Dr Caroline Leaf and her can of worms

Posted on October 18, 2015 by cedwardpitt

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. She also likes to think that she’s an expert on mental health. So this morning, she felt like she was quite justified in publishing a meme about the evils of psychiatric medications.

She quoted Professor Peter Gøtzsche, stating that “Psychiatric Drugs are the third leading cause of death, after heart disease and cancer.” Then followed it with “Take all thoughts into captivity, not drug all thoughts into captivity. You have the mind of Christ! (1 Cor 2:16) **DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

The subsequent comments were primarily made up of the usual sycophantic responses that Dr Leaf has cultivated by blocking anyone that disagrees with her. But there were more than the usual responses confused by her meme, and quite a few that we’re asking for help in weaning off the medications that they were on.

Then there were those who weren’t happy at all. One respondent, a certified Nurse Practitioner, wrote, “I am appalled that you are posting this inaccurate information and causing vulnerable people to possibly stop taking medication that may be allowing them to function and live.” The same person followed up with another comment soon after, quoting the CDC figures for the top ten causes of death in the US, in which the third on the list wasn’t psychiatric drugs at all, but chronic lower respiratory diseases.

The overall response must have taken her aback, because Dr Leaf posted a follow-up comment to explain herself, an unusual step for her.

In it, she said, “I do not speak out against psychiatric medication because I want to condemn people, or make them feel guilty. I want to help people. If, for example, I knew that eating some food could kill you or seriously injure you, and kept this to myself, you would justifiably be angry at me. These drugs have serious, proven long term side affects that are hidden from the public, and the logic behind them is not God’s desire for you to be healthy in your spirit, soul and body. Psychiatric drugs are based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological brain that has chemicals that need to be “balanced”. You are more than your biology; you are the temple of the Lord, created in his image. This is not a game: these drugs can decrease your lifespan by 15-25 years. I want you to have those 15-25 years, and I want them to be characterized by God’s perfect, good plan for your life. I ask you to not to just take my word for this, but to do your own research. You can find a multitude of references on my site http://www.drleaf.com under Scientific FAQs. It is my earnest desire that people do not perish for lack of knowledge (Hosea 4:6). **DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

But it was too late. Dr Leaf had opened a can of worms, and once out, those wriggly little critters are impossible to put back in.

Both her initial offering and her reply shows just how poor Dr Leaf’s understanding of mental health truly is. She is fixated on the notion that the mind controls the brain, and she is unwilling to consider any other notion, instead preferring to accept any opinion that conforms to her world view, no matter how poorly conceived it might be. This includes the work of Gøtzsche, accepting it as gospel even though he has critics of his own.

It’s important to examine Dr Leaf’s reply in more detail as her statement has the potential to cause a great deal of harm to those who are the most vulnerable. Lets break down Dr Leaf’s statement and review each piece, and then I will outline some other important and contradictory considerations of Dr Leaf’s stance.

The safety of psychiatric medications

Dr Leaf claims that “These drugs have serious, proven long term side affects {sic} that are hidden from the public” and “This is not a game: these drugs can decrease your lifespan by 15-25 years.”

Dr Leaf is right in saying that psychiatric medications have serious proven long term side effects. And we should be careful. I mean, if you knew that thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema and Stevens Johnson syndrome, bronchospasm and hepatic dysfunction were the potential side effects for a medication, would you take it?

Most people wouldn’t. Reading the list makes that drug sound really dangerous. We should be up in arms about such a dangerous drug … except that this list of side effects isn’t for a psychiatric drug at all, but is actually the side effect profile of paracetamol (Panadol if you’re in Australia, Tylenol if you’re in the US). People take paracetamol all the time without even thinking about it. Saying that we shouldn’t take medications because of potential side effects is a scarecrow argument, a scary sounding straw man fallacy. All drugs have serious proven long term side effects, and most of the time, those serious long term side effects don’t occur. Licensing and prescribing a medication depends on the overall balance of the good and the risk of harm that a medication does.

Oh, and no one has ever hidden these side effects from the public as if there’s some giant conspiracy from the doctors and the pharmaceutical companies. The side effects are listed right there in the product information (here is the product information for fluoxetine. See for yourself).

As for Dr Leaf’s assertion that psychiatric medications decrease your lifespan by 10-25 years, I think that’s a red herring. I read through Dr Leaf’s ‘Scientific FAQ’ and I couldn’t find any references that back up these statements, so who knows where she got this figure of ’15-25 years’ from.

On the contrary, what is known is that severe mental illness is associated with a 2 to 3-fold increase in mortality, which translates to an approximately 10-25 year shortening of the lifespan of those afflicted with severe depression, schizophrenia or bipolar disorder [1]. So Dr Leaf has it backwards. It isn’t the medications that cause people who take them to die 25 years earlier than they would have without the illness, but it’s the illness itself.

The benefits of long term psychiatric medications

So psychiatric medications have their side effects, true, but they also have protective benefits which Dr Leaf consistently fails to acknowledge.

Correll and colleagues note in the conclusion to their article that “Although antipsychotics have the greatest potential to adversely affect physical health, it is important to note that several large, nationwide studies providing generalizable data have suggested that all-cause mortality is higher in patients with schizophrenia not receiving antipsychotics.” [1]

More specifically, in one recent study, the use of any anti-psychotic medication for a patient with schizophrenia decreased their mortality by nearly 20% [2]. In another study, the mortality of those with schizophrenia who did not take anti-psychotics was nearly ten times that of the healthy population, but taking anti-psychotic medication cut that back to only four times the risk [3].

These findings are mirrored by other studies on other psychiatric medications. For example, as noted by Correll and colleagues, “clozapine, antidepressants, and lithium, as well as antiepileptics, are associated with reduced mortality from suicide. Thus, the potential risks of antipsychotics, antidepressants and mood stabilizers need to be weighed against the risk of the psychiatric disorders for which they are used and the lasting potential benefits that these medications can produce.” [1]

So psychiatric medications are not useless. Let me be clear, I’m not saying that taking psychiatric medications always makes life a cake-walk – there are still side effects from the medications, and the disease isn’t always fully controlled. But on average, well treated patients with psychiatric conditions clearly do better than patients who are not treated.

Therefore Dr Leaf’s assertion that psychiatric medications are harmful are inaccurate. And given that there are genuine benefits to these medications, particularly in the prevention of suicide, Dr Leaf’s discouragement of these medications has the real potential to result in real harm to those of her followers who take her at her word.

The ‘logic’ behind psychiatric medications

Dr Leaf says in her statement, “the logic behind them (psychiatric medications) is not God’s desire for you to be healthy in your spirit, soul and body. Psychiatric drugs are based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological brain that has chemicals that need to be ‘balanced’. You are more than your biology; you are the temple of the Lord, created in his image.”

Dr Leaf’s argument here is that based on a false premise and some straw man fallacies which inevitably leads to a false conclusion.

Evolution is a mindless unguided process
Evolution says that you are just a machine
Psychiatric illness is because of a chemical imbalance in that machine (a false premise)

therefore taking psychiatric medication is accepting evolution (a straw man fallacy)

and

You are more than your biology,
you are the temple of the Lord, created in his image,

therefore evolution is wrong (another straw man fallacy)

therefore psychiatric medications are not God’s desire (false conclusion)

The problem with this logic is that it could be applied to all medications, since modern medicine has predominantly been devised by agnostic scientists within an evolutionary framework, and nearly all disease is defined by an imbalance of one thing or another.

For example, simply rewording Dr Leaf’s statement shows up the distorted logic that it entails:

“Insulin can have serious, proven long term side affects that are hidden from the public, and the logic behind it is not God’s desire for you to be healthy in your spirit, soul and body. Diabetes is based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological pancreas that has chemicals that need to be ‘balanced’.”

You can’t have this both ways. If psychiatric medications are against God’s plan, then all medications are against God’s plan. But if we accept medications for physical ailments, then we also have to accept medications for psychological ailments.

