Reintegrating the body, brain and mind in counselling and therapy

ABC Blog Post

15th September 2018

Copyright (c) Jim Byrne, 2018

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Dr Jim’s Blog: Mental health is not just about childhood experiences;

Or current stressors; or badly managed thoughts…

Mental health is related to diet and nutrition, inner dialogue, physical exercise, re-framing of experience, and sleep science…

Introduction

Body-mindIn science as well as popular culture, the body and mind have long been pulled apart, and treated as separate entities.

And when they are treated as being connected – as in the modern psychiatric theory of ‘brain chemistry imbalances’ causing negative moods and emotions, the ‘brain chemistry’ in question is taken to be unrelated to how you use your body; what you eat; how well you sleep.

It is assumed to be ‘special brain chemistry’ – separate and apart from Lifestyle Factors – which can only be fixed by consuming dangerous drugs!

Front cover Lifestyle CounsellingIf you are interested in the impact of lifestyle practices on mental health and emotional states, then you will enjoy our page of information about how all of the ideas above are presented in our book about Lifestyle Counselling.  We see this as the core of most holistic healing practices of the future.

In the immediate future, lifestyle counselling practice will be a novel service offering for counselling and psychotherapy clients who have realized that:

# the body and mind are intimately connected;

# that the body-mind is an open system, permeated by a whole range of lifestyle factors which can be managed well, or mismanaged,

# which results in excellent or poor mental health, physical health, and personal happiness.

In the pages of our popular book on lifestyle counselling, we have presented:

Diet,exercise book cover– a summary of our previous book about the impact of diet and exercise on mental health and emotional well-being;

– a chapter which integrates psychological theories of emotion with physical sources of distress – for the emotions of anger, anxiety and depression – and recommends treatment strategies;

– a chapter on the negative effects of sleep insufficiency on our thinking, feeling and behaviour;

– a chapter on how to re-frame any problem, using our Six Windows Model (which includes some perspectives from moderate Buddhism and moderate Stoicism) – but excludes the extreme forms of those philosophies of life!);

– a chapter on how to divine and assess the counselling client’s multiple sources of emotional disturbance, using our Holistic-SOR Model;

– and a chapter on how to set about teaching lifestyle change to counselling and therapy clients.

For a page of information about this book’s contents, including extracts, and the contents pages and index pages, please click the following link: *Lifestyle Counselling and Coaching for the Whole Person… by Jim Byrne***

And/or you could also look at our current range of six books on this area of counselling and therapy theory and practice: Books about E-CENT Counselling.***

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BlueLogo13CThat’s all for now.

Best wishes,

Jim

Dr Jim Byrne, Doctor of Counselling

ABC Coaching and Counselling Services

jim.byrne@abc-counselling.com

Telephone: 44 1422 843 629

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Lack of sleep can ruin your career and relationships

Blog Post No. 60

9th September 2018 (Updated on 4th January 2019)

Copyright © Renata Taylor-Byrne, 2018-2019

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Renata’s Coaching Blog: Why you must ‘safeguard your sleep’!

Does your job entail dealing with people all day long?  If so, then your sleep level really makes a difference – and here’s why:

Introduction

draft cover 2 for selling pageI continue to research and write my book – the working title of which is now:

SAFEGUARD YOUR SLEEP AND REAP THE REWARDS:
Better health, happiness and resilience

By Renata Taylor-Byrne

do I think you should safeguard your sleep, in a culture which is increasingly sleep deprived?

Essentially, if you do not get enough high quality sleep, your physical and mental health will suffer; as will your quality of life, level of happiness, and relationships at home and at work.

In this blog, I want to explain the connection between sleep quality and quantity, on the one hand, and your level of emotional intelligence, on the other.

And I also want to explore the importance of emotional intelligence to your career success and self preservation.

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Sleep and interpersonal intelligence

A BlinkDeep, restful, and nourishing sleep is crucial for everyone who is working with people all day long.

You need to be able to face the working day with energy and stamina, and to have enough vitality to fuel your ability to read and understand the non-verbal and verbal messages you get from other people; and to be able to manage your interactions with those people constructively.

This kind of social/emotionally intelligent ability to read nonverbal communication is an extremely valuable set of skills in the workplace: whether dealing with customers/clients or colleagues

This vitally important skill set includes:

– understanding how the other person is feeling;

– having the ability to spot the beginnings of conflict situations;

– being able to restore calm; and:

– having the ability to negotiate with, and successfully handle, other people, so that they feel respected, listened to, and understood.

