Radical CBT
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Radical Acceptance!
A common criticism of Cognitive Behavioral Therapy (CBT) is that much of it hinges on the following process:
- You are having bad feelings
- Which were caused by negative automatic thoughts
- Which can be taken apart logically
- Thus diffusing the feelings
- And then feeling better
For example:
- I feel like I’m an unwanted burden to my friend
- Because he canceled on me today
- But a reasonable explanation is that he indeed accidentally double-booked himself and the other thing wasn’t re-arrangeable
- My friend is trusting me to be an understanding friend myself, and greatly values my friendship
- I feel better and look forward to our next time together
But what if the negative automatic thoughts are, upon examination, reasonable?
Does CBT argue that we should just “keep the faith” and go on looking at a cruel indifferent world through rose-tinted spectacles?
Nope, there’s a back-up tool.
This is more talked-about in Dialectic Behavior Therapy (DBT), and is called radical acceptance:
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Radical acceptance here means accepting the root of things as true, and taking the next step from there. It follows a bad conclusion with “alright, and now what?”
“But all evidence points to the fact that my friend has been avoiding me for months; I really can’t ignore it or explain it away any longer”
“Alright. Now what?”
- Maybe there’s something troubling your friend that you don’t know about (have you asked?)
- Maybe that something is nothing to do with you (or maybe it really is about you!)
- Maybe there’s a way you and he can address it together (how important is it to you?)
- Maybe it’s just time to draw a line under it and move on (with or without him)
Whatever the circumstances, there’s always a way to move forwards.
Feelings are messengers, and once you’ve received and processed the message, the only reason to keep feeling the same thing, is if you want to.
Note that this is true even when you know with 100% certainty that the Bad Thing™ is real and exactly as-imagined. It’s still possible for you to accept, for example:
“Alright, so this person really truly hates me. Damn, that sucks; I think I’ve been nothing but nice to them. Oh well. Shit happens.”
Feel all the feelings you need to about it, and then decide for yourself where you want to go from there.
Get: 25 CBT Worksheets To Help You Find Solutions To A Wide Variety of Problems
Recognizing Emotions
We talked in a previous edition of 10almonds’ Psychology Sunday about how an important part of dealing with difficult emotions is recognizing them as something that you experience, rather than something that’s intrinsically “you”.
But… How?
One trick is to just mentally (or out loud, if your current environment allows for such) greet them when you notice them:
- Hello again, Depression
- Oh, hi there Anxiety, it’s you
- Nice of you to join us, Anger
Not only does this help recognize and delineate the emotion, but also, it de-tooths it and recognizes it for what it is—something that doesn’t actually mean you any harm, but that does need handling.
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AI: The Doctor That Never Tires?
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AI: The Doctor That Never Tires?
We asked you for your opinion on the use of Artificial Intelligence (AI) in healthcare, and got the above-depicted, below-described set of results:
- A little over half of respondents to the poll voted for “It speeds up research, and is more methodical about diagnosis, so it’s at least a good extra tool”
- A quarter of respondents voted for “I’m on the fence—it seems to make no more nor less mistakes than human doctors do”
- A little under a fifth of respondents voted for “AI is less prone to fatigue/bias than human doctors, making it an essential new tech”
- Three respondents voted for “AI is a step too far in medical technology, and we’re not ready for it”
Writer’s note: I’m a professional writer (you’d never have guessed, right?) and, apparently, I really did write “no more nor less mistakes”, despite the correct grammar being “no more nor fewer mistakes”. Now, I know this, and in fact, people getting less/fewer wrong is a pet hate of mine. Nevertheless, I erred.
Yet, now that I’m writing this out in my usual software, and not directly into the poll-generation software, my (AI!) grammar/style-checker is highlighting the error for me.
Now, an AI could not do my job. ChatGPT would try, and fail miserably. But can technology help me do mine better? Absolutely!
And still, I dismiss a lot of the AI’s suggestions, because I know my field and can make informed choices. I don’t follow it blindly, and I think that’s key.
