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Tayla Schuit

25/05/2022
Tayla Schuit
In All Articles, Dr Yu Sun Bin, Sleep

Research Review: Can We Sleep To Much?

In this article, our expert Dr. Yu Sun Bin reviews: Can People Sleep Too Much? Effects of Extended Sleep Opportunity on Sleep Duration and Timing by Klerman EB, Barbato G, Czeisler CA, Wehr TA. 

 

1) What was the high-level summary of the research? 

People cannot sleep ‘too much’. The amount of sleep we get is regulated by the homeostatic and circadian systems which drive us towards a stable amount of sleep, provided we allow enough time for it. 

While we cannot sleep too much, we can spend excess time in bed. When given 12-14 hours of opportunity to sleep, healthy people can develop patterns similar to those with insomnia and take longer to fall asleep, wake more often in the middle of the night, and wake too early and be unable to go back to sleep. 

 

2) What did the study try to measure? 

The study measured objective sleep using sleep studies. The study assessed whether, when given long periods of time in which to sleep, people could sleep to excess, or if they would reach a stable point with a roughly consistent amount of sleep every night. 

 

3) How was the study undertaken? 

The authors of this study analysed data from two of their previous studies. 

In Study 1, healthy volunteers were given the opportunity to spend 14-hours in bed per night for 28 days; In Study 2, volunteers were given the opportunity to spend 12-hours in bed for 8 nights, with the addition of a 4-hour window for napping during the day. 

Neither study interfered with the sleep of the volunteers, apart from giving instructions that they should try to sleep during those windows of time. Both studies involved volunteers sleeping in research labs so that factors such as work and socialising did not influence how much volunteers slept and when they went to sleep and woke up. 

 

4) What did the study find? 

In both studies, volunteers slept more during their first week in the lab – on average, sleeping 2 hours longer than they did at home. However, the differences between volunteers were marked: some did not sleep more at all when given the opportunity, whilst others slept almost 6 hours longer! 

After the first week of extended opportunity for sleep, the total sleep time of the volunteers stabilised: on average, people in Study 1 slept 8.6 hours nightly, whilst those in Study 2 slept 8.9 hours on average. However, individual needs for sleep were very different: at one extreme, one volunteer stabilised at 5.2 hours of nightly sleep, whilst at the other extreme, another stabilised at 11.0 hours. These results show that during the first week in the lab, having protected sleep time was important for many of the volunteers to catch up on sleep. However, once they had caught up, their sleep stabilised and they tended to have roughly the same amount of sleep every night. This amount of sleep was unique to them.

Also important to note is that sleep quality decreased for many of the volunteers in these studies – that is, even though the same amount of sleep was achieved, it took them longer to fall asleep, they woke up more often or too early on some nights. However, unlike people with chronic insomnia, these healthy volunteers then made up for this slight sleep loss the next night. This is exactly how sleep is supposed to work as dictated by the sleep homeostatic process which maintains an equilibrium in our sleep/wake cycles. 

 

5) Is there any other research out there that supports these findings or contradicts it? 

There is plenty to support it! For example, in large scale epidemiological studies that link long sleep durations (>9 hours) to poor health, the association is no longer seen when existing health conditions are taken into account. This suggests that it is time in bed and poor sleep quality that contributes to poor health, or that poor health contributes to excess time in bed and poor sleep quality.

Similarly, in terms of performance, it is not possible to sleep more to ‘bank’ sleep, but it is possible to reduce existing sleep debt so that you are better protected from any effects of future sleep deprivation. 

 

6) How much weight should we give this research?

This research is highly credible given the supporting evidence. The only thing to keep in mind is that the studies were limited to young people, aged 18 to 36 years, without any health conditions so the expectation of ~8 hours of sleep being average may not be applicable to other age groups and people with existing health conditions.

 

7) What does this mean for your work/research/industry? 

There is often a disconnect and conflict in the sleep field about what advice we give to people with clinically significant insomnia and to the general public at large. The message we try to give to the general public is that typically, people should sleep more to get enough sleep. However, the clinicians who work with insomnia sufferers are unhappy with this message, because spending more time in bed can make insomnia worse. 

This study shows that there is a direct connection between those two messages and that they are actually not in conflict. That is, we should all try to sleep enough, for us to be individually well-rested, but avoid spending more time in bed beyond that point, because it only creates poor sleep quality that’s similar to symptoms of insomnia. 

