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What books are good for people with chronic illness?

Chronic illnesses are difficult to manage. People often report being bounced from consultant to consultant, hospital to hospital, and still end up without resolution.

Unfortunately, many chronic conditions are likely to be lifelong companions with the person experiencing them. That can be frustrating, and can result in a feeling of utter hopelessness.

As a health psychologist I regularly work with people with chronic illness and chronic conditions. Many have spent an absolute fortune on supplements, new diets, complimentary therapies, courses, etc. All with the aim of trying to recover.

Obviously, why wouldn’t someone want to recover from any illness? Yet some are with us.

Myself, I have a long-term health condition in the form of a degenerative retinal condition. Mine is only going to get worse and no amount of supplementation will really make a difference. Positive health behaviours, such as exercise and a diet including a naturally colourful dose of fruit and veg can support the system and may mitigate and speeding up of the degeneration. But my condition is currently incurable.

I’m including below some links to resources that help people develop skills to deal with chronic conditions. I hope, if you’re reading this, and you are experiencing a chronic condition, that you find at least one of these a useful resource. I know that not everyone gets offered psychological support via the NHS, and many cannot afford a private psychologist to support them to adapt.

Ray Owens’ Living with the Enemy is a compassionately written self-help resource for anyone experiencing chronic illness. Drawing on acceptance, compassion, CBT, and mindfulness it can help you to navigate the stresses of chronic illness.

Russ Harris’ Happiness Trap isn’t just a book that people with chronic illness would benefit from, but possibly one that almost everyone would benefit from. Russ talks about how the strivation (yes, i made this word up!) for happiness can shine a spotlight on anything that isn’t happiness. The result is that we can really highlight suffering and overly normalise happiness as an ideal. The reality, life is a spectrum of experiences: good, less good, painful, grief-ridden, sadness, excitement, anxiety, lowness, high, and possibly happiness, mixed in with the wealth of other experiences that humans can have. By recognising that happiness and positivity can, in themselves, be problematic aims, and then learning how to live with all the other experiences that life affords us, we can learn to function better. The aim of Russ’ book is to help people to identify what is important in life and to do more of what is important, no matter what life throws at us.

A highly recommended book that has helped hundreds of thousands across the globe already.

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DOES HYPNOTHERAPY WORK?

(Originally posted on 13/5/2017)

If you speak to the majority of my clients that have experienced hypnosis within my sessions the answer would be a resounding

YES!”

Hypnotherapy works!

Even clients who have thought during the session that the hypnosis element was a total waste of time, have the following week(s) contacted me to state how many changes they keep noticing.  

The funny thing is, I am bound to say this.  I do back up these statements with the occasional testimonial/review from clients, and now I shall do similarly with a little science.  I’m a scientist and an evidence-based practitioner so it makes perfect sense for me to demonstrate that.

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THE BRITISH PSYCHOLOGICAL SOCIETY

Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium.  

BPS (2001)

The use of the word ‘proven’ is an unusual one as many people debate the notion that anything can be proven – only that it can be demonstrated to be effective at that particular time, and place.

In a balanced review of the literature, the BPS explore hypnosis and discuss what it has shown to be effective in, and what it has not.

What they declare hypnotic interventions are effective for include:

  • Chronic pain
  • Acute pain
  • Stress
  • Anxiety
  • Tension
  • Insomnia
  • Headaches & Migraines
  • Irritable Bowel Syndrome and other Gastro-intestinal complaints
  • Asthma
  • Warts, and other skin complaints such as eczema, psoriasis, and urticaria.
  • Smoking Cessation

I have been successfully using hypnosis to help people with chronic pain, stress, anxiety, and IBS for the past two years and love seeing the relief in the clients’ faces when they experience relief for the first time in a long time.

The BPS also state that it’s likely that both children and adults can benefit from hypnotherapeutic interventions.  

This is a 2001 article from the BPS and hypnosis has come on leaps and bounds since then.  