AI is less prone to fatigue/bias than human doctors, making it an essential new tech: True or False?
True—with one caveat.
First, a quick anecdote from a subscriber who selected this option in the poll:
❝As long as it receives the same data inputs as my doctor (ie my entire medical history), I can see it providing a much more personalised service than my human doctor who is always forgetting what I have told him. I’m also concerned that my doctor may be depressed – not an ailment that ought to affect AI! I recently asked my newly qualified doctor goddaughter whether she would prefer to be treated by a human or AI doctor. No contest, she said – she’d go with AI. Her argument was that human doctors leap to conclusions, rather than properly weighing all the evidence – meaning AI, as long as it receives the same inputs, will be much more reliable❞
Now, an anecdote is not data, so what does the science say?
Well… It says the same:
❝Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001).❞
See the damning report for yourself: Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors
AI, of course, does not suffer from burnout, fatigue, or suicidal ideation.
So, what was the caveat?
The caveat is about bias. Humans are biased, and that goes for medical practitioners just the same. AI’s machine learning is based on source data, and the source data comes from humans, who are biased.
See: Bias and Discrimination in AI: A Cross-Disciplinary Perspective
So, AI can perpetuate human biases and doesn’t have a special extra strength in this regard.
The lack of burnout, fatigue, and suicidal ideation, however, make a big difference.
AI speeds up research, and is more methodical about diagnosis: True or False?
True! AI is getting more and more efficient at this, and as has been pointed out, doesn’t make errors due to fatigue, and often comes to accurate conclusions near-instantaneously. To give just one example:
❝Deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. The area under the curve was 0.994 (best algorithm) vs 0.884 (best pathologist).❞
About that “getting more and more efficient at this”; it’s in the nature of machine learning that every new piece of data improves the neural net being used. So long as it is getting fed new data, which it can process at rate far exceeding humans’ abilities, it will always be constantly improving.
AI makes no more nor
lessfewer mistakes than humans do: True or False?False! AI makes fewer, now. This study is from 2021, and it’s only improved since then:
❝Professionals only came to the same conclusions [as each other] approximately 75 per cent of the time. More importantly, machine learning produced fewer decision-making errors than did all the professionals❞
See: AI can make better clinical decisions than humans: study
All that said, we’re not quite at Star Trek levels of “AI can do a human’s job entirely” just yet:
BMJ | Artificial intelligence versus clinicians: pros and cons
To summarize: medical AI is a powerful tool that:
- Makes healthcare more accessible
- Speeds up diagnosis
- Reduces human error
…and yet, for now at least, still requires human oversights, checks and balances.
Essentially: it’s not really about humans vs machines at all. It’s about humans and machines giving each other information, and catching any mistakes made by the other. That way, humans can make more informed decisions, and still keep a “hand on the wheel”.
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The Exercises That Can Fix Sinus Problems (And More)
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Who nose what benefits you will gain today?
This is James Nestor, a science journalist and author. He’s written for many publications, including Scientific American, and written a number of books, most notably Breath: The New Science Of A Lost Art.
Today we’ll be looking at what he has to share about what has gone wrong with our breathing, what problems this causes, and how to fix it.
What has gone wrong?
When it comes to breathing, we humans are the pugs of the primate world. In a way, we have the opposite problem to the squashed-faced dogs, though. But, how and why?
When our ancestors learned first tenderize food, and later to cook it, this had two big effects:
- We could now get much more nutrition for much less hunting/gathering
- We now did not need to chew our food nearly so much
Getting much more nutrition for much less hunting/gathering is what allowed us to grow our brains so large—as a species, we have a singularly large brain-to-body size ratio.
Not needing to chew our food nearly so much, meanwhile, had even more effects… And these effects have become only more pronounced in recent decades with the rise of processed food making our food softer and softer.
