Tag

Mental Health

28/10/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

End of Lockdown Anxiety

After the seemingly endless days spent on repeat at home, many people are enjoying the end of lockdowns and the beginning of our new ‘COVID-normal’ lives. A lot of us, however, experience a mixture of excitement and anxiety. We welcome the ability to see our friends and family and to go to a café or the movies, but we also worry about the possible consequences of opening up to the new normal.

Now that we are no longer able to stay at home and avoid contact with others, some of us worry about the possibility of getting infected with coronavirus (SARS-COV-2) and getting seriously ill from COVID-19. Psychology research has shown that in general, our level of anxiety is primarily determined by two subjective judgments: the perceived likelihood of something bad happening, and the perceived harmfulness of that outcome. People who are very anxious tend to overestimate either the likelihood or the harmfulness (or both) of what they fear. Therefore, these judgments need to be adjusted to reflect reality, rather than our own subjective (over)estimations. 

We have lived with daily reminders of the possibility of serious illness or death from COVID for nearly two years. Understandably, some of us may be reluctant to risk that possibility and do not welcome the idea of going back to the office or sending children back to school. However, it is now important to reset our mental image about COVID and to remind ourselves that vaccinations greatly reduce the possibility of becoming seriously ill, as well as the possibility of getting infected with the virus. In other words, both the likelihood of a bad outcome (getting infected) and its harmfulness (getting seriously ill as a result of an infection) is now greatly diminished. That reminder should allow the more nervous amongst us to slowly get used to the idea that we need to live with the virus circulating in the population, and that we can adjust to the new normal while taking reasonable precautions to avoid infection. 

Of course, we need to enter our new COVID-normal life at our own pace. While some are happy to jump into socialising again, others might be less keen. Indeed, for those of us on the introverted end of the introversion-extroversion spectrum, the lockdown may have provided a welcome reprieve from the pressures of a busy social life. Introverts may enjoy social functions, but they also need to spend time alone to recharge. Now, as we no longer have the lockdown as an excuse to prioritise our own time and say no to social invitations, we need to learn to set boundaries. It is indeed ok to have fewer social engagements and to enjoy the quieter periods that the lockdown allowed us to have. If you enjoyed your alone time during the lockdown, there is no reason why you should give in to the pressures of social expectations and say yes to all invitations. Take your time. 

Perhaps an important experience for many of us who were able to take time to reflect on our lives during the COVID years was a rethinking of our values and priorities.  You may have found that the time spent with family and children, or the attention given to your own health and well-being during the lockdown was a welcome change from your previous life. Trying to remember those priorities and resisting pressure to jump back into a more frantic, high-pressure life we lived previously may be an important challenge in the coming months.

Whatever the challenge you find yourself facing, it is important to take your time. We are in uncharted territory. Having compassion towards yourself and towards others who are struggling to navigate these unprecedented, uncertain times is the most important attitude we need to carry forward from our two years of living with COVID.

 

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney. 

11/10/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

What is Cognitive Behavioural Therapy?

Have you ever considered the idea that it is not your outside circumstances that determine how you feel? It’s not the traffic in the morning that makes you feel angry, or the person who stands you up on a date that makes you feel unlovable, or the presentation at work that makes you feel anxious.

There’s something else at play, and this is a good thing!

Once we stop focusing on the things that we can’t control, like the traffic or other people’s behaviour, we can begin to look inward at ourselves. This allows us to change what we can control – how we think, how we perceive things, our behaviour and how we respond to difficult situations. Ultimately, this can change how we feel.

So, where do we begin?!

Cognitive Behavioural Therapy (CBT) is a well-known form of therapy that combines cognitive psychology and behavioural psychology. In other words, the science of our thinking and our actions. The best thing is that it’s evidence based, which means that it has been rigorously tested and proven to be effective through scientific evaluation.  CBT has proven to be effective in the treatment of depression, anxiety, relationship problems, sleep difficulties, chronic pain, work related stress and many more conditions. But Cognitive Behavioural Therapy is equally as helpful for alleviating day-to-day stress as it is for combatting enduring psychological distress.

Changing your thoughts can help lead to behavioural changes, and vice-a-versa.

To change your thoughts, you need to look at both the cognitive (how we think) and behavioural (how we react) components of our thoughts. Both components are important in order to effect meaningful, lasting change in a person and help them manage and maintain good mental health.

 

Cognitive component:

1.Be aware of your negative or unhelpful thinking

We have to be aware of our mind, as often our thoughts are automatic and we respond to them without challenging them. Did you know that the average person has between 12,000 and 70,000 thoughts per day? And of those thoughts, most of them are negative and repetitive? Keeping a thought diary is a useful way of becoming more self-aware of your thinking.

