Jayne Jubb

Are you tired?

You may be looking around and thinking, “I get 8 hours of sleep every night, what’s wrong with me?”

Well, first—I am so happy that you’re getting adequate sleep! 7-9 hours of sleep is recommended for adults; if you’ve struggled with sleep, then you know that you can sleep 8 hours and not feel rested. While rest is supposed to be the product of sleep, that isn’t always how it works when we are impaired by stress or mental illness. Also, sleep is most closely linked to physical rest and we often need more than that.

Feeling tired may have nothing to do with not getting enough sleep. There are 7 different kinds of rest that you need: physical, mental, emotional, spiritual, social, sensory, and creative. Each one requires unique activities to help reduce the rest deficit.

Physical Rest

There are both passive and active forms of physical rest.

Sleeping and napping are the two most common forms of passive rest. To maximise the likelihood of getting restful sleep, make sure that you follow a sound sleep protocol (e.g. consistent bedtime, control your bedroom temperature, not drinking caffeine late in the day, wind-down routine so that you’re not working on the computer then diving straight into bed).

Active physical rest includes activities like stretching or yoga, breathing exercises, progressive muscle relaxation, hot baths, and massages.

The type of physical rest you require will depend on where and how much strain you carry in your body. For instance, if you spend a lot of your day sitting, you can have a build-up of tension in your back, shoulders, neck, and hips. It can be helpful to do, for example, Yin Yoga in the evenings to stretch everything out and provide relief.

Watch out for signs that you need physical rest, such as lacking the energy to make it through the day, feeling tired but having difficulty falling asleep, weakened immune system, frequent muscle pain and soreness, reliance on substances to give you energy (e.g. energy drinks, coffee, sugar), and depending on substances to give you more rest (e.g. alcohol or drugs).

Mental Rest

Next up is mental rest—who doesn’t need some of that with all of the stress we have in our lives and with the covid pandemic! Mental fatigue can result from a variety of things including negative self-talk, over-thinking, anxious what-if thinking, being stuck in the past, and judgements.

Signs that you may need mental rest include irritability or decreased frustration tolerance, avoiding activities, feeling like you’re in a mental fog throughout the day, and feeling overwhelmed by daily tasks.

One way to ease the mental load is through use of good time management skills. Remember to take into account not only the amount of time the task takes, but the emotional load of the task as well. There are things that we do that may not take that much time, but we will need time before or after the event due to the strain on our minds or emotions. For example, spending 1 hour folding the washing is different from spending 1 hour caring for an ill family member. The effective time for the family member activity might be
3 hours because you may feel sad afterwards or you might feel anxious beforehand wondering if it will be a good day or a bad day for them.

Another thing you can do to help get mental rest is meditate. Giving yourself little meditation breaks throughout the day is a great way to improve your mental stamina.

Emotional Rest

Where are you spending your emotional energy? Were you anxious while watching the news? Did you have a conflict with a co-worker? Is your teenager being a pain in the bum? Was the recent death of your pet on your mind? Are you finding yourself feeling increasingly inadequate?

Some signs that you may be experiencing an emotional rest deficit include beating ourselves up for small mistakes, excessive worry or anxiety, feelings of self doubt, and over-apologising.

The first step in getting more emotional rest is being mindful of your environment. Emotions are contagious! Are you around people who complain all the time or are judgmental? As best you can, modify these environments by removing unnecessary negativity and coping ahead for when you have to be in stressful situations.

Emotional awareness is key for identifying emotional drains and emotional restorers. You may feel drained by a friend who constantly moans about her problems without even asking how you are. But you might feel restored by a walk in the woods. Just start to become aware of what restores you – and what drains you – so that you can take action to spend as little time as possible with the drainers.

Another thing that is helpful in reducing the amount of (social) comparisons that you do. You probably wouldn’t be surprised that many of us engage in emotionally draining comparisons several times a day. Are you scrolling through social media, comparing your looks, your skills, and your furniture choices to those you see on Facebook and Instagram? Stop it, it’s creating more of a deficit for you.

Spiritual Rest

Spirituality is broad. It can include organised religious practices, but spiritual rest can simply be about connecting with something greater than yourself. It could include prayer or a spiritual practice. But basically anything that gives you a sense of belonging, a sense of purpose and feeling connected to that ‘something bigger’ means you’re on the right track.

Social Rest

A social rest deficit occurs when we fail to differentiate between relationships that restore us and relationships that drain us. It can also occur when we are engaging in too much or too little social interaction.

Signs that you have a social rest deficit include feeling alone, feeling detached, finding it hard to maintain close relationships, isolating from others, or finding that you are attracted to those that mistreat/take advantage of you.

If you’re by nature an introvert and yet you’re involved with people all day then you’ll probably benefit from alone time at the end of your day. Without it you might start to feel shut down or disconnected from others because you’ve not had had enough time to recharge. This may all sound counterintuitive, but that’s why you have to listen to your social needs and not compare yourself to others. Someone who is by nature an extrovert might feel rejuvenated adfter a day’s work by having a busy, social evening. This would leave an introvert downright exhausted ;=)

But do remember that your social circles – be it a club, a group of friends or a team sport – help to deepen relationships and make you feel more connected. People are dynamic and it’s important to embrace all of your social needs. Whatever you’re into, there is a group of people who like the same thing—and that can feed your social rest need too.

Sensory Rest

Sensory rest is about giving your senses a break. People need sensory rest when they overwhelm their senses with constant stimuli.

You want to think in terms of each of your 5 senses. If you live in a big city, it can be brutally loud, assault you with a myriad of smells from delicious to disgusting, cram you in like sardines during a bus ride, and always have something to look at between the people, cars, buildings, and randomness on every corner. Needless to say, sensory overload can occur!

How to cope with this? Unplug. Spend some time away from your ‘devices’ (laptop, computer, iPad, tablet, mobile phone). Read a physical book instead. Turn off the lights with nothing but silence in the background. If you notice you’ve eaten nothing but bread all day, throw in a vegetable. Listen to your senses—give the one(s) that appear agitated a break.

Creative Rest

If you’ve ever felt like you’re just out of good ideas, you’ve experienced being creatively drained. Most people experience it as being uninspired or feeling blocked from your creative juices. And if you’ve been there, you know that pushing through doesn’t always work.

For many, when we hear creative rest we may think, “I’m not creative,” or “I’m not an artist, musician, or actor.” Think about creativity more broadly that that. Creativity doesn’t have to be about drawing or painting! It could be also about cooking, putting together a party, thinking up a gift for the colleague that’s leaving, revamping your bathroom…. Creativity is our ability to be innovative, think outside the box, or be inventive. People require creative rest when they feel stuck, uninspired, and unable to generate new ideas or solutions to problems. The key here is to remove the requirement to produce and get involved with activities that inspire you.

So dear readers: go forth and rest!

“Be present.”

I’m sure that you’re more than familiar with the expression.

This is the mantra of mindfulness meditation and a key to self-awareness and acceptance. In mindfulness exercises, the goal is to perform routine activities with a heightened sense of attention. Take the time to experience your environment with all of your senses—touch, sound, sight, smell and taste.

That’s all well and good – until I have to get 10 kilos of tomatoes chopped for a soup that will be served to a party of waiting (and paying) guests within the next hour. It’s in those moments that mindfulness starts to trip me up. I want the knife in my hand to just darn well chop without having to think about it so much. I want to be present, be mindful (even though my mind is starting to think about all the other tasks I’ll need to do to make sure that the diners are going to get fed on time), I don’t want to chop off my fingers because I’m so hyped-up, adrenaline-filled and distracted that I’m not concentrating….. To hell with the lovely smell of those tomatoes that still have the scent of the vines on them, to hell with the slight burning tingle of the acidic juice as it seeps into a cut on my fingers from a couple of days ago, and I don’t care about the fire engine red colour of these gorgeous plump fruits. I want to be quick. I just need to get the job done.

Sound familiar?

Mindfulness may indeed have psychological benefits. Earlier this year, a synthesis of randomised controlled trials revealed that mindfulness-based interventions had small to moderate benefits for a number of health outcomes, including stress, anxiety and depression. That said, the effects of mindfulness were smaller and less consistent when compared with those of other therapies, and some effects appeared to fade months after the intervention. Taken together, the results suggest that mindfulness-based interventions may be better than nothing for some outcomes but that more research is needed to compare mindfulness with other therapies.

One thing the mindfulness-based interventions had in common is that they all attempted to cultivate focus on the present moment via multiple sessions of meditation practice.

Although mindfulness has its merits, psychological research has also revealed that in some circumstances it’s important to be mindless. That is, as we develop skill in complex tasks, we can perform them with increasing facility until attention seems to be unnecessary. Everyday examples range from riding a bike to chopping tomatoes to brushing your teeth.

Underlying this state of “automaticity” (as cognitive psychologists call it) are mental processes that can be executed without paying attention to them. These processes run off without conscious awareness—a chain reaction of mental events. We don’t perform all tasks automatically, but many can be performed this way once they are well practiced.

To be clear, paying attention is important when learning a new skill. In a 2019 study, measures of cognitive ability that tapped the capacity to focus attention predicted novice pianists’ ability to learn and play “Happy Birthday to You.”

But expertise research has also revealed that paying too much attention to what you’re doing can have damaging effects, particularly when you perform well-practiced skills. In fact, this is one reason why some experts appear to “choke under pressure”: they think too much about the mechanics of the task at hand.

In a classic 2002 study, cognitive scientist Sian Beilock and her colleagues had skilled golfers attempt to sink putts under different experimental conditions. In one scenario, the golfers were simply instructed to pay attention to the swing of their club and say “stop” when they finished their swing. In another condition, they were instructed to listen for a target sound while ignoring other noises and say the word “tone” when they heard the target sound.

Counterintuitively, the skilled golfers performed substantially worse when they focused on their swing than when they paid attention to irrelevant sounds. The effect of paying attention to their swing was so damaging that the golfers actually did better when they were warming up before the experiment began.

More recently (2013), psychologist Yannick Balk and his colleagues had golfers try different interventions designed to lessen the effects of performance pressure. The researchers induced performance pressure by videotaping the participants, telling them that their score sheets would be posted publicly at the clubhouse and incentivising strong performance with coupons to the golf shop.

Without an intervention, the golfers performed significantly worse under pressure. Yet participants who were encouraged to think about something else—specifically, a song they knew by heart—improved when the stakes were high. (It is worth cautioning that these results probably need to be replicated in larger samples and across different contexts).

Nevertheless, the important message from this research is that focusing too carefully on the execution of well-practiced motor sequences can cause mistakes. Of course, we should not resign to go through life on autopilot, missing opportunities to make deeper
connections with ourselves, one another and our environment. But there are situations where we should let ‘mindlessness’ (=automaticity) take over. The next time you ride a bike – or have to chop far too many tomatoes – don’t overthink it…..

