Stress and Mindset

 

The perception of stress is that all stress is negative and something to be avoided. The definition of mindset in the American Heritage Dictionary is: “a fixed mental attitude that predetermines a person’s responses to and interpretations of situations.” Carol Dweck’s research has brought attention to the overriding importance of mindsets and has also dispelled the myth that they are immutable. https://gwilliamsfamilyeye.wordpress.com/2015/04/01/mindset-the-new-psychology-of-success/ There is now a substantial body of research – the conclusions of which are counterintuitive – which proves that mindsets can be changed and that these changes can be permanent. It is also clear that stress can be positive. Stress is not all the same and it provides important motivation.

Changing our mindset can make dramatic and lasting changes in our lives. Almost like the magical force in “Star Wars”, in The Upside of Stress, Kelly McGonigal uses research to demonstrate how the forces of mindfulness and mindset can control our responses to anxiety and stress. While everyone has heard of the “fight or flight” response to stress, the “challenge” response and the “tend and befriend” responses are less well known.

To demonstrate that stress is not necessarily bad for us, McGonigal shares the following: “In 1998, thirty thousand adults in the United States were asked how much stress they had experienced in the past year. They were also asked, ‘Do you believe stress is harmful to your health?’ Eight years, later, the researchers scoured public records to find out who among the thirty thousand participants had died. Let me deliver the bad news first. High levels of stress increased the risk of dying by 43 percent. But – and this is what got my attention – that increased risk applied only to people who also believed that stress was harming their health. People who reported high levels of stress but who did not view their stress as harmful were not more likely to die. In fact, they had the lowest risk of death of anyone in the study, even lower than those who reported experiencing very little stress.” p. xii

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Also, “Those who had a positive view of aging in midlife lived an average of 7.6 years longer than those who had a negative view. To put that number in perspective, consider this: Many things we regard as obvious and important protective factors, such as exercising regularly, not smoking, and maintaining healthy blood pressure and cholesterol levels, have been shown, on average, to add less than four years to one’s life span.” p. xiv

 

McGonigal goes on to explain that mindsets are core beliefs we have about how the world works. They tend to be invisible, like prejudices. “The mindset doesn’t feel like a choice that we make; it feels like an accurate assessment of how the world works.” p. 32 If we think about mindsets at all, we don’t realize that they are choices we have made and that we can change our choices. “Our physical reality is more subjective than we believe. Perception matters.” P. 4

“People who believe that stress can be helpful are more likely to say that they cope with stress proactively. For example, they are more likely to:

  • Accept the fact that the stressful event has occurred and is real.
  • Plan a strategy for dealing with the source of stress.
  • Seek information, help, or advice.
  • Take steps to overcome, remove, or change the source of stress.
  • Try to make the best of the situation by viewing it in a more positive way or by using it as an opportunity to grow.

These different ways of dealing with stress lead to very different outcomes. When you face difficulties head-on, instead of trying to avoid or deny them, you build your resources for dealing with stressful experiences. You become more confident in your ability to handle life’s challenges. You create a strong network of social support. Problems that can be managed get taken care of, instead of spiraling out of control. Situations that you can’t control become opportunities to grow. In this way, as with many mindsets, the belief that stress is helpful becomes a self-fulfilling prophecy.” p. 18

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The thinking and life changes that people go through to avoid anxiety and stress have been demonstrated to produce more stress than the situation that they attempt to avoid. Also, “It turns out that a meaningful life is a stressful life.” p. 65 “Feeling burdened rather than uplifted by everyday duties is more a mindset than a measure of what is going on in your life. These are normal and expected parts of life, but we treat them as if they are unreasonable impositions, keeping our lives from how they should really be.” p. 69 Resilience was the theme of a prior blog https://gwilliamsfamilyeye.wordpress.com/2015/01/21/resilience/ which discusses the balance between load and resilience. The research on mindsets supports that changing your mindset decreases your load and increases your resilience. Kelly McGonigal’s favorite description of resilience is from Salvatore Maddi; the courage to grow from stress. p. 94