2. Examine your thoughts and ask yourself if you’re engaging in a thinking error. Examples of thinking errors include:

    • Black and white thinking: Categorising things into one of two extremes, such as seeing situations as good or bad.
    • Catastrophising: Blowing things out of proportion and thinking the worst-case scenario will occur.
    • Personalising: Attributing negative external events such as a rescheduled meeting or heavy traffic to something about you or something you’ve done, when there is actually no link.
    • Jumping to conclusions: Making a judgement with no supporting information.

3. Look for the evidence and deal with the facts

Once you have acknowledged that your belief is just a thought and not a fact, try and look for evidence of what is actually going on and deal with the facts.

4. Come up with a more rational or helpful thought about the situation 

Use the evidence to come up with a more helpful and less distressing way of perceiving the situation. e.g. If a meeting has been rescheduled it is much more likely to be because of an issue with an unrelated project than it is to be about you personally.

 

Behavioural component:

Now that we have examined the ‘C’ in CBT, let’s look at the ‘B’ or the behavioural component. After all, CBT is action-orientated so we must find ways to practice it effectively.

1.Graded exposure

Identify those behaviours or things that you are doing that are maintaining the problem. If a behaviour is maintaining a problem it means that it is keeping the problem alive, like kindling to a fire. Did you know that avoidance is the greatest maintaining factor for anxiety? For example, the more you avoid social situations because they make you feel uncomfortable, the greater your anxiety around social situations will be. Encourage yourself to slowly engage in situations that you find difficult and make sure you start with easier situations, and build up to the more difficult ones.

2. Behavioural experiments

Create behavioural experiments or exposure tasks to challenge your unhelpful thinking. For example, if you believe that the lift will break down and you’ll be stuck for hours and unable to breathe (so you always take the stairs at work)… take the lift with a colleague and see what actually happens!

3. Activity scheduling

Schedule positive activities to gain a sense of achievement and enjoyment in your week…. from tidying your linen cupboard to texting a friend, it doesn’t need to be complicated.

4. Physiological component

The fight/flight/freeze response is our body’s automatic survival response to a perceived threat. It can include a racing heart, sweating, shaking and dilated pupils. Learning techniques to get your body to relax when there is a perceived threat is important for being able to face difficult situations that you may be avoiding.

 

Related techniques:

In addition to shifting unhelpful thinking and undesirable behaviours, CBT also includes the acquisition of many other skills and techniques to improve how we feel.

  • Relaxation training
  • Mindfulness techniques
  • Goal setting
  • Problem-solving techniques
  • Communication training

Homework

CBT has homework! It’s like going to the gym; you have to learn to condition your mind in a different way. You also need to start behaving differently and setting yourself behavioural tasks each day or week for effectively changing how you feel.

In practice

The most effective way to benefit from CBT is to be guided by a qualified professional, such as a psychologist. There are also many APPs available that apply the techniques of CBT, which can help you with changing your thinking and behaviour. Either way, it is empowering to know that it’s up to you to change how you feel!

06/09/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

What is Mindfulness?

Mindfulness-based programs have become extremely popular in the past decade. They are offered as a solution to a wide range of problems in work and health settings, in schools, and even in prisons. Considering such a huge uptake, it is important to understand what mindfulness is and to appreciate the evidence behind the claims for its usefulness. 

Mindfulness was popularised in Western healthcare by Professor Jon Kabat-Zinn in the 1970s.  A long-time practitioner of yoga and Buddhist meditation, he aimed to create a structured, secular program that would enable his patients to improve their quality of life in spite of living with chronic illnesses and pain. This initiative became the now well-known Mindfulness Based Stress Reduction (MBSR) program. 

Another important program is Mindfulness-Based Cognitive Therapy (MBCT), first offered at Oxford University by Professor Mark Williams and his colleagues in the 1980s to help people remain well after they had experienced a period of clinical depression. These two programs provided the basis for many other mindfulness-based interventions that were developed in the following decades. 

The first research study about mindfulness was published nearly 40 years ago, and a large amount of research has been conducted since then. In people without a diagnosed mental or physical health problem, mindfulness-based interventions have been found to reduce stress, anxiety, depression, distress, and burnout, and to improve quality of life in general.  As clinical treatments, these programs are effective for recurrent depression, some anxiety disorders, chronic pain, addictive behaviours, and child behaviour problems when mindfulness training is given to the parents. But what is mindfulness and how does it improve well-being in the face of life’s difficulties? 