 

8) What’s the key takeaway for us to take from this research?

It isn’t possible to sleep ‘too much’ but it is possible to spend too long in bed. If you spend too long in bed, the quality of your sleep can suffer. 

 

9) Will you be doing anything differently because of this research? 

I think this study highlights we should give ourselves the opportunity for enough sleep every night and try to figure out where our equilibrium point of ‘enough sleep’ is. We should then try to protect our sleep time to achieve our required amount of sleep as much as possible.

 

Dr Yu Sun Bin is an epidemiologist and public health researcher. Her particular research interests are on sleep and circadian rhythms and how these biological systems are reflected in behaviour, health, and disease.

17/05/2022
Tayla Schuit
In All Articles, Dr Yu Sun Bin, Sleep

6 Evidence-Based Strategies For Optimising Your Sleep

Most researchers agree that adults need at least seven hours of sleep each night for proper cognitive and behavioural functions. Talk to people around you though and chances are many of them will identify sleep as something they struggle with. Like diet and exercise, sleep has a huge impact on our wellbeing. The good news is, we can actively work on our sleep habits and improve them. Sleep researcher, Dr Yu Sun Bin offers these 6 strategies for optimising your sleep.

#1 – Stick to a Sleep Schedule

Our circadian rhythm has a direct influence on when melatonin (the body’s sleep hormone) is released to help induce sleep. If your circadian rhythm is out of sync with the natural cycle of day and night, it can make it harder to fall asleep. 

The circadian rhythm is influenced mainly by light and dark, but also by your daily activities. Sticking to a consistent sleep cycle can help you avoid what is referred to as social jet lag. Social jet lag occurs when the time you want to go to sleep as dictated by your internal body clock doesn’t align with your actual sleep patterns due to work or social commitments.

To ensure your circadian rhythm stays in sync, try to stick to a reasonable and consistent time you go to bed and wake up every day, including weekends.

#2 – Take That Nap!

Life has its ups and downs and sometimes not being able to get enough sleep is out of our control. The good news is that naps are science-approved. It’s important to understand though what constitutes a good nap, when to nap, and how long we should be napping to avoid waking up feeling groggy or having sleep inertia. 

To increase alertness, the best time for most people to nap is between 2-4 pm, after your morning peak and as alertness is starting to decline. If you are sleep deprived, it’s generally good to get a nap earlier in the day. Science shows us that the ideal nap is generally short, between five to thirty minutes, with a ten-minute short nap having the best immediate benefit. 

The key to napping is keeping it light. You don’t want to allow your body to fall into a deep sleep, so set an alarm to wake up.

#3 – Avoid Caffeine in the Afternoon

Caffeine presents in the brain as a molecule similar in structure to adenosine, a chemical that builds up in the brain when we’re awake and affects how sleepy we feel. When we consume caffeine it blocks the receptors in the brain that normally receive the adenosine molecule, making us feel more alert. Once the caffeine wears off, the adenosine molecule re-attaches to the receptors, putting a sudden break to brain activity and making you feel tired or sluggish. 

Half the caffeine we consume is metabolised in about six hours. If you have a regular flat white at 2 pm, half of the caffeine will still be present in your system at 8 pm. This explains why drinking caffeine in the afternoon can disrupt your ability to fall asleep. 

To optimise your sleep, try to avoid caffeine after 2 pm, and if you would like to cut back on your caffeine intake, do it gradually to avoid withdrawal symptoms such as headaches.

#4 – Reduce Alcohol Intake

Many of us get caught in the alcohol sleep paradox and don’t even realise the effect it is having on our bodies. What is the alcohol sleep paradox you ask? Drinking alcohol is known to help us fall asleep, but what most people don’t realise is that it also contributes to disturbed sleep patterns as it increases our waking throughout the night. 

For the average adult who sleeps for eight hours a night, just four standard drinks can deprive you of ~50 minutes of quality sleep. 

#5 – Exercise Outdoors & Synchronize your Circadian Rhythm to Daylight

We all know that exercise has numerous health benefits. Yet not everyone is aware of the relationship between exercise and sleep. For instance, exercising at night can delay your bedtime as your body needs to lower its core temperature after exercise in order to induce sleep. 

