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:

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  • Capsaicin For Weight Loss And Against Inflammation

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    Capsaicin’s Hot Benefits

    Capsaicin, the compound in hot peppers that makes them spicy, is a chemical irritant and a neurotoxin. However, humans being humans, we decided to eat them for fun.

    In contrast to many other ways in which humans recreationally enjoy things that are objectively poisonous, consuming capsaicin (in moderation) is considered to have health benefits, such as aiding weight loss (by boosting metabolism) and reducing inflammation.

    Let’s see what the science says…

    First: is it safe?

    Capsaicin is classified as “Generally Recognized As Safe”. That said, the same mechanism that causes them to boost metabolism, does increase blood pressure:

    Mechanisms underlying the hypertensive response induced by capsaicin

    If you are in good cardiovascular health, this increase should be slight and not pose any threat, unless for example you enter a chili-eating contest when not acclimated to such:

    Capsaicin and arterial hypertensive crisis

    As ever, if unsure, do check with your doctor first, especially if you are taking any blood pressure medications, or otherwise have known blood pressure issues.

    Does it really boost metabolism?

    It certainly does; it works by increasing oxygen consumption and raising body temperature, both of which mean more calories will be burned for the same amount of work:

    Dietary capsaicin and its anti-obesity potency: from mechanism to clinical implications

    This means, of course, that chili peppers enjoy the status of being functionally a “negative calorie” food, and a top-tier one at that:

    Chili pepper as a body weight-loss food

    Here’s a good quality study that showed a statistically significant* fat loss improvement over placebo:

    Capsaicinoids supplementation decreases percent body fat and fat mass: adjustment using covariates in a post hoc analysis

    *To put it in numbers, the benefit was:

    • 5.91 percentage points lower body fat percentage than placebo
    • 6.68 percentage points greater change in body fat mass than placebo

    See also: Difference between percentages and percentage points

    For those who prefer big reviews than single studies, we’ve got you covered:

    The Effects of Capsaicin and Capsiate on Energy Balance: Critical Review and Meta-analyses of Studies in Humans

    Does it really reduce inflammation?

    Counterintuitive as it may seem, yes. By means of reducing oxidative stress. Given that things that reduce oxidative stress tend to reduce inflammation, and in turn tend to reduce assorted disease risks (from diabetes to cancer to Alzheimer’s), this probably has more knock-on benefits too, but we don’t have room to explore all of those today.

    Fresh peppers are best for this, but dried peppers (such as when purchased as a ground spice in the supermarket, or when purchased as a capsule-based supplement) still have a very respectable anti-inflammatory effect:

    How much should we take?

    It’s recommended to start at a low dose and gradually increase it, but 2–6mg of capsaicin per day is the standard range used in studies.

    If you’re getting this from peppers, then for example cayenne pepper (a good source of capsaicin) contains around 2.5mg of capsaicin per 1 gram of cayenne.

    In the case of capsules, if for example you don’t like eating hot pepper, this will usually mean taking 2–6 capsules per day, depending on dosage.

    Make sure to take it with plenty of water!

    Where can we get it?

    Fresh peppers or ground spice from your local grocery store is fine. Your local health food store probably sells the supplements, too.

    If you’d like to buy it online, here is an example product on Amazon.

    Note: options on Amazon were more limited than usual, so this product is not vegan, and probably not halal or kosher, as the capsule contains an unspecified gelatin.

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  • Walking… Better.

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    Walking… Better.

    We recently reviewed “52 Ways To Walk” by Annabel Streets. You asked us to share some more of our learnings from that book, and… Obviously we can’t do all 52, nor go into such detail, but here are three top tips inspired by that book…

    Walk in the cold!

    While cold weather is often seen as a reason to not walk, in fact, it has numerous health benefits, the most exciting of which might be:

    Walking in the cold causes us to convert white and yellow fat into the healthier brown fat. If you didn’t know about this, neither did scientists until about 15 years ago.

    In fact, scientists didn’t even know that adult humans could even have brown adipose tissue! It was really quite groundbreaking.

    In case you missed it: The Changed Metabolic World with Human Brown Adipose Tissue: Therapeutic Visions

    Work while you walk!

    Obviously this is only appropriate for some kinds of work… but if in your life you have any kind of work that is chiefly thinking, a bunch of it can be done while walking.

    Open your phone’s note-taking app, lock the screen and pocket your phone, and think on some problem that you need to solve. Whenever you have an “aha” moment, take out your phone and make a quick note on the go.