REFERENCES:

Simon B. Goldberg et al.

The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials.

Perspectives on Psychological Science. February 2021.

doi: 10.1177/1745691620968771

Alexander P. Burgoyne, Lauren Julius Harris and David Z. Hambrick,

Predicting piano skill acquisition in beginners: The role of general intelligence, music aptitude, and mindset,

Intelligence. 2019, volume 76, 101383,

https://doi.org/10.1016/j.intell.2019.101383

Sian L. Beilock et al.

When paying attention becomes counterproductive: Impact of divided versus skill-focused attention on novice and experienced performance of sensorimotor skills.

Journal of Experimental Psychology: Applied. 2002, 8(1), 6–16.

https://doi.org/10.1037/1076-898X.8.1.6

Yannick A. Balk et al.

Coping Under Pressure: Employing Emotion Regulation Strategies to Enhance Performance Under Pressure

in Journal of Sport and Exercise Psychology. 2013, volume 35(4), 408-418.

https://doi.org/10.1123/jsep.35.4.408

Few hallmarks of old age are clearer than the sight of grey hair. As we grow older, black, brown, blonde or red strands lose their youthful hue. Although this may seem like a permanent change, new research reveals that the greying process can be undone—at least temporarily.

Hints that grey hairs could spontaneously regain colour have existed as isolated case studies within the scientific literature for decades. In one 1972 paper, the dermatologist Stanley Comaish reported an encounter with a 38-year-old man who had what he described as a “most unusual feature.” Although the vast majority of the individual’s hairs were either all black or all white, three strands were light near the ends but dark near the roots. This signaled a reversal in the normal greying process, which begins at the root.

In a study published in June in eLife, a group of researchers provide the most robust evidence of this phenomenon to date in hair from around a dozen people of various ages, ethnicities and sexes. It also aligns patterns of greying and reversal to periods of stress, which implies that this aging-related process is closely associated with our psychological well-being. These findings suggest that there is a window of opportunity during which greying is probably much more reversible than had been thought for a long time.

Around four years ago Martin Picard, a mitochondrial psychobiologist at Columbia University, was pondering the way our cells grow old in a multistep manner in which some of them begin to show signs of aging at much earlier time points than others. This patchwork process, he realised, was clearly visible on our head, where our hairs do not all turn grey at the same time. It seemed to him that our hair makes visible what we know happens at the cellular level. He wondered if there was something that could be learned from that…that maybe the hairs that turn white first were the more vulnerable or the least resilient.

While discussing these ideas with his partner, Picard mentioned something in passing: if one could find a hair that was only partially grey—and then calculate how fast that hair was growing—it might be possible to pinpoint the period in which the hair began aging and thus ask the question of what happened in the individual’s life to trigger this change. He was thinking out loud…but unexpectedly, his wife turned to him and said she had seen such two-coloured hairs on her head. She went to the bathroom, plucked a couple of her own greying hairs—that’s when and how the project started!

Picard and his team began searching for others with two-coloured hairs through local ads, on social media and by word of mouth. Eventually, they were able to find 14 people—men and women ranging from nine to 65 years old with various ethnic backgrounds (although the majority were white). Those individuals provided both single- and two-coloured hair strands from different parts of the body, including the scalp, face and pubic area.

The researchers then developed a technique to digitise and quantify the subtle changes in colour, which they dubbed hair pigmentation patterns, along each strand. These patterns revealed something surprising: In 10 of these participants, who were between age nine and 39, some greying hairs regained colour. The team also found that this occurred not just on the head but in other bodily regions as well. This happens thus not just in one person or on the head but across the whole body. The reversibility only appeared in some hair follicles, so it’s likely that it’s limited to specific periods when changes are still able to occur.

Most people start noticing their first grey hairs in their 30s—although some may find them in their late 20s. This period, when greying has just begun, is probably when the process is most reversible. In those with a full head of grey hair, most of the strands have presumably reached a “point of no return,” but the possibility remains that some hair follicles may still be malleable to change.

What was most remarkable was the fact that they were able to show convincingly that, at the individual hair level, greying is actually reversible. What scientists are learning is that, not just in hair but in a variety of tissues, the biological changes that happen with age are, in many cases, reversible—this is a nice example of that.

The team also investigated the association between hair greying and psychological stress because prior research hinted that such factors may accelerate the hair’s aging process. Anecdotes of such a connection are also visible throughout history: according to legend, the hair of Marie Antoinette, the 18th-century queen of France, turned white overnight just before her execution at the guillotine.

In a small subset of participants, the researchers pinpointed segments in single hairs where colour changes occurred in the pigmentation patterns. Then they calculated the times when the change happened using the known average growth rate of human hair: approximately one centimeter per month. These participants also provided a history of the most stressful events they had experienced over the course of a year.

This analysis revealed that the times when greying or reversal occurred corresponded to periods of significant stress or relaxation. In one individual, a 35-year-old man with auburn hair, five strands of hair underwent greying reversal during the same time span, which coincided with a two-week vacation. Another subject, a 30-year-old woman with black hair, had one strand that contained a white segment that corresponded to two months during which she underwent marital separation and relocation—her highest-stress period in the year.

For now, the next step is to look more carefully at the link between stress and greying. Picard and colleagues are currently putting together a grant to conduct another study that would examine changes in hair and stress levels prospectively—which means tracking participants over a specified period of time rather than asking them to recall life events from the past.

Eventually, Picard says, one could envision hair as a powerful tool to assess the effects of earlier life events on aging—because, much like the rings of a tree, hair provides a kind of physical record of elapsed events. Hair would seem to encode part of our biological history: it grows out of the body, and then it crystallises into a‘hard’, stable structure that holds the memory of our past.

Interesting, right?

REFERENCES:

Stanley Comaish. White Scalp Hairs Turning Black – An Unusual Reversal of the Ageing Process. British Journal of Dermatology, May 1972, Volume 86, Issue 5, Pages 513-514.

Ayelet M. Rosenberg et al. Quantitative mapping of human hair greying and reversal in relation to life stress. eLife2021, 10:e67437

Zhang et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature 2020, volume 577, pages 676–681.

Eva M. J. Peters et al. Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress. PLoS ONE 12(4): e0175904.

Alexander A. Navarini and Stephan Nobbe. Marie Antoinette Syndrome. Archives Dermatology 2009, Volume 145(6), page 656.

In the early days of the pandemic, economist Jeanet Bentzen of the University of Copenhagen examined Google searches for the word “prayer” in 95 countries. She identified that they hit an all-time global high in March 2020, and increases occurred in lockstep with the number of COVID-19 cases identified in each country. In the USA, according to the Pew Research Center, 55 percent of Americans prayed to end the spread of the novel coronavirus in March 2020, and nearly one quarter reported that their faith increased the following month, despite limited access to houses of worship.

These are not just interesting sociological trends—they are clinically significant. Spirituality has historically been dismissed by psychiatrists, but results from a pilot program at McLean Hospital in Massachusetts indicate that attention to it is a critical aspect of mental health care.

In 2017 David Rosmarin and his multidisciplinary team of mental health clinicians, researchers and chaplains created Spiritual Psychotherapy for Inpatient, Residential and Intensive Treatment (SPIRIT), a flexible and spiritually integrated form of cognitive-behavioural therapy. They subsequently trained a cadre of more than 20 doctors, stationed on 10 different clinical units throughout McLean Hospital, to deliver SPIRIT and evaluated the approach. Since 2017, SPIRIT has been delivered to more than 5,000 people. Their results suggest that spiritual psychotherapy is not only feasible but highly desired by patients.

In the past year, American mental health sank to the lowest point in history: Incidence of mental disorders increased by 50 percent, compared with before the pandemic, alcohol and other substance abuse surged, and young adults were more than twice as likely to seriously consider suicide than they were in 2018. Yet the only group to see improvements in mental health during the past year were those who attended religious services at least weekly (virtually or in-person): 46 percent report “excellent” mental health today versus 42 percent one year ago. As former congressional representative Patrick J. Kennedy and journalist Stephen Fried wrote in their book A Common Struggle, the two most underappreciated treatments for mental disorders are “love and faith.”

It’s no wonder that nearly 60 percent of psychiatric patients want to discuss spirituality in the context of their treatment. Yet psychiatrists and doctors rarely provide such an opportunity. Since Sigmund Freud’s characterisation of religion as a “mass-delusion” nearly 100 years ago, mental health professionals and scientists have eschewed the spiritual realm. Current efforts to flatten the COVID-19 mental health curve have been almost entirely secular. The American Psychological Association’s extensive set of consumer resources makes no mention of spirituality. And the Centers for Disease Control and Prevention’s only spiritual recommendation is to “connect with your community- or faith-based organisations.” Of more than 90,000 active projects presently funded by all 27 institutes and centers within the National Institutes of Health, fewer than 20 mention spirituality anywhere in the abstract, and only one project contains this term in its title. Needless to say, a lack of funding for research on spirituality hamstrings clinical innovation and dissemination.

This situation goes beyond separation of church and state. Health care professionals falsely disconnect common spiritual behaviours and experiences from science and clinical practice. As a result, potential spiritual solutions to our mental health crisis are ingnored, even when our well-being is worse than ever before.

Rosmarin’s research has demonstrated that a belief in God-Spirit is associated with significantly better treatment outcomes for acute psychiatric patients. And other laboratories have shown a connection between religious belief and the thickness of the brain’s cortex, which may help protect against depression. Of course, belief in God is not a prescription. But these compelling findings warrant further scientific exploration, and patients in distress should certainly have the option to include spirituality in their treatment.

Countless anecdotes of the value of a belief in God-Spirit were found during the recent year-long clinical trial of SPIRIT that Rosmarin’s research team. More than 90 percent of patients reported experiencing some kind of benefit, regardless of religious affiliation.

The study also revealed key opportunities in patient care, particularly for younger and seemingly secular patients. Psychiatric folklore has long suggested that psychotic, manic and obsessive patients gravitate more toward spirituality, as do older adults. Rosmarin’s findings, however, suggest that patients benefited from SPIRIT irrespective of their diagnosis or age. Apparently, depressed millennials are just as likely to want and benefit from spiritual psychotherapy as geriatric patients.

Their results also suggest that spiritual care is not only for religious individuals. The largest group of patients to voluntarily attend SPIRIT (39 percent of the sample) were individuals with no religious affiliation at all. Apparently many nonreligious people still seek spirituality, especially in times of distress. In fact, such individuals may be most likely to attend spiritual psychotherapy because their spiritual needs are otherwise ignored. In this vein, recent declines in church membership may actually increase the need for spiritual care.