THE AMERICAN PSYCHOLOGICAL ASSOCIATION

(article: ​http://www.apa.org/monitor/2011/01/hypnosis.aspx)

In this 2011 article the author talks about how stage and tv hypnotists have damaged the reputation of the professional hypnotherapist.  I do think to some extent this is true, and as a psychologist I do find myself defending the method to my clients, explaining what hypnosis is, and what it is not.  

The article discusses how hypnosis can be used to help cancer patients recover post-operatively by experiencing less pain, nausea, fatigue, and discomfort, requiring less analgesia (pain relief).  There was a net financial saving post-operatively compared to those who did not undergo the brief pre-operative hypnotic intervention.

Whilst the evidence for the treatment of pain, anxiety, etc is strong, the article discusses how the evidence for smoking is not quite so strong. I suspect this is due to the nature of the beast – smokers sometimes like smoking.  The smokers I accept into my clinic room prove to me that they are determined to succeed – that they really want to become non-smokers.  I do not see many for stop-smoking work yet when I do they are successful.  

HYPNOSIS CAN RESOLVE ISSUES FASTER

A study (originating from 1970) published in the American Health Magazine in 2006 found that people tend to deem hypnosis as a last resort for changing habits, resolving anxieties, stopping smoking, etc.  Yet the study demonstrated that people experience a 38% recovery after 600 sessions of psychoanalysis (the freudian approach to psychotherapy that often involves 2-3 sessions per week – an expensive luxury).  People tend to experience a 72% recovery following 22 sessions of behaviour therapy.  And people tend to experience a 93% recovery after just 6 sessions of hypnotherapy.  This is quite staggering.  

As a psychologist trained in various behavioural therapies, hypnotherapy, and solution-focused therapies, I tend to bespoke my approach to the client and as the hypnotherapy component can occasionally last just 10-15 minutes, I combine behavioural therapies into sessions and increase efficacy significantly.  Some extremely serious conditions have been resolved in just 2-3 sessions.  There are some people with whom issues take longer to resolve – yet it is not uncommon for 6 sessions to be the most someone would need.

​To back this up, the Washington Post reported on a German Meta-Analysis of 444 studies  concluding a 64% success rate for hypnotherapy with Anxiety, Stress, and Chronic Pain.  

CONCLUSION

Hypnotherapy is an effective therapeutic tool to help people recover from a wide array of issues, including chronic pain, IBS, anxiety, stress, and many other issues.  The key is to choose a good hypnotherapist or therapist – one that you know will help you on the recovery journey.

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CHILDREN & MOBILE DEVICES

(Originally posted on 24/7/2017)

SAFE? NOT SAFE?

In a recent article in the Journal of Child Development it was suggested that children’s use of a mobile phone during the nighttime can lead to increased risk of anxiety and depression (1).  

There are some obvious differences between the childhoods of the younger generations, and generations born in the 80s.  When I was younger there was no such thing as a mobile phone – you saw them occasionally in brief cases that housed the battery.  

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Mobile gaming came out in the late 80s (2) and they were basic monochrome games.  Even games consoles were totally different with the NES (I used to love Duck Hunt), the Sinclair Spectrum, and the Mega Drive.  

The world of mobile gaming that the children of today experience and expect was not even really imaginable when I was a child.  The thought of having a mobile phone would never have crossed my mind.  I did actually get my first mobile phone when I was 16 – an Ericsson GA628 and I loved that phone.  Not sure it had SMS though as it was a feature not yet introduced.  

Anyway, it is quite difficult for modern parents to fully comprehend the lives of a modern child as the things that are now available were not even featuring in our childhood dreams.

If we ditch the mobile phones and other devices, then we risk throwing the baby out with the bathwater.  Research presented at the 2016 World Congress of Anaesthethesiorogists suggested that children that play on an iPad before surgery experience lower anxieties and thus experience a better anaesthetic induction (3).  This suggests that mobile devices do have some benefit for children.  Mobile devices are also increasingly used as tools to deliver psychological interventions and engage children in therapy.  There are many benefits to be had, yet they have a place within life – they are not the be-all of life.

