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Low-fat or low-carb? It’s a draw, study finds — ScienceDaily

Low-fat or low-carb? It’s a draw, study finds

What’s the best diet? (stock image)
Credit: © Pavel Bobrovskiy / Fotolia

New evidence from a study at the Stanford University School of Medicine might dismay those who have chosen sides in the low-fat versus low-carb diet debate.

Neither option is superior: Cutting either carbs or fats shaves off excess weight in about the same proportion, according to the study. What’s more, the study inquired whether insulin levels or a specific genotype pattern could predict an individual’s success on either diet. The answer, in both cases, was no.

“We’ve all heard stories of a friend who went on one diet — it worked great — and then another friend tried the same diet, and it didn’t work at all,” said Christopher Gardner, PhD, professor of medicine and the lead author of the study. “It’s because we’re all very different, and we’re just starting to understand the reasons for this diversity. Maybe we shouldn’t be asking what’s the best diet, but what’s the best diet for whom?”

Past research has shown that a range of factors, including genetics, insulin levels (which helps regulate glucose in the body) and the microbiome, might tip the scales when it comes to weight loss. The new study, to be published Feb. 20 in JAMA, homed in on genetics and insulin, seeking to discover if these nuances of biology would encourage an individual’s body to favor a low-carbohydrate diet or a low-fat diet. The senior authors of the study are Gardner; Abby King, PhD, professor of health research and policy and of medicine; Manisha Desai, PhD, professor of medicine and of biomedical data science; and John Ioannidis, MD, DSc, professor of medicine.

A tale of two diets

In his quest to find out if individual biological factors dictate weight loss, Gardner recruited 609 participants between the ages of 18 and 50. About half were men and half were women. All were randomized into one of two dietary groups: low-carbohydrate or low-fat. Each group was instructed to maintain their diet for one year. (By the end of that year, about 20 percent of participants had dropped out of the study, due to outside circumstances, Gardner noted.)

Individuals participated in two pre-study activities, the results of which were later tested as predictors of weight loss. Participants got part of their genome sequenced, allowing scientists to look for specific gene patterns associated with producing proteins that modify carbohydrate or fat metabolism. Then, participants took a baseline insulin test, in which they drank a shot of glucose (think corn syrup) on an empty stomach, and researchers measured their bodies’ insulin outputs.

In the initial eight weeks of the study, participants were told to limit their daily carbohydrate or fat intake to just 20 grams, which is about what can be found in a 1.5 slices of whole wheat bread or in a generous handful of nuts, respectively. After the second month, Gardner’s team instructed the groups to make incremental small adjustments as needed, adding back 5-15 grams of fat or carbs gradually, aiming to reach a balance they believed they could maintain for the rest of their lives. At the end of the 12 months, those on a low-fat diet reported a daily average fat intake of 57 grams; those on low-carb ingested about 132 grams of carbohydrates per day. Those statistics pleased Gardner, given that average fat consumption for the participants before the study started was around 87 grams a day, and average carbohydrate intake was about 247 grams.

What’s key, Gardner said, was emphasizing that these were healthy low-fat and low-carb diets: A soda might be low-fat, but it’s certainly not healthy. Lard may be low-carb, but an avocado would be healthier. “We made sure to tell everybody, regardless of which diet they were on, to go to the farmer’s market, and don’t buy processed convenience food crap. Also, we advised them to diet in a way that didn’t make them feel hungry or deprived — otherwise it’s hard to maintain the diet in the long run,” said Gardner. “We wanted them to choose a low-fat or low-carb diet plan that they could potentially follow forever, rather than a diet that they’d drop when the study ended.”

Continuing to mine the data

Over the 12-month period, researchers tracked the progress of participants, logging information about weight, body composition, baseline insulin levels and how many grams of fat or carbohydrate they consumed daily. By the end of the study, individuals in the two groups had lost, on average, 13 pounds. There was still, however, immense weight loss variability among them; some dropped upward of 60 pounds, while others gained close to 15 or 20. But, contrary to the study hypotheses, Gardner found no associations between the genotype pattern or baseline insulin levels and a propensity to succeed on either diet.

“This study closes the door on some questions — but it opens the door to others. We have gobs of data that we can use in secondary, exploratory studies,” he said. Gardner and his team are continuing to delve into their databanks, now asking if the microbiome, epigenetics or a different gene expression pattern can clue them in to why there’s such drastic variability between dieting individuals.

Perhaps the biggest takeaway from this study, Gardner said, is that the fundamental strategy for losing weight with either a low-fat or a low-carb approach is similar. Eat less sugar, less refined flour and as many vegetables as possible. Go for whole foods, whether that is a wheatberry salad or grass-fed beef. “On both sides, we heard from people who had lost the most weight that we had helped them change their relationship to food, and that now they were more thoughtful about how they ate,” said Gardner.

Moving forward, he and his team will continue to analyze the reams of data collected during the yearlong study, and they hope to partner with scientists across Stanford to uncover keys to individual weight loss.

“I’m hoping that we can come up with signatures of sorts,” he said. “I feel like we owe it to Americans to be smarter than to just say ‘eat less.’ I still think there is an opportunity to discover some personalization to it — now we just need to work on tying the pieces together.”

The study’s other Stanford co-authors are postdoctoral scholars John Trepanowski, PhD, and Michelle Hauser, MD; research fellow Liana Del Gobbo; and senior biostatistician, Joseph Rigdon, PhD.

Gardner, Desai and Ioannidis are members of the Stanford Cancer Institute. Gardner and Ioannidis are members of the Stanford Cardiovascular Institute. Gardner and Desai are members of the Stanford Child Health Research Institute. Ioannidis is a member of Stanford Bio-X.

The study was funded by the National Institutes of Health (grants 1R01DK091831, T32HL007034 and 1K12GM088033), the Nutrition Science Initiative and Stanford’s Clinical and Translational Science Award (grant UL1TR001085).

Stanford’s departments of Medicine and of Health Research and Policy also supported the work.

Story Source:

Materials provided by Stanford Medicine. Original written by Hanae Armitage. Note: Content may be edited for style and length.

Journal Reference:

  1. Christopher D. Gardner, John F. Trepanowski, Liana C. Del Gobbo, Michelle E. Hauser, Joseph Rigdon, John P. A. Ioannidis, Manisha Desai, Abby C. King. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical TrialJAMA, 2018; 319 (7): 667-679 DOI: 10.1001/jama.2018.0245

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Stanford Medicine. “Low-fat or low-carb? It’s a draw, study finds.” ScienceDaily. ScienceDaily, 20 February 2018. <>.


What are Panic Attacks and what’s happening when we have them?

Explainer: what are panic attacks and what’s happening when we have them?

Image 20151210 7428 1rgdbaj.jpg?ixlib=rb 1.1

It’s important to remember the symptoms of a panic attack are “just” caused by anxiety and are not life-threatening.