    For that matter, if you have the money and space (or are fortunate to have an employer disposed towards facilitating such), you could even set up a treadmill desk… At worst, it wouldn’t harm your work (and it’ll be a LOT better than sitting for so long).

    Walk within an hour of waking!

    No, this doesn’t mean that if you don’t get out of the house within 60 minutes you say “Oh no, missed the window, guess it’s a day in today”

    But it does mean: in the evening, make preparations to head out first thing in the morning. Set out your clothes and appropriate footwear, find your flask to fill with the beverage of your choice in the morning and set that with them.

    Then, when morning arrives… do your morning necessaries (e.g. some manner of morning ablutions and perhaps a light breakfast), make that drink for your flask, and hit the road.

    Why? We’ll tell you a secret:

    You ever wondered why some people seem to be more able to keep a daylight-regulated circadian rhythm than others? It’s not just about smartphones and coffees…

    This study found that getting sunlight (not electric light, not artificial sunlight, but actual sunlight, from the sun, even if filtered through partial cloud) between 08:30—09:00 resulted in higher levels of a protein called PER2. PER2 is critical for setting circadian rhythms, improving metabolism, and fortifying blood vessels.

    Besides, on a more simplistic level, it’s also a wonderful and energizing start to a healthy and productive day!

    Read: Beneficial effects of daytime light exposure on daily rhythms, metabolic state and affect

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  • Knit for Health & Wellness – by Betsan Corkhill

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Betsan Corkhill, a physiotherapist, has more than just physiotherapy in mind when it comes to the therapeutic potential of knitting (although yes, also physiotherapy!), and much of this book is about the more psychological benefits that go way beyond “it’s a relaxing pastime”.

    She makes the case for how knitting (much like good mental health) requires planning, action, organization, persistence, focus, problem-solving, and flexibility—and thus the hobby develops and maintains all the appropriate faculties for those things, which will then be things you get to keep in the rest of your life, too.

    Fun fact: knitting, along with other similar needlecrafts, was the forerunner technology for modern computer programming! And indeed, early computers, the kind with hole-punch data streams, used very similar pattern-storing methods to knitting patterns.

    So, for something often thought of as a fairly mindless activity for those not in the know, knitting has a lot to offer for what’s between your ears, as well as potentially something for keeping your ears warm later.

    One thing this book’s not, by the way: a “how to” guide for learning to knit. It assumes you either have that knowledge already, or will gain it elsewhere (there are many tutorials online).

    Bottom line: if you’re in the market for a new hobby that’s good for your brain, this book will give you great motivation to give knitting a go!

    Click here to check out Knit For Health & Wellness, and get knitting!

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  • Is it OK to lie to someone with dementia?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    There was disagreement on social media recently after a story was published about an aged care provider creating “fake-away” burgers that mimicked those from a fast-food chain, to a resident living with dementia. The man had such strict food preferences he was refusing to eat anything at meals except a burger from the franchise. This dementia symptom risks malnutrition and social isolation.

    But critics of the fake burger approach labelled it trickery and deception of a vulnerable person with cognitive impairment.

    Dementia is an illness that progressively robs us of memories. Although it has many forms, it is typical for short-term recall – the memory of something that happened in recent hours or days – to be lost first. As the illness progresses, people may come to increasingly “live in the past”, as distant recall gradually becomes the only memories accessible to the person. So a person in the middle or later stages of the disease may relate to the world as it once was, not how it is today.

    This can make ethical care very challenging.

    Pikselstock/Shutterstock

    Is it wrong to lie?

    Ethical approaches classically hold that specific actions are moral certainties, regardless of the consequences. In line with this moral absolutism, it is always wrong to lie.

    But this ethical approach would require an elderly woman with dementia who continually approaches care staff looking for their long-deceased spouse to be informed their husband has passed – the objective truth.

    Distress is the likely outcome, possibly accompanied by behavioural disturbance that could endanger the person or others. The person’s memory has regressed to a point earlier in their life, when their partner was still alive. To inform such a person of the death of their spouse, however gently, is to traumatise them.

    And with the memory of what they have just been told likely to quickly fade, and the questioning may resume soon after. If the truth is offered again, the cycle of re-traumatisation continues.

    older man looks into distance holding mug
    People with dementia may lose short term memories and rely on the past for a sense of the world. Bonsales/Shutterstock

    A different approach

    Most laws are examples of absolutist ethics. One must obey the law at all times. Driving above the speed limit is likely to result in punishment regardless of whether one is in a hurry to pick their child up from kindergarten or not.

