Join the clots – Strokes and the oral contraceptive pill

 

Doing the rounds on Facebook recently was a story broadcast on Channel Seven News (Brisbane) from the 22nd of June 2015. It was the story of a previously healthy young Melbourne woman who suffered a stroke at work. She was simply sitting at her desk, and was suddenly unable to move her arm to control her mouse. Because of the quick thinking of one of her co-workers, Melissa James got urgent medical attention and appears to have made a very good recovery.

Channel Seven’s angle on this story was that Melissa’s oral contraceptive pill Yasmin was to blame. Perhaps it was. Perhaps it wasn’t. No one can fairly say from the limited information that was given in the two minute clip.

The report also suggested that Yasmin was responsible for strokes in countless other women, stating that Bayer, Yasmin’s manufacturer, was paying out billions of dollars in damages, and that Yasmin caused a “six-fold increase in strokes”, potentially putting hundreds of thousands of women at risk.

That the oral contraceptive pill is associated with an increase risk of strokes is not in contention. Strokes and blood clots are well known to be side effects of the pill. Remember, any drug that has an effect is also going to have side effects. The oral contraceptive pill is no different. The question then becomes: Is the pill still safe to use, or should women be ditching it in favour of other forms of contraception?

To answer that, one has to start trawling through statistics. Don’t worry, I promise there won’t be too many numbers, because statistics make my brain hurt. Instead, I want to show you a few graphs, because it’s actually much easier to understand the risk of the pill if you have the right perspective.

One of the largest and most recent studies on the risk of strokes and the oral contraceptive pill was done in Denmark in 2012 [1]. Lidegaard and colleagues followed 1,626,158 women over a decade, and analysed the risk of strokes while using different forms of hormonal contraception. The sheer number of women involved in the study make the statistics very strong. Overall, women taking Yasmin were 1.64 times more likely to have a stroke than the average woman not taking any contraception.

Even at this early stage, there are two important points to consider:
1. I’m not sure what source the Channel Seven reporter was quoting when she suggested that Yasmin was six times more likely to cause strokes. Certainly, the numbers in this study don’t come close to this, and
2. A relative risk of 1.64 is the same as saying there was a 64% increase in stroke risk. This still sounds bad for Yasmin … until you look at the risks for some of the other pills discussed in the study.

JoinTheClots_Fig1_optimised

The graph shows that there are actually quite a few contraceptive pills that have a higher risk of stroke than Yasmin. According to the numbers of Lidegaard et al, Yasmin is not all that spectacular – just somewhere in the middle in terms of the risk of stroke, compared with common pills.

Though when you factor in a broader array of pills, other contraceptive methods, and other everyday situations for women, the risk of stroke from Yasmin, or any pill for that matter, doesn’t look bad at all.

JoinTheClots_Fig2_optimised

The risk of stroke from taking Yasmin is nothing compared to the risk of stroke in the few weeks after birth, but there are no news reports of the dangers of stroke after having a baby.

There’s probably a couple of reasons for that – post-partum strokes are brought about by babies, which are cute and cuddly, and not by multinational drug companies, which are repugnant and evil, and much more newsworthy. It’s also because even though the risk of stroke in the few weeks after delivery is nearly 25-times higher than the stroke risk for an average non-pregnant woman, that number is still so small on average that the overall chance of getting a stroke in the few weeks after delivery (in statistical parlance, the “absolute risk”), is tiny.

JoinTheClots_Fig3_optimised(additional statistics: [2] and flying risk extrapolated from [3])

In the Lidegaard study, there were 2260 strokes in 9,336,662 person-years. That’s a rate of only 24.2 strokes for every 100,000 women in a year. Even though the risk of stroke after birth is still very high, it hardly creates a impression on the graph of absolute risk. And because the risk from most contraceptives is quite a bit lower, they don’t even make a blip.

Thinking about it in a different way, even with the increased risk of taking Yasmin, for every 100,000 women taking Yasmin for a year, there will only be an extra 16 strokes on average compared to the general population. 16 in 100,000 … that’s like trying to find a straight middle-aged man at a One Direction concert.

