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.

 

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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.

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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.

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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.

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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.

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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.'

Orthorexia – a new type of eating disorder?

You might have heard some of the negativity in the press recently about so called ‘clean eating’ and it’s advocates, who promote a lifestyle which involves cutting out any processed food and often entire food groups (gluten/dairy etc). This is not because of any medical reason, but simply just to be as ‘healthy’ as possible. I’m not going to go anymore into the debate around clean eating today (there’s too much to say, and several people have done it already) but I’ve mentioned it here as it has been linked to a rise in a condition known as orthorexia.

Orthorexia nervosa (so called by Steven Bratman, 1996) is characterised by a fixation with healthy food consumption. More than just dieting, sufferers will become obsessed with healthy food, and food will become preoccupying and a source of anxiety. Other problems often caused by this disorder include social isolation due to having to have complete control over their food intake, and some nutrient deficiencies caused by an extremely limited diet.

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image from http://www.thefullhelping.com/neda-week-2014-considering-orthorexia

People with orthorexia (like some who ‘eat clean’) will often cut whole food groups or types of food out of their diet, thinking this will benefit their health. Common foods to be avoided are those which include artificial colours, flavours or preservatives, or foods perceived as containing too much sugar, or salt (Catalina et al., 2005). Orthorexics will also develop strict rules about food, which may also extend to rituals around food preparation (Chaki et al, 2013).

However, despite it’s increasing recognition, orthorexia isn’t listed as an official disorder by the DSM-V diagnostic manual for mental illness. As it is a relatively new disorder, research on orthorexia is lacking compared to other eating disorders such as anorexia or bulimia. There is some debate about whether orthorexia is a subtype of one of these existing eating disorders (Zamora et al, 2005), an eating disorder in it’s own right (Bratman & Knight, 2000), or a type of obsessive-compulsive disorder (e.g. Mathieu, 2005). Alternatively, some researchers view it as a combination of the above e.g. Brytek-Matera (2012) who describes orthorexia as “a disturbed eating habit which is connected with obsessive-compulsive symptoms.”

As researchers are still unclear how to categorise orthorexia, it is unsurprising it hasn’t yet made it in the DSM-V. However, despite it’s absence, Bratman & Knight (2000) have developed some guidelines for diagnosing orthorexia. These include:

  • preparing healthy food overtaking other activities in life, with sufferers spending over 3 hours a day thinking about or preparing food
  • following a very strict and restrictive diet plan
  • a healthy diet becoming linked to self-esteem, and feelings over superiority over others who do not follow such a strict regime
  • the nutritional value of a meal becoming more important than it’s taste or the joy from eating it

Orthorexia can be treated successfully, with a combination of cognitive behaviour therapy and medication such as SSRIs (a type of antidepressant) being shown to be effective in some cases (Mathieu, 2005). This study also suggested that orthorexics responded better to treatment than suffers of other eating disorders, perhaps due to their concerns and increased awareness about their health.

There is no question that more research needs to be done to establish more data on people living with this condition, which will enable preventative measures and effective treatments to be developed.

 

The Power of Conversation

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It’s a well known fact that a problem shared is a problem halved, right? But when you’re feeling down or worried sometimes talking about your feelings can seem too hard. For some people it could be easier to bury these feelings and try and carry on regardless, or for others admitting how they truly felt would seem a sign of weakness.

As you may know it’s Mental Health Awareness week in the UK, so this year I’ve decided to write about the power of conversation, and why you don’t have to deal with everything on your own.

Talking to others about their feelings is something men can be particularly bad at, especially when it comes to any concerns about their physical or mental health. To quote the columnist and campaigner Bryony Gordon in her recent article “Women are encouraged to talk about their problems. Men just have football.” Prince Harry was recently praised for his honesty in talking about his mental health – something which will hopefully change the stereotypical view that British men should have a ‘stiff upper lip’ and not show any sign of emotion.

This gender divide has led to inequality in mental health. In 2016, 3 times more men committed suicide than women. Suicide takes more lives of men under the age of 45 than accidents or disease.

Why is it that men are more at risk of suicide than women, when more women are diagnosed with a common mental illness? One explanation is that men aren’t as good at accessing healthcare as women – for example in the first 3 quarters of 2015, only 36% of those who accessed Improving Access to Psychological Therapy (IAPT) services were male*. Men are also less willing to let others know if they have a problem, with one survey finding that only a quarter of men said they had disclosed a mental health problem to a friend within a month, compared to a third of women. Almost 30% of men said they never tried to access help for their last mental health problem, compared to just under 20% of women **.

Accessing the correct care early is vital in the successful treatment of mental illness. For most common mental illnesses, talking therapies are used as a form of treatment (possibly in conjunction with medication). These include Cognitive Behavioural Therapy (CBT), Psychotherapy, Dialectic Behaviour Therapy, or Counselling – just to name a few. Having the opportunity to talk about thoughts and behaviours with a trained professional can give you the space to work out the cause of your worry or identify any patterns in your thinking which contribute to negative feelings. Therapies such as CBT also try to change behaviours using set goals agreed between the patient and professional which can lead to an improvement in mental wellbeing.