    Pragmatic ethics rejects the notion certain acts are always morally right or wrong. Instead, acts are evaluated in terms of their “usefulness” and social benefit, humanity, compassion or intent.

    The Aged Care Act is a set of laws intended to guide the actions of aged care providers. It says, for example, psychotropic drugs (medications that affect mind and mood) should be the “last resort” in managing the behaviours and psychological symptoms of dementia.

    Instead, “best practice” involves preventing behaviour before it occurs. If one can reasonably foresee a caregiver action is likely to result in behavioural disturbance, it flies in the face of best practice.

    What to say when you can’t avoid a lie?

    What then, becomes the best response when approached by the lady looking for her husband?

    Gentle inquiries may help uncover an underlying emotional need, and point caregivers in the right direction to meet that need. Perhaps she is feeling lonely or anxious and has become focused on her husband’s whereabouts? A skilled caregiver might tailor their response, connect with her, perhaps reminisce, and providing a sense of comfort in the process.

    This approach aligns with Dementia Australia guidance that carers or loved ones can use four prompts in such scenarios:

    • acknowledge concern (“I can tell you’d like him to be here.”)
    • suggest an alternative (“He can’t visit right now.”)
    • provide reassurance (“I’m here and lots of people care about you.”)
    • redirect focus (“Perhaps a walk outside or a cup of tea?”)

    These things may or may not work. So, in the face of repeated questions and escalating distress, a mistruth, such as “Don’t worry, he’ll be back soon,” may be the most humane response in the circumstances.

    Different realities

    It is often said you can never win an argument with a person living with dementia. A lot of time, different realities are being discussed.

    So, providing someone who has dementia with a “pretend” burger may well satisfy their preferences, bring joy, mitigate the risk of malnutrition, improve social engagement, and prevent a behavioural disturbance without the use of medication. This seems like the correct approach in ethical terms. On occasion, the end justifies the means.

    Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Walnuts vs Pecans – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing walnuts to pecans, we picked the walnuts.

    Why?

    It was very close, though, and an argument could be made for pecans! Walnuts are nevertheless always a very good bet, and so far in our This-or-That comparisons, the only nut to beat them so far as been almonds, and that was very close too.

    In terms of macros, walnuts have a lot more protein, while pecans have a little more fiber (for approximately the same carbs). Both are equally fatty (near enough; technically pecans have a little more) but where the walnuts stand out in the fat category is that while pecans have mostly healthy monounsaturated fats, walnuts have mostly healthy polyunsaturated fats, including including a good balance of omega-3 and omega-6 fatty acids. So, while we do love the extra fiber from pecans, we’re calling it for walnuts in the macros category, on account of the extra protein and the best lipids profile (not that pecans’ lipids profile is bad by any stretch; just, walnuts have it better).

    In the vitamins category, walnuts have more of vitamins B2, B6, B9, and C, while pecans offer more of vitamins A, B1, B3, B5, E, K, and choline. The margins aren’t huge and walnuts are also excellent for all the vitamins that pecans narrowly beat them on, but still, the vitamins category is a win for pecans.

    When it comes to minerals, walnuts take back the crown; walnuts offer more calcium, copper, iron, magnesium, phosphorus, potassium, and selenium, while pecans have a little more manganese and zinc. Once again, the margins aren’t huge and pecans are also excellent for all the minerals that walnuts narrowly beat them on, but still, the minerals category is a win for walnuts.

    In short: enjoy both of these nuts for their healthy fats, vitamins, minerals, protein, and fiber, but if you’re going to pick one, walnuts come out on top.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts!

    Take care!

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  • Colloidal Gold’s Impressive Claims

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    All That Glitters…

    Today we’ll be examining colloidal gold supplementation.

    This issue of 10almonds brought to you by the writer suddenly getting lots of advertisements for this supplement. It’s not a new thing though, and has been around in one form or another since pretty much forever.

    Colloidal gold is…

    • Gold, as in the yellow metal
    • Colloidal, as in “very tiny insoluble particles dispersed though another substance (such as water)”

    What are the claims made for it?

    Honestly, just about everything is claimed for it. But to go with some popular claims:

    • Reduces inflammation
    • Supports skin health
    • Boosts immune function
    • Combats aging
    • Improves cognitive function

    So, what does the science say?

    Does it do those things?

    The short and oversimplified answer is: no

    However, there is a little bit of tangential merit, so we’re going to talk about the science of it, and how the leap gets made between what the science says and what the advertisements say.