Draft Full cover 3 for selling page.JPG

Front line people skills

Mathew Walker, why we sleepThese skills are integral to the work of police officers, health care professionals, teachers, social workers, negotiators, sales people and many other professions who are on ‘the front line’ of dealing with the public.

Emotionally intelligent people-reading is also very important in our personal relationships: with family members; people who provide services to us; and relationships with work colleagues.

However, emotionally intelligent reading of the nonverbal signals given off by other people, and diplomatically responding to them, is not a fixed set of skills, that you learn once and for all, and can then deliver or utilise, whenever you like, under any kind of personal circumstance.  In fact, you need a great deal of energy and stamina to perform these tasks effectively.

The key elements fuelling this energy and stamina include what you eat, and how well rested you are.

The inside story

But we are not just interested in the feelings of other people, when we talk about being emotionally intelligent. We are also concerned with what’s happening inside you as you deal with people in the workplace? It’s very important for your health and well-being to be able to recognise and acknowledge your own emotions and feelings as well, and be able to accept them as they take place.

A Marabain chart

Then you need the skill of being able to constructively manage your feelings so that they are dealt with in a therapeutic and constructive way.

This range of skills, I have just described, make up the skills of emotional intelligence, and here is a definition from Drs. Travis Bradberry and Jean Greaves:

“Emotional intelligence is your ability to recognise and understand emotions in yourself and others, and your ability to use this awareness to manage your behaviour and relationships”.[1]

There is growing research to support the belief that the most effective people in work and home relationships are those who are more emotionally intelligent.  And there is also evidence accumulating that those individuals who lack emotional intelligence, tend to get themselves into trouble in work, at home, and even in legal actions!

draft full cover 3 for selling page

The case of ‘who gets sued’

A, BradberryOne way to examine the value of emotional intelligence at work is to look at the likelihood of being sued for incompetence or malpractice if you are high or low on emotional intelligence.

Here’s an example of what happens when people don’t develop their emotional intelligence:

It comes from research conducted by Levinson, a medical researcher, into medical professionals (specifically surgeons,) and malpractice claims by their patients. When malpractice lawsuits are investigated, it has emerged that

– there are doctors who are error-prone, and who do not have legal claims or complaints made against them by their patients,

– but there are also highly competent doctors whose behaviour prompts patients to sue them frequently.

What is the difference between them?

Patients, according to Gladwell (2005)[2], don’t sue for inadequate treatment they have received. Instead, they sue because they have received inferior treatment, “…and something else happens to them”. (page 40)

The additional factor is the personal treatment the patients receive in their communications with their health professionals; which includes the health professional’s non-verbal manner with clients.

The research by Levinson

As part of her research investigations, Levinson recorded hundreds of conversations between one group of surgeons and their patients. One sub-group of the surgeons had never been sued, and the other group had experienced having legal action taken against them at least twice.

She spotted these differences between the two groups when she examined the recorded conversations: the non-sued group spent more time (approximately three minutes longer) with each patient. They took care to outline what would happen while the patient was being examined, and they made it clear that there was space for any questions. They listened fully and attentively to the client, and engaged in humour and light-heartedness with them.

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draft cover 2 for selling pageSo the essential difference discovered between these two groups was how the patients were spoken to.

Then Nalini Ambady, a psychological researcher, did some more sophisticated research on the recordings of patient/doctor conversations, and focused in on the emotional tone of the conversations alone.

The outcome, which totally surprised the judges and Ambady herself, was that using these categories enabled a pattern to quickly become apparent: it was possible to predict which of the surgeons were the ones being sued, and which surgeons were not. The results were clear: a surgeon with a dominating voice was most likely to be in the sued group. And a more attentive, solicitous voice would mean that the doctor was in the non-sued group.

This outcome revealed the importance of tone of voice:

“The most corrosive tone of voice that a doctor can assume is a dominant tone”. (Page 43)

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What has sleep got to do with maintaining and developing emotional intelligence?

Experiments have shown that, without sufficient sleep, our ability to regulate (manage and control) our emotions is reduced. Lack of sleep affects our frontal lobes which are vital for managing our emotional reactions and keeping our feelings under control.

