.425-446.

Pengilly, J.W. and Dowd, E.T., 2000. Hardiness and social support as moderators of stress. Journal of clinical psychology56(6), pp.813-820.

Kobasa, S.C., 1979. Stressful life events, personality, and health: an inquiry into hardiness. Journal of personality and social psychology37(1), p.1.

Steinhardt, M. and Dolbier, C., 2008. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American college health56(4), pp.445-453.

McAllister, M. and McKinnon, J., 2009. The importance of teaching and learning resilience in the health disciplines: a critical review of the literature. Nurse education today29(4), pp.371-379.

Why do we dream?

Have you ever stopped to wonder why we dream at night? From sweet dreams to recurring nightmares, our mind is rarely silent – regardless of whether we can really remember their content in the morning.

Sometimes, we find our dreams are linked to things going on in our lives right now, worries about future events or strong memories from the past. This therefore seems to suggest that dreams are in some way linked to our memory, but exactly how, no one seemed sure.

Recent research has investigated the role of dreams and REM sleep (the phase of deep sleep) in the consolidation of long term memory. Consolidation just means the process whereby our memories move from short term to long term storage. In our long term memory, memories are stored for recall. Rehearsal (thinking about) these long term memories briefly involves short term processing, and this rehearsal strengthens the storage of these memories. Dreams may play a part in this consolidation and rehearsal process.

To find out more about REM sleep and our sleep cycle then why not read my previous post here.

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Photo by clownbusiness/Shutterstock, with additional illustration by Lisa Larson-Walker

As I mentioned early, our dreams can have similarities to events which have taken place in our lives. Some research has focused on investigating the content of our dreams and found that the events which tend to be included in our dreams are ones which are rated as more emotional, although not more stressful, than those not incorporated (Malinoski & Horton, 2014). This suggests that REM sleep might help to process emotional memories. Further evidence to support this hypothesis is that levels of REM sleep are lower in people with depression (Cartwright, 1983) and PTSD (Ross et al, 1989).

However, although these dreams can contain elements of real life, they are often distorted: it is rare for the complete memory to be ‘played out’ in our dream. It is been suggested that this is because during sleep we cannot access full episodic memories (memories of events) but instead just traces of them.  This has been hypothesised to be due to reduced hippocampus (the part of our brain involved in memory processing) activity during REM sleep (Buzsàki, 1996). The fact that our dreams can contain strange events or impossibilities is thought to be due to a lack of activity in the prefrontal cortex – the area involved in attention and logic (Stickgold et al, 2001).

In addition to consolidating episodic memories another proposed function of our dreams is to enhance learning of procedural tasks (Smith et al, 1996). Studies in rats have found increased levels of REM sleep after procedural learning, and that less REM sleep resulted in poorer memory (Smith et al, 1985).

Whilst REM sleep and our dreams may be useful for certain types of memory consolidation, it doesn’t mean that this is the only way consolidation takes place, or that it is needed to consolidate every type of memory (Stickgold et al, 2001). The authors of this review hypothesize that dreaming enables the brain “to identify and evaluate novel cortical associations in the light of emotions… during REM”. To put it simply, when we dream our brain is working on processing new memories, learning procedures, and our emotions to events.

 

Seasonal Affective Disorder

It’s that time of year – the clocks have gone back, it’s cold, and already getting dark on our commute home. Whilst many people moan about this time of year, for some it can trigger symptoms of low mood and depression.

Seasonal Affective Disorder is defined as “a type of depression that comes and goes in a seasonal pattern.” (NHS Choices). It’s typically worse from December to February, getting better in spring and summer. For SAD to be diagnosed, there has to be clear evidence of worsening symptoms during winter, which can’t be explained by other circumstances (DSM-IV). In addition, there needs to be evidence for part or full remission during the summer months. Symptoms of SAD are similar to those of depression: low motivation and self-esteem, sleep problems, changes in appetite, withdrawing from social interactions and persistent negative thoughts.

