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Sarah McKay
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Science Writer, Freelance Medical Writer, Neuroscientist, Brain Health Blogger
Science Writer, Freelance Medical Writer, Neuroscientist, Brain Health Blogger

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The range of psychological therapies and treatments available today for mental illness can be overwhelming.

With new treatments and theories popping up all the time it can be difficult to know what will work best for you.

If you or someone you know is struggling with mental illness you should discuss with your GP or mental health professional what the best treatment options are for your individual circumstances and personality. But having a good working knowledge of the major types of psychological therapy and the theory behind them can help you understand your own circumstances and how best to go about getting treatment.

A guide to talking therapies
This guide will give you a brief overview of some of the most widely-used therapies; giving you insight into how they work, who they are for, and what you can expect in a typical session.

Cognitive Behavioural Therapy (CBT)
CBT works on the basis that while you can’t always change your circumstances, you can change the way you react to them. Identifying faulty or negative thought processes and training yourself to see the world more positively can have huge effects on your mood and behaviour.

CBT is widely regarded as one of the most successful treatments for a number of conditions including depression and anxiety. What’s more, CBT is a short-term treatment that focuses on giving you the tools to change your thinking through self-reflection and deliberate changes to your thoughts and behaviour. This makes it a powerful tool for long-term change.

Acceptance and Commitment Therapy (ACT)
Often those struggling with emotional trauma will go to great lengths to avoid confronting their pain. These avoidance strategies and “inner battles” can be far more destructive than the initial source of distress. ACT encourages clients to confront their distress rather than avoiding it and end the struggle with internal thoughts and emotions.

During ACT you will work with the therapist using introspection and thought exercises to make healthy connections with your thoughts and sensations and help you act more independently of them in service of your values. This approach has seen great success treating anxiety, depression, stress and even chronic pain.

Schema Therapy
Schemas are those deeply ingrained worldviews which are formed early in life and affect how we see ourselves and everything around us. Traumatic experiences in childhood can lead to the forming of maladaptive schemas which force a person to see the world in a highly negative light. This deeply rooted paradigm of self-defeating thought can have serious and long-term consequences.

Schema therapy is an intensive and long term therapy in which cycles of self-destructive behaviour and their root causes are exposed and re-written. Emotions, thoughts and behaviours are examined in detail to produce long-lasting change. Schema Therapy is highly effective in treating chronic conditions like Borderline Personality Disorder and in helping individuals who were previously considered untreatable.

Solution Focussed Brief Therapy (SFBT)
Individuals struggling with emotional distress can often develop their own ways of coping with their condition. These methods form the basis of SFBT, a goal-driven therapy which aims to empower the patient to use their own strengths and desire for change as a powerful means of recovery.

SFBT does not look into the underlying causes of emotional illness, instead focusing on developing goals and strategies for improvement over a short treatment period. SFBT is therefore a fast, effective and low-intensity treatment and a good first choice for a range of conditions.

Compassion Focussed Therapy (CFT)
Those struggling with depression and other illnesses often have difficulty seeing themselves positively and can have high levels of shame and self-criticism. Such patients can benefit from learning to have compassion for themselves through CFT.
In CFT inner mindfulness and powerful imagery is used to re-write those internal voices that are constantly criticising. Training yourself to react and think more positively can have great success in combating illnesses which stem from shame and low self-esteem.

Dialectical Behaviour Therapy (DBT)
DBT is an offshoot of CBT that developed to help those experiencing chaotic swings in emotion and an inability to cope with extreme feelings. Although initially developed with Borderline Personality Disorder in mind DBT has proven effective for a range of emotional difficulties.

Clients taking part in DBT develop skills in regulating their emotions and practice interacting with others in healthy, constructive ways through individual and group therapy. As in CBT, unhelpful thoughts are challenged and replaced with more positive alternatives.

Motivational Interviewing
Motivational Interviewing is a collaborative counselling technique that focuses on helping clients develop the motivation and drive to break themselves out of unhealthy behaviour. The therapist helps the client think about change and resolves any concerns or mixed feelings the client may have about changing their lifestyle.

Motivational Interviewing is a collaborative approach, valuing rapport between client and therapist and using the client’s internal motivations to drive change. This approach is mainly used to treat substance abuse and related disorders and is now established as an effective evidence-based treatment. It has also been applied successfully with anxiety treatment.