Try fitting your higher intensity workouts in the morning when you first wake and stick to lower intensity workouts like light yoga in the evening to help you optimise your sleep.

#6 – Eat a Healthy Diet

Eating a healthy diet can help you optimise your sleep. Increase your intake of fish and whole foods that contain lots of protein and fibre. Protein and fibre contain an important amino acid called tryptophan which is used to produce melatonin, the human sleep hormone. 

Try to eat your dinner more than three hours before bedtime to give your body enough time to register that it’s full and allow you to metabolise your food properly.

 

Dr Sun Bin is an epidemiologist and public health researcher. Her particular research interests are on sleep and circadian rhythms and how these biological systems are reflected in behaviour, health, and disease.

28/02/2022
Tayla Schuit
In All Articles, Dr Yu Sun Bin, Sleep

Research Review: The Impact of Sleep on Self-Control

sleep and self-control

In this article, our expert Dr. Yu Sun Bin – reviews: Sleep and self-control: A systematic review and meta-analysis by Guarana et al 2021. 

 

1) What was the high-level summary of the research?

The quality and duration of our sleep affects our levels of self-control i.e., our ability to control our impulses and overcome temptations.

 

2) How was the study undertaken?

This study was a systematic review, which means that the researchers comprehensively searched the scientific literature for studies on sleep and self-control to try and synthesise (bring all of the evidence together to summarise) what we currently know and to identify where more research might be needed. 

The team of researchers then sorted through more than 1600 studies, focusing in on studies that tried to answer the question of whether sleep affects self-control. Specifically, the researchers used meta-analysis which means that they combined the numerical results from the studies to find an overall result. This overall result should be more reliable and more indicative of the true effect of sleep on self-control than the results of individual studies, which can be ‘noisy’ and throw up unusual findings by chance. 

 

3) What did the study find?

The researchers found 56 studies on sleep and self-control.

Researchers tend to think of self-control in two ways: first, as a somewhat stable trait of a person (akin to personality), and second, as something much more fluid, like a state-of-mind which can change from moment to moment (like mood). 

These two ways of thinking about self-control are important when it comes to understanding the results.

When the researchers examined the studies that considered sleep and self-control as stable traits, they found that people who get more sleep tend to have better self-control than people who get less sleep but that this was a weak relationship (correlation r=0.17*).

Similarly, people who have better quality sleep have better self-control than people with poorer quality sleep (r=0.26), this relationship is stronger than the one between sleep duration and self-control, but is still considered a weak to moderate strength relationship. This could be because there are other factors responsible for both better sleep and for self-control (e.g. shared genes); or could be due to reverse causality, that is because people with better self-control are also more organised and conscientious about their sleep habits, leading to better and more sleep on average. This result is less useful for us as individuals because we might not be able to change how much sleep we need personally or our personality.

When the researchers examined the studies that consider sleep and self-control as malleable states, both longer sleep duration and better sleep quality were again related to high levels of self-control (r=0.32, and r=0.35 respectively). This is the more important practical result, because it shows that when we have a good night’s sleep, we have a higher level of self-control the next day, compared to when we have a poor night’s sleep or not enough sleep.

Both of these relationships were stronger than the relationships we see for self-control as a trait, meaning that our self-control changes more in response to how our sleep changes from day-to-day, than differences in levels of self-control between people who naturally need different amounts of sleep. 

It is important to note that the majority of studies relied on research participants to self-report their sleep which might lead to biases in the results. However, the researchers also found that the relationship between sleep and self-control was stronger when sleep was measured objectively, indicating that the results are not due to the way that people report or perceive their own sleep. 

 

4) Is there any other research out there that supports these findings or contradicts it?

The broader scientific literature supports these findings. We know that when people are sleep-deprived, our ability to monitor our own thinking and behaviour is negatively affected. Lack of sleep particularly affects activity in the prefrontal cortex, which is the part of the brain responsible for our ability to be aware of our own thinking and to control conscious actions. Self-control involves being aware of our instincts (e.g. to have more cake) and to actively overcome those instincts (e.g. to tell ourselves we have had enough and to put away the cake for another day). 

The results of this study also show that sleep quality is more important than sleep duration when it comes to self-control. This is supported by research showing that quality of sleep is generally more important than amount of sleep for wellbeing; shorter sleep durations (e.g., 6 hours a night) may not be a bad thing if it is accompanied by good sleep quality. This is because people can have a range of different sleep needs, with 7-9 hours of sleep opportunity recommended for working-aged adults. 