To define what mindfulness is, the following sentence from Jon Kabat Zinn is often quoted: “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally … “ 

In other words, mindfulness is defined as an ability to observe what is happening in each moment, with an attitude of acceptance, curiosity, and kindness. This detached awareness can include our thoughts, feelings, body sensations or behaviours, as well as the outside world.  When we engage in formal mindfulness practices, we aim to develop this ability. We choose a target for our focused awareness, (for example, the breath, the body, or a sound) and keep directing our attention to this target. At the same time, we notice that the mind wants to run off in all sorts of directions. When this happens, we notice the thought that the mind wants to engage with, then let it go and gently redirect our attention to the point of focus. Importantly, however, when quoting Kabat-Zinn’s definition of mindfulness, the second part of the sentence is sometimes ignored. The second part says,   

…  in the service of self-understanding and wisdom.” 

“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally, in the service of self-understanding and wisdom.” (Jon Kabat-Zinn, 2017)

Professor Mark Williams also put this point succinctly: “Mindfulness is an ability to recognise and to let go of the things that stop us from living to our full potential” (Mark Williams, personal communication, International Conference on Mindfulness, Amsterdam, 2018). 

This means that our ability to pay attention whilst practicing mindfulness is not the point. It is only a means to an end. It is important to carry this ability on to everyday life: noticing when our minds are giving us potentially false projections for the future or dragging us down the path of impotent guilt or rage about the past. To be able to notice what the mind is doing and to be able to decide whether it is helpful to believe our thoughts and to act on our impulses is a central skill in mindfulness. 

To be mindful is to be able to observe our thoughts as just thoughts and our emotions as just sensations in the body. We can calmly observe our thoughts, emotions, body sensations and our urges to act, and then decide what to do. In this way, mindfulness allows us to develop a high level of emotion regulation and enables us to act in accordance with our authentic values: to respond with wisdom rather than to react too quickly to life’s vicissitudes.

 

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.  

30/08/2021
Lara Gray
In All Articles, Dr Tony Boutagy, Exercise, Mental health, Nutrition, Sleep

Staying Healthy at Home

Many Australians are presently working from home. Cutting the travel time to and from work provide opportunities to spend that time doing other things we wouldn’t ordinarily have time for. But working at home can be a disruption to normal routines that we all tend to thrive on. One of the most common sentiments I hear as extended holidays draw to a close is that many actually look forward to having the routine that the work life brings. Lack of regularity is just one of several challenges being house bound presents us. With that in mind, I offer six suggestions to stay healthy and sane whist working from home for this next, unspecified period of time.

 

  1. Keep a regular sleep/wake schedule: Not having to wake up at a specific time to catch the bus to work and merely having to open the computer to start our day can allure us into creating haphazard sleeping schedules. Humans have evolved to keep regular sleep/wake, light/dark rhythms that rewards us with vitality, productivity and energy when we observe these regular sleep-wake cycles. This period of physical isolation allows us to firmly entrench an 8-hour sleep opportunity and circadian rhythm that we might never have again, as going out to restaurants and other entertainment is off the cards for the foreseeable future. Decide what time you would like to wake each day, work back 8-hours, allowing an extra 30 or so minutes for wind down, shower, intimacy and so on. Remembering to use bright lights in the morning hours and dim light in the period before bed. Then stick to this schedule every day. 

 

  1. Respect work/life balance: in our parents and grandparent’s day, for the vast majority, there were no mobile phones, computers and internet. Once the work day was done, adults did not go home and keep working until all hours.  Now that we are house bound and have access to emails on our phones, there can be a strong temptation to essentially work 7 days a week, without truly respecting down time. It would be wise to maintain ‘office hours’ and ‘personal hours’, where, during the latter, the phone and computer are off to work and on to family, friends and entertainment. 

 

  1. Set an exercise schedule: just as we have group exercise classes, personal training and running clubs, keeping a scheduled daily exercise regime (especially in the morning before work hours) is critical to maintaining momentum and not falling off the bandwagon during this time we are at home. Here are several suggestions:
  • Talking a 5 to 10-minute walk after meals aids blood sugar control and the energy slump we often get mid-afternoon. This is a very little time investment but has a huge potentially to make us feel great and energised;
  • Aim to walk in nature several times a week, so we don’t develop cabin fever from doing everything indoors.
  • Exercise every day and alternate hard (see next point) with easy sessions, such as walking and jogging;
  • Use time efficient modes of interval training, such as stair or hill runs, as the ‘hard’ sessions. Aim to accumulate at least 10 minutes of high-intensity work in these sessions. After a 5-minute warm-up, finding a hill or stairs it takes about a minute to reach the top, tackle these 10 times with a slow walk back down. Skipping is another tremendous exercise mode, where you would aim to do a similar workout (10 x 60-seconds of skipping with, say, 30-seconds rest in between);
  • Set up a body weight circuit three times a week. An example of a circuit might be: squats, push-ups, lunges, abdominal planks and skipping. Do each exercise for 60-seconds, moving quickly on to the next exercise. Rest a minute at the end of the circuit, and perform five rounds of the circuit, 

 

  1. Use house bound time wisely: This unusual time provides us with the perfect opportunity to work on aspects of health and fitness that we do no ordinarily have time for, such as stretching, trigger point work or foam rolling, deep breathing and meditation. It can be as simple as a 5-minute stretch, foam roll or deep breathing while you make your morning coffee or tea. It’s another healthy habit that takes basically no extra time from your day but doing it regularly will make you feel great.