Anxiety disorders can be crippling. People feel a loss of control. Lives are changed and the disorder can keep people constantly wary and fragile. Medications can help but behavioral interventions have the potential to be more powerful and more lasting. The following is an example of much of what has been discovered that is counterintuitive. “The value of rethinking stress is not limited to people who aren’t really struggling. In fact, embracing the stress response may be even more important for those who suffer from anxiety. Here’s why: Although people who have an anxiety disorder perceive their physiology as out of control, it actually isn’t. In Jamieson’s study, and in many others, people with anxiety self-report higher physical reactivity than those without anxiety. They think their hearts are pounding precariously fast and their adrenaline is surging to dangerous levels. But objectively, their cardiovascular and autonomic responses look just like those of the non-anxious. Everyone experiences an increase in heart rate and adrenaline. People with anxiety disorders perceive those changes differently. They may be more aware of the sensations of their heart beating or the changes in their breathing. And they make more negative assumptions about those sensations, fearing a panic attack. But their physical response is not fundamentally different.” p. 125

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As complicated as we are and as complicated as the world is, when we explore a wide range of behavioral problems and health problems, it is remarkable how we keep returning to a common core. We need to understand and take into consideration how our bodies, brains, and perceptions have evolved to produce the potentials that we have including the ability to adapt to the stresses of life. With this great potential we also have constraints. Understanding how our body/brain systems work provides insight into a range of disorders including sensory integration disorders, autism, allergies, auto-immune diseases, cancer, attention deficit disorder, and learning disabilities. Wellness and what fosters wellness is at least as difficult to study as are diseases. The variables are almost countless, but this is now being done and the revelations are astounding and exciting and have the potential to facilitate greater wellness in the future.

Worried Sick

What reality are you creating for yourself?

The Effects of the Fear of Failure in Education

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The Heroism of Incremental Care

Atul Gwande is an unusually talented observer, thinker, and writer who is a surgeon. I have blogged about his books in the past. If you are interested in health and healthcare, I think that you will find his article on incremental healthcare to be intriguing. Although it is long, I think that it will hold your interest. It can be accessed through Google.

GJW

The Heroism of Incremental Care/ The New Yorker

 

 

 

 

 

The Power of Habit:Why We Do What We Do In Life and Business

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Charles Duhigg

We cannot change behaviors – including visual behaviors – without changing habits. Habits are behaviors which have become so automatic that they require little or no conscious thought. We can override a habit through conscious attention but this exhausts our available working memory. We have all experienced the errors that we tend to make when our working memory is taxed, such as not being able to remember why we opened the refrigerator. Continue reading

Is It All In Your Head?

 

Suzanne O’Sullivan, MD

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Suzanne O’Sullivan reveals the power of mind-body connections through the enigma of psychosomatic illness. She is a neurologist, and while the treatment of this condition falls under the purview of psychology and psychiatry, the neurologist must first prove that there is not an organic explanation for the illness, have the patient accept the diagnosis, and convince them to engage in cognitive behavioral therapy.  Pharmaceuticals are not effective. The patient has real symptoms which convince them that it is an organic disease. “It can be very difficult for a patient to accept that they suffer from a conversion disorder (a medically unexplained neurological symptom) when that assumption is based entirely on what is missing.” Psychosomatic illness threatens an individual’s image of themselves and they fear that they will be perceived as being weak.

Suzanne O’Sullivan introduces the book with a discussion of blushing. “Blushing is an instantaneous physical change seen on the surface but reflecting a feeling of embarrassment or happiness that is held inside. When it happens, I cannot control it.” This leveler helps us to be more open about psychosomatic illnesses and understand that; they are real; they are no more a weakness than is succumbing to an organic illness; the patient cannot control them; their conscious mind wants to get better; it can happen to any of us. Somatization (a bodily response to a psychological effect) is usually benign, of short duration, and does not become an illness. Examples are trembling hands, perspiration, butterflies, shortness of breath, and laughing. “A psychosomatic illness is the body’s physiological response to stress. They serve a purpose even if that purpose is not always obvious.” The stress is not recognized because the subconscious moves the stress to the body. The person feels that they have handled the stress or may not even have recognized the degree of stress.Image result for blushing

“Illness is not the same as disease. Illness is the human response to disease. It refers to the person’s subjective experience of how they feel but does not assume an underlying pathology. Illness can be either organic or psychological.” “Approximately 70% of the people referred to me with poorly controlled seizures were not responding to epilepsy treatment because they did not have epilepsy. Their seizures were occurring for purely psychosomatic reasons.” “The effect the psyche can have on the physical self has long been observed, but for all that time, scientists and doctors have also been trying and failing to understand how it occurs.”