Lynne Harris, University of Sydney

What would you think was happening to you if out of nowhere your heart started to race, you were drenched in sweat, you found yourself trembling uncontrollably, short of breath, with chest pain and feeling nauseated, dizzy and lightheaded as though you might faint?

You might also be feeling very cold or very hot, with tingling sensations in your fingers and toes. You might feel removed from the world around you – as though it wasn’t real – and be worried that you might lose control or that you are going insane. You might try to work out what is happening and conclude you are having a heart attack or dying.

A panic attack is a sudden, intense feeling of fear or discomfort with at least four of the signs described above. For some people, a panic attack can come out of nowhere, like a sudden thunderstorm from a clear blue sky. For other people, panic attack may be more predictable, such as an abrupt escalation of a milder anxiety about giving a speech or speaking to someone in authority.

Just as a panic attack can follow an experience of relative calm or of mild anxiety, panic can resolve to a relatively calm state or to ongoing, less intense symptoms. But the symptoms of panic attack are severe and frightening. Many people experiencing a panic attack believe they are seriously ill and seek medical help.

What is happening to the body?

Often one of the first symptoms of a panic attack is hyperventilating (rapidly breathing in and out), which upsets the natural balance of oxygen and carbon dioxide in our system. One view says a low level of carbon dioxide in the blood directly triggers the symptoms of panic, such as feeling lightheaded and dizzy. When we breathe quickly we also build up oxygen in our blood. Paradoxically, too much oxygen is also associated with feeling short of breath.

Hyperventilation causes many of the other symptoms of a panic attack such as dizziness, blurred vision, tingling, muscle tension, chest pain, heart rate increases, nausea and temperature changes.

People who experience panic misinterpret the bodily signs of hyperventilation as indicating immediate physical danger and believe they have little control over the symptoms. When we then say things to ourselves such as “I might be having a heart attack” and “I can’t cope with this”, the anxiety gets worse.

In a 2013 study, researchers showed when people with no history of panic inhaled air with increased carbon dioxide they reported fear, discomfort and panic symptoms. People with a history of panic attack experience these symptoms at lower concentrations of carbon dioxide, suggesting they are hypersensitive to this internal signal for danger.

Panic attacks can occur with a range of diagnosed mental illnesses, including anxiety disorders, depressive disorders and substance use disorders, as well as physical illnesses, especially illnesses that affect heart function, breathing, balance and digestion. It is very important to understand and deal with panic attacks so they don’t lead to a more serious condition known as panic disorder.

People with panic disorder have a history of panic attacks and worry they will have further panic attacks. They change the way they live to ensure they do not have another panic attack. They avoid activities like exercise that cause feelings similar to panic attack (shortness of breath, sweating) and avoid situations where they fear another panic attack may occur. This avoidance brings many additional problems, as social, family and occupational worlds shrink due to fear of panic.

What should you do if you have a panic attack?

Panic attacks are common, with almost 23% of a people from a large US study of the general population reporting at least one panic attack during their lives. Panic attacks are more common in females than males. They are also more common in family members of people with panic disorder.

Panic attacks are more common among people who believe symptoms of anxiety are dangerous and harmful, rather than annoying and uncomfortable. They are also more likely if you are under emotional pressure, have been ill, are tired, are hungover or smoke.

As many of the symptoms of panic attack are physical and can be caused by a number of physical conditions, the first thing to do if you have symptoms like the ones described here is to see your doctor to check whether there is a medical reason for the symptoms.

If the symptoms are due to panic, then there are effective psychological approaches for controlling panic attacks. These focus on:

  1. monitoring and slowing breathing, as overbreathing causes many panic sensations

  2. correcting the interpretations about what the symptoms mean by looking at the things we say to ourselves before, during and after a panic attack. It is very important to remember the symptoms are “just anxiety” and are not life-threatening.

The ConversationThere is useful information about panic attack and how to cope with it available through Lifeline.

Lynne Harris, Professor of Psychological Sciences, School of Psychological Sciences, Australian College of Applied Psychology and Honorary Assoc Prof with the Faculty of Health Sciences, University of Sydney

This article was originally published on The Conversation. Read the original article.

The right words matter when talking about pain

The right words matter when talking about pain

Michael Vagg, Barwon Health

It is no coincidence that we describe the “pain” of loneliness or the “agony” of rejected romantic feelings. Paper cuts can be “excruciatingly painful”, but so can watching the social mishaps of Basil Fawlty or David Brent. Personal criticism can be “stinging”.

The book The Patient’s Brain outlines the evidence that later evolutionary traits such as social cognition and language appear to have grafted themselves onto the ancient brain functions that alerted us to external threats or bodily damage.

Words are neurological events. They are meaning-laden puffs of air that our brain transforms into knowledge, opinions, emotions or danger signals.

Shakespeare, perhaps the greatest wordsmith of all time, frequently used bodily sensations including sensitivity to pain as metaphors. If you’ve ever complained about the “bitter cold”, called an ugly sight an “eyesore” or felt it “sharper than a serpent’s tooth … to have a thankless child” you might know what I mean.

Words affect pain

The “right” words in a medical context can activate both the pain-busting endogenous opioid networks in the brain and the feel-good dopamine-driven reward centres. One of the most widely relied-upon pain assessment questionnaires, the McGill Pain Questionnaire, relies entirely on verbal descriptions of pain to diagnose the severity of someone’s pain.

I have a patient with complex regional pain syndrome (a severe, uncommon type of nerve pain), who has little pain in her affected foot as long as she doesn’t think or talk about it. Mention the foot and her symptoms burst into life, causing a severe burning and prickling sensation. Even listening to me discussing it with her husband can set it off.

Given how important language can be to pain sufferers, well-trained clinicians go to some lengths to use appropriate terms. We can spot patients at higher risk of disability by carefully listening to how they tell us about their pain predicament. I forbid any of my trainees in pain medicine to use the following phrases in consultations because of their poisonous effect on patients:

That’s the worst I’ve ever seen

It looks like bone-on-bone

Your disc is collapsed/busted/blown out/ruined

You will end up in a wheelchair

Just learn to live with it.

No doubt readers could expand this ghastly collection of backhanded reassurances with some from their own experience. The reason such phrases are unhelpful is that they come to define all subsequent attempts at therapeutic interaction. If you have any doubt about the power of medical words to influence perceived pain, I can quote a recent study that provides a good example.

This study compared “real” acupuncture to “sham” acupuncture where both were delivered with either a neutral or highly positive endorsement from the practitioner. Both the groups who received acupuncture showed an equal improvement compared to a group left on the waiting list.

Maybe pained smiley faces could convey how much pain we feel?
Macprohawaii/Flickr, CC BY

Those who received their acupuncture from a highly positive practitioner did better whether they got the “real” or the “sham” needle placement. Those who got a lukewarm practitioner didn’t get as much relief even when the needles were correctly placed.

This isn’t surprising, as this is just the most recent addition to a large literature confirming that positive feelings by the patient towards the context and manner in which an ineffective treatment is administered have an undeniable influence on short-term outcome. There’s a point to being positive when recommending treatments, though these initial responses don’t hold up over time in the absence of a genuinely therapeutic effect. You can’t fool all of the people all of the time.

