Viewing entries tagged
Mental Health

A Hangry Judge Could Ruin Your Life

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A Hangry Judge Could Ruin Your Life

Photo by  Alex Iby  on  Unsplash

Photo by Alex Iby on Unsplash

Some decisions are so consequential that the average person is forbidden from making them. To decide the treatment for another person’s disease, or the penalty for a criminal defendant, you need to go through years of careful training and education. As a doctor, you cannot afford to prescribe the wrong drug for a patient’s symptoms. And as a judge, you cannot afford to imprison an innocent person. We all know that these kinds of errors must happen occasionally. But at the same time, we hold certain professions to a higher standard. For that reason, it can often be a shock to discover those role models just being human.

When we are deprived of sleep for a day or two, all of us are capable of making some poor decisions. Our memory and attention capacities take a hit, so our work during the day is likely to be less effective. A lack of sleep increases the chances of a lapse in concentration, which can be disastrous when driving or using dangerous tools. But even outside immediate physical dangers, there may be major ethical consequences to being tired.

Judges often have to try many cases across their day. Their job may not be physically strenuous, but their high mental burden is bound to be exhausting, as I’ve previously described. If judges are as human as the rest of us, you might expect to see their decision-making change in line with their sleep patterns.

If you wanted to investigate the effects of sleep deprivation on real-world legal decision-making, it probably wouldn’t be sensible to ask a group of judges to go without sleep for a day. However, researchers at the University of Washington and University of Virginia thought of a clever way to test the idea without getting in the way of normal judicial proceedings. They made use of a natural change we all go through during the transition to daylight saving time in the spring: on Sunday, we turn our clocks forward and miss one valuable hour of peaceful sleep.

The researchers analyzed court sentences for US citizens between 1992–2003, and examined how long defendants were locked away for on the Monday after a clock change (“sleepy Monday”) compared to a typical Monday. Alarmingly, they found that sentences were 5% longer overall on sleepy Mondays.

You might find the results above surprising. Could a single hour of sleep really make such a difference? Some researchers are indeed disputing the extent of these sleep deprivation effects among judges. But to be clear, there does seem to be a difference between 6–7 hours of sleep and 7–8 hours of sleep when it comes to general health. During the Sleep Duration Consensus Conference in 2015, 15 experts in the field of sleep science reviewed all available evidence and voted on exactly how much we should be sleeping each night. The panel reached a consensus suggesting that 7–8 or 8–9 hours of sleep a night was ideal for optimal health, but 6–7 hours crossed into the suboptimal range.

Judges aren’t the only people who need to worry about sleep. The performance of medical professionals also suffers when they are bleary-eyed. As sleep loss increases, surgeons make more mistakes and are slower to perform particular tasks in a surgery simulation. The demanding working conditions and long shifts in many of the world’s healthcare systems may not be good for patients, or for the people trying to save their lives.

We don’t yet fully understand everything that goes on during sleep, or even the reasons why we sleep, but we know that we struggle without it. The effects of sleep loss are similar to the effects of alcohol intoxication. When researchers measured the hand-eye coordination of volunteers following either a few drinks or a night of no sleep, they found that 17 hours of sleep deprivation mimicked the performance problems of a 0.05% blood alcohol concentration. Staying awake for 24 hours was similar to a 0.1% blood alcohol concentration. Keep in mind that the legal alcohol limit for driving in the US is 0.08%. The more sleep we lose, the more drunkenly we behave.

Photo by  Hutomo Abrianto  on  Unsplash . Adapted by yours truly.

Photo by Hutomo Abrianto on Unsplash. Adapted by yours truly.

Food deprivation may be analogous to sleep deprivation when it comes to the quality of our decision-making. All of us get a little short-tempered and miserable when we feel hungry. Skipping lunch is not a popular proposition in my household. The feeling of frustrated hunger is so widespread that the world has come up with a dedicated word for it: “hangry”, a portmanteau of hungry and angry.

A hangry judge may be the last thing you want to see if you’re ever in court hoping for parole. Researchers analyzed the decisions of judges in Israel depending on when a parole hearing took place during the day. In these cases, judges had two options for their conclusions: “yes, parole is granted” or “no, go back to your cell”. The hearings took place in one of three daily sessions, each session separated by a break where the judges could grab some food and drink.

The researchers found that decisions to grant parole in favor of prisoners declined steadily between the start and end time of a session. And this was not just a minor effect we can easily ignore. Favorable rulings were at around 65% at the start of a session when the judge was feeling happy and refreshed, and declined to almost 0% just before the break. Straight after the refreshment break, the rate abruptly jumped back up to approximately 65%. There may be accompanying variables in addition to hunger that explain this pattern, but nobody in their right mind could have predicted such a dramatic effect before seeing this data.

