Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them
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Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.
The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.
For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.
Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.
However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.
Why do people hear voices?
It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.
Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.
Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.
What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.
Coping with hearing voices
When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.
The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.
Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.
Jason’s experience
Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.
He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.
Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.
Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.
Gaining recognition
Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.
We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.
As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.
We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.
Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Half Of Americans Over 50 Have Hemorrhoids, But They Can Be Prevented!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Hello. I was hoping you could give some useful tips about how to avoid a painful ailment that has affected Ernest Hemingway, Karl Marx, David Livingstone, Napoleon, Marilyn Monroe, King Alfred, and Martin Luther, and, I confess, me from time to time … namely, hemorrhoids. Help!❞
Firstly: that list could be a lot longer! We don’t have global stats, but in the US for example, half of adults over 50 have hemorrhoids.
So, you’re certainly not alone. People just don’t talk about it.
But, there are preventative things you can do:
Fiber, fiber, fiber. See also:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Hydrate, hydrate, hydrate.
This one’s simple enough. If you are dehydrated, constipation is more likely, and with it, hemorrhoids.
Watch your meds…
Some medications can cause constipation—painkillers containing codeine are a common culprit, for example.
When you go, go!
Not only can prolonged straining promote hemorrhoids, but also (if you’ll pardon the phrasing—there’s only so delicately we can say this) simply sitting with things partway “open” down there is not good for its health; things can quickly become irritated, and that can lead to hemorrhoids.
So: when you go, go. Leave your phone in another room!
Wash—but carefully.
Beyond your normal showering/bathing routine, a bidet is a great option for keeping things happy down there, if you have that option available to you.
However, if you have hemorrhoids, don’t use soap, as this can cause irritation and make it worse.
Warm water is fine, as is a salt bath, and pat dry and/or use gentle wet-wipes rather than rougher paper.
You can follow up with a hemorrhoid cream of your choice (or hydrocortisone, unless that’s contraindicated by another condition you have)
Know when to seek help
Hemorrhoids will usually go away by themselves if not exacerbated. But if it’s getting unduly difficult, and/or you’re bleeding down there, it’s time to see a doctor.
Note on bleeding: even if you’re 100% sure you have hemorrhoids, there are still other reasons you could be bleeding, and so it needs checking out.
Hemorrhoid treatment, if needed, will vary depending on severity. Beyond creams and lotions, there are other options that are less fun but sometimes necessary, including injections, electrotherapy, banding, or surgery.
Take care!
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Psychology Sunday: Family Estrangment & How To Fix It
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Estrangement, And How To Heal It
We’ve written before about how deleterious to the health loneliness and isolation can be, and what things can be done about it. Today, we’re tackling a related but different topic.
We recently had a request to write about…
❝Reconciliation of relationships in particular estrangement mother adult daughter❞
And, this is not only an interesting topic, but a very specific one that affects more people than is commonly realized!
In fact, a recent 800-person study found that more than 43% of people experienced family estrangement of one sort or another, and a more specific study of more than 2,000 mother-child pairs found that more than 11% of mothers were estranged from at least one adult child.
So, if you think of the ten or so houses nearest to you, probably at least one of them contains a parent estranged from at least one adult child. Maybe it’s yours. Either way, we hope this article will give you some pause for thought.
Which way around?
It makes a difference to the usefulness of this article whether any given reader experiencing estrangement is the parent or the adult child. We’re going to assume the reader is the parent. It also makes a difference who did the estranging. That’s usually the adult child.
So, we’re broadly going to write with that expectation.
Why does it happen?
When our kids are small, we as parents hold all the cards. It may not always feel that way, but we do. We control our kids’ environment, we influence their learning, we buy the food they eat and the clothes they wear. If they want to go somewhere, we probably have to take them. We can even set and enforce rules on a whim.
As they grow, so too does their independence, and it can be difficult for us as parents to relinquish control, but we’re going to have to at some point. Assuming we are good parents, we just hope we’ve prepared them well enough for the world.
Once they’ve flown the nest and are living their own adult lives, there’s an element of inversion. They used to be dependent on us; now, not only do they not need us (this is a feature not a bug! If we have been good parents, they will be strong without us, and in all likelihood one day, they’re going to have to be), but also…
We’re more likely to need them, now. Not just in the “oh if we have kids they can look after us when we’re old” sense, but in that their social lives are growing as ours are often shrinking, their family growing, while ours, well, it’s the same family but they’re the gatekeepers to that now.