Rephrasing pain

A critical task in pain psychology is therefore to help people learn to rephrase their inner monologue so it becomes more realistic and supportive. Being able to catch and recognise unhelpful or unrealistic impulses is not easy to do, but this skill is the basis of many successful adaptions to persistent pain. Imagine if every time you were pulled up short by your pain, you thought to yourself:

It’s ridiculous that I can’t do this, I’ve always been able to do it.

The resulting emotions caused by this language are frustration, shame and resentment. Anyone doing something ridiculous must be deserving of ridicule, which means the pain is making you into a figure worthy of contempt and embarrassment. Now imagine you caught yourself about to think that first thought but replaced it with:

It’s annoying I can’t do things like I used to. I’m working on getting better at it, but I’m not there yet.

This may be equally as factual as the first thought, but the tone is much less contemptuous and the resulting emotions are more likely to encourage resilience than sap morale. The thought may be father to the deed, but words are mother to the thought. This insight forms the basis of cognitive behavioural therapy (a form of psychotherapy that aims to change unhelpful thinking behaviours), which has been significant in helping people live with persistent pain for most of the last three decades.

Listen carefully to the language that surrounds people with pain. Listen to how you talk about them. Are you increasing their disability by using well-intentioned pain cliches?

If you have persistent pain, it can be valuable to test yourself and see if you may be holding yourself back without knowing it. A better life may be just a few helpful phrases away.

This article is part of a series focusing on Pain. Read other articles in the series here.

Michael will be on hand for an Twitter Q&A between 11am and noon AEDT on Thursday, December 3rd, 2015. Post your questions on Twitter using the hashtag #AskAnExpert.

The Conversation

Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon Health

This article was originally published on The Conversation. Read the original article.

What works best in the war on drugs

What works best in the war on drugs

By Alex Wodak, St Vincent’s Hospital, Darlinghurst (reprinted from the Conversation)

In 1967, the Beatles took out a full-page advertisement in The Times describing Britain’s marijuana laws as “immoral in principle and unworkable in practice”. Almost half a century later, both past and serving political leaders around the world are acknowledging that drug prohibition in the guise of the war on drugs hasn’t worked.

Global drug prohibition slowly evolved during the 20th century with several international meetings culminating in three UN drug treaties and a network of UN agencies to enforce them.

The three treaties – the Single Convention on Narcotic Drugs, 1961, the Convention on Psychotropic Substances, 1971, and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 – bound their signatories to pass legislation imposing criminal sanctions on those convicted of cultivating, producing, transporting, selling, buying, using or possessing any of the approximately 250 drugs listed by the UN system.

The UN Commission on Narcotic Drugs sets policy, the UN Office on Drugs and Crime implements it, the International Narcotics Control Board monitors national compliance, and the World Health Organization tells the Commission on Narcotic Drugs what to add to the list of illicit drugs.

This approach has been an utter failure.

The drug trade has expanded substantially in the half century since the first international drug treaty; the United Nations Office on Drugs and Crime estimated the total retail value of the global illicit drug trade in 2003 at US$320 billion.

And deaths, disease, crime, corruption and violence have all soared. It’s clearly time to go back to the drawing board.


Drug policies have to be realistic to be effective, and prohibition clearly isn’t. Whatever else drugs might be, they also create powerful markets; in the absence of a legal source, strong demand finds other forms of supply.

After the United States government prohibited alcohol in 1920, for instance, consumption fell. But, within a few years, it started rising again and by 1922, it had surpassed the 1920 level.

Since the start of the war on drugs, governments across the world have allocated most funds to drug law enforcement. But the policy failed abjectly because drug laws cannot be enforced.

Drug traffickers make so much money that they can corrupt or intimidate whoever stands in their way. Prohibition has undermined governments and eroded important civic institutions in both supplier and transit countries, such as Afghanistan and Pakistan.

Indeed, the drug trade is too big, too powerful, and too awash with profit to ever be eradicated. Still, we can do something about it.

To be effective, drug policies have to be based on evidence, rather than intuition about what should or shouldn’t work or public opinion. But while it is a terrible policy for society and public health – it lands masses of people in jail for minor crimes, for instance, and makes the difficult task of controlling blood-borne viruses almost impossible – the war on drugs is often good political strategy. It helps political candidates win elections on a law-and-order platform, providing a disincentive for ending the hardline approach.


Evidence shows drug law enforcement has been an expensive way to make a bad problem worse because it manifestly cannot do what it sets out to do, which is make drugs unavailable.

Health and social interventions, on the other hand, are relatively inexpensive ways of making a bad problem less bad, albeit slowly. Such approaches include harm reduction in the form of needle syringe and drug-replacement programs, and social interventions such as encouraging people who use drugs to get treatment.

Consider Switzerland, which was swamped with drug problems in the 1980s. When increasing funding to police and making penalties more severe failed to halt the soaring crime rate, increases in HIV transmission through needle sharing, and drug overdose deaths, the government turned to a different approach, including improved drug treatment.

A 2006 study in the nation’s largest city Zurich showed the annual number of new recruits to heroin in the city went from 80 people in 1975 to its estimated peak of 850 in 1990, and then dropped to 150 in 2002. It showed similar falls in crime, HIV prevalence, and drug overdose deaths.

The Swiss case illustrates how gains are small and slow rather than heroic and overnight. But slow and small gains are definitely worthwhile in the face of the alternative.

This kind of harm reduction approach is very effective and quite inexpensive. A 2008 UK review of the evidence for the cost effectiveness of needle syringe programs found they were overwhelmingly worthwhile.


The Australian government, for instance, spent A$150 million on such programs between 1988 and 2000, preventing an estimated 21,000 HIV infections and 25,000 hepatitis C infections. The program saved around 4,500 lives that would have been claimed by AIDS and 90 by hepatitis C. And for every dollar the government spent, it saved A$4 in health-care costs and A$27 in the lost economic contribution of drug users and the cost of drug use to the users themselves.

By contrast, reducing drug use remained the priority in the United States, so HIV spread extensively among and from people who inject drugs there.

There are only two studies estimating savings or social and health advantages from drug law enforcement.

A 1994 RAND Corporation report looked at the benefit of every dollar the government spent on coca plant eradication in South America, interdiction of powder cocaine being transported from South to North America, US Customs and police, and treatment of severely dependent US cocaine users.

US citizens benefited 15 cents per dollar spent on the first, and 32 and 52 cents, respectively for the second and third. But the benefit of the last measure, that is, treatment rather than law enforcement was US$7.46 for each dollar spent.

Another report found the annual reduction in total US cocaine consumption for a $US1 million investment was an estimated 13 kilograms for mandatory minimum sentences, 27 kilograms for conventional law enforcement, but over 100 kilograms for treatment of severely dependent users.


