An individual’s reaction to an exceptionally traumatic and stressful event ranges from a normative reaction to psychiatric disorders identifiable not only on the grounds of symptomology and course, but also on the basis of causative influence. An Acute stress reaction, Post-traumatic stress disorder (PTSD) or an Adjustment disorder are thought to arise always as a direct consequence of the acute stress or continued trauma. The time course of spontaneous recovery after a significantly traumatic experience varies considerably and individual vulnerability and coping capacity play a role in determining not only the severity, but also the occurrence of these disorders. They are maladaptive responses to severe or continued stress, which interfere with successful coping mechanisms and invariably lead to problems in personal, social and occupational functioning. 

These individual conditions are detailed in the referenced links. It is important to clarify the distinction between a normative response to trauma and a disorder involving dysfunction and diagnosis serves the crucial clinical objectives of identifying individuals in need of treatment and guiding treatment selection. Psychological and pharmacological interventions may shorten the course of the normal posttraumatic response, reduce PTSD symptoms, prevent the development of chronic PTSD, help to restore functioning and prevent functional deterioration.

References and links:

1. http://www.patient.co.uk/health/Stress-Acute-Reaction-to-Stress.htm
2. http://www.rcpsych.ac.uk/mentalhealthinfo/problems/ptsd/posttraumaticstressdisorder.aspx
3. http://www.adjustmentdisorder.org/
4. Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388.
5. Hetrick SE, Purcell R, Garner B, Parslow B. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2010;(7):CD007316.
6. Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database Syst Rev. 2010;(3):CD007944.

www.bbc.co.uk/iplayer/episode/b01hllwk/Sporting_Heroes_After_the_Final_Whistle/
www.bbc.co.uk/sport/0/17953358
www.telegraph.co.uk/sport/columnists/michael-vaughan/9252933/Michael-Vaughan-you-must-move-on-quickly-after-a-life-in-sport-or-it-can-become-a-life-sentence.html

From our clinical work we know that any period of transition or life change is accompanied by a set of emotional responses. For many the change is easily managed, some experience transient emotional distress and a small number develop psychological illnesses such as depression, anxiety disorder, alcohol or drug problems etc.

In providing the Rugby Players Association (RPA) confidential counselling service over the last 3 seasons (www.therpa.co.uk/playerservices/mens_health.php.) we have seen a number of players in need of psychological support at the end of their career. Some question their true identity – “Who am I?” as Tony Adams asked himself after leaving football. Some have a crisis of confidence, robbed of the self esteem which was previously based on their sporting achievements. Some pursue destructive paths in pursuit of the lost buzz of performing and winning.

Our work generally involves 3 or 4 sessions of cognitive behavioural coaching to challenge the negative and self defeating mind-set that can creep in during times of change and uncertainty. We encourage people to draw on their strengths and use the attributes and behaviours that have seen them achieve in sport to best effect in their new roles. And the results are very good.

More important than this reactive approach to ‘career termination issues’ however is the invaluable preparatory work done by the Player Associations for their members. Josh Lewsey the former England Rugby World Cup winner (aka “ex-minor sporting celebrity”) emphasised the importance of an “early investment in the future”. Through education & training, work placements, businesses networking events and other services, the Associations help their members to improve their performance during their careers and their prospects afterwards.

The mindset shift between pre & post after retirement was evidenced by comparing the carefree cricketer Matthew Hoggard to all the retired sportsmen. But most of all by comparing him to the reflective quadriplegic ex-rugby player Matt Hampson (“You come to realize there’s a lot more to life than sport”).

If Mr Hoggard was serious when he said, “Sometime I’m going to have to grow up!” he could do worse than hitting this link: http://www.thepca.co.uk/personal_development.html watch the video and then speak to his Player Development Manager at the Professional Cricketers Association.

The subject is ‘Building a Resilient Workplace with Mindfulness-based Cognitive Behavioural Therapy’. Our speaker is Rob Archer, Chartered Occupational Psychologist and Director, LPP Consulting.

 Overview:
Resilience is defined as the ability to perform under pressure, cope effectively with stress and recover from setbacks. A resilient workforce is therefore better able to cope with today’s fast-changing, demanding work environment.

