Ketamine- and psychedelic-assisted psychotherapy

20th October 2023 1:23 pm Comments Off

“Pychedelics are rapidly becoming a recognised and innovative method of treatment for many mental health crises”

Psychedelics are rapidly becoming a recognised and innovative method of treatment for many mental health crises, including suicidality, refractory depressive disorder, chronic PTSD and others.

Depression is a well-recognised and all-too-common cause of problems in the workplace and domestically. A family member’s depression can have ramifications for the extended family and the children of the depressed person, especially in the case of maternal depression (Barker et al., 2012).

While many sufferers of depression improve with prescribed antidepressants, especially when combined with therapies such as CBT and talking therapies, approximately a third of patients in the UK sadly will remain refractory to treatment or only moderately improve.

The evidence

Over the last 20 years, ketamine, an antagonist of the N-methyl-D-aspartate receptor, has been described to have antidepressant properties. Nowadays, a literature search shows many publications with promising results after a single infusion of low-dose ketamine with a rapid anti-depressive effect which lasts for one to two weeks after the infusion.

For patients who cannot attend a psychedelic clinic, intranasal sprays of ketamine have been approved by the Food and Drug Administration (FDA) for the treatment of depression.

Single-dose ketamine infusion has also been used as therapy for alcohol-use disorder with success. (Dakwar et al., 2019). The authors tested whether a single sub-anaesthetic infusion of ketamine combined with motivational enhancement therapy would affect the drinking of participants in the study.

Ketamine significantly increased the likelihood of abstinence, delayed the time to relapse and reduced the likelihood of heavy drinking days compared with midazolam

Forty participants attended five weeks of once-weekly motivational enhancement therapy. During the second week of therapy, they were randomly assigned to a 52-minute intravenous infusion of ketamine at a total dose of 0.71mg/kg (N=17) or the control midazolam at 0.025mg/kg (N=23).

Alcohol use following therapy was assessed using the timeline follow-back method, with abstinence confirmed by urine ethyl glucuronide testing.

Ketamine significantly increased the likelihood of abstinence, delayed the time to relapse and reduced the likelihood of heavy drinking days compared with midazolam.

So, what are psychedelics?

Ketamine, psilocybin and MDMA are all psychedelic therapies. Traditionally, psychiatric pathologies are treated with maintenance drugs. For example, once you are prescribed an antidepressant which helps you, you take it daily until you stop, if you stop.

With psychedelics, the drug is taken only a few times or sometimes only once, alongside appropriate psychotherapy, and then that’s the end of the pharmacological side of treatment. For some patients who suffer from side effects of traditional pharmacotherapies, this will be welcome. For patients for whom therapy has been unsuccessful, this can be life-changing.

Psychedelics are a loosely grouped class of drugs that can induce altered thoughts and sensory perceptions, and some can induce hallucinations.

Ketamine

There are more and more clinics every year opening in the UK specialising in psychedelic psychotherapy. Ketamine-assisted therapy is the most commonly prescribed treatment for depression, addiction, anxiety, eating disorders and PTSD.

Psilocybin

Imperial College London (Imperial) launched the first psychedelic research centre in the world and has recently conducted trials comparing psilocybin therapy with a conventional antidepressant drug (Carhart-Harris et al., 2021).

Results were quite consistent showing that the psilocybin therapy was really quite markedly better at reducing depressive symptoms

Dr Robin Carhart-Harris, research leader, psychiatrist and neuroscientist

During the above trial, all participants received talking therapy alongside either psilocybin or escitalopram – the conventional antidepressant.

Response rates in the psilocybin group averaged at 70 percent, compared with 48 percent in the escitalopram group.

Neuroplasticity

So how do the psychedelics work?

Psychedelic drugs work on the system in the brain called the serotonin system and especially the part of the system involved in neuroplasticity: the ability of the brain to change, be shaped and adapt.

In Imperial College London’s functional MRI research, they found that psilocybin increased plasticity and opened up new communication pathways

In Imperial’s functional MRI research, they found that psilocybin increased plasticity and opened up new communication pathways. As well as psilocybin, scientists also believe you can use MDMA to access a brain state where brain plasticity increases.

MDMA

Earlier this year, the first published study of an advanced clinical trial using MDMA in the US was found to be highly effective in treating PTSD. Researchers at the Multidisciplinary Association for Psychedelic Studies (MAPS) found that after three MDMA sessions, 67 percent of participants no longer qualified for a PTSD diagnosis and 88 percent experienced a reduction in symptoms (Mitchell et al., 2021).

These articles are well worth a read for those interested in psychopathologies, and bring hope to those suffering from refractory depression, suicidality, PTSD and alcohol dependence.

Feeling ok vs feeling better

1:20 pm Comments Off

“The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally”

Last month, I ran a seminar entitled “Embracing change” at a London-based small animal hospital that had recently been acquired by a corporate. There are so many changes when we join a group with a chain of managers and leaders – new protocols, systems of appraisal, pricing systems, and so on.

What do you enjoy doing?
One of our sessions was a contemplative session, where we pose a question and then spend some time in quiet contemplation and stillness thinking about our answers. The question I put to the group was this: “In your precious little free time, do you spend time doing what you enjoy? Or doing what will make you feel better?”

There’s obviously no right or wrong answer here.

We had already learned how to be non-judgemental that day, so there was no self-judgement or self-criticism when we were thinking about how we spend our time away from the practice.

Looking at our answers with clear fresh eyes and curiosity allows us to think factually: what activities do I spend time doing? Then, emotionally: do I enjoy them? And lastly: do they make me feel better afterwards?

Looking at our answers with clear fresh eyes and curiosity allows us to think factually: what activities do I spend time doing?

There was an amazingly lively discussion afterwards. I didn’t suggest what the nuanced differences might be between the two ways of spending time. This was an open discovery of each other’s interpretation of the question.

Some of the delegates felt that the way they spend their time does indeed make them feel better in the long run. Others felt that their own activities and pastimes perhaps didn’t actually result in greater contentment and happiness afterwards, although they were truly enjoyable at the time.

