The Benefits of Gratitude

I’ve been reading in lots of places recently about the benefits of being grateful.

The practice can take many forms, but a common format is to record daily what we are grateful for. These might be things, people, circumstances – anything that brings benefit to us in some way. And the more we look for things that we are grateful for, generally, the more we find.

It’s a great tool, as gratitude breeds more gratitude and is an effective antidote to the negative thinking that we can so easily find ourselves in. This is explainable by the inherent negativity bias of the human brain and I’ve referenced an article by Rick Hanson below which explores this further(1).

So it kind of seems logical that the practice of gratitude would be helpful in improving our mental health, right?

And in fact, this seems to be the case. I’ve referenced below a study from the Department of Counselling and Educational Psychology, Indiana which looked at college students who were seeking mental health counselling.

They were randomized into three groups. All students received counselling, but one group was instructed to write regular gratitude letters to other people and the other group was instructed to write about their thoughts and feelings in regards to negative experiences. Compared to students who received counselling or wrote about negative experiences, those who wrote gratitude letters, reported significantly better mental health at four and 12 weeks after the writing exercise ended. There’s an interesting discussion as to why gratitude was beneficial and I’d really encourage you to read the article to find out more (2).

So how do we practice gratitude? Well there are loads of different ways and the best thing is to find a way that works for you and to do it daily. Some people buy a nice notebook and start with writing down three things in the morning and perhaps three things in the evening when they review the day before bed. This helps people to sleep better as well. I’ve been practicing gratitude regularly for around six months and I use an app called Five Minute Journal which is a paid app (£4.99) which I love for various reasons, one being that it allows you to take pictures and embed them within the narrative. There is a free app called “Three Good Things” as well. If you don’t fancy using an app, then the notes section on a smart phone will do just as well.

The key seems to be in finding new and different experiences daily to be grateful for and really pushing yourself to do this. As you think about these experiences, immerse yourself in the feelings of gratitude they produce.  They don’t have to be “big flashy” experiences, they can be small things as well.

Most things in life have multiple perspectives and this search for the many things we have to be grateful for, changes our outlook and perspective. Like everything, this is a skill and the more it is practiced, the better the brain becomes at doing it. Try it for yourself and notice the effect that it has on your life.

  1. https://www.rickhanson.net/how-your-brain-makes-you-easily-intimidated/
  2. https://greatergood.berkeley.edu/article/item/how_gratitude_changes_you_and_your_brain

A GP’s advice to Freshers starting university

The new university term starts at the end of September and tens of thousands of Freshers will embark on the next stage of their lives as students. At my practice in Birmingham we look after over eight thousand students and these are my top tips for navigating Freshers

1. Feeling a range of emotions is normal and okay. It’s a big life change.

2. Get the basics right in the first few months and allow the other things to fall into place. This means finding somewhere to stay, eating healthily, prioritising good sleep and exercise and turning up to the seminars and lectures that are scheduled.

3. Register with a local GP and Dentist and prioritise your health. There’s usually a “student practice” close to campus where people tend to register. You might never need them, but they are there if you do. It’s possible to claim for help with health costs via a HC1/2 form. You can check if you are eligible by going to https://www.nhsbsa.nhs.uk/nhs-help-health-costs.

4. Ask for help and pace yourself academically. The first term and set of assessments can be quite stressful for people because it’s all new. There may be less structure and more free time when compared to a school environment which can take some getting used to. Ask if you are not sure about any aspect of the learning program. Most students will be assigned a personal tutor during the year and these generally are a good first port of call. You can buddy up with other students and support each other. Students from the year above are often good sources of wisdom when it comes to studying as they have already been though it. If you have any health problems or disabilities that you feel may impact your work, make sure that your department are aware of these well in advance. They may require a supporting letter from your GP which most practices are happy to do.