One of the reasons why iPad use reduces anxieties before an operation is due to the child being distracted from a potentially scary event – being cut open!  Distraction from unpleasantness can be functional as a behaviour, yet if used too often can become dysfunctional.  In the same way that alcohol can be a functional way to reduce stress, yet persistent use can become dysfunctional – it can become an addiction without you even realising.  Children are not the only ones at risk of addiction to smart devices, adults are severely prone to it too.  I am sure we have all seen groups of people in a restaurant, heads down on their mobile phones all night, no interaction with the human friends and family around them.  An article in the Journal of Cyberpsychology, Behaviour, and Social Networking found that parents who themselves have addictive patterns with smartphones are less likely to perceive their children’s addictions as problematic and also less likely to be a good role model for their children (4).  The Journal of Child Development suggests that parental use of technology has a negative impact on child behaviour (5.).  Some seem to believe this new connected world keeps us connected with friends and family yet another recent study suggests that is not necessarily the case, with the compulsive use of mobile phones being related to lesser feelings of connection to friends and family (6).

It is important that technology is incorporated into life, yet doesn’t take over life completely.  Face-to-face social interactions, outdoor playtime, technology-free family time (such as board games), reading, physical exercise, and conversations all play a vital role to child and adult development.  Having a full and varied life increases the chances of intellectual development, and a fit and healthy child (7).  I would suggest, as I would with any adult suffering with anxiety and insomnia, that tech gets switched off 30-60 minutes before bedtime so you can settle down with a book – allowing the brain to start preparing for sleep.

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WORLD MENTAL HEALTH DAY

(originally posted on 10/10/2017)

So today is world mental health day and it is estimated that there are 300 million people globally suffering with depression, and more than 260 million people suffering from anxiety (1).

The old ‘1 in 4’ experience mental health concerns within their life is, in my view, very conservative.  Especially as 1 in 5 people are reported to experience suicidal thoughts (2).

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I understand why these statistics are created as they are intended to normalise mental health issues so that there is, rightly, no shame in experiencing challenges and thus seeking support if and when required.  

From my point of view, and I don’t have evidence for this, yet I believe that the way mental health issues are framed within business and life, there is still a stigma surrounding them and therefore some people still experience shame and will not speak up.  

I truly believe the 1 in 4 is highly conservative.  I would anticipate that, at at least one point during their life, everyone will experience some form of anxiety, and potentially the symptoms of depression.  These are very human experiences that become problematic in life when they persevere.  

There is research at present into the causal factors of the symptoms of depression and it has been suggested that the presence of suicidality within people with major depressive disorder (MDD) have inflammatory markers, suggesting that the inflammation rather than the MDD may not be causing the suicidal thoughts (3).  This ties in with the increasing evidence that people with depression have neuroinflammation leading some to think that depression may, in fact, be an inflammatory disorder and thus the current treatment pathways are ineffective (45).

Are there benefits of this potential revelation?  Yes!

It means you can make some changes that could significantly improve the symptoms of depression.

  1. Exercise 2-4 times a week.  It has been shown that exercise reduces the symptoms of depression more than things like meditation and relaxation, and definitely more than not exercising or doing nothing (6)
  2. Eat a Mediterranean style diet.  It has been shown that a med-style diet consisting of very few/no processed foods, oily fish, olive oil, red wine (in moderation), dark chocolate (over 70%), low sugars, and a variety of fresh fruit and vegetables, increases the B vitamins and omega oils and contributes to a reduced risk of depression (78).  A wonderful side-effect of eating this way is you generally experience some weight loss too which can make you feel more self-confident.
  3. Sleep!  Sleep is another factor in mood and psychological resilience (9).  It has been estimated that 90% of those experiencing symptoms of depression, sleep is a problem (10) and therefore improving your sleep hygiene could make significant improvements to the symptoms of depression.  Simple changes such as having a note pad next to your bed to put your thoughts onto paper before going to sleep, rather than ruminating on them for hours on end – you can deal with them in the morning!  Switching off electronic devices an hour before bed and reading a book instead.  Making sure your bedroom isn’t too hot.  These simple changes can make a big difference.
  4. Relax.  A variety of studies have shown how beneficial relaxation is in improving the symptoms of both depression and anxiety.  It is a skill that must be learned, and often the harder you try, the harder it is to do.  Yet by mastering this skill you can help yourself reduce symptoms of depression (1112).