This evidence shows that the culture has to change. Why should it be taboo for men to speak about their feelings in the pub with their mates, as I do with my girlfriends over dinner? Anyone should feel like they have someone to talk to about their problems, even if that person is a healthcare professional – they’re there to help.

On a final note – one project I’m proud to be involved in which is aiming to reduce the stigma of mental illness is a zine called ‘do what you want’. This includes articles from a range of writers and has been featured in the Guardian, BBC and Grazia. All proceeds go to mental health charities, and the ebook (and print version whilst it’s still in stock!) can be ordered here: http://dowhatyouwantzine.co.uk

* https://www.menshealthforum.org.uk/key-data-mental-health

**https://www.mentalhealth.org.uk/news/survey-people-lived-experience-mental-health-problems-reveals-men-less-likely-seek-medical

Exercise and Mental Health

This blog post was inspired by the recent London Marathon, who’s official charity was Head’s Together (a charity set up by the Duke and Duchess of Cambridge and Prince Harry, which aims to reduce the stigma of mental illness) making it the first mental health marathon.

As well as raising millions of pounds for charities which work to improve our mental health, the physical act of training for and running the marathon can also provide a boost to our mental health.

That high you get after going for a run, dancing with your friends or a hard gym session? It’s caused by an increase in endorphins, a neurotransmitter released by the pituitary gland which have been shown to act as a painkiller, and improve your mood.

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Exercise has been found to have benefits for people suffering from different types of mental illness, from depression (Balchin et al, 2016), bipolar disorder (Ng et al, 2007) and schizophrenia (Gorczynski & Faulkner, 2010). Other studies have suggested that exercise could also help protect people from neurodegenerative conditions which can affect us as we get older, such as Alzheimer’s or Parkinson’s disease, as well as improving symptoms and quality of life for people with these conditions (Deslandes et al, 2009). This could be because exercise stimulates blood flow in the brain as well as improving overall fitness. Increased levels of exercise in older adults has been linked to have several positive outcomes, including improved mental health and social integration (Chodzko-Zajko et al, 2009).

Exercise can also help to improve mood in sedentary (but otherwise healthy) participants. One study in Turkey (Taspinar et al, 2014) compared participants who took part in either a Hatha yoga or a Resistance workout program where they trained for an average of 50 minutes, 3 times a week for 7 weeks, to participants who did no extra exercise. The researchers found that participants in the exercise groups showed improved quality of life, body image, self-esteem and lower symptoms of depression after taking part. Participants in the control group showed no change. Yoga was better for improving symptoms of tiredness and depression, and self-esteem, whilst resistance training led to higher improvements in body image perception. This study also shows that it doesn’t matter what type of exercise you do to get the benefits – although it probably helps to find one you enjoy as it means you’re more likely to continue. In case you’re still not convinced, this graphic summarises the 5 main ways exercise can improve your mood:

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However it is important to note that if you are suffering from a mental illness, exercise on its own may not be enough. For some people, it may be hard enough to get out of bed in the morning, to them going for a run would be completely unrealistic. This is why exercise can be so effective in conjunction with other therapies, be it medication or talking therapies like CBT. Once symptoms have started to improve, then incorporating exercise could be a good way to manage your mood.

So next time you’re feeling worried about an exam, stressed about a deadline or feeling lacking in motivation why not try going for a walk or a dance class? You might get hooked on a new hobby which can do much more than just improve your fitness.

Imposter Syndrome – Not feeling good enough and how to beat it

I’m sure you’ve all been there – earning a promotion, getting into uni or finding your dream job. All your hard work and sacrifices have paid off, and you should feel on top of the world. And for most of the time, you do. You feel happy and accept people’s congratulations of “I knew you could do it!” But despite all this, what about that niggling feeling of ‘why me?’, the feeling that you don’t quite fit in with your peers and that they are all so much smarter and more deserving to be there than you? Why can you not share the confidence in yourself held by your friends and family? This is known as Imposter Syndrome and tends to affect high achieving individuals, and is especially common in women (although men can of course suffer from this too).

Imposter syndrome can negatively affect your self-esteem, mood, and locus of control (this means you feel as though you have little control over things that happen to you). It has been found to be worse in people who feel as though they are outsiders, which could perhaps lead to feelings of not being as good as those around you.

 

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The term Imposter Syndrome was first coined by Clance & Imes in 1978, where it was identified to affect high achieving women. They studied women who were towards the top of the career ladder, or who were studying at either undergraduate or postgraduate level.

The women in the study who had the condition reported that they felt like a fraud, and thought they had only achieved their PhD or got onto their current role because of other factors, for example a mistake in the admissions process or because of others overestimating their abilities. Despite their excellent achievements they didn’t feel qualified to be working or studying at the level they were at and were fearful of being found out. Clance & Imes explain that the women ‘do not experience an internal feeling of success’ which leads them to overlook their achievements.

