Yoga to Manage Anxiety- Scientific Evidence

Practice Yoga to Manage Anxiety

Scientific Evidence​

In a fast-paced world filled with stressors and demands, anxiety has become a prevalent mental health issue affecting millions of people worldwide. The side effects and the high costs associated with the current pharmacological therapies has encouraged exploration of alternative methods of treatment. Fortunately, there are natural and holistic approaches to managing anxiety that do not rely on medication alone. Yoga has emerged as one such powerful tool to combat anxiety, offering both mental and physical health benefits.

 

In this article, we explore the science of anxiety, the basic tenets of yoga, and the evidence supporting it as an effective anxiety intervention. We will be able to find out about how yoga works by combining physical postures, breathing techniques, meditation, and relaxation to help calm the mind and reduce anxiety. This is the added bonus to the fact that, it also helps improve your overall physical health, which obviously is interlinked with your mental health.

The Science of Anxiety

Individuals grappling with anxiety often find themselves trapped in an endless cycle of excessive worry, fear, and tension. These emotional experiences of anxiety are accompanied by several physical symptoms, such as accelerated heart rate, muscle tension, shallow and rapid breathing, and a heightened state of alertness. These bodily responses are the result of the body’s intricate stress response system, which is designed to prepare us to react quickly in the face of perceived threats—a mechanism often referred to as the “fight-or-flight” response.

Scientific research has delved into the physiological underpinnings of anxiety, revealing intriguing insights into the body’s stress response. Studies consistently demonstrated that individuals with clinical anxiety disorders tend to exhibit significantly elevated levels of cortisol—a hormone produced by the body when in high-stress situations. Cortisol plays a crucial role in regulating various bodily functions, including metabolism and immune response to physical illnesses. In anxiety, the body’s cortisol production can become dysregulated, contributing to the ongoing experience of heightened stress.

Also cytokines, a group of proteins produced by the immune system as part of its response to infection, injury, or stress [1] is elevated, in individuals with clinical anxiety, suggesting a complex interplay between the immune system and the brain in the development and experience of anxiety disorders.

These findings clearly demostrate the intricate relationship between the mind and body in the experience of anxiety, in turn highlighting the importance of holistic approaches like yoga and mindfulness to address both the mental and physical aspects of this condition.

Yoga: History and Key Tenets

Yoga has a rich history dating back thousands of years in India, rooted in the idea of uniting the individual self with the universal consciousness. Its core philosophy is detailed in Patanjali’s Yoga Sutras, which includes moral guidelines, physical postures, breathing techniques and meditation, the principles of which have inspired mindfulness exercise, among other practices. Over time, yoga has become a global phenomenon, celebrated for its ability to create harmony between the mind, body, and spirit, and for its potential to deepen the practitioner’s connection with themselves and their experiences.

In the context of anxiety, yoga is believed to offer profound benefits. Its emphasis on breath work, mindfulness and physical postures, exercise and relaxation is thought to help activate the body’s relaxation response, reducing physiological symptoms like increased heart rate, muscle tension and shallow breathing. Moreover, yoga’s holistic approach can potentially address not only the symptoms but also the underlying causes of anxiety, promoting overall well-being and mental clarity [2].

Yoga promotes slow deep breathing techniques used to relax the mind and body as well as to increase oxygenation (pranayama). As we know, symptoms associated with anxiety include short and quick breaths, with resultant dizziness, yoga helps with breath training which may help during anxious episodes. Considering that yoga involves active attention exercises, it has been shown to increase deeper and mindful thinking processes, hence is calming.

One of the proposed actions of yoga is the activation of the part of our nervous system that slows breathing and heart rate down (parasympathetic nervous system). Studies have also shown that yoga increases the natural level of GABA, a brain chemical (neurotransmitter), which helps with a relief from anxiety.

Yoga & Anxiety: Evidence from Research

 

Several scientific research studies and systematic reviews of these studies provide substantial evidence supporting the effectiveness of yoga in reducing anxiety. One analysis found that yoga was effective in both short-term and long-term anxiety reduction for individuals with non-clinical anxiety (people who have not been formally diagnosed with an anxiety disorder). This analysis also found yoga to be effective in the short-term reduction of anxiety for those with a formal diagnosis, but less so in the long term [3].

Another review of 27 different studies focusing on yoga as either a primary or secondary treatment showed that in majority reductions in both physical and mental symptoms of anxiety [4] was experienced by those who were treated. Further research has shown yoga to be as effective as medication at reducing symptoms of anxiety and depression, and a combined treatment of yoga and medication to be more effective than medication alone [5]. One study looking specifically at the biochemical relationship between yoga and anxiety found that yoga effectively reduced helped reduce high blood pressure, elevated heart rate, cortisol levels, and cytokine production [6], suggesting that yoga’s benefits can be both physical and psychological.

Interestingly, these findings have been supported across every age group and gender. Several studies specifically focused on children and adolescents, showed that yoga was an effective intervention for anxiety in both the short and long term, and was superior to other holistic practices such as mindfulness and meditation [7.8].

Other research has found yoga to be more effective at reducing symptoms and anxiety and depression than other forms of exercise in elderly populations, as well as improving cognitive function [9]. Gender-specific research on yoga has shown it to be effective at reducing physical and mental symptoms of anxiety and depression in both women [10,11] and men [12].