 

5) How much weight should we give this research?

We should give the results of this study a lot of weight, because it systematically combines all the research that has been done so far on how sleep affects self-control. The main potential weakness of the study is that 32 of the 56 studies were correlational studies and these studies only show that sleep and self-control are correlated, not that sleep directly causes changes in self-control. With correlation studies, we cannot rule out the possibility of reverse causality i.e. that self-control causes better sleep. In the remaining 24 studies, researchers actively intervened to change the quality and duration of sleep in the research participants.

 

6) What does this mean for your work/research/industry?

This study opens up some interesting avenues for research. Having self-control is important for many aspects of life, including maintaining our health and for our success at work. It suggests that we should consider improving sleep as a way to improve people’s ability to self-regulate which in turn can enhance health and productivity. For health researchers, it suggests we should incorporate methods to improve sleep in programs that help people quit smoking or lose weight, as this could make them even more effective. 

 

7) What’s the key takeaway for us to take from this research?

The key takeaway is that having good quality sleep (of a sufficient duration) is important for enhancing self-control.

 

8) Will you be doing anything differently because of this research?

Personally, I think the study confirms what we all know from experience – and gives me an extra reason to make sure I get a good night’s sleep every night!

 

*Note: Correlations are used to estimate the strength of a relationship between two variables, specifically the degree to which one variable changes when another variable changes. If a correlation is zero, there is no relationship between two variables. The closer the correlation is to 1 or -1, the stronger the correlation between them. The correlation statistic used here is Pearson’s correlation. Correlations of 0.1 or 0.2 are considered weak, correlations of 0.3 to 0.6 are considered moderate, and correlations above 0.6 are considered strong.

 

Dr Yu Sun Bin is an epidemiologist and public health researcher. Her particular research interests are on sleep and circadian rhythms and how these biological systems are reflected in behaviour, health, and disease.

07/02/2022
Tayla Schuit
In All Articles, Dr Kieron Rooney, Nutrition, Sleep

Research Review: The Effect Of Sleep On Diet

Keiron - Sleep and Diet

In this article, our expert Dr. Kieron Rooney – reviews: Effect of sleep duration on dietary intake, desire to eat, measures of food intake and metabolic hormones: A systematic review of clinical trials, led by  Samira Soltanieh From the Department of clinical nutrition and dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

 

1) What was the high-level summary of the research? 

Individuals that have their sleep disrupted or who report naturally shorter sleep duration are more likely to also eat more. It is difficult to pinpoint exactly what they eat more of, but in general, adults seem to snack on foods with higher fat content and teenagers on higher glycemic index (GI) sweet foods.  

2) What did the study try to measure? 

This study sought out as many studies as possible in which a person’s sleep duration and dietary habits were investigated. They then explored if there was any association between what people ate with how long they slept. 

3) How was the study undertaken? 

This study is referred to as a systematic review. The authors themselves did not implement a study in which they collected data from individuals with disturbed sleep. Instead, they searched for, identified, and synthesised studies that met their inclusion criteria, which had already been conducted by other investigators. 

The authors found over 700 studies and ended up identifying 50 studies that reported both food intake and sleep duration; 43 of these studies were on adults. Once the review authors had found these studies, they looked at the dietary data to see what the individuals in those studies were eating, and, how long they slept for. They also looked for any studies that reported on hunger and/or appetite and any studies that may have measured hormones believed to influence what humans eat.

4) What did the study find? 

The main result the authors focused on here was total energy intake. This was reported in 30 of the 50 studies they found. Most studies – 19 of the 30 – associated short sleep duration with a tendency to overeat. While some studies showed this was a result of eating larger meals other studies reported that it was a result of more snacks being eaten throughout the day. There was no clear indicator of which – larger meals or more snacks – was likely to be common in specific people.

There was also no clear indication as to which macronutrients – fat, protein, or carbohydrate – may have been contributing to the excess energy being consumed. The authors summarised the studies and suggested the extra energy was coming from either fat or protein rather than carbohydrates, yet the results were very much 50/50 on this. A big reason for the lack of clarity here is that the review included studies that induced sleep deprivation from as short as 1 night by keeping people awake with entertainment and keeping lights on all night compared to other studies in which sleep was restricted for over a month to only 6 hours a night.