Most delegates, including myself, enjoy the odd binge-watch of our favourite series, beer and curry in hand, followed by sprawling out on the sofa in delicious escapism from the hectic emotionally exhausting practice. Most of us also enjoyed walks in the fresh air, some of us enjoyed exercise, and others reading, cooking, and so on.

The difference was this: the delegates who felt that their activities outside of work resulted in an overall improvement in their mood were typically the people who were exercising, playing tennis, playing music, meditating, journalling, reading, etc, whereas those of us who were enjoying our binge-watching Netflix, eating ice cream and finishing off the bottle of wine knew in our hearts of hearts that it didn’t necessarily result in an improvement in our mental well-being.

True self-compassion is improving your mental well-being from low to good to fantastic, and then reinforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place

Improving your mood doesn’t need to be reserved for when you’re feeling low or stressed. True self-compassion is improving your mental well-being from low to good to fantastic, and then reinforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place.

Staying non-judgemental, there’s nothing wrong with slobbing out on the sofa and being entertained by streaming networks or drinking alcohol. We knew that. However, it’s a temporary “fix”, not an “improver”.

So, if it’s clear to us what makes us feel better and which activity provides a band-aid to our mood, why is it that some of us choose the latter instead of one of the options which will improve our overall well-being?

We decided it was because often those activities require effort.

What is effort?
It’s putting our mental and often physical energy into something. Sometimes it’s quite unpleasant, like that extra spin class you shoe-horned into your week, or maybe it’s getting up earlier than we want in order to meditate. It might be having water instead of beer. It may also be doing guitar practice when we desperately want to be horizontal instead.

Other times, the means is as enjoyable as the end. In other words, the effort is pleasant, such as having a bath with candles and gorgeous bath foam or sitting in the garden leaving all technology indoors and on silent.

Whether we choose to make more effort or not is our individual choice. Maybe we will only make an effort when our mood is low, and we have a wake-up call that those meditations we did last month aren’t having the same effect now as they did then.

The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally. Maybe activities like running, meditation, piano practice and mindful reading are more enjoyable for some and more exhausting for others. After all, that’s the way life and personalities are.

Happiness is not ready-made; it comes from our own actions

The Dalai Lama
How do I do it?
It’s easy to make a list of “Things which make me feel better”, and to try to dip in and out of it regularly.

It’s important to notice how you feel prior to the activity, during it and afterwards. I usually can’t be bothered to go for a run after work. But once my trainers are on and I’m out the door, it’s “Oh my goodness this is amazing! I feel fantastic! What a treat.” Then afterwards, once the gasping for breath has settled and the muscle aches are setting in, I notice that I have done something for myself which required a hell of a lot of effort, and now I am high on endorphins and I’ll be congratulating myself on being that little bit fitter for the next few days.

Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practise guitar and meditate every day

Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practise guitar and meditate every day, I’m guessing. So, having plenty of activities to choose from means we never need to feel guilty for not doing everything on the list.

Conversely, if the list has only two to three things on it, we may feel obliged to do all three every day before we switch off. That’s unhelpful pressure and will probably end in our giving it up due to repetition and boredom. Most people will have 8 to 10 things that make them feel better. Getting started simply involves writing the list and noticing.

Book Release

7th September 2023 5:29 pm Comments Off

I’m so excited to share with you that my new book is now available on Amazon. All royalties are being donated to Vet Life and also to the provision of free of charge therapy for veterinary nurses in crisis.
It costs the same as half of 1 counselling session.
It is claimable as CPD, so it’s tax deductible and you can use part of your CPD allowance to buy it.
I hope you enjoy.

https://amzn.eu/d/3kJMfcz

From the Back Cover
Explore practical strategies for mental wellbeing across the veterinary professions

Mental Wellbeing and Positive Psychology for Veterinary Professionals: A Pre-emptive, Proactive and Solution-based Approach delivers a practical, hands-on guide to mental health and resilience for individual members of the veterinary professions and for those managing entire practices. Divided into 6 sections, the text offers valuable tools, including meditation, mindfulness, and positive psychology, to help readers grapple with the mental challenges presented by veterinary practice. The author has also included a series of case studies and anecdotes from her experience in counselling members of the professions, including a new-graduate vet, a specialist surgeon, and a head nurse, as they encounter issues like anxiety, compassion fatigue, fear of failure, imposter syndrome, and grief. By learning in advance about the common hurdles they will face during their careers, the reader will discover how to prepare for these in positive and proactive ways.

Readers will also find:

A thorough introduction to effective strategies for dealing with the difficulties of the veterinary professions, including mindfulness, empathy, and emotional intelligence
Comprehensive explorations of meditation, including body scan meditation, breath meditation, imagery, and mini-meditations
Practical discussions of specific challenges faced by veterinary practitioners, including moral injury, client complaints, burnout, imposter syndrome, and a loss of confidence
Fulsome case studies, including a veterinary nurse’s journey to mental wellbeing
Dr. Laura Woodward is well positioned to write on the topic, as both a working veterinary surgeon and an accredited counsellor and has crafted a text that is perfect for veterinarians, veterinary nurses, and practice managers. Mental Wellbeing and Positive Psychology for Veterinary Professionals will also benefit veterinary students, student veterinary nurses, and teaching staff seeking a comprehensive resource for veterinary mental health.

About the Author
Laura Woodward, MVB; CertVR; CertSAS; Dip Couns; MRCVS is the Founder of a counselling and mindfulness practice for veterinary professionals and also a surgical veterinarian at the Hampstead Village Vet Hospital in London in the United Kingdom. She is also mindfulness teacher, a positive psychologist, and is training to be an equine psychotherapist.

The Author has assigned a share of their Royalty to Vetlife and another to free of charge therapy for Veterinary nurses

Stress and Psychoneuroimmunology

1st July 2023 3:20 pm Comments Off

What is stress?
More importantly, what is stress to you? What is your stress at the moment?
The word ‘stress’ is such an all-encompassing word. A single word for the effects the world is having on different people in monumentally different circumstances at the same time.
These people might be working in a busy veterinary hospital, they may be the owners of the pets in that hospital, they may be crossing the channel in an inflatable dinghy, they may teachers in the US worried about gun crime, they may be hospital patients themselves.
In his book Full Catastrophe Living, Jon Kabat-Zinn tells the story of how he tried and tried to change the title of the first draft of the book over a decade ago. He just couldn’t find a name for the vast array of difficult experiences and stresses a human will come across in their life apart from ‘The Full Catastrophe’.