In these judicial cases, the decision to avoidgranting parole is essentially a decision to keep things as they already are. Granting parole would mean changing the status quo and releasing the prisoner. It may be that this burden is too much for a hangry judge to think about. When we are tired and struggling to focus because the only thing on our mind is food, we may be naturally drawn to the least dramatic option; the option least likely to get us in trouble if we make a mistake. When we are refreshed, happy, and comfortable, we can better weigh up the pros and cons of a problem in a bid to make the fairest and most rational decisions we can.

Next time you feel a little frustrated with someone, or you see them looking a little skittish, consider whether hunger or fatigue could have something to do with it. We have an overwhelming tendency to assume that when a stranger is unfriendly to us, it’s because they are a terrible person. But this bias may be irrational, because we are all capable of being a little mean on a bad day.

With some careful attention to the real influences underlying our own behavior and judgment, we can make better decisions when it matters. And with greater generosity in how we read other folks’ motivations, we can develop a more compassionate attitude toward the people around us.

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When Your Brain Becomes Your Puppetmaster

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When Your Brain Becomes Your Puppetmaster

Photo by  Sagar Dani  on  Unsplash

Photo by Sagar Dani on Unsplash

Some features of our lives just seem inviolable. Most people would never worry about failing to recognize objects they see every day, or beginning to believe that their arm does not belong to them. And yet, these are exactly the types of things that can go wrong. Body and brain functions are not physical laws like those of thermodynamics or relativity. Gravity may be here to stay, but when it comes to our behaviors and perceptions, we may be justified in being a little more nervous. So what would you do if you lost control of your own arm?

If I ask you to lift your arm, and you agree to participate in the exercise, you’ll probably see your arm start to rise. But you always feel that the arm is doing what you, as a conscious agent,want it to do.

Anarchic hand syndrome is a disturbing disorder in which patients lose the normal experience of voluntary movement. An arm can begin to move and act without the patient wanting it to, as if the limb has a will of its own. In fact, a patient will often begin fighting their own limb if it becomes uncooperative, trying to stop it from grabbing at their tissue while they blow their nose or from touching the person sitting next to them. Have a look at this video demonstrating the plight of an elderly patient in her hospital bed after she suffered a severe stroke.

In the most extreme cases, your own anarchic limb can try to kill you. One patient described her hand tearing away at her bedcovers in the night and grabbing her own neck to strangle her. The only sense she could make of her horrifying condition was to assume that her limb was possessed by an evil spirit.

Patients with anarchic hand syndrome are in the bizarre situation of knowing that their limb is their own but losing all sense of agency over it. Without the normal process of intending to perform an action, it’s hard to say that you turned on the light when you flick the switch. Your arm certainly did it. But not you.

It all links back to our sense of who we believe we are. When we use the words “I” or “me”, we normally refer to our conscious minds and experiences. It would be strange to say “I am beating my heart faster” after going for a run, even though the heart is a part of our own body. We simply say “my heart is beating faster”. But when it comes to lifting our arm, we say “I am lifting my arm”, not “my arm is lifting”. The difference all comes down to our sense of consciousness and intention. Our heart rate is automatically controlled behind the scenes of our awareness, so although we are educated enough to know that we own our heart as much as we own our arm, we don’t talk about heart activity as a product of our control.

Photo by  rawpixel  on  Unsplash . Adapted by yours truly.

Photo by rawpixel on Unsplash. Adapted by yours truly.

So in a sense, when we have anarchic hand syndrome, our arm becomes more like our heart. The arm is on us and it is a part of us. But we are not in control. The labels “anarchic hand syndrome” and “alien hand syndrome” are often used interchangeably, even in academic papers. But some researchers distinguish between them, explaining that patients believe anarchic hands belong to their own body even when they cannot control them, while alien hands are experienced as a completely disowned limb.

Anarchic hand syndrome typically follows extensive damage to motor-related areas towards the front of the brain, including the anterior corpus callosum and supplementary motor area. Alien hand syndrome usually features damage further towards the back of the brain, including the posterior corpus callosum and parietal areas. The symptoms can also arise from degeneration in the circuits that connect areas of our cerebral cortex with the basal ganglia, a system that is critical in allowing us to move smoothly and effortlessly.

During movements of an anarchic hand, the primary motor cortex in the brain — one of the final command centers for sending “move” signals to your limbs — is fully activated. But unlike with voluntary movements, that activity is practically isolated, appearing without the normal co-activation of premotor, prefrontal, and parietal areas that are so important for our experiences of intention and movement awareness.