5) Is there any other research out there that supports these findings or contradicts it? 

Absolutely, a 2017 systematic review was published that looked only at studies in which sleep was partially disturbed with reduced hours in bed. That review contained only 17 studies but they were so similar in design that the authors performed a meta-analysis. This is where the individual study results from each study are mathematically combined for each intervention, rather than simply being summarised such as in the present study. The smaller but more mathematically robust systematic review reported that even just partial sleep reduction of a couple of hours a night resulted in much greater energy intake with no effect on energy expenditure which was then concluded to lead to weight gain.

6) How much weight should we give this research?

This study is interesting and contains nearly three times the number of studies as the 2017 paper. However, the results of these studies are summarised rather than analysed and as such are very much open to interpretation. Despite this, this study provides a great resource for the complete repository of studies investigating the association between our diets and our sleep duration.

7) What does this mean for your work/research/industry? 

For me, I think this is interesting in the context of understanding why some people may find themselves eating more processed snacks than others. The big question that still needs answering is whether or not it is the disrupted sleep that promotes individuals to snack and eat more, or it’s the eating more that then disrupts sleep.

8) What’s the key takeaway for us to take from this research?

If you are looking for simple ways to cut your intake of processed high-energy snacks – get more than 6 hours of sleep a night! 

9) Will you be doing anything differently because of this research? 

Not so much differently – but perhaps I will start taking more sleep history surveys in my diet intervention studies.

 

Dr. Kieron Rooney completed his PhD in the Department of Biochemistry, within the Faculty of Science at the University of Sydney. Kieron’s primary interest focuses on conducting research and using this research to educate others on how what we eat, influences our metabolism. 

28/10/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

End of Lockdown Anxiety

After the seemingly endless days spent on repeat at home, many people are enjoying the end of lockdowns and the beginning of our new ‘COVID-normal’ lives. A lot of us, however, experience a mixture of excitement and anxiety. We welcome the ability to see our friends and family and to go to a café or the movies, but we also worry about the possible consequences of opening up to the new normal.

Now that we are no longer able to stay at home and avoid contact with others, some of us worry about the possibility of getting infected with coronavirus (SARS-COV-2) and getting seriously ill from COVID-19. Psychology research has shown that in general, our level of anxiety is primarily determined by two subjective judgments: the perceived likelihood of something bad happening, and the perceived harmfulness of that outcome. People who are very anxious tend to overestimate either the likelihood or the harmfulness (or both) of what they fear. Therefore, these judgments need to be adjusted to reflect reality, rather than our own subjective (over)estimations. 

We have lived with daily reminders of the possibility of serious illness or death from COVID for nearly two years. Understandably, some of us may be reluctant to risk that possibility and do not welcome the idea of going back to the office or sending children back to school. However, it is now important to reset our mental image about COVID and to remind ourselves that vaccinations greatly reduce the possibility of becoming seriously ill, as well as the possibility of getting infected with the virus. In other words, both the likelihood of a bad outcome (getting infected) and its harmfulness (getting seriously ill as a result of an infection) is now greatly diminished. That reminder should allow the more nervous amongst us to slowly get used to the idea that we need to live with the virus circulating in the population, and that we can adjust to the new normal while taking reasonable precautions to avoid infection. 

Of course, we need to enter our new COVID-normal life at our own pace. While some are happy to jump into socialising again, others might be less keen. Indeed, for those of us on the introverted end of the introversion-extroversion spectrum, the lockdown may have provided a welcome reprieve from the pressures of a busy social life. Introverts may enjoy social functions, but they also need to spend time alone to recharge. Now, as we no longer have the lockdown as an excuse to prioritise our own time and say no to social invitations, we need to learn to set boundaries. It is indeed ok to have fewer social engagements and to enjoy the quieter periods that the lockdown allowed us to have. If you enjoyed your alone time during the lockdown, there is no reason why you should give in to the pressures of social expectations and say yes to all invitations. Take your time. 

Perhaps an important experience for many of us who were able to take time to reflect on our lives during the COVID years was a rethinking of our values and priorities.  You may have found that the time spent with family and children, or the attention given to your own health and well-being during the lockdown was a welcome change from your previous life. Trying to remember those priorities and resisting pressure to jump back into a more frantic, high-pressure life we lived previously may be an important challenge in the coming months.