In Buddhist teachings, we learn about The Four Noble Truths which contain the essence of the Buddha’s teachings. It was these four principles that the Buddha came to understand during his meditation under the bodhi tree.

The truth of suffering (Dukkha)
The truth of the origin of suffering (Samudāya)
The truth of the cessation of suffering (Nirodha)
The truth of the path to the cessation of suffering (Magga).

Suffering, The Full Catastrophe and Stress, these are all words which by their nature will describe complex scenarios and emotions.
But the simplicity of at the heart of this word search is apparent: we are trying to unify a multitude of human experiences and responses in life and describe them with a single word or phrase. We’re communicating a distress.

Being stressed is neither right nor wrong. Feeling like you shouldn’t be stressed about work when others are less stressed about their life difficulties is being judgmental and self-deprecating and not helpful.

Stress can originate from a huge variety of sources and can be felt in our head, our stomach, our chest our mind. It will revisit us many times a day in all its various forms.
If we accept that life will have stressful events, we can work with it effectively rather than exhausting ourselves trying to fix it, avoid it or prevent it.
If the Buddha was able to break down the human existence into four truths, maybe we can look at stress in this way too. Most of us like flow charts, spider diagrams and spreadsheets.

Chicken and egg question
So, is stress the cause of our rapid heart rate? Or is stress our rapid heart rate in response to something that is happening?
In other words, which came first? Do I feel stressed which makes my case difficult? Or is that case a stressful case causing me distress?
In realty, the stress and the stressors are interconnected and inseparable.
So, in order to decrease the discomfort, maybe we need to identify and face the event or the fact (the stressor) and then examine our responses to it (the stress).

To make it a bit more complicated, sometimes the stressor comes from within us rather than being an external event or situation. For example, my ruminations may be causing stress. My thoughts may be rational, or irrational (based on statistics) and cause me stress.
It can take a bit of work to identify what’s what. It can take days with our eyes closed, sitting on the cushion to untangle the plethora of stressors, catastrophes and sufferings.

Using mindful curiosity, along with a willingness to explore with fresh eyes, we can untangle the stressors, the responses, the internal and the external. The untangling in itself is a valuable and fruitful exercise.
Some people, me included, find it easier to triage the stressors and identify the stressful emotions with pen and paper. The flow diagrams, strategies, pros and cons lists are some methods which can help.

If you enjoy running on adrenaline and caffeine, and many of us do, what’s the appeal of leading a less ‘stress-filled’ life when we’re happy as we are?

Psychoneuroimmunology

Hans Selye said “Between stimulus and response there is a space. In that space lies our freedom to choose our response, and therein lies our freedom”.

He also proposed that long-term exposure to stressors without our learning how to alleviate their effects on our bodies and our minds could compromise our immunity and therefore lead to decreased resistance to viruses and bacteria.
We now know so much more in the field of Psychoneuroimmunology, (PNI), but Hans Selye said it first.

The upside of this is that if we learn to adapt to the inevitable and varied stressors in our lives, if we manage to experience joy despite experiencing hassle at the same time, we will feel less daunted by the shock of the next stressor coming around the corner at us and the one after that and the next one etc.

We will also fight off viruses, SSI’s and the debilitating effects of arthritic pain better than if we don’t learn to adapt.

“We cannot stop the waves, but we can learn how to surf” Jon Kabat-Zinn

Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient’s neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient’s emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates.(1)

A young friend of mine was recently diagnosed with chordoma of C1-C2: a locally invasive tumour expanding rostrally into her pharynx from her upper cervical spine.
The statistics for this don’t exist, just a few case reports it’s so rare.
She was given the choice of having her upper cervical spine removed through her mouth or allowing the tumour to progress.

It would involve many teams of surgeons and anaesthetists, a day and night in theatre, fusion of her remaining cervical spine to her skull, tube feeding, maybe a tracheotomy. Heart attack, stroke and death were all possibilities.
Why was she encouraged to go through this by the surgical, oncological and anaesthetic teams?
It was because they had got to know her. This woman is strong, determined, unshakeable. They new her life story and realised that she had been surfing the waves of life her whole life. Ironically, when we swim in the sea, she prefers to stay in the shallows.
But whatever life had thrown at her, she had faced it with profound self-awareness and the ability to accept stress as part of the normal human existence without detracting from her happiness and enjoyment of life running beside the stressors in parallel.

Once she had decided to go ahead with the surgery, word of her courage and determination got around the London medical world.

The world-renowned surgeon who had written and co-written those few case-reports heard about this woman who takes on stress and challenges and surfs with them, and he decided he would cherry-pick this case for himself. He swooped in and took it from the original surgeons. He knew that attitudes like hers get results.
It’s a happy story about an amazing woman who defied all the odds, came through the most ambitious of surgeries, and stunned the medical teams with her rate of recovery.

We’re not all built like that. Her grit and determination to fight for life and to be there for her family is legendary and inspirational.
The moral of the story, however, is that, if we can allow our stressors to be recognised and acknowledged, if we can accept that they may cause us stress, suffering and the full catastrophe, we can learn to surf the waves without being shocked or surprised that they keep on coming like a good beach in Cornwall.
That will subconsciously build up our resilience and inner strength, so that when bigger stressors come along, we might be pulled under temporarily only to resurface nearer to the beach, rather than succumb to a tsunami and go under for ever.

Tagge EP, Natali EL, Lima E, Leek D, Neece CL, Randall KF. Psychoneuroimmunology and the pediatric surgeon. Semin Pediatr Surg. 2013 Aug;22(3):144-8. doi: 10.1053/j.sempedsurg.2013.05.002. PMID: 23870208.

Feeling Good vs Feeling Better

3:03 pm Comments Off

Last month I ran a seminar entitled “Embracing Change” at a London based small animal hospital which had recently been acquired by a corporate.
There are so many changes when we join a group with a chain of managers and leaders. New protocols, systems of appraisal, pricing systems, etc.