 

  1. Be mindful of eating ‘as something to do’: Most people working from home have already worked this out – we eat because we are bored, procrastinating or as something to do. So that we all don’t gain unwanted weight over this time, it would be helpful to set an eating schedule that we stick to every day and avoid mindless walks into the kitchen to snack.

 

  1. Stay connected: It has already been observed that the phase ‘social distancing’ is unhelpful and the term ‘physical distancing’ might be more appropriate. We are very used to seeing people at work, on the bus or after work. This, for the time being, has largely stopped. Rather than just texting people, make the time during ‘personal hours’ try to use FaceTime, Skype and Zoom as a way of connecting with others, especially those really affected by isolation, such as the elderly. Try to call people as well, rather than texting. In this way, those who are more affected by physical distancing will feel a much greater sense of connection, which is far better for everyone’s mental health.

 

Dr Tony Boutagy is an Exercise Physiologist with a PhD in exercise and sports science from Charles Darwin University. He’s conducted over 50,000 training sessions in his career that has spanned 25 years, and is regarded as one of the premier personal trainers in the country. 

26/08/2021
Lara Gray
In All Articles, Dr Marianna Szabo, Mental health

The Four Horsemen of the Relationship Apocalypse

Having a happy, supportive romantic relationship is an important source of life satisfaction for most people. However, relationships can also be hard work, and are often a source of frustration and distress. It is no wonder then that nearly half of all marriages end in divorce. But is it possible to know what predicts divorce?

Professor John Gottman at the University of Washington was one of the first psychologists who did so successfully. In several research studies, Gottman and his colleagues observed newlywed couples interacting with each other and followed them up for several years, aiming to find interaction patterns that could predict which couples would stay married and which ones would get divorced within 5-10 years.  

Among the many predictors of divorce he identified, one of the best known is what Gottman called “The Four Horsemen”, referring to the biblical “Four Horsemen of the Apocalypse” bringing destruction. Gottman’s “Four Horsemen” describe four behaviours or emotional reactions during couple conflict. They build on one another and compound each other’s negative effects, leading to a cascade of increasingly hostile interactions and emotional withdrawal from the relationship.

So what are Gottman’s Four Horsemen? 

Criticism

The cascade starts with criticism. It is important to differentiate criticism from a legitimate complaint. In successful relationships, a complaint is expressed in a tactful, respectful way that concentrates on the actual behaviour to be discussed. Criticism, as one of the “Horsemen”, can be identified by harsh, broad statements that attack the whole person. It often starts with “you always…” or “you never…” or “you are so … (selfish, careless, cold, etc)“. Frequent criticism and attacks of this kind can then lead to the appearance of the next “Horseman”: defensiveness. 

Defensiveness

Defensiveness is a common response to criticism. It is not pleasant (and usually not fair) to be attacked in such harsh, broad terms. A partner may therefore respond by denying responsibility or even shifting blame from themselves and counterattacking their partner. Of course, this then can cause their partner to feel that their concerns are not taken seriously, so they intensify their criticism. A cascade of attacks and counterattacks follows, with each partner feeling increasingly frustrated and unsupported. 

Contempt

Repeated criticism of one another and responding to this criticism with defensiveness (such as shifting blame or countercriticism) can lead to a sense of contempt. At this phase of the interaction, a lack of respect is expressed by sarcastic statements about the partner, name calling, eye rolling, mockery, and hostile humour. Gottman suggests that contempt is the most destructive of “The Four Horsemen”. 

Stonewalling

Stonewalling is a response to the first three behaviours. In the middle of a fight, some people stonewall as an instinctive self-protection mechanism. Because they feel psychologically overwhelmed, they need to shut down emotionally or remove themselves from the situation physically. They may stop responding, or they may leave the interaction. In the long term, one or both persons in the couple begin to avoid interacting with the other. Very little communication takes place, and what does take place is either reduced to talking about trivial, “safe” matters or continue to be destructive, peppered with repeated low-level expressions of criticism, counterattacks, and contempt. 

Of course, not all couples who are stuck in such destructive interaction patterns end the relationship. There are many other predictors of relationship dissolution, as well as of staying in unhappy relationships. Nevertheless, if you notice getting engaged in increasingly hostile interactions, it may be a good time to stop and consider whether there is a more helpful way to solve conflicts with your partner. 