Medicap-Pharmacy-sad

Estimates of the prevalence of SAD range from 0 – 9.4% of the population, depending on who is being studied (Magnusson, 2000). One study compared rates of SAD at 4 different latitudes in the USA and found that is was most common in the northern latitudes (Rosen et al, 1990), which would be expected as SAD can be triggered by lower levels of natural light. This study also found higher rates of SAD in females than males (this finding is in line with overall levels of depression between men and women). It is thought to be caused by the lack of sunlight in winter months disrupting our circadian rhythm, which can be described as our internal body clock. This can affect the serotonin system in the brain, which is responsible in part for mood regulation.

There are various different treatment options for SAD, including light therapy, cognitive behavioural therapy, or antidepressants (Lurie et al, 2006). I’ve spoken about CBT before on this blog (see here for more information), so today I’ll just focus on light therapy and antidepressants as treatments for SAD.

sadimage

Light therapy involves sitting by a specialised lamp, which emits a specified wavelength and brightness of light (at least 2500 lux). It is thought to work by encouraging the brain to produce serotonin – a neurotransmitter which is linked to feeling happy. Sitting by a lamp for 30 minutes to an hour each morning is the recommended ‘dose’ of light (NHS.uk). One meta-analysis has shown that light therapy is as effective as drug therapy in treating SAD (Golden et al, 2005).

Some antidepressants also work by increasing our serotonin levels. Known as SSRIs (selective serotonin reuptake inhibitors), they work by stopping as much serotonin from being reabsorbed at synapses in the brain and therefore leading to an increase in our mood. For antidepressants to be optimally effective in SAD, the NHS recommend starting to take them before winter and continue until spring.

 

A week of Mindfulness

I’m sure by now you’ll have heard of mindfulness. It seems to have exploded in popularity in recent years, and is recommended as everything from a cure for severe depression to improved concentration.

Mindfulness can be described as being aware of the present, in particular how we feel on the inside. It generally involves bringing focus back to the body and how it feels at that time. Focus is directed towards the present moment, as opposed to worrying about past or future events. Eyes are typically closed, and attention is directed towards the breathing as opposed to any outside stimuli. Rather than try and block out our thoughts, mindfulness aims to help us acknowledge our thoughts and feelings, but lets them pass without paying them too much attention, which can lead to stress or anxiety.

 

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For someone with an interest in all things psychology and mental health, I’m almost ashamed to say I’ve never properly tried mindfulness myself, with the exception of a couple of group sessions at conferences. I definitely find it easier when I take part in a led session rather than try and do it myself, so I downloaded the Headspace app and decided to give it a go. Here’s how I got on:

 

1st session: It’s been a few months since I’d had last had a guided session at work – I did try to practice a couple of times recently but found it hard to keep my focus. I started off using the Basics package in Headspace, which starts with an introduction to mindfulness and a few tips to get started. I began with a short 3 minute session, and afterwards I felt noticeably more relaxed, I’m definitely looking forward to the next one. The 3 minutes went by really quickly, I found it quite easy to concentrate on my breathing. No massive change but only day 1!

2nd session: Another short 3 minute session. I found it harder to stop myself focusing on thoughts that popped into my head during the session today. I started it as soon as I’d finished studying and found thoughts kept popping into my head – I know this is okay and you’re meant to acknowledge them and move on but that’s quite difficult in reality! I think I’ll try it at a different time tomorrow and see if that makes it easier.

3rd session: I completely ran out of time so ended up practicing just before I went to bed. I switched to the 5 minute session today, and the focus of this session was on letting thoughts pass. This is definitely the bit that I find most difficult, but it was easier than yesterday. I found the session very relaxing, it really put me in the mood for sleep!

4th session: Again ended up practicing just before bed, and I almost feel asleep! Today I found that I was better at paying attending to my breathing (counting helped) and it meant that I couldn’t really focus on other thoughts which popped into my head. The 5 minutes went so quickly too.

5th session: Getting into more of a routine and practicing at the end of the day. Not much change on this session, but I am definitely enjoying it and look forward to practicing.

6th session: Today I really wasn’t feeling in the mood for practicing mindfulness, I’d had a really busy day and it just felt like another thing I had to do. I did feel so much better afterwards and was glad I did, a bit like going for a run! I found my mind didn’t wander too much but things I need to do tomorrow kept popping into my head, which I found hard to ignore.