It changed the shape of our jaw and cheekbones, just as the size of our brains taking up more space in our skull moved our breathing apparatus around. As a result, our nasal cavities are anatomically ridiculous, our sinuses are a crime against nature (not least of all because they drain backwards and get easily clogged), and our windpipes are very easily blocked and damaged due to the unique placement of our larynx; we’re the only species that has it there. It allowed us to develop speech, but at the cost of choking much more easily.
What problems does this cause?
Our (normal, to us) species-wide breathing problems have resulted in behavioral adaptations such as partial (or in some people’s cases, total or near-total) mouth-breathing. This in turn exacerbates the problems with our jaws and cheekbones, which in turn exacerbates the problems with our sinuses and nasal cavities in general.
Results include such very human-centric conditions as sleep apnea, as well as a tendency towards asthma, allergies, and autoimmune diseases. Improper breathing also brings about a rather sluggish metabolism for how many calories we consume.
How are we supposed to fix all that?!
First, close your mouth if you haven’t already, and breathe through your nose.
In and out.
Both are important, and unless you are engaging in peak exercise, both should be through your nose. If you’re not used to this, it may feel odd at first, but practice, and build up your breathing ability.
Six seconds in and six seconds out is a very good pace.
If you’re sitting doing a breathing exercise, also good is four seconds in, four seconds hold, four seconds out, four seconds hold, repeat.
But those frequent holds aren’t practical in general life, so: six seconds in, six seconds out.
Through your nose only.
This has benefits immediately, but there are other more long-term benefits from doing not just that, but also what has been called (by Nestor, amongst many others), “Mewing”, per the orthodontist, Dr. John Mew, who pioneered it.
How (and why) to “mew”:
Place your tongue against the roof of your mouth. It should be flat against the palate; you’re not touching it with the tip here; you’re creating a flat seal.
Note: if you were mouth-breathing, you will now be unable to breathe. So, important to make sure you can breathe adequately through your nose first.
This does two things:
- It obliges nose-breathing rather than mouth-breathing
- It creates a change in how the muscles of your face interact with the bones of your face
In a battle between muscle and bone, muscle will always win.
Aim to keep your tongue there as much as possible; make it your new best habit. If you’re not eating, talking, or otherwise using your tongue to do something, it should be flat against the roof of your mouth.
You don’t have to exert pressure; this isn’t an exercise regime. Think of it more as a postural exercise, just, inside your mouth.
Quick note: read the above line again, because it’s important. Doing it too hard could cause the opposite problems, and you don’t want that. You cannot rush this by doing it harder; it takes time and gentleness.
Why would we want to do that?
The result, over time, will tend to be much healthier breathing, better sinus health, freer airways, reduced or eliminated sleep apnea, and, as a bonus, what is generally considered a more attractive face in terms of bone structure. We’re talking more defined cheekbones, straighter teeth, and a better mouth position.
Want to learn more?
This is the “Mewing” technique that Nestor encourages us to try:
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Brain Maker – by Dr. David Perlmutter
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Regular 10almonds readers probably know about the gut-brain connection already, so what’s new here?
Dr. David Perlmutter takes us on a tour of gut and brain health, specifically, the neuroprotective effect of healthy gut microbiota.
This seems unlikely! After all, vagus nerve or no, the gut microbiota are confined to the gut, and the brain is kept behind the blood-brain barrier. So how does one thing protect the other?
Dr. Perlmutter presents the relevant science, and the honest answer is, we’re not 100% sure how this happens! We do know part of it: that bad gut microbiota can result in a “leaky gut”, and that may in turn lead to such a thing as a “leaky brain”, where the blood-brain barrier has been compromised and some bad things can get in with the blood.
When it comes to gut-brain health…
Not only is the correlation very strong, but also, in tests where someone’s gut microbiota underwent a radical change, e.g. due to…
- antibiotics (bad)
- fasting (good)
- or a change in diet (either way)
…their brain health changed accordingly—something we can’t easily check outside of a lab, but was pretty clear in those tests.
We’re also treated to an exposé on the links between gut health, brain health, inflammation, and dementia… Which links are extensive.
