Gratitude through Gmail

As I wrote earlier, gratitude is a vital ingredient for wellbeing, and one way to increase our gratitude is to remember and reflect on the good things that happen to us, or what went well (WWW).

Recently, I realised that I've received a lot of emails this year that have brought a smile to my face. For example, emails where people have kindly agreed to help me out, have given me positive feedback, have replied to a thank you note I've sent or have thanked me, and where I've been accepted into programs. What if we could create an easy-to-access digital repository of such good events, harnessing technology to support our gratitude practice?

I'd like to share with you a really simple system that I use, harnessing Gmail's built-in Labels and Filters.

Basic Method: Create a Label

1. Scroll down to the bottom of the left column of your Gmail. Click "Create a label". You can name this whatever you want - e.g. Gratitude, Hope, WWW, Good Things in Life, Positivity. I named mine Smiles, because after all, these are emails that made me smile!

2. Select all the positive messages in your inbox and move them to that folder.

At this point, you're pretty much done! Click through to the label in your left column, and there are all your positive messages, ready for easy access and appreciation.

Ok, so what if you have more than one email inbox, but you want all your positive messages in one location? This is the case for me, with a university email address and a personal email address. Or if you want to email yourself your daily WWWs and have them automatically stored in this folder? Here's how to extend this basic method.

Extension: Create a Filter

3. Create a filter: Settings → Filters → Create a Filter.

In the "To" box, type in: yourusername+yourlabelname@gmail.com. Then click through to "Create filter with this search".

Select the checkboxes for "Skip the Inbox", "Mark as read", and "Apply the label: Your label". Click "Create filter".

4. Forward your positive emails from your other account to your "WWW email address" (yourusername+yourlabelname@gmail.com). These emails will automatically appear in your designated folder.

5. It is even possible to use this system to email ourselves our daily WWWs, instead of writing them down in a physical journal, if that's what you'd prefer. Just email them through to your WWW email address.

6. Did something good happen elsewhere on the internet (e.g. a nice Facebook message)? Take a screenshot, and email that to your WWW email address. The possibilities are endless.

Try it out!

So there you have it. An easy way to set up a system for creating a digital bank of gold, ready to access and savour on the go, especially in those times when you find it difficult to think of anything that's going well in your life, or when you just want to increase your feelings of gratitude.

Let me know if you end up trying it out! I'd love to hear if you find it useful.

Does Elevation Lead to Altruistic Behaviour? Commentary on Schnall, Roper and Fessler (2010).

Today, I presented an article at the Moral Psychology Journal Club at UniMelb, Elevation Leads to Altruistic Behavior by Simone Schnall (University Cambridge), Jean Roper (University of Plymouth), and Daniel Fessler (UCLA). I chose this article because I'm really interested in positive psychology, and I was eager to learn more about the elevation and prosocial behaviour. Some really interesting discussion (i.e. critique) ensued so I felt motivated to share some thoughts on this paper.

First, the paper.

What is elevation?

Elevation, coined by Haidt (2003), is "a positive emotion experienced upon witnessing another person perform a virtuous act, principally one that improves the welfare of other people" (Schnall, Roper, & Fessler, 2010, p. 315). Typically, people experiencing elevation will report that they feel inspired and uplifted, and motivated to perform a similarly prosocial act themselves.

Does elevation lead to altruistic behaviour?

Previous research had shown limited and indirect evidence for this hypothesis, for example through self-reported altruistic behaviour (Landis et al., 2009), more nurturant behaviours towards their babies in nursing mothers (Silvers & Haidt, 2008), and increased donations to a Black charity from Whites who are high in social dominance orientation, a construct linked to anti-Black racism (Freeman, Aquino, & McFerran, 2009). 

However, Schnall, Roper, and Fessler (2010) argued that self-report is subject to impression management considerations, that helping one's own child isn't true altruism, that it was still unknown whether elevation motivates helping outside of the context of group-based prejudice, and that none of these experiments had shown whether elevation motivates helping above and beyond the effects of general positive affect. Schnall, Roper, and Fessler (2010) therefore tried to establish whether elevation actually and unambiguously produces altruistic behaviour.

Experiment 1

Method

Participants. 59 women, aged 18-26 years from the University of Plymouth.

Materials. For the elevation condition, they used a 7-min clip from "The Oprah Winfrey Show" where musicians thank the teachers who had mentored them as underprivileged youths. For the control condition, they used 7 mins of a nature documentary.

They used six self-report measures of feelings and cognitive appraisals associated with elevation: how much participants felt "moved," "uplifted," "optimistic about humanity," "warm feeling in chest," "want to help others," and "want to become a better person," on a 9-point scale (1 = didn't feel at all, 9 = felt very strongly). Using the same scale, they also asked participants to rate how happy they felt, to assess the effect of condition on general positive affect.

Procedure. Participants watched either the elevation-inducing clip or the control clip. They then spent 5 mins writing a short essay recalling as much as they could about it. The experimenter then left the room, ostensibly to photocopy another form. Before she left, she paid the participant and asked them to complete a payment receipt containing the dependent measure, a check box asking if the participant was willing to participate in an additional, unpaid study. On her return, the experimenter gave the participant the form with the seven self-report measures to complete.