As well as tone of voice being a very powerful communicator which, if unregulated, can result in dire interpersonal results, there is also the importance of being able to read the facial expressions of others: When we sleep at night, the parts of our brain which assess non-verbal messages and facial expressions are rested and reinvigorated by rapid eye movement sleep (REM). This means that when our brains are refreshed the following day, we are able to see the subtle changes in micro momentary expressions and our ability to assess accurately the emotional states of the people around us is back to full strength.

Matthew Walker (2017) described an experiment which showed how lack of sleep affected this crucial skill. The experiment was as follows: participants came to his sleep laboratory and had a long, restful night’s sleep. Then the next morning they were shown a lot of pictures of one person’s face. The facial expressions in the pictures varied from very hostile and aggressive, through to less emotional, calm and friendly facial expressions.

There were distinct, yet small changes in the facial expressions of the person shown in the pictures, but the main feature of them was that there was this range of facial expressions from friendliness and warmth through to anger and strong dislike.

As the participants looked at the faces they had their brains scanned by a MRI machine (which uses radio waves and strong magnetic fields to create quite detailed pictures of the brain). The task they were given was to assess each picture in terms of its friendliness or hostility, or in other words, how threatening or welcoming the facial expressions were.

The second stage of the experiment involved the participants performing a similar facial expression assessment activity. This time they were sleep deprived, and significantly, weren’t allowed to have REM sleep.

Half of the participants had the full night’s sleep experience followed by the picture assessment, and then were sleep deprived the following night, and then performed the assessment procedure.

The other half of the group had the sleep deprivation condition first, and then assessed the pictures, followed by a full night’s sleep the following night, and did a visual assessment process afterwards. In each experimental condition, there were different individuals chosen to display the full range of emotional expressions, so the facial expressions had not been seen before in previous pictures.

Participants who had experienced a good night’s sleep with REM (rapid eye movement sleep) in it, had no difficulties in sorting out the different facial expressions from each other, from the range of friendly to menacing facial expressions. They performed this task inside the MRI scanner and their assessments were accurate.

There was a variation in the quality of the REM sleep, which the participants experienced. And those who had the superior quality of REM sleep showed that they were very well equipped to understand the messages from the pictures.

But the participants were then put in the second condition of the experiment: they were deprived of sleep (in particular, REM sleep) and then had to enter a MRI scanner and describe the emotions they could see on the pictures they were given, of the different facial expressions. And this time the participants found it much less easy to differentiate between the varieties of emotions shown on the collection of facial expressions.

Because of their lack of sleep (including REM sleep) they had lost the ability to quickly spot emotional states shown on someone’s face. They saw facial expressions of kindliness and welcome as hostile and menacing. Walker (2017) considers that the removal of REM sleep had affected the ability of the participants to assess others’ moods accurately:

“Reality and perceived reality were no longer the same in the “eyes” of the sleepless brain. By removing REM sleep we had quite literally removed participants’ level-headed ability to read the social world around them” (Page 217)

Why do we need REM (rapid eye movement) sleep?

REM sleep replenishes the brain’s ability to assess the level of seriousness of situations requiring emotional intelligence. It is crucial for those occupations that demand that workers perform their duties at night, to be aware of the importance of getting enough sleep prior to working, so that they get REM sleep.  This includes nurses, doctors and staff in the support services, the police and also other shift workers. For example, medical and nursing staff need their emotional intelligence to be at a high level to assess the level of pain that a person was experiencing, or their reactions to a new type of medication.

Here is an example of the effects of lack of sleep:The Daily Express of Tuesday June 26th, 2018, had as the main news item on its front cover: “Exhausted Doctors act like drunks” and described the effects of long hours of work and insufficient sleep:

“Tired and overworked doctors have an adverse effect on patient safety and the NHS must shift how it looks after the mental and physical health of its workforce”, was a comment made at the British Medical Association’s conference in Brighton. And the branches of the BMA in the City of London and Hackney division put forward a motion to the conference to consider:

“After twelve hour shifts doctors have been tested and behave as if they are drunk in terms of concentration and judgement. The doctors tested had no idea that their judgement was impaired.”

Conclusion

Lack of sleep can really affect our ability to assess situations around us accurately, and people who are working on the front line in the policing, security and health and caring services need to be well-rested as they perform their jobs, as the evidence shows. Their behaviour has a very powerful, knock-on effect on their clients and members of the public.

Nata-Lifestyle-coach8As I stated earlier,this applies to managers at every level: directors, company executives, university and college managers, social and health care managers, emergency service managers, police management, psychiatrists, supervisors, teachers, and parents; and many others. Because of this wear and tear, self-care is very important when managing people, as is the need to take care of the people being managed.

