Showing posts with label Professor Garry Egger. Show all posts
Showing posts with label Professor Garry Egger. Show all posts

Tuesday, November 1, 2011

SWSLHD and Bowral's Health - 49

Can you think yourself well?


Medical Observer 

Learning to deal with negative thoughts in a positive way may help manage depression.
Far be it for me to paraphrase a great French philosopher, but I’m sure if Descartes was alive today he would agree that his famous dictum, “I think, therefore I am”, could be made more topical by adding “...depressed, anxious, self-conscious, happy, sad, disturbed... whatever!”

Similarly, Brillat-Savarin, who first said you are what you eat, might be tempted to reposition this to ‘you are what you think’.

Thought is the basis of emotions. As such, it’s the driving force of much behaviour (and lack of it) associated with mental and physical health. It can influence fear, depression, stress and distress. Indeed, most modern psychological therapies, from CBT (cognitive behavioural therapy) to RET (rational emotive therapy), are based around different ways of changing an individual’s way of thinking.

The importance of this is summed up by some of our greatest thinkers through the ages.

Over 2000 years ago the philosopher Epictetus said: “People are disturbed not by things, but by the views they take of them.” This view was shared by Shakespeare, who had Hamlet muse that “there is nothing either good or bad, but thinking makes it so”, and Mark Twain, who personalised this concept in his self-deprecating expose that “I’ve suffered a great many catastrophes in my life. Most of them never happened”.

Perhaps the most powerful influence of thought on mental health is exemplified through its effect on depression. At least in its milder forms, depression can start as a series of adverse experiences (reactive depression). Coupled with a non-resilient personality and genetic influences, a downward spiral can then develop, through depressive thought cycles, into biological changes in the brain from which escape becomes more difficult.

Where this is the case, early intervention is paramount. Simple lifestyle changes, like increased physical activity and dietary improvements can help slow, and even reverse, some of the central neural atrophy associated with being ‘bitten by the black dog’.

More relevant however is a change in the processes of thinking. Thoughts, like behaviours, can be changed. But for someone who has had a lifetime of thinking in a certain way, this is not as simple as just telling him or her to think positively.

A first stage in the process is to recognise that thoughts are not reality. They are a learned way of interpreting the world. Next is learning to differentiate between functional thoughts, or those required for daily living, and non-functional or emotion based thoughts that are generally egotistical and can be either irrationally positive or negative.

This latter type can become ‘cemented’ into the mind through constant recurrence. If this was positive, all might be well. But usually it’s the negative and the ‘me-based’ thoughts that recur more often, and therefore stick hardest.

Good treatment, whether psychotherapy, meditation or reality approaches, helps the individual differentiate functional from non-functional thought and reduces the potency of the latter, hence bringing learning into the cognitive process. In some instances this means reducing the opportunity for negative thought.

A common prescription for the early stages of depression is, for example, to exercise in the morning after waking early, rather than lie in bed, ruminating.

Problems can occur in a sound healthy body via various microbes and destructive lifestyles. Problems also get in the way of a sound mind through learned and ‘me-centred’ non-functional thinking. Negative thoughts are like the bad microbes of the mind, for which ‘psychological immunisation’ through learned thinking can be likened to a regular flu shot.

The body’s immune system is functional at birth and acts to restore physical health in the presence of invading pathogens. In a similar way, the inherent tendency of a sound mind towards maintaining good psychological health is like a psychological immune system that struggles to restore a natural core of good mental health in light of life experiences.

If negative, non-functional thoughts can be reduced, the natural core of good psychological health becomes the default mode, just as good physical health is the default mode when the body’s immune system fights off disease.

Perhaps the last word comes from the author and psychologist Dr Richard Carlson, who made the point in his book Stop Thinking and Start Living that “being upset by your own thoughts is similar to writing yourself a nasty letter – and then being offended by that letter”.

The trick is in learning how to stop writing such letters to oneself.

Professor Garry Egger
Director, Centre for Health Promotion and Research, Sydney; Professor of lifestyle medicine and applied health promotion, Southern Cross University, Lismore, NSW.




Comments:


hk
27th Oct 2011
3:52pm
well-written wisdom - thank you!
 
nan
28th Oct 2011
10:47am
You are quite right. Negative thoughts should be analyed as negative and removed and replaced with positive thoughts. People need to be trained on how to deal with negative thoughts and how to encourage positive thinking. Lets have less dependence on medications and external health providers and more self improvement .

Tuesday, September 27, 2011

SWSLHD and Bowral's Health - 19

A toolkit for life


What can GPs do to encourage lifestyle changes for patients?
IT IS now widely accepted that lifestyle and environmental issues are the causes of much chronic disease.

Simply advising patients to eat better, do more exercise and improve their sleep and stress levels can be as effective as telling the cat to get off the bed.

Of more benefit would be a ‘toolkit’ of available initiatives to encourage change.

The inside of a potential ‘lifestyle medicine toolkit’ might look something like that shown in the table below.

Some of these tools are self-explanatory, others may need some interpretation.

The Readiness to Participate questionnaire* was developed in New Zealand and has been modified for Australia.

It can be filled out before a consultation and gives you an idea of the areas on which to focus.

BIA (bio-impedance) scales measure not just weight, but the percentage of body fat, giving a better idea whether fat (not necessarily weight) loss is important for health improvement.

Blood measures such as CRP  and Interleukin-6  can give an indication of potential lifestyle-related causes of disease.

Highly sensitive CRP that is slightly higher than normal is often ignored as not being important.

However, chronically elevated markers like these could indicate a form of low-level chronic inflammation indicative of poor lifestyle variables such as inactivity, inadequate sleep or poor nutrition.

The Flow Whiz sleep monitor was developed by Professor Ron Grunstein from the Woolcock Institute in Sydney.

This is a small portable device available for overnight hire that detects sleep problems and avoids the need for an overnight stay at a sleep clinic.

Importance and Confidence scales* are simple 10-point scales on which patients rate how important it is to them to change a behaviour and how confident they are that they can succeed at such a change. This then helps hone in on the focus for behaviour change.

DAB-Q (Diet, Activity and Behaviour Questionnaire) assesses those aspects of diet and exercise that require attention with a scaling score based on the practicalities of whether a change is possible or not. The test is available free at  www.professortrim.com/DAB-Q.

It can be completed at leisure and a printout brought to a consultation when dealing with dietary and exercise prescriptions.

Act, Belong, Commit (ABC) – advice for improved mental health – was developed at Curtin University in Western Australia. This package of material, including a website (www.actbelongcommit.org.au) offers advice and instructions for low level mental health problems, particularly depression (see Medical Observer, Lifestyle Matters, 5 August).

The 5 S’s Prescription covers stamina, size, strength, suppleness and stability, and how to measure each to get a total score (maximum 100) from which recommendations can be made to improve those areas that are most deficient (and everybody is usually deficient in at least one).

Of course, the fulfilment of any lifestyle prescription depends on the patient’s motivation to change and self-manage, but is this very different to expecting compliance to a pharmaceutical prescription?

Professor Garry Egger
Director, Centre for Health Promotion and Research, Sydney; Professor of lifestyle medicine and applied health promotion, Southern Cross University, Lismore, NSW.