In closing, we’ll mention that throughout this book we’re also given many tips and advices to improve our gut/brain health, reverse damage done already, and set ourselves up well for the future.
Click here to check out “Brain Maker” on Amazon and take care of this important part of your health!
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What Your Brain Is Really Doing When You’re Doing “Nothing”
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Unless we are dead, our brain is never truly inactive. And it’s not just a matter of regulating autonomic functions, either…
Default Mode Network
When the brain is at rest but not necessarily asleep, the Default Mode Network (DMN) engages. This makes up for around 20% of the brain’s overall activity, and contributes to complex cognitive processes.
What constitutes “at rest”: the DMN activates when external tasks stop and is engaged during self-reflection, mind-wandering, and relaxed memory recall (i.e. reminiscing, rather than answering questions in a difficult test, for example).
As for its neurophysiology, the DMN is connected to the hippocampus and plays a key role in episodic, prospective, and semantic memory (memories of experiences, future plans, and general knowledge), as well as being involved in self-reflection, social cognition, and understanding others’ thoughts (theory of mind). The DMN thus also helps integrate memories and thoughts to create a cohesive internal narrative and sense of self.
However, it doesn’t work alone: the DMN interacts with other networks like the salience network, which switches attention to external stimuli. Disruptions between these networks are linked to psychiatric disorders (e.g., schizophrenia, Alzheimer’s, depression), in various different ways depending on the nature of the disruption.
Sometimes, for some people in some circumstances, the option to disrupt the DMN is useful. For example, research shows that psilocybin disrupts the DMN, leading to changes in brain activity and potential therapeutic benefits for depression* and other psychiatric disorders by enhancing neuroplasticity.
*Essentially, kicking the brain out of the idling gear it got stuck in, and into action
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
- The Wandering Mind – by Dr. Michael Corballis ← a book, largely about the DMN and how to use it beneficially
- Taking A Trip Through The Evidence On Psychedelics ← for a shorter read, touching on psilocybin
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Make Your Vegetables Work Better Nutritionally
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Most people know that boiling vegetables to death is generally not best for them, but raw isn’t always best either, and if we want to not sabotage our food, then there’s more to bear in mind than “just steam them, then”.
So, what should we keep in mind?
Water solubility
Many nutrients are water-soluble, including vitamin C, vitamin B-complex (as in, the collection of B-vitamins), and flavonoids, as well as many other polyphenols.
This means that if you cook your vegetables (which includes beans, lentils, etc) in water, a lot of the nutrients will go into the water, and be lost if you then drain that.
There are, thus, options;
- Steaming, yes
- Use just enough water to slow-cook or pressure-cook things that are suitable for slow-cooking, or pressure-cooking such as those beans and lentils. That way, when it’s done, there’s no excess water to drain, and all the nutrients are still in situ.
- Use as much water as you like, but then keep the excess water to make a soup, sauce, or broth.
- Use a cooking method other than water, where appropriate. For example, roasting peppers is a much better idea than roasting dried pulses.
- Consume raw, where appropriate.
Fat solubility
Many nutrients are fat-soluble, including vitamins A, D, E, and K, as well as a lot of carotenoids (including heavy-hitters lycopene and β-carotene) and many other polyphenols.
We’re now going to offer almost the opposite advice to that we had about water solubility. This is because unless they are dried, vegetables already contain water, whereas many contain only trace amounts of fat. Consequently, the advice this time is to add fat.
There are options:
- Cook with a modest amount of your favorite healthy cooking oil (our general go-to is extra-virgin olive oil, but avocado oil is great especially for higher temperature cooking, and an argument can be made for coconut oil sometimes)
- Remember that this goes for roasting, too. Brush those vegetables with a touch of olive oil, and not only will they be delicious, they’ll be more nutritious, too.
- Drizzle some the the above, if you’re serving things raw and it’s appropriate. This goes also for things like salads, so dress them!