That’s why a decent night’s sleep is essential if you are working with people the following day, and want to be as well-prepared, and as capable as possible.

In addition to the importance of emotional intelligence in work, we must also take seriously the important effects of sleep deprivation, or sleep insufficiency upon relationships at home.  A lot of broken relationships could perhaps have been preserved and improved if the couple had taken sufficient care of their need for at least eight hours of good quality sleep each night!

draft cover for selling pageI hope you’ve found this blog interesting and helpful; and that you watch out for my book, which is coming soon. The title includes the words, “Safeguard your Sleep”, and  now you know some of the reasons why it’s very important to do that!

SAFEGUARD YOUR SLEEP AND REAP THE REWARDS:
Better health, happiness and resilience

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That’s all for now.

Best wishes,

Renata

BlueLogo13CRenata Taylor-Byrne

Lifestyle Coach-Counsellor

ABC Coaching and Counselling Services

Email: renata@abc-counselling.org

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[1]  Quotation by Dr Travis Bradberry and Dr Jean Greaves in an article entitled: ‘About Emotional Intelligence’ Available at: http://www.talentsmart.com/about/emotional-intelligence.php   Accessed 25/06/2018.

[2] Gladwell, M. (2005) Blink: The Power of Thinking without Thinking. London: Penguin.

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Lifestyle factors complicate counselling and therapy assessments

Blog Post No. 174

By Dr Jim Byrne

8th September 2018

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Dr Jim’s Blog: “What’s wrong with my counselling client?” Lifestyle factors complicate counselling-psychological assessments…

 Copyright (c) Jim Byrne, September 2018

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Introduction

Emotions-and-survivalMany of the human tragedies that clients bring to our counselling and psychology consulting rooms have pure social-psychological roots. These include:

– childhood abuse or neglect;

– traumatic experiences later on;

– stress and strain of difficult lives;

– relationship problems;

– and the normal human responses to losses, failures, threats, dangers, frustrations and insults; and so on.

We also see our fair share of

– attachment problems;

– personality distortions (or mal-adaptations to parents and others);

– and retreats from an intolerable reality.

New complications

DrJimCounselling002But all of this is now complicated by the existence of

– widespread consumption of junk food;

– disruption of normal sleep patterns by economic stress and new technologies which destroy melatonin;

– plus adoration of sedentary lifestyles;

– and various other lifestyle factors that

# precipitate problems of anger, anxiety and/or depression, in their own right; or

# magnify emotional disturbances that have psychological roots.

Body-and-mind

Because of this changed reality, which has come upon us in the past couple of decades, in the main, we now need to be able to spot the contribution of lifestyle factors to emotional and behavioural disturbances which may or may not be otherwise psycho social in origin.

SOR-model3

Our solution

The Lifestyle Counselling Book

We have done a lot of research on the multiple sources of human disturbance; and compiled that in a book, titled Lifestyle Counselling and Coaching for the Whole Person: Or how to integrate nutritional insights, exercise and sleep coaching into talk therapy.

We have also written a page of information about these Lifestyle Counselling problems, abstracted from our book, which you can find by clicking the following link: https://abc-counselling.org/counselling-the-whole-person/

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This book, like all our other books, is available via Amazon outlets, all over the world, as both a high quality paperback and as a downloadable Kindle eBook.

A Kindle dBooks imagePS: If you want to see the kind of range of ideas that I write about, please go to Books about Emotive-Cognitive Therapy (E-CENT).***

That’s all for today.

Best wishes,

Jim

 

Dr Jim Byrne, Doctor of Counselling

ABC Coaching and Counselling Services

jim.byrne@abc-counselling.com

Telephone: 44 1422 843 629

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Lifestyle counselling resources available in eBook format

Sunday 2nd September

Blog post

Dr Jim’s Counselling Blog: Lifestyle counselling resources are now being made available in low-cost eBook format via Kindle

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Resources for counsellors and psychotherapists – and for self-help enthusiasts

The following resources are now available in low-cost, Kindle eBook format:

The Lifestyle Counselling Book

Lifestyle Counselling and Coaching for the Whole Person: Or how to integrate nutritional insights, physical exercise and sleep coaching into talk therapy,

By Dr Jim Byrne with Renata Taylor-Byrne.

Available here: https://abc-counselling.org/counselling-the-whole-person/

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How to control your anger, anxiety and depression, using nutrition and physical exercise,

by Renata Taylor-Byrne and Jim Byrne.