Gottman has written several books advising couples who would like to improve their relationship.  Some of these may be helpful: 

Gottman, J.  (1995). Why Marriages Succeed or Fail And How You Can Make Yours Last.

Gottman, J. & DeClaire, J. (2002). The Relationship Cure.  

Gottman, J. & Silver, N. (2015). The Seven Principles for Making Marriage Work.

 

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney. 

12/08/2021
Lara Gray
In All Articles, Dr Nick Chartres, Nutrition

The Truth About Supplements

Supplements

Supplements are often the first question I get asked about.

The magic bullet that will improve your overall health and wellbeing in one or two (or sometimes 6) tablets a day! There are few, but critically important populations that do need supplements. For example, any woman of reproductive age is recommended to take a multivitamin every day to get sufficient folic acid. Folic acid supplementation reduces the chance of having a baby with neural tube defects. These defects occur very early during gestation, often before a woman knows she is pregnant. 

The main challenge in determining if they work or not is the one size fits all approach. There is A LOT of research done on supplementation. It is a multibillion-dollar industry that benefits from making health claims demonstrating the efficacy and or effectiveness of their products. 

If you think about all of the different supplements out there and all of the different health outcomes they purport to benefit, you are going to find some that have evidence to support their use. For example, if you look at the Cochrane Library Database* that houses the GOLD standard in reviews of the evidence for clinical studies and type in “probiotic” you will see that there are 56 reviews on them spanning topics such as “probiotics for treating eczema” to “probiotics for non‐alcoholic fatty liver disease and/or steatohepatitis”… And you will see there are over 7381 individual trials on them! 

So do they work? Maybe. It depends on what you are trying to measure. 

One of the biggest issues (and sometimes dangers) with recommending supplements is that there is an assumption that a particular naturally occurring vitamin or mineral in food, if taken in isolation and in high doses will lead to better health as we believe we understand the mechanisms by which it works.

Let’s take vitamin A or E as an example. These are antioxidants that combat free radicals. We assume vitamin A or E will reduce the damage to cells caused by free radicals, including damage to our DNA, which may play a role in the development of cancer. Seems logical these vitamins could help reduce cancer. Better load up on antioxidants supplements. 

Well they did just that back in the 1990s and early 2000s with a series of studies that were designed to improve cancer outcomes in high risk groups. 

One study conducted in the 1990’s wanted to test if the health effects of vitamins found in fruits and vegetables, retinol and beta carotene, (think vitamin A), which had been seen to be in higher concentrations in people with lower rates of lung cancer, would be the same when taken as a supplement. 

Over 18,000 men and women at a high risk of developing lung cancer were either assigned a beta-carotene and retinyl  palmitate (vitamin A) supplement taken daily or a placebo. The study was stopped ahead of schedule because participants who were randomly assigned to receive the beta-carotene and Vitamin A were found to have a 28% increase in incidence of lung cancer and a 17% increase in incidence of death compared to the placebo group. 

A second study in 2001 was conducted to determine the long-term effect of vitamin E and selenium on reducing the risk of prostate cancer in approximately 34,000 relatively healthy men >55 years. It was assumed these antioxidants would reduce the risk of cancers in high enough doses. 

Oral selenium and vitamin E was planned to be taken for a follow-up of a minimum of 7 and maximum of 12 years at very high doses. It was found that the risk of prostate cancers in men that were supplemented with vitamin E was 17% greater compared to a placebo (no supplement). In the selenium group there was also an increased risk but it wasn’t statistically significant.

So what does all of this mean?

Both of these studies highlight that caution should be used when recommending or using high doses of vitamins or micronutrients. Naturally occurring dietary constituents (i.e. vitamins and minerals) are part of normal physiology, and either deficiency or excessive doses are harmful. 

It doesn’t mean you shouldn’t adhere to advice given to you by your doctor or dietician if treating a medical condition, but it does show that the assumed benefit of a vitamin or mineral is not always correct when taken in isolation. 

This lack of benefit/potential harm from single antioxidants was later confirmed in 2012 with one of those GOLD standard Cochrane reviews I was talking about before that looked at Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. 

This review included 78 clinical trials with 296,707 participants randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. They found, wait for it, an increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium, with absolutely no benefit of antioxidant supplements in the general population or in patients with various diseases.

Ok, but you are really here for me to tell you whether fish oil is good for you or not. Right? Well. 

A recent large Cochrane Review assessed the effects of increased intake of fish and plant-based omega-3 fats on all-cause mortality, cardiovascular events and blood lipids levels, mainly via capsules, as many people believe that taking omega-3 supplements reduces risk of heart disease, stroke and death. 