Perhaps most interesting, patients responded better to SPIRIT when it was delivered by religiously unaffiliated clinicians. This surprising finding suggests that secular doctors may be particularly effective in providing spiritual treatment. This is good news because psychiatrists are the least likely of all doctors to be religious!

It remains to be seen whether God-Spirit can solve our mental health crisis. But the potential clinical benefits of spirituality, and patients’ desire for spiritual treatments, provide a reason to believe (and hope) that it can!

REFERENCES:

Jeanet Bentzen. Rising religiosity as a global response to COVID-19 fear.

https://voxeu.org/article/rising-religiosity-global-response-covid-19-fear

PEW Research Center

(1) https://www.pewresearch.org/social-trends/2020/03/30/most-americans-say-coronavirus-outbreak-has-impacted-their-lives/

(2) https://www.pewresearch.org/fact-tank/2020/04/30/few-americans-say-their-house-of-worship-is-open-but-a-quarter-say-their-religious-faith-has-grown-amid-pandemic/

David H. Rosmarin et al. Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment. American Journal of Psychotherapy (2019), volume 72, issue 3, pages 75-83. 

David H. Rosmarin et al. Predictors of Patients’ Responses to Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT). Psychiatr. Serv. (2021) volume 72, issue 5, pages 507-513.

Megan Brenan. Americans’ Mental Health Ratings Sink to New Low.

https://news.gallup.com/poll/327311/americans-mental-health-ratings-sink-new-low.aspx

William Wan

https://www.washingtonpost.com/health/2020/11/23/covid-pandemic-rise-suicides/

Patrick J. Kennedy and Stephen Fried. A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction. 2016. Blue Rider Press.

David H. Rosmarin et al. Interest in spiritually integrated psychotherapy among acute psychiatric patients. J Consult Clin Psychol (2015) volume 83, number 6, pages 1149-53.

American Psychological Association, Help Center.https://www.apa.org/helpcenter

Centers for Disease Control and Prevention. ‘Coping With Stress.’ https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Lindsay Abrams. People Who Believe in God Are More Responsive to Treatment of Depression.

https://www.theatlantic.com/health/archive/2013/04/study-people-who-believe-in-god-are-more-responsive-to-treatment-of-depression/275314/

Lisa Miller et al. Spirituality, religion may protect against major depression by thickening brain cortex (2014).

https://www.sciencedaily.com/releases/2014/01/140116084846.htm

Farr A. Curlin et al. The Relationship Between Psychiatry and Religion Among U.S. Physicians. Psychiatr Serv.(2007). Volume 58, number 9, pages 1193–1198.

As a therapist, I’m especially concerned about one specific type of burnout that I see increasingly happening to those in the caring and healing professions — compassion fatigue.

This can happen when you have experienced so much empathy for and absorbed so much of others’ suffering that you yourself begin to have trauma reactions. This seems (to me) to be getting more prevalent as a result of all the Corona problems. Those reactions can include things like emotional numbing, physical illness, and feelings of hopelessness.Ironically, one of the very traits that make a person good at being a nurse or therapist or just a good friend can become a liability.

Compassion fatigue was first described in emergency department nurses and oncology nurses. Nurses may constantly witness pain, decline, and death, often without being able to save patients no matter how much of themselves they put into their work. Compassion fatigue has also been documented in child protection workers and mental healthcare providers.

Compassion fatigue can even happen to people who don’t work in the helping professions. People who are highly empathic almost can’t help but feel others’ pain.

How can we protect ourselves from compassion fatigue while continuing to care for others? The answer is not to become emotionally numb to others’ suffering, but rather, to build good boundaries, take care of ourselves, and better understand our role.

Let’s have a look at how to protect yourself from compassion fatigue.

1. Know the signs of compassion fatigue

Fatigue—just being tired all the time—is one of the most common things people experiencing compassion fatigue report. That makes sense because pumping stress-related hormones, and often having the fight-or-flight system on high alert, uses up a lot of energy.

Some other signs of compassion fatigue include:

• Trouble sleeping (can’t shut off thoughts, feeling too wound up, easily woken)
• Irritability, impatience, anger, blaming others
• Dreading going to work (or finding yourself often late for work or calling in sick)
• Having a hard time empathising or finding meaning in your life or work
• Having unexplained physical symptoms (such as exacerbated pain, acne flare-ups, gastro-intestinal problems)
• Feeling isolated or wanting to isolate from others
• Feeling helpless, hopeless, or both
• Having trouble making decisions

Having just one or two of these symptoms could be a fluke. But if you’re experiencing a few of these, chances are good that you’re experiencing compassion fatigue.

The first thing to do is to recognise that compassion fatigue is not a weakness. It also doesn’t mean you’re not compassionate anymore. It’s very natural for your body and mind to react this way. But now that you’re aware of what’s happening, it’s not too late to start doing something to help improve – or avoid – it.

2. Hit the reset button and take care of your basic needs

Sometimes we underestimate the importance of the basics—water, food, sunlight, oxygen. And sometimes, we get so overwhelmed with our thoughts and emotions that we neglect these basics. It can almost feel silly to say it, but a powerful reset button for your body and mind can simply be one weekend of:

• Carrying a water bottle everywhere and constantly sipping
• Eating balanced meals and snacks at consistent times (rhythms are important!)
• Spending at least 30 minutes per day outside in the sun. (Bonus points if you’re physically active or spending time with friends!)

3. Beware of destructive coping methods

When we feel emotionally depleted, it can be tempting to reach for quick fixes and shortcuts. This might mean reaching for that third or fourth glass of wine because it feels relaxing in the moment, or compulsively online shopping beyond our budget because we find comfort in “retail therapy,” or saying hurtful things to people we love because it feels like that’s the only way to express our anger. We’ll try anything that gives us a chance to release some tension. The problem is that this release is only a distraction. It won’t tap into what’s really weighing you down.

There’s no need to judge yourself for these impulses; they’re just your brain trying to help you cope with difficult feelings as quickly as possible. But once you’ve noticed what’s going on, be honest with yourself. Take a deep breath and say out loud, “This is not the coping method that will really help me.” Pour the rest of the wine down the drain and move on to the next step.

4. Practice self-compassion

You’ve been giving compassion to your patients or your family or total strangers. But have you been giving any to yourself? Do you forgive yourself for mistakes or cut yourself some slack when you need a break? Do you say to yourself the comforting things that you would say to your best friend? Self-compassion is an important ingredient in loosening up compassion fatigue.

If you haven’t taken care of yourself as well as you have others, it’s not too late. Start by simply sitting quietly with your eyes closed and asking yourself, “What do you feel? How do you feel?” There’s no rush to arrive at an answer—don’t automatically tell yourself that you’re “fine.” Sincerely take the time to walk your attention through your body and ask each body part what it feels. At some point, you’ll arrive at emotions that might have been hiding in your stomach or scrunching up your jaw. When you get there, allow yourself to feel whatever emotions you find, whether pleasant or painful.

Say to yourself, out loud:

• It’s okay to feel like this.
• I’ve been carrying a lot, so it’s natural to feel heavy.
• I’ve been so strong, and I need some relief.

5. Practice radical acceptance

As a caregiver, or even just an emotionally sensitive person, you might be holding onto ideas like:

• “I need to take care of people.”
• “If I don’t care of them, nobody else will.”
• “If only I worked harder, maybe I could have saved them.”

This sense of responsibility we feel for righting wrongs and healing hurts is a double-edged sword. On one hand, it’s the fuel that drives us to be compassionate—to be a therapist, doctor, nurse, or just a very caring person in general. On the other hand, it can give us a disproportionate sense of responsibility, to the point where we think we can, and therefore should, make everything right. The reality is that there are many, many things we can’t control no matter how much we care. Even the best treatment cannot always save a patient, the wisest advice cannot always change someone’s mind.

In moments when we catch ourselves thinking, “If only…” (“If only he would take better care of himself,” “If only the system weren’t so stacked against her,” “If only this child had grown up in a safe home”), we need to practice radical acceptance.

Radical acceptance means recognising that you cannot ultimately control anyone or anything; you can only control your own actions. It challenges you to allow that there will always be pain, injustice, uncertainty, and imperfection in the world. When you put down the weight of perfection and responsibility, you can breathe and be a force for good in a sustainable way.

6. Compartmentalise

There’s a reason we have different rooms in a house for different activities. We humans need contextual cues to help us switch gears between working, playing, relaxing, and all of our important modes of being. We can harness this to redirect from compassion fatigue to balanced living.

In practice, this means that if your job is causing you compassion fatigue, you keep work at work. When you come home, consciously tell yourself, “I’m leaving my patients/clients at work” before walking into your home. Change out of your work clothes right away and immediately do something that takes up your attention (not a mindless chore), ideally something fun.

You may have to get creative to design your own compartmentalisation. If your compassion fatigue is coming from work, some good elements you might include are:

• Maintaining a social life (in as far as that is possible nder the current COVID restrictions) with people other than your coworkers
• Consistently doing hobbies and activities that have nothing to do with work
• Having a ritual to mentally set aside work when you leave, such as having a box on your desk that you symbolically put all work-related thoughts and emotions into
• If you work from home, making sure that you have a separate room for work and leisure

7. Get support from friends (or a therapist)

Social support is as close to a psychological panacea as it gets. This may be especially true for compassion fatigue, a condition that can make us feel lonely and isolated even when we’re surrounded by people.

If you work in a helping profession, you may have access to support groups (inclusing intervision/supervision groups) at work specifically designed to give you a safe space to vent. You’ll be surrounded by others who experience similar emotional rollercoasters, emotional numbing, confusing changes in the way they think about people, or dips in their ability to find meaning in their work. Sometimes, just having these feelings validated can go a long way toward rejuvenating you. Better yet, join a mindfulness class. These have successfully decrease compassion fatigue and increased compassion satisfaction for helping professionals.

If you don’t have support groups, share your feelings with a trusted friend or coworker, someone who will not be judgmental. A therapist, too, can help you to process what you’re going through.

We all deserve to have an empathic ear when we’ve been lending ours, and to be carried when we’ve been carrying others.

REFERENCES:

Stacie Hunsaker et al. Factors That Influence the Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in Emergency Department Nurses. Journal of Nursing Scholarship. 2015. Volume 47, Issue 2, pages 186-194.

David Conrad and Yvonne Kellar-Guenther. Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse & Neglect. Volume 30, Issue 10, October 2006, Pages 1071-1080.

Charles R. Figley. Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology. Volume 58, Issue 11, November 2002,Pages 1433-1441.

Patricia Potter et al. Compassion Fatigue and Burnout: Prevalence Among Oncology Nurses. Clinical Journal of Oncology Nursing. October 2010, 14(5), E56-62.

