But I’m normally a rational person …

She shifted uncomfortably in her seat, her uneasy hands fidgeting together, her eyes flitting around as she tried to focus on the wall across from her, unable to find a target for her empty gaze.

“But … I’m normally a rational person,” she said, finally putting words to the thought that had been evading her for half a minute.

She was a woman in her mid thirties, with a comfortable job, a family and a mortgage in the suburbs.  We were halfway through a standard GP consult, and we had already discussed and resolved something trivial before she finally plucked up the courage to change tack and reveal the hidden agenda she’d hoped to discuss all along.

“I’m anxious all the time.  I try so hard, but I can’t seem to stop thinking about all the things that could go wrong.”

I empathised.  I’ve been there too – I’ve lived through times when my anxiety disorder was so debilitating that I wouldn’t call someone on the phone for fear of dialling the wrong number.  Or when I was so depressed that I couldn’t see anything positive for the future, when nearly every thought I had was saturated with moribund darkness.

I was anxious as a teenager, but I was depressed as an adult.  I’d been through medical school and I had attained by GP fellowship when my depression took hold.  During the four years or so that I spent with the black dog, I was constantly haunted by the same narrative that now haunted my patient … “I’m a rational person, why am I thinking like this?”

The fact I had fellowship level medical training intensified my mental self-flagellation, “I know all about depression.  I understand CBT.  I know I’m ruminating on catastrophic thoughts.  So why can’t I stop them?  If only I could think more positively, I’d be so much better.”

I found myself in a self-defeating spiral, often called the struggle switch, where I thought I knew how to climb out of my psychological mire, but all I achieved in trying to climb out was to sink further in, making me feel more defeated, even more of a failure.  It was a very difficult time which I thought would never end.

Eventually it lifted, like a heavy fog thinning in the morning sunlight, but it certainly wasn’t the result of anything clever I did.  So why did my rational brain keep filling my mind with irrational thoughts?

The answer lay in a paradigm shift away from the long held beliefs that we were taught at medical school and in our general practice training.  We’ve been lead to believe for so many years that our thoughts were the key driver of our behaviour, but it turns out that it’s actually the other way around, our behaviour is but one of a number of key driver of our thoughts.

The foundation of CBT is the notion that challenging maladaptive thoughts helps to empower behavioural change.  Except that research suggests that cognitive therapy specifically targeting problem thoughts offers no extra improvement over behavioural therapy alone.

Herbert and Forman confirm this when they point out that, “proponents of behavioral activation point to the results of component control studies of CT, in which behavioral activation or exposure alone is compared to behavioral activation (or exposure) plus cognitive restructuring. The majority of these studies have failed to demonstrate incremental effects of cognitive restructuring strategies.” [1]

This fact has been further confirmed by a number of meta-analyses [2] and by a large randomised controlled trial comparing behavioural therapy and cognitive therapy side by side with medication for depression [3].

So therapies aimed at fixing thinking works equally as well as therapies aimed only at promoting therapeutic action.  However, when thinking therapies are added to behaviour therapies, they add no extra benefit over and above the behaviour therapies alone [2].  This suggests that action is the driver of the therapeutic effects of psychological therapy.  If thinking were the driving force of psychological change, the addition of cognitive therapy to behaviour therapy should have an incremental effect.

That cognitive therapy works equally well as behavioural therapy may be related to their fundamental similarities. Dobson et al explains, “Behavioural Activation is implemented in a manner that is intended to both teach coping skills and to reduce future risk. The same is true for Cognitive Therapy, which adds an emphasis on cognitive change, but otherwise takes a similar skills-training approach.” [3]  In other words, cognitive behavioural therapy is just behavioural therapy with bling.

Herbert and Forman summarise it nicely, “The ideas that thoughts and beliefs lead directly to feelings and behavior, and that to change one’s maladaptive behavior and subjective sense of well-being one must first change one’s cognitions, are central themes of Western folk psychology.  We encourage friends to ‘look on the bright side’ of difficult situations in order to improve their distress. We seek to cultivate ‘positive attitudes’ in our children in the belief that this will lead to better academic or athletic performance. Traditional cognitively-oriented models of CBT (e.g., CT, stress inoculation training, and rational emotive behavior therapy) build on these culturally sanctioned ideas by describing causal effects of cognitions on affect and behavior, and by interventions targeting distorted, dysfunctional, or otherwise maladaptive cognitions.” [1]

I understand this is going to ruffle some feathers, and not everyone is going to be keen to dispense with CBT just yet, but I hope this gets us thinking about thinking at the very least.