The review included 86 clinical trials and over 120,000 participants that compared greater omega-3 intake versus lower omega-3 intake for at least a year. The review found that increasing EPA and DHA (omega-3 fats found in fish) had little or no effect on all cause mortality, cardiovascular death, stroke, or heart irregularities.

So, what’s the take away from all this?

Some supplementation is necessary for some people. 

There will be new studies that may change what we know on some of the topics I have shared with you here, and if they do, and the reviews are high quality, without industry funding then the thinking around supplementation may change. But if you’re healthy, and not a female trying to fall pregnant or sexually active and of reproductive age, eat a minimally processed, plant-based diet and you are going to be in good health!

 

* Cochrane Library Database – If you ever want a summary of the evidence on a topic that uses randomized controlled trials to test an intervention, then this is the place to look – and they now give great plain language summaries.

 

​Dr Nick Chartres is the Director of Science & Policy at the University of California, San Francisco working with the Program of Reproductive Health and the Environment. His work focuses on US federal chemical policy and regulation.

Nick received his PhD from The University of Sydney, where his thesis examined ways to reduce bias in public health guidelines, including the primary studies that are used in our national Dietary Guidelines. Nick also has a Masters in Nutrition.

05/08/2021
Lara Gray
In All Articles, Exercise, Mental health, Nutrition, Simone Chartres, Sleep

The Stages of Change

People know that smoking is bad for their health, but still choose to smoke. People know they ‘should’ go for that run, but still choose to sleep in. People know that the McDonalds drive through is not the healthiest option for dinner, but still use it on a Friday night after work. People are informed and educated around healthy behavioural choices, however still make unhealthy choices. Even when an individual has a serious health scare, they still may not want to change or know how to change the behaviours that have led them to their condition. 

The Transtheoretical Model (Stages of Change) can explain why. 

Social psychological research into dietary change and levels of physical activity are often the forgotten piece in understanding how to promote healthy behavioural change, long term. 

Health Behaviour Models

The contribution of social psychology is now becoming more and more influential in affecting long term dietary and exercise change. The most important contribution has been the advancement and application of various health behaviour models to initiate and promote change.

Some of the most popular models of health behaviour include: the health belief model; social cognitive theory; protection motivation theory; the theory of planned behaviour; and finally, and importantly, the transtheoretical model of change.

The Transtheoretical Model of Change (Stages of Change Model)

Developed by Prochaska and DiClemente, the model’s central concept is that all individuals pass through similar stages of change regardless of the problematic behaviour that they are trying to change.

These stages are:

  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance

With relapse common in the attempt to maintain any new behaviour.

Think of a current behaviour in your life that is potentially unhealthy. It doesn’t need to be anything too sinister; perhaps your partner has been telling you to drink less wine during the week, or you’re staying up past midnight binging on Netflix, or you’ve only exercised once in the past month. Look at each stage outlined below and see if you can identify which stage you are currently in, where you have been, and most importantly, where you would like to be!

Pre-contemplation: This is where a person has little to no awareness that their current behaviour is unhealthy or problematic. People in the pre-contemplation stage have no intention to change their behaviour in the foreseeable future. This is your husband or wife who you have desperately wanted to exercise for the past ten years, and despite your every attempt to change his or her behaviour, they haven’t even walked past the gym!! They’re thinking… “What problem?! It’s not a problem!”

Contemplation: This is where a person is thinking about making a change, but they haven’t yet taken any kind of action. This may have been you before joining the gym. People in contemplation see the advantages and disadvantages of their problematic behaviour… “I know that half a bottle of red wine each night isn’t great for my waist line, but it really helps me to relax once the kids have gone to bed.” Sound familiar?! 

Preparation: This is the third stage where a person shows intent to act and has gone about planning for changing their behaviour. This may have been you when you hired a personal trainer and started arranging for a regular time to be available in your week for exercise. 

Action: Once a person is engaging in their new healthy behaviour, they are in action. For example, doing your first exercise session!! This is also known as the “doing” stage.

Maintenance: Once a person has continued with their new behaviour for 6 months or more, they are in the final stage of change.  

Relapse: A relapse or a ‘lapse’ is a normal part of changing an unhealthy behaviour. A relapse is defined as going back to the problematic behaviour (or worse), whereas as a ‘lapse’ is like a little slip up. The important thing is to learn from any lapses or relapses by identifying the trigger, and then putting strategies in place for preventing another one from occurring in the future. 

As you pass through each identified stage of change, so too does your level of self-efficacy. In other words, once you progress to maintenance (especially if you have been following a detailed program) you will find it easier to identify and overcome any common barriers in the future. Therefore, when you relapse or lapse (which is very normal), you can re-implement your new learnt and healthful behaviours. The goal is to move towards maintenance, while increasing your levels of self-efficacy. 