If we have a good relationship, this goes fine. However, it might only take one big argument, one big transgression, or one “final straw”, when the adult child decides the parent is more trouble than they’re worth.
And, obviously, that’s going to hurt. But it’s pretty much how it pans out, according to studies:
Here be science: Tensions in the Parent and Adult Child Relationship: Links to Solidarity and Ambivalence
How to fix it, step one
First, figure out what went wrong.
Resist any urge to protect your own feelings with a defensive knee-jerk “I don’t know; I was a good, loving parent”. That’s a very natural and reasonable urge and you’re quite possibly correct, but it won’t help you here.
Something pushed them away. And, it will almost certainly have been a push factor from you, not a pull factor from whoever is in their life now. It’s easy to put the blame externally, but that won’t fix anything.
And, be honest with yourself; this isn’t a job interview where we have to present a strength dressed up as a “greatest weakness” for show.
You can start there, though! If you think “I was too loving”, then ok, how did you show that love? Could it have felt stifling to them? Controlling? Were you critical of their decisions?
It doesn’t matter who was right or wrong, or even whether or not their response was reasonable. It matters that you know what pushed them away.
How to fix it, step two
Take responsibility, and apologize. We’re going to assume that your estrangement is such that you can, at least, still get a letter to them, for example. Resist the urge to argue your case.
Here’s a very good format for an apology; please consider using this template:
The 10-step (!) apology that’s so good, you’ll want to make a note of it
You may have to do some soul-searching to find how you will avoid making the same mistake in the future, that you did in the past.
If you feel it’s something you “can’t change”, then you must decide what is more important to you. Only you can make that choice, but you cannot expect them to meet you halfway. They already made their choice. In the category of negotiation, they hold all the cards now.
How to fix it, step three
Now, just wait.
Maybe they will reply, forgiving you. If they do, celebrate!
Just be aware that once you reconnect is not the time to now get around to arguing your case from before. It will never be the time to get around to arguing your case from before. Let it go.
Nor should you try to exact any sort of apology from them for estranging you, or they will at best feel resentful, wonder if they made a mistake in reconnecting, and withdraw.
Instead, just enjoy what you have. Many people don’t get that.
If they reply with anger, maybe it will be a chance to reopen a dialogue. If so, family therapy could be an approach useful for all concerned, if they are willing. Chances are, you all have things that you’d all benefit from talking about in a calm, professional, moderated, neutral environment.
You might also benefit from a book we reviewed previously, “Parent Effectiveness Training”. This may seem like “shutting the stable door after the horse has bolted”, but in fact it’s a very good guide to relationship dynamics in general, and extensively covers relations between parents and adult children.
If they don’t reply, then, you did your part. Take solace in knowing that much.
Some final thoughts:
At the end of the day, as parents, our kids living well is (hopefully) testament to that we prepared them well for life, and sometimes, being a parent is a thankless task.
But, we (hopefully) didn’t become parents for the plaudits, after all.
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Encyclopedia Of Herbal Medicine – by Andrew Chevallier
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A common problem with a lot of herbal medicine is it’s “based on traditional use only”, while on the other hand, learning about the actual science of it can mean poring through stacks of Randomized Clinical Trials, half of which are paywalled.
This beautifully and clearly-illustrated book bridges that gap. It gives not just the history, but also the science, of the use of many medicinal herbs (spotlight on 100 key ones; details on 450 more).
It gives advice on growing, harvesting, processing, and using the herbs, as well as what not to do (with regard to safety). And in case you don’t fancy yourself a gardener, you’ll also find advice on places one can buy herbs, and what you’ll need to know to choose them well (controlling for quality etc).
You can read it cover-to-cover, or look up what you need by plant in its general index, or by ailment (200 common ailments listed). As for its bibliography, it does list many textbooks, but not individual papers—though it does cite 12 popular scientific journals too.
Bottom line: if you want a good, science-based, one-stop book for herbal medicine, this is a top-tier choice.
Click here to check out the Encyclopedia of Herbal Medicine, and expand your home remedy repertoire!
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Do We Need Supplements, And Do They Work?
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Does our diet need a little help?
We asked you for your take on supplements, and got the above-illustrated, below-described set of results.
- The largest minority of respondents (a little over a third) voted for “I just take something very specific”
- The next most respondents voted for “I take so many supplements; every little helps!”
- Almost as many voted for “I just take a vitamin or two / a multivitamin”
- Fewest, about 8%, voted for “I get everything I need from my diet”
But what does the science say?
Food is less nutritious now than it used to be: True or False?
True or False depending on how you measure it.