Utilization behavior refers to actions that appear fully functional, but emerge habitually and automatically in the wrong environments. They can occur after lesions to frontal areas of the brain, similar to anarchic hand syndrome, but patients often do not comment on their actions being out of the ordinary (unlike the woman with the anarchic hand in the video linked above, who repeatedly complained about her arm). When a patient sits in a doctor’s office, and sees a pen and paper sitting on the table, they might pick up the pen and begin to write. When they see a pack of cards, they might deal them as though they are about to start a game with the doctors. None of these actions have anything to do with the doctor’s instructions. Even when the doctor says that the objects should not be touched, the patient returns to their action after a small distraction. The patients simply use the objects because they are there.

Some theories of motor behavior explain that whenever we see a manipulable object in our environment, our brains automatically prepare the relevant action for handling that object. When we see a hammer, we initiate a motor program for a palm-grasp action. When we see a grape, we initiate a program for a smaller precision grip with our fingers. Thankfully, under normal conditions, we have the control systems in place to suppress those action plans when they are contextually irrelevant (although, when I spot a delicious bunch of grapes in a bowl, I often struggle with that suppression). Efficient hammering is great when we are putting together furniture, but not when we are in a doctor’s waiting room. When the control systems in our brain are destroyed, particularly following frontal damage, we may find ourselves acting for the sake of acting.

Photo by  Maja Petric  on  Unsplash . Adapted by yours truly.

Photo by Maja Petric on Unsplash. Adapted by yours truly.

When you read enough about brain dysfunctions, it begins to seem as though there is nothing in your life that you can depend on. We should remember that disorders like the ones described above are incredibly rare. And on the plus side, they can inspire us to appreciate some of the smaller facts of our existence. Even on your most boring day, you probably achieved several minor miracles of purposeful action and awareness. The notorious 3-pound organ sitting in our skulls can cause us grief during testing times, but it also makes life worth living the rest of the time.

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The Upsides of Being an Autumn Baby

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The Upsides of Being an Autumn Baby

Photo by  Lydia Winters  on  Unsplash

Your month of birth may be more life-altering than you think. It’s nothing to do with your star sign. Several variables depend on which month you happened to enter the world. Your mother’s food choices during pregnancy, the season of your earliest days of life, and your exact age at starting school are all good examples. Could any of these variables have a noticeable effect on our successes and failures in later life? It’s a tricky question with many possible answers, but studies have been taking on the challenge. Now, there are some curious stories coming out of the data.

Let’s first look at health. When you compare overall lifespan past the age of 50, Austrian and Danish people (Northern Hemisphere) live approximately half a year longer on average if they were born in autumn rather than spring. The same benefits apply in Sweden too. In fact, this autumn advantage is even true in Australia (Southern Hemisphere), where the seasons are reversed across the year, so that autumn begins in March/April. Fascinatingly, the lifespans of British immigrants in Australia maintain the annual pattern of their European counterparts, rather than adopting the schedule of their new Australian friends. So insight number one: seasons of birth seem to influence longevity.

Photo by  Barbara Alçada  on  Unsplash . Adapted by yours truly.

Photo by Barbara Alçada on Unsplash. Adapted by yours truly.

There is an ongoing debate around exactly why seasonality might affect our health or other life outcomes. The characteristics of mothers who are trying to conceive could be one relevant factor. For example, between 1989–2001, teenage mothers were most likely to give birth in January. Given the disadvantages that young mothers may face in bringing up children, you might expect that children born in January are more likely, on average, to experience problems in their growing life. However, this explanation alone is not sufficient.

In a 2013 study, researchers looked at mothers who had multiple children across different months. By looking at differences between siblings, and therefore studying the same mothers, general effects of varying maternal characteristics could be ruled out. And yet, the data still showed effects of seasonality in child health. Babies conceived in May (births due around February), were most likely to arrive prematurely and have low birth weights, possibly due to changes in maternal nutrition between seasons. The months of greatest maternal weight gain overlapped with the months of conception that produced the healthiest baby birth weights (summer months of June-August). But the birth pattern also showed a striking correspondence with the prevalence of influenza in health centers. When May-conceived babies were born, often prematurely in late January or early February, seasonal influenza was at its peak. The strong correlation between influenza prevalence and gestation length suggests that the seasonality of certain diseases could partly explain the effects of birth month on health.

