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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The End of Old Age – by Dr. Marc Agronin
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First, what this book is not: a book about ending aging. For that, you would want to check out “Ending Aging”, by Dr. Aubrey de Grey.
What this book actually is: a book about the purpose of aging. As in: “aging: to what end?”, and then the book answers that question.
Rather than viewing aging as solely a source of decline, this book (while not shying away from that) resolutely examines the benefits of old age—from clinically defining wisdom, to exploring the many neurological trade-offs (e.g., “we lose this thing but we get this other thing in the process”), and the assorted ways in which changes in our brain change our role in society, without relegating us to uselessness—far from it!
The style of the book is deep and meaningful prose throughout. Notwithstanding the author’s academic credentials and professional background in geriatric psychiatry, there’s no hard science here, just comprehensible explanations of psychiatry built into discussions that are often quite philosophical in nature (indeed, the author additionally has a degree in psychology and philosophy, and it shows).
Bottom line: if you’d like your own aging to be something you understand better and can actively work with rather than just having it happen to you, then this is an excellent book for you.
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Cold Weather Health Risks
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Many Are Cold; Few Are Frozen
Many of those of us in the Northern Hemisphere are getting hit with a cold spell around now. How severe that may be depends on more precisely where we are, but it’s affecting a lot of people. So, with apologies to our readers in Australia, we’re going to do a special on that today.
Acute cold is, for most people, good for the health:
A Cold Shower A Day Keeps The Doctor Away?
Persistent cold, not so much. Let’s look at the risks, and what can be done about them…
Hypothermia
It kills. Don’t let it kill you or your loved ones.
And, this is really important: it doesn’t care whether you’re on a mountain or not.
In other words: a lot of people understand (correctly!) that hypothermia is a big risk to hikers, climbers, and the like. But if the heating goes out in your house and the temperature drops for long enough before the heating is fixed, you can get hypothermia there too just the same if you’re not careful.
How cold is too cold? It doesn’t even have to be sub-zero. According to the CDC, temperatures of 4℃ (40℉) can be low enough to cause hypothermia if other factors combine:
CDC | Prevent Hypothermia & Frostbite ← you can also see the list of symptoms to watch out for, there!
Skin health
Not generally an existential risk, but we may as well stay healthy as not!
Cold air often means dry air, so use a moisturizer with an oil base (if you don’t care for fancy beauty products, ordinary coconut oil is top-tier).
Bonus if you do it after a warming bath/shower!
Heart health
Cold has a vasconstricting effect; that is to say, it causes the body’s vasculature to shrink, increasing localized blood pressure. If it’s a cold shower as above, that can be very invigorating. If it’s a week of sub-zero temperatures, it can become a problem.
❝Shoveling a little snow off your sidewalk may not seem like hard work. However, […] combined with the fact that the exposure to cold air can constrict blood vessels throughout the body, you’re asking your heart to do a lot more work in conditions that are diminishing the heart’s ability to function at its best.❞
Source: Snow shoveling, cold temperatures combine for perfect storm of heart health hazards
If you have a heart condition, please do not shovel snow. Let someone else do it, or stay put.
And if you are normally able to exercise safely? Unless you’re sure your heart is in good order, exercising in the warmth, not the cold, seems to be the best bet.
See also: Heart Attack: His & Hers (Be Prepared!) ← can you remember which symptoms are for which sex? If not, now’s a good time to refresh that knowledge.
Immune health
We recently discussed how cold weather indirectly increases the risk of respiratory viral infection:
The Cold Truth About Respiratory Infections
So, now’s the time to be extra on-guard about that.
See also: Beyond Supplements: The Real Immune-Boosters!
Balance
Icy weather increases the risk of falling. If you think “having a fall” is something that happens to other/older people, please remember that there’s a first time for everything. Some tips:
- Walk across icy patches with small steps in a flat-footed fashion like a penguin.
- It may not be glamorous, but neither is going A-over-T and breaking (or even just spraining) things.
- Use a handrail if available, even if you don’t think you need to.
You can also check out our previous article about falling (avoiding falling, minimizing the damage of falling, etc):
Fall Special: Some Fall-Themed Advice
Take care!