One of our sessions was a contemplative session i.e., where we pose a question and then spend some time in quiet contemplation and stillness thinking about our answers.

The question I put to the group was this: “In your precious little free time, do you spend time doing what you enjoy? Or doing what will make you feel better?”

There’s obviously no right or wrong answer here.
We had already learnt how to be non-judgmental that day, so there was no self-judgment or self-criticism when thinking about how we spend our time away from the practice.
Looking at our answers with clear fresh eyes and curiosity allows us to think factually: What activities do I spend time doing?
Then emotionally: Do I enjoy them?
And lastly: Do they make me feel better afterwards?

It was an amazingly lively discussion afterwards. I didn’t suggest what the nuanced differences might be between the two ways of spending time. This was an open discovery of each other’s interpretation of the question.

Some of the delegates felt that the way they spend their time does indeed make them feel better in the long run.
Others felt that their own activities and pastimes perhaps didn’t actually result in greater contentment and happiness afterwards although they were truly enjoyable at the time.

Most delegates including myself enjoy the odd binge watch of our favourite series, beer and curry in hand, followed by sprawling out on the sofa in delicious escapism from the hectic emotionally exhausting practice.
Most of us also enjoyed walks in the fresh air, some of us exercise and others reading, cooking etc.

The difference was this: the delegates who felt that their activities outside of work resulted in an overall improvement in their mood were typically the people who were exercising, playing tennis, playing music, meditating, journalling, reading etc. whereas those of us who were enjoying our binge watching Netflix, eating ice cream and finishing off the bottle of wine, knew in our hearts of hearts that it didn’t necessarily result in an improvement in our mental wellbeing.

Improving your mood doesn’t need to be reserved for when you’re feeling low or stressed. True self compassion is improving your mental wellbeing from low to good to fantastic, and then re-enforcing that strong, unwavering contentment and joy by continuing the activities which improved it in the first place.

Staying non-judgmental, there’s nothing wrong with slobbing out on the sofa and being entertained by streaming networks or drinking alcohol etc. We knew that. However, it’s a temporary ‘fix’ not an improver.

So, if it’s clear to us which makes us feel better and which provides a band-aid to our mood, why is it that some of us choose the latter instead of one of the options which will improve our overall wellbeing ?

We decided it was because often those activities require effort.

What is effort?
It’s putting our mental and often physical energy into something. Sometimes it’s quite unpleasant like that extra spin class you shoe-horned into your week, or maybe it’s getting up earlier than we want in order to meditate. Or it might be having water instead of beer. Or it might be doing guitar practice when we desperately want to be horizontal instead.
Other times, the means is as enjoyable as the end. In other words, the effort is pleasant. E.g. having a bath with candles and gorgeous bath foam or sitting in the garden leaving all technology indoors and on silent.
Whether we choose to make more effort or not is our individual choice. Maybe we will only make an effort when our mood is low and we have a wake-up call that those meditations we did last month aren’t having the same effect now as they did then.

The people who continue to feel fantastic no matter what life does or doesn’t throw at them are probably making more of an effort than the people who feel great occasionally, Maybe the activities like running, meditation, piano-practice, mindful reading etc. are more enjoyable for some and more exhausting for others, that’s the way life and personalities are.

How do I do it?
It’s easy to make a list of Things Which Make Me Feel Better, and to try to dip in and out of it regularly.
It’s important to notice how you feel prior to the activity, during it and afterwards. I usually can’t be bothered to go for a run after work. But once my trainers are on and I’m out the door, it’s “oh my goodness this is amazing, I feel fantastic, what a treat”, then afterwards once the gasping for breath has settled and the muscle aches are setting in, I notice, I have done something for myself which required a hell of a lot of effort, and now I am high on endorphins and I’ll be congratulating myself on being that little bit fitter for the next few days.
Choosing different things off the list keeps it fresh and varied. We’re not going to run, cook healthy food, practice guitar, and meditate every day I’m guessing. So, having plenty of activities to choose from means we never need to feel guilty for not doing everything on the list.
Conversely if the list has only 2-3 things on it, we may feel obliged to do all three every day before we switch off. That’s unhelpful pressure and will probably end in our giving it up due to repetition and boredom.
Most people will have 8-10 things which make them feel better.
Getting started simply involves writing the list and noticing.

“Happiness is not ready made; it comes from our own actions”.
The Dalai Lama

Guilty pleasures

20th October 2023 1:34 pm Comments Off

“When you feel guilty but haven’t harmed anyone, you’re just in the realm of perfectionism or criticism”

In 2012, Goldsmith et al. observed how guilt, which is looked upon as a negative emotion, can have a positive effect by enhancing the enjoyment of a particular “guilty pleasure” (Goldsmith et al., 2012). These pleasures were viewed as hedonistic – as something the world would judge us poorly for doing – by the consumer. We decide we should feel shame for doing, eating or drinking it.

Some participants in the study were primed to feel guilt, others to feel angry or disgusted, while another group were not primed, although none of the groups were aware of this. Then they were allocated various activities, including binge-watching films, browsing dating websites and eating chocolate. The study found that, relative to no priming or negative priming, the negative emotions of anger and disgust decreased the pleasure of the activity, while guilt enhanced it.

[Guilty] pleasures were viewed as hedonistic – as something the world would judge us poorly for doing – by the consumer. We decide we should feel shame for doing, eating or drinking it

So, if guilt enhances pleasure, the marketing strategists are having a field day! Tobacco companies must have read this study and complied joyfully with the pictures on the packets that make smokers feel guilty for smoking. It makes the smoke all the nicer, it seems. In fact, another article shows that incidental exposure to “no smoking” signs ironically boosts cigarette-approach tendencies in smokers (Earp et al., 2013). Thus, anti-smoking and other public health campaigns may ironically increase the very behaviours they seek to reduce.