For me, coming to an understanding that my thoughts were just the dashboard and not the engine helped me to pay less attention to them and to focus my healing energies on what was really important, taking values based action rather than just fighting with my stream of thoughts.

And it’s helped me to empathise differently with my patients and reassure them that you can still be a rational person even if your thoughts don’t always seem to follow suit.

References
[1]       Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[2]       Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[3]       Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.


KINTSUKUROI CHRISTIANS – Available at Koorong, Amazon, iBooks and other good book retailers

Dr Caroline Leaf and Testimonials – Good marketing, poor evidence

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She is a pseudoscientist of the highest order. She once wrote a PhD. Now she has episodes of her TV show titled “Surviving cancer by using the Mind”.

This weeks edition of her newsletter started off with some subtle boasting:

“We have received many E-mails over the past years asking for Testimonies with regards to Dr Leaf’s research and teachings. We have summarized eight pages of testimonies received at TESTIMONIES. Be encouraged and feel free to refer them to friends, family, acquaintances, and work colleagues struggling with Mind issues.”

Testimonials are an empty box wrapped in shiny paper and trimmed with a bow. They look really good but offer nothing of substance. They’re simply an old advertising trick.

According to the Market Science Institute, “Testimonial solicitations – in which firms solicit consumers’ personal endorsements of a product or service – represent a popular marketing practice. Testimonials are thought to offer several benefits to firms, among them that participating consumers may strengthen their positive attitudes toward a brand, through the act of writing testimonials.” [1]

Who can argue with a person who says that Dr Leaf helped turn their life around? Saying anything negative just makes you sound like a cynical old boot.

And that’s the real problem, because while publishing a whole bunch of positive stories is good for marketing, it makes it very hard for those who had a genuinely bad experience to say anything. No one wants to listen to those people whom Dr Leaf has confused or mislead – it makes for terrible PR. Those people feel devalued, and sometimes worse, because it seems like everyone else had a good result from Dr Leaf’s teaching, except them.

Testimonials also make for very poor scientific evidence. Indeed, testimonials are considered the lowest form of scientific evidence [2]. It’s all very well and good for a bunch of people to share their positive experiences, but as life changing as the experience may have been, they are not evidence of the effectiveness of Dr Leaf’s teaching. Without specific, well-designed research, no one can say if the testimonials Dr Leaf is publishing are the norm. Recent research demonstrates that self-help literature for depression may not have any benefit over a placebo treatment [3]. So it may be that any improvement attributed to Dr Leaf’s teaching was actually the placebo effect. Dr Leaf can list testimonials until she’s blue in the face, but that doesn’t prove that her work is scientific or therapeutic.

Indeed, selectively publishing testimonials is duplicitous, telling half-truths, positively spinning her own story. How many e-mails has Dr Leaf gotten from people who have found her teaching inaccurate, ineffective, unbiblical or harmful? Dr Leaf’s social media minions deliberately delete any negative comments and block anyone from her sites that disagree with her. And over the years, many people have shared with me how arrogant and dismissive her team has been to polite, genuine concern or criticism. I can personally attest to the same treatment. If Dr Leaf was honest with her followers, she would be openly publishing the brickbats as well as the bouquets.

For her readers and followers, the testimonials need to be seen for what they are: just individual stories. Sure, we should rejoice with those who are rejoicing (Romans 12:15), and so good for those who feel Dr Leaf has helped them. But they do not constitute evidence for the therapeutic efficacy or scientific integrity of the work of Dr Leaf.

For people genuinely struggling with “mind issues”, the last thing they need is testimonials collated by Dr Leaf’s marketing team.  They don’t need to be referred to Dr Leaf’s work, they need to be referred to psychologists and doctors.

And if Dr Leaf really wanted to prove her legitimacy, she would rely on independent peer-reviewed published research, not on the list of vacuous, self-serving cherry-picked testimonials that she is currently offering.

