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Thursday, 8 September 2016

Depression is an Inflammatory Thing!

As one of my specialist areas is psychoneuroimmunology, I want to highlight some interesting research that I've been aware of for some time, that takes a new and intriguing view of depression, one that views depression from an immunological point of view.

As any therapist knows, depression can be a devastating illness, plaguing millions of people worldwide with feelings of sadness, hopelessness, apathy and fatigue. The pharmacy industry has made an absolute fortune out of creating drugs that are used to treat the condition. But despite numerous antidepressants being produced, different classes of antidepressants being created, different doses being tried out, as many as a third of patients with depression don’t respond to medication at all. Why this may be the case has remained a conundrum, one that has forced doctors and researchers to step outside the box, as it were, and be more creative in exploring different treatment options for patients, and to revisit the underlying theories that try to explain what depression is.

Researchers have increasingly been focussing on a seemingly unrelated condition, one that has traditionally fallen into the realm of immunology: inflammation. We all know that inflammation can stem from injury or infection. After all, it’s part of our bodies healing response that brings white blood cells and other elements of the immune system to where they are needed. We call it inflammation because the affected area becomes red as blood flows there. What we now know is that emotional issues such as an unhappy relationship or problems at work can result in tissues within our body becoming inflamed. Not to the same extent as when they are injured, but inflamed all the same. It is helpful to remember that some amount of inflammation is generally beneficial to us, as it ramps up production of cytokines - proteins found in our immune system that play a major role in healing and protecting us.

But remember: too much of a good thing can lead to harm! Research has found that excessive levels of cytokines, and the inflammation they bring on, could come at an emotional cost. There are an increasing number of studies that suggest that high levels of cytokines could be a contributing factor in depression. On top of this, some studies are also indicating that anti-inflammatory drugs could potentially be used to reduce cytokine levels and possibly help people recover from depression.

But we need to make sure we aren’t jumping the gun too soon. As promising as anti-inflammatory drug administration might seem to be for depression, using them as a treatment isn’t as straight forward as we could hope. Studies have indicated that only 20 to 30 percent of people with depression have demonstrably high levels of inflammation. Where there is treatment-resistant depression, it’s 45 percent showing high inflammation levels. We need to remember, however, that as yet no clinical treatment guidelines exist to identify who these patients are and what levels of anti-inflammatory medication they may need.

And there is, of course, the question of whether treating depressed patients with low levels of inflammation would be beneficial or detrimental.

This research also brings into question the concept of what depression is. Is it one particular condition, or is the word ‘depression’ a cover-all for a group of different conditions, the characteristics of which are only just being discovered.

Peter Mabbutt FBSCH
Director of Studies, LCCH

Here are two reviews exploring the role of cytokines in depression for those who want to read more:

Köhler O, Benros ME, Nordentoft M, Farkouh ME, Iyengar RL, Mors O and Krogh J (2014) Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: a systematic review and meta-analysis of randomized clinical trials JAMA Psychiatry 71(12): 1381-1391

Mills NT, Scott JG, Wray NR, Cohen‐Woods S and Baune BT (2013) Research review: the role of cytokines in depression in adolescents: a systematic review Journal of Child Psychology and Psychiatry 54(8) 816-835

Tuesday, 9 August 2016

Mindfully Depressed: Mindfulness in the Treatment of Depression

As many of us are aware, mindfulness is one of the third-wave of cognitive therapies that are becoming increasingly popular, not just with therapists, but within the established healthcare arena too. There has been a welcome increase in the amount of research being carried out into its efficacy in treating a wide range of presenting conditions. Recently, one of these studies has indicated that mindfulness-based cognitive therapy (MBCT) may be as good as antidepressant medication at stopping people relapsing after recovering from major bouts of depression.

MBCT was developed by bringing CBT together with mindfulness techniques which, as I am sure we are all aware, encourage individuals to pay more attention to the present moment. In treating depression, MBCT teaches patients to recognise that negative thoughts and feelings will return (known as a relapse prediction), but that they can disengage from them, understand them and accept them, and therefore avoid being dragged down into a spiral leading back into depression.