There is no shame in experiencing symptoms of depression, anxiety, or any other mental health condition.  If the symptoms persist then take action and seek support.

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FAKE NEWS?: ANTIDEPRESSANTS EFFECTIVE FOR DEPRESSION – HYPERBOLIC CLICK-BAIT IN THE MEDIA.

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(post originally posted on 22/2/2018 and moved over to this new website)

I wake this morning to cries of horror from colleagues and friends over the news headlines:

I am very opposed to the use of such hyperbolic language within healthcare, and the media reporting on things they clearly have not understood.  

Do antidepressants work better than placebo?  Yes, and no.

The article published in the Lancet talks about Moderate to Severe Major Depressive Disorder and how antidepressants are more effective than placebo for the people with this diagnosis.  This information is not new nor revolutionary – it has been acknowledged for many years.

Lancet Article:  Link

My frustration is that the media has conflated Severe Major Depressive Disorder with the word Depression as a whole.  

It is estimated that 3 in 100 people in the UK will experience some form of depression, and around 7 in 100 will experience a mix of anxiety and depression (mind uk).

What it is difficult to do is strip out non-clinical depression, mild cases of Major Depressive Disorder, and the Moderate to Severe cases from the prevalence statistics to give a real picture of the issue at hand.

The evidence shows that antidepressants increase in efficacy as the severity of the condition increases, yet for milder cases of depression there is no real basis for giving antidepressants as they are not shown to work (links 123).

I really do wish the media would report accurately, although I guess if they stated the facts cleanly and clearly the headlines would be less sensationalist.  We live in a click-bait society where people want their adverts read and that is more important that reporting the facts.

Antidepressants do work better than a sugar pill (in some cases) with increasing levels of efficacy as the condition severity increases.  

Yet they are also missing out something.  

The result they are looking at is comparing pharmacological interventions against the imagination!    

There are other things that can help improve depression:

St John’s Wart – there is a fair amount of research that states that this can be effective (links: 123 4).  Some studies show it is useless, no different to placebo (as is something like cirtraline), and others show it can benefit people with mild to moderate clinical depression.  There are possible side effects so caution should be taken before any supplement is consumed.

Exercise – there is evidence that exercise is more beneficial than placebo, meditation, and relaxation therapies.  It may also help, where depression is due to an inflammatory response, reduce inflammation and thus act as a prevention and a treatment for depression (links: 123)

Talking Therapies & Hypnosis – hypnosis can be effective with the treatment of major depression although at present the quality of the research is quite poor.  Despite this, some research shows that hypnosis can have a fairly rapid impact on the client (1).  One flaw that appears to be present within the current IAPT system is the manualised approach.  When a psychologist uses talking therapies effectively, developing a bespoke approach for the individual sitting opposite them, the work can be effective, long-term, with no reliance on medications for life (1).  

My preferred option:

I would prefer a blend of approaches.  I am not averse to antidepressants as a short-term resolution to provide some stability and to support the individual to start making changes within their life, yet a long-term biopsychosocial plan would be optimal.  Using and building on your support networks to ensure you have friends and family around you that will provide support, laughter, and comfort.  To exercise, have a good diet, and look after your health to provide a good environment for your body.  A positive psychological outlook, dealing with the challenging thoughts in a sustainable way and changing the filter which you look at life through.  Our minds give us a lot of information each day, most of it is not necessarily true, fact, nor useful.  By doing what is important to us and finding some purpose we can plough forward and have something to give us a sense of satisfaction.