An apple today and an apple from a hundred years ago are likely to contain the same amounts of micronutrients per apple, but a lower percentage of micronutrients per 100g of apple.
The reason for this is that apples (and many other food products; apples are just an arbitrary example) have been selectively bred (and in some cases, modified) for size, and because the soil mineral density has remained the same, the micronutrients per apple have not increased commensurate to the increase in carbohydrate weight and/or water weight. Thus, the resultant percentage will be lower, despite the quantity remaining the same.
We’re going to share some science on this, and/but would like to forewarn readers that the language of this paper is a bit biased, as it looks to “debunk” claims of nutritional values dropping while skimming over “yes, they really have dropped percentage-wise” in favor of “but look, the discrete mass values are still the same, so that’s just a mathematical illusion”.
The reality is, it’s no more a mathematical illusion than is the converse standpoint of saying the nutritional value is the same, despite the per-100g values dropping. After all, sometimes we eat an apple as-is; sometimes we buy a bag of frozen chopped fruit. That 500g bag of chopped fruit is going to contain less copper (for example) than one from decades past.
Here’s the paper, and you’ll see what we mean:
Supplements aren’t absorbed properly and thus are a waste of money: True or False?
True or False depending on the supplement (and your body, and the rest of your diet)
Many people are suffering from dietary deficiencies of vitamins and minerals, that could be easily correctable by supplementation:
However, as this study by Dr. Fang Fang Zhang shows, a lot of vitamin and mineral supplementation does not appear to have much of an effect on actual health outcomes, vis-à-vis specific diseases. She looks at:
- Cardiovascular disease
- Cancer
- Type 2 diabetes
- Osteoporosis
Her key take-aways from this study were:
- Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases
- People using supplements tend to be older, female, and have higher education, income, and healthier lifestyles than people who do not use them
- Use of supplements appreciably reduces the prevalence of inadequate intake for most nutrients but also increases the prevalence of excess intake for some nutrients
- Further research is needed to assess the long term effects of supplements on the health of the general population and in individuals with specific nutritional needs, including those from low and middle income countries
Read her damning report: Health effects of vitamin and mineral supplements
On the other hand…
This is almost entirely about blanket vitamin-and-mineral supplementation. With regard to fish oil supplementation, many commercial fish oil supplements break down in the stomach rather than the intestines, and don’t get absorbed well. Additionally, many people take them in forms that aren’t pleasant, and thus result in low adherence (i.e., they nominally take them, but in fact they just sit on the kitchen counter for a year).
One thing we can conclude from this is that it’s good to check the science for any given supplement before taking it, and know what it will and won’t help for. Our “Monday Research Review” editions of 10almonds do this a lot, although we tend to focus on herbal supplements rather than vitamins and minerals.
We can get everything we need from our diet: True or False?
Contingently True (but here be caveats)
In principle, if we eat the recommended guideline amounts of various macro- and micro-nutrients, we will indeed get all that we are generally considered to need. Obviously.
However, this may come with:
- Make sure to get enough protein… Without too much meat, and also without too much carbohydrate, such as from most plant sources of protein
- Make sure to get enough carbohydrates… But only the right kinds, and not too much, nor at the wrong time, and without eating things in the wrong order
- Make sure to get enough healthy fats… Without too much of the unhealthy fats that often exist in the same foods
- Make sure to get the right amount of vitamins and minerals… We hope you have your calculators out to get the delicate balance of calcium, magnesium, potassium, phosphorus, and vitamin D right.
That last one’s a real pain, by the way. Too much or too little of one or another and the whole set start causing problems, and several of them interact with several others, and/or compete for resources, and/or are needed for the others to do their job.
And, that’s hard enough to balance when you’re taking supplements with the mg/µg amount written on them, never mind when you’re juggling cabbages and sardines.
On the topic of those sardines, don’t forget to carefully balance your omega-3, -6, and -9, and even within omega-3, balancing ALA, EPA, and DHA, and we hope you’re juggling those HDL and LDL levels too.
So, when it comes to getting everything we need from our diet, for most of us (who aren’t living in food deserts and/or experiencing food poverty, or having a medical condition that restricts our diet), the biggest task is not “getting enough”, it’s “getting enough of the right things without simultaneously overdoing it on the others”.
With supplements, it’s a lot easier to control what we’re putting in our bodies.
And of course, unless our diet includes things that usually can’t be bought in supermarkets, we’re not going to get the benefits of taking, as a supplement, such things as:
Etc.