Current best practice, endorsed by the National Institute for Health and Care Excellence (NICE) is to encourage people with a history of recurrent depression to remain on antidepressants for at least two years. As I am sure those of us who work with depression know, in reality this can be much longer. As may be expected, some patients are very reluctant to keep taking pills, while others find their depression comes back when they finally stop using the tablets.

The study in question was published in The Lancet, and involved a group of 424 adults taken from GP practices in the south-west of England, who were willing to try either antidepressants or MBCT. Half were randomly allocated to each group. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. This cohort of patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.

Interestingly, the relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the pharmacotherapy. The researchers had thought the study might show that MBCT was more effective than medication, based on a 2008 pilot study where there was a suggestion that MBCT might do better than medication. However, the reality is very different.

What was established was that MBCT is equally as good as antidepressant therapy. This is encouraging as it potentially offers a new option for those who don't want to be on medication for years. The study also indicated that MBCT might work better than antidepressants for those with very troubled histories and who are at the highest risk of relapse. It was found to have protected people with increased risk because of a background of childhood abuse. The researchers hypothesised that perhaps MBCT confers resilience in this group because these patients learn skills that address some of the underlying mechanisms of relapse.

It will be interesting to see what NICE makes of the study, and what recommendations may come from that in regard to the treatment of recurrent depression. As treating depression places an enormous financial burden on the already struggling global healthcare system, the results of this study are potentially significant. In comparison to medication, MBCT is relatively cheap to administer, the more so because it is generally carried out as group therapy.

Despite research, and the increased use of drugs, the long-term outcome of mood disorders has not improved in the 21st century. Having an alternative non-medication strategy to reduce relapse is an exciting and important means to help patients with depression.

And where does hypnotherapy come into all this? Well, it has been said that it is the intent with which you use mindful approaches that determines what you are doing: if the intent is to carry them out using meditation then it’s mindfulness. If, however, the intent is to do so using hypnotic trance, then it’s hypnotherapy. A little controversial, I know. So having lit that particular blue touch paper I will now stand back and let the mindfulness vs hypnotherapy debate take on a life of its own.

Peter Mabbutt FBSCH
Director of Studies, LCCH

For those who want to read the original research:

Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, Causley A, Cowderoy S, Evans A, Gradinger F, Kaur S, Lanham P, Morant, N, Richard J, Shah P, Sutton H, Vicary R, Weaver A, Wilks J, Williams M, Taylor RS and Byford S (2015) Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial The Lancet 386(9988): 63-73

Friday, 27 May 2016

What We Can Learn from our Pets

It is widely recognized that having pets around can help to calm us when we’re feeling stressed. Scientists have found that increased levels of the “love hormone” oxytocin, associated with strengthening the bond between mothers and babies, are also found in dog owners and their dogs. The highest levels are found in owners whose dogs stared lovingly into their eyes the most!

In the same way that animals are attuned to our positive emotions, they are also good at picking up human stress levels and can be affected by these. This isn’t all bad as a vet at Cornell University illustrates by telling of a parrot who was able to tell when its owner was about to have a seizure and warn her! However, humans and animals share their experience of some of the less desirable effects of stress and anxiety. These include the release of hormones such as adrenaline and cortisol causing us to experience the “fight or flight” response.

A cat or dog might actually be in a situation where they face the potential for physical injury, perhaps in a scuffle with another animal. Generally, where this is the case, once the altercation is resolved, the animal returns to a state of balance, a “rest and digest” state, appropriate to their surroundings. These days it’s relatively rare for humans to face real physical threats. Many of our “fight or flight” responses are triggered by things that we imagine happening. Perhaps worrying about changing jobs, moving house or concerns about health and wellbeing. Often we worry continuously about such things in the background and may not follow the example of our pets, returning to that state of balanced relaxation once a perceived threat is over. We simply replace one worry with another, remaining in a state of background stress. Often one of the biggest worries we have is about feeling stressed!

There are a variety of answers to help us to return to a beneficial state of relaxation. As a hypnotherapist, one of my most important roles is to remind people to make time to relax. One of the simplest methods I can suggest is around paying attention to your breathing for one minute.

Minute Mindfulness

Finding time for relaxation doesn’t have to be a chore. By taking a minute to do the following exercise you can help your body to rebalance itself, becoming more relaxed.