The Mind-Brain link

Dr Leaf tried to protect herself with a glib disclaimer at the end of both posts in question today, “**DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

Which is interesting, because in her Scientific FAQ, Dr Leaf has this to say about the mind,

“The Brain is part of the Physical Body and therefore is controlled by the Mind. The Mind does not emerge from an accumulation of Brain activity. Brain activity, rather, reflects Mind activity. Even though the Mind controls the Brain, the Brain feeds back to, and influences, the Mind. The Brain seats the Mind, and therefore the Mind influences the Physical world through the Brain.”

So if that’s true, then why is withdrawal from psychiatric medication so difficult? If the mind is outside the physical realm and controls the brain as Dr Leaf proposes, then the medications effect on brain chemistry should make little or no difference to the mind, and withdrawal should be simple.

The fact that withdrawal from these medications is not simple is testament to the fact that the mind is a function of the brain, and does not control the brain as Dr Leaf proposes here and through her books and other written materials.

Issuing the warning is responsible, but shows again just how far Dr Leaf’s teaching is from scientific reality.

Dr Leaf’s motivations

Finally, I want to talk about Dr Leaf’s motivation. In her statement, Dr Leaf said, “I do not speak out against psychiatric medication because I want to condemn people, or make them feel guilty. I want to help people.” And, “I want you to have those 15-25 years, and I want them to be characterized by God’s perfect, good plan for your life … It is my earnest desire that people do not perish for lack of knowledge (Hosea 4:6).”

I want to state, for the record, that I believe Dr Leaf when she says this. I don’t doubt her motives are to try and help people. But good intentions are not enough. What she says has real life consequences.

Dr Leaf is idolised by her followers and portrayed as a mental health expert by the churches she preaches at. People don’t question experts recommended to them by their pastors or their friends. So when she says that psychiatric medications kill people, people on psychiatric medications will want to come off them, because of fear, because of stigma, because of their desire to live true to God and his good and perfect plan. Without wanting to sound melodramatic, there is a very real chance that some of those people who were stable on their medications but who unnecessarily cease them because Dr Leaf told them to, may harm themselves or take their own life, since that’s what the studies tell us [1, 4]. At the very least, they are likely to have a shorter life expectancy because of it [2, 3]. So telling people that psychiatric medications are dangerous is morally and ethically dubious.

There are also potential legal implications too. God forbid, but if a person committed suicide because they went off their medication because of what Dr Leaf wrote, law suits could easily follow. No one wants that situation. Dr Leaf also runs the risk of being accused of practicing medicine without a licence, since some of her followers have asked personal medical questions in the comments, and the reply from Dr Leaf’s Facebook team is to direct them to their programs like the 21-day detox, which depending on the legal interpretation and the mood of a judge, could be seen as giving medical advice, which Dr Leaf is not legally qualified to give.

To summarise, I certainly hope that neither of these hypothetical scenarios becomes reality, but Dr Leaf and her social media team are skating on thin ice, and a glib disclaimer at the end of a post won’t necessarily cut it.

I would hope that Dr Leaf and her social media team would reconsider their approach. In fact, I would suggest that Dr Leaf unequivocally apologises for what she’s written, retracts her statement, and encourages people to see their doctors if they have concerns about their medication, or their mental health.

Indeed, I would implore Dr Leaf to step back and re-evaluate the entire breadth of her teaching, and the advice that she is giving. Dr Leaf is obviously a very smart woman and a very engaging speaker. With great power comes great responsibility. If she were to reconsider her teaching and start from a basis of scientific fact, then she could be a major force for the good of the church and its physical and mental health. At the moment, I fear that she is doing the opposite.

This is not a game: people’s lives are at stake. I hope that Dr Leaf sees this before it’s too late.

References

[1]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[2]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[4]        Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Archives of general psychiatry 2012 May;69(5):476-83.

Here’s my glib disclaimer: This article is a rebuttal of Dr Leaf’s opinion regarding psychiatric medication. This blog doesn’t constitute individual medical advice. If you do not like your medication or think you should come off it, please talk to your own GP or psychiatrist. Do not stop it abruptly or without adequate medical advice.

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

Posted on June 24, 2015 by cedwardpitt

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 …”

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

Posted on June 23, 2015 by cedwardpitt

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

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.

The Prospering Soul – Just what is mental health?

Posted on May 10, 2015 by cedwardpitt

When Paul wrote to the church at Thessalonica a couple of thousands years ago, he said, “May God himself, the God who makes everything holy and whole, make you holy and whole, put you together—spirit, soul, and body—and keep you fit for the coming of our Master, Jesus Christ.” (1 Thessalonians 5:23 -The Message)

The modern western church has two out of three. As modern Christians, we have the fitness of the Spirit pretty well down, and we’re not too shabby on our physical fitness either. Unfortunately, we still have a way to go on the Soul thing.

In 2013, Rick Warren stood in front of his church after the suicide of his son, and promised he would work to reduce the stigma of mental illness in the Christian church (http://swampland.time.com/2013/07/28/rick-warren-preaches-first-sermon-since-his-sons-suicide/). Rick Warren experienced the stigma and destruction of poor mental health first hand. So have many others in the church, as have I.

It’s my passion to help the Christian church prosper, our bodies, our spirits, AND our souls. Over the next few months, I’ll be doing a series of blogs on mental health, to encourage and help those in the church battling mental illness, and everyone else in the church to know how to assist them in their battle.

Together, we can help to eliminate the stigma and destruction that mental health can bring into the lives of Christians, and that we may prosper in all things and be in health, just as our soul prospers (3 John 1:2).

To start with, it would help if we knew what it meant to be in good mental health, and what separates mental health from mental illness. The distinction isn’t always so obvious. There are a few ways to define or conceptualise mental health and illness, but to cut through the thousands of words of medical and scientific jargon, the difference between good mental health and bad mental health is often to do with changes to our thinking, mood, or behaviour, combined with distress and/or impaired functioning. [1] Our mental health is intimately linked with our physical health, and often physical illness will lead to changes to our thinking, mood, or behaviour, combined with distress and/or impaired functioning too, although strictly speaking, that’s not a pure mental health disorder.

What IS important for the average church goer to understand is that we all experience some changes to our mental health at different times in our lives. For example, we all experience grief and loss at some time in our lives, and at that time, it’s normal to experience extreme sadness, sleeplessness, anger, or guilt. What differentiates grief from depression is the trigger, and the time the symptoms take to resolve. In general, how we perceive our thoughts and behaviours, and how much any signs and symptoms affect our daily activities can help determine what’s normal for us.

There are some common signs that can help in knowing if professional help may be needed. This isn’t an exhaustive list, but if you or a loved one experiences:

Marked change in personality, eating or sleeping patterns
Inability to cope with problems or daily activities
Strange or grandiose ideas
Excessive anxiety
Prolonged depression or apathy
Thinking or talking about suicide
Drinking alcohol to excess or taking illicit drugs
Extreme mood swings or excessive anger, hostility or violent behaviour

then consult your family doctor or psychologist, or encourage your loved one to seek help. With appropriate support, you can identify mental health conditions and explore treatment options, such as medications or counselling.

Many people who have mental health conditions consider their signs and symptoms a normal part of life or avoid treatment out of shame or fear. If you’re concerned about your mental health or a loved one’s mental health, don’t hesitate to seek advice.

If you or a loved one have, or still struggle with, mental illness, I welcome your comments.

I can’t give specific counselling or advice in this forum, but if you are suffering from mental health problems and need help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

References

National Institute of Mental Health, Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, Editor 1999, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services: Rockville, MD.

Gluten mad!

Posted on February 24, 2015 by cedwardpitt

Tonight as I was browsing Facebook again, I came across an article a person had posted on gluten. The article claimed that gluten is connected to depression, and indeed, nearly every other neurological disorder for good measure.

Gluten is a protein found in certain grains like wheat, barley and rye. Gluten also makes foods taste better and improves their texture, so it’s often added to everything else.