7th session: The last one in my week’s trial! It feels like the time during the session seems to go quicker every day, and I always feel much calmer by the end of it. This session started with a short animation using the analogy of the calm mind as a blue sky, and thoughts as clouds which pass across it, which I quite liked. I know the app recommends practicing first thing in the morning but for me I think I’ll probably do it more in the evenings. I’ve got a bit more time, and I think it’s a nice thing for me to do at the end of the day – I’m someone who can find it hard to switch off at night so practicing before bed could help me relax.

 

By the end of the week I can’t say I’ve noticed any significant changes but I have looked forward to the sessions. I do have to admit – there were a couple of days in between where I didn’t end up practicing, usually if I was out in the evening and got back too late to want to practice. On reflection. these busy days were probably the ones where I should have made sure to take the time out for it – it’s only a few minutes and makes me feel more relaxed afterwards. By the end of the week I felt like I was better at concentrating on my breathing instead of letting my mind wander, although I still slipped up from time to time. In particular, I kept finding myself thinking about things I could say in this post, so now it’s written maybe I’ll find it easier to focus!

 

I’d definitely recommend giving mindfulness a go, especially if you haven’t already, just to see whether you notice any changes after each session. Have you tried mindfulness before? Let me know in the comments!

Why do we find things scary?

Happy Halloween!

Ever wondered why you don’t like clowns, or why just hearing creepy music on a film makes the hairs on the back of your neck stand on end? Today’s blog post is keeping things topical and asking why is it that we find certain things scary.

Image result for halloween

When we watch a scary film, it can activate the same part of the brain which would become active if we were under a real threat – the amygdala. This is part of the limbic system, and is thought to be responsible for processing aspects of memory and emotion. One particular function of the amygdala is to trigger the ‘fight or flight’ response to threatening stimuli – that feeling of fear where you don’t know whether to stand your ground or run away and hide.

From an evolutionary perspective, feeling fear is helpful. It would have been useful for our ancestors to be scared of snakes or poisonous spiders – stay away from these things and you’re more likely to survive. But what about when there’s no current threat, why do we get scared by a film, or a creepy picture?

One argument as to why we find some things creepy is that they contain an element of uncertainty. We find a clown, or someone wearing a mask scary because we can’t see their face, meaning we can’t use social cues to help us understand what is going on. The ‘bad guy’ in horror movies is often covered with a mask, or is a monster with distorted facial features, or in some cases completely covered by a hood, so no features are visible at all. We tend to feel uneasy when we see figures which look human, but not completely human. There is something off about them – think staring emotionless faces or someone wearing blacked out contact lenses. This uncertainty causes us to feel uneasy – there is no recognisable threat but the ambiguity causes a partial fear response in the brain and gives us the impression that something’s creepy. This theory can also be applied to people who are scared of the dark – it’s the not knowing what’s out there which causes fear

Sometimes, it’s not even things we see which make us feel scared, but things we hear. Ever wondered why the chords of the music to Jaws or the shower scene in Psycho are so iconically scary? Dan Blumstein, an academic at UCLA and expert on animal distress calls hypothesises that sounds made by animals in distress (think a piglet screaming or a dog barking) called ‘nonlinear chaotic noise’ also cause an emotional response in humans. He  argues that horror films use scores which feature these same characteristics: harsh, unpredictable or sudden higher sounds to provoke a kind of biological response which increases arousal (our emotional response). He tested his theory, and found that participants who were played different melodies scored sounds as being more negative if the melodies suddenly went higher, mimicking a scream, as opposed to lower.

Uncertainty is also what causes certain sounds to appear scary. Hearing a creak on the stairs is fine, if you can see someone walking up them. What makes that creak sound scary is when we can’t see the cause. Our minds start racing to think of possible explanations, and more often than not we choose something scary to fill the gap.

stephen king

 

 

 

Perfect Memory Syndrome

Can you imagine being able to remember every single day of your life? This is the case for people with highly superior autobiographical memory (HSAM) – an extremely rare condition which affects fewer than 100 people in the world.

In contrast to the majority of us, who can probably recall some details about what we’ve been doing on specific days for the last fortnight or so, people with HSAM can do this for years, and some even right back to when they were a baby.