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We cannot live without stress. Positive stress motivates us (see The Upside of Stress). It is stress that continues and that we are impotent to relieve that causes changes in our brains. To balance the stress in our lives, we must maintain our resilience. One concern that I have is that I see an increasing number of children who are anxious. We went from the extreme of everyone receiving a reward because they participated, to accelerated curricula and the majority of “play” being on organized teams. Children have little free time, supervised from afar, whose importance in development is overlooked. Children need time for unstructured play; to daydream, relax, and decompress; to solve problems of their own or with peers; to imagine; to figure out how to occupy themselves other than an addiction to electronics; to create; and to learn from errors of their own choosing. (see What If Everyone Understood Child Development and How to Raise an Adult)

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Worried Sick

Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial 

Welcome to Your Child’s Brain

BALANCE

A Dizzying Journey Through the Science

Of Our Most Delicate Sense

Carol Svec

Balance usually works so well that people don’t think about it until we get older. After over eighteen months of research, interviews, being an experimental subject, and writing, Carol Svec concludes, “We don’t have a sense of balance. We are balance. Balance gives us our place and space in the world, but it also contributes to our sense of self.”pensioners-2399602_960_720 Continue reading

ADHD Nation Children, Doctors, Big Pharma, and the Making of an American Epidemic

adhdnation

 

Alan Schwarz

ADHD Nation is as important for understanding the evolution of the diagnosis and treatment of attention disorders, the role of Big Pharma, and how attention disorders have been mismanaged as are the books NeuroTribes and In a Different Key for understanding the evolution of our understanding of autism.

Alan Schwarz is an award-winning investigative journalist whose work made public the seriousness of concussions in the NFL. Like concussions in sports, the potential side-effects of ADHD medications have been largely ignored. Big Pharma and the scientists they support have been complicit in this omission.

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ADHD medications have the potential to improve attention, motivation, and energy which is not dependent on having ADHD. When used properly, the drugs can help many people and the side-effects are minimized. But the statistics make it clear that the condition is being over-diagnosed in this country. The drugs are also being used (and misused) by many high school and college students and by others who feel that they need a boost and have never been diagnosed. The causes of their problems are not being investigated nor are other possible means of treatment. Consider the following…

In the 1930s, a drug was developed with the goal of treating asthma or nasal congestion which, serendipitously, was found to make people feel good. Smith, Kline, & French “licensed it before knowing exactly what medical condition the stuff might actually treat. Finding out was a lot easier then than it is today: Lax federal regulations did not require any proof of safety, let alone efficacy, before a drug was released for public experimentation. So SKF sent boxes of what it called ‘Benzedrine sulfate’ to any doctor willing to try the drug on patients with various ills, from asthma to postpartum depression.”

Due to known problems with amphetamines, a close cousin to amphetamines was developed to have the same effects with fewer side effects. “CIBA termed the chemical formulation of this drug ‘methylphenidate’. The company released it to the American market in 1956 as Ritalin, a treatment for narcolepsy, chronic fatigue, depression, and erratic behavior caused by senility. (Again, only in adults; the medication was untested in children.)”

Dr. Keith Connors, author of the Connors Rating Scale, is the best-known researcher in the field of ADHD. “Connors needed no questionnaire to assess the effects of Ritalin on himself. Late one afternoon, following an exhausting day in the lab, he had to attend an eight-p.m. lecture by Harry Harlow, a behavioral psychologist famous for locking young monkeys away from their mothers and studying their emotional demise. Knowing he’d never stay conscious for the whole thing, Connors found the tub of Ritalin capsules so generously donated by CIBA and took one. Within thirty minutes he snapped awake and thought to himself, ‘This is fantastic!’ He kept working until eight. He skipped dinner. He zoned in on the lecture, chatted with folks afterward, and stayed up until three in the morning. Just one dose felt so beguiling, that he never tried the stuff again for the rest of his life.”

In the early 1990s, Obetrol was an amphetamine which was prescribed for weight control but it was not a financial success. After a pediatrician discovered that it worked for some children who did not respond well to Ritalin, Obetrol was remarketed as Adderall.

“Psychiatry journals teemed with more than a thousand studies on ADHD conducted by Biederman, Barkley, and other pharma-sponsored scientists. The Food and Drug Administration relied on them when green-lighting medications as safe and effective. Their findings served as the backbone for the lectures that drug companies’ key opinion leaders delivered on world tours. The whirlwind created a self-affirming circle of science, one that quashed all dissent.”