However, in another study, researchers demonstrated that participants who naturally associated eating chocolate cake with guilt had less belief in their self-control than the people who associated eating cake with positive feelings, such as celebrating (Kujier and Boyce, 2014). So, although the cake brings us more pleasure, it brings us poorer mental well-being because of our guilt, which makes us judge ourselves as weak and lacking in self-control. The authors observed: “Participants with a weight-loss goal who associated chocolate cake with guilt were less successful at losing weight over a three-month period compared to those associating chocolate cake with celebration.”

Anti-smoking and other public health campaigns may ironically increase the very behaviours they seek to reduce

Why am I telling you about this research?

It’s not to ruin your cake eating, honestly. Rather, it’s to enhance it.

Eating cake can bring us huge amounts of pleasure: it’s delicious, it’s sometimes celebratory and it’s social when at communal gatherings like teatime. Guilt, by definition, should be a term reserved for when one’s actions harm another. So, any guilt we associate with this sweet snacking is misplaced guilt. Dr Kristen Neff, an associate professor at the University of Texas at Austin, said: “When you feel guilty but haven’t harmed anyone, you’re just in the realm of perfectionism or criticism.”

Women are more likely than men to feel this misplaced guilt. Society has historically demonised women’s pleasure, even with food. A 1999 study showed that 50 percent of Japanese women associated high-fat foods and cake with guilt compared to only 9 percent of Japanese men (Rozin et al., 1999).

If you are medically overweight, cake is still appropriate to eat. If you’re trying to lose weight, it’s still possible (from the evidence) to have some cake and lose weight, so long as we knock guilt out of the experience. Diabetes no longer means that eating cake is risky now that we have insulin pumps, continuous glucose monitors and, most recently, systems that combine a pump and monitor for algorithm-driven automation of insulin delivery.

The true questions are:

Can we adjust our way of thinking?
Can we change from guilt to celebration?
Can we go from shame to self-compassion?

It isn’t rocket science or magic. It simply takes some time and mental effort to choose to make this change.

What’s the evidence?

Pleasure is not sinful, impure nor overindulgent. And the evidence base is there (because in our veterinary world, we need evidence to make a change).

Eating mindfully, non-judgementally and in a self-compassionate way can help one cope with symptoms of anxiety and depression

In 2015, a study reported that eating mindfully, non-judgementally and in a self-compassionate way (Körner et al., 2015) can help one cope with symptoms of anxiety and depression. Self-compassion, we already know, is a protective factor against depression.

Final thoughts

I meet many people in therapy who are high achievers, apparently successful, happy, beautiful and in great physical shape. But sometimes achieving gets in the way of enjoying, and self-judgement gets in the way of self-compassion. It is possible to have achievements, enjoyment and self-compassion all running together, and it takes effort.

My son asked me to buy him a giant jar of Nutella last week. He’s studying hard for exams and is generally a lovely person to me, his sister and everyone else. I bought it for him, and the first thing I did was dip a spoon into its sheen of deliciousness and eat it. I practise authentic self-compassion, I felt no guilt or shame, just joy and pleasure as I ate it mindfully. It was a true nutty chocolate paradise. I go to the gym because I want to be fit and healthy. They are very compatible side by side. One without the other would decrease my growth and my experience of life and simple pleasures.

Acceptance and commitment therapy: insomnia and anxiety

1:32 pm Comments Off

Acceptance and commitment therapy for insomnia lessens the brain’s level of nocturnal arousal, encouraging a state of rest rather than a state of insomnia

We’re constantly being told we have to strive to be happy, “turn that frown upside down” or – my personal favourite – “cheer up, love – it might never happen”. Consumerism aims to make us happy, and product design is there to make us feel better. So, it’s unsurprising that we subconsciously decide that feeling happy is “right” and feeling unhappy is “wrong” or something which must be changed to restore order.

Teaching the four noble truths, the Buddha tells us suffering is normal: an unavoidable part of being human. So, what does this mean? Should I sit here miserable and never try to feel good?

No, not at all.

The pressure of happiness

I was speaking with a client recently. It was her first session in therapy, and she was understandably nervous. “The goal,” I said, “isn’t to make you happy. It’s to help you to notice when you’re not happy and to be OK with it”.

After I said this, she told me that suddenly a pressure was lifted: she had been yearning and striving for most of her adult life to “be happy”. She felt obliged to be happy for her family, who had invested so much time and effort into helping her achieve her dream of becoming a vet. But then, here I was, saying she could take the lows with the highs and relax a bit.

The non-judgemental part of mindfulness allows us to see our thoughts and feelings with fresh eyes and not to place them into the “good” or “bad” category – they just are

The non-judgemental part of mindfulness allows us to see our thoughts and feelings with fresh eyes and not to place them into the “good” or “bad” category – they just are. If we are truly focused on our thoughts and feelings, we’ll see that we can have many feelings all going on simultaneously: some upbeat and some downbeat.

Every lifetime, every year, every day, there are going to be difficult times, thoughts and feelings, and there are also going to be joyful times, thoughts and feelings. It’s like running for a bus in the rain. You race through the downpour without an umbrella, splashing through puddles in your sandals, and you manage to get on the bus just the second it leaves; you’re delighted you made the bus and you’re soaked through and miserable at the same time.

ACT for anxiety

In the early 1980s, Steven Hayes developed “ACT” or acceptance and commitment therapy (which we have discussed in a previous article on re-entry anxiety post-COVID). During this, he observes that it’s not just what you feel and think that matters – it’s more important to notice how you relate to those thoughts and feelings.

It’s not just what you feel and think that matters – it’s more important to notice how you relate to those thoughts and feelings

ACT has many applications in therapy. Large randomised controlled trials have provided the evidence base for its application in the treatment of depression, anxiety, addiction, insomnia, chronic pain and cancer. But it can also be used with many other difficulties, such as psychosis, stigma, fear of failure and grief.

Anxiety is often due to a lack of psychological flexibility. It’s an inability to come into the present moment and open up to your emotions; to see your thoughts as they are and accept them rather than judging them as too unpleasant to bear.

ACT teaches you to focus on what’s really important to you so you can proceed towards it rather than being paralysed by anxiety. You can develop a sense of self beyond the limited story you’re used to telling about yourself and others – the one that gets in the way.

Carrying on with your day while shouldering these feelings of anxiety and panic isn’t easy, and it takes enormous courage, discipline and practice.