Punitive drug policies have turned out to be an expensive waste of time, at great social cost. When newly-elected Mexican president Felipe Calderon assumed office on December 11, 2006, he freshly declared war on drugs. When he left the presidency six years later, around 70,000 Mexicans had been murdered by drug traffickers, the army or the police.

Prohibition also helps more dangerous drugs to push less dangerous ones out of the market.

In the 1950s and 60s, anti-opium policies in Laos, Hong Kong, and Thailand where the drug was traditionally used, turned out to be pro-heroin. Young, sexually active men injecting heroin replaced old men smoking opium, leading not only to a heroin industry but an increase in the price of narcotic drugs and health problems because of parental drug use. It also created the right conditions for an HIV epidemic among injecting drug users.

Another problem with punitive drug policies is they need a lot of law enforcement. This is only good news for people who work in customs, police, courts and prisons.

The number of people incarcerated in the United States, for instance, increased from 500,000 in 1980 to 2.3 million in 2009. Much of this growth was the result of sentences for drug-related offences. Indeed, one estimate puts the number of years of life lost in New York state as a result of the punitive drug laws of the early 1970s was comparable to the number lost as a result of 9/11.

If we approached drug policy with a return-on-investment approach, high cost-low gain interventions such as incarceration and sniffer dogs would be wound down.

Supporters of drug prohibition often insist reform supporters articulate a fully worked-out alternative. But reform should be thought of as a process rather than an event. It should be carried out in incremental steps with further steps adopted if evaluation shows the earlier reforms have been successful and more is required.

The threshold step is redefining the problem as primarily a health and social issue. As shown above, taxpayers clearly get significant benefits from government spending on reducing the demand for and harm from drugs.


Once the problem is redefined, most decisions fall into place. The paramount aim of the reformist approach must be to reduce the adverse health, social and economic costs of both drug use and drug policy, rather than aiming to reduce drug use regardless of consequences.

When the drug market has been brought down to a manageable size using health and social interventions, drug law enforcement may well start to be effective.

The aim should be to regulate the market as much as possible while acknowledging it will never be completely regulated. There will always be a black market for drugs, and the best way of shrinking it is to expand the regulated market.

Drugs can be regulated by prescription controls, pharmacy controls, premises where drugs are sold with consumption occurring on site, and premises where drugs are sold but consumption occurs off site.

Methadone is a good example of a drug regulated by prescription controls across most of the world. It represents a pragmatic compromise between the preference of drug users to keep using heroin and the community, which would prefer drug users to abstain.

This is not a shot in the dark; there are examples of countries that have seen positive results from embracing an alternative to the war on drugs.

In 2001, Portugal set threshold quantities for every type of illicit drug. People found in possession of quantities above the threshold levels are referred to the criminal justice system. Those found in possession of quantities below the threshold are referred to the Commission for Drug Dissuasion where a small panel carries out an interview to determine how the person is functioning as part of the community.

If they are leading a normal life – raising children, for instance, or studying or training, or holding down a job and keeping up with financial commitments – they are reviewed again in a year or so. Those not functioning poorly are referred to drug treatment.

Portugal also improved its drug treatment system as any country must do if it wishes to reduce drug problems. And treatment has be raised to the same standard as the rest of the health-care system. The policy has worked well for the country; overdose deaths, HIV, crime, and problematic drug use have all fallen.


Instead of this way to deal with drugs, most of the world continues with a criminal justice approach and draconian policies despite evidence of its failure.

Clearly, the war on drugs has taken a grave international toll, and not all of it has been discussed here. Many of the nations it affects are in the process of developing and they are often brought to their knees by corrosive effects of drug prohibition.

The first thing to do is publicly acknowledge the failure of the war on drugs. Then we can start reversing the system. This may be difficult, but it is by no means impossible.

This article is the first in a series that will examine the complex problems facing humanity, and assess the evidence on what works best to fix them.

The Conversation

Alex Wodak is president of the Australian Drug Law Reform Foundation.

This article was originally published on The Conversation.
Read the original article.

Quiting Smoking reduces stress, depression and anxiety

Quitting smoking reduces stress, depression and anxiety

By Fron Jackson-Webb, The Conversation

Quitting smoking is associated with reduced depression and anxiety, and has a similar effect to antidepressant drugs for mood disorders, British researchers have found.

Published today in the journal BMJ, the study shows the improvement in mood, stress levels and quality of life is as large among the general population as those with existing mental health disorders.

The researchers, from the universities of Birmingham, Oxford and Kings College London, set out to test the assumption that tobacco improves users’ mood.

“Although most smokers report wanting to quit, many continue as they report that smoking provides them with mental health benefits,” the authors said in the paper.

The researchers analysed the results of 26 studies that assessed the mental health of participants before and after they quit. Participants had an average age of 44, smoked around 20 cigarettes a day, and were followed up for an average of six months.

They found consistent evidence that stopping smoking is associated with improvements in depression, anxiety, stress, psychological quality of life, and positive feelings compared with continuing smoking.

The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.

While the observational data cannot prove quitting smoking causes the improvements in mood and quality of life, the researchers say there is a plausible biological explanation for the effect.

Professor of Psychiatry at The Alfred and Monash University Jayashri Kulkarni said the study convincingly refuted the mythology of smoking being “relaxing”.

“The relationship between anxiety reduction and smoking is commonly seen in people who have an addiction to nicotine – hence the urge or craving to smoke is experienced as anxiety, which is relieved by smoking,” she said.

“If the addiction is overcome by using successful quitting techniques, then the craving disappears and hence the ‘anxiety’ is also relieved.”

The results reflect Prof Kulkarni’s clinical observations of improved mental health when patients overcome a powerful addiction.

“There is often a resultant sense of mastery, self-control and empowerment which are powerful self-esteem enhancers,” she said.

Sharon Lawn, Associate Professor at Flinders University’s Department of Psychiatry said the study was extremely important because it provided clear evidence to challenge entrenched cultural beliefs about smoking and mental illness.

“Mental health services and health professionals have held many myths about smoking and mental illness for decades – that people need to smoke, that they can’t quit, that quitting would make them more unwell, that now is not the right time, and so on.

“Surely, the response has to be better than this,” she said.

“Among people reporting a mental illness, the proportion of smokers is 32%, which is double that of the general population, and smoking rates are even higher for people with psychotic illness.”

The flow-on effects are that people with mental illnesses have are two- to three-times more likely to have chronic diseases such as diabetes and heart disease and can expect to die 20 years earlier than their peers, Assoc Prof Lawn said.

Consumer advocacy groups and mental health services should support people with mental illnesses not to relapse into smoking, Assoc Prof Lawn said, adding it was important to have consistent responses which did not condone smoking in one context and encourage quitting in another.

The findings will also be useful to mainstream health organisations, which can incorporate this information into their health promotions campaigns, she said.

The Conversation

This article was originally published on The Conversation.
Read the original article.


Michael Guy offers hypnotherapy to assist with stopping smoking.


Sugar Free Diet ?