We now know that resilience is not a trait but a skill, which anyone can learn if they know where to start. In this one hour briefing, Rob will highlight the most important psychological factors involved in building resilience, and identify practical ways of developing resilience in the workplace. In particular, Rob will focus on mindfulness – and how practical ways of incorporating mindfulness into the workplace can boost both wellbeing and performance.

If you’re responsible for workplace performance or wellbeing, we would love to have you along. Please get in contact with Anna Curtin on anna.curtin@lppconsulting.org or call her on 020 3219 3080,

Over the years, various models have been proposed to help us understand why people become and then stay depressed. In the 1970s, Martin Seligman conducted animal experiments that are now considered unethical. By giving electric shocks to dogs, he found that dogs who consistently were given no control over their situations, developed a sense of ‘learned helplessness’ (2). This meant that they stopped trying to avoid pain and became passive in a similar way to people who are depressed.

Given the recent global economic difficulties, it is interesting to consider a parallel that has been drawn between depression and limiting one’s investments. Robert Leahy (2002) suggests that depression can be understood in terms of an ‘investment model’ (3). That is, when a person experiences a loss and develops depression as a strategy to guard against further loss. For example, if a businessperson loses money in a deal, it makes sense that he or she may be reluctant to make a similar investment again. This analogy can help us make sense of the common thinking and behavioural patterns in people with depression, as if someone who is depressed has found that trying to move on has not worked, it makes sense that they may not want to risk investing their already dwindling resources again. Leahy uses the term ‘strategic pessimism’ to explain why people who are depressed resist change in order to prevent further losses. According to this model, negative thinking is not distorted, but rather it represents a bias towards being prepared for the worst case scenario. Given this bias, the person is then less likely to engage in a full search of the possible solutions to their problem. Rather than focusing on what could be gained, the focus is on what might be lost. In this way, people with depression can be seen as similar to prudent investors, who take a low-risk approach to investments.

Using Leahy’s model of depression as a strategy to minimise further loss can help us to make sense how difficult it is to recover from chronic depression. More importantly, this model may lead people with depression to consider whether continuing with limited investment is helping them move forward in their lives.

1. The Health & Social Care Information Centre, 2009, Adult psychiatric morbidity in England, Results of a household survey
2. Seligman, M. (1975). Helplessness: On Depression, Development, and Death. San Francisco: W. H. Freeman.
3. Leahy, R. (2002). An Investment Model of Depressive Resistance. Psychology of Economic Thinking: Cognitive Processes and Conceptualisation. http://www.springerpub.com/ Available online at http://www.352express.com/wpm/files/40/springer%20INVEST080901-1.pdf

‘‘Individuals’ beliefs about themselves influence how they act in particular situations, the goals they pursue in life, how they feel about life events and relationship partners, and the ways in which they cope with and adapt to new environments’’ (Robins et al., 2001, p. 465). Subsequently, self-esteem may also influence engagement in a new environment such as Facebook (Zywica & Danowski, 2008). According to Ellison, Gibbs & Heino (2006) the “digital identity” represents how a person is perceived in the online environment and it has a direct impact in enabling or preventing social interactions as well as the types of interaction. Identity (real or fake) is formed and moulded as the person unveils his or her thoughts and have others offer comments and feedback on SNS’s. The online environment has a direct impact in creating active social interactions to assist in defining our identity. Self-presentation refers to a person’s effort to express a specific image and identity to others (Baumeister, Tice, & Hutton, 1989).

A study investigating the use of Facebook warns that people can misrepresent themselves more easily by controlling impressions and information via computers. People utilize different strategies to maintain their “persona” (Ellison, Gibbs & Heino, 2006). People often misrepresent themselves through pictures or false statements that make them seem more attractive. This kind of “false advertising” may have negative repercussions when the first meeting between individuals takes place, and the authenticity of prior communication and appearance is verified in person (Hardey, 2004). This raises questions about the relationship that exit between SNS usage and an individual’s self-esteem.

As a CBT practitioner I am “mindful” that we may need to start thinking about how Facebook could be incorporated into CBT practice to assist the therapeutic process. It could potentially serve as a platform to investigate and challenge the client’s automatic thoughts, erroneous beliefs, cognitive errors and compensation strategies. This could also raise a multitude of questions about incorporating Facebook (or other social networking sites) in treatment interventions for different disorders for example narcissism, depression and social phobia.