Narrative Therapy
When people experience traumatic events, the consequences of the event and the person’s interpretations of them turn the event into a story or narrative. Narrative Therapy enables clients to look objectively on their narratives and gain new insight into their lives.

Narrative Therapy focuses on separating the person from the problem, externalising issues so that they can be viewed objectively and addressed more effectively. Narrative Therapy also helps clients see issues in the larger context of their life story and build new narratives for themselves to follow.

Summary
Different therapies work better for different individuals, depending on their personality, the type and severity of their condition and the amount of time they can commit to therapy. All of the above therapy types are evidence-based and draw upon years of scientific study to help understand mental illness from different perspectives. Each has been shown to be effective in treating disorders and emotional difficulties, and new research is constantly improving existing techniques, empowering clients to change the way they think.

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Are there ways to maintain a ‘youthful’ brain and mind? This week, we take a look at how we can reduce age-related memory loss as well as keep a youthful mindset.

Cognitive reserve refers to the brain's resilience or ability to cope, despite damage or degeneration. Ample evidence shows that people who lead mentally, socially and physically stimulating lives have a reduced risk of age-related cognitive decline. It’s thought this risk is reduced because mental, physical and social challenges build cognitive reserve. Here are 10 tips to keep mentally, physically and socially engaged in life, no matter your age. 
 
Move your body
One of the best brain exercises is physical exercise. The most physically active people have the lowest risk of cognitive decline. Exercise increases blood flow to your brain, can stimulate the birth of new brain cells, and strengthens the connections between pre-existing neurons. A daily walk in nature is a powerful mood-lifter, reduces stress, and promotes healthy immune responses.

Go back to school
Rich educational experiences or engaging in mentally challenging occupations have a major influence on how you age cognitively. This is because mentally stimulating activities help build cognitive reserve. The present-day opportunities available for low-cost or free on-going education both in-person and online are enormous.

Cultivate curiosity
Curiosity is a state of active interest or genuinely wanting to know more about something. The brain circuits involved in curiosity influence and interact with brain circuits that govern learning and memory. This means that being extra curious and interested in what you’re learning induces a motivational state that enables you to better learn other things too.

Make music
Playing a musical instrument engages many aspects of brain function and requires a host of sensory, cognitive, and motor skills. If you play a musical instrument, challenge yourself to learn a complex new piece. Never learned as a child? Adults have some key advantages over children when it comes to learning how to play an instrument: not only do adults want to learn, they have the ability to tackle complex abstract concepts, and the focus and discipline to put in the practice required for mastery.

Be adventurous
Lab mice kept in bare cages with no toys or places to explore show greater rates of age-related cognitive decline compared to their counterparts kept in enriched novel environments full of toys, tunnels and mazes. Humans are no different. People who stay physically and mentally actively engaged in life and constantly challenge themselves to step out of their comfort zone have a reduced risk of age-related cognitive decline.

Play games
Adults tend to play less and take life more seriously than kids. But you don’t lose the need for novelty and pleasure once you grow up. Game playing, whether it be video or online, traditional board games, or team or individual sports, has been shown to alleviate boredom, anxiety, depression, loneliness, despair and even physical pain.

Share your wisdom
Knowledge alone is not useful unless you can make connections, or connect the dots, between what you know. Wisdom is gained from experience and can also be shared. Share your wisdom, skills and experience with younger people by finding opportunities for mentoring, teaching or coaching.

Get crafty
The rhythmic and repetitive nature of yarn crafts, drawing, painting or even throwing a clay pot is calming, comforting and contemplative. It’s not a stretch for you to imagine crafting as a mindfulness practice, or form of meditation. Perhaps this explains the current boom in adult colouring books? Crafting is intrinsically creative, but also develops hand-eye coordination, spatial awareness and fine motor skills. It also involves problem solving, memory formation and retrieval.

Connect with others
People who participate in high numbers of different leisure activities such as going to clubs, visiting friends, playing cards, and community or volunteer work have a lower risk of developing dementia. Conversely, loneliness is associated with more than double the risk of developing dementia.

Believe in you
Accumulating evidence suggests that people who consider themselves to be old and frail are more likely to abandon activities that can keep them healthy in old age. Think yourself young by remaining socially, mentally and physically active. As the saying goes, age isn’t a number but an attitude.