The “gluten is toxic” meme is a very catchy one that’s doing the rounds again. I first heard of the idea that gluten is the cause of nearly every disease when I was in medical school, when every person I knew who’d seen a naturopath was told they had gluten intolerance and were conned into an unappetising and restrictive diet which didn’t make any of them better.

The same meme is now making it’s way back around again now that the low-fat, sugar-free, zucchini broth-type diet fads are waning.

The proposed link between depression, anxiety and gluten is a new twist to the old story. But with depression becoming a preeminent disease in the 21st century, the link doesn’t surprise me.

So what does the evidence say? Is gluten the culprit behind the modern scourge of mental illness?

I certainly don’t think so, at least according to my interpretation of the medical literature. As far back as 2001, researchers studying the mental health of patients with coeliac disease noted that coeliac disease patients had much higher levels of anxiety and depression than healthy matched controls (up to about three to six times greater in one study), and after a year on a gluten free diet, there were no changes to the rates of anxiety and depression (Addolorato et al., 2001).

In more recent times, larger studies have been performed. Hauser, Janke, Klump, Gregor, and Hinz (2010) confirmed higher levels of anxiety in German female coeliac patients who were on a gluten free diet, compared to the normal controlled population. Mazzone et al. (2011) showed that children with coeliac disease on gluten-free diets for about 7 years on average still showed an increased rate of anxiety and depression symptoms and showed higher scores in “harm avoidance” and “somatic complaints” as compared to healthy control subjects.

A larger cross sectional survey was performed in the Netherlands in 2013, on 2265 adults with coeliac disease (van Hees, Van der Does, & Giltay, 2013). That survey showed that a significantly higher proportion of those with coeliac disease, despite being on a strict gluten free diet, reporting a higher rate of anxiety and depression compared to the general population. It also showed (albeit in a smaller subgroup of respondents) that poor adherence with a gluten free diet did not affect the likelihood of depressive symptoms.

To be fair, cross sectional surveys and longitudinal cohorts aren’t necessarily the strongest form of evidence, but it is the best we’ve currently got. There was a recent randomised controlled trial, a stronger form of evidence, looking at the effect the introduction of gluten had on depressive symptoms in people who did not have coeliac disease but reported gluten sensitivity and were controlled on a gluten free diet (Peters, Biesiekierski, Yelland, Muir, & Gibson, 2014). While this showed some worsening of depressive symptoms in those subjects given gluten, the exposure was short, the effect was moderate, and the results should be considered cautiously given the small number of subjects reduced the power of the study.

Given the weight of evidence, I can’t help but be sceptical of books touting the ‘gluten = depression’ theory, books like “Grain Brain”. It’s author, American neurologist Dr David Perlmutter, attests that more than 38 different diseases are caused by gluten, including autism and depression. If you believe the celebrity chiropractor who reviewed Perlmutter’s work (http://www.glutenfreesociety.org/gluten-free-society-blog/gluten-leaky-brain-the-connection-to-depression/), increased intestinal permeability and intestinal dysbiosis (“leaky gut” and bad gut bacteria) combine to increase inflammation in the blood and in the brain, causing depression.

But correlation does not equal causation. Just because brain diseases, inflammation and gut problems tend to occur together does not prove that gut problems cause inflammation and brain problems. Rather, the evidence suggests that it’s the other way around, with all of the processes linked to genetics.

For example, autism is related to a number of genes that both reduce the proteins that help nerve cells grow branches (Won, Mah, & Kim, 2013), and at the same time, switch on a low grade form of inflammation (Onore, Careaga, & Ashwood, 2012). I believe it’s the pre-existing inflammation that adds to the cellular dysfunction of the brain and at the same time, promoting low grade inflammation of a number of organs, including the gut. It’s the pre-existing inflammation that causes the gut to become “leaky”, not the “leaky” gut causing the inflammation.

Because if gluten was the primary cause, then why do people with coeliac disease who do not eat gluten report more depressive and anxious symptoms than control groups who do eat gluten? Why would those with coeliac disease who are eating sporadic gluten be just as depressed as those patients who do not?

If you don’t have coeliac disease, then gluten free diets are just like Amway products. You really don’t need them, and you could probably do much better without them. All you’re really doing is just making someone else obscenely rich.

Not only are you wasting your money, but you might also be harming your health by eating gluten free foods, since most foods that are stripped of gluten are also stripped of most of their other nutrients.

As Nash and Slutzky (2014) summarise, “Every major change in our diet carries with it the possibility of unforeseen risks. Many readers — the general public, as well as medical professionals — accept what they read at first glance. Myths have been part of our medical lore for millennia. Those jumping on the gluten-free/high-fat bandwagon may be disappointed when their symptoms are not mitigated; more critically, they may be at increased risk for other, more dangerous ailments.”

If you really think you feel better off gluten, then talk to your doctor or registered dietician to make sure you remain healthy off it.

References

Addolorato, G., Capristo, E., Ghittoni, G., Valeri, C., Masciana, R., Ancona, C., & Gasbarrini, G. (2001). Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scand J Gastroenterol, 36(5), 502-506.

Hauser, W., Janke, K. H., Klump, B., Gregor, M., & Hinz, A. (2010). Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World J Gastroenterol, 16(22), 2780-2787.

Mazzone, L., Reale, L., Spina, M., Guarnera, M., Lionetti, E., Martorana, S., & Mazzone, D. (2011). Compliant gluten-free children with celiac disease: an evaluation of psychological distress. BMC Pediatr, 11, 46. doi: 10.1186/1471-2431-11-46

Nash, D. T., & Slutzky, A. R. (2014). Gluten sensitivity: new epidemic or new myth? Every major change in our diet carries with it the possibility of unforeseen risks. Am J Cardiol, 114(10), 1621-1622. doi: 10.1016/j.amjcard.2014.08.024

Onore, C., Careaga, M., & Ashwood, P. (2012). The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun, 26(3), 383-392. doi: 10.1016/j.bbi.2011.08.007

Peters, S. L., Biesiekierski, J. R., Yelland, G. W., Muir, J. G., & Gibson, P. R. (2014). Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study. Aliment Pharmacol Ther, 39(10), 1104-1112. doi: 10.1111/apt.12730

van Hees, N. J., Van der Does, W., & Giltay, E. J. (2013). Coeliac disease, diet adherence and depressive symptoms. J Psychosom Res, 74(2), 155-160. doi: 10.1016/j.jpsychores.2012.11.007

Won, H., Mah, W., & Kim, E. (2013). Autism spectrum disorder causes, mechanisms, and treatments: focus on neuronal synapses. Front Mol Neurosci, 6, 19. doi: 10.3389/fnmol.2013.00019

Don’t stress about stress – Part 4: Stress breaking bad

Posted on December 14, 2014 by cedwardpitt

This is the last blog post in my brief series on stress. Today, we’re going to look at what happens when we do hit stress overload, and a few simple methods that may be able to help you through a tough situation.

One of my favourite shows of all time was Breaking Bad. Breaking Bad told the story of Walter White, a high school chemistry teacher and average family man, who is diagnosed with terminal lung cancer. To support his wife and disabled son after he’s gone, he uses his knowledge of chemistry to launch himself into an underworld career manufacturing crystal meth.

Allostatic overload is the term modern scientists use for stress breaking bad. Stress moves from an agent of growth and change to an agent of disease and death.

In the last few blogs, we discussed that stress is actually more of a positive than a negative. It’s not that stress can’t be bad, because we know from the stress-productivity curve and from the Yerkes-Dodson Law that too much stress overwhelms our capacity to cope with it. The model used to describe the balance of stress on our body is the theory of Allostasis.

Allostasis

All living things maintain a complex dynamic equilibrium – a balancing act of the many different physiological systems that all rely on the other systems working at an optimal range. Imagine trying to stack ten spinning tops on top of each other while trying to keep them spinning. The body does the chemical equivalent of this very difficult combination of balance and dexterity every day. It’s called homeostasis. This balancing act is constantly challenged by internal or external events, termed stressors. Both the amount of stress and amount of time that the stressor is applied is important. When any stressor exceeds a certain threshold (“too strong, or too long”), the adaptive homeostatic systems of the living thing activate responses that compensate.