Evidence drawn from attachment and neurobiology research shows that it is the quality of the emotional relationship with the caregivers which equips the child with the capacity to be able to regulate its psychobiological states (and thereby affect, cognition, and behaviour) as it matures (Schore,2001; Balbernie, 2001).  When a parent loves and enjoys her baby in an ordinary way, a positive interactive cycle takes place which is mutually rewarding and beneficial to the baby’s development.

Some parents’ emotional sensitivity to their baby can be blunted or distorted if they are under stress or feeling emotionally distressed.  This can present as forms of postnatal depression. Often this resolves itself, but nevertheless causes distress and disruption to the sufferer and the family. Some continue to feel unhappy, irritable or anxious about being a parent and worried something feels amiss in the relationship with their baby. Help is available if a mother or father feels negative about being a parent or are worried about feeling numb, or rejecting or hostile towards the baby.  The emotional well-being of a parent really matters to the developing infant, and it is very important that parents seek help before too long from a sympathetic health professional

Parents seeking psychotherapy in the peri-natal period are often worried about difficult feelings, or that something in their own past is being repeated. A confidential talk with a non-judgmental psychotherapist enables difficult feelings and worrying thoughts to be understood, helping to free a parent to enjoy more their child and increases the likelihood for resilience and emotional well-being for the baby later in life.

References

Balbernie, R. (2001) Circuits and circumstances: the neurobiological consequences of early relationship experiences and how they shape later development. Journal of Child Psychotherapy, Vol 27, No 3, 2001 237-255

De Neve, J-E., Oswald, A. (2012) ‘Happiness Pays: measuring the effect of subjective well-being on later income using sibling fixed effects’

Schore, A.N. (2001) The effects of relational trauma on right brain development, affect regulation, and infant mental health. Infant Journal of Infant Mental Health, 22:201-269

One wonders how parents respond to headlines such as these. Is it fair for parents to be defined as a “problem” by society? Given the pressure that this description places on parents, it might be hard for parents to imagine surviving parenting struggles and to find solutions. 

After all, every parent who has had a problem managing their child’s behaviour will also have had so many successes along the way in everyday life. It is easy to lose sight of these but vital to hold on to them. Experiences of success, however small, are money in the bank, and the key to identifying solutions.

Every parent could probably benefit from a solution tool box. This might include strategies for:

• Remembering that there is no one single solution to any one problem.

• Emphasizing successes and harnessing resources to construct future positive behaviour patterns. For example, if as a parent you’ve been able to remain calm and manage your child’s angry outburst, consider that a success. Look back on what you did in that moment and use those skills in the future.

• Setting goals, providing they are immediate, concrete and achievable, are useful for identifying where you want to get to. A goal for a parent might be to spend more time each day in a shared activity with their child. Not easy when you are leading a busy life or having a tough time with your children, but useful in strengthening a parent-child relationship

• Identifying preferred futures. When you feel you are not coping in the present, it is easy to fast forward to a future where everything is worse. This leaves you with less energy for managing present problems. It is about visualising a time in the future, say 6 months ahead, when family life is going well. Once you have constructed a detailed picture of what this future looks like, you can track back and work out the steps to needed to achieve it.

A headline for parents trying to resolve problems might be: “If it works, do more of it. If it doesn’t work, don’t do it anymore. Do something different” Quick (1996).

References:

Quick E (1996) ‘Doing what works in Brief Therapy. A strategic solution focused approached’ San Diego Academic Press

De Shazer (1988) ‘Clues investigating solutions in brief therapy’ New York W.W Norton & Co.

http://www.telegraph.co.uk/topics/weather/9193379/Weather-Easter-Monday-washout-as-torrential-rain-and-gales-batter-UK.html

Sunshine & Gloom, Leaders’ Easters in The Daily Telegraph page 4 Monday 8th April 2012

Rain and gale force winds spoiled Bank Holiday plans for millions across the UK, including the Prime Minister David Cameron and his family who made the most of the overcast weather in North wales. The rainfall may have boosted water supply to gardens and reservoirs; however a nationwide lack of sunshine has deprived the UK workforce and their families, of the health benefits of topping up their vitamin D levels.¹

Vitamin D is synthesised in the skin on exposure to sunshine, so it is not surprising that levels in the UK population are usually higher during the summer months and lower in the winter months, as body stores are depleted. However even during the summer months long office hours, indoor lifestyle, and overuse of sunscreens have contributed to an insufficiency of this key nutrient.¹

According to Chief Medical Officer for England Professor Dame Sally Davies “A significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood.” Women who are pregnant or breastfeeding, those with darker skin tones, those that cover their skin for cultural reasons, together with the elderly, teenagers and those under 5 years may be at further risk of vitamin D deficiency.²

Why all the fuss?