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The relationships between mental, environmental, social and physical aspects of health and wellbeing are complex. Add in the brain—the most complex of living structures, one that enabled humans to walk on the moon, map the human genome, and compose masterpieces of literature, art, and music—and you’re faced with a daunting task of understanding how the brain affects and is affected by the health of the mind, body, and world around us.

Bottom-Up, Outside-In, Top-Down: a Model of Brain Health.

One useful way I like to think about the many elements that influence the health of the brain is what I call the Bottom-Up, Outside-In, Top-Down Model of Brain Health. 

Bottom-Up elements are the biological or physiological determinants of brain health and include genes, hormones, the immune system, nutrition, exercise, and other lifestyle choices.
Outside-In elements include social and environmental factors, stress, life events, education, current circumstances, and family background.
Top-Down elements include thoughts, emotions, mindset, and belief systems.
Not only do these many elements determine the health of the brain, each element can impact others in complex, multi-directional and dynamic ways. For example, our thoughts can influence our physical health (which is why psychological stress can lead to heart disease), our social environment can directly impact our brain health (folk who are socially isolated are at greater risk of dementia), and our physical health and mood are intimately entwined (which is why exercise is key for mood regulation).

The 7 habits to adopt for brain health, wellbeing and a flourishing life.

Based on my Bottom-Up, Outside-In, Top-Down Model here are the 7 key habits I believe you should adopt to promote a highly healthy brain and flourishing life – one free of physical or mental illness, disease, pain, or angst.

I’ve listed these loosely in order of importance, and you’ll see that they build from Bottom-Up (Sleep, Move, Nourish) to Outside-In (Connect, Calm) to Top-Down (Challenge, Believe).

1. SLEEP. A good night sleep every night should be a priority, not a luxury. Sleep is overlooked, underappreciated, and the number one, fundamental bedrock of good health. Sleep deprivation (even a few hours a night) impacts cognition (thinking), mood, memory and learning and leads to chronic disease.

Sleep is essential for consolidating memories and for draining waste products from the brain.  Not only do we under-sleep, we under-consume natural light during the day and over-consume artificial light at night leaving our natural circadian rhythms, hormones and immune systems dysregulated.

Short afternoon naps consolidate memory, spark creativity and smooth your rough emotional edges (no guru, course or app required!).

2. MOVE. The best exercise for your brain is physical exercise. Daily exercise increases blood flow to the brain. Exercise triggers the release of brain derived neurotophic factor (BDNF), which promotes neuronal growth and survival, reduces inflammation, and supports the formation of long-term memories.

Exercise reduces the risk of dementia (and other chronic lifestyle diseases), acts as an anti-depressant, and regulates mood.

Our brains evolved to support bodies that move through, make sense of, and respond to the natural world around us. A simple walk outdoors gets you away from digital devices and into nature. You’ll do your best thinking when walking.

3. NOURISH. A healthy brain requires a healthy well-nourished body. Research points towards a Mediterranean-based diet of mostly plants (vegetables, fruit and legumes), fish, some meat, olive oil and nuts as optimal nourishment for brain health. Wine and coffee in moderation (yes, really!) prevent cognitive decline, memory loss and protect against dementia (Plus, the little pleasures in life are important too!).

4. CALM. Find your moment of calm. Not all stress is bad, but chronic stress, especially life events that are out of our control, can change the wiring of our brains. Too much cortisol (a stress hormone) prevents the birth of new neurons and causes the hippocampus (the brain structure involved in learning and memory) to shrink, reducing your powers of learning and memory.

To de-stress find your place or moment of calm. Do something pleasurable — meditate, practice mindfulness, walk, or nap. The most pleasure is to be found in doing something you’re reasonably good at and that also poses some degree of challenge.

5. CONNECT We are born as social animals and have a fundamental need for human warmth and connection. Having supportive friends, family and social connections helps you live longer, happier and healthier. Socialising reduces the harmful effects of stress and requires many complex cognitive functions such as thinking, feeling, sensing, reasoning and intuition. Loneliness and social isolation have comparable impacts on health and survival as smoking.

6. CHALLENGE. Keep your brain mentally active. Adults who regularly challenge their minds and stay mentally active throughout life have healthier brains and are less likely to develop dementia. It’s thought ongoing education and mentally challenging work build cognitive reserve (the capacity to cope better and keep working properly if any brain cells are damaged or die).

Choose mentally challenging activities that you can practice regularly, that are reasonably complex and that take you out of your cognitive comfort zone. Try activities that combine mental, social and physical challenges.