The first recorded case of HSAM was in a woman called Jill Price in 2000, by memory specialist Dr James McGaugh at the University of California. Jill could remember every day of her life in detail, back until she was 14 years old. She knows what happened on any given date and what day of the week it was, right down to specific details like sounds and smell. She believes her extraordinary memory was triggered by her and her family moving to a different part of the USA when she was 8 – she was anxious about forgetting things about her old life and after this period, found her memory had changed.

However, just because people with HSAM can remember every detail about what has happened in their lives, this doesn’t mean that they have a superior memory when it comes to other types of information. For a quick recap – our long term memories are divided into 3 main groups: episodic – personal information about us e.g. memories of what we did for our birthday last year, or our experience of school when we were little; semantic – facts e.g. knowing the year London held the Olympics or the capital city of Spain. The third category is procedural memory, which is memory for actions e.g. how to ride a bike (for more information see this blog post). People with HSAM have extraordinary episodic memory, but they perform similarly to the general population on tests which involve the other two – they have no greater capacity to remember facts or memorise large amounts of information than we do. Another study has shown that they are more susceptible than control participants to a task which aims to plant false memories (Patihis et al, 2013) – so their memory is still as unreliable as ours.

How people with HSAM encode memories has also been tested, and the authors of the study (Leport et al, 2017) concluded that they seem to create memories in exactly the same way as the general population. This, added to the results of the false memory test seems to suggest that there isn’t something special about the way memories of people with HSAM are made which means they can remember more. The current hypothesis is that it is something in between encoding and retrieval which makes their memory so special.

The brain structure of people with HSAM has been investigated using fMRI, with images showing that people with the condition have differences to the parahippocampal gyrus, anterior insula and temporal gyrus. (LePort et al, 2012). Previous research has shown that these areas are involved in autobiographical memory, so this result perhaps isn’t surprising. There was also evidence of improved coherence in the white matter tract which connects the two hemispheres, suggesting a superior ability to transfer information between different parts of the brain. However, this study alone is not enough to show whether these differences were caused by the advanced memory capabilities of these participants, or whether they are a result of them remembering so much information.

Although having perfect memory might seem to be an advantage, people will this condition can often struggle with the sheer amount of information they can remember. Memories are often described as intrusive, popping up when they see anything which reminds them of something in the past. Jill Price says that she perceives a ‘split screen’, with the present happening on the left, and a constant stream of memories on the right. Having the ‘perfect memory’ might be more trouble than it’s worth.

 

'Memory stick.'

What’s your story? When positive thinking works

This post is inspired by a book I read on holiday recently – Derren Brown’s Happy. In this book, Derren talks about ways we can change our mindset in order to feel more content, and builds on the Stoic principle that it is how we feel about events which causes them to affect us, not the events themselves. For example, we might worry about an upcoming presentation, getting ourselves really worked up and thinking of all the ways we could embarrass ourselves – tripping over, stumbling over our words, failing to hold the attention of the audience. The presentation becomes a source of dread. However if we were instead to put aside our worries and focus on preparing our slides we might feel more in control, and a whole lot calmer about the situation. Or alternatively noticing a scratch on our car could make us angry, wishing harm to come to the perpetrator and causing us to spend the whole day in a bad mood, being grumpy with others which makes us feel worse. Whilst to someone else this would be a minor annoyance, and not affect the rest of their day at all. So the same event can affect us differently, depending on how we feel about it, and our internal narrative.

In his book, Derren is unconvinced of the advice often given in popular modern self-help books, which state that we can achieve anything we want through the power of positive thinking. Want a promotion? All you need to do is think positively enough about it, convince yourself you’ll get one and the universe will reward you. If it doesn’t work out? Well you just weren’t thinking positively enough. This example seems fairly harmless, but what about when people with a serious illness are told they need to ‘think positive’ to help them get better? When of course some people don’t get better it is as though it is their fault, for not being positive enough.

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However, he points out a type of positive thinking which can be useful, especially when it relates to our internal narratives, that is the stories we tell ourselves about our past. Some people are always lucky, others pride themselves in being hardworking, whilst some are always being hard done by. But is someone who thinks of themselves as lucky really lucky all of the time?   Our internal narratives are often affected by something call ‘confirmation bias’ – that is, we recognise all evidence which correlates with the theory we have about ourselves, and ignore anything to the contrary. So in the example of someone who thinks of themselves as lucky, they remember the one time they won first prize on a raffle, but forget that every week they play the lottery without reward, or all the other times where luck has failed them.