5. Keep safe. It’s basic stuff really, take care when walking around, particularly after dark in cities and stick with other friends where possible. If you are out at night, work out how you are going to get home in advance. Don’t accept lifts from people that you don’t know and be mindful of your alcohol consumption. If you are sexually active, it’s much safer to use a condom with new partners to reduce the risk of sexually transmitted infections (STIs). Many of these infections have no symptoms and can have serious health consequences. Your GP or local sexual health service can provide testing for STIs. Find out more here, https://www.nhs.uk/Service-Search/Sexual-health-information-and-support/LocationSearch/734

6. It’s okay not to know right away what you want to do with the rest of your life. Every experience is a learning experience. Follow your bliss, find out what excites you.

7. Have fun, experiment, join some fun clubs. At the Freshers’ Fair, you will be bombarded with all sorts of activities that you can take part in. I even joined the trampolining club for a short while. Being at university is a great opportunity to take up a new sport or activity and meet new people.

8. Look out for new friends. Some of the friends you meet at university, may well become friends for life. We tend to gravitate towards those we feel are like us, but keep your eyes open and you may well find friends you didn’t expect to find!

Enjoy the experience!

Five ways to ease a panic attack

Panic attacks can be scary and are a common reason for people to see their GP. They are sometimes treated with medication but not everyone wants to go down this route. Here are some ways to help ease the symptoms quickly using the power of your own nervous system.

What are panic attacks?

Quite simply they are when the body and mind perceives some sort of “threat” to the person. Various changes take place very quickly to deal with the threat and help, at its root to keep the person safe. There may be feelings of overwhelming panic, a sense of “impending doom”.

The heart may race and the person may sweat, feel out of control or worry that they are going mad in some way. It can feel very unsettling and people can become very worried about having another attack.

It’s really important to remember that at its root anxiety and panic are protective factors designed to keep us alive. They are usually being over-protective and so to deal with panic, we have to learn to teach our nervous system that things are safe even if they don’t feel it. Then things will start to calm. (1)

Using the breath

Breathing in a specific way when panicky is really helpful. Commonly I’ve noticed that people will either stop breathing temporarily or breath shallowly. This tends to exacerbate feelings of panic. Slowing the breathing down and allowing the out-breath to be slightly longer than the in-breath helps to turn on the relaxation part of our nervous system. It’s best to practice this when things are less intense and the brain learns to calm itself quicker and quicker with practice (2).

Tapping

Tapping with a couple of fingers under the chin and around the mouth for a few minutes also helps to switch on the calming part of the nervous system (3).

Connection

It’s not uncommon for people to feel embarrassed and then want to withdraw from others when they are experiencing panic. It can be really helpful to find someone who you feel safe with to sit with until the anxious feelings subside (which they will). Being with others who understand is profoundly calming. If you are with someone who is panicking, doing less is more. Generally it’s not helpful to try and talk them out of it or offer lots of suggestions. Calm yourself and sit with the person, perhaps encourage them gently to breath and wait. Strong emotions will generally peak and then start to fade.(4)

Using the phone

This can be useful in a public place as a kind of calming and distraction technique. When people feel anxious, the senses are often heightened and there can be a sense of wanting to hide and avoid eye contact with others. It’s becoming more and more socially acceptable for people to be looking at their phones in public and so this is a way of utilising this. It works best if it is prepared in advance. Go onto Google Images and find a picture with a repeating pattern on it – I like the “Where’s Wally” pictures myself because they are amusing and remind me of being a child. Screen-shot the picture and keep preferably several different pictures on the phone. Then breathe and count the number of squares / people / whatever takes your fancy. When I was testing this, I counted the number of people wearing hats on a Where’s Wally picture. Once I’d got them all, I moved onto another category.

This works because it engages the thinking part of the brain. This part can go offline with high anxiety and engaging it in a non-threatening task (Where’s Wally) combined with breathing helps to calm the nervous system down. (5)

The Tesco trick

This method came to me whilst standing in a queue in Tesco. It was around Christmas time and the store was crowded and noisy and I started to feel anxious for some reason. I was standing next to the drinks section and I started to notice the labels of some of the drinks. I realised that I could calm myself by spelling out the letters of the name of the drink one by one in my head. In this case it was a bottle of Tango. So the trick is to breathe in and say T, out and say A, in and say N and so on. Then move on to another label until you feel calmer. This can be done with any written word that’s out there – Road signs, place names, street signs. Obviously be mindful if you are driving and pull the car over and stop if necessary.