Available here: https://abc-counselling.org/diet-exercise-mental-health/

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Writing Theapy book coverHow to Write a New Life for Yourself,

by Dr Jim Byrne

(with Renata Taylor-Byrne).

Available here:

https://abc-counselling.org/how-to-write-a-new-life-for-yourself/

~~~

These three books have proved very popular with counsellors and psychologists on LinkedIn, and they are selling in significant numbers.

DrJimCounselling002It seems there is an appetite for radical change abroad in the world of counselling and psychotherapy at the moment, and people are ready to explore new ideas.  In particular, the relationship between the body and mind (the body-mind connection); the problems of sedentary lifestyle and inadequate nutrition; plus inadequate sleep; and how to process our own experiences in a journal.

All of these developments are very encouraging for the future health of our counsellors and therapists, and for their clients!

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That’s all for now.

Best wishes,

Jim

Dr Jim Byrne, Doctor of Counselling

ABC Coaching and Counselling Services

Telephone: 01422 843 629

Email: jim dot byrne at abc-counselling dot com

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Hype about antidepressants

Blog Post No. 163

By Dr Jim Byrne

27th February 2018

Dr Jim’s Counselling Blog:

Regarding some announcements about depression and medication

Some research results that should be known by all counsellors and psychotherapists, as well as their clients

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Copyright (c) Jim Byrne, 2018

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Context

Moncrieff on antidepressants.JPGWe wanted to post a blog about the new hype about antidepressants, which has been generated by a new report, which will be mentioned below; and which has been wildly hyped in the British newspapers over the past few days.

Then the magazine, What Doctors Don’t Tell You, produced an article which we liked, and we posted a link to that article, on Facebook, as follows:

“Antidepressants are a family of drugs that are bad and dangerous to know – and now researchers have named Effexor (venlafaxine) as the baddest of the bad. Patients are much more likely to attempt suicide while taking Effexor than any of the other antidepressants, a new study has found.

“The news comes as no surprise to those who’ve already been exposed to the drug. It’s considered to be one of the most powerful antidepressants, and one of the hardest to tolerate. In fact, around 19 per cent of patients stop taking the drug early because they can’t stand the side effects, which include anxiety, sexual dysfunction, weight gain, high blood pressure and thyroid depression. One patient even reported a sudden change of hair colour.

“They are the lucky ones. Once over the initial hurdles of life-destroying side effects, withdrawal symptoms are so severe that it’s almost impossible to stop taking the drug.

Antidepressants are a family of drugs that are bad and dangerous to know – and now researchers have named Effexor (venlafaxine) as the baddest of the bad…
WDDTY.COM

~~~

Some time later, there was a response.

A statement in defence of antidepressants!

A contact on a major social media platform posted this piece:

Unnamed Person: “…”  (The statement made by Unnamed Person has been removed, at their request, and is now replaced by a simple statement of the objections they made to my post above.) This was the substance of their objection:

1. It is ridiculous to post my post, because it is based on just ONE study!.

2. It seemed to Unnamed Person that there is a rigorous 6-year study of antidepressants and talking therapy which I should have posted alongside my post, for the sake of balance. And for the sake of acting responsibly.

I (Jim Byrne) responded like this:

Jim Byrne Hi Unnamed Person,
DrJimCounselling002Thanks for your message. So I looked up the study to which you refer, and this is what I found:

“The international study – an analysis pooling results of 522 trials covering 21 commonly-used antidepressants and almost 120,000 patients – found that all such drugs were more effective than placebos.” (Source, SBS News, Australia: https://www.sbs.com.au/…/antidepressants-really-do-work…).

What could possibly be wrong with the design of that study?

Well, look! They “…pooled the results of 522 studies…”.

What could be wrong with that?

Well, *how many* studies were *conducted* by drug companies, where they *refused* to release the results? It could be that they hide the almost half of studies which show *no benefit*, and publish the just over 50% that show *modest benefits*. (And they try very hard to *hide* the very widespread and *very serious* negative side effects of all of these ‘medicines’. (See this report in The Sydney Morning Herald – an equally well known Australian news outlet: https://www.smh.com.au/…/2008/03/02/1204402265828.html)

Here are some extracts from that Sydney Morning Herald source:

“The key issue is simple. In any situation, to make any kind of sensible decision about which treatment is best, a doctor must be able to take into account all of the available information. But drug companies have repeatedly been shown to bury unflattering data.”