Which brings us to the take home messages:

1. Always take health stories on the news with a pinch of salt. The media often use a liberal amount of poetic licence to sell their stories. I’m not sure where Channel Seven got their source material, but it doesn’t seem to fit the data that I’ve unearthed in a quick search of the medical literature. The story of Melissa James is newsworthy as an exploration of the struggle of a young woman who suffered a tragic complication, and I’m really glad for her that she seems to be winning that battle. But her story can’t be extrapolated to every other woman on Yasmin, or any other pill for that matter. The statistics suggest that experiences like that of Melissa James are thankfully rare.

2. There is more to the oral contraceptive pill than just the risk of strokes. The oral contraceptive pill has a number of other potential complications, and each form of contraception needs to be matched correctly to the woman who’ll be taking it. This is why the pill remains on prescription in Australia (and most other countries), not sold off the shelf at the pharmacy or the supermarket. If you have any concerns about your risk from the pill, or any other method of contraception, see your GP for a full assessment.

References

[1]        Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. The New England journal of medicine 2012 Jun 14;366(24):2257-66.
[2]        Izadi M, Alemzadeh-Ansari MJ, Kazemisaleh D, Moshkani-Farahani M, Shafiee A. Do pregnant women have a higher risk for venous thromboembolism following air travel? Advanced biomedical research 2015;4:60.
[3]        Centers for Disease Control and Prevention. CDC Health Information for International Travel 2014. New York: Oxford University Press, 2014.

Declaration: For the record, I declare no conflict of interest in the publication of this post. I do not receive payment, commission, or any kind of gratuity, from Bayer, or any pharmaceutical company. I do not directly own shares in Bayer or any other pharmaceutical company. Nor do I have any professional links to any pharmaceutical company. I wrote this post to promote rational use of medicine, not to specifically promote or defend one particular brand of medication.

Seven Elements of Good Mental Health: 7. Create social networks – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

7. Create social networks

Before 2004, everyone knew what social networks were. Now when you talk about ‘social networks’, people assume you’re referring to Facebook. It seems like virtual social networking has been around forever, whereas in contrast, real social networking actually has.

We know this, because we’re wired for social interaction, with specific areas of the brain devoted to social behaviour, such as the orbitofrontal cortex, and there are neurotransmitters and hormones that are strongly associated with bonding and maintenance of social relationships, like oxytocin and β-endorphins. Research has also shown that both humans and other primates find social stimuli intrinsically rewarding – babies look longer at faces than at non-face stimuli, for example [1].

People who engage in social relationships are more likely to live longer, some estimate by an extra 50% [2]. Certainly it appears that the opposite is true. Loneliness predicts depressive symptoms, impaired sleep and daytime dysfunction, reductions in physical activity, and impaired mental health and cognition. At the biological level, loneliness is associated with altered blood pressure, increased stress hormone secretion, a shift in the balance of cytokines towards inflammation and altered immunity. Loneliness may predict mortality [3].

So what is loneliness, and conversely, what defines good social relationships? Fundamentally, good or bad social relationships are related to the quality of the social interaction. This rule applies equally to real social networks [3] and their on-line equivalents [4]. So quality is fundamentally more important than quantity in terms of friendships, with that quality strongly determined by the connection within those social relationships. For example, loneliness “can be thought of as perceived isolation and is more accurately defined as the distressing feeling that accompanies discrepancies between one’s desired and actual social relationships” [3].

The corollary is that friendship can be thought of as perceived connection within social relationships, or the comforting feeling that accompanies the match between one’s desired and actual social relationships.

So healthy social relationships aren’t defined by the size of your network, but by the strength of the connections that your network contains, relative to what’s important to you. Just because you’re not a vivacious extrovert who’s friends with everyone doesn’t mean that your social network is lacking. It also means that you can have meaningful connections to friends through social media, just as much as you can have meaningful connections through face to face interactions. It’s not the way you interact, but the quality of the connection that counts.

What is it about other people that makes us more likely to be their friends? Connection between friends is often the result of attraction to individuals of similar personalities or skills, although recent research suggests that friendship may be related to a much deeper level. Brent et al notes that “Humans are especially predisposed toward homophily, with recent evidence suggesting this even extends to the genetic level; people are more likely to be friends if they have similar genotypes. Taken together, these findings advocate the need to consider not only an individual’s genome, but also their metagenome, when asking questions about the causes of friendship biases … Unrelated friends are more likely to be genetically similar, equivalent to the level of fourth cousins, compared to unrelated strangers.” [1]

As Christians, we’re encouraged to engage with other Christians on a regular basis, which in our modern world, is through regular church attendance. As the Bible says in Hebrews 10:23-25, “Let us hold unswervingly to the hope we profess, for he who promised is faithful. And let us consider how we may spur one another on towards love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another – and all the more as you see the Day approaching.” But as the research has shown, it’s not just being part of the crowd, but connecting with those in the church in a meaningful way. It’s very easy to be lonely in a crowded church.