It is important to note however, that ‘at-risk’ populations are often not prepared for the action stage and will not be served by traditional educational programs. Therefore, helping people set more realistic goals and assisting them in moving towards action with a trained professional is a very important step in this process. Professionals who have the right skills can guide you in changing your thinking and attitudes.

If you have issues with self-worth, or anxiety around changing your behaviour, or perhaps a belief that prevents you from acting, this is completely normal! Seeing a psychologist may be a crucial step for you in changing your problematic behaviour. Psychologists are well trained in dealing with ambivalence. It is very common for people to be ‘stuck’ in the contemplation stage. If this sounds like you, a psychologist can guide you in working through the pros and cons of changing your behaviour and collaborate with you to start preparing for change. 

Take Home Message

Changing life long behaviours and creating new healthy habits can be incredibly difficult. The first and most crucial step to the process is about identifying the behaviours in your life that are problematic. If you believe that you don’t have the ability to change, it is recommended that you seek professional help from a psychologist to guide you in commencing the process of change. Everybody can change a problematic behaviour; you may just have to change your attitude towards the behaviour first!

 

Simone Chartres is an endorsed Clinical Psychologist with the Australian Health Practitioner Regulation Agency (AHPRA). She has over 10 years of clinical experience working with young people and adults with complex presentations in the public and private sector. Simone has extensive clinical experience in the assessment, diagnosis and treatment of anxiety disorders, mood disorders, substance use disorders and eating disorders.

05/07/2021
Lara Gray
In All Articles, Mental health, Simone Chartres

Expert Q&A: Introducing Simone Chartres

1) Could you tell us a little about your career and areas of expertise/interest? 

I’m a Clinical Psychologist and have worked with various mental health presentations. I started out working with homeless adolescents, and have since worked in drug and alcohol rehabilitation, in a phobia clinic, within the area of perinatal mental health, as well as the school setting. I love the variety that a career in psychology brings, however I have a particular interest in working with trauma and anxiety disorders. 

 

2) What drew you to this line of work/research in the first place? 

I’ve always been passionate about people being able to access quality and affordable mental health support. I find human behaviour fascinating and feel so fortunate that I get paid to help people improve their lives!

 

3) How do you look after your own physical and mental wellbeing?

Exercise, good food, good coffee and socialising!

 

4) Do you have a favourite post-workout cafe?

Anywhere with outdoor seating and the smell of the ocean!

 

5) What is one thing you wish people knew about wellbeing? 

There is no quick fix or magic pill! It’s about a lifestyle and slowly making positive changes that you can maintain.

 

6) What is one of the most ridiculous things you’ve read or seen about wellbeing that you know to be untrue? 

During my Clinical Masters training I was fortunate enough to do a placement at Royal North Shore Hospital Pain Management Clinic.  It was incredible. The patients came in with chronic pain that they had been suffering from for years. They were all on a cocktail of drugs, but still in pain. They completed a 6 week course with a team of psychologists, physios and doctors, and walked out on no drugs and pain that they were able to manage. Opioids do not work for managing chronic pain, despite what the pharmaceutical companies try to tell us!

 

7) Do you have any favourite books, podcasts or websites on health or wellbeing that you’d recommend?

I love listening to Conversations with Richard Fidler and Sarah Kanowski. It always reminds me of how interesting humans are and the incredible things that people have survived. Often when we are anxious we are stuck in our minds thinking about ourselves. Taking the time to listen to the life of someone else can be incredibly healthy for your own wellbeing.

 

8) What is your top tip for living a healthy and happy life? 

Build self awareness and be able to recognise when a behaviour is more hindering than helpful. And stay connected to other people!

 

17/06/2021
Lara Gray
In All Articles, Dr Marianna Szabo, Mental health

Expert Q&A: Introducing Dr Marianna Szabo

1) Could you tell us a little about your career and areas of expertise/interest? 

I have a double BA degree in Psychology and in Theatre and Film Studies from the University of New South Wales. I graduated in 1998 with 1st Class Honours in Psychology, the Australian Psychology Society Prize for best performance in Honours, and the University Medal for Highly Distinguished Academic Merit. 

I continued at UNSW and gained a Master of Clinical Psychology and a PhD degree in 2003. My PhD research investigated worry and anxiety in both adults and children. It established my life-long interest in understanding anxiety disorders and a desire to help those who live with these often disabling conditions.

In 2003 I took up an academic position as a lecturer in the School of Psychology at the University of Sydney. At about this time I also developed an interest in mindfulness and other types of meditative, contemplative practices. My teaching and research have primarily focussed on anxiety, depression, stress, stress-related coping behaviours, and mindfulness. My research has been reported in more than 50 international publications and conference presentations.