    First… What makes gold so special, in general? Historically, three things:

    1. It’s quite rare
    2. It’s quite shiny
    3. It’s quite unreactive
    • The first is about supply and demand, so that’s not very important to us in this article.
    • The second is an aesthetic quality, which actually will have a little bit of relevance, but not much.
    • The third has been important historically (because it meant that shiny gold stayed shiny, because it didn’t tarnish), and now also important industrially too, as gold can be used in many processes where we basically need for nothing to happen (i.e., a very inert component is needed)

    That third quality—its unreactivity—has become important in medicine.

    When scientists need a way to deliver something (without the delivering object getting eaten by the body’s “eat everything” tendencies), or otherwise not interact chemically with anything around, gold is an excellent choice.

    Hence gold teeth, and gold fillings, by the way. They’re not just for the bling factor; they were developed because of their unreactivity and thus safety.

    So, what about those health claims we mentioned above?

    Here be science (creative interpretations not included)

    The most-backed-by-science claim from that list is “reduces inflammation”.

    Websites selling colloidal gold cite studies such as:

    Gold nanoparticles reduce inflammation in cerebral microvessels of mice with sepsis

    A promising title!The results of the study showed:

    ❝20 nm cit-AuNP treatment reduced leukocyte and platelet adhesion to cerebral blood vessels, prevented BBB failure, reduced TNF- concentration in brain, and ICAM-1 expression both in circulating polymorphonuclear (PMN) leukocytes and cerebral blood vessels of mice with sepsis. Furthermore, 20 nm cit-AuNP did not interfere with the antibiotic effect on the survival rate of mice with sepsis.❞

    That “20 nm cit-AuNP” means “20 nm citrate-covered gold nanoparticles”

    So it is not so much the antioxidant powers of gold being tested here, as the antioxidant powers of citrate, a known antioxidant. The gold was the carrying agent, whose mass and unreactivity allowed it to get where it needed to be.

    The paper does say the words “Gold nanoparticles have been demonstrated to own important anti-inflammatory properties“ in the abstract, but does not elaborate on that, reference it, or indicate how.

    Websites selling colloidal gold also cite papers such as:

    Anti-inflammatory effect of gold nanoparticles supported on metal oxides

    Another promising title! However the abstract mentions:

    ❝The effect was dependent on the MOx NPs chemical nature

    […]

    The effect of Au/TiO2 NPs was not related to Au NPs size❞

    MOx NPs = mineral oxide nanoparticles. In this case, the gold was a little more than a carrying agent, though, because the gold is described and explained as being a catalytic agent (i.e., its presence helps the attached mineral oxides react more quickly).

    We said that was the most-backed claim, and as you can see, it has some basis but is rather tenuous since the gold by itself won’t do anything; it just helps the mineral oxides.

    Next best-backed claim builds from that, which is “supports skin health”.

    Sometimes colloidal gold is sold as a facial tonic. By itself it’ll distribute (inert) gold nanoparticles across your skin, and may “give you a healthy glow”, because that’s what happens when you put shiny wet stuff on your face.

    Healthwise, if the facial tonic also contains some of the minerals we mentioned above, then it may have an antioxidant effect. But again, no minerals, no effect.

    The claim that it “combats aging” is really a tag-on to the “antioxidant” claim.

    As for the “supports immune health” claim… Websites selling colloid gold cite studies such as:

    Efficacy and Immune Response Elicited by Gold Nanoparticle- Based Nanovaccines against Infectious Diseases

    To keep things brief: gold can fight infectious diseases in much the same way that forks can fight hunger. It’s an inert carrying agent.

    As for “improves cognitive function”? The only paper we could find cited was that mouse sepsis study again, this time with the website saying “researchers found that rats treated with colloidal gold showed improved spatial memory and learning ability“ whereas the paper cited absolutely did not claim that, not remotely, not even anything close to that. It wasn’t even rats, it was mice, and they did not test their memory or learning.

    Is it safe?

    Colloidal gold supplementation is considered very safe, precisely because gold is one of the least chemically reactive substances you could possibly consume. It is special precisely because it so rarely does anything.

    However, impurities could be introduced in the production process, and the production process often involves incredibly harsh reagents to get the gold ions, and if any of those reagents are left in the solution, well, gold is safe but sodium borohydride and chloroauric acid aren’t!

    Where can I get some?

    In the unlikely event that our research review has given you an urge to try it, here’s an example product on Amazon

    Take care!

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