- Enjoy your vegetables alongside healthy fatty foods such as nuts and seeds (or fatty animal products, if you eat those; fatty fish is a fine option here, in moderation, as are eggs, or fermented dairy products).
For a deeper understanding: Can Saturated Fats Be Healthy?
Do not, however, deep-fry your foods unless it’s really necessary and then only for an occasional indulgence that you simply accept will be unhealthy. Not only is deep-frying terrible for the health in a host of ways (ranging from an excess of oil in the resultant food, to acrylamide, to creating Advanced Glycation End-products*), but also those fat-soluble nutrients? Guess where they’ll go. And unlike with the excess vegetable-cooking water that you can turn into soup or whatever, we obviously can’t recommend doing that with deep-fryer oil.
*see also: Are You Eating AGEs?
Temperature sensitivity
Many nutrients are sensitive to temperature, including vitamin C (breaks down when exposed to high temperatures) and carotenoids (are released when exposed to higher temperatures). Another special case is ergothioneine, “the longevity vitamin” that’s not a vitamin, found in mushrooms, which is also much more bioavailable when cooked.
So, if you’re eating something for vitamin C, then raw is best if that’s a reasonable option.
And if it’s not a reasonable option? Well, then you can either a) just cope with the fact it’s going to have less vitamin C in it, or b) cook it as gently and briefly as reasonably possible.
On the other hand, if you’re eating something for carotenoids (especially including lycopene and β-carotene), or ergothioneine, then cooked is best.
Additionally, if your food is high in oxalates (such as spinach), and you don’t want it to be (for example because you have kidney problems, which oxalates can exacerbate, or would like to get more calcium out of the spinach and into your body, which which oxalic acid would inhibit), then cooked is best, as it breaks down the oxalates.
Same goes for phytates, another “anti-nutrient” found in some whole grains (such as rice and wheat); cooking breaks it down, therefore cooked is best.
This latter is not, however, applicable in the case of brown rice protein powder, for those who enjoy that—because phytates aren’t found in the part of the rice that’s extracted to make that.
And as for brown rice itself? Does contain phytates… Which can be reduced by soaking and heating, preferably both, to the point that the nutritional value is better than it would have been had there not been phytic acid present in the first place; in other words: cooked is best.
You may be wondering: “who is eating rice raw?” and the answer is: people using rice flour.
See: Brown Rice Protein: Strengths & Weaknesses
Want to know more?
Here’s a great rundown from Dr. Rosalind Gibson, Dr. Leah Perlas, and Dr. Christine Hotz:
Improving the bioavailability of nutrients in plant foods at the household level
Enjoy!
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Mythbusting Cookware Materials
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In Wednesday’s newsletter, we asked you what kind of cookware you mostly use, and got the above-depicted, below-described, set of responses:
- About 45% said stainless steel
- About 21% said cast iron
- About 15% said non-stick (e.g. Teflon)
- About 9% said enamel
- About 6% said aluminum
- And 1 person selected “something else”, but then commented to the contrary, writing “I use all of the above”
So, what does the science say about these options?
Stainless steel cookware is safe: True or False?
True! Assuming good quality and normal use, anyway. There really isn’t a lot to say about this, because it’s very unexciting. So long as it is what it is labelled as: there’s nothing coating it, nothing comes out of it unless you go to extremes*, and it’s easy to clean.
*If you cook for long durations at very high temperatures, it can leach nickel and chromium into food. What this means in practical terms: if you are using stainless steel to do deep-frying, then maybe stop that, and also consider going easy on deep-frying in general anyway, because obviously deep-frying is unhealthy for other reasons.
Per normal use, however: pretty much the only way (good quality) stainless steel cookware will harm you is if you touch it while it’s hot, or if it falls off a shelf onto your head.
That said, do watch out for cheap stainless steel cookware that can contain a lot of impurities, including heavy metals. Since you probably don’t have a mass spectrometer and/or chemistry lab at home to check for those impurities, your best guard here is simply to buy from a reputable brand with credible certifications.
Ceramic cookware is safe: True or False?