The theory of allostasis is related to these homeostatic mechanisms, although not just in terms of stress, but broadly to the concept of any change of the optimal range of these homeostatic balancing processes, in response to a change in the environment or life cycle of an organism [1].

McEwen and Wingfield give an example of some bird species, which change their stress response to facilitate their breeding capacity during mating season. They note that the benefit of the increased chance of breeding is important to the bird, but also comes at a cost of increased susceptibility to some diseases because of the weakening of the stress response at the time [1].

When it comes to stress, we adapt in a similar way. A lack of stress, or an excess of a stressor in some way (either too long or too strong) results in adaptation, which is beneficial, but can come at a cost. This is demonstrated by that broadly applicable U-curve, the stress productivity curve.

Chrousos wrote, “The interaction between homeostasis disturbing stressors and stressor activated adaptive responses of the organism can have three potential outcomes. First, the match may be perfect and the organism returns to its basal homeostasis or eustasis; second, the adaptive response may be inappropriate (for example, inadequate, excessive and/or prolonged) and the organism falls into cacostasis; and, third, the match may be perfect and the organism gains from the experience and a new, improved homeostatic capacity is attained, for which I propose the term ‘hyperstasis’.” [2] And as noted by McEwen, “Every system of the body responds to acute challenge with allostasis leading to adaptation.” [3]

More often than not, we adapt to the stressor, either the same as before, or possibly better. It’s only if the response to the stressor is inadequate, excessive and/or prolonged that stress ends up causing us trouble. This is what people normally think of when they think of stress – called allostatic overload – simply stress breaking bad.

Keeping stress in check

To ensure that we keep our stress levels at the optimum to ensure maximum productivity and growth, here are a few simple techniques. Remember, everyone handles stress differently, and so which of these techniques works best for you will be something you’ll have to learn by trying them.

Breathing

The simplest tool is breathing. Sounds a little silly really, since you obviously breathe all of the time! But we usually take shallow breaths, so our lungs are not being used to their full capacity. When we focus on our breathing and deliberately take slow, deep breaths we increase the amount of air going in, and therefore allow more oxygen to enter the blood stream. This better fuels our cells and helps them do their job more efficiently. However, it also sets in motion a physiological mechanism that slows our heart rate.

Our heart pumps blood from our body, through the lungs to get oxygenated. As we take a deep breath, more blood is sucked up into our chest cavity from our veins, because breathing in causes a temporary vacuum in our chest cavity. The extra blood then fills our heart more efficiently. A more efficient heart beat reduces the need for the body to stimulate the heart to pump harder. This promotes more of the parasympathetic “rest-and-digest” nervous system activity, and less of the sympathetic “fight-or-flight” nervous system, via the vagal brake mechanism.

So, to slow your breathing down simply sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Meditation

Meditation takes the techniques of breathing one step further, in that meditation involves deliberately switching your brain’s focus to something simple, and in the present. Focussing on nothing – just breathing and turning off your thinking for while – does take some practice. Concentrating on something in the present (not thinking about the past or the future), tends to be easier and requires less practice, although ignoring all the other thoughts that routinely clamour for your attention might be hard when you first try it.

Focusing on the present moment is part of the practice of Mindfulness. Mindfulness meditation has been studied quite extensively over the last few decades, and has been shown to have benefits over a large number of psychological symptoms and disease states [4].

Sometimes it is easier to focus on something visual, that you can see easily in your field of view, or listen to something constant, like the ocean, or a metronome. The easiest thing to do is to again, focus on your breathing. Concentrate on the sound, rhythm and feeling of your breathing, but don’t engage your thoughts, or allow others to creep in. Meditation quietens the mind, which is excellent for reducing stress, and can help to revitalise and refresh your mind.

Guided Imagery

Guided imagery is a step along from meditation. Instead of focussing on something tangible, guided imagery lets you imagine that you are somewhere pleasant, relaxing, or rejuvenating. Some people describe it as a vivid daydream.

Get comfortable, close your eyes and start to breathe slowly and deeply. Once you begin to relax, imagine your favourite scene. It could be at the beach, or in a log cabin in the snow-capped mountains, or swimming in the cool waters in a tropical rain-forest. Whatever you choose, try to imagine the scene in as much detail as possible, and involve all five of your senses if you can, like, for example, the cool water of the waterfall on your bare skin, the sounds of the birds in the trees, the smell of the moss-covered rocks, the canopy of tall trees and vines split by the waterfall and stream allowing the sunlight to spill in to the forest floor. Enjoy the details and the relaxation that this brings. To “come back”, some recommend counting back from ten or twenty, and to tell yourself that when you reach one, you will feel calm and refreshed.

Guided imagery allows you to actively replace the harassing thoughts of your daily routine with pleasant soothing thoughts. There is some early scientific literature suggesting effectiveness, although more research is required [5, 6]. Again, with practice, this can be done anywhere, and can be done quickly if you need a short break to unwind.

Visualisations

Visualisations build on the techniques of guided imagery, but instead of the rain-forest or tropical paradise, you imagine yourself achieving goals, which again could be anything from improving your health, closing that deal, or hitting that perfect drive from the first tee. Again, try and imagine the scene in as much detail as you can, and involve all of your senses.

PMR

Progressive Muscle Relaxation, or PMR for short, is similar to meditation, except that you contract, hold, and then relax your muscle groups in turn. You concentrate on the feel of the tightening and relaxing of the muscles instead of, or as well as, your breathing. Like meditation, it can be done anywhere and involves very little training.

The contraction of the muscle groups, beginning in your feet – working your way up the calves and thighs, tummy, chest, arms and neck, sequentially pumps all of the blood back towards your heart, giving you a boost of blood flow to your lungs. The deep breathing oxygenates this extra blood and hence, gives your brain a burst of oxygen.

Using PMR to meditate helps engage the vagal brake, and there is some evidence that it helps to reduce persistent pain [7, 8].

Exercise

Exercise releases stress and enhances your physical health [9, 10]. It is flexible and easily adaptable – it is usually free and can often be done without any equipment. The downside is that it is not possible everywhere (you can’t go jogging in a plane), but as a daily discipline, it will enhance your physical and emotional wellbeing.

The benefits of exercise are firstly physical. It gets your heart pumping, the blood flowing and your lungs working to their full capacity. It builds physical fitness, which is important to enable the heart and lungs to work efficiently at all times. Exercise has effects on mood, improving depression [11] and anxiety [12].

It can also act as a form of meditation – the solitude of a run or swimming a few laps, concentrating only on the splash of your strokes or the pounding of your feet on the ground – is similar to meditation except that you’re moving (whereas meditation proper involves being still and relaxed). But the outcome is the same, and stress is often reduced by a session of physical exercise.

Music

Music is almost as fundamental to human existance as breathing, and it’s almost as diverse as mankind itself. Listening to ones favourite music can enhance feelings of control and can increase pain tolerance and improve short term anxiety (stress) [13]. The common characteristics of ‘therapeutic’ music was music which had less tonal (pitch) variation, less prominent chord changes, bass lines, or strong melodies [14].

But the key element was personal preference overall, as some of the participants in the study chose music like Metallica. So enjoy music. Make it part of your day. Even Country and Western may be considered therapeutic!

Yoga

Yoga is an ancient practice that has several components including physical postures (asanas), controlled breathing (pranayama), deep relaxation, and meditation.

It’s not for everyone, but it has clearly defined and scientifically validated benefits to your physical and psychological well-being. “It is hypothesized that yoga combines the effects of physical postures, which have been independently associated with mood changes and meditation which increases the levels of Brain-derived neurotrophic factor (BDNF). Other effects that have been noted include increased vagal tone, increased gamma-amino butyric acid (GABA) levels, increase in serum prolactin, downregulation of the hypothalamic-pituitary-adrenal axis and decrease in serum cortisol, and promotion of frontal electroencephalogram (EEG) alpha wave activity which improves relaxation.” [15] So, translated: Yoga is good for stress relief!