Results

Manipulation check. The mood induction of elevation was successful: Participants in the elevation condition reported higher ratings on all six items indicative of elevation ("moved," "uplifted," "optimistic about humanity," "warm feeling in chest," "want to help others," and "want to become a better person"), compared with the control condition. The groups didn't differ in their reported happiness.

Intention to volunteer. As predicted, more participants in the elevation condition volunteered for the unpaid study.

Discussion

Three limitations of this experiment were:

1. Their single measure of happiness may not have been enough to rule out the possibility that their results were driven by general mood differences, because elevation is positively-valenced.
2. Since the dependent measure was yes/no, they couldn't assess dose-dependent effects of emotions
3. The dependent measure only measured a commitment to help, not actual helping behaviour

Hence, enter Experiment 2...

Experiment 2

Method

Participants. After 4 participants were excluded, 32 female participants remained.

Procedure & materials. To account for the positive valence of the elevation condition, they introduced a new condition, the mirth condition, induced using a comedy clip. So they had three conditions this time: elevation, mirth and control. Participants watched one of these clips, then completed the self-report measures from Experiment 1, which also included a rating of how amused they felt. The experimenter then faked some technical difficulties that made it "impossible to continue the experiment", so told the participant she was free to leave, but would receive the full hour's course credit. Then as an "afterthought", the experimenter asked the participants whether she would be willing to complete another questionnaire, emphasising that the questionnaire was rather boring, and that the participant was under no obligation and was free to stop whenever she wanted, but that completing any number of the items would greatly assist the experimenter. Participants who agreed to help were given 85 elementary math problems and secretly timed on how many minutes they spent "helping" the experimenter.

Results

Manipulation check. Elevation and amusement were induced in their respective conditions, whilst reported happiness didn't differ between the three conditions.

Helping behaviour. Participants in the elevation condition spent roughly twice as much time on the questionnaire (~ 40 mins)  as participants in the control or mirth conditions; the latter conditions didn't differ. The dependent variable, minutes spent on the questionnaire, was significantly positively correlated with 5/6 of the elevation variables, but not significantly correlated with amusement or happiness.

Key conclusions

1. The two experiments provided "convincing evidence" that elevation leads to increased altruistic behaviour.
2. Elevation is distinct from mere positive mood.
3. Elevation inspired helping in spirit, not in kind (i.e. imitation), as their helping behaviours (volunteering for a study/completing a questionnaire) bore no resemblance to that in the stimulus (mentoring underprivileged youths).
4. By eliciting elevation, even brief exposure to other individuals' prosocial behaviour increases altruism. This is a potential way to increase the general level of prosociality in society.

Now, some questions.

When I first read the paper, I thought it was great! But I totally expected that the more experienced members of the Journal Club would tear it apart somehow, and of course they did, and I am truly grateful for the chance to learn from them and develop my skills in critically reading and evaluating psychological research. So these were our key concerns:

Gender. They only had female participants in this study, because of concerns that men might exhibit more helping behaviour because the experimenter was female. However, we thought that this wasn't really justified, unless you expected that men would be so eager to help that there would be a ceiling effect. In only testing females, they've excluded half the human population in being able to generalise these findings.

Sample size. In Experiment 2, there were only 32 participants, across 3 conditions! That means about 10 people in each condition. Surely at least 20 in each condition would be considered a minimal requirement here.

Mediation analyses (or lack thereof). This was the most important issue. The purpose of these experiments, as suggested by the title, was to show that elevation leads to (i.e. causes) altruistic behaviour, but they didn't really show that at all. Rather, they showed that the elevation condition induced elevation, and that the elevation condition increased altruistic behaviour, but they didn't do (or report) any basic regression analyses to show that elevation was actually mediating the relationship between the condition and the increased altruistic behaviour. In other words, they didn't rule out the possibility that elevation may have been epiphenomenal, and that something else may have mediated the relationship between witnessing the prosocial act and helping behaviours. For example, the Oprah Winfrey clip could have simply established a helping norm, basically priming helping behaviours. (In fact, we were wondering if it would be possible to ever get past this confound - is there a way to induce elevation without witnessing prosocial behaviour, or is that by definition impossible?)

On a final note regarding the mediation analyses, it looks like Thomson and Siegel (2013) more recently established elevation as a mediator between thinking about a time when they witnessed someone performing a moral act benefiting someone else, and donation behaviours, in samples with both genders. Take this with a grain of salt though, or check it out yourself, because I haven't had a chance to read the paper in-depth yet.

Overall, we weren't convinced that the experiments established that elevation leads to altruistic behaviour. Perhaps a more accurate title would have been, "Witnessing prosocial behaviour leads to elevation and altruistic behaviour in females". I would be extremely interested to see what happens if we (1) test both males and females, (2) have an adequate sample size, and (3) ran the mediation analyses. Would it then show that elevation leads to altruistic behaviour? Given the current crisis of confidence in social psychology, it's more important than ever to ensure that studies are as rigorous and unconfounded as possible.