The affects of our internal narrative can be illustrated nicely by the following experiment, first done by Charisse Nixon at Penn State Erie University. To start, all you need to do is complete these 3 easy anagrams. They shouldn’t take very long, so if you haven’t solved it after 5 seconds, just move on to the next one. Here they are:

WHIRL

5 seconds.. if you don’t get it just move on.

SLAPSTICK

Again, 5 second limit..

CINERAMA

 

How did you do?

In this experiment, half the people in the room were given the same 3 anagrams to solve as those shown above. The other half were given the words TAB and LEMON instead of WHIRL and SLAPSTICK, but the last word, CINERAMA remained the same. Here’s the trick: the first two words that you were shown above were unsolveable (sorry), whereas the ones given to the other half of the people in the experiment were easy. Participants were asked to raise their hand when they’d solved each anagram, so of course the ones given BAT and LEMON raised their hands straight away. And this is the interesting bit – did you solve the last anagram, CINERAMA? The chances are you didn’t, and this was also the case for the participants in the experiment who had received that list of words too. Interestingly, most of the participants given the first two easy anagrams solved this last one without a problem. Whilst the first half had given up, thinking they were worse at this task than their peers, these participants were confident, having already completed two anagrams easily. So more of them were able to solve the last one too.

The phenomenon illustrated by this experiment is called ‘learned helplessness’. The participants given the unsolvable anagrams struggled with the task, whilst they saw their peers complete it easily. This caused them to feel like a failure, that this was something they weren’t very good at. And as a result, they were more likely to fail the last part of the task. This experiment shows the importance of your internal narrative and how it can affect different aspects of your life. If you’re interested, here’s a video showing this experiment in action.

As Derren says, the good news is that we are free to change our stories. They are concocted by us, and we have the power to alter our them – we don’t have to play out the same role every time.

World Mental Health Day 2017

Today, Tuesday 10th October is World Mental Health Day – a day aimed to raise awareness of current mental health issues affecting society. The theme this year is mental health in the workplace.

I’ll start by asking you a question: Would you tell your boss you were going to take a day off work due to a mental health problem?

Sick days should be used equally for both mental and physical health, however recent data shows that isn’t the case. In the UK last year, workers took 137 million sick days, with 15.8 million of these being for a mental health problem. To put this into perspective, 34 million sick days were taken for coughs and colds1. One in five people are estimated to be suffering with mental illness at any one time, so why don’t the figures reflect this?

Of course one of the reasons the figure for mental illnesses looks comparatively low could be because they are under-reported – some people may prefer to call in and say they have the flu if they are worried about prejudices at work. People may also be reluctant to take a day off at all if they are struggling with an illness like anxiety, feeling instead like they should be able to carry on. If you had hurt your back and couldn’t move, most people would view this as a legitimate reason to take some time off. But what if you’re struggling to get out of bed due to depression?

 

world mental health day

 

There are several reasons why it makes sense for us to be more open about our mental health at work, without it affecting our rights or how we are treated. The recent positive response of a director when one of his workers took some days off for her mental health shows how actually having the conversation around this topic at work can break down some of the perceived stigma around it. Hopefully the publicity surrounding cases such as these will encourage others to take time off to deal with their mental health when they feel as though they need a break.

As well as the obvious advantages of creating a supportive working environment there are also economic benefits of improved mental health in the workplace. It has been estimated that 91 million work days are lost each year due to mental health problems, with a total cost to employers of £26 billion – or £1035 for every worker in the UK2. This isn’t just due to sick days, but staff turnover and reduced productivity too. When people are happier and healthier their performance will improve – these figures show it pays for companies to care about their employees mental health.

If you’re struggling with your mental health at work, or work as a manager and want to make your workplace a more supportive environment then Mind have some great resources – find them here. 

 

 

  1. http://www.bbc.co.uk/news/uk-40593256
  2. https://www.centreformentalhealth.org.uk/employment-the-economic-case