Behavioral Activation Against Depression & Anxiety
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Behavioral Activation Against Depression & Anxiety
Psychologists do love making fancy new names for things.
You thought you were merely “eating your breakfast”, but now it’s “Happiness-Oriented Basic Behavioral Intervention Therapy (HOBBIT)” or something.
This one’s quite simple, so we’ll keep it short for today, but it is one more tool for your toolbox:
What is Behavioral Activation?
Behavioral Activation is about improving our mood (something we can’t directly choose) by changing our behavior (something we usually can directly choose).
An oversimplified (and insufficient, as we will explain, but we’ll use this one to get us started) example would be “whistle a happy tune and you will be happy”.
Behavioral Activation is not a silver bullet
Or if it is, then it’s the kind you have to keep shooting, because one shot is not enough. However, this becomes easier than you might think, because Behavioral Activation works by…
Creating a Positive Feedback Loop
A lot of internal problems in depression and anxiety are created by the fact that necessary and otherwise desirable activities are being written off by the brain as:
- Pointless (depression)
- Dangerous (anxiety)
The inaction that results from these aversions creates a negative feedback loop as one’s life gradually declines (as does one’s energy, and interest in life), or as the outside world seems more and more unwelcoming/scary.
Instead, Behavioral Activation plans activities (usually with the help of a therapist, as depressed/anxious people are not the most inclined to plan activities) that will be:
- attainable
- rewarding
The first part is important, because the maximum of what is “attainable” to a depressed/anxious person can often be quite a small thing. So, small goals are ideal at first.
The second part is important, because there needs to be some way of jump-starting a healthier dopamine cycle. It also has to feel rewarding during/after doing it, not next year, so short term plans are ideal at first.
So, what behavior should we do?
That depends on you. Behavioral Activation calls for keeping track of our activities (bullet-journaling is fine, and there are apps* that can help you, too) and corresponding moods.
*This writer uses the pragmatic Daylio for its nice statistical analyses of bullet-journaling data-points, and the very cute Finch for more keyword-oriented insights and suggestions. Whatever works for you, works for you, though! It could even be paper and pen.
Sometimes the very thought of an activity fills us with dread, but the actual execution of it brings us relief. Bullet-journaling can track that sort of thing, and inform decisions about “what we should do” going forwards.
Want a ready-made brainstorm to jump-start your creativity?
Here’s list of activities suggested by TherapistAid (a resource hub for therapists)
Want to know more?
You might like:
- How To Use Behavioral Activation (guide for end users)
- Treatment Guide: Behavioral Activation (guide for clinicians)
Take care!
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Why do disinfectants only kill 99.9% of germs? Here’s the science
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Have you ever wondered why most disinfectants indicate they kill 99.9% or 99.99% of germs, but never promise to wipe out all of them? Perhaps the thought has crossed your mind mid-way through cleaning your kitchen or bathroom.
Surely, in a world where science is able to do all sorts of amazing things, someone would have invented a disinfectant that is 100% effective?
The answer to this conundrum requires understanding a bit of microbiology and a bit of mathematics.
Davor Geber/Shutterstock What is a disinfectant?
A disinfectant is a substance used to kill or inactivate bacteria, viruses and other microbes on inanimate objects.
There are literally millions of microbes on surfaces and objects in our domestic environment. While most microbes are not harmful (and some are even good for us) a small proportion can make us sick.
Although disinfection can include physical interventions such as heat treatment or the use of UV light, typically when we think of disinfectants we are referring to the use of chemicals to kill microbes on surfaces or objects.
Chemical disinfectants often contain active ingredients such as alcohols, chlorine compounds and hydrogen peroxide which can target vital components of different microbes to kill them.
Diseinfectants can contain a range of ingredients. Maridav/Shutterstock The maths of microbial elimination
In the past few years we’ve all become familiar with the concept of exponential growth in the context of the spread of COVID cases.
This is where numbers grow at an ever-accelerating rate, which can lead to an explosion in the size of something very quickly. For example, if a colony of 100 bacteria doubles every hour, in 24 hours’ time the population of bacteria would be more than 1.5 billion.