ACT-i

Continuing with ideas of increasing your psychological flexibility, acceptance and commitment therapy for insomnia, or “ACT-i”, aims to increase people’s willingness to experience the conditioned psychological and physical discomforts of being unable to sleep. Paradoxically, this acceptance lessens the brain’s level of nocturnal arousal, thus encouraging a state of rest and sleepiness rather than a state of arousal and insomnia.

Natural sleep involves a slowing down of the psychological pressures and tasks of our daily life at the end of the day. This includes problem solving, social interactions, decision making and being alert, and also a slowing down of physiological parameters, such as heart rate, breathing rate, blood pressure, bowel movements and muscle tone.

Paradoxically, [ACT-i] lessens the brain’s level of nocturnal arousal, thus encouraging a state of rest and sleepiness rather than a state of arousal and insomnia

On the other hand, insomnia is a difficulty with sleeping that typically involves hyperarousal and worry about not sleeping, which causes more arousal leading to even more poor sleep. It is our unwillingness to experience the unwanted thoughts, emotions and physical sensations associated with not sleeping and the ensuing struggle with them that heightens our arousal levels and perpetuates sleeplessness. We’ve all been there – you’re so fed up with lying awake that you can’t let go of that annoyance which also keeps you awake.

So, how can mindfulness help? Well, mindfulness is focusing on the present moment non-judgementally. In other words, it is the ability to objectively and non-judgementally take notice of your internal and external experiences as they unfold.

Mindfulness in conjunction with ACT can help insomniacs stand back and observe their level of wakefulness, unwanted thoughts and emotional reactions without becoming overly entangled with them or judging them – a quality inherent in the normal act of falling to sleep.

How do I do it?

Simple body scans and breath meditation techniques are a great place to start.

However, during these, your active mind might notice that it doesn’t feel sleepy yet. It can become the judgemental voice in your exhausted head and shouts that because it isn’t asleep yet, you must be trying to trick it, so it judges it all as a sham.

[Your active mind] can become the judgemental voice in your exhausted head which shouts that because it isn’t asleep yet, you must be trying to trick it, so it judges it all as a sham

Using these techniques, noticing the thoughts and feelings that arise when you find you’re still awake, and, most importantly, not judging them as wrong but instead accepting that they exist, is a worthwhile direction to take towards what seems to be that elusive good night’s sleep.

A path out of abuse – lessons from Tina Turner and her Buddhist faith

1:24 pm Comments Off

“People around the world have gleaned solace and comfort from Tina’s story, and many have subsequently found the huge burst of courage it takes to say that enough is enough”

Tina Turner, the legendary rock star with an iconic gravelly voice and lyrics which stick in your head, credited her Buddhist faith with giving her the physical and emotional strength to leave her abusive husband, Ike.

People around the world have gleaned solace and comfort from her story, and many have subsequently found the huge burst of courage it takes to say that enough is enough.

“She was my strength when I left my abuser,” former journalist Laura Keeney wrote while tweeting a Turner obituary, “and she introduced me to Buddhism as a balm for my soul.”

Abuse may not be obvious

Being in an abusive marriage or relationship eats you up from the inside out. It’s not just impoverished, uneducated victims who find themselves in the grip of an abusive partner. So often, it’s smart, previously upbeat and strong individuals with a relationship that looks solid from the outside who are suffering desperately behind closed doors.

Ike and Tina were spellbinding together when on stage. Their relationship looked amazing from the outside. The abuser can be the most charismatic of hosts in the home when the door opens to guests, and a monster behind closed doors once the guests leave and they turn their charm off like a light switch.

Abuse can be physical, sexual, emotional or financial, or a combination of any of these.

The abuser is often so controlling that their victim is too scared to leave or to call out their behaviour. Often it seems easier to just stay silent and hope for a better future.

The constant put-downs, gaslighting, insults and rage attacks can make the victim feel weak and terrified, especially when there are children involved. And this is why the cycle of abuse, terror and loneliness continues: because the victim is trying to make it OK for them or for their children. They are scared to tell anyone because the abuser will punish them even more.

“I was afraid to put it out [talk about the abuse] because of what I would get from Ike,” Tina told journalist Carl Arrington. Ike Turner denied he had abused Tina even though he freely admitted that he would “slap her about if she was sad”.

Sometimes the perpetrator is adamant that they are not abusive, often to the extent that they will go on a campaign of winning the hearts and minds of anyone who will agree with them that their actions aren’t defined as actual abuse.

If you’re a seasoned abuser, you can easily become so good at reinventing your private and past self to others that you start to believe your own lies. When this happens, even the abuser suffers because they can’t see themselves for the person they are. Ike claimed that slapping someone for being sad was not abusive.

So, when it becomes public that someone is abusive, the gaslighting continues because the victim gets further abuse for using the word “abuse”. A common defence from the abuser is to tell their victim that they’re losing their mind. It’s called gaslighting and it is the narcissist’s favourite tool.

Gaining strength from Buddhism

Tina Turner is not the only woman to gain enough strength from Buddhism to leave her violent husband.

Meditation helps us to gain focus when we’re reeling from yet another shouting match (which is an ironic phrase because “match” indicates that the shouting is back and forth, and usually it’s completely one-sided).

When we learn to clear our rollercoaster mind, we can see more clearly what we’re enduring

When we learn to clear our rollercoaster mind, we can see more clearly what we’re enduring. Once the fog has cleared, we need to begin the process of forgiving ourselves for getting into this situation. By being self-compassionate, we may be experiencing compassion for the first time.

Tina Turner was introduced to Valerie Bishop, who practised Nichiren Buddhism, by her ex-husband and abuser Ike. Nichiren Buddhists often chant “nam-myoho-renge-kyo” which expresses devotion to the laws of cause and effect. This chanting can be calming for the mind when in turmoil.

She chanted and practised meditation right up until her death in May, and many times said that it was her faith that gave her the courage to save herself from Ike. Not only did she send him packing, but since that day her strength grew and flourished in an exponential way through positive psychology, and her story empowered so many people to also say, “I can have a better life than this” and to leave their monsters.