Most gyms and community centres will have yoga instructors, so go ahead and make some enquiries.

Massage

I love massage! The first time I had a proper massage was in the small city of Launceston in the tiny Australian state of Tasmania. After just 30 minutes of the therapist kneading my muscles with her fingers of iron, I felt pretty good, but when I sat up, I was actually light-headed for a little while. My heart rate and blood pressure had reduced so much that it took me a while before I could stand up properly!

Deep pressure massage has also been shown to help release the vagal brake enhancing the activity of the parasympathetic (rest-and-digest) part of the autonomic nervous system. There is good evidence of this effect in pre-term infants [16]. The evidence for adults isn’t so strong, although that’s probably because of a lack of quality research [17]. The good studies that have been done show a reduction of cortisol, blood pressure and heart rate after massage, with some studies showing small persistent effects [17].

The data might be thin, but there is enough evidence to make it worth trying at least once.

Probiotics

I add probiotics to this list as a reference for the future. There is good evidence of the anxiolytic effect of having a friendly bacteria garden in your intestines that interacts with your gut and your immune system in positive ways. But there is, at this point, very little in the way of good quality human clinical trials. And we still don’t know exactly which strains of probiotics are the most helpful for different conditions [18, 19]. But given that they are unlikely to be harmful, it may be worth trailing a course of probiotics, and see how you feel in 30 days.

The bottom line – stress is not the enemy. Sure, if it isn’t handled right, stress can overwhelm us and make us sick, but most of the time, stress makes us productive and strong, and helps us to grow. So, don’t stress about stress.

References

McEwen, B.S. and Wingfield, J.C., What is in a name? Integrating homeostasis, allostasis and stress. Horm Behav, 2010. 57(2): 105-11 doi: 10.1016/j.yhbeh.2009.09.011
Chrousos, G.P., Stress and disorders of the stress system. Nat Rev Endocrinol, 2009. 5(7): 374-81 doi: 10.1038/nrendo.2009.106
McEwen, B.S., Stressed or stressed out: what is the difference? J Psychiatry Neurosci, 2005. 30(5): 315-8 http://www.ncbi.nlm.nih.gov/pubmed/16151535
Keng, S.L., et al., Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev, 2011. 31(6): 1041-56 doi: 10.1016/j.cpr.2011.04.006
Jallo, N., et al., The biobehavioral effects of relaxation guided imagery on maternal stress. Adv Mind Body Med, 2009. 24(4): 12-22 http://www.ncbi.nlm.nih.gov/pubmed/20671330
Trakhtenberg, E.C., The effects of guided imagery on the immune system: a critical review. Int J Neurosci, 2008. 118(6): 839-55 doi: 10.1080/00207450701792705
Baird, C.L. and Sands, L., A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs, 2004. 5(3): 97-104 doi: 10.1016/j.pmn.2004.01.003
Morone, N.E. and Greco, C.M., Mind-body interventions for chronic pain in older adults: a structured review. Pain Med, 2007. 8(4): 359-75 doi: 10.1111/j.1526-4637.2007.00312.x
Fletcher, G.F., et al., Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation, 1996. 94(4): 857-62 http://www.ncbi.nlm.nih.gov/pubmed/8772712
Warburton, D.E., et al., Health benefits of physical activity: the evidence. CMAJ, 2006. 174(6): 801-9 doi: 10.1503/cmaj.051351
Rimer, J., et al., Exercise for depression. Cochrane Database Syst Rev, 2012. 7: CD004366 doi: 10.1002/14651858.CD004366.pub5
DeBoer, L.B., et al., Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother, 2012. 12(8): 1011-22 doi: 10.1586/ern.12.73
MacDonald, R.A., Music, health, and well-being: a review. Int J Qual Stud Health Well-being, 2013. 8: 20635 doi: 10.3402/qhw.v8i0.20635
Knox, D., et al., Acoustic analysis and mood classification of pain-relieving music. J Acoust Soc Am, 2011. 130(3): 1673-82 doi: 10.1121/1.3621029
Balasubramaniam, M., et al., Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front Psychiatry, 2012. 3: 117 doi: 10.3389/fpsyt.2012.00117
Field, T., et al., Preterm infant massage therapy research: a review. Infant Behav Dev, 2010. 33(2): 115-24 doi: 10.1016/j.infbeh.2009.12.004
Moraska, A., et al., Physiological adjustments to stress measures following massage therapy: a review of the literature. Evid Based Complement Alternat Med, 2010. 7(4): 409-18 doi: 10.1093/ecam/nen029
Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathog, 2013. 5(1): 3 doi: 10.1186/1757-4749-5-3
Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: part III – convergence toward clinical trials. Gut Pathog, 2013. 5(1): 4 doi: 10.1186/1757-4749-5-4

Dr Caroline Leaf and the cart before the horse, take two

Posted on December 1, 2014 by cedwardpitt

In between her sightseeing in the UK and ballet concerts in the Ukraine, Dr Leaf, communication pathologist and self-titled cognitive neuroscientist, took the time to post some more memorable memes.

Today, Dr Leaf posted, “A chaotic mind filled with thoughts of anxiety, worry, etc. sends out the wrong signal right down to the level of our DNA.”

Hmmm, that one looked familiar … actually, Dr Leaf posted the exact same phrase on the 5th of October this year. I’m all for recycling, but of renewable resources, not tired ideas.

This meme has been soundly rebuffed before, and the idea that the mind controls our DNA has been thoroughly dismantled. Reposting it won’t make it any truer.

This meme is better off being put into the trash than the recycling bin.

(For more information on the rebuttal of the mind over matter meme, see also “Hold that thought: Reappraising the work of Dr Caroline Leaf“, “Dr Caroline Leaf: Putting thought in the right place” Part 1 and Part 2, “Dr Caroline Leaf and the matter of mind over genes“, “Dr Caroline Leaf, Dualism, and the Triune Being Hypothesis”, “Dr Caroline Leaf and the Myth of the Blameless Brain” and “Dr Caroline Leaf and the Myth of Mind Domination” just to name a few references).

Don’t stress about stress – Part 3: Coping

Posted on November 23, 2014 by cedwardpitt

In our last two blogs, we’ve been looking at stress, and why stress is usually more helpful than harmful.

It’s not that stress can never be harmful. Stress can be a trigger to some illnesses (although not as many as the popular media often portrays). What is it that makes the difference between helpful and harmful? What is it that causes one person to surf the tsunami of sewerage that often confronts us in life, while another person sinks?

The answer lies in resilience.

WHAT IS RESILIENCE?

Resilience is the term given to the individual’s capacity to cope.

Researchers in the field of psychiatry often use the term resilience, which “is the capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning” [1] although psychologists and social science researchers would use the term “coping”, which is defined by Compas et al as, “conscious and volitional efforts to regulate emotion, cognition, behavior, physiology, and the environment in response to stressful events or circumstances.” [2] Skinner and Zimmer-Gembeck define coping as, “action regulation under stress.” [3]

Considering the definitions used, the terms are essentially interchangeable. The other observation to be made here is that coping/resilience is an active process. It’s not something that happens despite of us – we actively cope with stress. In the face of a situation involving emotional arousal (danger or stress), we take steps to deal with our inner and outer environments (the physiological processes of our body, as well as the environment around us). Sometimes these steps are conscious and/or under our control. But theorists also consider automatic, unconscious, and involuntary responses to also be part of the coping spectrum [4].

WHAT CONTRIBUTES TO RESILIENCE?

Coping Strategies

What makes up those actions? What influences the action steps?

Psychologists have described hundreds of individual methods of coping through recent research, although there have been efforts to consolidate the plethora of individual coping strategies into “family” clusters, based on function. For example, a primary tier is to “Coordinate actions and contingencies in the environment” which involves “finding additional contingencies” which on the third level involves “reading, observation, and asking others.” [3] Table 1 in the paper by Skinner and Zimmer-Gembeck [3] summarize the many ways of coping and how they can be grouped together into families, and their corresponding adaptive process.