  • Allow yourself to relax and breathe comfortably
  • Begin to breathe in through your nose and out through your mouth
  • Find a way of timing one minute – watch, clock etc. and decide when you will begin to time your breathing

When you do:
  • Focus on your breathing
  • Count how many breaths you take in that minute
  • Take note of this number (This is the number of breaths you will take to create you own “Mindful Minute”)

When you next find yourself beginning to feel agitated:

  • Stop and focus on your breathing
  • Count the breaths you take until you have reached your “Mindful Minute”
  • Note how your body has relaxed through stopping and focusing on your breathing
So, if your pet seems to be anxious, it is worth considering if perhaps they are picking up a “stress” vibe from you. If you think this might be the case then give the minute mindfulness exercise a try. After all if your pet has helped you de-stress why not return the favour?

Julia Lewis


Monday, 15 February 2016

Free Yourself from Phobias with Hypnotherapy

Did you know that fear of heights is called acrophobia? Or that brontophobia is the fear of thunder?

There are many types of phobias, some are very common others quite exotic, but if you have one it doesn’t really matter what it’s called. What does matter about these irrational fears is how they restrict your life and your ability to enjoy it. Anxiety in general is on the increase (Anxietyuk.org.uk) and phobias are a very common anxiety, which may have serious life curtailing outcomes.

Frequently the fear of the phobia is worse than the phobia itself and you may find yourself taking extraordinary measures to avoid certain situations or things. It may lead to more unpleasant physical and mental consequences such as blushing or sweating, or even panic attacks. You may find some relief in prescription medication from your doctor.

But whenever this excessive fear began and however it started, it something that can often be helped rapidly and safely with hypnotherapy, usually without needing to know the exact origin though many will remember the activating event in vivid, graphic detail. When patients are describing uncomfortable situations to their therapist, they may be surprised to find themselves smiling or laughing as they realise how unfounded their fears actually are. It is the beginning of changing perspectives and seeing things in proportion. If necessary, however, it is even possible to work with a phobia without discussing it fully.

Phobias are especially well matched with hypnosis as they are unconscious responses and hypnosis is all about unlocking the unconscious mind. Furthermore, in your imagination, facilitated and enhanced by hypnosis, you can replicate phobic situations or objects which can be difficult, and potentially a little frightening, to do in real life in the four walls of a therapy room. In therapeutic trance patients usually feel relaxed and comfortable despite the somewhat unpleasant content of the session making the process more effective than the equivalent real life exposure.

Most people respond quickly to the use of what is called systematic desensitization. This technique is based on the patient’s particular phobia and trigger situations which are discussed fully beforehand. You are next encouraged to imagine these scenarios that begin quite gently then progress in disturbance, step by step, at your own pace and within your control. Your unconscious mind begins to associate relaxation, rather than fear, with the phobic situations.

Even if you don’t reach your own ‘worst-case scenario’ you may very well have moved on enough in your unconscious mind to have overcome your phobic responses. This process may be carried out over more than one session and you can return to the last comfortable point the next time, perhaps finding you have become even less sensitive over the intervening period. This method can bring a surprisingly large and rapid improvement to quality of life that as a therapist is almost as rewarding to see as it is for the patient to experience.

Generally specific phobias are overcome in around three sessions but can be resolved even more rapidly if necessary (for example if you are due to fly in the very near future). Occasionally other approaches are needed to help more complex cases such inner child work or parts therapy, but all of these can be incorporated in the hypnotherapeutic process.

Patients often gain increased self-confidence from overcoming a fear, particularly if it has been a part of their lives for a long time or has stopped them doing something they really want to do. Overcoming phobias can be a life changing achievement, regaining control and opening up new possibilities – going where you always wanted to go without worrying about flying or perhaps driving on the motorway, for example -  giving you back your time and liberating you from fear.

Kirsty Grant

Tuesday, 29 March 2011

Open Access Journals

Students and therapists often ask us about where to go to get current research. There are of course the old favourites of PubMed and ScienceDirect. What many people don't realise is that there are a plethora of highly respected peer reviewed journals whose content is available for free on the web. These are known as 'open access journals'. As there are literally thousands of such journals available searching for them can be daunting. The good news is that there are two very good directories that list these journals and provide links to their respective websites.