This inability to have an internal feeling of success is an important symptom to note. One of the causes of imposter syndrome has been identified as having problems with attributions of success. For someone who suffers with these symptoms, they tend to explain a positive event such as a promotion as being down to an external unstable cause, such as luck or someone else’s mistake. The ‘external’ is important here, as it reinforces the fact that successes are not attributed to their own skills and actions. This has been shown to occur more in women than men, who are more likely to attribute success to an internal cause, such as skill or hard work (Deaux, 1976). This author hypothesised that if a women refers to a success as due to an unstable external factor, it does not give her confidence that she will be successful in the future, which causes a cycle of feelings of being an imposter.

So what next? If you’re suffering from Imposter Syndrome, what can you do to overcome it?

I spent a while searching academic journals for evidence on interventions that have been successful in reducing these symptoms. Unfortunately, any combination of the words *imposter* *syndrome* *treatment* or *overcoming* found no relevant results at all.

So instead, here are some recommendations that I did manage to find – mostly from various news articles or academic blogs (see below) mixed with my own advice. Also please remember that I’m not a healthcare professional, but I hope you find them helpful.

  • Be mindful of your self expectations. Don’t expect to be the best at everything and accept you don’t know it all and that’s okay. Don’t be afraid to ask if you don’t know something, that’s much more productive than sitting there feeling inadequate because of it.
  • Make sure you acknowledge the work you’ve done and remember that you’ve worked hard to be where you are now. Once my colleague corrected me when I described myself as ‘lucky’ for getting my current role – “no you weren’t, you applied to loads and worked really hard”. It turned out to be a very helpful comment – good things don’t just happen, you have to make them.
  • Aim to be ‘good enough’ – it isn’t realistic to strive for perfection. If you’re trying to make something perfect, it is likely you will never finish it. Instead accept that ‘good enough’ can sometimes be the way to go.
  • Finally, talk to someone about how you’re feeling – they will probably say they’ve felt like that before too, and you’ll realise you’re not alone.

 

Whether or not you are a student or work in academia, I can recommend this posts on Imposter Syndrome: http://jameshaytonphd.com/phd-impostor-syndrome/

 

 

Body Image Therapy for Anorexia – what is it and how does it work?

Today’s post is for eating disorder awareness week, which this year has a focus on early detection and intervention. Often, sufferers are unable to access treatment until they have been ill for some time, which makes recovery so much harder than if treatment happened once symptoms first began. As well as having obvious benefits for patients, there is also a financial advantage of early intervention (sadly, cost has to be taken into consideration when deciding if a new treatment is worth it). With the current state of the NHS it is important from a financial point of view, as preventive rather than curative medicine is much cheaper overall. So with the benefits of early intervention being brought to our attention, today I thought I’d write about a type of treatment for anorexia – Body Image Therapy.

For those of you who aren’t already aware of the symptoms, Anorexia Nervosa is characterised by:

  • severely restricting food intake, leading to extremely low body weight
  • a fear of gaining weight
  • distorted body image perceptions, with sufferers believing they are fatter than they are.

 

Contrary to what you might think, it isn’t just girls and young women who can have anorexia, men make up about 10% of total suffers (although some studies estimate higher). It is also becoming more common, with inpatient hospital admissions increasing by about 7% a year since 2005. As well as this increase, raising awareness and improving treatment is so important as anorexia has the highest mortality rate of any mental illness.

One of the reasons anorexia can be so hard to overcome is that sufferers have a distorted body image and believe they are much bigger than they truly are. This reinforces the cycle of restricting food or overexercising, and makes anorexia hard to beat. Studies have also shown (e.g. Fairburn et al, 1985) that the symptom of body image disturbances is also a predictor for relapse once therapy has been completed.

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Diagram adapted from Fairburn et al (2008)

Therefore, it makes sense to include body image therapy when treating a patient with anorexia. It is a type of cognitive therapy, which aims to reduce the harmful thoughts about body and weight. One type of body image therapy is Mirror Therapy, in which patients view their body in front of a mirror during a therapy session. Exposure can be increased over time and leads to an immediate emotional response which can be discussed during therapy. The therapist encourages the patient to look at their body as a whole rather than focus on perceived flaws, and to describe their body accurately as opposed to using negative language. This helps patients to learn that there are other ways of viewing their body and the consequences of negative thoughts about it (Delinsky & Wilson, 2006). Over time, cognitive therapy with mirror therapy has been shown to be more effective in terms of reducing body dissatisfaction and avoidance compared to cognitive therapy alone (Key et al, 2001).

Body image training in anorexia is therefore important as it could help to overcome the cognitive processes which make it hard to break the cycle of disordered eating and improve recovery rates for people suffering from an eating disorder.

Thanks for reading, and don’t forget to help spread awareness using the hashtag #eatingdisorderawarenessweek

If you would like to read more about the possible causes of eating disorders then see a previous post here or read about body dysmorphia in anorexia here

If you or someone you know is suffering from an eating disorder then there is help available. Contact your doctor or charities such as Beat, who can provide you with the correct support.