Personality factors

Coping strategies follow along the lines of personality type [5], as well as the stage of development in children [3]. Personality types such as Neuroticism and Openness have been well studied, with Neuroticism associated with maladaptive coping strategies, and Openness correlated with adaptive coping (in marital relationships [6] and in public speaking tasks [5]).

Further research has shown how personality significantly influences coping, with the severity of the stress, and the age and culture of a person influencing the strategy and strength of the coping response [4]. Of course, personality traits like neuroticism sound bad, but they confer their own strengths. For example, negative affect has protective benefits by enhancing the detection of deception [7].

Biological factors

The shared connection that personality types and coping responses have is in their shared genetics, with personality and coping styles influenced by common genes [8]. This makes perfect sense as it has been shown that changes in individual genes effect the ability of the brain to associate the correct value to rewards [9], which then influences both mood [10], and learning [11]. Even though environmental variables are important in determining personality and learning aspects of coping with stress, the brains underlying capacity to process the incoming signals correctly will significantly influence the direction and outcome of the learning process, which includes learning which coping strategies work best for each individual.

On a deeper level, there are several biological processes that make up the features of resilience. Animal studies on resilience, as a whole, have shown that resilience “is mediated not only by the absence of key molecular abnormalities that occur in susceptible animals to impair their coping ability, but also by the presence of distinct molecular adaptations that occur specifically in resilient individuals to help promote normal behavioral function.” [12] That is, resilient individuals have the full complement of critical components in the resilience pathway, and have some extra tools too.

Human studies thus far have shown strong links to genetic changes that affect the proteins in the stress system. Epigenetic mechanisms are involved, and the role of the environment is also significant, especially uncontrollable early childhood trauma. Wu et al list the current studies of genetic changes that effect resilience in humans [1: Table 1]. The proteins involved are responsible for the growth of new nerve pathways (BDNF), and for their function, especially within the stress system (CRHR1, FKBP5) and in control of mood and reward systems (COMT, DAT1, DRD2/4, 5-HTTLPR, the HTR group).

Wu et al [1] also summarised the currently known facts about epigenetic factors in resilience. Interestingly, they noted an animal study in which chronic stressors increased an epigenetic marker called histone acetylation in the hippocampus in mice, which enhanced the protective effects of the stress (epigenetics will be the subject of a future blog)

Resilience on a personal level

So coping and resilience are known protective factors for stress, and are more commonly deployed than most people realize. Despite all of the publicity that stress has generated, human beings remain remarkably unscathed. It’s estimated that, “in the general population, between 50 and 60% experience a severe trauma, yet the prevalence of illness is estimated to be only 7.8%.” [12] (Note: By ‘illness’, the authors were referring to Post Traumatic Stress Disorder, not all of human sickness).

But when it comes to recommending different coping strategies on an individual level, it is a much harder thing to do. What is adaptive in some situations and for some people is maladaptive in other situations and for other people.

For example, in animal studies, “stressed females tend to perform better than males on non-aversive cognitive or memory tasks … Conversely, in tests of acute stress or aversive conditioning, stress enhances learning in males and impairs it in females … the literature suggests that in cognitive domains females cope better with chronic forms of stress, whereas males tend to cope better with acute stress.” [12] So animal studies confirm a difference in the biological stress response between men and women. If these studies in animals can be extended to humans, it may explain the tendency for men to engage in “fight-or-fight” responses to stress where women usually move to “tend-and-befriend” mode [13].

Human studies on coping also demonstrate that what is good for one is not necessarily good for another. Connor-Smith and Flachsbart confirm that, “In particular, daily report and laboratory studies suggest that individuals high in sensitivity to threat may either benefit from disengagement or be harmed by engagement in the short term, with the opposite pattern appearing for individuals low in threat sensitivity.” [4]

So in other words, just because engaging may be a positive method of coping does not mean that it should be recommended to everyone. Some people will have more harm from trying to engage. Care should be taken when giving people advice about how to manage their stress. Ill-informed instructions can actually make things worse.

SUMMARY

It’s well established that stress can have negative impacts on your physical and mental health. But contrary to the popular view, stress is not always bad. As a number of authors point out, most people go through significant stress at some point in their lives, but only a fraction succumb to that stress.

The difference is the factors that make up resilience. Where we are along the stress spectrum (that is, whether you are wired to be more stressed, or more resistant to stress) depends on our genetic predisposition, which determines the physiology of our stress system and our personality, and the ways we learn to cope.

How we cope best depends on our individual traits and the situation. There is no one-size-fits-all. Pushing a person into a form of coping that’s not suitable can actually cause a lot of harm.

Remember, we normally find what coping strategies work for us automatically as our resilience is mostly innate, and we all go through severe stress at some point or another in our lives, but only a small fraction of us will succumb to that stress.

In the last blog in the series, we’ll have a brief look at what happens when stress overwhelms us … when stress is breaking bad.

References

Wu, G., et al., Understanding resilience. Front Behav Neurosci, 2013. 7: 10 doi: 10.3389/fnbeh.2013.00010
Compas, B.E., et al., Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull, 2001. 127(1): 87-127 http://www.ncbi.nlm.nih.gov/pubmed/11271757
Skinner, E.A. and Zimmer-Gembeck, M.J., The development of coping. Annu Rev Psychol, 2007. 58: 119-44 doi: 10.1146/annurev.psych.58.110405.085705
Connor-Smith, J.K. and Flachsbart, C., Relations between personality and coping: a meta-analysis. Journal of personality and social psychology, 2007. 93(6): 1080
Penley, J.A. and Tomaka, J., Associations among the Big Five, emotional responses, and coping with acute stress. Personality and individual differences, 2002. 32(7): 1215-28
Bouchard, G., Cognitive appraisals, neuroticism, and openness as correlates of coping strategies: An integrative model of adptation to marital difficulties. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 2003. 35(1): 1
Forgas, J.P. and East, R., On being happy and gullible: Mood effects on skepticism and the detection of deception. Journal of Experimental Social Psychology, 2008. 44: 1362-7 http://bit.ly/Jm66a7
Kato, K. and Pedersen, N.L., Personality and coping: A study of twins reared apart and twins reared together. Behavior Genetics, 2005. 35(2): 147-58 http://link.springer.com/article/10.1007%2Fs10519-004-1015-8
Dreher, J.-C., et al., Variation in dopamine genes influences responsivity of the human reward system. Proceedings of the National Academy of Sciences, 2009. 106(2): 617-22
Felten, A., et al., Genetically determined dopamine availability predicts disposition for depression. Brain Behav, 2011. 1(2): 109-18 doi: 10.1002/brb3.20
Ullsperger, M., Genetic association studies of performance monitoring and learning from feedback: the role of dopamine and serotonin. Neuroscience & Biobehavioral Reviews, 2010. 34(5): 649-59
Russo, S.J., et al., Neurobiology of resilience. Nature neuroscience, 2012. 15(11): 1475-84
Verma, R., et al., Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J, 2011. 20(1): 4-10 doi: 10.4103/0972-6748.98407

Don’t stress about stress, part 2

Posted on November 20, 2014 by cedwardpitt

In the last blog post, we looked at some of the different ways of looking at stress outside of the medical field – the stress on a guitar string, the power band of the car engine, and the action of gravity on our bodies. In this post, I want to expand on those metaphors, using them to help us understand how we can respond to stress, and why stress isn’t our enemy, but it actually brings out our best if managed in the right way.

One of the reasons why gravity gives you strong muscles and bones, and zero gravity gives you weak muscles and bones, is because of resistance.

Movement involves work. We do “work” everyday in simple everyday activities, because our muscles and bones have to apply a certain amount of force in order to overcome gravity. Our muscles adapt by growing the muscle fibres to provide that force, and bones remodel themselves to provide the maximum resistance to the loads that gravity and the muscles put through them. We’re not aware of this day-to-day because we never experience prolonged changes in our gravitational fields.