Yoga Helpful Practice

Medication used as the first line treatment of ADHD, including Elvanse (Lisdexamfetamine), Concerta, Ritalin (methylphenidate), do they help improve your performance at work or school? What about your social life, is the medication effective in improving your ability to make and maintain friendships and relationships? Below are some scientific facts and observations about the effectiveness of stimulants in treatment of ADHD.

Breathwork

 

Experts state that taking 3 slow deep (more likely the mean abdominal breaths) causes release of serotonin, a brain chemical that helps with reducing anxiety and depressive symptoms. Yoga helps expand the lungs, which in turn causes a feeling of calm.

– most breath practices in yoga involve inhaling and exhaling through the nose, not mouth breathing, there is evidence that this promotes inhalation of more nitric oxide (no).  Nitric oxide is drawn deeply into the lungs, where it can reduce the respiratory rate, thus slowing down the breathing rate and therefore help reduce hyperventilation. Slow natural breathing, humming breath techniques, gentle breath retention practices and chanting (mantra) or positive vocal affirmations can all help promote increased no levels in the bloodstream, which help reduce anxiety, as well as holding us safe and without self-judgement in the present moment as we focus on our breath.

Physical activity/ Postures

 

Not to be overlooked is the anxiolytic benefit of physical yoga practice! There is substantial evidence that exercise and body movement helps manage anxiety. Most forms of yoga (hatha yoga) are physical mindful. The fact that we are completely focused on the postures and the breath through internalisation, avoids external distractions which induce anxiety. Repetitive physical movements with breath intertwined, which acts like a mindful moving meditation, helps dampen the sympathetic nervous system’s stress response via promoting a return to the parasympathetic response. One breath practice which is strongly  calming is ujayii (victorious) breath.

Regular routine of practice – regular practice is encouraged for longer term management of anxiety. It works best if we have a fix every day!

A space to self nurture and feel safe – there is this ritual; we roll out our mat to practice, maybe light a candle, find our self in a familiar space. We designate a safe place for ourselves where we can put our anxieties at the periphery. The ‘me time’ is anxiety soothing and empowering in its own right.

Effects on improving sleep. Yoga helps improve sleep. Poor sleep makes anxiety states worse so there is a positive feedback loop here.

Anxiety disorders & neurodiversity – may include of comment to broaden things, linking anxiety to other anxiety disorders and neurodevelopmental disorders such as ASD/ ADHD etc

Conclusion

 

In conclusion, the science of anxiety has illuminated the intricate relationship between our mind and body, revealing how the body’s stress response system can become dysregulated in the face of excessive worry and tension. The physiological markers of anxiety underscore the complexity of this condition. However, amidst this complexity, the ancient practice of yoga offers a powerful tool to combat anxiety. Its emphasis on breath work, mindfulness, and physical relaxation activates the body’s relaxation response, alleviating the physical symptoms of anxiety. Moreover, through its holistic approach, yoga’s capacity to address both the symptoms and underlying causes of anxiety promotes overall well-being and mental clarity.

A wealth of scientific evidence supports the effectiveness of yoga in reducing anxiety across age groups and genders. From children to the elderly, yoga has consistently demonstrated its potential to enhance mental and physical well-being and should be promoted as an effective intervention. Whether used alone or in conjunction with medication, yoga proves itself as a versatile and potent tool for managing anxiety.

Author: Dr Meetu Singh

Dr Singh is the consultant psychiatrist with a special interest in neuropsychiatry.  Having seen and treated hundreds of patients with ADHD, in London and Birmingham and with masters in Neuropsychiatry, she is well known as an expert in this field. 

 

Contact Dr Singh: clinicadmin@oaktreeconnect.co.uk
Website: 020 39277699

ADHD & Relationships- Can We Do Them, Yes We Can! Find out How

ADHD & Relationships

Can We Do Them, Yes We Can! Find out How ​

Ever wondered why it is so hard to sustain happy, committed relationships with ADHD (Attention-Deficit/Hyperactivity Disorder) like the other millions of people who suffer from this disorder.
 

 

From personal experience and research on this topic, we know that ADHD can significantly impact relationships, both personal and professional. 
 

 

Although the boisterous, interesting and mostly outwardly cheerful disposition of many people with ADHD makes them attractive and engaging at first, the symptoms of inattention, impulsivity, and hyperactivity, disorganisation can create various challenges for them in their ability to maintain healthy and positive, long term relationships.

If you suffer from ADHD or someone you love or care about does the following information will help you better understand these challenges:

Inattentiveness: People with ADHD may have difficulty paying attention to conversations or activities, making their partners feel ignored or unimportant. It can sometimes be taken personally by others as a deliberate act of not listening, purely to insult them.

Impulsivity: Impulsivity can lead to saying or doing things without thinking through the consequences, which can result in misunderstandings, conflicts, or hurt feelings.

Forgetfulness: Memory problems are common in individuals with ADHD, leading to missed anniversaries, birthdays, or other important events, which can be hurtful to their loved ones.

Procrastination: Difficulty initiating tasks or completing them on time can cause stress and frustration, especially when it affects shared responsibilities, such as household chores or financial obligations.