References

[1] Marketing Science Institute. Consumer Testimonials as Self-Generated Advertisements: Evaluative Reconstruction Following Product Usage. [cited 2014, Aug 3]; Available from: http://www.msi.org/reports/consumer-testimonials-as-self-generated-advertisements-evaluative-reconstru/.
[2] Fowler, G., Evidence-based practice: Tools and techniques. Systems, settings, people: Workforce development challenges for the alcohol and other drugs field, 2001: 93-107
[3] Moldovan, R., et al., Cognitive bibliotherapy for mild depressive symptomatology: randomized clinical trial of efficacy and mechanisms of change. Clinical psychology & psychotherapy, 2013. 20(6): 482-93

The Secret Teaching of Dr Caroline Leaf

Unless you’ve lived under a rock for the decade, “The Secret” is no secret.  We’ve all heard of the book or the movie, or the countless gurus that promote how they’ve made millions of dollars and found untold happiness by unlocking the power of the Law of Attraction.  You can have that same success too if you buy their book or attend their seminar, or sign up to be part of their network marketing scheme.

Let’s be honest, we’ve probably all, at some point, indulged someone telling us that we just need to think positive or visualise our goal and it will be ours.  It’s even something that many preachers over the years have sold to us in various guises, like hyper-faith, name it and claim it, sowing your seed.

The Secret claims that if we understand we’re all energy, one with the universe and its power, then we can leverage that power to create or receive anything we want with our thoughts.  We just need to think positively and visualise it.  It’s a repackaging of the human potential movement, new age philosophy and cosmic consciousness, all of which is a repackaging of pantheism and Eastern religious teaching.

The author, Rhonda Byrne, (who I’m embarrassed to say is Australian) wrote, “If you’re feeling good, it is because you are thinking good thoughts.”  Ok, but what about when you’re thinking good thoughts and you still feel bad?  What exactly are ‘good thoughts’ anyway?

She also wrote, “Remember that your thoughts are the primary cause of everything.”  So the rise of ISIS is because of my thoughts.  Donald Trump might be President … my thoughts.  An oceanic tectonic shift cuts the undersea trunk line taking out the internet for half the eastern seaboard … Sorry, my bad, I was having negative thoughts again.

So The Secret really doesn’t make a lot of objective sense.  I could go on, but it’s been taken down well enough by a number of commentators and critics over the last decade or so (https://skeptoid.com/episodes/4096; http://www.christianitytoday.com/ct/2007/june/20.71.html), so I’m not going to reinvent the wheel.  But suffice to say, The Secret fundamentally sells the power of thought to shape our reality … wait, that sounds oddly familiar.  Dr Leaf said the same thing at TD Jakes’ church, the Potter’s House, only this week.

leaf-the-secret

@bishopjakes proudly shared this Instagram post which Dr Leaf duly forwarded to her adoring fans.  “You can shape your reality by the way you think” was even the title of her message.  (She followed it up with an e-mail to her subscribers saying the exact same thing …)

img_5295_trimmed

Dr Leaf’s teaching is eerily similar to The Secret in many other ways.  That quote from before: “Remember that your thoughts are the primary cause of everything” sounds remarkably similar to “Thoughts influence every decision, word, action and physical reaction we make.” (Who Switched Off My Brain, p13)

There are lots of others.  From The Secret:

“Everything else you see and experience in this world is effect, and that includes your feelings. The cause is always your thoughts.”

“Every thought of yours is a real thing – a force.”

“Everything else you see and experience in this world is effect, and that includes your feelings. The cause is always your thoughts.”

“Food cannot cause you to put on weight, unless you think it can.” (This one made me giggle more than the others … yep, those three bottles of Coke I just drank have absolutely no effect on my waistline because I believe that excessive soda consumption is slimming …)

“Your imagination is an extremely powerful tool.”

“Quantum physicists tell us that the entire universe emerged from thought!”

“Quantum physics … says that you can’t have a universe without mind entering into it, and that the mind is actually shaping the very thing that is perceived.”

“The amazing work and discoveries of the quantum physicists over the last eighty years has brought us a greater understanding of the unfathomable power of the human mind to create.”

“Thoughts are magnetic, and thoughts have a frequency. As you think thoughts, they are sent out into the Universe, and they magnetically attract all like things that are on the same frequency. Everything sent out returns to the source – you.”

“There are no limits to what you can create for you, because your ability to think is unlimited!”