But when we need to do more work than our muscles are accustomed to, our muscle fibres increase in strength, first as the nerve networks that supply the muscles become more efficient, after about two weeks of ongoing training, the fibres themselves increase in size [1, 2]. The growth in muscle fibres is caused by three related factors: mechanical tension, muscle damage and metabolic stress [2]. Mechanical tension involves “force generation and stretch”. In other words, the muscle fibres are stretched just beyond their usual capacity, and they actively fight against the resistance. This damages the weaker muscle fibres, which are repaired. The remaining muscle fibres are forced to adapt by growing larger because of the stimulation of growth factors [2].

One of my favorite “Demotivator” posters says, “That which does not kill me postpones the inevitable” [3]. Of course, the phrase that they’ve parodied is, “That which does not kill us makes us stronger.” Why is there truth to that idiom? Adversity occurs when life circumstances come against us. In other words, adversity resists us. In the arm wrestle between adversity and overcoming, work is involved. We have to fight back.

In a similar way, we grow when adversity pushes us just beyond what we have done before, stretching us. We may sustain some damage in the process, but that helps to reduce our weaknesses, and forces us into growth as we heal. When we push back against adversity, the “cells” of our character grow.

Of course, we all know examples where muscles fail under intense or prolonged loads. I vividly remember the pictures of the UK’s Paula Radcliffe, succumbing to the grueling hills and scorching Athens heat with only four miles left in the 2004 Olympic Marathon. Muscle failure from excessive stretch or excessive endurance parallels the allostatic load response, which is what people commonly referred to as ‘stress’.

Scientific evidence that stress is positive

There have been recent studies in animals that demonstrate that stress is physically as well as mentally enhancing.

Neurogenesis is the process of new nerve cell formation. Studies of rodents placed under intermittent predictable stressors showed an increase in neurogenesis within the hippocampus, which is the part of the brain related to learning and memory. Along with this enhancement of neurogenesis, the function of the hippocampus increased, specifically hippocampal-dependent memory, with a reduction in depression and anxiety-like behaviours.

As Petrik et al noted in their review, “Contrary to stress always being ‘bad’, it has long been appreciated that stress has an important biological role, and recent research supports that some amount of stress at the right time is actually useful for learning and memory.” [4]

Lessons from stress

So what can we learn from stress? How do we use the stress that we are exposed to every day to make us grow strong and durable?

Firstly, like the guitar string, we need to learn when we are in tune, at the peak of our productivity. Or like the car engine, what it feels like to be in the power band. When we know where our sweet spot is, we can operate within it, achieving our best in life without doing ourselves harm. This is the first point that we need to identify on our own personal stress/productivity curve. This is the point of maximum productivity.

The other life principle to be gained from the car engine analogy is that not all of us are high performance engines. I would love to think that I’m a F1 racing engine – highly tuned, supreme power – but I recognise my limitations. I would even settle for a 5-litre V8, but I know that I’m probably more like a well-tuned V6. We are what we are. Sometimes we apply the most stress to ourselves when we try to drive in the power band of someone else’s engine. We need to accept who we are.

It seems logical that if too much stress is bad for us, then having little or no stress is good for us. But like the new guitar string, minimal stress makes us unproductive. Like zero gravity on the body, little or no stress makes us weak.

And we need to understand that a bit more stress is ok. It’s inevitable that we are going to be stressed beyond what we usually cope with at times. But without that challenge, there would be no growth. Challenges usually hurt. You can’t have growth without pain. In the muscle analogy, at the stretch at which peak growth occurs, muscle fibres tear and the lactic acid build up in the remaining cells can be very uncomfortable. The key is learning how far we can push ourselves before we start to falter and fail. This is the second point we need to discover on our personal stress/productivity curve. This is the point of maximum growth.

Once we understand our own individual points of maximum productivity and growth, we can use them as guides to our personal growth and achievement. Actually, I should specify that these are our starting points, since as we face challenges and experience growth, the points will change slightly. We can remap those points and continue in our pattern of growth and development.

Pushing ourselves into just enough stress to achieve growth, then pulling back to rest and restore, is a pattern of growth that is seen in many facets of the natural world and the human body. Body builders and athletes use this method all the time in their training. They push themselves with more repetitions and heavier weights, or longer or faster runs, then they pull back to consolidate their gains. During our adolescence, our bodies naturally go through growth spurts – periods of rapid growth followed by a plateau, before the next burst of growth hormone hits us again. Even tree rings demonstrate that growth and consolidation occur all the way through the natural world.

This is the Stressed-Rest cycle. The studies in animals on neurogenesis strengthen the theory, because it was the animals that experienced bursts of stress that showed enhanced neurogenesis, memory and reduced depression/anxiety behaviours.

If you want maximum personal growth, constant stress does not help. There has to be times of rest. Some people think that rest time is wasted time, reducing productivity. But as explained, without rest time, productivity rapidly falls away. Without rest, stress goes bad, leading to allostatic overload.

So in summary, excessive stress is bad. But if all stress were bad, then we would all crumple any time that something became difficult. So stress is not a force for evil. Stress is part of our normal everyday lives, and is vital if we are to see ongoing personal growth.

We know from living life that we all don’t fall in a heap when things go wrong. We have in-built ways of coping that help us to absorb troubles and adversities and like emotional photosynthesis – turn them into fuel for growth.

This is the science of resilience, the counterbalance to the forces of stress that help us cope and adapt in a rapidly changing natural and social environment, the Yang to allostatic overload’s Yin. A discussion on the science of stress is not complete without a discussion of resilience, which I’ll discuss in the next blog in this series.

References

Hortobagyi, T. and Maffiuletti, N.A., Neural adaptations to electrical stimulation strength training. Eur J Appl Physiol, 2011. 111(10): 2439-49 doi: 10.1007/s00421-011-2012-2
Schoenfeld, B.J., The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res, 2010. 24(10): 2857-72 doi: 10.1519/JSC.0b013e3181e840f3
Adversity. Demotivators [cited July 2013]; Available from: http://www.despair.com/adversity.html.
Petrik, D., et al., The neurogenesis hypothesis of affective and anxiety disorders: are we mistaking the scaffolding for the building? Neuropharmacology, 2012. 62(1): 21-34 doi: 10.1016/j.neuropharm.2011.09.003

Don’t stress about stress – Part 1

Posted on November 18, 2014 by cedwardpitt

Stress gets a bad rap. Everywhere you look, stress seems to be getting the blame. Though as Richard Shweder wrote in the New York Times, “Imprecise and evasive language may be a disaster for science but it is a boon in everyday life. ‘I am stressed out’ is non-accusatory, apolitical and detached. It is a good way to keep the peace and, at the same time, a low-cost way to complain.” [1]

Selye said that, “Everybody knows what stress is, but no one really knows.” [2] Hans Selye is considered the father of modern stress research. He was one of the first scientists to conceptualise and measure this ethereal force.

As with some of the most important discoveries in the history of science, Selye came upon the discovery of what he termed the “alarm reaction” incidentally when he was injecting rats with impure ovarian extract, and noted that they became sick. He looked further at the physical changes in the rats and noted an unusual cluster of changes to their adrenal glands, thymus, spleen and gut [3]. He was able to reproduce the same responses by exposing the rats to cold temperatures, surgical injury, spinal shock, excessive muscular exercise, or intoxications with sublethal doses of drugs such as adrenaline, morphine or formaldehyde [4]. After years of research, he confirmed that ongoing exposure to the same physical conditions or drugs would follow the same three-stage process of initial physical changes, recovery and adaptation, then eventually exhaustion (and death). He called this model the “General Adaptation Syndrome.” [4]

The General Adaptation model was groundbreaking, and the sheer volume of work done by Selye brought his theories to the forefront of the scientific community. With time, the theory slowly descended from its place of adulation as other evidence came to light [5], but it has remained foundational, and Selye is still revered as the father of modern stress research.