Time management issues: Chronic lateness or difficulty estimating how long tasks will take can lead to frustration and resentment from partners who are left waiting or burdened with extra responsibilities.

Emotional dysregulation: Some individuals with ADHD may struggle with emotional control, leading to mood swings and impulsive outbursts that can be unsettling for those around them.

Difficulty with communication: ADHD-related difficulties in organizing thoughts and staying on topic can make it challenging to have productive conversations, leading to misunderstandings and conflict.

Neglect of personal responsibilities: Adults with ADHD may struggle with managing their own finances, healthcare, and self-care, which can place additional stress on their partners.

Inconsistent follow-through: People with ADHD may start projects or commitments enthusiastically but struggle to follow through, leaving their partners feeling disappointed or unsupported.

Relationship insecurity: Repeated difficulties and misunderstandings in relationships can erode self-esteem and lead to insecurity and anxiety in both partners.

The list seems long but fortunately there are ways to deal with these issues. And it’s important to note that while these challenges can and do make trouble in relationships, individuals with ADHD can still have successful, fulfilling relationships. The likelihood of this is higher with some of the strategies and interventions that can help mitigate these issues. Through years of working with patients I have learnt that those with high motivation to succeed (like in any other endeavour) and most engagement with these strategies have done the best.

Education

Learning about ADHD and its impact on relationships can help both partners understand the challenges better. You may want to read articles, asking about other people’s problems with ADHD can be good source of information.

Communication:

A common error is to think that in more committed relationships, the partners know and understand the other person’s feelings and expectations without any verbal communication. This is simply not true.

Like in any other relationship, open and honest communication is essential between partners. Speaking to your partner to set clear expectations can be a valuable way forward. Similarly, discussing your feelings about behaviours and your concerns can improve understanding and reduce future conflict.

Treatment

ADHD is a mental disorder, very well treated with medication and therapy. There are milder forms of ADHD where medical treatment may not be required. But struggling on with severe symptoms that are potentially harmful to a loving relationship is unnecessary painful. The response to medication, in the form of noticeable control of the symptoms is common, when treatment is started and adhered to.

The calmness of thought, reduced impulsivity, less volatile temper and better capability to be able to listen in conversations, all known effects of treatment, do improve relationship dynamics.

Couples therapy:

Many couples who seek couples therapy together benefit from it. Seeing a therapist provides a safe space for the couple to then address the core relationship issues. If both partners engage with the therapy, they can develop effective strategies for coping with ADHD-related challenges.

The willingness to engage with therapy encourages confidence in the significant other that the relationship is valuable. 

Time management and organisation 

I am fully aware that this being one of the major issues with ADHD, simply the knowledge of how to be more organised and a lecture about this is not likely to be helpful.

However, when on medical and psychological treatment for ADHD, it becomes practical to start thinking about implementing strategies to improve time management and organisation which reduces stress in the relationship. These strategies can include writing down a daily list of work, prioritising the most important ones, breaking down larger tasks into smaller chunks and rewarding yourself when you finish a particularly demanding task and many more.

Support networks:

There are now hundreds if not thousands of online support groups for people from any age group or demographic. Also, building and developing a support network that includes friends, family, and or support groups can provide valuable assistance and understanding for both partners. It can validate their experiences and offer more education about personal strategies by the other members.

While ADHD can pose challenges in relationships, it’s important to recognise that with patience, understanding, and the right treatment and support, individuals with ADHD can build and maintain successful and loving relationships.

Author: Dr Meetu Singh

Dr Singh is the consultant psychiatrist with a special interest in neuropsychiatry.  Having seen and treated hundreds of patients with ADHD, in London and Birmingham and with masters in Neuropsychiatry, she is well known as an expert in this field. 

 

Contact Dr Singh: clinicadmin@oaktreeconnect.co.uk
Website: 020 39277699

Pros and Cons of ADHD Medication

Pros and Cons of ADHD Medication

To Take or Not to Take, that is the question?

If you are considering a costly private ADHD assessment or ADHD testing given the ever-growing NHS waiting list, the first consideration would be if you want the long-term medication, the ‘first line of treatment’? This blog may help you make that decision.

 

The decision to go on Attention Deficit Hyperactivity Disorder (ADHD) medication should be made in consultation with  qualified professional such as a psychiatrist or a general practitioner with experience in diagnosing and treating ADHD. Needless to say, that before starting medication, it’s imperative to hold a thorough discussion about the treatment options with a mental health care practitioner.

 

The psychiatrist would provide you with the basic factual information and leave the decision to you. Weighing up the risks and benefits can be challenging given that everyone’s circumstances, physical make up and feelings about being on long term medication differs widely.

This decision about treatment is even harder when deciding about if it’s worth your while to go through the assessment, post 2 or more years wait on the NHS or pay significant amount of money for an ADHD testing with a private psychiatrist or psychologists. It would not be wise to go for a long and expensive assessment if you have reservations about taking stimulant medication.

To add to the complicated scenario, we now (since October 2023) face a severe shortage of ADHD medication (ADHD Medication/ Treatment) including Lisdexamfetamine, also known as Adderall/ Elvanse/ Vyvanse one of the main long acting (once daily dose) drug used for ADHD treatment. This further caused the of loss of trust in consistent supply of medicine.