In Daniel Lindsay and T J Martin’s 2021 documentary Tina, the singer said she was so nervous about doing the interview where she would describe the abuse she had suffered that she asked her psychic if it would ruin her career.

The singer recalled, “She [the psychic] said, ‘No, Tina, it’s going to do just the opposite. It’s going to break everything wide open.’”

And it gained her the added adulation of many tens of thousands of people suffering domestic abuse.

Abuse of another person is wrong. No two ways about it. Abusing someone and not admitting that it’s abuse is narcissistic. Telling a victim that you didn’t abuse them when you did is gaslighting and abusive.

These days it’s even more appropriate to call this behaviour out in the public domain. Children know it’s wrong and they are insightful enough to know what’s abusive and what’s not.

But there will always be what’s called “victim blaming”, where people under the influence of the charismatic abuser tell the victim that somehow it’s their fault their partner became abusive. And the perpetrator claims they can’t help beating, shouting or cheating on the victim because “they made me do it” or some other phrase that they feel makes them blameless. Hard to believe, I know.

Buddhism teaches us to look at the present rather than rehashing the past or getting preoccupied with the future. Only through focusing with pinpoint concentration on your present reality can you assess what’s happening and where you are.

But it’s so hard and sometimes impossible to use breathing or body scan techniques to calm the mind to bring us into our present. While in the foggy world of domestic abuse, our minds are all over the place, in survival mode.

When in turmoil because of abuse, sometimes chanting is the only way to still the mind. Alcohol only numbs it temporarily. Tina used chanting. Repetitive and melodic, it is soothing and possible.

With a clear mind, getting rid of the abuser becomes something very feasible. It’s like looking down on your life from above and it becomes crystal clear what’s happening and what needs to be done. It’s easier than you think.

With a clear mind, getting rid of the abuser becomes something very feasible. It’s like looking down on your life from above and it becomes crystal clear what’s happening

Once liberated, instead of looking backward, you can experience the delightful feeling of freedom in every fibre of your being, and done daily, that brings even more strength and creates a life well lived.

“I was living a life of death. I didn’t exist,” she said. “But I survived it. And when I walked out, I walked. And I didn’t look back.”

Ukraine War and How It Affects Us

30th April 2022 10:33 am Comments Off

Just as we were getting over Covid…………………… Putin messes it all up.

Most of us were affected emotionally at least on some level by the pandemic.

So much has been written about the mental health impact of it, including here.

And then, just as the world could look up, de-mask and breathe a sigh of relief filled with common humanity and the potential of connecting with our fellow humans around the globe in collective recovery………………….Putin ordered his troops into Ukraine.

We don’t know what the orders were. Some say the Russian soldiers were told they were just in training exercises. In any case, there is now a new and horrible collective grief and horror at the suffering, death, and destruction caused by the war in Ukraine.

Some of us thrived despite the Coronavirus Pandemic. Through huge efforts and work on our mental wellbeing, we quickly learned to accept that it was a reality. Acceptance, as I have written about here before, is a key part of having emotions while not suffering because of those emotions.

So we learnt acceptance.

Accepting our emotions and allowing them to just sit there within us instead of pushing them away or shoving them into our box of ‘never to be revisited feelings’ , is way more effective than resisting them.

You know when you try not to feel something like anxiety or sadness, it just comes back bigger and stronger to get you.

Even if you assume zombie, emotion-less mode through alcohol or drugs or even just through binge-watching Netflix, once the numbness wears off, it still hurts, and sometimes it hurts even more because we haven’t accepted any of the pain.

This war is different on so many levels albeit it is still another global crisis.

For one thing, this time there is a perpetrator.

So while our minds have to deal with familiar emotions like anxiety, fear, and despair. We now have anger to add to the mix. Helplessness, hopelessness, and guilt are in there too.

The Three circles of control

There is a prayer called the Serenity Prayer which is by far one of the most famous prayers that were written in the 1800s by Reinhold Niebuhr (1892-1971).

Its popularity grew even more in the 1940s when Alcoholics Anonymous took up using a shortened version for its recovery program.

The Serenity Prayer

God grant me the serenity

To accept the things I cannot change;

Courage to change the things I can;

And wisdom to know the difference.

Living one day at a time;

Enjoying one moment at a time;

In Counselling Psychology, there is a concept called circles of control, that helps us to understand and reflect on how close things that affect us are to our influence.

The idea here is that some things – many things happen that are entirely beyond your influence, so your energy is better focused on things that you can influence.

In the central circle are things that we can control. Although it may take effort and instruction, we can make changes here for the better. This includes the most important thing of all: our mind.

With good instruction, we can change our minds. Mindfulness can rapidly move our chaotic way of thinking and reflexive way of behaving into an easy and methodical way of thinking and a way of behaving which is reflective rather the reflexive. I.e. we decide our reactions to things.

“Between every action and our reaction, there is a space. In that space lies our freedom to choose”.

– Viktor Frankl

The middle ring contains things over which we have a small amount of control. This will include many things: our friends, family, jobs, habits, and daily life. Through compassion, self-compassion, kindness, and purposeful actions, we can have an enormously beneficial effect on the people around us. Sometimes just giving off good vibes can be palpably calming for those around us. Other times, a change in our daily habits can turn our profound sadness into joy. I say this from the experience of experiencing horrific tragedy and soon afterward feeling blissful about tiny things surrounding me.

The outer ring is made up of things we cannot control.

Vladimir Putin is going to pursue his military agenda whatever you or I think, do or say, so this sits in our outer circles, beyond any kind of control we might have.

So, how can we just accept it?

We see the Ukrainian people resist and fight back with unfathomable resilience and bravery.

The public awareness thanks to Zelensky keeping Ukraine in the forefront of the minds of everyone around the globe is phenomenal.

We’re angry and want to se Putin accountable.

Acceptance is not about sitting here like a blancmange doing nothing and saying “Que sera, sera”.

It’s not about being complacent and ineffectual.

Acceptance is about feeling that anger and maybe pure unadulterated hatred for the perpetrators of human tragedy, and accepting that we feel that way.

So we can have all that anger within us, for obvious reasons, and still, be kind to those in our inner circle (ourselves) and our middle circle.

