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By ianfielder, Dec 26 2019 10:45AM

Mindfulness has been widely dubbed a powerful solution for a wide range of issues, from the pressure of a hectic lifestyle to mental health issues. The interest surrounding mindfulness has soared exponentially in recent years, both in the general public but also the scientific community.

As it is thought of in clinical terms, mindfulness is an umbrella term covering a range of different practices, but, as defined by the NHS, generally refers to "paying more attention to the present moment". Mindfulness meditation typically involves a breathing practice, awareness of the body and mind, and muscle relaxation.

This can help people with feelings of depression and anxiety: Professor Mark Williams, former director of the Oxford Mindfulness Centre, states that it "lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply 'mental events' that do not have to control us". This awareness of our emotional symptoms can help us deal with them more effectively.

Scientific evidence shows that mindfulness can have temporary and long-lasting effects on certain regions of the brain, perhaps most specifically on the amygdala. The amygdala is a cluster of nervous cell bodies in the central nervous system, specific to complex vertebrates, and plays a primary role in the processing of memory, decision-making and emotional responses such as fear and anxiety.

A 2012 study performed by the Martinos Centre for Biomedical Imaging involved researchers taking fMRI scans of subjects' brains whilst viewing images with varying emotional content (either positive, negative or neutral) before and after an eight-week training course in mindful attention meditation. While there was no significant effect on the control group, the results showed a decrease in right amygdala response. This implies that mindfulness training can improve emotional stability and response to stress, and that these effects can be long term and manifest even when an individual is not actively practising meditation.

The research into the efficacy of mindfulness can, however, be dubious. Nicholas van Dam, a clinical psychologist and research fellow at the University of Melbourne, has stated that "there are many areas where mindfulness-based programs seem to be acceptable and promising, but larger-scale randomised, rigorous trials are needed". It has also been argued that such practices can be overhyped for financial profit: as the market for meditation-based apps and studios becomes increasingly saturated, it is clear to see that whether mindfulness practices are effective or not, they certainly make for lucrative business.

Many of the problems with assessing the efficacy of mindfulness stem from the difficulty in obtaining reliable data. Sample sizes are often small and therefore not representative, and many investigations lack an adequate control group, meaning that the placebo effect cannot be ruled out. A 2015 review published in American Psychologist reported that only around 9% of research into mindfulness-based interventions that had been tested in clinical trials had included a control group. Furthermore, many previous studies have attempted to analyse the effectiveness of meditation methods by using self-rated measure, but these tend to have heavy levels of bias as the subjects are affected by their own self-perception.

However, there have been concerted efforts to address this. Researchers from John Hopkins University reviewed almost 19,000 studies on meditation practices to find trials which met their rigorous criteria. Out of the 47 trials which met these standards, they found that such programmes can indeed have positive effects on anxiety, depression and pain.

Furthermore, in order to try and quantify the analysis of the effects of mindfulness training, medical imaging techniques may be used. Electroencephalograms (EEGs) can demonstrate objectively that mindfulness practices can have an effect by measuring voltage fluctuations arising due to ionic currents within the neurons of the brain, leading to an assessment of the electrical activity of the brain.

Previous studies have claimed that meditation can be associated with decreased alpha blocking. Alpha waves are neural oscillations with frequency specifically in the range of 8-12Hz, and alpha blocking refers to the disappearance or reduction in amplitude of these waves when an individual is focused on a specific stimulus. This scientifically suggests that mindfulness practices can encourage relaxation. An alternative imaging strategy is functional magnetic resonance imaging (fMRI), which uses magnetic properties of blood haemoglobin to detect areas of the brain with increased or decreased metabolic activity.

This enables researchers to view the effect of mindfulness training on different regions of the brain, and was used to show changes in amygdala activity in the Martinos' Centre's investigation.

And while conclusions regarding meditation may be muddy, a combination of mindfulness training and an artificial physiological input may provide a way to improve cognitive ability. A study carried out by the University of New Mexico on thirty-four healthy participants revealed that combining mindfulness-based training with non-invasive electrical stimulation of the brain resulted in improvements in working memory capacity, though other abilities tested such as sensation were not affected significantly. Further developments into such fields could have applications in the future.

While some of the research into mindfulness is contested, it can be stated with certainty that its practices can reduce symptoms such as stress and depression, while also improving focus. Better research with controlled studies into this alternative therapy may go further to support this in the future.

Published in National Hypnotherapy Society December Newsletter

By ianfielder, Sep 22 2019 12:07PM

Research shows that 'flexible work boundaries' often turn into 'work without boundaries'

Employer expectations of work email monitoring during nonworking hours are detrimental to the health and well-being of not only employees but their family members as well. William Becker, a Virginia Tech associate professor of management in the Pamplin College of Business, co-authored a new study, "Killing me softly: electronic communications monitoring and employee and significant-other well-being," showing that such expectations result in anxiety, which adversely affects the health of employees and their families. "The competing demands of work and nonworking lives present a dilemma for employees," Becker said, "which triggers feelings of anxiety and endangers work and personal lives."

