This month’s article is taken from a talk that I will be giving on this topic.
You may have felt a tingle in May of last year as the nature of reality as we know it shifted. The big book of psychiatric labels was revised to a flurry of debate in the professional and public press. Although difficult at times to watch, I think one good thing about this process is it fosters a debate about the nature and politics of mental illness. But what about the flipside, the nature of mental health? Research and thought about this falls under what we call resiliency.
So what is resiliency? Going to the dictionary, resiliency is defined as the capability to withstand or recover quickly from difficult conditions. In Psychology, it refers to changing the perspective to looking at those who remain well and trying to learn from them for the sake of all of us doing our best to thrive. For this talk, my concept of resilience includes things that promote our quality of life and our longevity.
An example will help convey how I think about resiliency. I always think of studies where, let’s say, an entire city block is affected by a fire or other disaster. As the people return to their homes, its safe to say that none of them are overjoyed with the outcome, but how many become clinically distressed in the following weeks? The answer is not 100%, or even 50%, but closer to 10%. When we look at those who cope with this situation, many will be working together to make sense of what has happened and to collect their lives and plan as best as they are able. Coping and making meaning in a difficult situation is resilience and as none of us will avoid difficult situations during our time, resilience is a desirable trait. The recurring message is always that we may not be able to control events, but we can control how we react to them.
Some of what we might think of as resilience is genetic. Personality and temperament is highly heritable and about 50% of our level of happiness is built in. However, there is ample left under our control and its that we want to exert our influence on for the best life possible.
So what I want to talk about in my time today is 6 things that research has shown build resilience and will absolutely improve both your quality if life and longevity. Just as we do when we look at psychological difficulties people may have, I want you to think about these 6 things in terms of the physical, emotional, and cognitive aspects. So if we think about something clinical like chronic pain, people tend to think about the physical pain, but there are also emotional consequences as many are unhappy about the pain, and cognitive consequences because pain interferes with learning and memory. For depression, we think of sadness, but aches and pains and an array of other physical symptoms are common, and again cognitively, depression gets in the way of planning, learning, and memory.
So, the same is true of the flip side, of building resiliency. We may work on something physical, for example, but also see positive emotional and cognitive effects, you’ll see what I mean.
The 6 things for building resiliency that we will look at today are not especially clever secrets, but rather: (a) diet; (b) exercise; (c) cognitive diversity; (d) social engagement; (e) meditation; and (f) meaning making.
So first, by diet, I mean what we consume, not the torture of dieting. Diet is a hotbed of debate and there are issues related to allergy, but there is a strong research foundation for the positive effects of the Mediterranean diet, features of which include a proportionally high consumption of olive oil, legumes, unrefined cereals, fruits and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of meat and meat products. Typical findings are greater cardiovascular health, general functioning, and longevity.
Apparently its not cool to try and exchange vegetables for more wine.
A recent study that fell into my collection showed that 7 servings of vegetables per day was optimal in terms of preventing death by all causes. Fruit, unfortunately, was not as effective.
So, exercise. Exercise within our means improves physical, emotional, and cognitive functioning, regardless of when in life you begin to exercise and regardless of disability status, assuming the exercise chosen is not harmful. In one study, a group of older adults who weren’t fast enough to avoid the study were put through a 2-week fitness program that produced measurable improvements in several areas, including tested intelligence.
If you are using exercise to manage mood, we’re looking for 30 to 60 minutes a day. Really though, regular, safe movement makes a significant difference in physical, emotional, and cognitive functioning.
Recently, in addition to the exercise people, there have been what I call the sitting people. The typical paper reviews in some detail the adverse health effects of our tendency to sit for 6 to 8 hours or more per day. They rub it in that even regular working out does not offset the adverse impact of prolonged sitting between workouts. Overall, it looks like we’re really supposed to use our muscles and bones and when we do, there are rewards.
So what else can we do that can build resilience? Well we know that, within reason, being involved in multiple roles or involvements is better. The diversity brings spice to life, and when there are bumps in one role, you can have the support of another role.