Below is an article on sugar free dieting from The Conversation followed by some other diet related material:

Sweet enough? Separating fact from fiction in the sugar debate

By Chris Forbes-Ewan, Defence Science and Technology Organisation

Forget lemon detox diets and soup fasts, sugar-free was the fad diet choice of 2013. But while it’s wise to limit the foods and drinks you consume that contain added sugars, this doesn’t mean you need to eliminate sugars from your diet altogether.

In 2003 the World Health Organisation (WHO) considered recommending limiting intake of “free sugars” to 10% of total energy intake. Free sugars are sugars added to the food by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices.

Although this recommendation was based largely on the well-established relationship between sugars and dental health, the evidence available in 2003 suggested that, at least when consumed in liquid foods, sugars may also contribute to obesity.

The US sugar lobby argued tenaciously against the recommendation, to the point where it was accused of adopting similar tactics to those used by the tobacco lobby a few decades previously. To its credit, the WHO held firm and the 10% limit was recommended.

A recent report in the UK press suggests that the WHO is considering halving its recommended maximum intake of free sugars to 5% of total energy. This is based on recent evidence that, it is claimed, implicates sugars in the onset of heart disease and strengthens the link with obesity, in addition to the previously demonstrated association with tooth decay.

So, how strong is the evidence that consumption of sugars causes (or is at least a major contributor to) obesity and heart disease?

In preparation for the proposed update, the World Health Organisation published a review of the effects of sugars on obesity was published last year.

One study found increasing sugar consumption led to a 0.8 kg weight gain. Flickr/foshydog

In summary, the report found that increasing intake is associated with a small, but statistically significant (around 0.8 kg) weight gain, while decreasing intake is associated with a similar level of weight loss. It also concluded that consumption of sugar-sweetened beverages is particularly likely to lead to increased body weight.

Sugars in liquid form are often attributed as a main cause of obesity and related chronic diseases. One study, for example, was reported to have found a direct link between consumption of sugary drinks and 180,000 deaths annually worldwide.

The relationship between consumption of sugars in liquid form and adverse health effects is reflected in the Australian Dietary Guidelines, which were revised by the National Health and Medical Research Council (NHMRC) last year. The new sugar guideline emphasises the importance of limiting intake of:

… sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.

However, although the strength of the evidence that sugar-sweetened drinks are associated with weight gain was regarded by the NHMRC as grade B (meaning it can probably be trusted, but is not entirely convincing), no evidence of a direct link between intake of sugars and heart disease was found.

Even so, the NHMRC suggested a possible indirect link with heart disease through an association of consumption of sugar-sweetened drinks with type 2 diabetes and “metabolic syndrome”, a set of conditions that predisposes to both heart disease and diabetes.

In 2009 the American Heart Association (AHA) concluded that:

Excessive consumption of sugars has been linked with several metabolic abnormalities and adverse health conditions … evidence from observational studies indicates that a higher intake of soft drinks is associated with greater energy intake, higher body weight, and lower intake of essential nutrients.

The AHA report recommended an upper limit of approximately 400 kilojoules (six teaspoons) per day from sugars for a woman, and 600 kilojoules (nine teaspoons) per day for a man. These quantities constitute about 5% of total energy intake and are consistent with the reported potential revised WHO recommendation.

There will be little or no harm done if the recommended maximum level of sugar is decreased. Flickr/stevendepolo

One of the leading proponents of the concept that sugar is the major cause of obesity, heart disease and type 2 diabetes is Robert Lustig, a US professor of pediatrics. In an opinion piece published in Nature last year Lustig and colleagues argued that sugar is as dangerous as alcohol and tobacco, and that it’s fuelling a global obesity pandemic, contributing to 35 million deaths annually worldwide from diseases such as diabetes, heart disease and cancer.

It is important to note that “sugar” (the crystalline product commonly used to sweeten foods and beverages, and known scientifically as sucrose) consists of two components, glucose and fructose. Lustig (and colleagues) believe that it is the fructose component of sugar that is the culprit, while glucose is an “innocent bystander”.

However, other experts in the field remain unconvinced that moderate intakes of fructose-containing sugars (up to about 10% of total energy intake) are major contributors to heart disease or obesity.

An extensive review of the scientific literature published in 2010 found:

… no evidence that the consumption of normal levels of intake (of fructose) causes biologically relevant changes in triglyceride [a type of fat that is associated with increased risk of heart disease] or body weight in overweight or obese individuals.

John Sievenpiper, a world-renowned expert from the University of Toronto, came to the conclusion that far from being harmful, small doses (up to 36 grams) of fructose per day may reduce the risk of type 2 diabetes, while having no adverse effects on body weight or blood lipids.

Fruit also contains fructose. Matthew Kenwrick

This quantity of fructose equates to 72 grams of sucrose, which corresponds to about 10% of total energy intake for a typical man (the current maximum intake recommended by the WHO).

However, some of our ingested fructose should be coming from fruit, so this finding doesn’t constitute a suggestion that 10% of energy intake “should” come from sucrose, only that this level of intake may not be harmful.

So what can we conclude – from the current state of evidence – about the appropriateness of the reported proposal by the WHO to reduce recommended maximum sugar intake from 10% to 5% of total energy intake?

One prediction I can confidently make is that the sugar lobby will strenuously oppose any recommendation to further reduce sugar intake, as it did for the 2003 WHO recommendation.

I also believe that there will be little or no harm done if the recommended maximum level is decreased, while some good may come from such a revision.

However, it still remains to be seen if the WHO will go ahead with this recommendation. Watch this space.

Chris Forbes-Ewan received funding from the National Health and Medical Research Council in 2006 for his contribution to the development of Nutrient Reference Values for Australia and New Zealand. His contribution was in the area of estimated energy requirements.

The Conversation

This article was originally published at The Conversation.
Read the original article.


My response

As a psychologist I often talk about diet.  My post on the was:


My personal experience is that when I want to reduce my weight I cut my sugar intake. This has worked for me for many years. I am currently 7 kgs overweight and about to do this again. Last time was a 5kg weight reduction in 2012.

I have a “sweet tooth” with a particular weakness for cakes and biscuits. I drink minimal alcohol. When I go on this diet I get sugar cravings. I cope with these by distracting myself with fruit. I can therefore relate to the idea of sugar as an addiction. I find when I do this I become more conscious of my diet and portion size so I don’t think it is the sugar alone.

To me reducing sugar is a simple way to reduce calorie intake and it works for me.

My professional experience is that obese people often use food as a distraction from negative emotions. This is very similar to other addictions and this is core to the approach I take with those clients in terms of looking at alternative ways to deal with the emotions and looking at strategies to deal with the triggers for non-compliance with their diet.


Other Articles and links 

This article talks about psychological aspects of weight loss:


This article notes:  ”The first step in my weight-loss journey had little to do with food and a lot to do with changing the way I talked to myself. I was my own worst coach – trying to motivate myself with insult and abuse rather than empowerment. I was telling myself very damaging lies, which I had to address before I could make any sort of permanent changes in my life. The most harmful of these, I’ve already addressed: that my weight determined my value. But I also told myself things like “I’m too fat to be loved”, “everyone sees my fat first”, and “I’m too fat to eat in front of people”. Moreover, I began with the damaging mindset that gaining weight meant failure while losing weight meant success. This, I believe, is what kept me on the rollercoaster for so long.”