Other studies have shown that the stress of increased job demands leads to strain and conflict in family relationships when the employee is unable to fulfil nonworking roles at home -- "such as when someone brings work home to finish up."

Their new study, he said, demonstrates that employees do not need to spend actual time on work in their off-hours to experience the harmful effects. The mere expectations of availability increase strain for employees and their significant others -- even when employees do not engage in actual work during nonworking time. Unlike work-related demands that deplete employee resources, physical and psychological, by requiring time away from home, "the insidious impact of 'always on' organisational culture is often unaccounted for or disguised as a benefit -- increased convenience, for example, or higher autonomy and control over work-life boundaries," Becker said. "Our research exposes the reality: 'flexible work boundaries' often turn into 'work without boundaries,' compromising an employee's and their family's health and well-being."

As negative health outcomes are costly to them, what can employers do to mitigate the adverse effects identified by the study? Becker said policies that reduce expectations to monitor electronic communication outside of work would be ideal. When that is not an option, the solution may be to establish boundaries on when electronic communication is acceptable during off-hours by setting up off-hour email windows or schedules when employees are available to respond. Additionally, he said, organisational expectations should be communicated clearly. "If the nature of a job requires email availability, such expectations should be stated formally as a part of job responsibilities." Knowing these expectations upfront may reduce anxiety in employees and increase understanding from their family members, he said.

As for employees, they could consider practising mindfulness, which has been shown to be effective in reducing anxiety, Becker said. Mindfulness may help employees "be present" in family interactions, which could help reduce conflict and improve relationship satisfaction. And, he added, mindfulness is within the employee's control when email expectations are not.

Becker, whose research interests include work emotion, turnover, organisational neuroscience, and leadership, is based at Virginia Tech's National Capital Region campus in metro Washington, D.C. "Employees today must navigate more complex boundaries between work and family than ever before," said Becker. "Employer expectations during nonworking hours appear to increase this burden, as employees feel an obligation to shift roles throughout their nonworking time. "Efforts to manage these expectations are more important than ever, given our findings that employees' families are also affected by these expectations."

1st published in the National Hypnotherapy Society newsletter Spetember 2019

By ianfielder, Sep 4 2019 03:28PM

Britain is training record numbers of workplace “mental health first aiders” to confront a sharp rise in people expressing mental distress, though evidence of success is mixed, according to a Guardian study.

Requests sent to every FTSE 100 company show that they alone have trained more than 10,000 staffers, while mid-tier and even tiny businesses are appointing first responders who can be approached confidentially by those with depression, anxiety, stress and other conditions.

A national training body, Mental Health First Aid England, said 140,000 people were trained in 2018-19 – the most ever in a single year, from local hairdressers to employees in global corporations.

Almost half a million people in Britain have now been through an MHFA programme – about one in every 100 adults.

“We have worked in more than 20,000 businesses and organisations,” said its chief executive, Simon Blake. “The exciting thing for me is that training courses are as likely to have someone from a shop in Doncaster as from a City firm.”

In terms of numbers, big firms lead the way. More than half the FTSE 100 companies have mental health first aiders (some call them “buddies”, “champions”, “advocates” or even “be well allies”). Lloyds Banking Group has a programme to train 2,500 by next year, while National Grid and Severn Trent both have more than 1,000

The BBC, NHS and other firms including Goldman Sachs are in on the act. The construction and finance sectors seem particularly keen. Government departments have trained prodigious numbers: the Department for Work and Pensions alone has more than 1,000, according to Blake.

But there is concern that mental health first aiders are being viewed as a panacea when actually their impact can be quite limited.

In a report last year, the Health and Safety Executive concluded: “There is limited evidence that MHFA training leads to sustained improvement in the ability of those trained to help colleagues experiencing mental ill health.” Academic research has found that training is good for raising awareness, but unproven as a strategy for improving mental health.

Experts in workplace health warn that some recruits might not be the best people for what is a subtle role, and warn that first aiders need support and supervision themselves to ensure their own wellbeing. They add that a two-day training course does not produce instant experts.

Alan Bradshaw, a business psychologist, said: “My main problem with it is that organisations see it as a tick in the box. It’s essentially reactive, when what they really need to be doing is the preventive bit, the proactive management of stress risks at work.”

Dr Jo Billings, a consultant clinical psychologist at UCL, said: “There are pros and cons. Anything that raises people’s understanding of mental health is a really good thing. But it’s not sufficient to tackle mental illness in the workplace.”

While some companies may be keen to simply tick boxes, others say that their first aider programmes are part of a bigger strategy. Some offer free subscriptions to digital tools such as Headspace and Unmind. Others provide counselling and cognitive behavioural therapy (CBT) for staff. Many have confidential helplines, often known as employee assistance programmes.

Mental health first aiders volunteer for the role and typically complete a two-day training session. They are not counsellors, psychologists or experts, but simply first responder “listeners” who can signpost services.

Imogen Truphet, who works at the School of Life in London, says the intense two-day course gave her confidence to respond to distressed colleagues without saying the wrong thing.