Most of us feel better when the sun is shining. However we may not know that Vitamin D has multiple beneficial effects on the tissues, organs and systems of the body.³

Interest in vitamin D has broadened in recent years from a focus on bone health and the prevention of rickets and osteoporosis,⁴ to consideration of its role in cancer,⁵ cardiovascular disease,⁶ and autoimmune conditions such as multiple sclerosis.^7,8 Moreover poor vitamin D status has been linked to increased mortality,⁹ infertility,¹⁰ diabetes,¹¹ body weight,¹² frequent infections,¹³ and mood disorders.^14,15,16

There is some indication that vitamin D boosts performance in athletes^17,18 which is newsworthy considering that London hosts the 2012 Olympics.

What can we do?

We can get more sun exposure perhaps in our lunch breaks and at weekends if the sun is shining. In the UK optimal synthesis of vitamin D occurs between May and September. Current guidelines are 20-30 minutes daily skin exposure to sunlight of the arms, legs and torso, before application of sunscreen. Sunscreen even as low as factor 8 will prevent 96% of vitamin D synthesis. Short breaks to sunny destinations are also advocated if possible. However sunbathing is not recommended and the photosensitive are advised to seek advice from GP or dermatologist.¹⁹

We can eat foods that contain vitamin D such as oily fish, dairy products, eggs and fortified foods such as breakfast cereals and fat spreads.

We can take vitamin D supplements, however since adverse effects may occur at high dosages it is advisable to seek expert advice from a healthcare professional. UK Dietary Reference Values for vitamin D are currently under review by The Scientific Advisory Committee on Nutrition (SACN) ²⁰ and research to clarify the health benefits of vitamin D is on-going.

So now you really have a good excuse to take that short midday break outdoors when the sun is shining.

References

1. Pearce S. Diagnosis and management of vitamin D deficiency. BMJ 2010; 340:b5664.
2. Department of Health http://.dh.gov.uk/2012/02/vitamin-d/
3. Holick M. Vitamin D Deficiency N Engl J Med 2007; 357:266-281
4. Heaney RP The effect of vitamin D dose on bone mineral density. Osteoporos Int. 2012 Feb; 23(2):789-90.
5. Buttigliero C, Monagheddu C. et al Prognostic role of vitamin d status and efficacy of vitamin D supplementation in cancer patients: a systematic review. Oncologist 2011; 16(9): 1257-27.
6. Lavie CJ, Lee JH, Milani RV Vitamin D and cardiovascular disease will it live up to its hype? J Am Coll Cardiol. 2011 Oct 4;58(15):1547-56.
7. Shoenfeld N, Amital H, Shoenfeld Y. The effect of melanism and vitamin D synthesis on the incidence of autoimmune disease. Nat Clin Pract Rheumatol. 2009 Feb; 5(2):99-105.
8. Compston, A. Coles, A. Multiple sclerosis. Lancet. 2008 Oct 25; 372 (9648): 1502-17.
9. Schöttker B, Ball D, Gellert C, Brenner H. Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies. Ageing Res Rev. 2012 Feb 17. [Epub ahead of print]
10. Lerchbaum E, Obermayer-Pietsch BR. Vitamin D and fertility-a systematic review Eur J Endocrinol. 2012 Jan 24.
11.  Stivelman E, Retnakaran R. Role of vitamin d in the pathophysiology and treatment of type 2 diabetes. Curr Diabetes Rev. 2012 Jan 1; 8(1):42-7.
12. Soares MJ, Murhadi LL, et. al. Mechanistic roles for calcium and vitamin D in the regulation of body weight. Obes Rev. 2012 Mar 2. doi: 10.1111/j.1467-789X.2012.00986.x.
13. Khoo AL, Chai L, et.al. Translating the role of vitamin D (3) in infectious diseases. Crit Rev Microbiol. 2012 Feb 5. [Epub ahead of print].
14. Tariq MM, Streeten EA, et.al Vitamin D: a potential role in reducing suicide risk? Int J Adolesc Med Health. 2011; 23(3):157-65.
15.  Cherniack EP, Troen BR, et.al. Some new food for thought: the role of vitamin D in the mental health of older adults. Curr Psychiatry Rep. 2009 Feb; 11(1):12-9.
16. Annweiler C, Schott AM, et.al. Vitamin D and ageing: neurological issues Neuropsychobiology. 2010 Aug; 62(3):139-50. Epub 2010 Jul 14.
17. Cannel J, Hollis B, et. al. Athletic performance and vitamin D. Medicine in Science & Sports Exercise 2009, 1102-1110.
18. Hamilton B. Vitamin D and Athletic Performance: The Potential Role of Muscle. Asian J Sports Med. 2011 December; 2(4): 211–219.
19. Holick M, Binkley N, Bischoff-Ferrari H, et.al. Controversy in Clinical Endocrinology: Guidelines for Preventing and Treating Vitamin D Deficiency and Insufficiency JCEM 2012 97: 1153-1158.
20. SACN Vitamin D http://www.sacn.gov.uk/meetings/working_groups/vitamin/index.html