Always remember: “Befriend, and be a friend” – that’s how you’ll find benefit to your spirit, soul and body.

References

[1]        Brent LJ, Chang SW, Gariepy JF, Platt ML. The neuroethology of friendship. Annals of the New York Academy of Sciences 2014 May;1316:1-17.
[2]        Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS medicine 2010 Jul;7(7):e1000316.
[3]        Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Social science & medicine 2012 Mar;74(6):907-14.
[4]        Oh HJ, Ozkaya E, LaRose R. How does online social networking enhance life satisfaction? The relationships among online supportive interaction, affect, perceived social support, sense of community, and life satisfaction. Computers in Human Behavior 2014;30:69-78.

Seven Elements of Good Mental Health: 6. Forgiveness – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

6. Forgiveness

“You’d think after five months of lying on my back, I would have given up any idea of getting even, just be a nice guy and call it a day. Nice guys are fine: you have to have somebody to take advantage of… but they always finish last.”

Mel Gibson’s character spoke these words as an introduction to the movie “Payback.” It’s plot line sees him maim or kill every person linked in the chain of thugs and organised crime that ripped him off of his seventy thousand dollars. At the end of the movie, after he exacts the final revenge on the last villain, he drives off with a smile on his face, his money and his renewed romance. But if this was real life, would he have been happy, or would he have just been even?

It’s human nature to repay wrong with another wrong. Eye for an eye, tooth for a tooth. If you hurt me, natural justice is fulfilled if I make you feel the same pain in return. So what choices do you have if someone hurts or wrongs you? Well, you could retaliate. You could plan retribution. Ask for recompense. Or simply push for recognition of your pain. Sometimes these strategies lead to resolution, but usually not immediately, and in order to stay motivated to achieve a delayed resolution, you have to keep reminding yourself of the pain caused to you, so that the effort you’re making will be worthwhile.

As the old proverb goes, “Two wrongs don’t make a right.” If you hurt me, hurting you back doesn’t make my pain go away. It just adds more pain to the world, because I’m still in pain and now you’re in pain. Then you’ll want to hurt me back, and the cycle escalates. Francis Bacon said, “A man that studieth revenge keeps his own wounds green, which otherwise would heal and do well.” In other words, you may be able to bring about retribution, but during the process, you’ll end up keeping your own wounds open and festering, instead of letting them close and heal. It’s like someone cut you with a knife, and if order to show them what damage they did to you, you keep reopening the wound every few days. The wound may look open and fresh should they ever care to notice, but you’re the one who had to put up with an open wound for an extended time, and re-live the pain every time you reopened it.

Interestingly, research tend to support this notion. One study showed that when subjects were asked to think of reacting aggressively to a given scenario, parts of the limbic system in their brains increased in activity. This isn’t unsurprising, given that our brain subconsciously prepares us all the time for fight or flight responses when it starts to sense danger, in preparation for possible action. What was more interesting is that it also reduced the activity of the subjects frontal lobes as well. As discussed by Worthington and colleagues, “Thus, one implication might be that negative emotion acts antagonistically toward reasoning. This suggests that reasoning is disrupted by anger and that imaginally rehearsing angry and aggressive mental scenarios (i.e., ruminating angrily) could (a) catapult one into negative emotive responding and (b) shut down rational approach and calm emotions. Imagery as well as verbal rumination might stimulate similar effects.” [1]

The other option is a particular form of acceptance, which we know as forgiveness. Forgiveness, the act of moving on from insult or injustice, a actually a complex psychological process. There have lots of studies looking at different aspects of forgiveness, but without getting bogged down in details, forgiveness helps to rebalance things. People who forgive habitually tend to also have lower systolic, diastolic blood pressure, and individual acts of forgiveness and lower hostility predicted lower stress levels, which in turn predicted lower self-reported illness, a strong mediator being reduced negative affect (a “bad mood”) was the strongest mediator between forgiveness and physical health symptoms, although they also noted other variables such as spirituality, social skills, and lower stress also had a role in the forgiveness-health relationship [2].