Whatever the challenge you find yourself facing, it is important to take your time. We are in uncharted territory. Having compassion towards yourself and towards others who are struggling to navigate these unprecedented, uncertain times is the most important attitude we need to carry forward from our two years of living with COVID.

 

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney. 

11/10/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

What is Cognitive Behavioural Therapy?

Have you ever considered the idea that it is not your outside circumstances that determine how you feel? It’s not the traffic in the morning that makes you feel angry, or the person who stands you up on a date that makes you feel unlovable, or the presentation at work that makes you feel anxious.

There’s something else at play, and this is a good thing!

Once we stop focusing on the things that we can’t control, like the traffic or other people’s behaviour, we can begin to look inward at ourselves. This allows us to change what we can control – how we think, how we perceive things, our behaviour and how we respond to difficult situations. Ultimately, this can change how we feel.

So, where do we begin?!

Cognitive Behavioural Therapy (CBT) is a well-known form of therapy that combines cognitive psychology and behavioural psychology. In other words, the science of our thinking and our actions. The best thing is that it’s evidence based, which means that it has been rigorously tested and proven to be effective through scientific evaluation.  CBT has proven to be effective in the treatment of depression, anxiety, relationship problems, sleep difficulties, chronic pain, work related stress and many more conditions. But Cognitive Behavioural Therapy is equally as helpful for alleviating day-to-day stress as it is for combatting enduring psychological distress.

Changing your thoughts can help lead to behavioural changes, and vice-a-versa.

To change your thoughts, you need to look at both the cognitive (how we think) and behavioural (how we react) components of our thoughts. Both components are important in order to effect meaningful, lasting change in a person and help them manage and maintain good mental health.

 

Cognitive component:

1.Be aware of your negative or unhelpful thinking

We have to be aware of our mind, as often our thoughts are automatic and we respond to them without challenging them. Did you know that the average person has between 12,000 and 70,000 thoughts per day? And of those thoughts, most of them are negative and repetitive? Keeping a thought diary is a useful way of becoming more self-aware of your thinking.

2. Examine your thoughts and ask yourself if you’re engaging in a thinking error. Examples of thinking errors include:

    • Black and white thinking: Categorising things into one of two extremes, such as seeing situations as good or bad.
    • Catastrophising: Blowing things out of proportion and thinking the worst-case scenario will occur.
    • Personalising: Attributing negative external events such as a rescheduled meeting or heavy traffic to something about you or something you’ve done, when there is actually no link.
    • Jumping to conclusions: Making a judgement with no supporting information.

3. Look for the evidence and deal with the facts

Once you have acknowledged that your belief is just a thought and not a fact, try and look for evidence of what is actually going on and deal with the facts.

4. Come up with a more rational or helpful thought about the situation 

Use the evidence to come up with a more helpful and less distressing way of perceiving the situation. e.g. If a meeting has been rescheduled it is much more likely to be because of an issue with an unrelated project than it is to be about you personally.

 

Behavioural component:

Now that we have examined the ‘C’ in CBT, let’s look at the ‘B’ or the behavioural component. After all, CBT is action-orientated so we must find ways to practice it effectively.

1.Graded exposure

Identify those behaviours or things that you are doing that are maintaining the problem. If a behaviour is maintaining a problem it means that it is keeping the problem alive, like kindling to a fire. Did you know that avoidance is the greatest maintaining factor for anxiety? For example, the more you avoid social situations because they make you feel uncomfortable, the greater your anxiety around social situations will be. Encourage yourself to slowly engage in situations that you find difficult and make sure you start with easier situations, and build up to the more difficult ones.

2. Behavioural experiments

Create behavioural experiments or exposure tasks to challenge your unhelpful thinking. For example, if you believe that the lift will break down and you’ll be stuck for hours and unable to breathe (so you always take the stairs at work)… take the lift with a colleague and see what actually happens!

3. Activity scheduling

Schedule positive activities to gain a sense of achievement and enjoyment in your week…. from tidying your linen cupboard to texting a friend, it doesn’t need to be complicated.

4. Physiological component

The fight/flight/freeze response is our body’s automatic survival response to a perceived threat. It can include a racing heart, sweating, shaking and dilated pupils. Learning techniques to get your body to relax when there is a perceived threat is important for being able to face difficult situations that you may be avoiding.