Compare that to just a small sample of Dr Leaf’s work:

“Our mind is designed to control the body, not the other way around.  Matter does not control us; we control matter through our thinking and choosing.” (Switch On Your Brain, p33)

“Research shows that 75 to 98 percent of mental, physical and behavioral illness comes from ones thought life.” (Switch On Your Brain, p33)

“DNA actually changes shape according to our thoughts.” (Switch On Your Brain, p35)

“Whatever you are thinking about affects every cell in your body.” (Switch On Your Brain, p94)

“Everything you do and say is first a thought in your physical brain.  You think, then you do, which cycles back to the original thought, changing it and the thoughts connected to it in a dynamic interrelationship.  If your thinking is off … then your communication though what you do and say is off, and vice versa.” (Switch On Your Brain, pp98-99)

“Quantum theory converts science’s conception of humans from being mere cogs in a gigantic, mechanical machine to being freethinking agents whose conscious, free choices affect the physical world.” (Switch On Your Brain: p120-1)

“Thought signals seem to move faster than the speed of light and in ways that classical physics cannot explain.  This means our mind controls matter, and is therefore a creative force.” (Switch On Your Brain, p121)

“These statistics show that the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of food-related health issues …” (Think and Eat Yourself Smart, p84)

The only difference between The Secret and Dr Leaf’s ministry is Dr Leaf’s claim that science and scripture support it, though lexical contortions of scripture, and cherry-picked pseudoscience does not qualify as supporting evidence.

In the last ten years since The Secret was published, many critics have lined up to pull it apart, some prominent Christians included.  So they should, because The Secret is an abhorrent, unscientific concoction of new age humanism, or as one critic astutely put it, “spiritual narcissism”.

I’ve dissected Dr Leaf’s teaching over the last three-and-a-bit years and shown that her science is wanting, and her scripture is tenuous.  As this week’s sermon aptly demonstrates, Dr Leaf’s teaching appears to be a lukewarm re-serving of The Secret, sprinkled with some scripture and pseudoscience to try and make it more palatable for the Christian church.  Despite the shared narratives of self-obsession and magical thinking, the Christian church still fawns over Dr Leaf.  It’s embarrassing to see the same Christian leaders and media outlets lambaste The Secret but unquestioningly accept the same message woven through Dr Leaf’s teaching.  Dr Leaf’s teaching is so close to The Secret I’m surprised Rhonda Byrne hasn’t asked for royalties.

“The only thing necessary for the triumph of evil is for good men to do nothing”.  The same goes for ignorance—the only thing necessary for the triumph of ignorance is for smart men (and women) to do nothing.  We also need consistency.  Rejecting The Secret but accepting the same teaching from Dr Leaf creates a cultural cognitive dissonance amongst the Church that’s unhealthy.

Church, it’s time to stand against mistruth no matter what the source.

Bibliography

Byrne, R., The Secret, Atria Books, New York. 2006 ISBN 978-1-58270-170-7

Leaf C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. Southlake, TX, USA: Inprov, Ltd, 2009.

Leaf C.M., Switch On Your Brain: The Key to Peak Happiness, Thinking, and Health. Grand Rapids, Michigan: Baker Books, 2013.

Leaf C.M., Think and Eat Yourself Smart. USA: Baker Books, 2016.

60 seconds – Dr Leaf and Anxiety

Screen Shot 2016-08-22 at 9.32.03 PM

Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, says that “A chaotic mind filled with rogue thoughts of anxiety and worry sends out the wrong signals and affects you right down to the level of your DNA!” She also says that “Toxic thinking destroys the brain!”

In other words:

Anxiety → Toxic thought → DNA changes +  Brain damage

But that’s not what science says. According to modern research, anxiety disorders are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [1]. The other way of looking at it is that people who don’t suffer from anxiety disorders have a fully functional capacity for resilience [2,3].

In other words:

DNA changes + External stress → Anxiety

Dr Leaf’s teaching is backwards. Perhaps it’s time she turned it around.

References

[1] Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2
[2] Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10
[3] Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84

Dr Leaf and Anxiety

Dr Caroline Leaf and the mind-brain revisited again

Screen Shot 2016-06-01 at 8.05.14 PM

Dr Leaf’s theme for the week is the mind-brain link. In the last few days, Dr Leaf has posted memes claiming that the brain is seperate from, and subservient to, the mind. Despite evidence to the contrary, she continued the same theme today.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. Her teaching is strongly influenced by one of her foundational philosophical positions; that the mind (the intellect, will and emotions) controls the body, which includes the brain. While this idea may be popular with philosophers, it’s not with neuroscientists.