“Sometimes they bury data that shows drugs to be actively harmful. This happened in the case of Vioxx and heart attacks, and SSRIs and suicidal thoughts. Such stories feel, intuitively, like cover-ups. But there are also more subtle issues at stake in the burying of results showing minimal efficacy, and these have only been revealed through the investigations of medical academics.”

“In January a paper in the New England Journal Of Medicine dug out a list of all trials on SSRIs that had ever been registered with the US Food and Drug Administration and then went to look for those same trials in the academic literature. There were 37 studies which were assessed by the regulator as positive and, with a single exception, every one of those positive trials was written up, proudly, and published in full.”

“But there were also 33 studies which had negative or iffy results and, of those, 22 were simply not published at all – they were buried – while 11 were written up and published in a way that portrayed them as having a positive outcome.”

I (Jim) then commented:

So, Unnamed Person, let me sum up. You cannot evaluate the effectiveness of drugs when the companies producing those drugs are allowed to selectively publish the results they want you to hear; and to hide the results they do not want you to hear.

And if some idiot, or charlatan, does a meta-analysis of the studies published by the drug companies, and their patsies, and says this proves those drugs are safe and effective, I have just one thing to say to them: This is not science! This is not good academic work! This is propaganda for the drug companies!

So, Unnamed Person. Who is being ridiculous? Think again about the flag you were flying under: “There is a *rigorous* 6-year study of antidepressants”. That flag is a pirate rag! There is no possibility of rigorous studies of all of the data on antidepressants so long as drug companies are allowed to hide bad data, and to publish what they choose to show us! 

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Unnamed Person‘s response

Later, Unnamed Person, got back to me:

Unnamed Person: OK – if you batter me about what has been omitted, what ignored, what privileged by Pharma, money generally, academic status, medical ranking… then who am i to make such a foolish, academically unfounded post? Goodness, i will not use the word rigorous again. I similarly hope that your posted promulgations are way beyond the deeply adulterated processes they used. Mea culpa – and i look forward to hearing more about external academic critiquing of your claims to efficacy as well.
Jim Byrne Hi Unnamed Person, I did not mean to batter your about. You came out batting for Big Pharma – without realizing that that was what you were doing. You thought you were citing irrefutable evidence of a high quality against my paltry single study. The point about my single study is that it adds a little to the body of knowledge we are building up about the effects of food on mood. People who eat junk foods, or a diet high in carbohydrate are likely to get inadequate amounts of the amino acid studied – argenine. As such, they may be vulnerable to major depression. They should be informed of that risk, and not told that they can eat any kind of diet they like – including high carbs, high sugar, and junk – and then Big Pharma will fix them up with ‘Medicine’. But most of the antidepressants being prescribed for depression should not be in use at all, because the *proportion* of patients who take them, who will develop serious side effects – like sexual dysfunction or suicidal ideation – is well above the 10% safety line – often as high as 40%, or 50% or more than 60%. It is *unethical* for physicians to cause so much predictable *harm*! But they continue to do it, and studies of the kind you cited earlier do help to keep their consciences quiet! PS: I did not mean to beat you up. But if you call my attempts to educate the public – about self-care – ‘ridiculous’, I guess I will normally come out fighting! 🙂
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Some thoughts from Mad in America
PS: Since Unnamed Person was interested in how well or how badly my position on antidepressants might be supported by scientific studies and expert support, I was pleased to see that Dr Joanna Moncrieff has published a piece on the latest hype in the Mad in America online blog – here: https://www.madinamerica.com/2018/02/challenging-new-hype-antidepressants/

Here is an extract from the opening of Dr Moncrieff’s piece:

Challenging the New Hype About Antidepressants

By

Joanna Moncrieff, MD

February 24, 2018

Joanna Moncrieff, MDThe extraordinary media hype over the latest meta-analysis of antidepressants puts the discussion of these drugs back years. Despite the fact that 9% of the UK population are taking antidepressants,1 and rates of prescribing have doubled over the last decade,2 the authors of the analysis are calling for yet more prescribing. John Geddes suggested in The Sun newspaper that only 1 in 6 people are receiving adequate treatment for depression in high income countries. In The Guardian he estimates that 1 million more people require treatment with antidepressants in the UK, but by my maths, if 9% are already taking them and they only represent 1 in 6 of those who need them, then 54% of the population should be taking them. I make that another 27 million people!