7. BELIEVE. Seek out your purpose in life. Find your north star, your passion, your bliss, your inner voice, your wisdom, your calling. Whatever you call it. Research has found that people who score high on life purpose live longer, healthier and more fulfilling lives.

Do extraordinary things! Set fantastic, passionate goals and work like crazy to achieve them. Find your place of flow—that sweet spot where you so intensely and completely focus on the present moment and the task at hand and that time passes effortlessly. Some say flow is the point of life.

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Neuroscience is seductive. We have studies proving that the presence of irrelevant neuroscience information makes explanations of psychological phenomena more appealing! And throwing in fMRI pictures further increases that allure.

Neuromyths are abound and understandably there are numerous neuroscientists, bloggers and others lining up to sneer and throw rocks at people who believe them or who continue to peddle them (entertaining for some, but unhelpful and off-putting for those who’re genuinely curious to learn more).

Short of signing up for a PhD in neuroscience, or trawling through the over 100,000 research articles published annually containing the word ‘brain’ how does one know where to turn to for simple, relevant, evidence-based information about the mind and brain?

I recommend the following 13 science writers, bloggers and podcasters. They discuss with warmth, insight, wisdom and a solid foundation of knowledge the latest science and stories related to the mind, brain and behaviour.

Follow them and your brain will thank you.

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If you never read another article on neuroplasticity (ever), take time to sit down and absorb this one. You'll need a hot coffee (or long cool drink) as its long. But worth it ... can you THINK yourself into a different person, or is this another in a long line of neuro-myths?

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The human capacity for creative thought and innovation has enabled our species to survive and prosper. Creativity has allowed us to adapt flexibly to changing circumstances, to manage complex social relationships, and to build civilisations. We take a look at the brain regions that are involved in the creative process, and how you can maximise your creativity.  
Creativity: the driver of human civilisation
Our creative endeavours include not only the works of painters and sculptors, but engineers, architects, designers, medical and technology innovators, software developers, and so on. Because creativity is a broad concept, researchers have had to come up with an accepted definition, and they’ve settled on: the production of something both novel and useful. Using this definition, numerous studies have been conducted investigating both the brain regions involved in creative thought, and ways to enhance creativity in individuals.
Where is creativity located in the brain?
One conclusion drawn from brain imaging studies is that creativity doesn’t involve one single brain region, or side of the brain. Instead, creativity is a process that recruits different, but interacting, brain networks. Writing in the Scientific American, psychologist Scott Barry Kauffman has described three major brain networks involved in creative thought.
The Executive Attention Network is recruited when a task requires laser-beam-like focus. This network is active when you’re concentrating on a challenging presentation or engaging in complex problem solving. Structurally, the network includes regions of the prefrontal cortex and the posterior parietal lobe.
The Imagination Network (also called the Default Network) is involved when you think about the future, imagine alternative perspectives and scenarios to the present, or when you try to imagine what someone else is thinking. This network resides in areas deep inside the prefrontal cortex, temporal lobe, and regions of the parietal cortex.
The Salience Network constantly monitors both what’s going on around you and your internal stream of consciousness. It then passes the baton to whatever information is most relevant to solving the task at hand. This network consists of the dorsal anterior cingulate cortices and anterior insular.

Creativity research has found that one key is a lack of concern for criticism. This typically means switching off the higher-order reasoning and social judgment roles played by the executive attention network. Doing this allows you to loosen your associations, your mind to roam free, and lets you imagine new possibilities all whilst silencing the inner critic. But Kaufman cautions it’s always a good idea to bring that network back online, to critically evaluate and implement your creative ideas.

Seven tips to maximise your creativity:
Become an expert. Expertise frees up mental resources from mundane tasks. Experts have a talent of seeing immediately what is relevant.
​Read something absurd. Reading something absurd or surreal can help creative thinking. It’s thought the mind is seeking to make sense of the things that it sees, which puts it into ‘creative overdrive’.
Exercise. Exercise gets your blood pumping and lifts mood, both of which improve creative problem solving.
Let your mind wander. Daydreaming and napping allow your brain to make associations between previously unrelated concepts.  Intentionally trying to dream about a particular problem, called dream incubation, increases the chance that you will come up with a solution.
Think about something else. Focussing on another problem or task is a well-known method for overcoming a creative block.
Put limits on yourself. Dr Suess famously wrote ‘Green Eggs and Ham’ when he was challenged to write a book using only 50 words. Placing a self-imposed limit forces you to come up with creative solutions.
Embrace extreme moods. It’s well known that positive moods enhance creative problem solving. But so too does anger.