Not that this bothers Dr Leaf, of course, since she’s not really a neuroscientist.

Today’s meme is more or less exactly the same as what she claimed over the previous couple of days, except today’s version is more verbose.

She said,

“Mind directs what the brain does, with the mind being our intellect, will and emotions (our soul realm). This is an interesting concept posing huge challenges and implications for our lives because what we do with our mind impacts our spirit and our body. We use our mind to pretty much do everything.”

At this point, I’m having a strong and nauseating sense of deja vu.

I know I’m going to be repeating myself, but to reinforce the message, lets go through Dr Leaf’s meme to show that it hasn’t gotten any righter with repetition.

“(The) Mind directs what the brain does” … The relationship of the mind to the brain is like the relationship of music and a musical instrument. Without a musical instrument, there is no music. In the same way, the mind is a product of the brain. It’s not independent from the brain. Without the brain, there is no mind. Indeed, changes to the structure or function of the brain often results in changes to the mind. Yesterday I used the example of medications. Caffeine makes us more alert, alcohol makes us sleepy or disinhibited. Marijuana makes it’s users relaxed and hungry, and sometimes paranoid. Pathological gambling, hypersexuality, and compulsive shopping together sound like a party weekend in Las Vegas, but they’re all side effects linked with Dopamine Agonist Drugs, which are used to treat Parkinson’s disease. If a pill affecting the brain can change the function of the mind, then it’s clear that the mind does not direct what the brain does.

“This is an interesting concept posing huge challenges and implications for our lives because what we do with our mind impacts our spirit and our body” … The relationship between our body, mind and spirit is interesting. I’ve written about this before in an essay on the triune being and dualism. But there are no great challenges here or implications here. If anything, knowing that our thoughts don’t have any real power over us is incredibly freeing. Rather than increasing our psychological distress in trying to suppress or control our thoughts, we can step back and focus on committed actions based on our values.

“We use our mind to pretty much do everything” … Actually, we don’t. Much of what we do, say, and even perceive, is related to functions of our brain that are entirely subconscious. This idea is summed up very nicely by Dr David Eagleman, best-selling author and a neuroscientist at Baylor College of Medicine in Texas;

” … take the vast, unconscious, automated processes that run under the hood of conscious awareness. We have discovered that the large majority of the brain’s activity takes place at this low level: the conscious part – the “me” that flickers to life when you wake up in the morning – is only a tiny bit of the operations. This understanding has given us a better understanding of the complex multiplicity that makes a person. A person is not a single entity of a single mind: a human is built of several parts, all of which compete to steer the ship of state. As a consequence, people are nuanced, complicated, contradictory. We act in ways that are sometimes difficult to detect by simple introspection. To know ourselves increasingly requires careful studies of the neural substrate of which we are composed.” https://goo.gl/uFKF47

So no matter which way Dr Leaf says it, it simply isn’t true that the mind controls the brain. As I said in my previous post, this is a fatal flaw for Dr Leaf’s teaching. That she keeps using this trope is entirely her choice and her right, but it certainly doesn’t aid her reputation as a credible neuroscientist.

Running of the Elephants – Why thought suppression doesn’t work

Have you ever found yourself about to give a speech or sit an exam, and one of your friends tries to calm you down by saying, “Stop worrying … just don’t think about it!”  Does that ever work?  Not usually!  The more you try to intentionally block it from your mind, the more it wants to pop up again.

Why is that?  It seems intuitive that if you don’t want to think about something, all you need to do is to take control and block it out of your mind, right?

One of Hollywood’s better movies in recent times was “Inception”.  In one of the key early scenes, Arthur is explaining to Saito why inception is impossible,

Saito: If you can steal an idea, why can’t you plant one there instead?
Arthur: Okay, this is me, planting an idea in your mind. I say: don’t think about elephants. What are you thinking about?
Saito: Elephants?”

This is a great little dialogue about thought suppression.  Thought suppression is the process of consciously trying to avoid certain thoughts, either by trying to replace the unwanted thought with another thought, or simply trying to repress the unwanted thought.