The term stress “generally refers to experiences that cause feelings of anxiety and frustration because they push us beyond our ability to successfully cope.” [6] Scientifically, stress has been difficult to define. Different researchers often use different definitions of stress depending on what they’re studying or what field of psychology or science they belong to [7].

I wanted to look at stress from a different perspective. In the next series of posts, I want to look at the basic concepts of stress and its functions in nature. I will spend some time looking at different ways of conceptualising stress, and look at how they offer is life lessons on how to approach our stress. I’ll then have a look at what it is that helps us cope with stress.

A broad concept of stress

To gain a better understanding of stress, it’s useful to step away from the medical concept of stress, and think about what the term means in other fields.

When an engineer thinks about stress, it’s usually in relation to a physical force on a material object. My son is a huge Mythbusters fan. He was watching an episode the other day where the Mythbusters were testing the myth of Pykrete, a material that was nothing but wood shavings and ice. They were testing to see whether it was more durable than ice alone, whether it was bulletproof, and whether it could be used to build a boat! [8] In order to test out these crazy claims, they made some in their workshop and compared it with normal ice. How did they test it? By stressing it – placing weights on the end of the block of the ice/pykrete until it broke. (In the end, pykrete was ten times stronger than ice, was bulletproof, and they made a fully operational motor-boat from it!)

So the mechanical definition of stress is, “pressure or tension exerted on a material object.” [9] There are a few illustrations of mechanical stress, in our bodies and in everyday life, that are good metaphors for stress in our lives.

The Classical Stress/Productivity Curve

I confess I am NOT a musician. I’ve never learnt to read music or play an instrument. But I do know that when you first put a new string on the guitar, it’s unstretched – there is literally no force on it at all. If all you did was tied the two ends of the string to the tone peg and the tuning peg, the string would remain limp and lifeless. It wouldn’t be able to do anything useful. It certainly wouldn’t play a note.

When the tuning peg is twisted a few times, there is some tightness in the wire. The string is now under tension (i.e. stress). It is now able to play a note of some form, so it can do some work and fulfill some of the function of a guitar string. But the pitch isn’t good enough – the note is out of tune.

With a small adjustment, the string reaches its optimal tension and can play the correct note! This is the point where the string is fulfilling its designed purpose. Optimal stress equals optimal function.

With further tightening of the string, the perfect pitch is lost, but the string can still produce a sound of some form. With more tension, the string can still make a noise, but it sounds awful, and the fibres inside the cord are starting to tear. If the string were wound further and further, it would eventually break.

If this ratio of the tension of the string versus the usefulness of the string were to be plotted as a graph, it would look like an upside down “U”. This is the classic stress/productivity curve.

The Exponential Stress/Productivity Curve

The second metaphor that I think illustrates a different concept of the stress/productivity relationship is a car.

As well not being a musician, I am also NOT a mechanic! I know the important things like where the petrol goes, and how to drive them, but otherwise cars are very mysterious and powerful devices, their mystery is only exceeded by their power.

What I do know is that the engine is very much like the guitar string. As more petrol is fed into the engine, the engine gets more powerful. Soon, the engine finds its “power band”, a zone of maximum torque that can be achieved at moderate revolutions. As the engine is given more gas, the power output declines from the middle of the power band. If the engine was maxed out then the amount of functional power coming out is reduced.

This would plot as a similar graph to the U-curve of the stress/productivity curve. But cars not only have engines, but also a gearbox. The gears allow for multiplication of the work done (the productivity) for the same stress on the engine.

G-Force!

As a child, I didn’t dream of becoming an astronaut, but I was interested in space. The beauty of our night sky is as stunning as any forest, river or mountain. I would read of the astronauts in rockets and in space stations, floating around in zero gravity, swimming through the “air”. That sounded like a lot of fun.

But zero gravity isn’t particularly good for you. Some early astronauts had to be carried off their landing craft on stretchers because the effect of zero gravity would render these men weak and atrophied. They boarded the spacecraft at the peak of their physical strength and fitness, but after only a few weeks without gravity, their bodies resembled that of the elderly (although without the wrinkles) [10].

It’s a general principle of the human body that any tissue that isn’t needed shrinks in size – a process called atrophy. In zero gravity, the body doesn’t need as much muscle, so the muscles shrink. The body doesn’t need as much bone strength, so the bones weaken. There is no gravity to pull their blood away from their head, so the blood volume decreases. Because there is less muscle to pump blood to, and less blood to pump, the heart doesn’t work as hard, so the heart muscle atrophies. The net effect of zero gravity is to make you physically weak [10].

On the other hand, too much gravity is not great either. Animals can adapt to small amounts of hypergravity [11]. But large amounts aren’t so good. During astronaut training, NASA subjects the rookie spacemen to rigorous tests including placing them in a large centrifuge and spinning it very fast. The result is an increase in the gravitational forces applied to their bodies. The increased gravity makes everything in the body heavier and their blood is pulled towards the legs and away from the brain, which leads to what is known as G-LOC (Gravity-induced Loss Of Consciousness). In other words, the heart can’t fight the increased force of gravity and the brain loses its blood supply, which makes you pass out. Josh McHugh did an entertaining piece on his experience with G-LOC and the centrifuge in Wired (2003) [12].

In this sense, gravity is to us physically like stress is to us mentally. Without gravity, our physical bodies turn to mush as we slowly weaken from the inside. Too much gravity, and our physical bodies are slowly squashed by the invisible weight of the extra G’s. Our bodies work best at 1G.

In the next post in this series, I’ll look at how these different models of stress apply to our everyday.

References

Shweder, R.A., America’s Latest Export: A Stressed-Out World. The New York Times, New York, 26 January 1997 http://www.nytimes.com/1997/01/26/weekinreview/america-s-latest-export-a-stressed-out-world.html
What Is Stress. [cited 2013, July]; Available from: http://www.stress.org/what-is-stress/.
Half a century of stress research: a tribute to Hans Selye by his students and associates. Experientia, 1985. 41(5): 559-78 http://www.ncbi.nlm.nih.gov/pubmed/3888652
Selye, H., A syndrome produced by diverse nocuous agents. 1936. J Neuropsychiatry Clin Neurosci, 1998. 10(2): 230-1 http://www.ncbi.nlm.nih.gov/pubmed/9722327
Fink, G., Encyclopedia of stress. 1st ed. 2000, Academic Press, San Diego:
McEwen, B.S., Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci, 2006. 8(4): 367-81 http://www.ncbi.nlm.nih.gov/pubmed/17290796
Hackney, A.C., Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Expert Rev Endocrinol Metab, 2006. 1(6): 783-92 doi: 10.1586/17446651.1.6.783
Beyond Entertainment / Discovery Channel, The Alaska Special 2 (Season 7, Episode 2), Mythbusters: 2009 Discovery Channel, 44min. http://www.imdb.com/title/tt1427433/
Oxford Dictionary of English – 3rd Edition, 2010, Oxford University Press: Oxford, UK.
Gravity Hurts (So Good). NASA Science | Science News 2001 [cited July 2013]; Available from: http://science1.nasa.gov/science-news/science-at-nasa/2001/ast02aug_1/.
van Loon, J.J., Hypergravity studies in the Netherlands. J Gravit Physiol, 2001. 8(1): P139-42 http://www.ncbi.nlm.nih.gov/pubmed/12650205
McHugh, J., Surviving 7G. Wired, 2003. November(11),

Dr C. Edward Pitt

Faith, Hope, Love, Science.

Tag Archives: anxiety

Dr Caroline Leaf and her can of worms

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

The Prospering Soul – Just what is mental health?

Gluten mad!

Don’t stress about stress – Part 4: Stress breaking bad

Dr Caroline Leaf and the cart before the horse, take two

Don’t stress about stress – Part 3: Coping

Don’t stress about stress, part 2

Don’t stress about stress – Part 1

A broad concept of stress

The Classical Stress/Productivity Curve

The Exponential Stress/Productivity Curve

G-Force!