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Today’s blog post ‘The Body Whisper’ comes from the wise and super smart Xian Hu, a.k.a. Mandy, who studied Neurobiology at the University of Amsterdam and majored in Science Communication. Who she is? A writer, a traveller and a dreamer. She is still searching for her voice in science writing, but to get an idea of her writing style you can take a look at her travel blog (http://mandy-hu.tumblr.com/).

The Body Whisperer

‘They could see into the creature’s soul and sooth the wounds they found there.’  Nicholas Evans, The Horse Whisperer

The horse whisperer, the dog whisperer, the cat whisperer, the ghost whisperer… We seem to have come upon the craze of the ‘whisperer’-phenomenon. Albeit equines, canines, felines or… deadines, the idea is that there is an effective method to communicate and connect to a being and thereby improving their health and well-being. Sounding a bit too lofty for your taste? What if I were to tell you that this phenomenon is happening right here and right now while you are reading this – to your own body. I like to call it the body whisperer, but it is more commonly known as the cerebrum, or, if you prefer: the brain.

What we think matters

You might be one of those skeptics who believe that what happens in our heads is merely an epiphenomenon: present, sometimes annoying, but certainly not physically harmful. I sure used to be one. I recall laughing at my sister many years ago when she told me that she had a stomach ache caused by stress. Well, if you’re reading this, sis, I’d like to apologize, because I have changed my mind. And here is to why.

Thoughts can predict the course of mental illness

In Montreal, Jean-Jacques Breton and his research team investigated what the risk factors were for developing depression and, on the other hand, what factors provided protection. They found that non-productive coping strategies, such as worrying, ignoring the problem, self-blame and hopelessness led to more severe depression. However, productive coping strategies, mainly focusing on the positive, protected against this.

You might still be skeptical: depression is a mental illness, so I still haven’t built the bridge from brain to body. I disagree, depression has been shown to be related to many somatic changes. But I will humour you and tell you another, perhaps more convincing story.

Worrying predicts bodily stress and worse health outcome

In the United Kingdom, researchers investigated people’s bodily responses after a writing intervention. They found that people who reported higher stress-related thinking while writing about a stressful or traumatic event, showed higher levels of the stress-hormone cortisol after 4 weeks. Moreover, these people more often came down with upper respiratory infection symptoms 6 months following writing. These results imply that chronic and persistent worrying has a significant effect on the stress and immune system, and leads to longer-term health consequences.

So if you can get sick through worrying, can you also get better through positive thinking? My next illustration involves one of the most interesting and mysterious phenomena in science.

The placebo effect

‘People have been aware for centuries that sick people, given a substance known to be inert by a doctor, frequently get better.’ – Daniel E. Moerman

It has puzzled scientists and doctors for hundreds of years, how a treatment that is not supposed to have any effect, can inexplicably benefit health.

The placebo effect has been demonstrated in many serious illnesses, amongst which Parkinson’s disease. This disease is largely determined by movement problems and involves the death of brain cells producing dopamine, a neurotransmitter particularly involved in the reward system. It has been shown that in Parkinson’s patients that placebo increases dopamine release in the brain comparable to an active drug. In fact, when the patient’s expectancy of the treatment was higher, there was a greater release of dopamine.

So if you tell a patient a treatment works, or rather, if the patient believes that a treatment works, it often will work.

My message to you

I think that our thoughts have an important effect on our body, but that doesn’t mean that I’m advising you to be positive all the time. Now that would be absolutely exhausting. Life is messy. We have to deal with stress, pressure, loss, trauma, disease and disappointment. Some of the losses will never be regained and some of the traumas will never be forgotten. And telling ourselves that the pain will cease entirely and that we will be just as happy as before is not realistic nor helpful. I am, however, advising you against destructive thoughts.

I am worthless. I can never forgive. I don’t want to live. I do not deserve. I hate myself. I hate the world.

Believe me, I’ve been there and I’ve swum in the pool of depression and disease. However tempting that place of self-pity and negativity was, it was destroying me. It took me over 3 years to realize that I needed to change – that my thoughts needed to change.

Just breathe. One step at a time. We will do better tomorrow. It’s okay. I accept. I feel. I love.

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