Relatedly, it seems that for staying cognitively sharp diversity is best. Pondering, solving, exploring, and considering multiple issues is preferable to devoting oneself exclusively to a single intellectual pursuit. We are now in the age of plasticity, the realization that as we age, some neurons in our brain die, yes, but more importantly, new interconnections are formed all the time, and it is this that contributes to mental sharpness. Classically with age, the speed with which we can solve problems or recall information slows, but the quality of problem-solving does not normally change. We are capable of learning throughout our lifespan, and it is this new learning that forms the important interconnections in the brain. So, if you have devoted yourself to exclusively doing suduko until your ears bleed, I encourage you to branch out.
For social engagement, a gazillion studies have shown that we function much, much better by being a part of social groups.
A punch line of my homily is that it is more and more my opinion that close social groups (e.g., churches, hobby groups), which are frequently described by members as a special extended family, contribute significantly to resilience. The reasons for this are many, friendly faces, similar beliefs, kind words, validation, support.
So, meditation. I did mindfulness for my continuing education last year and I’m really excited about the positive effects of regular meditation. One could say that given meditation has been around for about 2,500 years, I’m a bit of a slow burn on this. The areas of research on the impact of meditation have exploded with the rebranding of mindfulness, but it is clear that a regular meditation practice of 20 minutes per day or so has substantial positive effects on our physical, emotional, and cognitive self’s. I’ll pick 2 things that are particularly cool. First, meditation seems to help with hard to treat depression because learning skills to be in the moment takes us away from ruminating about what we think our shortcomings have been, or will be. Second, we have looked for a long time for ways to build up the brain. Through meditation, increasing our skill at directing attention to the present moment appears to build attention skills in general in a way that generalizes to everyday life. With better attention we get improvements elsewhere, such as better memory and better planning.
Finally, let’s spend some moments on meaning making. Trying to understand what its all about and why we’re here is a basic of the human experience, and something else we can actively participate in for a better life. You’re doing it right now, as we do, together every week.
On key source for meaning making is Victor Frankl’s book, “Man’s Search for Meaning,” based on his experiences in a concentration camp. Frankl is one of the kings of meaning making; of embracing the existential imperative to actively define our world, our reactions, and what is important or not.
Of the many things one can take from this book, two things stand out for me. The first is that no matter how uncontrollable the situation, we continue to retain control over our attitude. Second is the importance of hope and having goals to draw us forward and give meaning and purpose to life.
For Frankl, then, meaning is a key component in resiliency. He quotes Nietzsche’s words, “He who has a why to live for can bear with almost any how.” In a later edition of the book he notes: “Once an individual’s search for a meaning is successful, it not only renders him happy but also gives him the capability to cope with suffering.” In other words we gain strength and resiliency with a sense of meaning and purpose for our lives. In the findings about happiness, it has been found that meaningful experiences will cause a greater and more sustainable boost to happiness than do accumulating consumer goods.
While it is one thing to talk about the importance of a sense of meaning, it is another to explore one’s own sense of meaning. In such a situation, it is helpful to try meaning making exercises. In providing you with an example, I am drawing from a book entitled: “Cancer As A Turning Point: A handbook for people with cancer, their families, and health professionals” by Lawrence LeShan, Ph.D. (Plume/Penguin). Therefore, I conclude with the following exercise.
LIFE ON EARTH ENDS IN SIX MONTHS. “Let us imagine that astronomers make an announcement. A giant comet is sweeping toward the Earth and in six months the world will be destroyed. They have been studying this strange new visitor for a long time and there is no doubt that it is going to happen. Nothing can be done – there is no possible way of averting the disaster. There will be no effects for six months and then, overnight, all life on this planet will die and the planet itself will be thrown into the Sun. What are you going to do with these six months? Reread what you have written on the last page. What does this tell you about yourself? If there are things that you would do in these last six months of life on Earth, what in you has kept you from doing them in the past?” (p. 230)
* * *
The authors are Prof Linda H Aiken PhD a Corresponding AuthorEmail Address, Douglas M Sloane PhD a, Luk Bruyneel MS b, Koen Van den Heede PhD b, Prof Peter Griffiths PhD c, Prof Reinhard Busse MD d, Marianna Diomidous PhD e, Prof Juha Kinnunen PhD f, Prof Maria Kózka PhD g, Prof Emmanuel Lesaffre PhD h, Matthew D McHugh PhD a, M T Moreno-Casbas PhD i, Prof Anne Marie Rafferty PhD j, Rene Schwendimann PhD k, Prof P Anne Scott PhD l, Prof Carol Tishelman PhD m, Theo van Achterberg PhD n, & Prof Walter Sermeus PhD b, for the RN4CAST consortium.