Having said all this, in line with a positive psychology perspective, I want to recognise the strengths in this paper. The math questionnaire dependent measure was quite clever, as it was a way to quantitatively measure extents of helping behaviour. I also liked how they introduced the mirth condition to try and match the affective valence (although I suspect that elevation may still be higher in valence and intensity than mirth). And in the end, at least they showed that witnessing prosocial behaviour inspires prosocial behaviour. If we want to increase prosocial behaviour, that is, to encourage a society where people more regularly help one another out, then that is still an important, relevant and practically applicable finding in terms of publicising morally praiseworthy events, regardless of whether elevation, or something else, is mediating that relationship.

References

Freeman, D., Aquino, K., & McFerran, B. (2009). Overcoming beneficiary race as an impediment to charitable donation: Social dominance orientation, the experience of moral elevation, and donation behavior. Personality and Social Psychology Bulletin, 35, 72-84. doi: 10.1177/0146167208325415

Haidt, J. (2003). Elevation and the positive psychology of morality. In C.L.M. Keyes & J. Haidt (Eds.), Flourishing: Positive psychology and the life well-lived (pp. 275–289). Washington, DC: American Psychological Association.

Landis, S.K., Sherman, M.F., Piedmont, R.L., Kirkhart, M.W., Rapp, E.M., & Bike, D.H. (2009). The relation between elevation and self-reported prosocial behavior: Incremental validity over the five-factor model of personality. Journal of Positive Psychology, 4, 71–84. doi: 10.1080/17439760802399208

Schnall, S., Roper, J. & Fessler, D.M.T. (2010). Elevation leads to altruistic behavior. Psychological Science, 21(3), 315–320. doi: 10.1177/0956797609359882

Silvers, J.A., & Haidt, J. (2008). Moral elevation can induce nursing. Emotion, 8, 291–295. doi: 10.1037/1528-3542.8.2.291

Thomson, A.L., & Siegel, J.T. (2013). A moral act, elevation, and prosocial behavior: Moderators of morality. The Journal of Positive Psychology, 8(1), 50-64, doi: 10.1080/17439760.2012.754926

The Power of Gratitude

In a society where negativity often predominates and entire conversations centre around complaints, the experience of gratitude, an awareness and appreciation of the good things that happen, is refreshing and grounding. However, with the negativity bias, the human tendency to notice, remember and pay attention to the negative much more quickly than the positive (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001), gratitude requires conscious effort to rewire habitual patterns of thinking. Luckily, positive psychology research has empirically validated certain techniques, showing that "counting your blessings" is no longer a platitude, but a tried-and-tested way of enhancing your wellbeing and positive emotion.

Why be grateful?

Individual differences in gratitude have been linked with subjective well-being (high positive affect, low negative affect, and high life satisfaction) in 12 studies (as reviewed by Wood, Froh, & Geraghty, 2010). Wood, Joseph, and Maltby (2008) also found that gratitude predicts psychological well-being (autonomy, environmental mastery, personal growth, positive relationships, purpose in life, and self-acceptance) above the effect of the Big Five personality traits. Furthermore, gratitude has also been negatively associated with depression (e.g. Wood, Maltby, Gillett, Linley, & Joseph, 2008), perhaps because positive life orientation is incompatible with the negative cognitive biases associated with depression. Gratitude is also related to perceived quality of relationships, forgiveness, low narcissism, greater perceived social support, relationship connection and satisfaction, conflict resolution and reciprocally helpful behaviour (as reviewed by Wood, Froh, & Geraghty, 2010). Finally, gratitude improves your quality of sleep (Wood, Joseph, Lloyd, & Atkins, 2009), as grateful people are more likely to think about positive things as they are falling asleep, promoting sleep quality, instead of negative thoughts that impair sleep (Nelson & Harvey, 2003).

Not currently oriented towards gratitude? Not a problem at all - gratitude is a skill that everyone can develop, and that's where gratitude interventions come in! These are exercises specifically designed to increase your levels of gratitude, changes that can persist through practice. Indeed, Emmons and McCullough (2003) found that participants who were asked to reflect on five things they were grateful for in the past week, over 9 weeks, had more positive and optimistic appraisals of their life, fewer physical symptoms, higher levels of positive affect and lower levels of negative affect, were more likely to offer emotion support to others, had better sleep quality, and a sense of connectedness to others. Similarly, Seligman, Steen, Park, Nansook, and Peterson (2005) asked participants to write down three things that well well each day and their causes every night for one week. These 411 participants experienced increased happiness and decreased depressive symptoms, with the effect lasting for six months after the intervention. Seligman et al. (2005) also found that participants who were instructed to go on a "gratitude visit", where one writes a letter to someone they are grateful to, and reads it out to them in person, reported increased happiness and decreased depression both at the immediate post-test and at the 1 month follow-up. For these reasons, gratitude interventions are seen as the most successful psychology interventions yet.

The exercises...and some reflections

The exercises themselves are deceptively simple, but as pointed out above, are effective. Here are the basic steps:

What went well (WWW)? 

Try this for a week (or more!):

1. Write down three things that went well with your day. These can be mundane (e.g. "The sun was shining today") or important (e.g. "I got a new job!").
2. For each of these things, answer the question, "Why did this happen?" (e.g. "Because Spring is coming!"; "I worked hard to prepare for the interview").