This article from the Guardian talks about dieting makes you fatter;


A new book The Diet Myth by Dr Tim Spector notes the importance of eating a variety of foods and the role of microbes:

  • The living cells in our bodies are 10 per cent human and 90 per cent microbe
  • Eating lots of fatty cheese or yoghurt can improve health and weight
  • A handful of garden soil holds more microbes than there are stars in the known universe
  • Sweeteners in ‘diet’ fizzy drinks have adverse effects on our metabolism and microbes and can make us gain weight
  • Cubans, despite eating on average twice the amount of sugar as Americans, are far healthier
  • We evolved from microbes millions of years ago, share their genes and still perform many tasks for them and they perform many more for us.
  • Foods advertised as ‘low-fat’ are actually making us fatter
  • Fasting diets such as the 5:2 diet work by beneficially altering our microbes and their metabolism
  • Skipping breakfast may be a healthy strategy for many people
  • The average twenty-year-old today will have already had eighteen courses of antibiotics and will have abnormal microbes increasing risk of obesity
  • The diversity of microbes in our bodies is 30 per cent lower than fifty years ago
  • Gut microbes, when disrupted, are a major cause of obesity and diabetes but they are also essential for health
  • Thousands of people are now having poo transplants – many with significant success (see link to ABC Catalyst below)
  • Microbes in your gut can affect your brain and mental health, and contribute to autism and depression and even the urge to eat more
  • Much of our food is contaminated with low levels of antibiotics used in farming, making us fat
  • A third of people have genes and microbes that prevent them getting fat
  • Microbes enjoy eating the polyphenols in dark chocolate which may keep us slim
  • Key nutrients and essential vitamins are extracted from our food only through our gut bacteria
  • Babies need microbes for development of their brains and immune systems
  • The success of the Mediterranean diet is due largely to providing fertiliser for our microbes
  • Unpasteurised cheese is one of the richest sources of living healthy microbes and fungi
  • Most probiotics in yoghurt don’t work well in humans and may need to be personalised
  • Olive oil and nuts are ultimate health foods that nourish our microbes
  • Living on a dirty farm or having pets helps microbes and protects you against allergies
  • Whether you like to eat salads, broccoli chips or garlic is partly genetic
  • Belgian Beer, garlic, coffee, leeks and celery are perfect foods to increase gut microbes
  • A diet of junk food can dramatically reduce healthy gut microbes in only two days
  • Increasing the diversity of our diet will increase our microbes, our health, happiness and lifespan


Here is an interesting 30 minute documentary on the role of fibre and the potential for high fibre diets to help various medical conditions including asthma, irritable bowel, and psoriasis:


If you have one and half hours to watch Dr Robert H. Lustig, UCSF Professor of Pediatrics in the Division of Endocrinology, he talks on the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin;

Dr Robert Katz argues against fads including the sugar free diet here;
A well reasoned article but low fat diets are argued to be the fad here (with a low carb diet recommended);
Here is a fact sheet from the ABC on sugar:






Description:  There have been a number of articles on following a sugar free diet. Psychological strategies can help stay on a diet.

Keywords:  Diet Psychologist

Regular bed times as important for kids as getting enough sleep

Regular bed times as important for kids as getting enough sleep

This is republished from The Conversation.  My comment follows.  It is by Sarah Biggs, Monash University

We’ve long known that children need a certain amount of sleep: nine to 11 hours per night for older kids, and up to 14 hours in 24 for toddlers. There’s no doubt that getting enough sleep is paramount to a child’s healthy development, but recent research has shown that a regular routine – going to bed the same time every night and waking the same time every morning – is just as important to a child’s daytime functioning.

An Australian study of almost 2,000 school-aged children recently showed that, when compared to a child with the same bedtime (less than a 30 minutes difference across the week), a child with a 60-minute difference was twice as likely to display hyperactive behaviours and have problems controlling their emotions.

Children who had a two-hour difference in bedtime across the week were six times as likely to display hyperactive behaviours. This association was seen even when the children were getting the recommended amount of ten hours of sleep per night.

Irregular bedtime schedules have a similar impact in teenagers, with an older study in adolescents reporting that inconsistent sleep schedules were associated with increased anxiety and depression, again, regardless of the total amount of sleep obtained.

Behavioural problems may reduce with a regular bedtime. Image from

So, are the irregular routines driving the poor behaviour or are the behavioural problems resulting in poor routines?

A recent study of more than 10,000 children in the UK suggests the former. The researchers found that if a child went from having a regular bedtime schedule when a toddler (three years) to an irregular schedule when they started school (five years), their behaviour worsened over time. This study also showed that behaviour problems improved if the child went from an irregular schedule to a regular one.

If your child or teen is getting the right amount of sleep, why should it matter that they go to bed at different times?

The answer lies in the way sleep is regulated within the body. The need for sleep is a biological process and is regulated, in part, by a circadian rhythm which stems from the brain. The circadian rhythm is the body’s internal clock and regulates sleep and wake by producing hormones at certain times of the day, based on the cycle of light and dark, to trigger alertness or tiredness.

Most people are familiar with, and may have even experienced, jetlag. When we move quickly from one time zone to another, the circadian rhythm falls out of sync with the environmental clock or activities. This leaves us with feelings of extreme tiredness, fuzzy headedness, poor concentration, irritability and even nausea.

These same feelings can arise when the circadian is forced out of sync by our everyday activities, such as when bedtimes change night to night, or even when bed and wake times shift later on weekends. This phenomenon is termed social jetlag.

Social jetlag is often most obvious in teenagers. During puberty, the circadian rhythm shifts so that the biological cues for sleep and wake occur later than at other stages of the life cycle. This results in teenagers not wanting to go to sleep until late into the night and wanting to sleep through to late morning, early afternoon. The use of electronic devices at night will intensify this shift.

Don’t worry, social jetlag is relatively easy to fix. Image from

As a result of study, family and work or sporting commitments, many teenagers have highly irregular schedules and chronic sleep deprivation. This leaves them experiencing all the physical and mental consequences of flying across to the other side of the world.

Research shows social jetlag can affect younger children too. The problem is that, unlike jetlag which resolves after the circadian system adjusts to the new time zone, social jetlag can be ongoing.

The good news is that social jetlag is relatively easy to fix. Here are some simple tips that will help your child or teenager maintain a regular sleep routine:

  • Set a regular, non-negotiable, bedtime each night
  • Turn off all electronic devices at least 30 minutes to an hour before the child’s bedtime
  • Have a sleep preparation routine (for example, get pyjamas on, brush teeth, read a story, and so on)
  • Don’t allow your child to have any caffeinated foods or beverages at least three to four hours before bedtime
  • Keep light levels low in the bedroom.