Martin C. Delaney. Caring for the caregivers: Evaluation of the effect of an eight-week pilot mindful self-compassion (MSC) training program on nurses’ compassion fatigue and resilience. PLOS One. November 21, 2018.https://doi.org/10.1371/journal.pone.0207261

Joana Duarte and José Pinto-Gouveia. Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. International Journal of Nursing Studies. Volume 64, December 2016, Pages 98-107.

It all began with a cough.

Three years ago Tracey, a Scottish woman in her mid-30s, caught a bad chest infection that left her with a persistent cough that refused to subside, even after medication. A few months later strange symptoms started to appear. She noticed numbness spreading through her legs and began to feel that their movement was out of her control. When she walked, she felt like a marionette, with someone else pulling the strings. Over the course of two weeks the odd loss of sensation progressively worsened. Then, one evening at home, Tracey’s legs collapsed beneath her. She lay there, feeling like she couldn’t breathe. Unable to feel anything below her waist, her mother rushed her to the hospital where she then remained for more than half a year.

During her first few weeks in the hospital, Tracey endured a barrage of tests as doctors tried to uncover the cause of her symptoms. It could be a progressive neurodegenerative condition such as motor neuron disease, they thought. Or maybe it was multiple sclerosis, a disease in which the body’s own immune cells attack the nervous system. Bafflingly, however, the brain scans, blood tests, spinal taps and everything else came back normal.

Tracey’s predicament is not uncommon. According to one of the most comprehensive assessments of neurology clinics to date, roughly a third of patients have neurological symptoms that are deemed to be either partially or entirely unexplained. These may include tremour, seizures, blindness, deafness, pain, paralysis and coma and can parallel those of almost any neurological disease. In some patients, such complications can persist for years or even decades; some people require wheelchairs or cannot get out of bed. Although women are more often diagnosed than men, such seemingly inexplicable illness can be found in anyone and across any life span.

Generations of scientists have tried to understand these bizarre conditions, which have historically been given diverse names, such as hysteria, conversion disorder or psychosomatic illness. These labels have, however, long imposed particular explanations for what many researchers now regard as a complex illness at the interface of psychiatry and neurology. Some are still in use today, but the newest name for these conditions, functional neurological disorder(FND), is deliberately neutral, simply denoting a problem in the functioning of the nervous system.

Patients with FND have long struggled to obtain adequate care. They have been accused of feigning or imagining symptoms, painfully but often fruitlessly probed for childhood trauma and dismissed by doctors who did not know how to treat someone who, based on all the usual tests, appeared to be healthy. For many, many years physicians have underestimated the prevalence of these disorders and the human toll it takes. These people have really fallen in the gap between the fields of neurology and psychiatry.

Over the past decade or so, however, using techniques such as functional magnetic resonance imaging (fMRI), researchers have begun to understand what happens in the brains of patients with this enigmatic illness. And by applying new models of how the brain works, they are gaining a better understanding of how the condition arises and how it may be treated.

ENIGMATIC ILLNESSES

More than 3,000 years ago Mursili II, king of the Hittites, was caught in a terrifying thunderstorm. The experience left him with a temporary speech impediment that went away—only to return several years later, after the monarch woke from a nightmare about the incident. His subjects attributed their king’s curious ailment to the wrath of the Storm God, one of the most important deities of the ancient civilization. When modern-day scholars revisited the documents detailing the event, they interpreted it as functional aphonia (the inability to speak).

Like the Hittites, people throughout history have turned to the supernatural—gods, witchcraft and demonic possession—to explain illnesses that today would likely be diagnosed as FND. According to some historical interpretations, the first scientific attempt to account for them emerged around 400 B.C.E., when Greek physicians, including Hippocrates, coined the term “hysteria” to describe a wide collection of ailments, among them paralysis, headaches, dizziness and pain, in the belief that they were caused by the uterus (hystera, in Greek) wandering about the body.

Hysteria had its heyday in the 19th century, when it moved from the womb to the brain. Among several physicians who studied it was Jean-Martin Charcot, regarded by many as the “father of neurology.” At the Salpêtrière Hospital in Paris, he painstakingly detailed the symptoms of patients with hysteria and, after they died, conducted autopsies on their brains. Although Charcot was unable to identify any structural aberrations in those subjects, he was convinced that the impairments he saw were associated with unobservable, fluctuating changes in the brain, which he called “dynamic or functional lesions.”

Charcot also discovered that, contrary to common belief, male hysteria was not rare; instead it often went undetected. He highlighted, for example, cases of hysteria among workers at a national railway company that had seemingly emerged after minor physical injuries. His work popularised the study of hysteria, inspiring several researchers, including Joseph Babinski, Pierre Janet and Sigmund Freud, to investigate it as well.

Unlike Charcot, however, these men viewed the condition as a disorder of the mind rather than the brain. Freud proposed that it arose when repressed trauma from childhood abuse or other disturbing events was transformed into physical symptoms; accordingly, he called it conversion disorder. That view and label cemented the displacement of the disorder from the realm of neurology to that of psychiatry and became the dogma for much of the 20th century. Perhaps coincidentally, as Freud’s influence in psychiatry faded over the decades, so did cases of conversion disorder—to the point where some viewed it as a bygone ailment of the Victorian era.

A century later a new generation of investigators has turned its attention to this condition. Careful observation of patients indicates that despite the drop in diagnoses in the latter half of the 1900s, these disorders have not disappeared. And new research reveals that the condition encompasses both neurology and psychiatry. In 2013 some physicians, concerned that the term “conversion disorder” was not widely accepted by patients and perhaps incorrectly pointed to psychology as an exclusive driver for the condition, lobbied for a change—causing FND to be included as an alternative name for the ailment in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

TELLTALE SIGNS

Jon Stone of the University of Edinburgh specialises in diagnosing and treating FND. Stone listens carefully as people describe when, where and how their symptoms started. He collects detailed information about their medical and personal histories and conducts a neurological examination. He listens. Then, like a detective, he pieces these details together to make a diagnosis.

In recent years FND has gone from a diagnosis of exclusion—a label doctors reserved for patients whose conditions defied all other explanations—to one made after identifying distinct signs and symptoms. These resemble those of other neurological disorders but possess identifiable differences. One example is Hoover’s sign, in which weakness in a limb is temporarily corrected when the patient’s attention is directed elsewhere. Another is tremour entrainment: when patients with a functional tremour in one arm are asked to start shaking the other at a regular rhythm, the affected hand will start to shake with the same rhythm as the other. This effect does not occur in people with neurodegenerative conditions such as Parkinson’s disease. Clear signs of functional seizures include tightly shut eyes, rapid breathing and shaking that lasts for several minutes—features rarely seen during epileptic attacks.

Such indicators have been known to doctors for decades—Hoover’s sign, for one, was observed by physician Charles Franklin Hoover in the 19th century. In the past, doctors (according to Stone) would hide such signs from patients. But he shows them to patients to help them understand the nature of their condition and notes that doctors are increasingly taking up this practice. Seeing such clues can help to grasp a condition that Stone likes to describe as a “software problem, not a hardware problem” in the brain.

Stone first came across these disorders as a junior doctor in the early 1990s. He found himself fascinated by them; having grown up with a stutter meant that he had experienced being unable to control his own body. And he was disturbed by how those with FND, as he prefers to call the condition, were being treated. The common attitude among medical professionals was that the symptoms were not real—at least not in the same way as those seen in multiple sclerosis or stroke, for example. Many physicians were concerned that they would either fail to identify the true cause of a patient’s illness or be fooled by someone faking their symptoms. As a result, patients with FND did not receive the same level of sympathy, attention or care as those with so-called organic neurological illnesses.

Stone decided to dig deeper. During his doctoral studies at the University of Edinburgh, he met Alan Carson, who was training to become a psychiatrist and shared his interest. In 2002 the pair began to assess the scale of the problem by following the referrals to four neurology centres in Scotland over a period of 15 months. Their examination, which included more than 3,700 patients, revealed that 1,144—close to a third—had neurological symptoms deemed as partially or completely medically unexplained. Of those, only four ended up being diagnosed with another neurological issue 18 months after their initial consultation. This work demonstrated how widespread these disorders were.

Eventually Stone and Carson joined forces with Mark Hallett, a neurologist at the National Institute of Neurological Disorders and Stroke in the U.S., who had also been taking strides to advance the field. In addition to conducting his own research, Hallett had begun mobilising a group of scientists and doctors who could contribute to the study of FND. The community gradually ballooned from several dozens of attendees at a small workshop to a full-blown society for FND, which was founded by Hallett, Carson and Stone and was inaugurated in 2019.

PREDICTIONS GONE AWRY

A year after landing in the hospital because of her FND, Tracey was referred to a psychologist. At first, she did not think she needed to be there—her symptoms had been improving with physiotherapy. After several sessions of psychotherapy, however, she made a shocking discovery: she had blocked the memory of certain key events in her childhood. Among those forgotten experiences were years of physical abuse at the hands of a family friend.

Although she had initially been reluctant to consider the role of psychological factors in her illness, Tracey now says that she thinks they do contribute. Many of those who study FND today would agree—with caveats. Unlike Freud, who focused on the role of repressed trauma, researchers now recognise that myriad factors are associated with this condition. These include predisposing factors, such as adverse experiences during childhood, a previous physical injury or mood and anxiety disorders; triggers such as physical injury or a stressful life event; and maintaining factors, such as a lack of access to proper treatment or a patient’s responses to and beliefs about the condition. The leading framework for thinking about FND, the so-called biopsychosocial model, takes all these factors into account.

As yet, there is no single, widely accepted explanation for how these influences come together to create FND, but some scientists have suggested that the malady involves arguably one of the most fundamental functions of the brain: predictive processing. Championed by neuroscientist Karl Friston of University College London, predictive processing posits that the brain is constantly making and evaluating predictions by comparing the data generated from our sensory organs to internal models built from previous experience. When mismatches occur between inferences and reality, the brain either updates its existing models or sends commands back down to the body to act in ways that align with our expectations. For instance, if you want to walk, but your leg is not moving, the brain will generate a prediction error that can be resolved if you move that leg. In this way, Friston and others propose, predictions underlie everything the brain does, from perception to movement to decision-making.

Neurologist Mark Edwards of St. George’s University Hospital in London and his colleagues have suggested that with FND, this predictive machinery goes awry, so that patients develop abnormal inferences of how their body should feel or function. One of the biggest drivers of this anomaly, according to Edwards, is excessive focus on one’s own body. This heightened attention can be attributed to a variety of factors, including an existing physical illness, mood and anxiety disorders, or childhood abuse. When a person experiences a triggering event—say, an injury to a limb or a panic attack—this heightened attentiveness may drive one’s brain to develop altered predictions about the body. In some cases, a past experience, such as exposure to sickness in the family, might also help shape these expectations.