Easy, right? Extending this into daily life, I've decided to start asking people WWW? more often, instead of the typical "How's it going/How was your day?". So far, there have been interesting responses. When I asked a group of peers at lunch the other day, they kinda looked a bit baffled, before responding along the lines of not being able to think of anything, or "nothing much", or even "nothing at all". Another friend thought that it was a nice question to ask. Recently, and more positively, one friend thought it was "kinda touching", because she felt that asking WWW instead of the standard "how are you" shows that you care, and also that it reminded her that things actually did go well that day, despite it being a difficult day. For the most part though, people are taken by surprise when they are asked this question. For me, this just illustrates the negativity bias. I bet you, if I had asked, "What went wrong today?", the response time would have been far quicker, and people would have thought of many more things to complain about. The threshold of activation seems far higher for positive events than negative events, as even minor annoyances seem to be remembered more readily than even relatively major positive events. However, any change in attitudes or norms takes repetition (and education), so I'll keep trying!

The Gratitude Visit 

People like to be thanked, but tend to be under-appreciated. It means something special to people when they are recognised for their efforts, to know that they are valued. So here's my challenge to you:

1. Think of a person in your past who has benefited you in some way and who you have not properly thanked.
2. Write them a gratitude letter, expressing your thanks and appreciation for what they have done for you. Be as specific as you can, and try to illustrate just what impact they have made in your life. Aim for around 1/2 a page to one page of text.
3. Make a time to visit the person, but don't say what the visit is about. (If the person is overseas or interstate, Skype is ok, but probably not the phone)
4. Visit the person and read the letter out loud to them. Read it slowly and mindfully, with meaning, intent, and eye contact. 
5. Give the person time to respond to the reading. This will be probably be a highly emotional experience for them.
6. Optional, but a highly likely outcome: Hug them! :)

I personally tried this out last week (I would be a hypocrite if I was writing this and I hadn't done it myself!), and thought I'd share a few reflections, which will be a bit unspecific when talking about the reactions of the person I thanked as I guess it is a personal experience in a way. 

I'll admit it, despite being in the habit of writing thank you letters and telling people I appreciate them, I felt quite a bit of aversion to the idea of actually reading a whole letter out loud to the person. To be honest, it took me awhile to think of exactly who I would write my letter to, but once I did, it made complete sense to thank them for what they had done for me. Writing out the letter helped me to further clarify exactly what I was grateful to them for, and enhanced my sense of appreciation for what they had done. It was actually quite a profound realisation. 

Before visiting her, I felt slightly nervous and awkward, but mildly excited. When I told her I had written a thank you letter and would like to read it out loud to them, she was surprised but went along with it. The actual reading felt really natural and authentic. Afterwards, she was clearly touched, and teary, and had realised the difference she had made in my life. There were smiles all around and a great sense of connectedness, understanding, and of course, gratitude, for both of us.

Immediately post-visit, I felt enthused, excited, and just plain HAPPY that I had helped her feel appreciated and valued. I felt connected and peaceful, and motivated to spread more kindness. I also took the Positive and Negative Affect Scale (PANAS) questionnaire online at the Authentic Happiness website (it's free!) the night before and immediately after the visit, and my positive affectivity had increased from 23/50 (~30th percentile of respondents) to 36/50 (~80th percentile), while my negative affectivity remained stable (11/50, minimum = 10). While that was probably rather unscientific as I was tired the night before, the subjective experience of increased positive emotion was undeniable.

In the end, the visit reminded me of how important it is to tell people you appreciate them, and how much it means to them. It also taught me that it is important to have the courage to SAY THESE THINGS. You will not be ridiculed or rejected or embarrassed. You will make someone's day, touch their hearts, and help them feel like they matter. This is the beautiful thing about positive psychology - it not only enhances individual wellbeing; it enhances the wellbeing of those around you too, contributing to the flourishing of whole communities.

Conclusion

A growing scientific knowledge base is showing that cultivating gratitude could be one of the most important things you can do to not only insure yourself against mental illness, but to support your overall wellbeing and flourishing. Granted, this requires active, intentional effort to overcome the negativity bias and focus on what you do have (vs. what is missing in your life), what has gone well (vs. what went wrong), and the good in others (vs. what's wrong with others). However, if you can achieve this subtle shift in mindset as often as you can, the most likely outcome is increased happiness and flourishing for you, as well as for those around you. The power of gratitude is in your hands.

Try it out!

What went well for you today, or this week? Would you go on a gratitude visit? If not, what's holding you back? Let me know in the comments!

References

Baumeister, R. F., Bratslavsky, E., Finkenauer, C.,, & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323-370.

Emmons, R. A., & McCullough, M. E. (2003). Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life. Journal of Personality and Social Psychology, 8(2), 377-389.

Nelson, J., & Harvey, A. G. (2003). An exploration of pre-sleep cognitive activity in insomnia: Imagery and verbal thought. British Journal of Clinical Psychology, 42, 271-288.

Seligman, M. E., Steen, T. A., Park, N., & Peterson, C. (2005). Positive Psychology Progress: Empirical Validation of Interventions. American Psychologist, 60(5), 410-421.

Wood, A. M., Froh, J. J., & Geraghty, A. W. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890-905.

Wood, A. M., Joseph, S., Lloyd, J., & Atkins, S. (2009). Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of Psychosomatic Research, 66, 43-48.