So on average, winter and spring babies live slightly shorter lives and suffer worse health at birth. And it may not end there. Some researchers have looked at birth patterns among populations with specific disorders. In one study, researchers analyzed data for over 42,000 multiple sclerosis (MS) patients across Europe and Canada. Compared to a non-MS control group, patients were significantly less likely to have been born in November and more likely to have been born in May. The number of MS patients born in May was 9.1% more than expected, while the number born in November was 8.5% less than expected. Once again, the mechanisms that explain this pattern are a little foggy, but MS is a product of both genetic and environmental factors. Vitamin availability and susceptibility to specific viral infections are amongst the environmental influences that could vary by season, and might explain some of the story behind heightened risks for MS in May births.

Surely spring babies can’t have all the downsides? When it comes to academic performance, they may be outdone in their misfortunes by summer babies. Many school systems around the world, including in the US and UK, have cut-off birthdays between August and September to decide which academic year you fall into. If you are born in August, this means you end up the youngest in your class, while if you’re born a month later in September, you’ll probably be the oldest in your class. Children’s mental abilities change rapidly in their early development, so August babies might have a disadvantage in keeping up with their older classmates. If this holds true, you would expect to find a consistent difference between the academic outcomes for August babies and September babies of the same year, even if they were born only a day apart (e.g. 31st August instead of 1st September when the cut-off puts them into separate academic years).

When you look at the data, the older children in class (September births) do indeed outperform the younger children, and the difference is at least partly driven by the age at which children take academic tests. It’s not that the younger children develop weaker cognitive skills as they grow up, it’s that their skills are tested earlier in their development, therefore creating an uneven playing field. As you’d expect from this account, the differences between the older and younger children decline as they get older and their developmental trajectory evens out. However, the more troublesome difference between children may be in their beliefs about their academic competence. The younger children have a harsher view of their own competence than the older children do, even when asked for their judgments at around the same age. This pessimistic outlook may be more persistent, and could potentially sabotage later outcomes. Easy fixes for these issues are hard to come by. More affluent families tend to address the age imbalance by delaying their young child’s entry into school (a practice known as redshirting), while less affluent families are more likely to have young children who are held back a grade before testing. Both practices may have compensatory effects on test scores, but they may also come with substantial costs further down the line, like delayed work experience. Age-based adjustments for test scores could provide another option for balancing academic outcomes early on, but that comes with its own controversies.

Photo by  Jacob Postuma  on  Unsplash . Adapted by yours truly.

Photo by Jacob Postuma on Unsplash. Adapted by yours truly.

The youngest children in a class may also be at greater risk of mental health challenges. One study published in 2000 looked at schools in Northern Ireland, and found that children who were referred to psychological services were significantly more likely to be born at the end of the school year than the start. Similarly, in 2015, survey and register data in Denmark suggested that a 1 year delay in entry to kindergarten reduced scores on hyperactivity and inattention scales at age 7. Some of the mental health costs of relative youth could be driven by the negative self-perceptions of competence that I highlighted earlier.

Exposure to high temperatures during early life may also impact economic outcomes. Some evidence suggests that exposure to high temperatures (>32°C or >90°F) during prenatal development or during the first year of life is associated with lower earnings in adulthood. Each extra day of heat exposure correlates with a 0.1% reduction in annual earnings at age 30. The good news is that regular access to air-conditioning entirely cancels out this effect, so a community can easily mitigate the potential downsides of sun and heat exposure if they can afford the relevant resources.

After all of this, there seems to be a clear winner in the lottery of birth timing. Those born in autumn (September-November) have some probabilistic advantages over their spring, summer, and winter peers. The summer babies may have heightened risks from the sun and their pesky school schedules, while the late winter/spring babies may have a greater risk of health problems from viruses and nutritional deficits. It’s important to treat all of the evidence carefully. Most of it is correlational, which means we are still waiting on a definitive insight into the causes of differences between children born in different months. We should also remember that there is enormous variability in life circumstances and outcomes, so even when we find average differences according to month of birth, there will be a multitude of other genetic and environmental influences that make it practically impossible to predict how well someone will do purely from their birthday. A final note of caution is that we will have an incomplete picture of these effects for decades to come.

For now, autumn babies look like the lucky ones. But I would bet that the costs of fall are lurking in the darkness, waiting to be discovered by keen-eyed researchers.

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Mindfulness Lessons from Science and Children

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Mindfulness Lessons from Science and Children

Photo by  Vanessa Serpas  on  Unsplash

There are some human characteristics that we describe as childlike. In growing up, we gladly leave behind many of those qualities. Adults shouldn’t throw tantrums in supermarkets and cry about parents’ tyrannical desires to prevent accidental deaths in the playground. However, some childish adjectives are earnestly used as compliments for adults. When we describe an adult as childlike, we usually refer to some innocent or charming quality about them. That’s a nice sentiment, but some features of children’s mindsets may even be profoundly healthy for adults to cultivate. So in what ways do we need to be more like a child again?