1. https://www.mind.org.uk/media/1892482/mind_anxiety_panic_web.pdf

2. https://www.breatheology.com/delicate-nervous-system/

3. Personal communication from Kevin Laye (http://psy-tap.com ).

4. https://www.google.co.uk/amp/s/www.psychologytoday.com/us/blog/in-practice/201607/how-help-someone-anxiety%3famp

5. http://www.panic-attacks.co.uk/course/5-the-brain-and-panic-attacks-emotional-hijacking/

With huge thanks to Garner Thomson for his help with the contents of this article

https://www.medicalnlp.com

Psy-Tap – seriously fast change

Wouldn’t it be cool to eliminate intense emotions like anger, grief and panic in seconds? Or more importantly, perhaps to have the choice as to whether to feel these emotions or not, putting us instantly back in control.  Earlier on this week, I  attended a Psy-Tap practitioner course helping to support 50 other therapists training in this unique system.  If you haven’t yet heard of Psy-Tap, I’d suggest having a look at the website. http://psy-tap.com/.  Despite the name, Psy-Tap has nothing to do with tapping.  It stands for “Psychosensory Techniques and Principles”.  It was developed by Kevin Laye who was a former executive with Dolby.  He has used an engineer’s mindset to create techniques which are unique and work seriously quickly.  We are talking seconds to minutes to eliminate lifelong traumas and phobias. It’s being used in schools to help calm students and reduce anxiety and there’s no doubt you will be seeing more of it out there in the near future.     

For more information, visit Kevin’s website http://psy-tap.com to find a practitioner near you or my website at www.boundlessflow.co.uk

How to handle exam stress

Over the ten years, I’ve been a university GP, I’ve seen many students sitting exams. It can be a tense time and below are some of the hacks that students have told me have worked for them. I see revision as a kind of training – more of a marathon than a sprint. Sitting exams and revision does seem to get easier and more familiar with practice. 

Sleep 

Stress can affect sleep as sleep comes when we feel safe and can let go. Around exam time, the head can feel busy with thoughts playing through the mind. A regular mindfulness practice e.g. Calm or Headspace apps can really help decompress the active mind. Keep a regular sleep routine so that your body gets used to it and avoid napping during the day. I’d suggest avoiding the use of sleeping tablets around exam time as they can affect cognitive performance and memory in subtle ways. Pause is really helpful app that some of my students have found helpful https://www.google.co.uk/amp/s/techcrunch.com/2015/10/08/pause-ustwo/amp/. It’s best used a couple of hours before bedtime as the blue light from screens in the hour before sleep can keep us awake. 

Working smart 

It’s really tempting to spend long hours in front of books and screens chalking up the revision hours. As humans we are not really designed to be stationary for this long and I quite frequently see students in the surgery with muscular neck and back pains from sitting. I think the record for one was 8 hours without moving! Long hours in front of screens also can reduce the blink rate of the eyes increasing the chance of eye irritation. If the eyes start to become irritated, lubricating eye drops can be purchased from most pharmacies. Any red eye pain or visual disturbance should be discussed with a optician or medical professional. 

We seem to work better when we take frequent breaks to move and rest our minds temporarily. A fantastic resource is the work of Francesco Cirillo and his Pomodoro technique https://francescocirillo.com/pages/pomodoro-technique. Basically the idea is that you pick your task and work on it without interruption for 25 minutes (set a timer). The 25 minutes is one pomodoro. Then have a five minute break before starting on the next 25 minute pomodoro. After four of these, have a longer break 20-30 minutes. These tests allow the brain to rest and assimilate the new information. 