Consider someone who falls and badly sprains a leg, resulting in a temporary loss of mobility in that limb. In most people, the brain’s predictions about the injured leg’s ability to move would get updated once mobility returns. This person, however, has a tendency toward mild anxiety that amplifies the levels of subconscious attention they pay to their body and has been sensitive to health events since the sudden death of a parent. These predisposing factors magnify the sensations associated with injury; in consequence, the internal model of the immobile leg persists even after the limb regains its function, leading to functional paralysis. (In some ways, this is the opposite of what happens in people who experience phantom limb syndrome. Those people are unable to update the prediction error that occurs when an expected sensation in a missing limb is not met with actual sensory feedback.)

The hypothesis that predictive processing is altered in FND patients has now been tested in a handful of experiments. In a 2014 study, for example, Edwards and his team used a task called force matching, in which a robotic device presses down on a finger and people are asked to match the force with their own hand. Healthy people tend to overestimate the force required by their own hand because the brain’s expectations “cancel out” some of its force (a similar explanation applies to why you cannot tickle yourself). People with FND, on the other hand, were abnormally accurate, indicating that the internal prediction system was functioning differently. Even so, much more evidence is needed to prove that this mechanism provides a correct and sufficient explanation for the condition.

PROBING THE BRAIN

Like Charcot, contemporary investigators of FND have been examining the brains of patients to find changes associated with the condition. Modern scientists, however, no longer have to wait to conduct an autopsy to peer into their subjects’ skulls. Using techniques such as fMRI, researchers have begun to reveal there are indeed differences in the brains of individuals with FND. They are beginning to identify the dynamic lesion that Charcot was looking for all those years ago.

With fMRI, researchers have identified distinct patterns of activity in brain areas such as the temporoparietal junction—associated with a sense of agency—in those with FND, compared with those asked to mimic the same symptoms. These findings help to confirm that unlike conditions such as factitious disorder (a severe form of which is known as Munchausen syndrome), in which patients deliberately act out other illnesses, symptoms in individuals with FND are out of their control.

Another significant discovery from neuroimaging is that people with FND have enhanced connectivity between the motor-control regions and two brain networks involved in emotional processing: the salience network, responsible for detecting and focusing on attention-worthy information, and the limbic network, one of the primary systems controlling emotion. In a 2010 study, for example, Hallett’s group reported heightened linkages between the amygdala, a key region in the limbic system, and the supplementary motor area, which is responsible for preparing to initiate movements. Others, such as David Perez, a neurologist-psychiatrist at Massachusetts General Hospital, have shown hyperconnectivity between motor regions and salience network areas such as the insula and the anterior cingulate. These observations suggest that, at least in a subset of people with FND, the emotional circuitry might be hijacking the motor system.

Perez’s team has also found that some risk factors may map onto these circuits. In a study published this year, his group reported that the magnitude of the coupling of the motor regions with the limbic and salience areas of the brain positively correlated with the degree to which patients experienced physical abuse during childhood. Perez emphasises, however, that this will probably be relevant only to the subset of patients in whom trauma is present: in his study, a significant proportion of patients did not report any childhood physical abuse. Still, he notes that these findings point to how a risk factor such as trauma could alter brain circuits in people who develop FND.

Scientists are also investigating how factors such as stress alter brain circuits in FND. Neurologist Selma Aybek of the University of Bern says that although not all patients have a history of trauma or stress, they may possess differences in their biological stress response. Her group has found that, compared with healthy individuals, FND patients have higher levels of the stress markers cortisol and amylase and report being more stressed after taking part in a stressful task. Building on these findings, her team is using neuroimaging to examine whether there is an association between stress-related regions and agency-related regions in FND patients’ brains.

Thus, a picture of the pathophysiology of FND patients is slowly emerging. But most of this work has been conducted in patients with motor symptoms, which means that sensory symptoms such as altered vision have yet to be explored. Many of these studies also have had small sample sizes, so findings will need to be validated in larger trials. How these neuroimaging findings fit with the predictive-processing model also remains an open question. It is plausible, Perez notes, that many of the areas identified so far may be the circuitry through which the altered predictions arise.

A BRIGHTER FUTURE

In the summer after her second year of teacher’s college in Scotland, a 19-year-old woman named Rachael Troup was rushed to the hospital with what appeared to be a stroke. Brain scans showed that she did not have a stroke, however, and tests for other neurological diseases came back normal. Eventually Troup was diagnosed with FND. But when she started treatment, it was excruciating. Neither her doctors nor her physiotherapists seemed to know much about how to treat her condition, and the exercises they made her do hurt more than they helped.

After a few months Troup decided to stop going to physiotherapy. At the time the entire right side of her body was barely functioning, and she was using a wheelchair for mobility. After being admitted to the hospital several more times for strokelike attacks, however, Troup met Stone’s team and was provided with FND-tailored care. It involved a form of physiotherapy that employs techniques such as distraction to shift the spotlight of attention away from the affected limbs while engaging in exercises to help restore normal control.

For FND patients, shifting focus away from affected limbs is often a crucial part of physiotherapy because, as Edwards’s predictive-processing model suggests, attention is critical to the generation of symptoms. With attention deployed elsewhere, the brain’s abnormal expectations about movement are unable to take hold. Stone and his colleagues are part of an ongoing U.K.-wide, randomised controlled clinical trial testing this type of specialised physiotherapy for functional motor disorders (a subset of FND affecting movement). In addition to retraining movement, the treatment includes educating patients about how such symptoms could arise and the physical and psychological factors that may underlie it.

To expand the tool kit of interventions for FND, researchers are also testing other alternatives. Another large clinical trial with more than 300 patients assessed the efficacy of cognitive-behavioral therapy (CBT)—a type of goal-oriented intervention focused on changing disruptive patterns of thinking or behavior—for functional seizures. The findings, published in June in Lancet Psychiatry, suggest that CBT may not reduce seizure frequency in all patients.

At King’s College London, neuropsychiatrist Tim Nicholson and his team are examining a noninvasive method of exciting the brain known as transcranial magnetic stimulation (TMS) as a potential intervention for FND. His group recently completed a feasibility study, and the results were promising enough to initiate a larger pilot clinical trial. There are competing explanations for why TMS might work. It induces a brief muscle twitch that could kickstart the relearning of movement; stimulating brain areas altered in FND might help restore function, or it may have a placebo effect. LaFaver’s group at Northwestern is examining the use of meditation and mindfulness practice, which, according to LaFaver, patients have anecdotally reported as helpful for maintaining the benefits of treatment.

Psychological treatments such as CBT currently remain among the first-line interventions for people with FND, according to Perez. There is a pressing need for a range of effective treatments, however: the prognosis remains poor. It is still relatively uncommon for FND patients to completely regain function, and relapses occur often. According to a 2014 meta-analysis of 24 studies, on average 40 percent of patients reported similar or worsened symptoms seven years after their initial diagnosis. On top of that, patients still experience high levels of stigma and have trouble accessing treatment.

Fortunately, the situation is changing. As researchers’ interest in FND surged over the past decade, so did the number of FND clinics around the world. Patients are speaking up as well. In 2012, for example, the international charity FND Hope was established with the aim of raising awareness and empowering patients.

Still, debates linger—and are reflected in an ongoing tussle over the name of the illness. In what fraction of patients are psychological factors present, for example? Do symptoms primarily arise through conversion of stressors, or are other explanations also necessary? One meta-analysis found that reports of stressors in FND patients vary between 23 and 86 percent in different studies. W. Curt LaFrance, Jr., a neurologist-psychiatrist at Brown University, says that it takes more time to identify such stressors than some doctors can devote to an individual patient—which may account for this enormous spread. In his clinic and in the scientific literature, he has consistently seen evidence of psychological stressors having converted into physical symptoms, and, accordingly, he supports use of the term “conversion disorder.” Partially reflecting such views, the older name remained when FND was added to the DSM-5, but the need to identify psychological factors for a diagnosis was dropped. That removal also remains contentious.

One thing is clear, however: because the condition lies at the crossroads of neurology and psychiatry, insights from both fields will be necessary to solve the puzzle. This blurring of the line between mental and physical illness is a growing trend. Scientists now understand, for example, that stress—a psychological factor—can predispose people to Alzheimer’s disease and that inflammation—a physical factor—may give rise to depression. In addition, traditional neurological diseases such as epilepsy and stroke are often associated with mood and behavioural disturbances.

Over the past few years Tracey, who started off the article this month, has frequently used a wheelchair because of her FND. But with the help of both physiotherapy and psychotherapy, she has started to recover. Her symptoms are not gone—she still experiences a lack of sensation in her legs, altered vision and pain—and some days are worse than others. She constantly feels like she’s fighting against her body, but she hopes to make a full recovery.

Maybe it’s obvious but the brain doesn’t separate into neurology and psychiatry. Perhaps what we actually need is a new science of brain and mind that really encapsulates that brain health equals mental health and physical health.

REFERENCES:

Jon Stone et al. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain, Volume 132, Issue 10, October 2009, pages 2878–2888.

Mark J. Edwards et al. A Bayesian account of ‘hysteria’. Brain. 2012 Nov; 135 (Pt 11) pages 3495-3512.

Isabel Parées et al. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain, Volume 137, Issue 11, November 2014, Pages 2916–2921.

Valerie Voon et al. The involuntary nature of conversion disorder. Neurology. January 19, 2010, 74 (3).

Susannah Pick et al. Emotional Processing in Functional Neurological Disorder: A Review, Biopsychosocial Model and Research Agenda. Journal of Neurology, Neurosurgery and Psychiatry, Vol. 90; 2019.

Valerie Voon et al. Emotional stimuli and motor conversion disorder. Brain.  2010 May;133(Pt 5), 1526-1536.

Diana Kwon. Decoding a Disorder at the Interface of Mind and Brain. Scientific American. November 1, 2020.

Ibai Diez et al. Early-life trauma endophenotypes and brain circuit–gene expression relationships in functional neurological (conversion) disorder. Molecular Psychiatry. 2020. https://doi.org/10.1038/s41380-020-0665-0

Kalliopi Apazoglou et al. Biological and perceived stress in motor functional neurological disorders. Psychoneuroendocrinology. 2017 Nov, 85, pages 142-150.

Laura H. Goldstein et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. Vol. 7, issue 6, pages 491-505.

Jeannette Gelauff et al. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J. Neurol Neurosurg Psychiatry. 2014 Feb, 85(2), pages 220-226.

Lea Ludwig et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry. Vol. 5, issue 4, pages 307-320.

I have a recurring nightmare in which I end up stuck in some endless conversation at a party or a networking event. I want to make my escape but can’t get out of the head-grip I feel I’m in with the other person.