We can donate cash with gift aid, we can drive a truckload of blankets to Poland, all the time allowing ourselves to feel anger, grief, and the excitement that comes with being proactive all at the same time.

By accepting our plethora of emotions one by one, maybe we will be more effective and courageous in the long run in changing the things we can and being wise to the things we can’t.

The use of language

22nd September 2021 12:19 pm Comments Off

“Don’t mix bad words with your bad mood. You’ll have many opportunities to change a mood, but you’ll never get the opportunity to replace the words you spoke.” – Unknown

A truly eloquent friend of mine recently asked me“Have you noticed how many people describe being stuck in traffic as a ‘disaster’, or spilling a cup of coffee as a ‘mess’ or (the big one) a case going wrong as ‘devastating’? Well, how’s about being stuck in traffic is a ‘nuisance’, spilling your coffee is a ‘niggle’ and an unsuccessful case is a ‘disappointment’!

His words made me think.

If we make the effort to ensure that our internal monologue is helpful and constructive,(or at least non-damaging), then that’s one less person bringing us down, and also our external words will be helpful and constructive for others.

Internal monologue

Psychologists reckon that only about 1 in 10 of us don’t have a chatter going on in our head for most of the day. It might be a list of things to do, an email we’re composing, a conversation we want to have or wished we’d had anything.

What a fantastic opportunity, therefore, this is to speak kindly to ourselves and to choose our language carefully.

I rarely swear out loud. But internally, when I drop and smash something, or inadvertently lock myself out of the house, or spill tea on my laptop, my internal monologue is the stuff of nightmares.

However, if my friend does the same, or if my kid break plates or the cat spills a pint of water on my electronics, I use calm, reassuring words and tone of voice, because it’s a simple mistake and they may be distressed already.

So why the disparity?

We’ve talked before about treating yourself as you would treat a friend. A helpful practice is to choose the words for our internal monologue as carefully as we would choose words for a friend or our child. Before long, it becomes a habit, so choosing helpful words and phrases for our external voice becomes something we do automatically. As a massive added benefit, the less internal self-flagellation we practice, the better our self-esteem and confidence.

External words to self

There’s little benefit from being attentive to our use of language towards others and congratulating ourselves on our kindness if we call ourselves an ‘idiot’ out loud for forgetting something or if we swear at ourselves when we drop coffee on the carpet. More damaging than the coffee stain on the carpet is the effect it has on our kids and loved ones to hear us berate ourselves if we do it out loud. How can they have healthy self-esteem and feel unjudged if their role model is cursing their own simple mistakes?

External words to others

If you have high levels of Emotional Intelligence, what you say can be profoundly powerful to those around you and to yourself.

Emotional intelligence has five key elements: self-awareness, self-regulation, motivation, empathy, and social skills.

We should ideally be putting all of these into practice each and every time we open our mouths.

With practice, you can run through all these in a few milliseconds.

Self-awareness: how do I feel?

Self-regulation: Am I going to speak to myself or to someone else reactively or after some thought?

Motivation: What do I want to achieve out of this situation?

Empathy: Am I aware of how the other person feels? What type of language will resonate with them? Cognitive empathy is, after all, all about using the language of the other person rather than our own.

Social skills: What tone and volume do I need to use in order to achieve my goal? Is my body language going to reflect what I want to say and how I want to say it?

Let’s take a (potentially unhelpful) everyday situation and apply Emotional Intelligent use of language to it.

So, driving to work in London traffic, can be many different things to different people. For some, it’s a daily, boring, time-wasting source of stress which always takes longer than expected. For others, it’s a chilled alternative to the tube, with music or guided meditation playing, a good coffee sitting in the holder, and a chance to take deep, mask-free breaths.

Someone cuts in front of me from the lane that was for turning right only, then stop while they catch up on their phone.

Self-awareness: I feel angry? Enraged? Vengeful? Non-plussed? Amused?

(or can I take it to the next level and say, “Thank you,” to this driver “for helping me to exercise my patience”? Seriously, every time I try this, I smile).

No emotion is right or wrong. You don’t need to justify why you are feeling it. The exercise is to notice the emotion and put a name on it rather than be carried away by it.

Self-regulation: I could swear internally or externally. I can sit on the horn. I can tailgate that driver for the next mile. I can shrug. I can smile. I can use any words reactively ranging from “bloody idiot” to “meh, Whatever”.

“Between action and reaction, there is a space. In that space lies our freedom to choose”

– Hans Selye

Motivation: here’s the thing. I do want to get to work as smoothly and as quickly as possible (and probably in as stress-free a way as possible).

So, in my experience, shouting and tailgating rarely result in a driver like that moving faster for me or letting me go in front of them because they can sense that I’m in a hurry.

Also, while it may feel that expressing anger and rage will make the stress go away, basic physiology tells us that that’s a fallacy.

So, our internal monologue can be littered with expletives. Try it and monitor your heart rate.

Or you can really thank them for helping you to exercise your patience, notice the breath, lower your shoulders and see if you can lower your heart rate through deep breaths alone.

In reality, if you get to your destination one car length slower than intended, that’s probably “just fine”. Your stress levels are going to be way more significant than the time at the end of the journey.

Empathy: Cognitive empathy, we know, is about communication. Whereas emotional empathy is about relating to how the other person is feeling. So, tailgating this individual will resonate with them because that’s the language they speak, and will effectively communicate that you’re up for this game of caffeine-fueled aggression.

The converse is also true: by not engaging, and not communicating via words or otherwise, your goal of getting to work in a chilled state is more likely to happen. Using your internal monologue of “no problem”, “meh”, “thank you” etc. can help you to achieve this state.

Social skills:

Body language is not just for the benefit of the onlooker.

It goes without saying that aggressive gestures out the window are unhelpful. Also unhelpful is colorful internal monologue describing the characteristics of this driver

A quick body scan where you sit up straight, lower your shoulders, relax your face and jaw, and breathe, calms you while communicating to road hogs that your intentions are different from theirs. An inner monologue of “yeah, okay, whatever” might fit the bill.

“But if thought corrupts language, language can also corrupt thought.”

– George Orwell

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