I understand that talking about forgiveness can bring up some deep and difficult feelings in some people. Just like physical wounds, some are shallow and heal quickly, but others are inflicted so deep that they’re hard to heal – severe trauma like rape, childhood abuse, domestic violence and other deep psychological insults. It’s important to clarify here that memories of such traumatic events often intrude into your conscious awareness, where it replays in your memory, but not of your own volition. That’s different to unforgiveness and rumination, which are memories which we foster and encourage. Forgiveness is still a part of the healing process of these severe traumas, but the healing process may take longer, and the process of finding that forgiveness may require a professional to help walk through the process. If you’ve been the victim of a severe trauma, you don’t need to go it alone. Find a psychologist or talk to your doctor if you’re not sure.

For the Christian, forgiveness is at the very core of the entire life of faith we lead. God forgave us, and we can enjoy that forgiveness if we choose to move away from a life enslaved to sin. It is through the death of Jesus on the cross that we have this chance, and Jesus himself showed the ultimate in forgiveness when, as he hung dying on the cross, he forgave the soldiers that put him there. Throughout his ministry, he preached the same message – forgiveness is a central text of the Lords prayer, he told Peter that he should forgive someone “seventy times seven”, and he showed grace to those around him such as the woman caught in adultery. There are many more examples of forgiveness in the Bible as well.

I don’t know if there is any one particular best method to forgive. Apologies help [3], but they aren’t necessary to be able to forgive someone. Sometimes people find actually saying the words “I forgive you” to be a powerful release. That can be to a person directly, although that may not always go down well. Saying it internally is valid. Sometimes writing it in a letter, and then tearing it up as an act of finality, can be useful.

I hope that you can find it in your heart to forgive those in your life that have wronged you and continue to move forward. Remember, “To forgive is to set a prisoner free, and discover that the prisoner was you.” (Lewis B. Smedes)

References

[1]        Worthington EL, Jr., Witvliet CV, Pietrini P, Miller AJ. Forgiveness, health, and well-being: a review of evidence for emotional versus decisional forgiveness, dispositional forgivingness, and reduced unforgiveness. Journal of behavioral medicine 2007 Aug;30(4):291-302.
[2]        Lawler KA, Younger JW, Piferi RL, Jobe RL, Edmondson KA, Jones WH. The unique effects of forgiveness on health: an exploration of pathways. Journal of behavioral medicine 2005 Apr;28(2):157-67.
[3]        Strang S, Utikal V, Fischbacher U, Weber B, Falk A. Neural correlates of receiving an apology and active forgiveness: an FMRI study. PloS one 2014;9(2):e87654.

Seven Elements of Good Mental Health: 5. Be grateful – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

5. Be grateful

As I was trolling through Facebook the other day, I came across this post by Sir Richard Branson, founder of Virgin: “Thanked an airport security worker, he said I was the first to say #ThankYou in three years. Shocked! Saying thank you should be second nature …”

Richard Branson Thank You

Perhaps the security worker was exaggerating for the billionaire, or perhaps everybody hates airport security at the airport where he works. At any rate, three years is a long time to go without someone saying thanks.

As Sir Richard said, “Saying thank you should be second nature …”. Saying thanks is a small part of the much larger psychology of gratitude, which is “part of a wider life orientation towards noticing and appreciating the positive in the world” [1]. In fact, there are several components to the overall orientation of gratitude, including “(1) individual differences in the experience of grateful affect, (2) appreciation of other people, (3) a focus on what the person has, (4) feelings of awe when encountering beauty, (4) behaviors to express gratitude, (5) focusing on the positive in the present moment, (6) appreciation rising from understanding life is short, (7) a focus on the positive in the present moment, and (8) positive social comparisons.” [1]

The research suggests that people who are naturally grateful tend to be less angry and hostile, less depressed, less emotionally vulnerable, and experienced positive emotions more frequently. Gratitude also correlated with traits like positive social functioning, emotional warmth, gregariousness, activity seeking, trust, altruism, and tender-mindedness. Grateful people also had higher openness to their feeling, ideas, and values, and greater competence, dutifulness, and achievement striving.