I don’t yet have my own children, but in interacting with my many young cousins, there is always one particular trait that stands out. That is their ability to live and experience life in the moment. Children seem to be able to have fun with just about anything. The other day, I saw a child screaming with laughter at the noise they were able to create by hitting a can with a stick. They did not worry about the latest disaster in the news or the state of the economy. They simply made the most of what they found in front of them, and appreciated every second as they experienced it.

Of course, none of this is to say that children are Zen masters. Far from it. If you’ve ever been in an airplane with a child around, you’ll know all too well that children do not hesitate to scream for what they urgently crave. Nevertheless, they seem to be able to engage wholly with an activity in a natural way that adults no longer find so easy.

This psychological quality of children is reminiscent of a mindset widely discussed in the sciences and the media: it’s called mindfulness. Jon Kabat-Zinn was a pioneer in bringing mindfulness into the sciences, and he defines it as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”. You can think of it as a mindset in which your attention is entirely locked on what is happening right now. Not what happened moments ago. Not what might happen in the future. What is happening now.

Photo by  Robert Collins  on  Unsplash . Adapted by yours truly.

Photo by Robert Collins on Unsplash. Adapted by yours truly.

Why should we care about the science?

It took a while for mindfulness to be taken seriously in the scientific world. This is because the principles within it were originally developed in a religious context, especially in the Buddhist tradition. It wouldn’t take you long to find a scientist who frowns upon the concept of religions. This frowning is due to the many religious premises and claims that cannot be supported by objective evidence. But the frowning often goes too far and becomes a phobic barrier to ideas that can actually be tested scientifically. Mindfulness occasionally still hits this barrier, but now features prominently in neuroscience and psychology studies. If you search for ‘mindfulness’ on Google Scholar, you’ll be reading papers for the rest of your life.

You will still find people who reject the scientific idea of mindfulness because of its religious baggage, and they will often lock horns with people who argue science has no place in discussing mindfulness. I’m in the camp who believe both teams are being too absolutist. Without scientific evidence, mindfulness will never be clearly distinguishable from the snake oils that do more harm than good for humanity, and it certainly won’t ever become a valuable part of our mainstream health services. And without an open and unbiased mind to take mindfulness seriously in the first place, you’ll never fairly weigh up the evidence to understand its true value. If we’re being practical and trying to avoid personal biases, we should enjoy any benefits of mindfulness in our personal lives, while acknowledging the value of emerging evidence through scientific scrutiny.

We don’t necessarily need evidence to believe that mindfulness is good for us personally, but we do need it to truly understand the extent of its benefits across different people, problems, and interventions. We cannot confidently and honestly recommend mindfulness as a useful intervention for others, unless we have independent research to back us. We have to rely on something more than the beliefs, feelings, and words that come from our own mind or the minds of those who agree with us. Clearly defined methods, testable hypotheses, and replicable experiments provide us with the material to convince a sensible doubter. Intercessory prayer has been around for thousands of years, with many religious people attesting to its value in improving the health of their loved ones. But with no scientific evidence to back up that claim, good doctors will never prescribe prayer as an intervention to support your loved one who may be suffering from a medical malady. Mindfulness, on the other hand, has growing scientific support replicating across independent research labs, and may eventually fall into that bucket of widely prescribed interventions. Science and evidence-based medicine have been crucial in our progress as a species. We cannot afford to dump them now.

The mechanics of meditation

Many of our anxieties are driven by a fear of something that may or may not happen in the future. Any pragmatist will tell you that it’s pointless to worry about something if you cannot change or affect it, but mindfulness provides a concrete approach for shifting your attention to something more helpful: your actual experience in the present moment. There are many types of meditation, but all of them are activities that cultivate this mindset in some form.

Photo by  Laurenz Kleinheider  on  Unsplash . Adapted by yours truly.

Photo by Laurenz Kleinheider on Unsplash. Adapted by yours truly.

I will highlight two types of meditation that I find particularly helpful. Rather than diving into their religious or historical context, I will adopt the labels and methods that have been used in the sciences. The first I will call focused meditation, and the second I will call open monitoring.