Wood, A. M., Linley, P. A., Maltby, J., Baliousis, M., & Joseph, S. (2008). The authentic personality: A theoretical and empirical conceptualization, and the development of the Authenticity Scale. Journal of Counseling Psychology, 55, 385-399.

Not Practicing is Practicing

The title of this post comes from a chapter in Jon Kabat-Zinn's book, "Wherever You Go, There You Are". I read this book towards the end of my break from university, and this chapter particularly resonated with me. So what does this seemingly paradoxical statement, "Not Practicing is Practicing", really mean?

In Jon Kabat-Zinn's words:

"every time you come back to yoga practice, you see the effect of not having done it for a while. So in a way you learn more by coming back to it than you would by just keeping it up...Forgetting or neglecting to be mindful can teach you a lot more than just being mindful all the time...Try noticing the difference in how you feel and how you handle stress in periods when you are into the discipline of daily meditation and yoga practice and in period of your life when you are not."

This seems applicable to most skills in life. I've seen it in my violin playing, singing, fitness, and now, mindfulness. I think this point is best illustrated with a personal example, so I apologise in advance if this seems a bit self-indulgent.

Slipping into mindlessness

I have to admit that my holidays were far from mindful. For various reasons, my regular meditation practice had slipped from something like this to something like this. Along with this neglect of formal mindfulness practice, I felt like I had also slipped back into a cloud of unawareness, emotional reactivity, negative emotions, and an auto-pilot lack of consciousness. 

I also noticed that I was causing myself a lot of suffering due to the attachments I had; ideas about I had about what holidays or home should be like, or how I should be able to keep up my meditation practice, or even, more deludedly, how other people should be. A commitment to formal mindfulness practice would have helped me to better apply the skills of letting go and letting be in my daily life, and seeing things as they are and not how I would like them to be, which I do better at nowadays than in my pre-mindfulness (mindless?) days.

In a nutshell, due to this lack of awareness, while there were many enjoyable aspects of the break and while I definitely wasn't miserable, I can't say I was flourishing or getting the most out of life, even during a period of near-complete freedom from obligations and commitments.

"It is in the coming back to mindfulness that seeing lies."

While the above may seem a little sobering, there is a bright side to the story. University has started again, and with the structure and momentum of semester, I have begun my regular formal practice again, and am already feeling more grounded, stable and more able to let go (e.g. getting over a burglary in my room relatively quickly).

I've also come back with new ideas about maintaining intention and purpose in my practice. To experiment with the idea of the value of "the coming back", I've decided to try something else to mix up my practice a bit; by practicing six days a week instead of seven. I think that one day off a week will prevent the practice from becoming mechanised and routinised, and leaves something to come back to. For now, I'll aim to meditate for 30 mins in the morning and 10 mins at night from Mon-Friday, take Saturday off, and meditate 1 hour Sunday morning and 1 hour Sunday evening, usually at a group sitting. It might turn out that I prefer to meditate every day, but I'll see how it goes.

Therefore, the key to this seemingly paradoxical statement, "Not Practicing is Practicing" is that not practicing is only practicing if you come back to it, so that you are able to learn something from your time away. More importantly, rather than flagellating oneself over not practicing, or regretting what has already happened, it makes more sense to simply return with a fresh approach, a beginner's mind, and begin again, and again, again, remembering that every moment is a new beginning and the only moment that we are fully alive in.

Book Review: Anatomy of an Epidemic

[Edit 12/06/15: After reading some critical commentary on this book that reveals its strong bias, I'm less convinced by the anti-medicine arguments. Reader beware.]

Psychiatry has apparently undergone a "psychopharmacological revolution", discovering drugs such as the atypical antipsychotics, Prozac, lithium, and the  benzodiazepines, to name a few, which appear to be promising candidates as "magic bullets" to cure a range of mental illnesses: schizophrenia, depression, bipolar disorder, anxiety, ADHD, etc... Finally, we've discovered the biological bases of mental illnesses, and have effective drugs for treating them.

If that is the case, we would expect that the incidence of mental illness and their disabling impact would be reduced today, compared to the late 1980s.

Instead, the reverse has occurred, with 1,100 adults and children being added to government disability rolls in the US every day, leading Whitaker to ask, "Why has the number of disabled mentally ill in the United States tripled over the past two decades?" In other words, what can explain this epidemic of mental illness?

What beliefs do you hold about drugs and mental illnesses?

• That all mental illnesses are caused by a chemical imbalance in the brain, and that psychiatric medications restore this balance?
• That psychiatric medications for psychotic, anxious, depressed or hyperactive patients are "like insulin for a diabetic"?
• That psychiatric medications have been scientifically shown to be efficacious and safe? 

These are all common claims made by psychiatrists and pharmaceutical companies alike, messages which have been purposefully disseminated to the public, and which are now, to a large extent, considered "common knowledge".

Indeed, prior to reading this book, I held these beliefs, at least to some extent, given the very limited (one lecture) knowledge of psychopharmacology I learned in Biological Psychology last semester. However, Whitaker's book, by telling "the story that wasn't told", shows how ill-conceived these beliefs may be, leaving the reader feeling disturbed about the scientists, the industry, and the ethical implications of our current standard of care, in which psychiatric medications, undeservedly, play a starring role.