The first is the Directory of Open Access Journals. This gives a comprehensive list of all scientific and scholarly open access journals available.

The second is BioMed Central. The list here is more focused on science, technology and medicine.

Both have very good search facilities that allow you to search through their entire catalogue of journals looking for relevant articles. Have a look around and enjoy the wealth of knowledge to be found for free on the internet.

Typical Calories Used in Exercise

Ever wondered how many calories are used up in exercise? Here's a brief guide that you and your patients may find useful:

Typical number of calories used
Running (calories per hour at 8-minute mile pace)                    913

Swimming (calories per hour for continuous laps)                    730

Uphill walking at a 10% gradient (calories per hour )               694

Rowing (calories per hour at a moderate pace)                        611

Cycling (calories per hour at 12-14mph pace )                         584

Jogging (calories per hour at 12-minute mile pace)                  511

Walking (calories per hour at 15-minute mile pace)                  365

Monday, 28 March 2011

Fat Burning Exercise Tips to Help Your Patients

As we all know, one of the not-so-secret secrets of effective weight management is to exercise regularly. To that end, here are some exercise tips to help your patients burn off some of that excess fat. Of course, your patient must always check with their doctor that it is safe for them to take up more exercise.

Be intense with your exercise
Don’t be fooled by the so-called fat-burning zone. This is the misguided notion that working at a lower intensity is better for fat burning than working at a higher effort level (say, for example, walking instead of running.) The harder you exercise, the more calories you will burn and it is this that really counts when it comes to losing fat.

Choose your exercise carefully
There is no such thing as the ‘ultimate’ calorie-torching activity. Energy burned is dependent not just on the activity itself, but on how much effort you put in, how skilled you are at it, how long you do it for, and how often. So choose something that you are going to do regularly and consistently. That means an activity that you actually enjoy (unless you want your workouts to involve untold misery and boredom!) and one that is practical and accessible.
Exercising larger muscles
Serious fat-burning activity uses the large muscle groups of the body – the thighs and bottom, chest and back. The greater the overall recruitment of muscle, the higher the calorie expenditure. So in the gym, you are much better off using, say, the rower than one of those arm-cranking machines.
Sustainable exercise development
To fire up the calorie furnace, fat-burning activity has to be sustainable for a reasonable period. So while skipping is great exercise, it’s not much use if you can only do it for three minutes. The American College of Sports Medicine recommends 20-60 minutes per session, three to five times per week. It doesn’t have to be continuous effort, however …
Interval training
Interval training, in which you mix hard efforts with bouts of recovery, is one of the best ways of maximising calorie expenditure, improving aerobic fitness and making use of limited time. To get the most out of an interval session, ensure that you work outside the comfort zone on the efforts and ease right off during the recoveries. Try a 2:2 rest/work ratio to start with.
Carry the exercise load
Activities that are weight bearing, such as walking and running, use more calories than those in which your weight is supported (such as swimming or cycling), simply because you have to shift your own body weight against gravity.
Running on empty?
You may have heard that exercising on an empty stomach in the morning burns more fat. It is true that the body has to rely on fat stores if you don’t break the overnight fast, but then again, the lack of a ready energy supply may mean that you don’t work out for as long, or as hard, as you may have otherwise done.
Go for the afterburn
One of the best things about exercise is that the fat-burning benefits continue long after you’ve got out the shower. This ‘afterburn’ (increased calorie expenditure) is far greater following exercise at 75% of maximum heart rate, or higher – another reason to eschew those low-intensity workouts!
Increase exercise intensity
If you want to keep seeing results in your fat-burning programme, you must keep increasing the intensity. This isn’t the same as increasing your effort, because as you get fitter, your body will be able to cope with increasing demands. If you rest on your laurels, the benefits will begin to tail off.
Keep moving
Maximise your daily fat burning by moving! Researchers at the Mayo Clinic have found that leaner people tend to stand and move more than overweight people in normal daily life. Their ‘non-exercise activity thermogenesis’ (NEAT) was as much as 350 calories higher each day. So don’t just sit there, wiggle your toes, shake a leg, get up regularly and move your body!