If you have any basic experience of meditation, you are probably familiar with focused meditation. The instruction is to focus on a specific object in the world or on your body. A convenient anchor is often the breath. You aim to maintain your attention entirely on your inhalations and exhalations in the present moment. This is far more challenging than it sounds, as any early practitioner will tell you. You don’t just consider the concept of breathing while mentally singing Ed Sheeran’s new song. You pay full and exclusive attention to every moment of the breath as it occurs. For example, if you are focusing on your chest, you want to experience it as it lies rested at its lowest point, then stay focussed on it as it slowly rises in each moment, then maintain your attention as it reaches its peak, and then do exactly the same with your mind as it sinks back to its resting position. Whenever you realize your attention has deviated from your breath — which might be as frequently as every few seconds — you simply return your mind calmly to the breath. Ideally without getting angry at yourself for having been distracted.

As you practice this, you will become better able to focus your attention on your breath for a few more seconds each time. Areas of the brain involved in sustained attention become more active as you start practicing meditation and improve your focus. However, at the highest levels of expertise (around 44,000 hours of practice), this activity is reduced again. In early practice, you become better able to recruit your attentional resources in the brain, but with expertise, focusing becomes effortless and you no longer need to rely on those resources. Distractions have a harder time dragging your attention away from where you direct it.

Open monitoring is a little different to focused meditation. Instead of choosing a specific object to direct your attention towards, the task is to focus your attention fully on any thought, feeling, or experience that arises in the present moment. There is no need to judge, anticipate, control, or react to anything that occurs. So an active mind that frequently jumps between objects is less of a concern during open monitoring than focused meditation as long as you are aware of what is happening. It’s still easy to become so distracted that you no longer pay close attention to your thoughts as they happen. There is an important distinction between being aware of thought and being lost in thought. I’m aware when I notice that my mind has floated from thinking about my breath to thinking about the work presentation I’m anxious about. I’m lost when my mind has drifted to worrying about the work presentation, panicking, wondering what I will need to do to prepare, and forgetting to notice each emerging experience.

The nice thing about open monitoring is that you can learn to apply it throughout your everyday life activities. With focused meditation, you usually need to find the time and space to quietly sit and focus on your breath. After a few days of this, most people will inevitably find some excuse to stop the practice. But with open monitoring, you can simply aim to remain aware and present with anything you happen to be doing: in the shower, you can focus your attention on the water as it hits your back; while walking in the park, you can focus on the colors of the trees; when eating, you can focus on the texture of the food as it rolls around your mouth. These are just examples, but the more you manage to bring your mind into the present as you go about your life, and the less you get lost in your head while your body does everything else on autopilot, the better you will appreciate your life as you live it. We too often let the day drift by and ask ourselves at the end of it “where did my Sunday go?”.

Evidence to support the benefits of mindfulness

Research is ongoing, and we still have much to learn. The experiments in this area are a mixed bag of higher and lower quality methods. A challenge in designing a good experiment is to compare mindfulness interventions with an appropriate control condition. If we want to understand how mindfulness impacts health, we need to know what it’s better than. Some experiments use no controls, which is clearly not ideal; if people improve in an aspect of their wellbeing following a mindfulness intervention, how do we know it’s not just because of the social interaction involved in their classes, or the effort of trying something rather than nothing? Other studies compare mindfulness to standard treatments for the targeted symptoms, or to different attention tasks, which is providing a more reliable insight into the specific health benefits of mindfulness itself. Review papers and meta-analyses that helpfully combine the results of multiple studies are also growing in number.

There is a way to go, but consistent effects are emerging. Mindfulness may not help everyone but there is now a large volume of evidence to suggest that it can have important, far-reaching benefits for many aspects of mental health. In general, extended mindfulness practice seems to adapt brain structure and function related to emotion, attention, and self-awareness. Experiments so far have highlighted benefits in areas including hypochondria, decision-making, chronic depression, and even chronic physical pain.

Some of the most convincing benefits are in emotions and relationships. Mindfulness techniques can be a great tool for shifting the mind away from ruminating on possible dramas and disasters. Most of my recent fears came from prognosticating outcomes that were either not that bad in the end, or did not happen at all. My time clearly would have been better spent focusing on my actual lived experiences. When we successfully apply mindfulness to our lives, many of us are happier, and we become more pleasant people to be around. We shouldn’t meditate with any specific goal in mind, because it’s counterproductive. A goal orientation is a distraction in itself. But it’s certainly helpful and motivating to know that whenever we do meditate, there are good reasons to believe it is worthwhile.

The child in us is waiting to emerge from a long slumber. There are many benefits to centering our minds on our current experiences and shifting away from the usual obsessions about objectives, plans, and goals. It’s about time we focused on the only thing we know for certain: that we are breathing, thinking, and feeling right now. We don’t need to keep a chart or track our data. Mindfulness is less of a life hack and more of a way to live. It provides an escape from our monotonous and robotic approach to our everyday activities. Next time you eat, shower, or fold the laundry, know that you can appreciate the moment rather than simply get through it. Life is always going to be too short. So you might as well live it.