The coverage was almost universally uncritical, and said little about the terrible adverse effects that some people can suffer while taking antidepressants, or while trying to get off them. The Guardian even claimed that the new “groundbreaking” study will “put to rest doubts” about antidepressants.

But there is nothing ground-breaking about this latest meta-analysis. It simply repeats the errors of previous analyses. Although I have written about these many times before, I will quickly summarise relevant points.

The analysis consists of comparing ‘response’ rates between people on antidepressants and those on placebo. But ‘response’ is an artificial category that has been arbitrarily constructed out of the data actually collected, which consists of scores on depression rating scales, like the commonly used Hamilton rating Scale for Depression (HRSD). Analysing categories inflates differences.3 When the actual scores are compared, differences are trivial, amounting to around 2 points on the HRSD which has a maximum score of 54. These differences are unlikely to be clinically relevant, as I have explained before. Research comparing HRSD scores with scores on a global rating of improvement suggest that such a difference would not even be noticed, and you would need a difference of at least 8 points to register ‘mild improvement’.

Moreover, even these small differences are easily accounted for by the fact that antidepressants produce more or less subtle mental and physical alterations (e.g. nausea, dry mouth, drowsiness and emotional blunting) irrespective of whether or not they treat depression. These alterations enable participants to guess whether they have been allocated to antidepressant or placebo better than would be expected by chance.4 Participants receiving the active drugs may therefore experience amplified placebo effects by virtue of knowing they are taking an active drug rather than an inactive placebo. This may explain why antidepressants that cause the most noticeable alterations, such as amitriptyline, appeared to be the most effective in the recent analysis.

Antidepressant trials often include people who are already on antidepressants. Such people may experience withdrawal symptoms if they are randomised to placebo, which, given that almost no antidepressant trial pays the slightest attention to the problems of dependence on antidepressants, are highly likely to be classified as relapse.

The analysis only looks at data for eight weeks of treatment, whereas in real life people often take antidepressants for months or even years. Few randomised, placebo-controlled trials have investigated long-term effects, but ‘real world’ studies of people treated with antidepressants show that the proportion of people who stick to recommended treatment, recover and don’t relapse within a year is staggeringly low (108 out of the 3110 people who enrolled in the STAR-D study and satisfied inclusion criteria).5 Moreover, several studies have found that the outcomes of people treated with antidepressants are worse than the outcomes of people with depression who are not treated with antidepressants,67 even in one case after controlling for the severity of the depression (as far as possible).8 The huge increase in prescribing of antidepressants over the last three decades has been accompanied by a substantial rise in the numbers of people who are in receipt of long-term disability benefits due to depression and related disorders in the UK, and this is at a time when benefits for other disorders, like back pain, have been reducing.9

Calling for antidepressants to be more widely prescribed will do nothing to address the problem of depression and will only increase the harms these drugs produce. …

…For more, please click the link that follows: https://www.madinamerica.com/2018/02/challenging-new-hype-antidepressants/

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Anger, anxiety, depression, and nutrition and physical exercise, imagePostscript

In November 2017, we (Renata Taylor-Byrne and Jim Byrne) published a book on How to Control Your Anger, Anxiety and Depression, Using nutrition and physical exercise.  There is a lot of evidence, and a growing evidence base, that the major mood disorders (which Big Pharma wants to treat with hard drugs with nasty side effects) can better be managed by healthy diet and regular physical exercise (and a good night’s sleep!)

Here is a brief extract from one of the main sections that deal with diet and depression:

(ii) Treating depression

There are many different views about how to treat depression, and here is a summary of some of the most recent explanations of what is happening to us when we are depressed.

Firstly, the views of Dr Kelly Brogan will be summarised, as she has a unique explanation, which she has described in her recent book, titled ‘A Mind of Your Own’ (2016)[i]. She is a practising psychiatrist in America, with training as a medical doctor, and a degree in cognitive neuroscience, including clinical training from the NYU School of Medicine. She uses holistic methods of treating her patients and describes her work as ‘lifestyle medicine’.  In this approach, she uses the techniques of meditation, nutrition and physical activity as crucial daily habits with which to treat her depressed patients (and this approach overlaps, but is not co-extensive with, the E-CENT approach [Byrne, 2016]).

Dr Brogan’s view is that depression is a symptom or sign:  “…that something is off-balance or ill in the body that needs to be remedied”.

She considers that mental illness symptoms aren’t entirely psychological or solely neurochemical. And she points out in her book that there is no single study which has produced evidence that depression is caused by a lack of chemical equilibrium in the brain.