PLEASE NOTE: As usual, I’ll include both the author’s email address (for requesting electronic reprints) and a link to the complete article at the end below.
Here’s how the article starts:
Constraint of health expenditure growth is an important policy objective in Europe despite concerns about adverse outcomes for quality and safety of health care.1, 2 Hospitals are a target for spending reductions. Health-system reforms have shifted resources to provide more care in community settings while shortening hospital length of stay and reducing inpatient beds, resulting in increased care intensity for inpatients. The possible combination of fewer trained staff in hospitals and intensive patient interventions raises concerns about whether quality of care might worsen. Findings of the European Surgical Outcomes Study3 across 28 countries recently showed higher than expected hospital surgical mortality and substantial between country variation in hospital outcomes.
Nursing is a so-called soft target because savings can be made quickly by reduction of nurse staffing whereas savings through improved efficiency are difficult to achieve. The consequences of trying to do more with less are shown in England’s Francis Report,4 which discusses how nurses were criticised for failing to prevent poor care after nurse staffing was reduced to meet financial targets. Similarly, results of the Keogh review5 of 14 hospital trusts in England showed that inadequate nurse staffing was an important factor in persistently high mortality rates. Austerity measures in Ireland and Spain have been described as adversely affecting hospital staffing too.6, 7
Another excerpt: “An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%…, and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7%…. These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients.”
Here’s how the Discussion section starts: “Our findings shows that an increase in nurses’ workload increases the likelihood of inpatient hospital deaths, and an increase in nurses with a bachelor’s degree is associated with a decrease in inpatient hospital deaths (panel). Findings of the RN4CAST study showed more variation in hospital mortality after common surgical procedures in European hospitals than is generally understood. Variation in hospital mortality is associated with differences in nurse staffing levels and educational qualifications. Hospitals in which nurses cared for fewer patients each and a higher proportion had bachelor’s degrees had significantly lower mortality than hospitals in which nurses cared for more patients and fewer had bachelor’s degrees. These findings are similar to those of studies of surgical patients in US and Canadian hospitals in which similar measures and protocols were used.14, 15”
Here’s how the article ends: “In summary, educational qualifications of nurses and patient-to-nurse staffing ratios seem to have a role in the outcomes of hospital patients in Europe. Previous findings from RN4CAST show that patients are more likely to express satisfaction with hospital care when nurses care for fewer patients each.24 To add to these findings, our data suggest that evidence-based investments in nursing are associated with reduction in hospital deaths.”
Reprint requests: <firstname.lastname@example.org>
The article is online at:
3 COGNITIVE STRATEGIES THAT DENY, DISCOUNT, & DISMISS TORTURE:
HOW INDIVIDUALS, GROUPS, GOVERNMENTS, & CULTURES ENABLE TORTURERS:
“Whenever people say ‘We mustn’t be sentimental,’ you can take it they are about to do something cruel. And if they add ‘We must be realistic,’ they mean they are going to make money out of it.”
–Brigid Brophy (1929-1995)
M. Jackson Group Update – February 2014 – An Osteoarthritis Primer
This month’s article is taken from Ken Pope’s listserv. The *New York Times* includes an article: “An Osteoarthritis Primer” by Paula Span.
Here are some excerpts:
Dr. C. Thomas Vangsness Jr., an orthopedist and chief of sports medicine at the University of Southern California’s Keck School of Medicine, has just published (with co-author Greg Ptacek) “The New Science of Overcoming Arthritis.”
I asked him about the most common form, osteoarthritis, in which cartilage wears away, causing joint pain, swelling and stiffness.
Q. It sounds like we’re all headed for osteoarthritis, eventually.
A. Pretty much. If you’re 55 or over, you have a 75 percent chance. By 79, almost everyone has some symptoms.
Q. Why do you say the prevalence of arthritis will get worse before it gets better?
A. The pervasiveness of obesity is one issue — if you’re heavy, it affects your joints. Plus, we’re living longer, so we take more steps and use our joints more, and they wear out over time.