Conversely, the killing or inactivating of microbes follows a logarithmic decay pattern, which is essentially the opposite of exponential growth. Here, while the number of microbes decreases over time, the rate of death becomes slower as the number of microbes becomes smaller.
For example, if a particular disinfectant kills 90% of bacteria every minute, after one minute, only 10% of the original bacteria will remain. After the next minute, 10% of that remaining 10% (or 1% of the original amount) will remain, and so on.
Because of this logarithmic decay pattern, it’s not possible to ever claim you can kill 100% of any microbial population. You can only ever scientifically say that you are able to reduce the microbial load by a proportion of the initial population. This is why most disinfectants sold for domestic use indicate they kill 99.9% of germs.
Other products such as hand sanitisers and disinfectant wipes, which also often purport to kill 99.9% of germs, follow the same principle.
You might have noticed none of the cleaning products in your laundry cupboard kill 100% of germs. Africa Studio/Shutterstock Real-world implications
As with a lot of science, things get a bit more complicated in the real world than they are in the laboratory. There are a number of other factors to consider when assessing how well a disinfectant is likely to remove microbes from a surface.
One of these factors is the size of the initial microbial population that you’re trying to get rid of. That is, the more contaminated a surface is, the harder the disinfectant needs to work to eliminate the microbes.
If for example you were to start off with only 100 microbes on a surface or object, and you removed 99.9% of these using a disinfectant, you could have a lot of confidence that you have effectively removed all the microbes from that surface or object (called sterilisation).
In contrast, if you have a large initial microbial population of hundreds of millions or billions of microbes contaminating a surface, even reducing the microbial load by 99.9% may still mean there are potentially millions of microbes remaining on the surface.
Time is is a key factor that determines how effectively microbes are killed. So exposing a highly contaminated surface to disinfectant for a longer period is one way to ensure you kill more of the microbial population.
This is why if you look closely at the labels of many common household disinfectants, they will often suggest that to disinfect you should apply the product then wait a specified time before wiping clean. So always consult the label on the product you’re using.
Disinfectants won’t necessarily work in your kitchen exactly like they work in a lab. Ground Picture/Shutterstock Other factors such as temperature, humidity and the type of surface also influence how well a disinfectant works outside the lab.
Similarly, microbes in the real world may be either more or less sensitive to disinfection than those used for testing in the lab.
Disinfectants are one part infection control
The sensible use of disinfectants plays an important role in our daily lives in reducing our exposure to pathogens (microbes that cause illness). They can therefore reduce our chances of getting sick.
The fact disinfectants can’t be shown to be 100% effective from a scientific perspective in no way detracts from their importance in infection control. But their use should always be complemented by other infection control practices, such as hand washing, to reduce the risk of infection.
Hassan Vally, Associate Professor, Epidemiology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
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When KFF Health News published an article in August about the “prior authorization hell” Sally Nix said she went through to secure approval from her insurance company for the expensive monthly infusions she needs, we thought her story had a happy ending.
That’s because, after KFF Health News sent questions to Nix’s insurance company, Blue Cross Blue Shield of Illinois, it retroactively approved $36,000 worth of treatments she thought she owed. Even better, she also learned she would qualify for the infusions moving forward.
Good news all around — except it didn’t last for long. After all, this is the U.S. health care system, where even patients with good insurance aren’t guaranteed affordable care.
To recap: For more than a decade, Nix, of Statesville, North Carolina, has suffered from autoimmune diseases, chronic pain, and fatigue, as well as a condition called trigeminal neuralgia, which is marked by bouts of electric shock-like pain that’s so intense it’s commonly known as the “suicide disease.”
“It is a pain that sends me to my knees,” Nix said in October. “My entire family’s life is controlled by the betrayal of my body. We haven’t lived normally in 10 years.”
Late in 2022, Nix started receiving intravenous immunoglobulin infusions to treat her diseases. She started walking two miles a day with her service dog. She could picture herself celebrating, free from pain, at her daughter’s summer 2024 wedding.
“I was so hopeful,” she said.