Whitaker's Argument

Whitaker's central claim is that psychiatric drugs have in fact contributed to the epidemic of mental illnesses (over and above, and making a greater contribution than other factors like social changes), worsening long-term outcomes. That is, a large proportion of mental illnesses may be maintained and even caused by iatrogenic processes; caused by the medications themselves. This is a rather counterintuitive and even shocking thesis, but through a thorough review of the literature and interviews with psychiatrists and patients, Whitaker presents a well-supported and compelling argument, showing us that:

• We still don't really know the biological bases of mental illnesses, so "magic bullets" can't really exist.
• Psychiatric drugs have transformed mental illnesses which used to have good long-term outcomes and recovery rates in the pre-psychopharmacology era to chronic illnesses that "require" constant medication with limited prospects for recovery.
• Psychiatric drugs may cause, rather than fix chemical imbalances in the brain by messing with the normal neurotransmitter pathways and mechanisms, leading to a range of long-lasting compensatory mechanisms in the brain.
• Side effects of these medications have deleterious effects on the physical health and cognitive function of patients.
• Children are being groomed to become lifelong patients by being diagnosed and medicated early on, and these medications may be used for the purposes of behavioural control, rather than the wellbeing of the child.
• There are effective alternatives to drug therapy, such as psychosocial care for schizophrenia, and exercise as an antidepressant
• Psychiatry and pharmaceutical companies are working in cahoots, and go to extensive lengths to deceive us, by hiding negative results and reporting false information in scientific journals. Why? The legitimacy of the field of psychiatry and a whole lot of $$$$$$ are at stake!
• And those who disagree are quickly shut up.

These are all disturbing points that are well worth at least considering.

Bottom Line

Today, mental illnesses are often compared to physical illnesses, which has contributed to the destigmatisation of mental illnesses. Yet, this process has also contributed to the normalisation of the use of psychiatric drugs.

However, while there probably remains a valid role for psychiatric drugs, perhaps they should be used in a selective, limited, and cautious manner, not right at the outset, and not as a long-term solution.

Moreover, with the health, wellbeing and lives of millions of patients at stake, doctors, scientists and pharmaceutical companies need to be honest about what these drugs can and can't do. There needs to be an honest scientific discussion about these matters.

For these reasons, this book is a must-read for physicians, mental health professionals and students alike, as well as those who are currently on psychiatric medications or considering taking them, to be fully informed of both sides of the argument.

Finally, perhaps this book reveals how irrational it may be, though typical of a "quick fix" society, to hope for "magic pills" to cure the ailments of something as complex as the mind.

I welcome your views...

Please, discuss!

The Mindful Way Through Exams

What do you associate with the word, "exams"? Stress? Work? Pressure? Tunnel-vision? I think these are some fairly common conceptions of what exam periods usually look like. However, I also believe that this is not an inevitable fate. While it is usually true that exam preparation involves increased demands of our physical and mental resources, I hope to explain here how mindfulness can be a particularly effective buffer against psychological stress. By studying with intention, starting or maintaining a formal practice, taking mindful breaks and maintaining a mindful attitude, exams can be a period of focused learning that remains simply another aspect of your life, rather than an all-consuming stressful experience.

Conscious Studying

Mindfulness, as the art of conscious living, applies to any area of life. This includes approaching study with purpose and intention.

Compare these illustrative examples:

Mindless Studying

• Pseudo-studying
• Studying with Facebook and your work open in two windows side-by-side and your phone next to you
• Studying while watching TV
• Autopilot studying
• Indiscriminately revising all content regardless of how well you already know it
• Passively reading/flipping through the textbook
• Copying your notes over and over again
• Punitive studying
• Locking yourself in the library (or your room) from 8am-12am with a 6-pack of Red Bull and no breaks

Conscious Studying 

• Reviewing flash cards with a spaced repetition function so you only study relatively unfamiliar content
• Making mind-maps to summarise and integrate your subject
• Practicing problem sets and past exams
• Practicing writing essays in exam conditions
• Splitting up your final essay into clearly defined stages with time limits:
• Find XX relevant sources (4 hours)
• Compile relevant evidence, with citations, from the sources in one document under headings of the topics you may want to address (3 hours)
• Given your research, rethink the structure of your essay and come up with a possible argument (2 hours)
• Write paragraph 1
• Write paragraph 2
• etc...
• After leaving for a day or two, edit for structure
• Edit for spelling/grammar
• Final sanity edit

Conscious studying is simply a more effective approach; by cutting out the distractions and being more specific about what you want to achieve, you get more done in less time and with less pain.

Formal Practice

Exams is as good a time as any to establish a formal practice. After all, mindfulness is associated with reduced anxiety and stress (Hofmann, Sawyer, Witt, & Oh, 2010; Evans et al., 2007), and increased working memory capacity and sustained attention (Chambers, Lo, & Allen, 2008). 

Apart from these performance-related benefits, mindfulness meditation can support your general sense of wellbeing. In a time when we are probably relatively focused on getting stuff done, taking 5 or 10 minutes to simply be with the breath brings you back to the present, helps you get back in touch with yourself, cultivates a sense of peace, and reduces perceived time pressure, when you realise that taking a few minutes to just be won't kill your study schedule.

So how do you do it?

Find a time that works for you. It may be first thing in the morning, last thing at night, or before dinner, for example.