Dr Predrag Petrovic and his team at the Department of Clinical Neuroscience found that players with the best test scores on executive functioning also had the best results on-field in the league (goals scored and assists). They also found that the players in the top division scored significantly higher than the players in division 1. In addition, footballers as a whole were in the top two percentile for the population by this measure. These results are unique, since they are based on scientifically standardised tests.

This result is another interesting and important finding in the process of discovering which psychological / neuro-psychological aspects are most important in predicting on-field performance. These types of assessment instruments can become a very important tool in developing new and potentially successful football players. Further studies would, however, be needed to determine if it is possible to improve executive functions or if it is an innate component. It is possible, as with most psychological components that it could be part learned and part inherited. Whatever the answer might be, it emphasises the important role that relevant scientific and psychological tools can play in elite sports performance as either a predictive tool or a baseline assessment for further intervention.

As clinicians, at LPP we are collaborating with various international partners to find ways of bringing these and other research findings to the sports environments to assist elite sports people in optimising performance.

So, using the same ‘data’, an event can either be “targeting the rich” or “a millionaires’ budget”. The point of my writing this is not to determine which of these perspectives is ‘correct’ but to demonstrate something central to our work in psychology: people interpret the same information in very different and often polarised ways. Unhelpful reactions, emotional or behavioural, are common consequences of this style of thinking, which can be seen as the mind’s attempt to simplify and make sense of information – humans tend not to enjoy ambiguity.

This sort of polarisation is typical of human minds, whether acting alone or in groups. Whilst the “answer” might be somewhere in the middle, starting out with views in such opposition rarely gets us to it.

Another process evident in the political and media reaction to the budget is something psychologists refer to as “cognitive fusion”– this occurs when people are ‘stuck’ in a particular way of viewing a situation or other people: new information confirms what they already ‘know’. In some parts of the house/society this was “the same old Tories” and in others it was “cleaning up Labour’s mess”. Wouldn’t these have been the reactions regardless of the content?

Again, my point is not to argue about the accuracy of such statements but to suggest that starting out with this viewpoint probably doesn’t encourage beneficial discussions.

If these kinds of thinking and responding are unhelpful, why do they persist? A major reason is one of the basic rules of behavioural psychology: behaviour that is rewarded is usually repeated. Anyone watching Question Time or BBC Parliament for more than a few minutes will see that polarised opinions fused to particular interpretations ‘truth’ are greeted with cheers. Audiences (not excluding this author sadly) are captivated by the baiting of some politician or other and ‘winning’ the debate is the goal above all. It is interesting to note that some of the same “traps” that lead to unnecessary emotional suffering are relevant at the level of our society. But it is also unsurprising – they are, after all, the human mind in action. In our consultations we work to identify these kinds of extremes and then focus on what works to move people forward in their lives. For example, we might notice that fusion to the goal of being successful prevents a person from making progress towards a professional, sporting or personal goal. A flexible approach to success and failure allows them to try something new and learn from their experience. Whilst a similar approach to the nation’s political life might not be such entertaining viewing I wonder if it might enable our leaders to get on with the real work.