But a few months after starting those infusions, she found out that her insurance company wouldn’t cover their cost anymore. That’s when she started “raising Cain about it” on Instagram and Facebook.
You probably know someone like Sally Nix — someone with a chronic or life-threatening illness whose doctor says they need a drug, procedure, or scan, and whose insurance company has replied: No.
Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients.
However, critics worry that prior authorization has now become a way for health insurance companies to save money, sometimes at the expense of patients’ lives. KFF Health News has heard from hundreds of people in the past year relating their prior authorization horror stories.
When we first met Nix, she was battling her insurance company to regain authorization for her infusions. She’d been forced to pause her treatments, unable to afford $13,000 out-of-pocket for each infusion.
Finally, it seemed like months of her hard work had paid off. In July, Nix was told by staff at both her doctor’s office and her hospital that Blue Cross Blue Shield of Illinois would allow her to restart treatment. Her balance was marked “paid” and disappeared from the insurer’s online portal.
But the day after the KFF Health News story was published, Nix said, she learned the message had changed. After restarting treatment, she received a letter from the insurer saying her diagnoses didn’t actually qualify her for the infusions. It felt like health insurance whiplash.
“They’re robbing me of my life,” she said. “They’re robbing me of so much, all because of profit.”
Dave Van de Walle, a spokesperson for Blue Cross Blue Shield of Illinois, said the company would not discuss individual patients’ cases.
“Prior authorization is often a requirement for certain treatments,” Van de Walle said in a written statement, “and BCBSIL administers benefits according to medical policy and the employer’s benefit.”
But Nix is a Southern woman of the “Steel Magnolia” variety. In other words, she’s not going down without a fight.
In September, she called out her insurance company’s tactics in a http://change.org/ campaign that has garnered more than 21,000 signatures. She has also filed complaints against her insurance company with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and Illinois attorney general.
Even so, Nix said, she feels defeated.
Not only is she still waiting for prior authorization to restart her immunoglobulin infusions, but her insurance company recently required Nix to secure preapproval for another treatment — routine numbing injections she has received for nearly 10 years to treat the nerve pain caused by trigeminal neuralgia.
“It is reprehensible what they’re doing. But they’re not only doing it to me,” said Nix, who is now reluctantly taking prescription opioids to ease her pain. “They’re doing it to other patients. And it’s got to stop.”
Do you have an experience with prior authorization you’d like to share? Click here to tell your story.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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What Melatonin Does To Your DNA
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Spoiler: it’s good
What dreams may come, when we have shuffled off this deoxyribonucleic coil,
…must indeed give us pause!
Researchers (Dr. Umaimah Zanif et al.) did a randomized, placebo-controlled trial of 40 night-shift workers tested whether taking 3mg of melatonin daily for 4 weeks before daytime sleep (because: night-shift workers) could improve the body’s ability to repair oxidative DNA damage.
Why Dr. Zanif and her team investigated melatonin: melatonin normally rises at night and helps regulate sleep and circadian rhythms, but overnight work suppresses melatonin production, which can reduce the body’s capacity to repair oxidative DNA damage, and could be one mechanism linking long-term night-shift work to a higher cancer risk.
Quick note about the participants: all workers had performed at least two consecutive night shifts per week for at least 6 months, with shifts lasting at least 7 hours, and none had sleep disorders or major chronic illnesses.
Of course, that’s not to say it’s only night workers who are affected—it’s relevant for anyone with disrupted sleep. But night workers make for a clear, consistent demographic in which to study these matters.
You may be wondering how DNA repair was measured: the team measured urinary 8-hydroxy-2′-deoxyguanosine (8-OH-dG), a marker of oxidative DNA damage repair capacity, with higher levels interpreted as greater DNA repair activity.
The results, in numbers:
- Main finding: during daytime sleep after night-shift work, the melatonin group showed approximately 1.8 times higher urinary 8-OH-dG levels than the placebo group, suggesting improved oxidative DNA repair capacity.
- Statistical analysis: the increase was described as borderline statistically significant, with a 95% confidence interval of 1.0 to 3.2 and a p-value of 0.06.