Eating and drinking 

Working brains need nutrition and central to this is adequate hydration. The body is comprised of 50-60% water https://www.livestrong.com/article/340756-healthy-body-water-percentage/ and so drinking plenty of water is important. The amount recommended per day is around eight x eight ounce glasses or two litres of water. There are some studies that suggest that mild dehydration can affect cognitive performance https://www.healthline.com/nutrition/how-much-water-should-you-drink-per-day. Eating little and often (5/6 meals per day)seems to work best as large meals can make us feel sluggish and bloated. The same goes for high fat/sugar foods such as pastries and cakes. It’s better to stick to proteins from lean meats/fruits and grains and snack on healthier snacks like dried fruits and grains https://www.schooldays.ie/articles/5-tips-for-healthy-eating-when-studying. Caffeine is a bit of a double edged sword and many of my students swear by it for improving concentration. I’d suggest keeping it to a minimum (max 1-2 cups / day) as it can make people feel jittery and anxious. Try to avoid drinking it after midday as this may hinder sleep. 

Schedule time for connection and play 

Humans are social creatures and are meant to be in connections with other humans https://greatergood.berkeley.edu/topic/social_connection/definition#what-is. Prolonged periods in isolation while revising affects us and I have come across students experiencing quite profound drops in mood because they have not caught up with their family and friends and have let their leisure activities and hobbies go by the wayside.  It is often necessary to cut back on some commitments but scheduling time for meals out and social gatherings can be really helpful. Studying in a group or with friends is also a useful antidote to isolation. Face to face connection seems to be the most helpful as opposed to interacting on social media. Spending time outdoors in nature appears to have significant health benefits http://www.bbc.co.uk/earth/story/20160420-how-nature-is-good-for-our-health-and-happiness

Are you struggling with stress? Please contact me for a free telephone consultation to see how I can help

http://boundlessflow.co.uk/contact-me/

 

Dr Lizzie Croton GP

http://www.boundlessflow.co.uk 

My four favourite health apps.

Health apps are transforming our experience of self-care and allowing us to have access to expert advice and support through the medium of technology in a way that could only be dreamed of a few years back. It’s not uncommon now for me to “prescribe” an app to some of my patients if I feel that it would help the particular issue they have come to me with. Before I recommend anything, I road test it thoroughly myself. Here are four of my favourites

Buddhify
https://buddhify.com/

iOS £4.99
Android £2.39

Buddhify is a mindfulness meditation app with a slight difference. It’s designed to work around whatever you are doing and so there are meditations for walking, phone use and dealing with difficult emotions. By slowing down and paying attention to what is happening now (as opposed to what has happened or what might happen) we start to experience things differently. Over time this mindfulness (paying attention), actually changes the structure and function of our brain which is a pretty awesome fact. We can become less reactive and more present in our lives. It’s not always easy but it’s worth it. I first started meditating 6 years ago and it’s transformed my life personally and professionally. Buddhify is different from some other meditation apps in that purchase is a one-off flat fee with no subscription service. In fact, the developers hope that one day, you won’t actually need the app as mindfulness becomes more and more of a daily habit in your life.

Curable – the app for chronic pain
https://www.curablehealth.com/

Subscription (approx as original prices in US dollars)
Monthly £9.30
Yearly £55
Lifetime £171

Some of you may remember my chronic pain article from the previous issue of Altrincham Today. Chronic or persistent pain is a huge problem and despite medical intervention, many people remain in pain. This app focusses on the hidden emotions believed to be at the root of chronic pain. It’s described as an online pain psychology programme. The basis of the Curable approach is that factors in our brains such as our thinking patterns and behaviours play a role in how pain is experienced. Over time, the brain becomes programmed with cycles of pain. The good news is that this programming can be reversed and the pain diminishes. Sufferers gain relief through a daily exercise lasting 5-20 minutes. Check out the website for more details as to the science behind Curable https://www.curablehealth.com/science

Please see your doctor first if you are experiencing any kind of chronic pain for a medical check-up and relevant tests before commencing the Curable programme. This is to rule out any physical illness or disease.