Our minds tend to focus on the content of a subject.  If the subject is elephants, no matter what words I put in front of it, your mind will think about elephants.  Like if I say, “I love elephants, or I say “Don’t think about elephants”, your brain hears, “blah blah blah elephants.”  And having been sensitized to the idea of not thinking about elephants, when your mind inevitably brings it up again, you’re primed to pay even more attention to it, “D’oh, I’ve just thought about elephants again … stop thinking about elephants …”.

This phenomenon is even more pronounced if your mind has already been focusing on the subject.  If you’re mind is going over and over a speech you have to give and I say, “Oh, don’t worry about that speech”, all your mind registers is, “blah blah blah SPEECH”.

Although it’s been discussed in the psychological sciences for decades, it’s only been since the late 1980’s that considerable attention has been given to the concept of thought suppression.  Despite our natural tendencies to try it or recommend it to people, the conclusion of nearly all the research is the same: thought suppression doesn’t work.

Wenzlaff and Wegner, two American psychology researchers, looked at all of the different research on thought suppression and came to the following conclusion,

“What has compelled the interest of the scientific and clinical communities is that suppression is not simply an ineffective tactic of mental control; it is counterproductive, helping assure the very state of mind one had hoped to avoid. The problem of thought suppression is aggravated by its intuitive appeal and apparent simplicity, which help mask its false promises.” [1]

I’m not really sure why we naturally gravitate to thought suppression.  Perhaps it’s part of our natural delusion of control.  Perhaps it’s a throwback from the pop-psychology assumptions that we can control our destiny, or the common myth that our mind is in control of our brain.

Whatever the reason, as time has passed, researchers are coming to understand why thought suppression is so unhelpful.  This quote from Magee and his colleagues helps to explain why:

“This shift in focus parallels advances in cognitive theories of intrusive thoughts, which suggest that having intrusive thoughts is a normative phenomenon; instead, the way an individual interprets those thoughts is expected to lead to benign versus serious outcomes … Similarly, having difficulties with thought suppression is a common experience … it is the way an individual interprets that experience that may be key. Previous discussions of thought suppression have frequently implied that people having difficulties with thought suppression often ascribe negative meaning to their difficulties.” [2]

We naturally struggle to suppress intrusive thoughts because intrusive thoughts are normal.  Trying to suppress them is like trying to suppress any other normal biological process.  Try to stop breathing for any length of time and you’ll see what I mean – it’s impossible, and trying is simply counterproductive.

The key is how we react to or feel about our thoughts.  If we feel like our thoughts might be somehow causing us harm, then our failure to stop them from bubbling up to the surface of our consciousness is going to cause us distress.  It’s a double whammy – we’re stressed because we’re expecting the negative consequences of our thoughts, and we’re distressed by our ‘failure’ to stop them.

Since it first started more than a century ago, the death toll from the famous Pamplona event, “Running of the Bulls” currently stands at 13.  Countless others have been gored and trampled.  Who are the people who get injured during the event?  Certainly not the smart ones standing behind the barriers on the edge of the streets, or the ones watching it broadcast on TV?  Only the morons who try to outrun the pack of foot-long bony skewers attached to the half-ton lumps of very cranky steak.

Similarly, the best way to manage our thoughts is to learn not to fight with them in the first place.  By non-judgmentally observing them, we can simply observe our thoughts for what they are … just thoughts.  By stepping back from our thoughts and giving them room, we find that they don’t have any real power over us.  Stepping back away from our thoughts and letting them be is the skill of defusion, one part of the process of psychological acceptance.  It’s the first step in living a life abundant in meaning and significance.

So just remember: don’t try to suppress an unwelcome thought.  Having intrusive thoughts is actually a normal process, not a sign of disease or mental weakness.  They’re not toxic or harmful, they’re just thoughts.  Give them space, like you would a charging angry bull (or elephant!)

References

[1]        Wenzlaff RM, Wegner DM. Thought suppression. Annual review of psychology 2000;51(1):59-91.
[2]        Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clinical psychology review 2012 Apr;32(3):189-201.

Does sadness make you sick?

LeafMeme20160107

We’ve all heard of being “homesick”, or “heartsick”, or “lovesick”.   Sometimes when we’re extremely sad, we feel the knot in our stomachs, the pressure in our chests, or the confusion and distraction in our minds as the waves of sadness wash over and discombobulate us.

But can being sad really make you physically ill as well as emotionally distraught?