However, these effects may be simply an association of gratitude with other personality traits. In other words, people who are naturally optimistic or conscientious are also more likely to be thankful, rather than the thankfulness causing someone to be more optimistic or conscientious. There are a few studies that show gratitude interventions improving self-worth, body image, and anxiety, although the evidence is that while gratitude was better than doing nothing, it was equal to, not superior to, currently accepted psychological interventions.

Even though gratitude may not be better than standard psychological treatments, it’s better than being ungrateful.  It’s also something that the Bible exhorts us to do (“In everything give thanks, for this is the will of God in Christ Jesus, concerning you.” – 1 Thess 5:18).  And let’s face it, it’s pretty easy to do.

The best studied gratitude intervention is a gratitude diary – writing something down every day that you are thankful for [1]. It doesn’t have to be long. A single sentence or phrase is good enough. Not that it has to be written if that’s not your thing. I had a friend who was determined to do a gratitude journal, but she also has a love and a knack for photography. So, she decided to take a photo a day of something that she was grateful for, and post it on Facebook. She had her moments where she doubted herself, struggled to find a subject of her gratitude, or struggled to find something unique, especially after day 300, but the end result was amazing. She grew in her gratitude and her photographic skill, and I often found myself blessed by her beautiful images and insights.

So, be thankful and express it in your own unique way.

References

[1]        Wood AM, Froh JJ, Geraghty AW. Gratitude and well-being: a review and theoretical integration. Clinical psychology review 2010 Nov;30(7):890-905.

Seven Elements of Good Mental Health: 4. Show some SSAS – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

4. Show some SSAS

SSAS stands for Supple, Strong and Skilful. This applies physically and mentally.

Physical fitness is good for us. This isn’t the main point of the blog, but I have never seen a study that shows exercise to be a bad thing. Ultimately, it’s not how fat you are that’s important for your longevity, it’s how fit you are [1, 2]. And the way to get fit is to exercise.

Physical exercise is not just good for the body but good for the brain as well. While the exact pathways are still being determined, there’s good evidence that moderate regular physical activity improves the balance of pro- and anti-inflammatory mediators in the body and in the brain. In the brain, this improves the overall function of our brain cells and their ability to form new pathways, which in turn, has been shown to improve mood disorders like anxiety and depression [3].

But being SSAS isn’t just about what being physically fit and active can do for your mood, but it also relates to being psychologically flexible and using psychological skills to leverage your strengths rather than just fighting with your weaknesses. One of the keys here is acceptance. Remembering your values that we spoke about in key 1 as your guide, exploit the things that you’re good at, using them to gain some self-confidence and momentum. Accept the things that can’t be changed in your life. Then when you have some momentum, learn some new skills to increase your resilience and strengthen your weaknesses.

I say this because sometimes we spend so much time focussing on all the bad things in our lives that we forget about the good things that we already have or can already do. It would be like an athlete spending all their time in the gym, getting really fit and strong, but never getting onto the field or court. It’s important that we courageously challenge ourselves to turn our weak points into strong points, but it’s more important to do what we can to help others around us.

References

[1]        Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in cardiovascular diseases 2014 Jan-Feb;56(4):382-90.
[2]        Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. Journal of the American College of Cardiology 2014 Apr 15;63(14):1345-54.
[3]        Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M. Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neuroscience and biobehavioral reviews 2013 May;37(4):573-84.

Seven Elements of Good Mental Health: 3. Mindfulness – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

3. Mindfulness

Mindfulness is a practice that we can all become better at.

Mindfulness involves directing our attention towards things in the present moment, and away from those thoughts that drag us into the faults of the past or the fear of the future [1]. Between the various disciplines of psychology and a number of different religions, there are many ways in which mindfulness has been defined. The way I consider mindfulness is similar to that in the ACT framework, which is simply non-judgemental awareness of one’s moment-to-moment experience. In other words, mindfulness involves accepting the experience our internal and external realities simply as they are, without judging them as good or bad, positive or negative. Mindfulness accepts the experience of events fully, without resorting to excessive preoccupation or suppression of the experience.

People who are naturally mindful are more likely to have higher levels of life satisfaction, agreeableness, conscientiousness, vitality, self esteem, empathy, sense of autonomy, competence, optimism, and pleasant affect, and are less likely to have depression, neuroticism, absent-mindedness, dissociation, rumination, cognitive reactivity, social anxiety, difficulties in emotion regulation, experiential avoidance and general psychological symptoms.