Calm – reduce anxiety, sleep better and feel happier
https://www.calm.com/

Subscription (approx as original prices in US dollars)
Monthly £9.30
Yearly £43
Lifetime £215.00

Calm is a smorgasbord of different features. There is a huge amount of content on the app which is broadly divided into mindfulness for anxiety and sleep and focussed practices for habit control and performance. There’s a section for improving your relationships and emotional awareness. There are sleep programmes and a fabulous “Bedtime Story” section for adults and kids read by some famous voices. I really like the masterclasses which tackle issues as diverse as screen addiction to mindfulness for pain. There’s quite a bit of free content and you can sign up for free for the first seven days to see if you get on with the approach and style. All of these apps track your progress which is a key feature of habit change and allow you to share what you are up to with your contacts on social media. We live in a world where human connection is under threat in some areas and by working on our insides, we can be more available for our fellow humans. It’s a virtuous circle.

Sleepio: an online CBT programme for sleep problems
https://www.sleepio.com/

Annual cost £286.00

Sleepio is an evidenced based online sleep improvement programme developed by Professor Colin Espie from the University of Oxford. Most people have heard of CBT or Cognitive Behavioural Therapy from its use in the NHS as a therapy to help those experiencing symptoms of anxiety and depression. Simply CBT looks at the relationship between thoughts, feelings and behaviours and aims to help people change these when they are unhelpful or causing problems. An example from sleep would be experiencing worrying thoughts about not being able to sleep. This pattern is likely to increase stress in the body and make sleep less likely to happen. An awareness of this pattern allows us to make changes and sleep better. Sleepio creates a tailored programme for the individual depending on what the particular sleep issues are. There are regular meetings with a virtual sleep expert and helpful tools to practice. Over time, the brain functions differently and sleep becomes easier. On the downside, it’s expensive but I think could be considered an investment in one’s future health given the health risks associated with poor sleep. I believe it is funded by the NHS in some areas although I was unable to find further information on this. There is also a corporate programme with some employers funding access.

Dr Lizzie Croton
www.boundlessflow.co.uk

Working with difficult thoughts, feelings and images

This is a really simple exercise.  The first part is not something I developed and I have not yet found the source. I have heard this described in Buddhist teachings and also have heard it described by Andy Puddicombe, the co-founder of the Headspace App (https://www.headspace.com/?utm_source=google&utm_medium=cpc&utm_campaign=917256451&utm_content=51529951612&utm_term=217943262717&headspace&gclid=EAIaIQobChMIy7PYkf-_2wIV5p3tCh2zzgmNEAAYASAAEgKj4_D_BwE)

It’s a really simple way of helping to get some distance from difficult thoughts and feelings.  The thing is that it isn’t so much the thoughts and feelings that we experience that cause problems but our reactions to them.  I was actually quite offended when I first heard this but after careful examination, it does appear to be true.

What happens to cause pain is that we experience the thoughts and/or feelings and we attach to them. If these experiences were foodstuffs, we metaphorically throw them into a pan, cook with them and perhaps even serve them at a dinner party!  The attachment creates pain.

Now simply, the next time you experience a painful thought or feeling, practice acknowledging it by simply saying “thinking” or “feeling”.  You will normally find that this allows some space for the thought or feeling to be let go of.  Interestingly this also can work with unpleasant images that pop into the mind  – “picturing”. I suppose, if we work on the premise that all thoughts, feelings and pictures are messages in some form, the labelling presents us with the choice of letting go.  It also tells the sender of the message that it has been received and so both parties are happy.

This aticle is designed for educational purposes only and is not intended to replace professional, personalised advice from your doctor. Please, if you feel ill and are unsure or concerned, seek advice from a qualified health professional which could be your GP or Accident or Emergency if you have a life threatening medical problem. If you unsure, NHS 111 in the UK can be accessed by dialling 111 from any phone.