It is worth discussing about what happens when severe symptoms of ADHD including lack of concentration, impulsivity, and hyperactivity remain undiagnosed and untreated. Effects of the other less talked about but equally common and troublesome ADHD features of emotional instability (ups and downs of mood, irritability and anger issues) and executive function difficulties (disorganisation, lower ability for planning and prioritisation skills) will also be considered as these hinder the ability to take on work and personal responsibilities.

This may help with your ability to make a decision about your assessment and treatment options

Untreated ADHD and Work

 

Adults with ADHD may experience difficulties in the workplace. Imagine a work colleague, who misses meetings or is constantly late or fidgets through them, not taking in any instructions, struggles to keep even the crucial deadlines, gets up from the desk every 15 minutes for a ‘chat’ or ‘little break’. They find reading through reports and completing simple administrative work an unsurmountable challenge and anything that’s not thrilling may bore them to tears with little patience to wait for anything. This is when they are trying.

It’s not surprising then that people with this neurodivergent disorder would not be the most popular workers with a reputation for reliable, consistent hard work even when they try their hardest. And are 60% more likely to be fired, as per the World Mental Health Survey Initiative published in the British Medical Journal, that is if they do not leave on an impulse themselves.

Impact of ADHD at work, including Loss of household income, Poor productivity, loss of employment, stress-induced illness, stigma that you will perhaps definitely have suffered is widely observed and described in detail. ADHD is a disability which is not recognised as such in spite of the law, by many employers.

Social and Interpersonal Challenges with ADHD

 

The struggles and challenges are pervasive, in other words present in every facet of the ADHD sufferer’s life. People with ADHD would often be described as the ‘class clown’, good entertainment but with few or no close friends. They maybe known for their ‘out of sight, out of mind’ tendencies as they find keeping in touch hard with an over-stimulated mind.

Understanding social cues can be a challenge and it does not help that their mind works at a ‘100 miles an hour speed’ so keeping tab of the conversation which is not at the same speed may end up in bouts of oversharing, interrupting or talking in tangents or zoning out altogether, not making for the delightful company. As expected leading to difficulties in forming and maintaining friendships and relationships.

The forgetfulness, difficulty in organising everyday life, not being attentive, impulsive over-spending or risk taking are also not factors that would maintain a long-term relationship with ADHD sufferers.

If you have ADHD, you may feel over-criticised, being treated like a child and micromanaged. Doing things to your partner’s liking may seem like immense hard work but not achievable. Or you may feel constantly guilty about letting your parents or partner down, pronouncing yourself lazy or useless or like an imposter when you do well. Your partner on the other hand may feel unheard, like they were ‘walking on eggshells’ around you and generally dissatisfied with your contribution to consistent housework, taking on parental responsibilities etc.

The mood swings, low frustration threshold (emotional dysregulation) and difficulties in managing anger and impulsive outbursts would add further fuel to the fire.

Untreated Severe ADHD and Risky Behaviours

 

One in four prisoners in Britain have features of ADHD, according to a new report published by The Guardian. This makes the prevalence of ADHD 5 to 10 times higher than its 2% to 4% in the general population. These numbers however are not an indication that people with ADHD have some form of ‘criminal genes’ and need careful consideration and understanding of the different factors that may contribute to this association:

The impulsivity and thrill seeking behaviour which is often part of the ADHD complex is mostly attributable. Many patients who suffer from ADHD would report that they act before considering the consequences. The other issues are associated with their struggle to stick to the societal norms and rules, which they may find tedious or cannot adhere to due to lack of organisation.

We often find that they would sign documents without reading through or promise to commit to activities without getting into the nitty gritty of what the activity is about.

It’s important to emphasise that majority of individuals with ADHD do not engage in criminal behaviour, and there is no criminality gene associated with ADHD. It can be attributed to the factors above. That makes an early diagnosis of ADHD with appropriate treatment and support vital for prevention.

So do the stimulant medicines for ADHD work, are they worth it?

 

Medication used as the first line treatment of ADHD, including Elvanse (Lisdexamfetamine), Concerta, Ritalin (methylphenidate), do they help improve your performance at work or school? What about your social life, is the medication effective in improving your ability to make and maintain friendships and relationships? Below are some scientific facts and observations about the effectiveness of stimulants in treatment of ADHD.

Pros / Advantages of ADHD Medication

 

The evidence from research shows that improvement in the ADHD symptoms related to concentration, attention and memory with medication is significant. There are hundreds of studies that show, improved academic performance in exams, better recall of events and instructions, higher exam scores are some of the findings which prove the above at least in the short to intermediate term. One of the methodical and high value scientific study by Daniel Cox added to the evidence that long-acting methylphenidate (Concerta XL, Medikinet MR etc.) reduce collision rates of young adult drivers with ADHD. with improved concentration and less likelihood of acting impulsively.

Other research, including that by Matthijssen and associates found discontinuation of the stimulant medication ended up in worsening of the symptoms of ADHD sand overall functioning at home, school and work.

An essay ‘Blame it on the Brain’ published by the Royal college of psychiatrists explores criminal behaviours in people with ADHD and if these can be prevented through treatment intervention. Put succinctly this report explores and confirms that treatment helps reduce impulsivity thus reducing offending behaviour across the population that suffers from ADHD.