 

Related techniques:

In addition to shifting unhelpful thinking and undesirable behaviours, CBT also includes the acquisition of many other skills and techniques to improve how we feel.

  • Relaxation training
  • Mindfulness techniques
  • Goal setting
  • Problem-solving techniques
  • Communication training

Homework

CBT has homework! It’s like going to the gym; you have to learn to condition your mind in a different way. You also need to start behaving differently and setting yourself behavioural tasks each day or week for effectively changing how you feel.

In practice

The most effective way to benefit from CBT is to be guided by a qualified professional, such as a psychologist. There are also many APPs available that apply the techniques of CBT, which can help you with changing your thinking and behaviour. Either way, it is empowering to know that it’s up to you to change how you feel!

23/09/2021
Tayla Schuit
In All Articles, Dr Kieron Rooney, Nutrition

Research Review: Ultra-Processed Food and Mortality

In this article, our expert Dr Kieron Rooney – Associates Professor at The University of Sydney & nationally recognised expert in nutrition research – reviews Ultra-processed food intake and all-cause mortality: DRECE cohort study by Ferreiro et al. 2021, and breaks it down to give us the vital parts we need to know. 

 

1) What was the high-level summary of the research?

The risk of dying increases with the amount of ultra-processed food products in one’s diet.

 

2) What did the study try to measure?

This study monitored the risk of what is referred to as “all-cause mortality” (death from any cause) during the 26 years that spanned 1991 – 2017 in Spain. The authors wanted to see if this risk was influenced by what people ate.

 

3) How was the study undertaken?

The study design described in this paper is called a longitudinal cohort survey. This simply means following the same group of people over a long period of time. Practically speaking, the authors gained access to a diet survey that was completed by 4679 individuals living in Spain in 1991. The survey is what is called a food frequency questionnaire and asked individuals to estimate over the previous 12 months how often they may or may not have eaten over 100 different foods.

Once the authors had this survey data, they classified the food items according to degree of “processing” as described by the NOVA classification.

The NOVA classification allocates foods into 1 of 4 groups depending on the level of processing the food has undergone. Group 1 for example are fruits and vegetables; Group 2 are culinary ingredients such as salts and oils; Group 3 are processed products with 3-4 ingredients while Group 4 are ultra-processed foods with multiple, highly refined ingredients and additives.

The authors then reviewed the National Institute of Statistics in Spain to see how many, if any, of these 4679 participants had died during the 26 years between completing the survey in 1991 and December 31, 2017.

Once they had both the diet and the incidence of death data, they used statistics to see if there was any increased risk of likelihood of dying in the 26-year period with the foods reported being eaten in 1991.

 

4) What did the study find?

The average age of individuals in the study was 30 years, and on average, this group of participants were eating about a quarter of their total daily energy from Group 4 ultra-processed foods products such as sugar sweetened beverages, milkshakes, meat and meat products like sausages and deli meats, dairy products, cakes pastries, sweets and cookies.

Of the 4679 individuals that completed the food frequency questionnaire in 1991, 450 had died by December 31, 2017.

And…. the higher the amount of Group 4 ultra-processed food products in the diet, the higher the risk of being one of those 450 individuals.

The actual risk reported by the study was a 15% increased likelihood of all-cause mortality for every 10% increase in the proportion of energy in the diet from group 4 products.

The authors also made some changes to the diet survey responses to see if the risk of all-cause mortality could be reduced and found that replacing Group 4 ultra-processed foods with Group 1 foods (fruits and veges) resulted in a statistically significant improvement and a reduced risk of all-cause mortality.

 

5) Is there any other research out there that supports these findings or contradicts it?

Absolutely, very similar studies have been completed on population data in France, the USA and Italy. Some of these studies have been completed in larger cohorts with the French study completed in over 100 000 individuals looking at cancer incidence in the first 8 years following diet survey. Each of these cohort studies are singing the same song – the higher the proportion of energy in your diet that comes from Group 4 ultra-processed food products. The higher the risk of health problems and disease.

To date, there are no studies that contradict this outcome.

 

6) How much weight should we give this research?

This study is interesting, and the statistical analysis is strong. Importantly it confirms data coming out of Europe and America that are generally telling us the same thing – the rise of ultra-processed foods is dangerous for our health. However, the sample size is relatively small, and there was only 1 diet survey completed in 1991 and how representative that was of each participant’s diet for the next 26 years is obviously a stretch.