“While almost all other developed nations immediately closed the loophole that Metadate had exploited – expressly banning direct-to-consumer advertising of controlled substances, usually through legislation – the United States sat back and let the market take over. To this day, the United States is only one of two developed nations that allow advertising of ADHD medications to the general public.”

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“Appallingly, some children have heightened anxiety interpreted not as a side effect of medication, meaning the drug should be reconsidered, but a new condition needing additional treatment…. Diagnosing young children with several overlapping psychiatric conditions became de rigueur in the 2000s, resulting in what some call a ‘medication cascade’. No doctor was more responsible for the trend than Joe Biederman up at Harvard, who evaluated dozens of drugs on behalf of his Big Pharma benefactors and almost invariably declared them safe and appropriate for children with multiple diagnoses like ADHD and bipolar disorder. Yet neither he nor anyone else tested the performance or risks of these drugs in combination – no pharmaceutical company would ever sponsor such a study, considering it too risky to their product’s reputation.”             “Adderall and methylphenidate have always been among the most addictive substances in medicine. Weird as it may sound, stimulants are dangerous by being not dangerous enough – the drugs have found a sweet spot in which their advantages are more common and immediately obvious than their more latent risks, lulling all involved into complacency.”

“Today, misuse of ADHD medications by high school students is far more widespread that most anyone realizes. About a million high school kids nationwide use Adderall, Concerta, Vyvanse, and others without a doctor’s prescription, getting them either from friends or from dealers for a few dollars a pill.”

“Dozens of studies since the 1990s have estimated that about 8 to 35 percent of undergraduates take stimulant pills illicitly to try to improve their grades; a reasonable estimate among high-pressure colleges is probably 15 to 20 percent. Most students, of course, don’t experience terrible outcomes – if they did, the dangers would already be better recognized. But many do. One 2006 study found that about one in ten adolescents and young adults who misused ADHD medications became addicted to them, with some of them becoming psychotic or suicidal.”

“A different study found that teachers suspected ADHD far more often in elementary school children whose birthdays made them one of the youngest in their grade – just a tick over six, say, when the rest of their classmates were nearing seven. Therefore, many kids were being diagnosed merely because they were born in the wrong month: ‘The youngest children in fifth and eighth grades,’ it concluded starkly, ‘are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”

ADHD Spectracell

At the end of his working career, Dr. Keith Connors sent a letter to a colleague and closed with the following: “Beware the simple & sovereign explanation.” That is good advice to all of us.

Alan Schwarz includes in the book a mock doctor/patient interview from a certified continuing education program purported to teach physicians how to diagnose ADHD. From the start of the conversation to the writing of the Rx was six minutes. Also, it was not revealed that there was a possible conflict of interest but the following was discretely printed at the end: “Supported by an independent educational grant from Shire.”

http://www.psychologytoday.com/tests/health/adhdattention-deficit-disorder-test

There are many possible causes for ADHD behaviors other than primary “brain dysfunction”. Since there is no litmus test for ADHD like blood work or imaging, ADHD is primarily a diagnosis of exclusion. Other possible causes of ADHD should be investigated and ruled out prior to considering medication. Visual problems are one of the possible causes of these signs and symptoms but so are the accelerated curriculum, fewer recesses in school, less time playing outside, more stimulation from video games, more organized activities which reduce free time, instant communication and responses, less sleep, and more pressure. Children whose problems are not primarily due to attention, may also do better with medication, but their underlying problems are not being addressed and they may be being medicated unnecessarily. “The human brain has evolved over many thousands of years, yet only in the last hundred, a blip on that time line, have we demanded that each and every young one sit still and pay attention for seven hours a day.”

MONASTRA VIDEO

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https://www.cdc.gov/ncbddd/adhd/index.html

 

Body by Darwin

Jeremy Taylor

This book presents the growing evidence that we cannot continue to make progress in health care unless we consider the influences of our evolutionary past. Jeremy Taylor addresses seven areas:

  • Our immune system;
  • Issues regarding fertilization, pregnancy, and childbirth;
  • The effects of upright posture;
  • The development of the eye and macular degeneration;
  • The challenges of cancer;
  • Coronary artery disease; and
  • Dementia.