True… Most of the time! Ceramic pans usually have metal parts and a ceramic cooking surface coated with a very thin layer of silicon. Those metal parts will be as safe as the metals used, so if that’s stainless steel, you’re just as safe as the above. As for the silicon, it is famously inert and body-safe (which is why it’s used in body implants).
However: ceramic cookware that doesn’t have an obvious metal part and is marketed as being pure ceramic, will generally be sealed with some kind of glaze that can leach heavy metals contaminants into the food; here’s an example:
Lead toxicity from glazed ceramic cookware
Copper cookware is safe: True or False?
False! This is one we forgot to mention in the poll, as one doesn’t see a lot of it nowadays. The copper from copper pans can leach into food. Now, of course copper is an important mineral that we must get from our diet, but the amount of copper that that can leach into food from copper pans is far too much, and can induce copper toxicity.
In addition, copper cookware has been found to be, on average, highly contaminated with lead:
Non-stick cookware contaminates the food with microplastics: True or False?
True! If we were to discuss all the common non-stick contaminants here, this email would no longer fit (there’s a size limit before it gets clipped by most email services).
Suffice it to say: the non-stick coating, polytetrafluoroethylene, is itself a PFAS, that is to say, part of the category of chemicals considered environmental pollutants, and associated with a long list of health issues in humans (wherein the level of PFAS in our bloodstream is associated with higher incidence of many illnesses):
You may have noticed, of course, that the “non-stick” coating doesn’t stick very well to the pan, either, and will tend to come off over time, even if used carefully.
Also, any kind of wet cooking (e.g. saucepans, skillets, rice cooker inserts) will leach PFAS into the food. In contrast, a non-stick baking tray lined with baking paper (thus: a barrier between the tray and your food) is really not such an issue.
We wrote about PFAS before, so if you’d like a more readable pop-science article than the scientific paper above, then check out:
PFAS Exposure & Cancer: The Numbers Are High
Aluminum cookware contaminates the food with aluminum: True or False?
True! But not usually in sufficient quantities to induce aluminum toxicity, unless you are aluminum pans Georg who eats half a gram of aluminum per day, who is a statistical outlier and should not be counted.
That’s a silly example, but an actual number; the dose required for aluminum toxicity in blood is 100mg/L, and you have about 5 liters of blood.
Unless you are on kidney dialysis (because 95% of aluminum is excreted by the kidneys, and kidney dialysis solution can itself contain aluminum), you will excrete aluminum a lot faster than you can possibly absorb it from cookware. On the other hand, you can get too much of it from it being a permitted additive in foods and medications, for example if you are taking antacids they often have a lot of aluminum oxide in them—but that is outside the scope of today’s article.
However, aluminum may not be the real problem in aluminum pans:
❝In addition, aluminum (3.2 ± 0.25 to 4.64 ± 0.20 g/kg) and copper cookware (2.90 ± 0.12 g/kg) were highly contaminated with lead.
The time and pH-dependent study revealed that leaching of metals (Al, Pb, Ni, Cr, Cd, Cu, and Fe, etc.) into food was predominantly from anodized and non-anodized aluminum cookware.
More metal leaching was observed from new aluminum cookware compared to old. Acidic food was found to cause more metals to leach during cooking.❞
~ the same paper we cited when talking about copper
Cast iron cookware contaminates the food with iron: True or False?
True, but unlike with the other metals discussed, this is purely a positive, and indeed, it’s even recommended as a good way to fortify one’s diet with iron:
The only notable counterpoint we could find for this is if you have hemochromatosis, a disorder in which the body is too good at absorbing iron and holding onto it.
Thinking of getting some new cookware?
Here are some example products of high-quality safe materials on Amazon, but of course feel free to shop around:
Stainless Steel | Ceramic* | Cast Iron
*it says “non-stick” in the description, but don’t worry, it’s ceramic, not Teflon etc, and is safe
Bonus: rice cooker with stainless steel inner pot
Take care!
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