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In the Future, We May Not Need to Face Our Fears

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In the Future, We May Not Need to Face Our Fears

This article was a front-page feature on Medium.

Photo by  denis harsch  on  Unsplash

Many people live with fear. Chronic fear: phobias, anxieties, and PTSD. Conditions like these can be debilitating and difficult to treat. Many treatment options cause painful physical and psychological side-effects. New and promising treatments, however, use advances in brain scans and neurofeedback to revolutionize the way science helps us overcome our fears.

The problem with drug-based treatments will always be their side effects and wide targets. There’s no drug to specifically cure a fear of snakes or fear of flying, for example; medications only dampen a generalized level of anxiety (sometimes, they even knock people out completely).

Medications can only dampen the general level of anxiety or perhaps even knock people out completely.

One of the best available treatments for a specific anxiety? Exposure therapy. In a controlled environment, participants are trained to relax and face their fears. If they have a phobia of snakes, for instance, they might be asked to imagine a snake in the first session, then look at a picture of a snake in the second, then watch a video in the third, then see a real snake in the fourth. If they make it through the therapy, they might successfully reduce their level of fear in the real world. The problem, as you might expect, is that dropout rates during this type of therapy are high. Repeated exposure to your deepest fears is a painful process.

Parallel to exposure therapy runs another stream of scientific research looking at a method known as neurofeedback. Through manipulating brain patterns, this technique trains people to shift their behavior in specific directions. If you were undergoing neurofeedback, the procedure might go something like this:

You sit and look at a circular disc on a computer screen while researchers measure your brain activity. You see that the size of the circular disc changes, and you know that its size is somehow linked to a target pattern of brain activity in your head. When that pattern is more active, the disc grows. When it’s less active, it shrinks. Over time, you begin to learn how to consistently make the disc bigger. But, strangely enough, you don’t always know exactly how you’re managing to control your brain activity in order to accomplish this. The learning process is implicit and outside your awareness.

Neurofeedback shows some potential as a tool for treating neurological or psychiatric disorders. The logic is that if doctors can identify a particular signature of activity in the brain that characterizes a patient’s symptoms, they might be able to use neurofeedback training to reduce that activity. If the activity is shown to have a meaningful role in causing their symptoms, then the hope is those symptoms will also decrease.

Emerging evidence supports these benefits for disorders, including ADHD and stroke recovery. Of course, there are still questions around the practicality and efficacy of this treatment. But the evidence, so far, is promising.

Repeated exposure to your deepest fears is a painful process.

Building on the potential of this research, a new study published in March 2018 by labs at UCLA and in Japan brings together the worlds of exposure therapy and neurofeedback. The study’s ambition was to expose participants not to their fears themselves (like in exposure therapy), but to the unconscious activity representing those fears in their brains (neurofeedback). By rewarding participants when their brains showed that unconscious activity, they tried to create a positive rather than negative emotional association with the feared object.

Critically, this method avoids the need to directly present the fear to participants, minimizing the chance they’ll drop out of therapy (a common problem with exposure techniques).

Surrogate volunteers with no phobias were shown the fear-based objects (e.g., spiders and snakes) and their brain activity was scanned. Researchers used these patterns to infer what fearful activity would look like in the brains of people with phobias toward those objects. Then they used neurofeedback training to reward participants whenever their brain activity looked like it represented the unseen feared object. Amazingly, neither researchers nor participants knew the fear that was being targeted: The computer randomly selected neurofeedback for each participant, automatically using an object they didn’t fear as a control.

If doctors can identify a particular activity signature in the brain that characterizes a patient’s symptoms, they might be able to use neurofeedback training to reduce that activity.

At the end of the experiment, participants’ physiological fear levels (skin conductance responses and brain activity in their amygdala) were reduced when looking at images of the object they feared. Fear responses to the control object, which was not targeted in the neurofeedback training, remained the same as before the experiment.

It’s amazing to consider what this kind of neurofeedback could do for people in the future. Imagine the benefits for those with chronic anxieties, phobias, or conditions such as PTSD. Could their symptoms one day be treated without ever exposing them to the terrors they suffer from?

When phobias are overwhelming enough that they take over our lives, we may be able to defeat them without ever directly facing them.

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When Your Body Is No Longer Yours

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When Your Body Is No Longer Yours

This article was a front-page feature on Medium.

Photo by  Andrei Lazarev  on  Unsplash

Have you ever wondered whether your arm actually belongs to you? I’d bet most people answer with a resounding “no”—because who would ask themselves such a question? But believe it or not, body ownership is something people take for granted far too often.