Dr Caroline Leaf declared today on her social media platforms that “Feeling sad can alter levels of stress-related opioids in the brain and increase levels of inflammatory proteins in the blood that are linked to increased risk of comorbid diseases including heart disease, stroke and metabolic syndrome.”

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  She believes that our cognitive stream of thought determines our physical and mental health, and can even influence physical matter through the power of our minds.

She also added some further interpretation to her meme: “So this is more evidence that our thoughts do count: they have major epigenetic effects on the brain and body! We need to apply the principles in the Bible and listen to the Holy Spirit – no excuses this year!”

With all due respect to Dr Leaf, the study she quotes doesn’t prove anything of the sort.

Dr Leaf’s meme is a copy and paste of the opening paragraph of a news report published by the university’s PR people to promote their faculty.  This isn’t a scientific summary, it’s a hook to draw attention to an article which amounts to a PR puff piece.  If Dr Leaf had read further into the article, I don’t think she would have been quite so bold in claiming what she did.

The article discussed a study by Prossin and colleagues, published in Molecular Psychiatry [1].  You can read the original study here.  The study specifically measured the change in the level of the activity of the opioid neurotransmitter system and the amount of a pro-inflammatory cytokine IL-18 across two experimental mood states, and in two different groups of volunteers, people with depression, and those without.

For a start, it’s important to note that the study isn’t referring to normal day-to-day sadness.  This was an experimentally induced condition in which a sad memory was rehearsed so that the same feeling could be reproduced in a scanner, and the study was looking at the effect of this sad “mood” on people who were pathologically sad, that is, people diagnosed with major depression.

It’s well known that people with depression are at a higher risk of major illnesses, such as heart attacks, strokes and diabetes [2] The current study by Prossin et al looked experimentally at one possible link in the chain, a link between a neurotransmitter system that’s thought to change with emotional states, and one of the chemical mediators of inflammation.

They found that:

> Depressed people were much sadder to start with, and remained so throughout the different conditions.  The depressed people stayed sadder in the ‘neutral’ phase, and the healthy cohort couldn’t catch them in the ‘sad’ phase.
> Depressed people had a much higher level of the inflammatory marker to start with, and interestingly, this level dropped significantly with the induction of the neutral phase and the sad phase.  What was also interesting was that the level of the inflammatory marker was about the same in the baseline and the sad phase for the healthy volunteers.
> A completely different pattern of neurotransmitter release was seen in the two different groups.  People with depression had an increase in the neurotransmitter release over a large number of areas of the brain, whereas in the healthy controls with normal mood, the sad state actually resulted in a decreased amount of neurotransmitter release, and in a much smaller area within the brain.  This suggests that the opioid neurotransmitter system in the brains of depressed people is dysfunctional.

Affect/Sadness Scores - Prossin et al Molecular psychiatry 2015 Aug 18.

Affect/Sadness Scores – Prossin et al Molecular psychiatry 2015 Aug 18.

IL18 v Mood state/diagnosis - Prossin et al Molecular psychiatry 2015 Aug 18.

IL18 v Mood state/diagnosis – Prossin et al Molecular psychiatry 2015 Aug 18.

Effectively, the results of the study reflect what’s already known – the emotional dysregulation seen in people with depression is because of an underlying problem with the brain, not the other way around.  And, sadness in normal people is not associated with a significant change in the evil pro-inflammatory cytokine.

So, according to Prossin’s article,

  1. normal sadness in normal people is not associated with physical illnesses.
  2. sadness is abnormally processed in people who are depressed, which maybe related to an abnormal inflammatory response, which might explain the known link between depression and increased risk of illness

The article is not “more evidence that our thoughts do count.”  If anything, it shows that underlying biological processes are responsible for our thoughts and emotions and their downstream effects, not the thoughts and emotions themselves.

And unfortunately, it appears that Dr Leaf hasn’t got past the opening paragraph of a puff piece article before jumping to a conclusion which only fits her worldview, not the actual science.

References

[1]        Prossin AR, Koch AE, Campbell PL, Barichello T, Zalcman SS, Zubieta JK. Acute experimental changes in mood state regulate immune function in relation to central opioid neurotransmission: a model of human CNS-peripheral inflammatory interaction. Molecular psychiatry 2015 Aug 18.
[2]        Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009 Apr 6;190(7 Suppl):S54-60.