In relation to efficacy, the positive effects of the medication in clinical practice, anecdotally from patient stories and revies as well as the results of several studies (meta-analysis and randomised control trials) convincingly demonstrate that all the stimulant medication, that is, Dexamphetamine, Lisdexamfetamine, Methylphenidate were better than placebo*

Cons / Disadvantages of ADHD Medication

 

Most significantly the concerns about side effects need to be considered here. Decreased appetite with unwanted loss of significant amount of weight, initial insomnia and dry mouth are the commonest. Understandably, Irritability developing on starting these may occur, increased heart rate and blood pressure are uncommon but most concerning adverse effects from the medical point of view.

These side effects can be prevented, modulated or treated with monitoring and early non-medical and behavioural methods or less often medically. These include taking medication earlier in the day, eat and drink regularly with daily exercise.

Stringent physical health monitoring of pulse rate and blood pressure when starting and increasing the medication is essential. In a small number of patients, treatment with high BP medication may be required, when the benefits outweigh the risks significantly.

Medication effect may reduce over time, also called tolerance. This is a very real problem, managed by a ‘treatment holiday’ at your psychiatrist’s advice. This is a a few weeks’ break from your medication intake may ‘reset’ the body so it recognises the medication as a new one when recommenced. A change in the type of stimulant can also help overcome this problem.

Another consideration is that although very effective in controlling inattention, hyperactivity and impulsivity related symptoms, the ADHD medicines are less effective with improving social behaviours and mood symptoms. This means the medicine is not as useful in case of people who deal with mood dysregulation. Psychological therapy should be used alongside medication.

Summary

 

In a nutshell generally speaking, the common consensus is that given the scientific evidence and patient experience taking medical treatment for ADHD is usually beneficial. Most researchers have concluded that this medication works as cognitive enhancers, and apart from this well-known ability, can improve memory and recall and help reduce impulsivity. Secondary to these core effects the above translate into better performance at work, enhancement of relationships, less risk taking or criminal behaviours.

However, medication cannot and should not replace psychological and behavioural interventions. Therapy alongside support from health workers, family and friends is essential. Medication and these psychological and social aspects of treatment and support together would make for optimal care with the best outcome.

Author: Dr Meetu Singh

Dr Singh is the consultant psychiatrist with a special interest in neuropsychiatry.  Having seen and treated hundreds of patients with ADHD, in London and Birmingham and with masters in Neuropsychiatry, she is well known as an expert in this field. 

 

Contact Dr Singh: clinicadmin@oaktreeconnect.co.uk
Website: 020 39277699
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Patient Talk – What does severe clinical depression feel like?

Patient Talk - What does severe clinical depression feel like?

Why did first you come to Oaktree?

 

I first came to Oaktree because I had lost trust in the service my GP practice was offering me, having seen 4 of the GP’s at the practice with no resolution of my problems, multiple changes of medication and no plan for taking things forward towards a satisfactory outcome.

 

Could you describe the daily struggles you faced beforehand?

 

I had no energy, and no motivation. I felt suicidal and had planned how and where I would carry out this act. I carried the means for doing this with me. I felt there was no point in going on with my life if this was all I could expect. I had had bouts of depression before but had been free from these for a significant period of time, following being prescribed fluoxetine (Prozac). In my mind I believed that if this didn’t work, nothing would. I couldn’t sleep at night, and couldn’t do anything during the day. I stopped going out and taking care of myself. I would go weeks without showering or changing my clothes. 

 

How would you describe your worst days? Your best days?

 

My worst days, strangely, were the days I had slightly more energy. My anxiety levels rose on these days and I could not control my thoughts. anything and everything was a cause for concern, but my main problems were to do with my depression and me not recovering and how I could go on if this were the case. My best days were not a lot better than this, frankly, but I did feel able to do a little more in terms of self care, though this might only be one thing out of the raft of routine activities that constitute looking after oneself. 

 

Were those around you aware of what you were going through? Friends/Family/Co-workers?

 

I wasn’t working at the time and did not see friends. My partner was aware to a limited extent but unsure how to handle or manage my moods or behaviour. Despite this he looked after me as best as he could.

 

Was there an event or trigger that made you decide get an assessment? 

 

I decided to get an assessment because the fourth doctor I saw at the surgery put me on a medication which raised my blood sugar to a dangerous level and I could not get this down. On phoning and speaking to him he said to leave it off for a week and then start taking it again. I was horrified by this medical advice and decided at that point I would find an alternative. I felt totally let down.

 

What did you learn about yourself from that first visit to Oaktree?

 

That I had severe and lifelong depression, well of course I knew that, but I needed to know that someone else believed that too, as it appeared to me that my consultations with the various GP’s I had seen indicated that they did not think so. 

 

How has your life improved since then? 

 

My depression has lifted with the prescription of two different types of medication, which, together, appear to increase the anti-depressant effect of both and provide a safety net, in case one or the other stops working. I have also benefitted tremendously from the skilled support of a consultant psychologist, which has helped me to determine the life events that have led to me suffering from this horrible illness, and to counter their effect through understanding them with a different perspective.

 

What advice would you give to people going through the same thing?