It seems I’m not alone. Scientists have recently investigated both sides of this coin: the trapper and the trappee. What if both people are thinking exactly the same thing, but are both stuck because they can’t move on when they’re really done?

A study published on 9th March in the Proceedings of the National Academy of Sciences USA reports on what researchers discovered when they climbed into the heads of talkers to gauge their feelings about how long a particular conversation should last. The team found that conversations almost never end when both parties want them to—and that people are a very poor judge of when their partner wishes to call it quits. In some cases, however, people were dissatisfied not because the talk went on for too long but because it was too short.

The research suggests that whatever you think the other person wants, you may well be wrong. The answer seems to be to leave at the first time it seems appropriate, because it’s better to be left wanting more than less.

Most past research about conversations has been conducted by linguists or sociologists. Psychologists who have studied conversations, on the other hand, have mostly used the research as a means of addressing other things, such as how people use words to persuade. A few studies have explored what phrases individuals say at the ends of conversations, but the focus has not been on when people choose to say them. Psychology seems to be waking up to the fact that this is an interesting and fundamental social behaviour.

Researcher Adam Mastroanni and his colleagues undertook two experiments to examine the dynamics of talk. In the first, they quizzed 806 online participants about the duration of their most recent conversation. Most of them had taken place with a significant other, family member or friend. The individuals involved detailed whether there was a point in the conversation at which they wanted it to end and estimated when that was in relation to when the conversation actually ended.

In the second experiment, held in the lab, the researchers split 252 participants into pairs of strangers and instructed them to talk about whatever they liked for anywhere from one to 45 minutes. Afterward the team asked the subjects when they would have liked the conversation to have ended and to guess about their partner’s answer to the same question.

Mastroianni and his colleagues found that only 2 percent of conversations ended at the time both parties desired, and only 30 percent of them finished when one of the pair wanted them to. In about half of the conversations, both people wanted to talk less, but their cutoff point was usually different. Participants in both studies reported, on average, that the desired length of their conversation was about half of its actual length. To the researchers’ surprise, they also found that it is not always the case that people are held hostage by talks: In 10 percent of conversations, both study participants wished their exchange had lasted longer. And in about 31 percent of the interactions between strangers, at least one of the two wanted to continue.

Most people also failed at intuiting their partner’s desires. When participants guessed at when their partner had wanted to stop talking, they were off by about 64 percent of the total conversation length!

That people fail so completely in judging when a conversation partner wishes to wrap things up is quite astounding. Conversations are normally an elegant expression of mutual coordination. And yet it all falls apart at the end because we just can’t figure out when to stop. This puzzle is probably one reason why people like to have talks over coffee, drinks or a meal, because the empty coffee cup or asking for the bill gives us an excuse which is a critical conversation-ending crutch.

Nicholas Epley, a behavioural scientist at the University of Chicago, who was not on the research team, wonders what would happen if most conversations ended exactly when we wanted them to. How many new insights, novel perspectives or interesting facts of life have we missed because we avoided a longer or deeper conversation that we might have had with another person?

While this cannot be determined in the countless exchanges of everyday life, scientists could feasibly design an experiment in which talks either end at precisely the point when a participant first wants to stop or continue for some point beyond. Do those whose conversations end just when they want them to actually end up with better conversations than those that last longer?

The findings also open up many other questions. Are the rules of conversation clearer in other cultures? Which cues, if any, do expert conversationalists pick up on? What about the dynamics of group chats?

The burgeoning science of conversation obviously needs more rigorous research, but it also needs causal experiments to test strategies that might help us navigate the important and pervasive challenges of conversation. It tickles me that we can put rovers on Mars, have amazing scientific breakthroughs and yet we’re just beginning to rigorously understand how we, as people, talk to each other!!

REFERENCES:

Do conversations end when people want them to? Adam M. Mastroianni, Daniel T. Gilbert, Gus Cooney, and Timothy D. Wilson. Proceedings of the National Academy of Sciences USA, March 9, 2021 118 (10) e2011809118; https://doi.org/10.1073/pnas.2011809118

That’s obviously a trick question, since dolphins obviously don’t have hands—but studying whether they have “handedness” has led to identifying a quirk of human perception.

Humans do not act symmetrically. Most of us prefer, and are better at, using one hand rather than the other; balancing on one leg rather than the other; and for those of you who spin (gymnasts, dancers or divers, for example), spinning in one direction rather than the other.

Brains also do not function symmetrically. A version of this idea has long lived in pop psychology, where people are sometimes characterised as being either left-brained (analytical) or right-brained (creative). And although the pop psychology version of this may rest on questionable data, the underlying idea of asymmetrical brain function (what scientists call lateralisation) is well-established. For example, in humans, language is typically processed in the left hemisphere, while spatial information is processed in the right.

Because each side of the brain controls a different side of the body, studying asymmetrical behaviours can provide us with information about asymmetrical brain function. And if we study this in animals, it may give us insights into brain evolution.

Handedness without hands

The type of lateralisation most familiar to people is undoubtedly handedness. This has been studied in animals by looking at things like which hand monkeys use to grab something, which paw dogs use to knock food out of a container, and so on. But what do you do when the animal you’re studying doesn’t have hands (or paws)? How do you study lateralisation in an animal like a dolphin?

It turns out that behavioural asymmetries come in various types, not just limb biases like handedness and footedness, but also sensory asymmetries, in which we do better on different types of tasks depending on which eye (or visual field) we use; and turning biases, where we prefer turning in one direction rather than the other.

Because different types of biases may come from different underlying causes, studying many different behaviour types, across many different animals, can provide us with a fuller understanding of brain lateralisation and its evolution.

A new spin on spinning

This is where it gets tricky. When comparing across animals, we have to take account of the fact that body plans and typical ways of moving may be different. For example, if the animal walks upright (like humans and birds) the long axis of its body is vertical, but if it walks on all fours, the long axis of its body is horizontal. This means that “turning” can involve very different types of movements. For an animal on all fours, turning involves crunching the long axis of its body to one side or the other. For an animal on two legs, turning involves spinning around the long axis of its body, which is kept straight. And for an animal like a dolphin who moves in three-dimensional space, either type of turning is possible.

When scientists set out to study lateralisation in dolphins, they were careful to separate these two different types of turning. But they ran into another problem when researchers kept disagreeing about what counts as a spin “to the right” (or left). After a lot of discussion (and sometimes argument), they realised that they had stumbled upon a weird quirk of human perception. Apparently, humans interpret the direction of spinning in opposite ways depending on the orientation of the animal.

To get a feel for this, try the following: First, stand up and spin “right.” Then lie down face-down on the floor and roll “right.” If you are like most people, in the upright case your right shoulder moved toward your back, while in the horizontal case your right shoulder moved toward your belly. That is, you made the exact opposite rotation. (And in case you’re wondering, no, you can’t get around this by describing spins as clockwise/counterclockwise instead of right/left. You get the same results if you substitute “clockwise” for “right” in the examples above.)

Before this, almost all scientific studies of lateralisation of turning or spinning motions had studied a single species in a single orientation, like a human turning (upright) or a whale breaching (horizontal)—so the issue had never come up. However, this meant that published research studies had in fact been using opposite coding systems for different animals, depending on their orientation. A spinning turn in which the animal’s right side moved towards its front was typically coded as left/ counterclockwise in studies of humans and walking birds, but as right/clockwise in studies of dolphins and whales. But of course, if you want to investigate turning lateralisation across different species, we all need to agree on the direction of a turn. This meant that scientists needed a new coding system.

Remember your school physics lessons?

The system they came up with was actually inspired by the “right-hand rule” of electromagnetism that many of us learned in school physics lessons. According to that rule, if you point your right thumb in the direction in which an electrical current flows through a wire, the curve of your fingers shows you the direction of the magnetic field flowing around that wire. The dolpihn researchers adopted the general outline of this schematic model to create the Right-Fingered Spin (RiFS) versus Left-Fingered Spin (LeFS) coding system. In this system, when a coder’s outstretched thumb is oriented along the animal’s long axis, pointed toward its head, the curled fingers of the relevant hand describe the direction of rotation. This allowed us to quickly and unambiguously code spinning/turning behaviours no matter the animal’s orientation or direction of movement.

So, what did the dolphin researchers find?

Some previous scientific papers had claimed that dolphins show strong rightward behavioural asymmetries, similar to human right-handedness, and therefore had a left-brain-hemisphere specialisation for action. But since “right” didn’t always mean the same thing in the earlier coding systems, it wasn’t clear if this claim was really true. To test it, different types of behavioural asymmetries were examned in a group of 26 dolphins, such as “Which direction do they swim around a lagoon?,” “Which side of their body do they touch things with?” and “Which direction do they spin if they dive up and to the side?” By making sure to separate out the different types of motion, and using the unambiguous RiFS/LeFS coding system, the researchers found that—contrary to previous claims—dolphins do not have a general rightward asymmetry after all.

People often think that scientific progress happens when we learn something new that we didn’t know before. But another kind of scientific progress happens when we realise that there is a problem with the way we’ve been looking at things all along. In those cases, figuring out a different way of looking can lead to seeing things more clearly. And as science fiction writer Isaac Asimov once pointed out, “The most exciting phrase to hear in science, the one that heralds new discoveries, is not “Eureka!’ but ‘That’s funny…’”

REFERENCES:

Jaakkola et al. ‘Do dolphins really have a rightward lateralization for action? The importance of behavior-specific and orientation-neutral coding.’ Behavioral Brain Research, Vol. 401, 5 March 2021, 113083. https://doi.org/10.1016/j.bbr.2020.113083

From forest bathing to belly laughing, cultures from around the world have cultivated well-being and self-care practices in many fascinating ways—and science agrees that they’re effective!

1. Danish “hygge”

I love the cold. I love coming in after a walk feeling like an ice cube and then being welcomed (and defrosted) by my warm kitchen. And I love being able to curl up with a book on long winter nights.

But I know that there are many who definitely don’t share my love of freezing weather.

In 2016, Denmark ranked as the happiest nation in the world in the World Happiness Report. Then, Finland became number one for the next three years, with Norway and Sweden never far behind. Did you ever wonder at the fact that the five happiest countries in the world are almost always cold, Nordic countries. How do they do it?

Of course, there are likely many factors involved. These countries often have less income inequality, greater oil wealth, and breathtaking natural landscapes. But I wondered if there were any specific Nordic secrets to happiness and wellness—even during winter.

The Danish believe in hygge (pronounced “hoo-gah”), which loosely translates to “coziness” and sounds to me a lot like ‘hug’! The word originated from an Old Norwegian word meaning “well-being,” and it captures all that is cozy, warm, and enjoyable. Curling up under a soft blanket while holding a warm mug of cocoa is hygge. Chatting with friends and family around a fire (ohhh I wish that that were possible at the moment….) is hygge. And simply enjoying the glow of a candle is hygge.