So mindfulness is obviously a good thing to have, though before we get too carried away, it may be that mindfulness isn’t the cause of all of these positive effects, but simply a common association. In other words, it might be that people who are psychologically health naturally tend to be more mindful.

For the most part, this is probably the case, but there is evidence for mindfulness as a psychological intervention for those who are not so naturally mindful.  Those who are taught to practice mindfulness skills also demonstrate an increased ability to cope with habitual urges (like a desire to smoke), feelings of anxiety, low mood, and fearfulness [2].

Mindfulness has some overlap with the psychological skill of acceptance. In mindfulness, we not only stop fighting with our feelings and thoughts, but we take a step back to pay attention to them and observe them in a non-judgemental way. With acceptance, we acknowledge the thoughts and feelings, but divert our attention to other things.

To clarify, mindfulness is non-judgementally observing our thoughts, feelings and emotions, not fighting with them to suppress them, or passively allowing our thoughts and feelings to overwhelm us. If our thoughts or feelings were like a hungry lion, mindfulness is standing outside of the cage, observing the different characteristics of the lion, rather than staying in the cage to try and fight it, or passively stand in the cage waiting to become lunch.

Mindfulness doesn’t need special training. Being mindful is simply being aware of your thoughts, feelings and emotions, and accepting them for what they are. Are you happy at the moment? What does that feel like in your body? What does anxiety feel like? Describe the feeling … hot or cold, squeezing, searing, heavy or light? Do you have an urge to do something, like have some chocolate or smoke a cigarette? What is that urge like? Can you put it into words?

Only one word of warning. It would be fair to assume that someone will be reading this who has experienced some severe trauma in their lives. Both acceptance and mindfulness will help to manage the feelings that your trauma will inevitably cause, but if the severity of that trauma causes you to be overwhelmed by your feelings, don’t try and tackle those memories and emotions on your own. Work with a psychologist or doctor who is experienced in mindfulness-based therapies, so there is someone to assist you through the process so you’re not overwhelmed, until you get better and stronger.

Often mindfulness is taught as a contemplative activity, that is, we think about the feelings as we observe them. However, there is nothing wrong with expressing your mindfulness in other ways, like drawing, painting or movement. You can also write them down. I often read through the Psalms that King David wrote, and wonder if he was modelling mindfulness for us in the way he acknowledged and described his feelings in the words that he wrote as prayer and poetry. Find what works best for you as you grow in the skill of mindfulness.

References

[1]        Harris R. The happiness trap : how to stop struggling and start living. Boston: Trumpeter, 2008.
[2]        Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clinical psychology review 2011 Aug;31(6):1041-56.

Seven Elements of Good Mental Health: 2. Be Kind – The Prospering Soul

Life shouldn’t just be about avoiding poor health, but also enjoying good health.  Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

2. Be kind

One of the best things you can do for your health and happiness is to be kind to other people. In their review of studies on altruism, Lozada et al (2011) showed that altruism activates rewarding neural networks, essentially the same brain regions as those activated when receiving rewards or experiencing pleasure. They also described studies showing that both hormones and the neurotransmitters in the brain involved in helping behaviour and social bonding can lessen stress levels and anxiety. Also, the immune and autonomous nervous systems are positively affected by the quality and extent of social networks, and increased sociability and concern for others’ wellbeing can improve immune system and stress responses [1].

The Bible has always encouraged us to show other people kindness. In Ephesians 4:31-32, Paul tells the church at Ephesus, “Get rid of all bitterness, rage and anger, brawling and slander, along with every form of malice. Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you.”

And that kindness wasn’t just for other people in the church, but to anyone in need (Matthew 25:34-40).

There are infinite ways to show kindness, but the thing that links them together is unselfishness, the “disinterested and selfless concern for the well-being of others”, or in less formal language, simply giving with no strings attached.

If you’re looking for some ideas on some new ways to show kindness, the Random Acts of Kindness Foundation has plenty of them. Check out https://www.randomactsofkindness.org/kindness-ideas

References

[1]        Lozada M, D’Adamo P, Fuentes MA. Beneficial effects of human altruism. Journal of theoretical biology 2011 Nov 21;289:12-6.