Q. And there’s some genetic component?
A. Absolutely. Some people are predisposed to arthritis. We’ll know more about that in time.
Q. Your recommendations emphasize diet and exercise, which sometimes seem like the prescription for everything.
A. You lose weight by picking the right grandparents or by eating right. Exercise by itself won’t cause weight loss. But exercise is still important.
Every time you do a heel strike, that puts shattering force up through the bones, increasing the wear and tear. If the muscles stay strong, they decrease the force across the joint. They take up some of that pounding, sort of like shock absorbers.
Also, joints like to be lubricated. Movement helps slosh the synovial fluid in your joints around and that nourishes the cartilage.
Q. What kind of exercise do you recommend for people with arthritis?
A. Nothing pounding. I use an exercise bike; you’re still putting weight on your joints, you get the aerobics, but it’s not like a treadmill. Less stress on your knees. Jogging isn’t as good an idea. Swimming is the best — moving your joints in a weightless environment.
Q. Every supermarket sells dietary supplements that claim to decrease arthritis pain. Do any of them work?
A. There’s conflicting scientific evidence. Good, unbiased randomized controlled studies don’t exist. Even for glucosamine and chondroitin, the studies are financed by the manufacturers and they’re flawed. But they suggest that glucosamine and chondroitin can be helpful, and they’re not harmful or expensive.
The scientific rigor I look for as a medical school professor says that the evidence is not there, but my patients tell me they feel better. So I say great, continue taking them — but let’s not kid ourselves. We don’t have F.D.A. regulation for these supplements.
Q. Green tea? Flaxseed? Herbs?
A. Where’s the beef? Show me the studies.
Q. How good are the drug options?
A. I tell patients they fan the smoke away from the fire, but the fire is still there. At this point, there’s nothing we have that can resurface cartilage.
Acetaminophen — Tylenol — just works on the pain. The NSAIDS — nonsteroidal anti-inflammatory drugs — work on the inflammation. Celebrex is a little different pathway, and it’s safer for your stomach but a lot more expensive.
We have new drugs coming down the road, probably in the next decade.
The article is online at:
RESOURCES FOR PSYCHOLOGISTS, PHYSICIANS, & OTHER HEALTH CARE PROFESSIONALS WANTING TO VOLUNTEER THEIR SERVICES TO PEOPLE IN NEED:
“Life’s most persistent and urgent question is: what are you doing for others?”
–Martin Luther King, Jr. (1929-1968)
M. Jackson Group Update – January 2014 – Reducing the Risk of Dementia
Happy New Year! TThis month’s article is taken from Ken Pope’s listserv. Cardiff University issued the following news release:
35 year study finds exercise reduces risk of dementia
The study identifies five healthy behaviours as being integral to having the best chance of leading a disease-free lifestyle: taking regular exercise, non-smoking, a low bodyweight, a healthy diet and a low alcohol intake.
The people who consistently followed four or five of these behaviours experienced a 60 per cent decline in dementia and cognitive decline – with exercise being the strongest mitigating factor – as well as 70 per cent fewer instances of diabetes, heart disease and stroke, compared with people who followed none.
“The size of reduction in the instance of disease owing to these simple healthy steps has really amazed us and is of enormous importance in an aging population,” said Principle Investigator Professor Peter Elwood from Cardiff University’s School of Medicine.
“What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health – healthy behaviours have a far more beneficial effect than any medical treatment or preventative procedure.
“Taking up and following a healthy lifestyle is however the responsibility of the individual him or herself. Sadly, the evidence from this study shows that very few people follow a fully healthy lifestyle. Furthermore, our findings reveal that while the number of people who smoke has gone down since the study started, the number of people leading a fully healthy lifestyle has not changed,” he added.
Recent surveys indicate that less than one per cent of people in Wales follow a completely healthy lifestyle, based on the five recommended behaviours, and that five per cent of the population follow none of the healthy behaviours; roughly equating to a city with a population the size of Swansea (240,000).
Professor Elwood continued: “If the men had been urged to adopt just one additional healthy behaviour at the start of the study 35 years ago, and if only half of them complied, then during the ensuing 35 years there would have been a 13 per cent reduction in dementia, a 12 per cent drop in diabetes, six per cent less vascular disease and a five per cent reduction in deaths.”
The Caerphilly Cohort Study recorded the healthy behaviours of 2,235 men aged 45-59 in Caerphilly, South Wales.