Setting up a new sleep routine for your child can be tough and may take some time to become a habit, much like starting a new exercise program. However, healthy sleep practices are not only about getting enough and making the effort to establish a regular sleep routine will be well worth it for both you and your child.

Sarah Biggs does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

The Conversation

This article was originally published at The Conversation.
Read the original article.


I then wrote the following comment:

“Social jetlag is often most obvious in teenagers. During puberty, the circadian rhythm shifts so that the biological cues for sleep and wake occur later than at other stages of the life cycle. This results in teenagers not wanting to go to sleep until late into the night and wanting to sleep through to late morning, early afternoon.”

I think the circadian rhythm shifts because the adolescent is staying up too late during the week then sleeping in on the weekend.  After sleeping in you don’t feel like sleeping till late creating a feed back loop that disrupts a normal sleep wake cycle (aka circadian rhythm).  I think this is part of trying to be an adult and a failure to recognise (by the adolescent and the parent) that during times of high learning or physical growth ten hours sleep is probably needed.

I ask a number of parents are you adolescents sleeping in on the weekend?  If they are I inform them that represents trying to catch up a sleep debt that means their child is probably half asleep at school.  I then suggest asking their child if they would like to improve their grades by 10%?  If they do then all they need to do is go to bed an hour earlier.

If you ask secondary school teachers they will tell you how many of their pupils are falling asleep at their desks!

In the United States I believe some schools have later start times for teenagers.  I think this is ridiculous.  What happens when they get a job?  Is an apprentice going to be able to turn up to work an hour later than everyone else?

The other tips to reset your circadian rhythm is to walk outside at Midday and get up at the same time seven days a week.  The brain will pick up that the sun is at its zenith.  As noted above it is the sleeping in on the weekends that may be the disruptor to the circadian rhythm in the first place so that needs to change if you want to reset it.

I often get clients to consider life before electricity and the ‘natural’ sleep wake cycle.  Those are the conditions our brains evolved in.

Disturbed sleep is seen in so many with psychological issues.  Better sleep goes with better mental health.



What’s behind our failure to return more injured people to work?

What’s behind our failure to return more injured people to work?

Below is an article republished from The Conversation that I wrote a comment on. 

By Alex Collie, Monash University

A recently released report by SafeWork Australia shows that there has been no improvement in our national return-to-work rates for the past 15 years.

Despite substantial growth in the international body of evidence about what works and what doesn’t in returning injured people to work, as a nation Australia is no better at this in 2013 than we were 15 years ago. Our practises are broadly the same. Our policies have not really changed. We have failed to innovate.

The report summarises the headline findings of a survey of injured and ill workers conducted every year by SafeWork Australia, the federal government agency with oversight of our workers compensation systems. The survey includes workers who were injured in the previous seven to nine months, and asks two key questions. First: have you worked at any time since your injury or illness? Second: are you currently working in a paid job?

Beginning in the 1997-1998 financial year, the survey has found that yearly, between 84% and 87% of people surveyed report that they have worked at some time since their injury. In 14 of those 15 years, between 72% and 77% of people reported that they were working at the time they were surveyed.

In other words, about a quarter of injured Australian workers are not working 7 to 9 months after their injury.

Over the same period there have been major improvements in workplace health and safety, with a 26% reduction in the incidence of serious workplace injury in the decade to 2010. Much of this has been driven by innovation in work health and safety policy and practice.

So while we have become much better at preventing workplace injury, we are no better at helping people back to work if they are injured.

This is a major economic and public health challenge that is worth careful consideration by government and industry. The figures may surprise many.

In Victoria alone, workplace injury and illnesses covered by the state workers compensation agency resulted in 189,000 years of lost working time between 1995 and 2008.

In other words, for every year in Victoria between 1995 and 2008 we lost approximately 13,500 years of productive working time due to workplace injury and disease. Even a small improvement in return-to-work will have major implications for the economy, industry productivity and the financial sustainability of the workers compensation system.

The health benefits of safe work are now well documented. We know that being out of work is bad for a worker’s health. We also now know that returning to work aids injury recovery, improves social and community inclusion, and has positive economic impact.

Of course it is possible that we are so good at return-to-work that there is little room for improvement. But the evidence would suggest otherwise.

There are differences between states. Last year, Western Australia, New South Wales and Comcare (the federal government workers’ compensation scheme) were the best performers with 80% of injured workers back at work when they were surveyed. In South Australia the figure was 70%. In Queensland 75%.

This variation suggests that there is at least some room for improvement, particularly in the states with the poorest results in the SafeWork survey. This would lift the national average.

Following a string of recent poor results in the SafeWork survey, WorkSafe Victoria has elevated return-to-work in its list of priorities in its recently released five year strategy.

Similarly, Minister Bill Shorten recently announced plans to make Comcare, one of the better performing compensation schemes in this year’s survey, a best practice model for workplace rehabilitation and return-to-work.

There is also abundant research evidence, mainly from North America and Europe, showing that it is possible to improve return-to-work outcomes, including evidence-based guidelines for employers on the important principles of successfully bringing injured people back to work.

The research suggests that evidence-informed approaches can and do work; but this takes careful planning and sustained effort on behalf of those involved.

Such approaches are lacking in Australia. To my knowledge, there have been only a few small studies of return-to-work interventions amongst injured workers in this country in the 15 year period of the SafeWork Australia survey. So even if we are trialling new approaches, we are not evaluating them or reporting on the outcomes.

To make positive and sustainable changes, we need a greater emphasis in this important public health and social policy arena.

The Institute for Safety Compensation and Research (ISCRR) at Monash University has established a major research program and are planning some large return-to-work trials – the first of their kind in this country.

This presents an opportunity to change the Australian return-to-work model. To innovate.

For the health of our injured workers, the productivity of industry, and the viability of our workers compensation systems, I hope we take it.

Alex Collie works at the Institute for Safety Compensation and Recovery Research at Monash University. ISCRR is a joint initiative of Monash University, WorkSafe Victoria and the Victorian Transport Accident Commission (TAC). He receives funding from the Australian Research Council, Worksafe Victoria, the TAC, Comcare, the New Zealand Accident Compensation Corporation and the Motor Accidents Authority of NSW.

The Conversation

This article was originally published at The Conversation. Read the original article.


My Comment

My understanding and experience is that insurers are much more focused on evidence based treatments than they were ten years ago. They mainly approve evidence based treatments. When treatment does not have an outcome they cease approval and payment for it. The reduction of lump sum payments has also reduced the interference of secondary gain so clients are more motivated for treatment outcomes.

You have not provided any international comparison with return to work rates or injury rates. Doing so would provide more valid criticism of Australian practices or validation that we are actually doing something right.

With a large reduction in accident rates but no change in the percentage remaining out of work, the absolute number has reduced and so has the absolute number that have not returned to work. To interpret this negatively is strange. It is in fact a positive outcome.


Psychopaths / Sociopaths

Psychotherapy often deals with the damage done by psychopaths.   In her recently published book, Confessions of a Sociopath: A Life Hiding in Plain Sight, M.E. Thomas shows just how different a psychopath can be from the rest of the population.