“You listen without judgment, you give them information and support but you don’t give them advice,” she says. “You encourage them to seek the appropriate professional help – mostly but not always about going to your GP – and encourage them to talk to family and friends.”

Natalie Rose, a wellbeing champion for HS2, says: “The first thing you have to do is listen. Show some understanding, compassion, have patience, point them in the right direction of where they can get some support.”

“If there was someone I was wildly concerned about I would let them know that I had a duty of care to speak to someone else about it. It’s a fine line because we do not replace any trained medical specialists.”

Mental health first aid came to the UK from Australia in the 2000s, but took a long while to take off. Trainee numbers were low until the middle of this decade, when concerns over the sharp rise in the number of people presenting with mental distress prompted a response from business.

Published in the Gaurdian

By ianfielder, Jun 3 2019 06:34AM

Although still not classified as a recognised medical condition, burnout has been included in the World Health Organization’s 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is described in the chapter: ‘Factors influencing health status or contact with health services’ – which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.

Burnout is defined in ICD-11 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

It is identifiable by three characteristics, claims the WHO:

feelings of energy depletion or exhaustion or increased mental distance from one’s job

feelings of negativism or cynicism related to one’s job

reduced professional efficacy

Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life, according to the WHO in ICD11.

The World Health Organization has also announced that is to embark on the development of evidence-based guidelines on mental wellbeing in the workplace.

If constant stress has you feeling helpless, disillusioned, and completely exhausted, you may be on the road to burnout. When you’re burned out, problems seem insurmountable, everything looks bleak, and it’s difficult to muster up the energy to care, let alone take action to help yourself. The unhappiness and detachment caused by burnout can threaten your job, your relationships, and your health. But by recognizing the earliest warning signs, you can take steps to prevent it. Or if you’ve already hit breaking point, there are plenty of things you can do to regain your balance and start to feel positive and hopeful again.

Whether you recognize the warning signs of impending burnout or you’re already past the breaking point, trying to push through the exhaustion and continuing as you have been will only cause further emotional and physical damage. Now is the time to pause and change direction by learning how you can help yourself overcome burnout and feel healthy and positive again.

Dealing with burnout requires the “Three R” approach:

Recognize – Watch for the warning signs of burnout

Reverse – Undo the damage by seeking support and managing stress

Resilience – Build your resilience to stress by taking care of your physical and emotional health

By ianfielder, Mar 20 2019 08:45AM

Most people are moderately responsive to hypnosis. This means they can have vivid changes in behaviour and experience in response to hypnotic suggestions. By contrast, a small percentage (around 10-15%) of people are mostly non-responsive. But most research on hypnosis is focused on another small group (10-15%) who are highly responsive.

In this group, suggestions can be used to disrupt pain, or to produce hallucinations and amnesia. Considerable evidence from brain imaging reveals that these individuals are not just faking or imagining these responses. Indeed, the brain acts differently when people respond to hypnotic suggestions than when they imagine or voluntarily produce the same responses.

Preliminary research has shown that highly suggestible individuals may have unusual functioning and connectivity in the prefrontal cortex. This is a brain region that plays a critical role in a range of psychological functions including planning and the monitoring of one's mental states. There is also some evidence that highly suggestible individuals perform more poorly on cognitive tasks known to depend on the prefrontal cortex, such as working memory. However, these results are complicated by the possibility that there might be different sub types of highly suggestible individuals. These neurocognitive differences may lend insights into how highly suggestible individuals respond to suggestions: they may be more responsive because they're less aware of the intentions underlying their responses.

For example, when given a suggestion to not experience pain, they may suppress the pain but not be aware of their intention to do so. This may also explain why they often report that their experience occurred outside their control. Neuroimaging studies have not as yet verified this hypothesis but hypnosis does seem to involve changes in brain regions involved in monitoring of mental states, self-awareness and related functions.

Although the effects of hypnosis may seem unbelievable, it's now well accepted that beliefs and expectations can dramatically impact human perception. It's actually quite similar to the placebo response, in which an ineffective drug or therapeutic treatment is beneficial purely because we believe it will work. In this light, perhaps hypnosis isn't so bizarre after all. Seemingly sensational responses to hypnosis may just be striking instances of the powers of suggestion and beliefs to shape our perception and behaviour. What we think will happen morphs seamlessly into what we ultimately experience. Hypnosis requires the consent of the participant or patient. You cannot be hypnotised against your will and, despite popular misconceptions, there is no evidence that hypnosis could be used to make you commit immoral acts against your will.

Meta-analyses, studies that integrate data from many studies on a specific topic, have shown that hypnosis works quite well when it comes to treating certain conditions. These include irritable bowel syndrome and chronic pain. But for other conditions, however, such as smoking, anxiety, or post-traumatic stress disorder, the evidence is less clear cut - often because there is a lack of reliable research. But although hypnosis can be valuable for certain conditions and symptoms, it's not a panacea.

Hypnosis probably arises through a complex interaction of neurophysiological and psychological factors - some described here and others unknown. It also seems that these vary across individuals.

Published in Hypnotherapy Society Newsletter March 2019

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