There are a variety of possible practices, including mindfulness of the breath, mindfulness of the body, mindfulness of sounds and thoughts, and the body scan. I'll just provide the instructions for mindfulness of the breath here (repeated from Mindfulness in a Nutshell). However, you can easily substitute "sensations of the breath" for the sensation of your body as a whole, for sounds in the environment, or for an awareness of your thought-stream. The basic idea of mindfulness is to choose an object of attention and to constantly bring your attention back to it.

1. Sit upright with wakefulness and dignity
2. Bring your attention to the sensations of the breath in the belly or nostrils, or wherever else you can feel the breath. Stick with this location for the session.
3. Feel the full duration of each in-breath and each out-breath.
4. When you notice that your mind is no longer on the breath (this is inevitable!), notice what is on your mind in that moment, and let it go, then escort your attention back to the breath.

Mindful Breaks

Even if you choose not to establish a formal practice, mindfulness can be an effective practice during study breaks. When we are studying, often we get wrapped up in the content and the learning, and in doing so, lose touch with the external world outside of our laptops or textbooks, and with ourselves. The 3-minute breathing space is a good exercise for bringing you back to the present moment, noticing everything else that is in it, including your own mental and physical state, that you have possibly been ignoring while studying. It's a good idea to study for perhaps 50 minutes before taking a 10 minute break, including a breathing space (or perhaps 25 minutes, then a 5 minutes break). An even simpler alternative for a mindful break is to just bring your attention to your breath for one minute.

Here are the instructions (again, repeated from Mindfulness in a Nutshell).

1. Awareness: Bring yourself into the present moment, asking yourself, “What is my experience right now…in thoughts…in feelings…and in bodily sensations?” Acknowledge and register your experience, even if it is unwanted.
2. Gathering: Gently redirect full attention to breathing, to each in-breath and to each out-breath as they follow, one after the other.
3. Expanding: Expand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression.

Stop! Try it now - go on, it'll only take 3 minutes!

Mindful Attitudes

Finally, and perhaps most importantly, mindful attitudes can help maintain a healthy and balanced mindset during exams.

Non-judging. Notice the tendency of the mind to label experiences as good or bad, to like or dislike. For example, you may be finding some aspects of study "boring", or feel aversion towards stressful thoughts and feelings, or label yourself as "dumb" if you don't get something, or "lazy" for procrastinating. Simply observe this judging tendency when it arises, without necessarily trying to change it. This is about developing an acceptance of your experiences, even if they are unwanted, and being gentle with yourself.

Acceptance. Seeing things as they actually are in the present, not how you would like them to be. This might involve noting that you are seriously behind on your study schedule, adjusting it, and moving on, rather than freaking out (reacting) or pretending it's all ok (denial). After an exam, this involves recognising that what has happened has happened, and letting go, without ruminating on it any further.

Beginner's Mind. A mind that is free from expectations and receptive to the unique possibilities in every moment. What happened yesterday and the day before has already happened. Whether it was productive or filled with setbacks, each day is a new day, and expectations either way can lead to disappointment. Approach each day with a fresh mind, ready to learn and tackle any problems that come up.

Trust. Everyone has their own way. You know your learning style best, so balance external guidance with a trust in your own basic wisdom and intuition.

Non-striving. Mindfulness is not about trying to get anywhere, because you are already here. This may sound like a completely bizarre attitude to invoke when it comes to exam preparation. After all, preparation, by definition, involves trying to achieve things (as was apparent in the Conscious Studying section). However, if you approach exam preparation with the idea that you need to get a certain amount of stuff done, or achieve a certain grade, then you've introduced the notion into your mind that you're not ok as you are. Thus, as paradoxial as it seems, it is worth balancing these goals with a realisation that your goals are not you, and that as long as you are breathing, there is more right with you than wrong with you.

Conclusion

Through a combination of a conscious approach to studying, formal practice, mindful breaks and mindful attitudes, mindfulness can help you to maintain balance and perspective during exams. It's a way that is not only effective, but more importantly, encourages you to be realistic, gentle with yourself, and to stay in touch with the present moment and therefore with life, which doesn't stop for exams!

References

• Chambers, R., Lo., C., & Allen, N. B. (2008). The impact of intensive mindfulness training on executive cognition, cognitive style, and affect. Cognitive Therapy and Research, 32, 303-322.
• Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22(4), 716-721.
• Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.

Mindfulness in a Nutshell

What exactly is "mindfulness", the theme of this blog? Why be mindful? How can mindfulness be developed? I aim to provide a brief introduction to these topics here.

What is mindfulness?

Mindfulness is the art of conscious living. This involves a mode of being that involves non-judgemental awareness of the present moment (Kabat-Zinn, 2003), allowing us to wake up, reconnect with ourselves and with the world, and to appreciate the richness of every moment. 

1. Present moment: Noticing whatever is actually here, right here, right now. Not what happened yesterday, or what you need to do tomorrow, or where you would like to be...but allowing yourself to fully experience what is already here. This could involve the breath, bodily sensations, sounds, thoughts, or a "choiceless awareness" of any aspect of the present moment.
2. Awareness: Paying attention. This is an active process of continually bringing your attention back to what you are observing in the present moment whenever your mind gets carried away. In this sense, mindfulness involves mastery of the mind, the opposite of mindlessness.
3. Non-judgemental: Accepting, embracing, and remaining equanimous to those present-moment experiences that you are paying attention to. Taking a break from liking and disliking, and instead, simply noticing whatever is here and allowing it to be.