She writes:

I am a sociopath. I suffer from what psychologists now refer to as antisocial personality disorder, characterised in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as “a pervasive pattern of disregard for and violation of the rights of others”. Key among the characteristics of the diagnosis are a lack of remorse, a penchant for deceit, and a failure to conform to social norms. I prefer to define my sociopathy as a set of traits that inform my personality but don’t define me: I am generally free of entangling and irrational emotions, I am strategic and canny, I am intelligent and confident and charming, but I also struggle to react appropriately to other people’s confusing and emotion-driven social cues.

I am not a murderer or a criminal. I have never skulked behind prison walls; I prefer mine to be covered in ivy. I am a typical well-respected, young academic, regularly writing for law journals and advancing various legal theories. I donate 10 per cent of my income to charity and teach Sunday school every week.

Maybe you are a sociopath, too. Recent estimates say that one per cent to four per cent of the population, or one in every 25 people, is a sociopath – that’s higher than the percentage of people who have anorexia or autism. Never imprisoned? Most of us aren’t. Only 20 per cent of male and female prison inmates are sociopaths, although we are probably responsible for about half of serious crimes committed.

Read more from a book at this link

NB My understanding is that Sociopath and Psychopath are interchangeable.  Sociopath was originally used to suggest that surroundings had produced the condition rather than it being hereditary.

Hearing Voices

Beyond madness: a modern approach to hearing voices

By Adèle de Jager and Paul Rhodes

Four years ago, a woman came to speak to my third year psychology class at the University of Auckland. Her story completely changed the way I thought about voice-hearing. Like most people, I associated “hearing things” with being very unwell psychologically; with madness. Yet here was an articulate, hilarious and confident woman – a mental health educator – who was very much in touch with reality.

The first voice she heard was a supportive, maternal voice which didn’t cause her any distress. Later, she heard a group of demonic-like voices who threatened to harm her or those she cared about. She was diagnosed with schizophrenia and institutionalised for many years.

Her turning point came when she asked her voices to show her some of their power by doing the dishes. When they didn’t, their hold over her started to loosen. Slowly, she learnt how to deal with her voices, built relationships with others and finally gained employment helping other voice-hearers. Hers is one of the stories of recovery recorded in Living with voices: 50 stories of recovery.

Voices can’t do the dishes. Peter Hellberg

What struck me most about her story was how easy it was to draw an analogy between her voices and internal “self-talk”. Immediately, the experience of voice-hearing seemed less foreign and incomprehensible and more akin to what most people experience. This
“inner-speech” theory is in fact the most well-known neuropsychological theory about what causes voices.

Apart from making voice-hearing seem less foreign, her story challenged several assumptions I held. First, it seemed that she was able to live a functional, productive and meaningful life while still hearing voices. Second, a diagnosis of schizophrenia is thought to carry with it a very poor prognosis, with little hope of recovery.

So, is her experience unique? It seems not. There is evidence of long-term recovery for around half of people distressed by their voices, enabling them to live meaningful lives and function to a degree considered normal by most people.

Indeed, it appears that hearing voices is not an abnormal human experience. General population studies show that 10% to 40% of the non-psychiatric population hear voices at some point in their lives. It is also not unusual for those who have lost a loved one to hear the voice of the deceased during the months following their death (although many initially deny this due to stigma surrounding voice-hearing). So it seems possible to be a “healthy” voice-hearer.

The other thing that really stood out from what she said was the profound mismatch between her needs and the help she got. She needed to talk about her experiences and figure out how to deal with her voices. At that time, however, talking to voice-hearers about their voices was discouraged as it was believed that this would worsen their symptoms. Instead, she was treated mainly with medication (in those days, large doses of it).

So, what treatments are available today? Medication remains the first-line treatment for distressed voice-hearers. Many find antipsychotic medications helpful, as they “dampen down” physical, mental and emotional responses.

But they can have serious side-effects. These include changes in metabolism that lead to weight gain and increased risk for stroke, heart disease and diabetes. They may also make some people feel “foggy” or “zombie-like”.

One-quarter of people who hear disturbing voices don’t respond to medication. Sam Catch

Medication is ineffective in eliminating voices in at least one-quarter of cases. This has lead to talking therapies gaining acceptance as a treatment for distressing voices. Instead of trying to get rid of voices, talking therapies aim to diminish the distress they can cause.

One way of doing this is through considering the evidence for and against beliefs about voices that make the hearer feel more upset. If your voice says threatening things and you believe it is powerful and intends to harm you, it makes sense to feel frightened. Testing out whether the voice has the power to do things (like doing the dishes) in a carefully planned way (for example, it wouldn’t be helpful to ask for a message through something ambiguous like a television program) can help the hearer feel more in control and less frightened.

Other strategies that can help in day-to-day management of voice-hearing include decreasing overall stress, listening to certain music, reading and focusing one’s attention on other sounds. Unfortunately, no one formula works for everyone: a lot of trial and error is usually required to find out what works.

The Maastricht approach – which is closely connected to the consumer movement, including the Hearing Voices Network – takes a more radical perspective. It defines voices as representing an emotional problem, either literally or metaphorically. This opens up interpretive possibilities, so even critical or threatening voices can be viewed as helpful.

One voice-hearer, for example, came to interpret a voice saying “I’ll kill you” as a warning not to make a particular decision in her life.

Some voice-hearers read a flare up of voices as a signal they’re stressed or tired. Image from

Another person who identifies that a critical voice appears or becomes louder when they are over-stressed or over-tired may come to respond by resting or giving excess work to a colleague. So the critical voice becomes protective. Putting voices into the context of the hearer’s life history helps the hearer to make sense of them and identify what positive role they could have.

Interestingly, voice-hearers’ style of relating to their voice is similar to how they relate to other people. Those who feel socially inferior to others, for instance, report feeling inferior to their voices. They are also more likely to comply with instructions to harm themselves, while the opposite is true of those who feel superior in both spheres.

We know that some people who are distressed by their voices learn ways to cope with their voices effectively and eventually recover. But how do they do it? That is the question we will be asking voice-hearers taking part in our research.

It’s hoped that giving voice to their experience, expertise and insider knowledge will help others struggling with their voices and help shape treatment approaches.

Adèle de Jager is a post-graduate student at the University of Sydney supervised by Dr Paul Rhodes and Dr Mark Hayward. Their research was developed with and supported by Douglas Holmes and others at the Hearing Voices Network NSW.

Paul Rhodes receives funding from the NHMRC.

The Conversation

This article was originally published at The Conversation.
Read the original article.

Michael Guy found this a very interesting article and posted a comment, “I ask clients is the voice inside your head or outside. For most they are inside and I then liken them to different parts of the self as in Gestalt Therapy or modes as in Schema Therapy. The aim would then be to integrate those different parts together. Questioning what they want and the tone with which they ‘speak’ is a way to engage the emotion associated with them.”