In addition to my academic work, I have a private clinical practice in Sydney. My main approach to treatment is Cognitive Behaviour Therapy (CBT), known to be the ‘gold standard’ for the treatment of most psychological problems. I am also very interested in the practice of Schema Therapy, an approach that seeks to understand a person’s long-term patterns of behaviour and to achieve lasting change via the emotional processing of adverse early experiences. 

 

2) What drew you to this line of work/research in the first place? 

Anxiety is such a common experience, being able to know when it is helpful and when it is harmful is a very important aspect of being able to help people.  In term of therapy, I was naturally drawn to mindfulness and schema therapy, as they both provide an additional depth to working from a CBT background.

 

3) How do you look after your own physical and mental wellbeing?

After I was diagnosed with a chronic pain disorder, I realised that I had not been following the advice I often give to my clients. Since then, I have made a commitment to making my health an absolute priority, working less, spending more time resting, sleeping well, and enjoying a state of calm.

 

4) Do you have a favourite post-workout cafe?

I’m not usually hungry after a workout and have no desire to go to a cafe. I tend to walk home from the gym or the park after my workout and enjoy the feeling of elation I get from physical activity.

 

5) What is one thing you wish people knew about wellbeing? 

Achieving more and more while not caring for yourself will be detrimental for your wellbeing. 

Caring for others more and more while not caring for yourself will be detrimental for your wellbeing. (These are two things, but they tend to be the two main things that lead people to burnout.)

 

6) What is one of the most ridiculous things you’ve read or seen about wellbeing that you know to be untrue? 

Too many to mention. Sadly, the number of conspiracy theories and anti-science messages grew exponentially during the COVID-19 pandemic. It is disheartening to see so many of these on social media.

 

7) Do you have any favourite books, podcasts or websites on health or wellbeing that you’d recommend?

I really like listening to anything by Dr Norman Swan.

 

8) What is your top tip for living a healthy and happy life? 

Make your health a priority, and build positive, supportive relationships. Start today.

 

27/05/2021
Lara Gray
In All Articles, Dr Kate Edwards, Exercise, Mental health

Research Review: Mental Health’s Impact on Physical Activity During the COVID-19 Pandemic

In this article, our expert Dr Kate Edwards – Associate Professor in Exercise and Sport Science at the University of Sydney – reviews A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic by Marashi et al. 2021 and breaks it down to give us the vital parts we need to know. 

1) What was the high-level summary of the research? 

This study from Canada found worsening of mental health and reduced physical activity during the COVID-19 pandemic in 2020. The proportion of respondents reporting feeling stressed ‘Fairly often’, ‘Often’, or ‘Very often’ increased from 45% pre-pandemic to 67% during the pandemic. Aerobic activity decreased by 22 minutes, and strength -based activity decreased by 32minutes. The authors found that barriers to physical activity shifted from primarily time (from 42% reporting as a barrier down to 16%), to lack of access/equipment (from 5% up to 46%). But results showed an interesting paradox with mental health being both a motivator and barrier to physical activity. People wanted to be active to improve their mental health but found it difficult to be active due to their poor mental health. For example, anxiety relief as a motivation to exercise was reported at greater frequency during the pandemic (+14%), but increased anxiety was also reported as a barrier at greater frequency (+8%).

 

2) How was the study undertaken & what was it trying to measure? 

This simple internet survey was completed by 1669 people, mostly women (82%), and mostly 18-65 years (90.8%). Questionnaires asked about current (during the pandemic) and past (per-pandemic) mental health, stress, physical activity habits and barriers and motivators to physical activity as well as demographics.

 

3) Is there any other research out there that supports these findings or contradicts it? 

Many other studies have shown reductions in physical activity during the COVID-19 pandemic across many countries with different lockdown timing and severity, and across all age groups. The relationship between physical activity and mental health is very well established, with studies showing that regular exercise is often more effective than medication at relieving depression symptoms. 

 

4) What’s the key takeaway for us to take from this research?

This study is interesting as it hints that there are divergent effects of the pandemic, for some people the pandemic increased motivators /reduced barriers and they became more active, and their mental health improved. But for others the reverse occurred, physical activity reduced as barriers increased and motivators decreased, and with that their mental health suffered. What we don’t know is why those different effects were seen, and that’s important, because as practitioners we want to know who it’s most important to support.

The research on physical activity effects of the current pandemic are often this style of internet based questionnaire, but they often bring bias. As here, often women are the predominant responders, they are usually highly educated and younger than the general population. This means we are missing a lot of information about other groups in society and need to consider ways to reach those in our work to understand and to support.