Why be mindful?

Mindfulness is based on an awareness that we literally only have moments to live. We spend much of our time thinking, planning and worrying about the future, or regretting and ruminating about the past. Each time our mind wanders from where we are in the present moment, we reduce our ability to fully experience and appreciate the present moment. By bringing our awareness back into this present moment, right here, right now, we can really live life in its full richness.

Therefore, by cultivating an accepting, non-judgemental attitude, and a mind that is able to both stay and see things as they are in the present moment, mindfulness has the potential to reduce the impact and influence of stressful thoughts and feelings, to promote balance, calm and peace, and emotional stability, and to develop self-acceptance and self-compassion.

In Western psychology, there has recently been an explosion of interest in mindfulness. It's no wonder why, when you consider the promising results of studies so far, which have linked mindfulness with reduction in anxiety and mood problems (Hofmann, Sawyer, Witt, & Oh, 2010; Evans et al., 2007), increased left-sided anterior brain activation (associated with positive emotions) and improved immune function (Davidson et al., 2003), reduced size of amygdala (involved in stress responses) and significantly reduced perceived stress (Hölzel et al., 2010), and improvements in self-reported depressive symptomatology, negative affect, working memory capacity, and sustained attention (Chambers, Lo, & Allen, 2008).

Given all of these likely benefits, it seems fair to conclude that mindfulness has a real potential to promote peace, wellbeing and health.

How is it developed? 

Mindfulness can be developed through both "formal" and "informal" practice.

Formal practice can involve sitting practices, such as mindfulness of the breath, mindfulness of the body, and mindfulness of sounds and thoughts. It can also involve a body scan, lying down. Alternatively, walking meditation is a suitable practice for those who don't like the idea of sitting or lying still.

10 minutes a day is a good place to start, and even 5 minutes a day can make a difference.

Here are some basic instructions for mindfulness of the breath and mindfulness of the body:


Mindfulness of the Breath

Breath is life. Mindfulness helps us to get in touch with the breath and how it changes with our moods, and to recognise how precious it is to be breathing.

1. Sit upright with wakefulness and dignity
2. Bring your attention to the sensations of the breath in the belly or nostrils, or wherever else you can feel the breath. Stick with this location for the session.
3. Feel the full duration of each in-breath and each out-breath.
4. When you notice that your mind is no longer on the breath (this is inevitable!), notice what is on your mind in that moment, and let it go, then escort your attention back to the breath.

Mindful Walking 

Bring your full awareness to the sensations of walking, noticing:

• The physical sensations of the contact of the feet with the ground
• The weight of your body transmitted through your legs and feet to the ground
• The changing patterns of physical sensations in the legs and feet as you transfer the weight of the body into each leg
• The movements of the body as it changes direction

You may like to start by walking at a pace that is slower than usual, and try faster speeds later.

Informal practice, which involves bringing mindfulness into everyday life, is just as important, and possibly even moreso, than formal practice. This is because the point of formal practice is to be able to bring mindful awareness into daily life, to bring the being into the doing. Here are a couple of suggestions:

Mindfulness of Everyday Activities 

Choose a routine activity in your daily life (e.g. brushing your teeth, showering, getting dressed, eating) and make a deliberate effort to bring moment-to-moment awareness to that activity each time you do it. Simply focus on knowing what you are doing as you are actually doing it.

3-Minute Breathing Space 

The breathing space provides a way to step out of “automatic pilot” and reconnect with the present moment.

1. Awareness: Bring yourself into the present moment, asking yourself, “What is my experience right now…in thoughts…in feelings…and in bodily sensations?” Acknowledge and register your experience, even if it is unwanted.
2. Gathering: Gently redirect full attention to breathing, to each in-breath and to each out-breath as they follow, one after the other.
3. Expanding: Expand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression.

Conclusion

Jon Kabat-Zinn's statement, "Mindfulness is about living life as if it really mattered," is an apt summary of what mindfulness is and why we should be mindful. Every moment is fragile and precious, and if we value life, then we need to be here to experience it. There are compelling reasons to believe that this way of existence is beneficial for us on psychological, medical, social and spiritual levels. It is exciting that Western medicine and psychology are finally recognising and validating the benefits of mindfulness, and I am looking forward to learning from, and hopefully contributing to, future research.

References 

• Chambers, R., Lo., C., & Allen, N. B. (2008). The impact of intensive mindfulness training on executive cognition, cognitive style, and affect. Cognitive Therapy and Research, 32, 303-322.
• Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S., et al. (2003). Alterations in Brain and Immune Function Produced by Mindfulness Meditation. Psychosomatic Medicine, 65, 564-570.
• Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22(4), 716-721.
• Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.
• Hölzel, B.K., Carmody, J., Evans, K.C., Hoge, E.A., Dusek, J.A., Morgan, L... Lazar, S.W. (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive & Affective Neuroscience, 5(1), 11-17.
• Kabat-Zinn, J. (2003). Mindfulness-based interventions in context - Past, present and future. Clinical Psychology: Science and Practice, 10(2), 144-156.