- One more thing: no significant difference between groups was observed during the subsequent overnight work period, suggesting the benefit occurred specifically during sleep rather than throughout the entire day.
In other words, restoring melatonin signaling can counter some of the biological stress caused by circadian disruption in general and night work as a top-tier example of that.
You can read the paper in full, here: Melatonin supplementation and oxidative DNA damage repair capacity among night shift workers: a randomised placebo-controlled trial
We’ve also written a bit about melatonin before, including:
Want more options?
Some sleep aids can help, but many are harmful and/or do not really work as such; here’s a rundown of examples of those: Safe Effective Sleep Aids For Seniors?
Want to learn more?
For a much more in-depth treatment of the topic of sleep in general, you might like this book that we reviewed a while back:
Why We Sleep – by Dr Matthew Walker
Basically, if you will read only one book on sleep, that’s the book.
Sweet dreams!
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Ready to Run – by Kelly Starrett
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If you’d like to get into running, and think that maybe the barriers are too great, this is the book for you.
Kelly Starrett approaches running less from an “eye of the tiger” motivational approach, and more from a physiotherapy angle.
The first couple of chapters of the book are explanatory of his philosophy, the key component of which being:
Routine maintenance on your personal running machine (i.e., your body) can be and should be performed by you.
The second (and largest) part of the book is given to his “12 Standards of Maintenance for Running“. These range from neutral feet and flat shoes, to ankle, knee, and hip mobilization exercises, to good squatting technique, and more.
After that, we have photographs and explanations of maintenance exercises that are functional for running.
The fourth and final part of the book is about dealing with injuries or medical issues that you might have.
And if you think you’re too old for it? In Starrett’s own words:
❝Problems are going to keep coming. Each one is a gift wanting to be opened—some new area of performance you didn’t know you had, or some new efficiency to be gained. The 90- to 95-year-old division of the Masters Track and Field Nationals awaits. A Lifelong commitment to solving each problem that creeps up is the ticket.❞
In short: this is the book that can get you back out doing what you perhaps thought you’d left behind you, and/or open a whole new chapter in your life.
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We looked at genetic clues to depression in more than 14,000 people. What we found may surprise you
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The core experiences of depression – changes in energy, activity, thinking and mood – have been described for more than 10,000 years. The word “depression” has been used for about 350 years.
Given this long history, it may surprise you that experts don’t agree about what depression is, how to define it or what causes it.
But many experts do agree that depression is not one thing. It’s a large family of illnesses with different causes and mechanisms. This makes choosing the best treatment for each person challenging.
Reactive vs endogenous depression
One strategy is to search for sub-types of depression and see whether they might do better with different kinds of treatments. One example is contrasting “reactive” depression with “endogenous” depression.
Reactive depression (also thought of as social or psychological depression) is presented as being triggered by exposure to stressful life events. These might be being assaulted or losing a loved one – an understandable reaction to an outside trigger.
Endogenous depression (also thought of as biological or genetic depression) is proposed to be caused by something inside, such as genes or brain chemistry.
Many people working clinically in mental health accept this sub-typing. You might have read about this online.
But we think this approach is way too simple.
While stressful life events and genes may, individually, contribute to causing depression, they also interact to increase the risk of someone developing depression. And evidence shows that there is a genetic component to being exposed to stressors. Some genes affect things such as personality. Some affect how we interact with our environments.
What we did and what we found
Our team set out to look at the role of genes and stressors to see if classifying depression as reactive or endogenous was valid.
In the Australian Genetics of Depression Study, people with depression answered surveys about exposure to stressful life events. We analysed DNA from their saliva samples to calculate their genetic risk for mental disorders.
Our question was simple. Does genetic risk for depression, bipolar disorder, schizophrenia, ADHD, anxiety and neuroticism (a personality trait) influence people’s reported exposure to stressful life events?
We looked at the genetic risk of mental illness to see how that was linked to stressful life events, such as childhood abuse and neglect. Kamira/Shutterstock You may be wondering why we bothered calculating the genetic risk for mental disorders in people who already have depression. Every person has genetic variants linked to mental disorders. Some people have more, some less. Even people who already have depression might have a low genetic risk for it. These people may have developed their particular depression from some other constellation of causes.