She considers depression to be a grossly misidentified state and in particular for women who, in the US, are being medicated at the rate of one in seven. Also, one in four women in their 40’s and fifties use psychiatric drugs.

She states: “We owe most of our mental illnesses – including their kissing cousins such as chronic worry, fogginess and crankiness – to lifestyle factors and undiagnosed physiological conditions that develop in places far away from the brain, such as the gut and the thyroid”, and she goes on to state that:

“You might owe your gloominess and unremitting unease to an imbalance that is only indirectly related to your brain’s internal chemistry. Indeed, what you eat for breakfast … and how you deal with that high cholesterol and afternoon headache (think Lipitor[ii] and Advil[iii]) could have everything to do with the causes and symptoms of depression.”

Her opinion of the foolishness of applying chemical solutions to people’s problems is very clear. In her view: “… if you think a chemical pill can save, cure or ‘correct’ you, you’re dead wrong. That is about as misguided as taking aspirin for a nail stuck in your foot.”

Her approach is to get a medical and personal history of her clients, their manner of birth (natural or section), whether breast fed or not; and she orders lab tests to ascertain the whole picture of their biological make-up.

She focusses on the information from their cellular analysis and the workings of the immune system, and points out to the reader of her book that, over the last twenty years, medical research has identified the significant part that inflammation plays in the creation of mental illness.

She also focuses on the client’s lifestyle, dietary habits e.g. sugar consumption, the condition of their guts, and microbe balance (in their guts), hormone levels – e.g. thyroid and cortisol – and genetic variations in their DNA, which could affect their susceptibility to depression. And finally, their beliefs about their own health can also play a role, she says.

So Dr Kelly Brogan shares the same conviction as Dr Perlmutter (2015): that the state of our guts is a very important determinant of our emotional well-being.

Dr Perlmutter (2015) states: “Depression can no longer be viewed as a disorder rooted solely in the brain. Some of the studies have been downright eye-opening. For example when scientists give people with no signs of depression an infusion of a substance to trigger inflammation (in the body), classic depression symptoms develop almost instantly”. (Page 76)

Perlmutter is a board-certified neurologist and Fellow of the American College of Nutrition. He is also president of the Perlmutter Health Centre in Naples, Florida. Dr Perlmutter considers that our mental health and physical wellness are totally affected by the internal systems of bacteria that operate in the gut.

But what exactly is going on in our guts? Apparently, we’ve all got millions of microbes in our body and most of them live in our digestive tract (10,000 species!). And each of the microbes have their own DNA, and that means that for every human gene in our body, there are at least 360 microbial genes. These organisms include fungi, bacteria and viruses.  In a healthy gut, most of these microorganisms are ‘friendly’, with a few ‘bad’ bacteria which are controlled by the ‘good’ stuff.

These tiny microbes: (1) strongly influence our immune system; (2) affect absorption of nutrients; (3) signal to us whether our stomach is empty or full; (4) and determine our level of inflammation and/or detoxification (which are directly related to disease and health).   They also affect our moods.

Apparently our guts contain 70-80% of our immune system, and so our gut bacteria participate in maintaining our immunity.

They can also keep cortisol and adrenaline in check. These are the two major hormones of the stress response, which can cause havoc in the body when they are continually triggered and flowing.

And our gut microbes influence whether we get any or all of the following conditions: Allergies, ADHD, asthma, dementia, cancer and diabetes, a good night’s sleep; or whether we quickly fall prey to disease-causing germs. And there is increasing evidence of a link to anxiety and depression.

Dr Perlmutter makes recommendations for changes in people’s diet which he says will:

(1) treat and prevent brain disorders;

(2) alleviate moodiness, anxiety and depression;

(3) bolster the immune system and reduce autoimmunity problems; and

(4) improve metabolic disorders, including diabetes and obesity, which are all linked to overall brain and body health.

He makes recommendations which are very practical, including…

…end of extract…

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Endnotes

[i] Brogan, K. (2016) A mind of your own: The truth about depression and how women can heal their bodies to reclaim their lives. London: Thorsons.

[ii] Lipitor is a drug commonly prescribed for reducing high cholesterol.

[iii] Advil (ibuprofen) is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen works by reducing hormones that cause inflammation and pain in the body.

For more about this book, please go to: How to Control Your Anger, Anxiety and Depression, Using nutrition and physical exercise.

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