 

7) What does this mean for your work/research/industry?

What this does for me is add strength to the need to continue to unpack the role of ultra-processed foods in the development of disease and empower individuals to make changes towards reducing the consumption of these foods.

 

8) What’s the key takeaway for us to take from this research?

If you can find the motivation and capacity to switch out an ultra-processed food product for its minimally processed equivalent – do it!

 

9) Will you be doing anything differently because of this research?

Not so much differently, but perhaps with more vigour, as it confirms the need for more current prospective studies in which we actively remove these group 4 foods from people’s diets and see if it improves their health as predicted.

 

Dr Kieron Rooney is a biochemist, nutritionist and exercise physiologist from the University of Sydney whose research focuses on how what we eat, influences our metabolism. 

 

06/09/2021
Tayla Schuit
In All Articles, Dr Marianna Szabo, Mental health

What is Mindfulness?

Mindfulness-based programs have become extremely popular in the past decade. They are offered as a solution to a wide range of problems in work and health settings, in schools, and even in prisons. Considering such a huge uptake, it is important to understand what mindfulness is and to appreciate the evidence behind the claims for its usefulness. 

Mindfulness was popularised in Western healthcare by Professor Jon Kabat-Zinn in the 1970s.  A long-time practitioner of yoga and Buddhist meditation, he aimed to create a structured, secular program that would enable his patients to improve their quality of life in spite of living with chronic illnesses and pain. This initiative became the now well-known Mindfulness Based Stress Reduction (MBSR) program. 

Another important program is Mindfulness-Based Cognitive Therapy (MBCT), first offered at Oxford University by Professor Mark Williams and his colleagues in the 1980s to help people remain well after they had experienced a period of clinical depression. These two programs provided the basis for many other mindfulness-based interventions that were developed in the following decades. 

The first research study about mindfulness was published nearly 40 years ago, and a large amount of research has been conducted since then. In people without a diagnosed mental or physical health problem, mindfulness-based interventions have been found to reduce stress, anxiety, depression, distress, and burnout, and to improve quality of life in general.  As clinical treatments, these programs are effective for recurrent depression, some anxiety disorders, chronic pain, addictive behaviours, and child behaviour problems when mindfulness training is given to the parents. But what is mindfulness and how does it improve well-being in the face of life’s difficulties? 

To define what mindfulness is, the following sentence from Jon Kabat Zinn is often quoted: “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally … “ 

In other words, mindfulness is defined as an ability to observe what is happening in each moment, with an attitude of acceptance, curiosity, and kindness. This detached awareness can include our thoughts, feelings, body sensations or behaviours, as well as the outside world.  When we engage in formal mindfulness practices, we aim to develop this ability. We choose a target for our focused awareness, (for example, the breath, the body, or a sound) and keep directing our attention to this target. At the same time, we notice that the mind wants to run off in all sorts of directions. When this happens, we notice the thought that the mind wants to engage with, then let it go and gently redirect our attention to the point of focus. Importantly, however, when quoting Kabat-Zinn’s definition of mindfulness, the second part of the sentence is sometimes ignored. The second part says,   

…  in the service of self-understanding and wisdom.” 

“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally, in the service of self-understanding and wisdom.” (Jon Kabat-Zinn, 2017)

Professor Mark Williams also put this point succinctly: “Mindfulness is an ability to recognise and to let go of the things that stop us from living to our full potential” (Mark Williams, personal communication, International Conference on Mindfulness, Amsterdam, 2018). 

This means that our ability to pay attention whilst practicing mindfulness is not the point. It is only a means to an end. It is important to carry this ability on to everyday life: noticing when our minds are giving us potentially false projections for the future or dragging us down the path of impotent guilt or rage about the past. To be able to notice what the mind is doing and to be able to decide whether it is helpful to believe our thoughts and to act on our impulses is a central skill in mindfulness. 

To be mindful is to be able to observe our thoughts as just thoughts and our emotions as just sensations in the body. We can calmly observe our thoughts, emotions, body sensations and our urges to act, and then decide what to do. In this way, mindfulness allows us to develop a high level of emotion regulation and enables us to act in accordance with our authentic values: to respond with wisdom rather than to react too quickly to life’s vicissitudes.

 

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.