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- Walk across icy patches with small steps in a flat-footed fashion like a penguin.
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Fruit, Fiber, & Leafy Greens… On A Low-FODMAP Diet!
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Fiber For FODMAP-Avoiders
First, let’s quickly cover: what are FODMAPs?
FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
In plainer English: they’re carbohydrates that are resistant to digestion.
This is, for most people most of the time, a good thing, for example:
When Is A Fiber Not A Fiber? When It’s A Resistant Starch.
Not for everyone…
However, if you have inflammatory bowel syndrome (IBS), including ulcerative colitis, Crohn’s disease, or similar, then suddenly a lot of common dietary advice gets flipped on its head:
While digestion-resistant carbohydrates making it to the end parts of our digestive tract are good for our bacteria there, in the case of people with IBS or similar, it can be a bit too good for our bacteria there.
Which can mean gas (a natural by-product of bacterial respiration) accumulation, discomfort, water retention (as the pseudo-fiber draws water in and keeps it), and other related symptoms, causing discomfort, and potentially disease such as diarrhea.
Again: for most people this is not so (usually: quite the opposite; resistant starches improve things down there), but for those for whom it’s a thing, it’s a Big Bad Thing™.
Hold the veg? Hold your horses.
A common knee-jerk reaction is “I will avoid fruit and veg, then”.
Superficially, this can work, as many fruit & veg are high in FODMAPs (as are fermented dairy products, by the way).
However, a diet free from fruit and veg is not going to be healthy in any sustainable fashion.
There are, however, options for low-FODMAP fruit & veg, such as:
Fruits: bananas (if not overripe), kiwi, grapefruit, lemons, limes, melons, oranges, passionfruit, strawberries
Vegetables: alfalfa, bell peppers, bok choy, carrots, celery, cucumbers, eggplant, green beans, kale, lettuce, olives, parsnips, potatoes (and sweet potatoes, yams etc), radishes, spinach, squash, tomatoes*, turnips, zucchini
*our stance: botanically it’s a fruit, but culinarily it’s a vegetable.
For more on the science of this, check out:
Strategies for Producing Low FODMAPs Foodstuffs: Challenges and Perspectives ← table 2 is particularly informative when it comes to the above examples, and table 3 will advise about…
Bonus
Grains: oats, quinoa, rice, tapioca
…and wheat if the conditions in table 3 (linked above) are satisfied
(worth mentioning since grains also get a bad press when it comes to IBS, but that’s mostly because of wheat)
See also: Gluten: What’s The Truth?
Enjoy!
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Yoga For Stiff Birds – by Marion Deuchars
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Quick show of hands, who here practices yoga in some fashion, but does not necessarily always look Instagrammable while doing it? Yep, same here.
This book is a surprisingly practical introduction to yoga for newcomers, and inspirational motivator for those of us who feel like we should do more.
Rather than studio photography of young models in skimpy attire, popular artist (and well-practised yogi) Marion Deuchars offers in a few brushstrokes what we need to know for each asana, and how to approach it if we’re not so supple yet as we’d like to be.
Bottom line: whether for yourself or as a gift for a loved one (or both!) this is a very charming introduction to (or refresher of) yoga.
Click here to check out Yoga For Stiff Birds, and get yours going!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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The Age-Proof Brain – by Dr. Marc Milstein
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Biological aging is not truly just one thing, but rather the amalgam of many things intersecting—and most of them are modifiable. The cells of your body neither know nor care how many times you have flown around the sun; they just respond to the stimuli they’re given.
Which is what fuels this book. The idea is to have a brain that is less-assailed by the things that would make it age, and more rejuvenated by the things that can make it biologically younger.
Dr. Milstein doesn’t neglect the rest of the body, and indeed notes the brain’s connections with the immune system, the heart, the gut, and more. But everything in this book is done with the brain in mind and its good health as the top priority outcome of all the things he advises.
On which note, yes, there is plenty of practical, implementable advice here. For a book that is consistently full of study paper citations, he does take care to make everything useful to the reader, and makes everything as easy as possible for the layperson along the way.
Bottom line: if you would like your brain to age less, this is an excellent, very evidence-based, guidebook.
Click here to check out The Age-Proof Brain, and age-proof your brain!
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