Each chapter stands on its own. I have chosen excerpts from his discussion of our immune system because these disorders affect such a large (and growing) number of our patients. “It is impossible to get to the root of the very peculiar human immune system and design really effective cures for allergies and autoimmune diseases without a fresh understanding of how the immune system evolved and for what reasons.” p. 7

“The world of our ancestors was a much dirtier place than it is now. Evolution took the expedient route, since microorganisms in prehistory could not be eradicated, of allowing humans to live with them rather than continually fight them. The great collateral cost of self-inflicted damage to our tissues caused by permanently raging immune systems was avoided by handing over the regulation of our immune systems to the microbes inside us, so that we ended up tolerating them. Evolution could not foresee a world where public hygiene, antibiotics, and chemicals that kill 99.9 percent of all household germs has so depleted this microbial population inside all of us that our immune systems no longer mature properly or are properly regulated, giving rise to dramatic increases in allergy and autoimmunity.” p. 8

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The author reviews volumes of research and shares a number of anecdotes including one about a boy with autism whose behavior was so uncontrollable that he had to be institutionalized. Soon after institutionalization, he had a complete reversal in behavior which was caused by chigger bites. To perpetuate his recovery, his immune system is now being treated with infusions of pig whipworms, without which his behavior regresses. This case supports the “hygiene hypothesis which links the bacteria, fungi, and helminths (parasitic worms) in our guts, on our skin, and in our airways and vaginas, with a host of autoimmune and allergic diseases. There is mounting evidence that the composition of all these organisms, living on and inside us – collectively known as our microbiota – can offer protection against a formidable list of autoimmune diseases, including the inflammatory bowel diseases Crohn’s disease and ulcerative colitis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, and, as we have seen, mental health.” p. 17

“Of all the autoimmune diseases, type 1 (or early-onset) diabetes is rapidly becoming the main scourge of life in the modern, hygienic Western world. Karelia is a large northern European landmass that used to belong to Finland but was partly ceded to Russia during World War II. As a result, the country has been partitioned. Although Russian and Finnish Karelians have the same genetic makeup, including the same susceptibilities to diabetes, the differences in their socioeconomic status and health could not be more stark. One of steepest standard-of-living gradients in the world exists at the border between Russian and Finnish Karelia, with the latter having eight times the gross national product of the former. Yet the incidence of type 1 diabetes, and a host of other autoimmune diseases, is far higher on the Finnish side. Finnish Karelians have six times the incidence of diabetes, five times the incidence of celiac disease, six times more thyroid autoimmunity, and much higher allergy levels than Russian Karelians.” p. 21

“The baby is born with a gut that is almost completely sterile and must be populated immediately with bacteria. If it is breast-fed, it starts to receive one of the most extraordinary products in the natural world. Human breast milk contains a complex array of fats and sugars – fast food – but it also contains immunoglobulin A, an antibody that protects the lining of the human gut and prevents pathogens from attacking and perforating it. It has also been estimated that a breast-fed infant receives over 100 million immune cells every day, including macrophages, neutrophils, and lymphocytes, together with a host of cytokines, chemokines, and colony-sustaining factors – molecules that signal between cells of the immune system and promote their growth. Over seven hundred species of bacteria have been found in human breast milk. It also contains oligosaccharides which the baby is totally incapable of digesting. It is present to feed the bacteria from the breast milk which are colonizing in the baby’s gut”. p. 24

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“Within a week or so after birth, the infant gut, originally sterile, has become colonized by up to 90 trillion microbes. The number of microbes in our guts eventually exceeds the total number of cells in our bodies by a factor of ten. Scientists now refer to the existence of a meta-genome to represent the combined genomes of human and microbiota, a superorganism in which we humans are the junior partner and without which we could no longer exist.” p. 27

“Our resident gut microbiota – the mass of over two thousand bacterial species identified as frequent, long-term inhabitants inside us – is extremely complex. Our relationship with them is so close and intertwined that many of the metabolic signatures that can be identified in human blood, sweat, and urine actually come from our commensal bacteria, not us.” P. 34

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“The gut has been called the ‘second brain’ and has its own dedicated nervous system embedded throughout the gut wall. It is becoming increasingly clear that our gut molecules can communicate directly with our brains, and they are implicated in brain development, brain chemistry, behavior, and mental illness.” pp. 36 – 37

This is support for the importance of children getting outside to play in areas that have a variety of foliage comes from a different perspective – as long as we check carefully for tics.

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The Power of Play

Let Them Eat Dirt

Gut: The Inside Story of Our Body’s Most Underrated Organ

Grain Brain