 

Don’t think your GP knows everything there is to know about severe clinical depression. They probably don’t. If your mood hasn’t improved in three months, ask for a referral to a community psychiatric team, it will probably take several months to get an appointment anyway. If that doesn’t work, find a way to consult a practicing psychiatrist privately, even if you get no more than a change of medication after your assessment, that may be enough to improve your mood and at the very least, your GP will be provided with a report on your medical condition, and hopefully a treatment plan that they can follow. Try to see a GP who is prepared to listen, make a double or triple appointment if necessary. and don’t get bullied into thinking there’s nothing much wrong with you. There is and if you are ever going to be a productive, reasonably normal person again, you need professional help.

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Anorexia Nervosa: Recognise the Quiet Killer

   

Anorexia Nervosa: Recognise the Quiet Killer

In the modern era, pressure to be thin is immense, originating from the social media “selfie” culture more than ever before.  1.25 million people in the UK have an eating disorder of whom 25% are male. This is increasingly becoming a major problem within the child & adolescent population. Children as young as 6 years of age being diagnosed with severe anorexia; one of the most fatal mental illnesses causing death through starvation, malnutrition or suicide. Less severe forms or if lucky, would still cause bone weakening, growth defects, psychological withdrawal. 

 

Anorexia is a mental disorder that stops people eating in order to lose weight, this results in complete preoccupation with eating (rather not eating), weight and shape. The sufferers develop a distorted sense of their own body image so that they believe that they are overweight when in fact they may be extraordinarily thin and dangerously so. This disease is dangerous and lethal in many cases and debilitating, disabling in most. However, the major issue with this is that it is not only hard to recognise but also encouraged and endorsed within many professions. 

 

The first hurdle in treating the sufferers is that only 1 in 10 will seek professional help. This could result from a multitude of factors:

  • The sufferers may not have an insight into their own eating difficulties and may consider their behaviour “normal” or in keeping with the trend. Unfortunately, thinness can be further reinforced by peers, employers in certain professions and even elders within the family.
  • Many of the sufferers do not want to have treatment for the fear of gaining weight. Even in treatment the disorder makes them hesitant or ambivalent towards receiving treatment.
  • In many cases, anorexia is not recognised by those even closest to the sufferer due to lack of understanding. In addition, people with anorexia sometimes become experts at camouflaging their obvious weight loss by wearing loose clothing, avoiding being weighed at the doctors’ or eating in front of others to not be detected as suffering from an eating disorder. 

In case of children and young adults at least, the onus of recognising signs & symptoms of anorexia, and prompting a them to see a doctor is upon the family or friends.

If someone in your family or amongst your friends:

 

    • Counts calories excessively 
    • Misses/ bins meals at home, school and work
    • Avoids eating with others
    • Weighs self repeatedly or avoids it completely
    • Spends inordinate amount of time exercising
    • Becomes dizzy, has episodes of loss of consciousness
    • Loses large amounts of hair 
  • Is uncharacteristically irritable
  • Inattentive in class
  • Becomes socially isolated with very little interest in going out 

 

It goes without saying that the earlier we are able to detect and recognise anorexia the better the outcome and lower the impact of this silent killer on the sufferer’s health and quality of life. 

 

Seek help and advice from your general practitioner or a psychiatrist. 

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Preventing Online Burnout

Preventing Online Burnout

COVID-19 pandemic has changed our lives beyond recognition, the forced social isolation, working from home or “hybrid working” meant that we had to swing into a world of online meetings. It is estimated that currently 300 million people are using zoom every day and whilst working from home has been a sought after benefit for many, the lack of physical communication has led to a form of video conferencing burnout.

 

Why is this happening?

 

Now that a vast majority of workers have evolved into remote positions and everything from medical appointments to business meetings have gone online, there are increasing reports of fatigue related to screen time. In part, this could be due to complete physical inactivity as  we sit at our desk looking at the screen for an extended amount of time and straining our eyes without rest. There is no walking around the office, rush to get to the train, bus or car to get home, no change of environment either. 

More alarming issue however is the sense of social isolation and inability to communicate with colleagues, clients and even strangers. How lovely is it to compliment someone on how radiant they look or express your dissatisfaction about the way something was done without having to email something unpleasant or smile at a kind stranger at the bus stop or in the coffee shop round the corner from your office. Unfortunately, all this is lost whilst sitting in front of the computer. 

70- 80% of our communication during work is nonverbal, so when in an online meetings there is often difficulty reading facial expression and body language, communication becomes that much more cumbersome as everything has to be verbalised by all present.  It is unsurprising that we feel less connected to others and the meeting that would have taken 30 minutes would now be much longer and tough. 

We then have the non-human factors which are tiresome and frustrating that cannot be ignored. Anyone have the instinct to throw the laptop out the window when the screen is frozen  mid-sentence or when you are making the most ridiculous face at the camera (may have been hilarious if you weren’t as frustrated) or when you utter the most important statement and the person on the other end says they did not hear a word due to audio failure. The combination of these factors alongside poor wifi signals have created challenging barriers to overcome.

 

So what can we do to prevent burnout?

 

Give yourself a break

Like all forms of social communication, it is important for us to regularly take breaks from our screens. Most of us will be flicking between our laptops, computers, phones and tablets throughout the day and so it is essential to get outside when we can and give our eyes and minds time to wind down.

