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!

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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.

 

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.

 

 

Behavioural Activation

This week’s post is about a technique used as part of cognitive behavioural therapy for people with depression. As you probably know already, symptoms of depression include low mood, low self-esteem, feelings of anxiety and helplessness, and having low motivation and interest in activities which they previously enjoyed.

Behavioural activation focuses on the ‘B’ of the CBT model, in this case on the last symptom in particular – the withdrawal from usual activities and friends. For example, they may start to avoid social engagement and ignore invites from friends or make excuses as to why they can’t meet up, whereas before they would have been happy to go. Although in the short term this avoidance causes a temporary relief, such as a lowering of anxiety, it simply reinforces feelings of low mood or low self-esteem. This maintenance of the condition is illustrated by this diagram below:

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Therefore, in order to break this cycle, behavioural activation aims to change the unhelpful behaviours which continue the cycle of low mood. It does this by gradually building up activities that the person can do, which is turn will improve their mood, and lead eventually to them getting back to activities they used to enjoy. This progression is important, as the change in mood is needed before larger behavioural changes can occur.

Key features of Behavioural Activation are as follows (taken from Jacobson et al, 2001):

  • Firstly, the model is presented to patients by their clinician, who explain a bit about it and why it works. This is called a treatment ‘rationale’ and it is important for the patient to feel confident that this will work. A good relationship and trust with the therapist is also important.
  • Developing treatment goals through collaboration between the patient and the therapist – these goals are new behaviours rather than moods or emotions.
  • Analysis of causes and maintenance factors of the depression
  • Graded task assignment – e.g. starting with something small such as walking to the corner shop. This is scheduled in between sessions, and a hierarchy is discussed with the therapist.
  • Establishing a routine, in the hope this results in improved mood.

Ultimately, the aim of Behavioural Activation is to help the patient re-engage and find joy in activities which they have been avoiding. This will raise mood, and therefore help someone recover from depression.

Phobias Part 2 – treatments

This week’s post is the second in a 2 part series about phobias, and will focus on different types of treatment, and what works. If you haven’t already, read part 1 (see here) for more information on types of phobias and possible causes.

If you’r a regular reading of my blog, you may remember that a while back I did a post on Cognitive Behavioural Therapy (CBT) and how that can be used to treat people with phobias. The main principle is to reduce the anxiety felt by encountering the phobia stimulus, be it crowds, flying, or needles. By teaching the patient breathing exercises to help them relax and working to change the thoughts (cognitions) about the phobic stimulus, therapists can help the patient to work towards overcoming their fear. The behavioural part of this technique is gradual exposure to the thing the patient is afraid of, whilst the patient works hard to control their breathing and stay calm. This exposure can help towards changing thoughts which contribute to the phobia such as ‘if I’m in a room with a dog it will bite me’, which in turn reduces fear.

For example, take a look at the diagram below which shows how phobias remain if the fears aren’t challenged. If therapy targets the thoughts, and tests the fear, then it is likely the phobia will be treated successfully.

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Another form of exposure therapy which has been used to treat phobias is known as ‘flooding’. Unlike in CBT, where the individual is gradually exposed to their fear, in this technique they are put straight in the worst situation they could imagine. This uses more behavioural techniques – as the body cannot sustain a physiological stress response for a long period of time, people begin to notice they feel calmer, even though they are in the presence of their fear. An example would be putting someone who was scared of birds in a room full of them! This also enables the individual to confront their worst fear and learn that nothing bad happens when they are in that situation.

Thanks for reading – there won’t be a post next week as I’ve got 2 interviews but I’ll be back the week after!