We looked at the genetic risk of conditions other than depression for a couple of reasons. First, genetic variants linked to depression overlap with those linked to other mental disorders. Second, two people with depression may have completely different genetic variants. So we wanted to cast a wide net to look at a wider spectrum of genetic variants linked to mental disorders.
If reactive and endogenous depression sub-types are valid, we’d expect people with a lower genetic component to their depression (the reactive group) would report more stressful life events. And we’d expect those with a higher genetic component (the endogenous group) would report fewer stressful life events.
But after studying more than 14,000 people with depression we found the opposite.
We found people at higher genetic risk for depression, anxiety, ADHD or schizophrenia say they’ve been exposed to more stressors.
Assault with a weapon, sexual assault, accidents, legal and financial troubles, and childhood abuse and neglect, were all more common in people with a higher genetic risk of depression, anxiety, ADHD or schizophrenia.
These associations were not strongly influenced by people’s age, sex or relationships with family. We didn’t look at other factors that may influence these associations, such as socioeconomic status. We also relied on people’s memory of past events, which may not be accurate.
How do genes play a role?
Genetic risk for mental disorders changes people’s sensitivity to the environment.
Imagine two people, one with a high genetic risk for depression, one with a low risk. They both lose their jobs. The genetically vulnerable person experiences the job loss as a threat to their self-worth and social status. There is a sense of shame and despair. They can’t bring themselves to look for another job for fear of losing it too. For the other, the job loss feels less about them and more about the company. These two people internalise the event differently and remember it differently.
Genetic risk for mental disorders also might make it more likely people find themselves in environments where bad things happen. For example, a higher genetic risk for depression might affect self-worth, making people more likely to get into dysfunctional relationships which then go badly.
If two people lose their jobs, one with a high genetic risk of depression the other at low risk, both will experience and remember the event differently. Inside Creative House/Shutterstock What does our study mean for depression?
First, it confirms genes and environments are not independent. Genes influence the environments we end up in, and what then happens. Genes also influence how we react to those events.
Second, our study doesn’t support a distinction between reactive and endogenous depression. Genes and environments have a complex interplay. Most cases of depression are a mix of genetics, biology and stressors.
Third, people with depression who appear to have a stronger genetic component to their depression report their lives are punctuated by more serious stressors.
So clinically, people with higher genetic vulnerability might benefit from learning specific techniques to manage their stress. This might help some people reduce their chance of developing depression in the first place. It might also help some people with depression reduce their ongoing exposure to stressors.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Jacob Crouse, Research Fellow in Youth Mental Health, Brain and Mind Centre, University of Sydney and Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sarah Raven’s Garden Cookbook – by Sarah Raven
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Note: the US Amazon site currently (incorrectly) lists the author as “Jonathan Buckley”. The Canadian, British, and Australian sites all list the author correctly as Sarah Raven, and some (correctly) credit Jonathan Buckley as the photographer she used.
First, what it’s not: a gardening book. Beyond a few helpful tips, pointers, and “plant here, harvest here” instructions, this book assumes you are already capable of growing your own vegetables.
She does assume you are in a temperate climate, so if you are not, this might not be the book for you. Although! The recipes are still great; it’s just you’d have to shop for the ingredients and they probably won’t be fresh local produce for the exact same reason that you didn’t grow them.
If you are in a temperate climate though, this will take you through the year of seasonal produce (if you’re in a temperate climate but it’s in for example Australia, you’ll need to make a six-month adjustment for being in the S. Hemisphere), with many recipes to use not just one ingredient from your garden at a time, but a whole assortment, consistent with the season.
About the recipes: they (which are 450 in number) are (as you might imagine) very plant-forward, but they’re generally not vegan and often not vegetarian. So, don’t expect that you’ll produce everything yourself—just most of the ingredients!
Bottom line: if you like cooking, and are excited by the idea of growing your own food but are unsure how regularly you can integrate that, this book will keep you happily busy for a very long time.
Click here to check out Sarah Raven’s Garden Cookbook, and level-up your home cooking!
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