 

Make yourself comfortable

Making sure that your immediate environment is suited to your schedule is an absolute must. 

  • Take a few moments to look at your desk and ensure that your camera is at the right height and angle so you are not straining.  
  • Consider your posture- is your chair comfortable, are your feet touching the floor, are you straining your wrists to type, 
  • Is the lighting good enough for you not to strain your eyes? 

These are all important aspects of reducing burnout and ensuring you can safely and comfortably complete your day-to-day tasks.

 

Communicate in different ways

Although it is difficult at the moment to not take part in some form of video conference, remember to take time to communicate in a variety of ways. 

  • If you find that you are struggling with your screen, maybe try taking a few phone calls instead or send a well crafted email. 
  • Most importantly however, if you can, take the opportunity to speak to people face to face. This could be family in your social bubble or meeting friends outdoors.

When it comes to video conferencing and burnout, we think that the key ingredient is a balance. Remember to make things as comfortable for yourself as you can, but don’t be too hard on yourself if you need to take a break!

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We wish you love, peace and joy this holiday season. Merry Christmas and Happy New Year.

 

Sad At Christmas? Help Is at Hand

Written by Aaron Gaur, Assistant Psychologist, The Oaktree Clinic

The holiday season can bring about lots of joy and fun for many people, it’s known as the time to be merry, mingle with family and spend time with closest of friends. However, for many people the holiday season can be a very sad time.

There are the multitude of demands that holiday season brings. Cooking the best meal of the year, pleasing family and friends with thoughtful presents, making the home sparkling clean for the \once a year’ relatives and all the planning that goes with it etc. etc. that can make the holiday season extremely challenging for so many people. However, the worst of all is everyone’s expectation that we ought to be outwardly jolly, sociable, looking forward to the festivities, irrespective of how we feel inwardly. The excessive eating and drinking, lack of sleep and every form of indulgence does not help in any way, Having said that though, It seems however that this is a better problem to have compared to those who have no one to share the festivities with.

Older people may end up feeling more isolated and lonelier as all those around them go about their business happily enough, similar to how people in hospitals, care homes, the army serving abroad or just stuck somewhere far from the family for any reason, would feel.

Have we considered people who may be at a financial disadvantage and may feel devastated during the holiday season with the societal pressures of having the ‘perfect holiday’ which entails all the expensive presents, food and wine, travel, brought about by the commercialisation of the holiday. Reasonably enough this can be overwhelming and is very present every holiday season.

The loneliness and isolation has multiplied several fold with the forced lockdowns and regulations, the general curtailing of ones liberty to socialise like before, with the rise of COVID-19.

The most worrying fact though is that this sadness can potentially escalate into a full-fledged depressive illness. Unfortunately, the prevalence of moderate to severe depression has increased three fold in the last 2 years.

The most important information to remember though is that THERE IS HOPE. Use the following strategies:

Structure your days

Put in place a number of things in advance that can help you during this time, here are some ideas:

    • Watch a film in the cinema
    • Volunteer- cooking for someone less fortunate, singing and entertaining those stuck in hospitals can be a rewarding experience and many more.
    • Make something- for those of us not the happiest in company and even the most ‘uncreative’, everyone is capable of this.  Maybe 5-minute crafts, knit, embroider, paint…
    • Visit neighbours
    • Bake
    • Go out for a cuppa with a friend

Exercise regularly

Exercise has been proven to help reduce symptoms of depression and sadness. Although difficult to stick to for many, the payoff is worth it.

Relax, Meditate, Put your feet up

Finding time for yourself to relax and do the things you love is extremely important during the holiday season. Especially if you are planning a lot of festivities and gatherings, leave some time out for relaxing and reflecting over the year gone past, look after yourself. Learning to take a break and enjoy ourselves is not a priority for many of us but it ought to be. This can really help reduce symptoms of sadness and stress.

Communicate

It is easy to get lost in our own world and f
orget that all important keeping in touch with old friends. Maybe find the time to write to or ring or even text an old friend, especially if feeling alone.

Communicating with oneself can be equally important, consider putting down your feelings and thoughts on paper. Processing these feelings and letting them out in a healthy way is a very effective tool that can help overcome sadness and helplessness.

It is true that loneliness is hard at any other time of life, but being alone and sad at this time of the year can make you feel helpless, but its imperative that you bear in mind that there is hope and you can do something to help yourself.

However, if you feel utterly hopeless and your symptoms are escalating, then do seek professional help from your doctor or book an appointment with our clinicians.

Contact Oaktree Connect team on 0121 3140330 or email admin@oaktreeconnect.co.uk

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Business Spending on Mental Health, Worth it?

Business Spending on Mental Health, Worth it?

 

Author: Dr Meetu Singh, General Adult Psychiatrist

 

As a business owner, when it comes to envisioning a new venture sustainability and success, mental health and emotional wellness is not often even considered at the outset, much less focused upon.  In this article, hope is to inform on how and why it ought to be.