So, there definitely are supplements with strong science-backed benefits, that probably can’t be found on your plate!
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What is type 1.5 diabetes? It’s a bit like type 1 and a bit like type 2 – but it’s often misdiagnosed
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While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes.
Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of both type 1 and type 2 diabetes.
More people became aware of this condition after Lance Bass, best known for his role in the iconic American pop band NSYNC, recently revealed he has it.
So, what is type 1.5 diabetes? And how is it diagnosed and treated?
Pixel-Shot/Shutterstock There are several types of diabetes
Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually more than ten types of diabetes, but the most common are type 1 and type 2.
Type 1 diabetes is an autoimmune condition where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production.
Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need insulin medication daily. Type 1 diabetes usually appears in children or young adults.
Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to overcome this resistance. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin.
Type 2 is more common in adults but is increasingly seen in children and young people. Management can include behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy.
People with diabetes may need to regularly monitor their blood sugar levels. Dragana Gordic/Shutterstock How does type 1.5 diabetes differ from types 1 and 2?
Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin immediately because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within five years of diagnosis, while those with type 1 typically require it from diagnosis.
Type 1.5 diabetes is usually diagnosed in people over 30, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2.
Type 1.5 diabetes shares genetic and autoimmune risk factors with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as obesity and physical inactivity which are more commonly associated with type 2 diabetes.
What are the symptoms, and how is it treated?
The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following symptoms:
- increased thirst
- frequent urination
- fatigue
- blurred vision
- unintentional weight loss.
Typically, type 1.5 diabetes is initially treated with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day.
When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are no universally accepted management or treatment strategies for type 1.5 diabetes.
Type 1.5 diabetes might be managed with oral medications, at least initially. Dragana Gordic/Shutterstock Type 1.5 diabetes is often misdiagnosed
Lance Bass said he was initially diagnosed with type 2 diabetes, but later learned he actually has type 1.5 diabetes. This is not entirely uncommon. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes 5–10% of the time.
There are a few possible reasons for this.
First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special antibody tests (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them.
Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults).
Third, people with type 1.5 diabetes often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin.
Finally, because type 1.5 diabetes has symptoms that are similar to type 2 diabetes, it may initially be treated as type 2.
We’re still learning about type 1.5
Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in non-European populations. In 2023, it was estimated type 1.5 diabetes represented 8.9% of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers.
Overall, there has been a limited awareness of type 1.5 diabetes and unclear diagnostic criteria which have slowed down our understanding of this condition.
A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road.
Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce diabetes distress. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.
Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University and Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sleeping on Your Back after 50; Yay or Nay?
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Sleeping Differently After 50
Sleeping is one of those things that, at any age, can be hard to master. Some of our most popular articles have been on getting better sleep, and effective sleep aids, and we’ve had a range of specific sleep-related questions, like whether air purifiers actually improve your sleep.
But perhaps there’s an underlying truth hidden in our opening sentence…is sleeping consistently difficult because the way we sleep should change according to our age?
Inspired by Brad and Mike’s video below (which was published to their 5 million+ subscribers!), there are 4 main elements to consider when sleeping on your back after you’ve hit the 50-year mark:
- Degenerative Disk Disease: As you age, your spine may start to show signs of wear and tear, which directly affects comfort while lying on your back.
- Sleep Apnea and Snoring: Sleep Apnea and snoring become more of an issue with age, and sleeping on your back can exacerbate these problems; when you sleep on your back, the soft tissues in your throat, as well as your tongue, “fall back” and partly obstruct your the airway.
- Spinal Stenosis: Spinal Stenosis–the often-age-related narrowing of your spinal canal–can put pressure on the nerves that travel through the spine, which equally makes back-sleeping harder.
- GERD: The all-too-familiar gastroesophageal reflux disease can be more problematic when lying flat on your back, as doing so can allow easy access for stomach acid to move upwards.
Alternatives to Back Sleeping
Referencing the Mayo Clinic’s Sleep Facility’s director, Dr. Virend Somers, today’s video suggests a simple solution: sleeping on your side. The video goes into a bit more detail but, as you know, here at 10almonds we like to cut to the chase.
Modifications for Back Sleeping
If you’re a lifelong back-sleeping and cannot bear the idea of changing to your side, or your stomach, then there are a few modifications that you can make to ease any pain and discomfort.
Most solutions revolve around either leg wedges or pillow adjustments. For instance, if you’re suffering from back pain, try propping your knees up. Or if GERD is your worst enemy, a wedge pillow could help keep that acid down.
As can be expected, the video dives into more detail:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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