With many perceptual and cognitive functions, the brain operates outside conscious awareness. Minds don’t need to be burdened with or use working memory capacity on processes that work perfectly well unconsciously. And body and limb ownership is exactly one of those unconscious processes. Considering whether our arm belongs to us isn’t something we need to do—except when that process has a problem.

In typical everyday life, most of us experience an inner self inside our bodies (an intuition not unlike what many religions describe as a “soul”). Although it’s scientifically implausible for an immaterial self to exist separate from a biological body, it is difficult to shake this natural intuition. But when the experience of self versus body goes awry, the oddity of it all is in full view.

Out-of-body experiences are characterized by a person feeling as though they are seeing their own body from the outside, e.g., from the ceiling looking down or from across the room. They experience their inner self as projected out of their bodies and flung across space. These experiences have occurred in a range of neurological and psychiatric patients, but around 10% of healthy people have also reported such encounters once or twice in their lifetime.

Strange vestibular (balance and spatial orientation) sensations are common during out-of-body experiences and include a feeling of floating or flying in space separate from the body. Under normal circumstances, our senses are fully integrated, creating a coherent perception of our body in the world. But when vestibular sensations fail to integrate with visual sensations, this creates a conflict between how we perceive our body in space and how we perceive the outside world. Add in conflicts between proprioceptive (body position) and tactile (touch) senses, and our sense of our own body can be so confused it produces an out-of-body experience.

These conflicts between senses can be caused by sudden disruptions of the temporoparietal junction (TPJ) in the brain, which can occur during a struggle to remain conscious. The TPJ is known to be involved in exactly the kinds of integrated sensations that give a unified sense of self and body. In fact, if what’s going on in the TPJ is temporarily interrupted with transcranial magnetic stimulation—or when virtual reality causes a conflict between senses—how someone experiences their body becomes warped, and they’ll potentially feel something resembling an out-of-body experience.

Credit: holdentrils/Pixabay/CC0 1.0; altered by yours truly.

A simple trick called the “rubber hand illusion” can create a distorted sense of body ownership. If you want to try it, first, grab a fake hand (a stuffed rubber glove works) and sit in front of a table with both hands resting on it. Place the rubber hand on the table immediately to the right of your left hand and then hide your real left hand from view (ideally with a screen between the fake hand and your real hand). Ask a friend to repeatedly stroke the individual fingers of the visible rubber hand at exactly the same time and in exactly the same way they stroke the fingers of your real hidden hand. As you look at the rubber hand, you might begin to feel that it’s your own real hand.

This happens because of the conflict between your visual and tactile senses. You can feel a stroke on your left hand through your tactile sense, and you can see only one hand on the table roughly where your real hand normally would be. The brain makes sense of this by shifting its representation of left hand to the fake hand. Reactions to this illusion can be entertaining to watch.

In the most extreme neurological cases, the sense of bodily awareness and ownership can fully hit the wall. I’ve previously described a phenomenon known as anosognosia for hemiplegia, where patients with a paralyzed limb believe they have no paralysis at all. Somatoparaphrenia is another bodily delusion where patients deny they even own their limb. For example, one patient with a paralyzed left arm was both unaware of her arm’s disability and firmly claimed the arm belonged to her granddaughter. Discussions and reasoning with doctors generally did not help, leading either to a confused response of “I do not know” or a stronger conviction in her delusional belief.

Although we never think about body ownership under normal circumstances, the brain actively represents our body as a unique entity belonging to us, separate from the bodies of everyone else we meet.

These symptoms are frequently associated with significant damage in the right hemisphere of the brain. In one study, researchers measured automatic bodily anxiety responses (specifically, skin conductance responses or SCRs) as a sharp needle approached patients’ paralyzed limbs. Unlike patients who have normal paralysis, patients with somatoparaphrenia actually elicited a weaker SCR when the needle approached their paralyzed and disowned hand than when it approached their normal right hand. In other words, their brain so completely disowned the limb, they no longer worried the limb would hurt when stabbed.

The study above may present the most compelling example of how a sense of body ownership can practically disappear when things go sufficiently wrong in the brain. It’s also a reminder that although we never think about body ownership under normal circumstances, the brain actively represents our body as a unique entity belonging to us, separate from the bodies of everyone else we meet.

At least for me, the general malleability and vulnerability of our body representations inspires a greater appreciation for what goes on behind the scenes of our awareness. We don’t need to wait for our senses to break down to consider how valuable they really are to us. Perhaps the next time you look down at your left arm, you’ll spend an extra few seconds pondering just how amazing it is that you know it’s there and that it is yours. One less thing to take for granted.

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