This concept of hygge not only gives practical inspiration for how to enjoy life—oversized scarves and hot drinks —but it also offers a philosophy for how to be with one’s environment instead of fighting against it. No wonder the Danes are happy in winter!

2. Japanese forest bathing

On the subject of being with the environment, we’ll ‘travel’ now eastwards to Japan, to take a dip in the woods. Not an actual swim, but rather, an immersion in nature called “shinrin-yoku,” loosely translated to “forest bathing.”

Forest bathing is exactly what it sounds like—being immersed in nature. Importantly, it’s not about going camping, hiking, or doing any hardcore exercise in a forest. In fact, it’s not a goal-oriented activity at all. It’s simply being with nature, with your senses open and your body as your guide.

Health researcher Dr. Qing Li and his colleagues have found that forest bathing enhances the immune system and encourages the expression of anti-cancer proteins. They also found that it decreases depression, fatigue, anxiety, and unsurprisingly, heart rate.

To take a forest bath yourself, you don’t need to seek out special destinations. You can simply find a spot of nature, even if it’s just a group of trees or a garden, and walk through the area slowly and aimlessly. Turn off your mobile phone and simply let the forest in through your five senses.

3. Indian laughter yoga

Who doesn’t enjoy a good belly laugh? But have you ever done it on purpose? The idea of (Indian) laughter yoga is that we don’t have to wait for something funny to happen in order to laugh. Instead, laughter can and should be practiced for its own sake.

Laughter yoga is often practiced in groups, where real playfulness and interaction between people can turn practiced laughs into real guffaws. And there seem to be real health benefits, even if the laughter is “fake.”

A recent meta-analysis found that simulated laughter may be even more effective than spontaneous, humorous laughter for improving mood. So why not give it a try—do a belly laugh like no one is watching. Or better yet, get together (online, probably nowadays) with others and laugh with them!

Whether it’s through the quietness of forest bathing, or the exuberance of laughter yoga, so many wellness practices and philosophies from around the world get back to the basics—feeling connected to our bodies, our minds, and one another. None of the ideas require you to buy a single thing. All of them invite us to be mindful and connected.

REFERENCES:

*World Happiness Report. https://worldhappiness.report

* Li, Q et al. Forest bathing enhances human natural killer activity and expression of anti-cancer proteins. Int J Immunopathol Pharmacol, Apr-Jun 2007; 20(2 Suppl 2): pages 3-8.

* Li, Q et al. Effects of Forest Bathing on Cardiovascular and Metabolic Parameters in Middle-Aged Males. Evid Based Complement Alternat Med. 2016; 2016: 2587381

* Li, Q. Forest Bathing Is Great for Your Health. Here’s How To Do It. https://time.com/5259602/japanese-forest-bathing/

See also Dr Li’s book ‘Forest Bathing: How Trees Can Help You Find Health and Happiness’. Viking (Penguin Publishing Group), 2018.

* van der Wal, N.C and Kok, R.N. Laughter-inducing therapies: Systematic review and meta-analysis. Social Science & Medicine Volume 232, July 2019, Pages 473-488.

Do you get excited and energised by the possibility of learning something new and complex? Do you get turned on by new ideas and imaginative scenarios?

If so, you may have an influx of dopamine in your synapses, but not where we traditionally think of this neurotransmitter flowing.

In general, the potential for growth from disorder has been encoded deeply into our DNA. We didn’t only evolve the capacity to regulate our defensive and destructive impulses, but we also evolved the capacity to make sense of the unknown. Engaging in exploration allows us to integrate novel or unexpected events with existing knowledge and experiences, a process necessary for growth.

Dopamine production is essential for growth. But there are so many misconceptions about the role of dopamine in cognition and behaviour. Dopamine is often labelled the “feel-good molecule,” but this is a gross mischaracterisation of this neurotransmitter. As personality neuroscientist Colin DeYoung notes, dopamine is actually the “neuromodulator of exploration.” Dopamine’s primary role is to make us want things, but not necessarily like things. We get the biggest rush of dopamine coursing through our brains at the possibility of reward, but this rush is no guarantee that we’ll actually like or even enjoy the thing once we get it. Dopamine is a huge energising force in our lives, driving our motivation to explore and facilitating the cognitive and behavioural processes that allow us to extract the most delights from the unknown.

If dopamine is not all about feeling good, then why does the feel-good myth persist in the public imagination? I think it’s because so much research on dopamine has been conducted with regard to its role in motivating exploration toward our more primal “appetitive” rewards, such as chocolate, social attention, social status, sexual partners, gambling or drugs like cocaine.

However, in recent years, other dopamine pathways in the brain have been proposed that are strongly linked to the reward value of information. People who score high in the general tendency toward exploration are not only driven to engage in behavioural forms of exploration, but also tend to get energised through the possibility of discovering new information and extracting meaning and growth from their experiences. These “cognitive needs,” as the humanistic psychologist Abraham Maslow referred to them, are just as important as other human needs for becoming a whole person.

How active is your nerdy dopamine pathway?

If some or all of these statements describe you, dopamine might well be flowing strongly to your prefrontal cortex! Welcome to the club :=)

• I love spending time reflecting on things.
• I am full of ideas.
• I have a vivid imagination.
• I am interested in abstract ideas.
• I am curious about many different things.

So if you don’t understand why everyone else around you is so interested in sex, drugs and money, but yet you get so turned on by stimulating ideas and learning new and interesting things, then now you have a potential answer: You may be highly sensitive to the reward value of information!

REFERENCES:

Colin G. DeYoung. The neuromodulator of exploration: A unifying theory of the role of dopamine in personality. Front. Hum. Neurosci., 14 November 2013 https://doi.org/10.3389/fnhum.2013.00762

Scott B. Kauffman. Transcend: The New Science of Self-Actualization. Tarcher Perigree, April 2020.

For many of us, living in a COVID-19 world feels as if we have been thrown into an alternative reality. We live day and night inside the same walls. If we venture into town we wear masks, and we get anxious if we pass someone who is not. We have trouble discerning faces. It’s like living in a dream.

COVID-19 has altered our dream worlds, too: how much we dream, how many of our dreams we remember and the nature of our dreams themselves. Early this year, when stay-at-home directives were put in place widely, society quite unexpectedly experienced a dream surge: a global increase in the reporting of vivid, bizarre dreams, many of which are concerned with coronavirus and social distancing. Terms such as coronavirus dreams, lockdown dreams and COVID nightmares emerged on social media. By early April, social and mainstream media outlets had begun broadcasting the message: the world is dreaming about COVID-19.

Although widespread changes in dreaming had been reported in the U.S. following extraordinary events such as the 9/11 attacks in 2001 and the 1989 San Francisco earthquake, a surge of this magnitude had never been documented. This upwelling of dreams is the first to occur globally and the first to happen in the era of social media, which makes dreams readily accessible for immediate study. As a dream “event,” the pandemic is unprecedented.

But what kind of phenomenon is this, exactly? Why was it happening with such vigour? To find out, Deirdre Barrett, an assistant professor at Harvard University and editor in chief of the journal Dreaming, initiated a COVID-19 dreams survey online in the week of March 22. Erin and Grace Gravley, San Francisco Bay Area artists, launched IDreamofCovid.com, a site archiving and illustrating pandemic dreams. The Twitter account @CovidDreams began operation. Kelly Bulkeley, a psychologist of religion and director of the Sleep and Dream Database, followed with a YouGov survey of 2,477 American adults. Postdoctoral research fellow Elizaveta Solomonova, at McGill University, along with Rebecca Robillard of the Royal’s Institute of Mental Health Research in Ottawa and others, launched a survey to which 968 people aged 12 and older responded, almost all in North America. Results of these inquiries, not yet published in journals but available in preliminary form online, document the precipitous surge, the striking variety of dreams and many related mental health effects.

Bulkeley’s three-day poll revealed that in March, 29 percent of Americans recalled more dreams than usual. Solomonova and Robillard found that 37 percent of people had pandemic dreams, many marked by themes of insufficiently completing tasks (such as losing control of a vehicle) and being threatened by others. Many online posts reflect these findings.

More recent studies found qualitative changes in dream emotions and concerns about health. Dream reports from Brazilian adults in social isolation had high proportions of words related to anger, sadness, contamination and cleanliness. Text mining of accounts of 810 Finnish dreams showed that most word clusters were laden with anxiousness; 55 percent were about the pandemic directly (lack of regard for social distancing, elderly people in trouble), and these emotions were more prevalent among people who felt increased stress during the day. A study of 100 nurses conscripted to treat COVID-19 patients in Wuhan, China, revealed that 45 percent experienced nightmares—twice the lifetime rate among Chinese psychiatric outpatients and many times higher than that among the 5 percent of the general population who have nightmare disorder.

It seems clear that some basic biological and social dynamics may have played a role in this unprecedented opening of the dreamtime floodgates. At least three factors may have triggered or sustained the dream surge: disrupted sleep schedules augmenting the amount of REM sleep and therefore dreaming; threats of contagion and social distancing taxing dreaming’s capacity to regulate emotions; and social and mainstream media amplifying the public’s reaction to the surge.

MORE REM SLEEP, MORE DREAMS

One obvious explanation for the surge is that sleep patterns changed abruptly when lockdowns took effect. Early publications demonstrate elevated levels of insomnia in the Chinese population, especially among front-line workers. In contrast, stay-at-home orders, which removed long commutes to work, improved sleep for many people. Chinese respondents reported an average increase of 46 minutes in bed and an extra 34 minutes in total sleep time. Some 54 percent of people in Finland said they slept more after lockdown. Overall, from March 13 to 27, time asleep in the U.S. increased almost 20 percent nationwide, and states with the longest commute times, such as Maryland and New Jersey, showed the largest increases.

Longer slumber leads to more dreams; people in sleep laboratories who are allowed to snooze more than 9.5 hours recall more dreams than when sleeping a typical eight hours. Sleeping longer also proportionally increases rapid eye movement (REM) sleep, which is when the most vivid and emotional dreams occur.

Relaxed schedules may also have caused dreaming to occur later than usual in the morning, when REM sleep is more prevalent and intense and, thus, dreams are more bizarre. Increased dreaming during late-morning REM intervals results from the convergence of several processes. Sleep itself cycles through deep and light stages about every 90 minutes, but pressure for REM sleep gradually increases as the need for deep, recuperative sleep is progressively satisfied. Meanwhile a circadian process that is tightly linked to our 24-hour core body temperature rhythm gives an abrupt boost to REM sleep propensity late in the sleep period and stays elevated through the morning.