Primarily, an understanding of the scale of the problem must be known and understood:

  • In 2020– a staggering 79% employees experience work-related stress, compared to 59% in 2018. (1)
  • Around 15% of people at work have symptoms of an existing mental health condition, at any given time. (2)
  • Annually, up to 300,000 people with mental health problems lose their jobs. (3)
  • Annual Cost to UK businesses due to mental illness is between £33 billion- £42 billion, due to staff turnover, sickness absences and presenteeism, latter defined as, “when individuals are less productive due to poor mental health in work.”
  • Every £1 spent on mental health of employees returns £5. (4)

It can therefore be stated with some confidence that it makes ethical sense that employers shoulder some responsibility of taking care of their workforce. The next question that comes up is, is a considered approach towards mental health and wellbeing required by law?

Employers have a ‘duty of care’. to do all they reasonably can to support employees’ health, safety and wellbeing. This includes, making sure the working environment is safe, protecting staff from discrimination, carrying out risk assessments to ensure they can dispose of their duties safely and effectively. (5)

What are the financial implications?

Do measures taken by businesses to improve mental health and wellness make business sense? On exploring the current research evidence, the following comes to light:

  • Better mental health support in the workplace can save UK businesses up to £8 billion per year. (6)
  • In another large study within a company with 500 employees, promoting wellbeing at work through personalised information and advice, a risk-assessment questionnaire, seminars, workshops and web-based materials will cost approximately £80/ employee/ year, therefore for all the employees to undergo the intervention, an initial investment of £40,000 will result in a net return of £347,722 in savings, mainly due to reduced presenteeism (lost productivity that occurs due to an employee working while ill) and absenteeism (missing work due to ill health). (7)
  • Spending £30.90 per employee for assessment, and a further £240.00 for the use of CBT to manage the problem, on screening and care management for those living with (or at risk of) depression in a company of 500 employees where two thirds are offered and accept the treatment, an investment of £20,676 results in a net profit of approximately £83,278 over a two-year period. (8)
  • A study in Geneva, found that every €1 invested in occupational health and safety generates a return of €2.20. So, health and wellness schemes not only save money, but they also lead to increased profitability. (9)
  • Healthy workers build a positive brand image in terms of public relations, talent acquisition and employee retention, boosting the morale and loyalty of those in the company, therefore reducing recruitment costs.

What can businesses do?

Are you left wondering, well the world is a tough place, how can the employers help that? To the relief of 1/3rd of the workforce who suffer and live with mental health challenges, businesses can make a significant difference to the quality of life at work, safety and general wellbeing of the employees as demonstrated by the studies above. This is what caring businesses can achieve with a relatively small investment:

First Step:

Produce, implement and communicate a mental health at work plan with perhaps the following aspects: 

Provide Good Working Conditions 

  • Promote effective people management– A firm but gentle management style with empathy and understanding encouraged in the organisation, would go a long way in preventing work related stress. The work ought to be fairly and reasonably distributed in keeping with each person’s capabilities and pace. Bullying and harassment, a major cause of stress at the workplace, needs to be dealt with swiftly and appropriately.
  • Healthy physical environment at work is more important than people think, well lighted, airy, non-cluttered and aesthetically pleasing offices provide a healthy environment as proven by the “hit” designs of Google (USA), Missing Link (South Africa) offices.

A Culture of Openness about Mental Health & Wellbeing

A culture of wellness can be cultivated without a great deal of spend, Mental health ought to be a topic people discuss openly without the stigma of being labelled or discriminated against. Encourage open and honest conversations about mental health.

“Mental Health First Aid” 

Developing mental health awareness throughout the ranks. It must be understood that mental illness is just that, not weakness or something to be ashamed of, after all statistically speaking a third of the most successful people suffer from it.

  • Formal training- to be able to identify, bust the myths & learn the facts, how to support people with these issues is of paramount importance in this process.

Routine monitoring of employee mental health and wellbeing

Making monitoring of general mental health and wellbeing through open discussions with line managers, forums and questionnaires, will in the medium and long term be useful.

Workshops About Managing Stress and Anxiety

These can be valuable, regular grounding, mindfulness, relaxation and breathing exercises should and hopefully be deemed as important as physical exercise is to boost physical health. In the past, some of these practices have been branded part of the “hippie” movement, again time to change attitudes, right?

References 

1.      The 2020 UK workplace stress survey, Perkbox

2.     Managing and supporting mental health at work: disclosure tools for managers, Dec. 2011

3.     Thriving at Work: a review of mental health and employers, An independent review of mental health and employers by Lord Dennis Stevenson and Paul Farmer, Nov. 2017

4.    Mental health and employers: refreshing the case for investment, Deloittes 

5.     Supporting mental health at work, ACAS

6.    Briefing 40: Removing Barriers. The facts about mental health and employment. Sainsbury Centre for Mental Health. 2009

7.     Mental Health Promotion and Mental Illness Prevention: The Economic Case. Knapp, M., McDaid, D., & Parsonage, M. 2011

8.    Mental Health Promotion and Mental Illness Prevention: The Economic Case. Knapp, M., McDaid, D., & Parsonage, M. 2011

9.    Calculating the International Return on Prevention for Companies: Costs and Benefits of Investments in Occupational Safety and Health International Social Security Association (ISSA)

For information or formal consultation about effective Mental Health at Work Strategic Plan, Contact Dr Meetu Singh at Oaktree Connect on 0121 314 0330

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