The study had multiple aims and has been the basis for over 400 research papers in the medical press. One of the most important aims was to examine the relationship between healthy lifestyles, chronic disease and cognitive decline over a 35-year period; and to monitor changes in the take-up of healthy behaviours.
Dr Doug Brown, Director of Research and Development at the Alzheimer’s Society, said: “We have known for some time that what is good for your heart is also good for your head, and this study provides more evidence to show that healthy living could significantly reduce the chances of developing dementia. These large, longitudinal studies are expensive and complicated to run, but are essential to understand how dementia can be prevented. We are calling on the G8 Summit next week to commit to greater funding of important studies such as this one which give us hope for reducing the impact of dementia in the future.”
Christopher Allen, Senior Cardiac Nurse at the British Heart Foundation, which part-funded the study, said: “The results of this study overwhelmingly support the notion that adopting a healthy lifestyle reduces your risk of cardiovascular disease and dementia. These findings will hopefully go a long way in encouraging people to carefully consider their lifestyle and how it will impact on their health in later years.”
Unhealthy living has accounted for around 10 per cent of the costs of the NHS in Wales since the study first started, while the annual expenditure on prevention and public health services in Wales is estimated to have been ?280M.
EFFECTS OF EXERCISE ON COGNITION – 31 RECENT STUDIES:
“I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot…and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”
This month’s article is taken from Ken Pope’s listserv. The International Osteoporosis Foundation issued the following news release:
Panel issues exercise recommendations for people with osteoporosis and spine fractures
Too Fit to Fracture international multidisciplinary panel provides health professionals with guidance to ensure safe and effective physical activity for osteoporosis patients
Today, experts from the Too Fit to Fracture Initiative presented the results of an international consensus process to establish exercise recommendations for people with osteoporosis, with or without spine fractures.
The results were presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases in Seville, Spain.
Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method, the international multidisciplinary panel examined literature on exercise effects on:
1) falls, fractures, BMD, and adverse events for individuals with osteoporosis or spine fractures; and
2) pain, quality of life, and physical function after spine fracture. Evidence was rated as high, moderate, low, or very low.
In addition, a consensus process was used to established recommendations on assessment, exercise, and physical activity in the context of three cases with varying risk – one having osteoporosis based on bone density; one having osteoporosis and 1 spine fracture; and one having osteoporosis and multiple spine fractures, hyperkyphosis and pain.
The panel recommends that all individuals with osteoporosis should engage in a multicomponent exercise program that includes resistance and balance training; they should not engage in aerobic training to the exclusion of resistance or balance training.
Other key points included:
*current national physical activity guidelines are appropriate for individuals with osteoporosis in the absence of spine fracture, but not for those with spine fracture;
*after spine fracture, aerobic activity of moderate intensity is preferred to vigorous; physical therapy consultation is recommended;
*daily balance training and endurance training for spinal extensor muscles are recommended for all individuals with osteoporosis;
*restrictions are a disincentive to activity participation, and for people with osteoporosis but no history of spine fracture, desired activities should be encouraged if they can be performed safely or modified;
*health care providers should provide guidance on safe movement, rather than providing generic restrictions (e.g., lifting);
*physical or occupational therapist consult is recommended for advice on exercise and physical activity among those with a history of spine fracture, particularly in the presence of balance or posture impairments, pain, comorbid conditions or that increase the risk of adverse events with exercise or activity, or unsafe movement patterns.
Lead author Dr Lora Giangregorio, University of Waterloo, Waterloo, Canada, stated, “People with osteoporosis and spinal fractures should be encouraged to participate in resistance training and balance training, as the strongest evidence we have supports multimodal exercise programs. We have developed evidence-based recommendations, as well as a report that addresses the “frequently asked questions” of patients and health care providers around physical activity. We hope that the recommendations are helpful to health professionals worldwide as they guide their osteoporosis patients in safe, effective – and enjoyable – exercise regimens.”
3 COGNITIVE STRATEGIES THAT DENY, DISCOUNT, & DISMISS TORTURE:
HOW INDIVIDUALS, GROUPS, GOVERNMENTS, & CULTURES ENABLE TORTURERS:
“Things falling apart is a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”
–Pema Chodron, 1st American-born woman to be ordained as a bhiksuni in Tibetan Buddhism