After the pandemic began, many people did sleep longer and later. In China, average weekly bedtime was delayed by 26 minutes but wake-up time by 72 minutes. These values were 41 and 73 minutes in Italy and 30 and 42 minutes among U.S. university students. And without commutes, many people were freer to linger in bed, remembering their dreams. Some early birds may have turned into night owls, who typically have more REM sleep and more frequent nightmares. And as people eliminated whatever sleep debts they may have accrued over days or even weeks of insufficient rest, they were more likely to wake up at night and remember more dreams.

DREAM FUNCTIONS OVERWHELMED

The subject matter of many COVID-19 dreams directly or metaphorically reflects fears about contagion and the challenges of social distancing. Even in normal times, we dream more about novel experiences. For example, people enrolled in programs to rapidly learn French dream more about French. Replaying fragments of experiences is one example of a functional role that researchers widely ascribe to REM sleep and dreaming: it helps us solve problems. Other roles include consolidating the prior day’s events into longer-lasting memories, fitting those events into an ongoing narrative of our lives and helping us regulate emotions.

Researchers have documented countless cases of dreams assisting in creative achievement. Empirical studies also show that REM sleep aids in problem-solving that requires access to wide-ranging memory associations, which may explain why so many dreams in the 2020 surge involve creative or strange attempts to deal with a COVID-19 problem.

Two other widely claimed dream functions are extinguishing fearful memories and simulating social situations. They are related to emotion regulation and help to explain why pandemic threats and social distancing challenges appear so often in surge dreams. Many dreams reported in the media include fearful reactions to infection, finances and social distancing. Threats may take the form of metaphoric imagery such as tsunamis or aliens; zombies are common. Images of insects, spiders and other small creatures are also widely represented.

One way to understand direct and metaphoric imagery is to consider that dreams express an individual’s core concerns, drawing on memories that are similar in emotional tone but different in subject matter. This contextualisation is clear in post-traumatic nightmares, in which a person’s reaction to a trauma, such as terror during an assault, is depicted as terror in the face of a natural disaster such as a tsunami. The late Ernest Hartmann, a Boston-area dream and nightmare research pioneer who studied dreams after the 9/11 attacks, stipulated that such contextualisation best helps people adapt when it weaves together old and new experiences. Successful integration produces a more stable memory system that is resilient to future traumas.

Metaphoric images can be part of a constructive effort to make sense of disruptive events. A related process is the extinguishing of fear by the creation of new “safety memories.” These possibilities, which I and others have investigated, reflect the fact that memories of fearful events are almost never replayed in their entirety during dreaming. Instead elements of a memory appear piecemeal, as if the original memory has been reduced to basic units. These elements recombine with newer memories and cognitions to create contexts in which metaphors and other unusual juxtapositions of imagery seem incongruous or incompatible with waking life—and, more important, are incompatible with feelings of fear. This creative dreaming produces safety imagery that supersedes and inhibits the original fear memory, helping to assuage distress over time.

This mechanism can break down after severe trauma, however. When this happens, nightmares arise in which the fearful memory is replayed realistically; the creative recombining of memory elements is thwarted. The pandemic’s ultimate impact on a person’s dreams will vary with whether or how severely they are traumatised and how resilient they are.

A second class of theories—also still speculative—may explain social distancing themes, which permeated IDreamofCovid.com reports. Emotions in these dreams range from surprise to discomfort to stress to nightmarish horror. Tweets located by the @CovidDreams account illustrate how incompatible dream scenarios are with social distancing—so incompatible that they often trigger a rare moment of self-awareness and awakening: “We were celebrating something by having a party. And I woke myself up because something wasn’t right because we’re social distancing and not supposed to be having parties.”

These theories focus on dreaming’s social simulation function. The view that dreaming is a neural simulation of reality, analogous to virtual reality, is now widely accepted, and the notion that the simulation of social life is an essential biological function is emerging. In 2000 Anne Germain, now CEO of sleep medicine start-up Noctem proposed that images of characters interacting with the self in dreams could be basic to how dreaming evolved, reflecting attachment relationships essential to the survival of prehistoric groups. The strong interpersonal bonds reiterated during dreaming contribute to stronger group structures that help to organise defenses against predators and cooperation in problem-solving. Such dreams would still have adaptive value today because family and group cohesion remain essential to health and survival. It may be the case that an individual’s concerns about other people are fine-tuned while they are in the simulated presence of those people. Important social relationships and conflicts are portrayed realistically during dreaming.

Other investigators, such as cognitive neuroscientist Antti Revonsuo of the University of Turku in Finland, have since proposed additional social functions for dreaming: facilitating social perception (who is around me?), social mind reading (what are they thinking?) and the practice of social bonding skills. Another theory advanced by psychology professor Mark Blagrove of Swansea University in Wales further postulates that by sharing dreams, people enhance empathy toward others. The range of dream functions is likely to keep expanding as we learn more about the brain circuits underlying social cognition and the roles REM sleep plays in memory for emotional stimuli, human faces and reactions to social exclusion. Because social distancing is, in effect, an experiment in social isolation at a level never before seen—and is likely antagonistic to human evolution—a clash with deep-rooted dream mechanisms should be evident on a massive scale. And because social distancing disrupts normal relationships so profoundly—causing many of us to spend excessive time with some people and no time with others—social simulations in dreams may play a crucial role in helping families, groups, even societies deal with sudden, widespread social adaptation.

THE ECHO CHAMBER OF SOCIAL MEDIA

There is one basic question about pandemic dreams that need to be nailed down: whether the dream surge was amplified by the media. It is quite possible that early posts of a few dreams were circulated widely online, feeding a pandemic-dreams narrative that went viral, influencing people to recall their dreams, notice COVID themes and share them. This narrative may have even induced people to dream more about the pandemic.

Evidence suggests that mainstream media reporting probably did not trigger the surge but may have amplified its scope, at least temporarily. The Bulkeley and Solomonova-Robillard polls corroborated a clear groundswell in dream tweeting during March, before the first media stories about such dreams appeared; indeed, the earliest stories cited various tweet threads as sources of their reporting.

Once stories emerged, additional surges in dream reporting through early April were detected by @CovidDreams and IDreamofCovid.com. The format of most early stories almost guaranteed amplification: they typically described some salient dream themes observed in a survey and provided a link directing readers to participate in the same survey. In addition, 56 percent of articles during the first week of stories featured interviews with the same Harvard dream scientist, which may have influenced readers to dream about the themes repeated by her in various interviews.

The surge began to decline steadily in late April, as did the number of mainstream media articles, suggesting that any echo-chamber effect had run its course. The final nature of the surge remains to be seen. Until COVID-19 vaccines or treatments are distributed and with waves of future infections possible, threats of disease and social distancing are likely to persist. Might the pandemic have produced a lasting increase in humanity’s recall of dreams? Could pandemic concerns become permanently woven into dream content? And if so, will such alterations help or hinder people’s long-term adjustments to our postpandemic futures?

Therapists may need to step in to help certain people. The survey information considered in this article does not delve into nightmares in detail. But some health care workers who saw relentless suffering are now themselves suffering with recurrent nightmares. And some patients who endured the ICU for days or weeks suffered from horrific nightmares during that time, which may in part have been the result of medications and sleep deprivation induced by around-the-clock hospital procedures and interminable monitor noises and alarms. These survivors will need expert help to regain normal sleep. Thankfully, there are specialised techniques that are highly effective.

People who are not traumatised but still a little freaked out about their COVID dreams also have options. New technologies such as targeted memory reactivation are providing individuals with more control over their dream narratives. For example, learning how to practice lucid dreaming—becoming aware that you are now dreaming—aided by targeted memory reactivation or other methods could help transform worrisome pandemic dreams into more pleasant, maybe even useful, dreams. Simply observing and reporting pandemic dreams seems to positively impact mental health, as Natália Mota of the Federal University of Rio Grande do Norte in Natal, Brazil, found in her studies.

Short of therapy, we can give ourselves permission to ease up and to enjoy banking those surplus hours of sleep. Dreams can be vexing, but they are also impressionable, malleable and at times inspirational.

The human brain is hardwired to map our surroundings. This trait is called spatial memory—our ability to remember certain locations and where objects are in relation to one another. New findings published this month in Scientific Reports suggest that one major feature of our spatial recall is efficiently locating high-calorie, energy-rich food. The study’s authors believe human spatial memory ensured that our hunter-gatherer ancestors could prioritise the location of reliable nutrition, giving them an evolutionary leg up.

In the study, researchers at Wageningen University & Research in the Netherlands observed 512 participants follow a fixed path through a room where either eight food samples or eight food-scented cotton pads were placed in different locations. When they arrived at a sample, the participants would taste the food or smell the cotton and rate how much they liked it. Four of the food samples were high-calorie, including brownies and potato chips, and the other four, including cherry tomatoes and apples, were low in calories—’diet foods’, you might call them.

After the taste test, the participants were asked to identify the location of each sample on a map of the room. They were nearly 30 percent more accurate at mapping the high-calorie samples versus the low-calorie ones, regardless of how much they liked those foods or odours. They were also 243 percent more accurate when presented with actual foods, as opposed to the food scents.

The main takeaway message from this study is that human minds seem to be designed for efficiently locating high-calorie foods in our environment. Lead author in this study Rachelle de Vries, feels her team’s findings support the idea that locating valuable caloric resources was an important and regularly occurring problem for early humans weathering the climate shifts of the Pleistocene epoch. Those with a better memory for where and when high-calorie food resources would be available were likely to have a survival—or fitness—advantage. Memory evolved so that we can remember things that aid our survival or reproduction—hence, it’s probably not surprising that we remember fitness-relevant information particularly well. And that includes high caloric content.

We tend to think of primates such as ourselves as having lost the acute sense of smell seen in many other mammals in favour of sharp eyesight. And to a large degree, we humans have developed that way. But the new findings support the notion that our sniffer is not altogether terrible: These results suggest that human minds continue to house a system optimised for ‘energy‐efficient foraging’ within erratic food habitats of the past. And it highlights the often underestimated capabilities of the human sense of smell.

One drawback of our spatial skills, as they relate to sustenance, is our modern taste for junk food. With a life span of not much more than 30—as was the case for humans until relatively recently—chronic diseases such as diabetes were not a concern for our ancestors. If you came across a rich grove of fruit trees, you consumed all the sugar you could to help ensure your survival. Now our taste for sweets and fats contributes to a global obesity epidemic and has us reaching for sugar over broccoli. In a way, our minds (and bodies) may be mismatched to our current food-rich circumstances. It seems that we’re more likely to remember sweet things, which was a real plus for most of our evolutionary history. But this is problematic in today’s world….when we’re still walking around with ‘Stone Age brains’. Whoops.

References

Rachelle de Vries et al.

Human spatial memory implicitly prioritizes high-calorie foods

Scientific Reports, volume 10, article number: 15174 (2020)