You’ve probably heard that the coronavirus pandemic triggered a worldwide mental-health crisis. This narrative took hold almost as quickly as the virus itself. In the spring of 2020, article after article—even an op-ed by one of us—warned of a looming psychological epidemic.
As clinical scientists and research psychologists have pointed out, the coronavirus pandemic has created many conditions that might lead to psychological distress: sudden, widespread disruptions to people’s livelihoods and social connections; millions bereaved; and the most vulnerable subjected to long-lasting hardship. A global collapse in well-being has seemed inevitable.
We joined a mental-health task force, commissioned by The Lancet, in order to quantify the pandemic’s psychological effects. When we reviewed the best available data, we saw that some groups—including people facing financial stress—have experienced substantial, life-changing suffering. However, looking at the global population on the whole, we were surprised not to find the prolonged misery we had expected.
We combed through close to 1,000 studies that examined hundreds of thousands of people from nearly 100 countries. This research measured many variables related to mental health—including anxiety, depression, and deaths by suicide—as well as life satisfaction. We focused on two complementary types of evidence:
Surveys that examined comparable groups of people before and during the pandemic and studies tracking the same individuals over time. Neither type of study is perfect, but when the same conclusions emerged from both sets of evidence, we gained confidence that we were seeing something real.
Early in the pandemic, our team observed in these studies what the media was reporting: Average levels of anxiety and depression—as well as broader psychological distress—climbed dramatically, as did the number of people experiencing clinically significant forms of these conditions.
For example, in both the U.S. and Norway, reports of depression rose three-fold during March and April of 2020 compared with averages collected in previous years. And in a study of more than 50,000 people across the United Kingdom, 27 percent showed clinically significant levels of distress early in the pandemic, compared with 19 percent before the pandemic.
But as spring turned to summer, something remarkable happened: Average levels of depression, anxiety, and distress began to fall. Some data sets even suggested that overall psychological distress returned to near-pre-pandemic levels by early summer 2020. We share what we learned in a paper that is forthcoming in Perspective on Psychological Science.
We kept digging into the data to account for any anomalies. For example, some of the data sets came disproportionately from wealthy countries, so we expanded our geographic lens. We also considered that even if the pandemic didn’t produce intense, long-term distress, it might have undercut people’s overall life satisfaction. So, members from our team examined the largest data set available on that topic, from the Gallup World Poll.
This survey asks people to evaluate their life on a 10-point scale, with 10 being the best possible life and zero being the worst. Representative samples of people from most of the world’s countries answer this question every year, allowing us to compare results from 2020 with preceding years. Looking at the world as a whole, we saw no trace of a decline in life satisfaction: People in 2020 rated their lives at 5.75 on average, identical to the average in previous years.
We also wondered if the surveys weren’t reaching the people who were struggling the most. If you’re barely holding things together, you might not answer calls from a researcher. However, real-time data from official government sources in 21 countries showed no detectable increase in instances of suicide from April to July 2020, relative to previous years; in fact, suicide rates actually declined slightly within some countries, including the U.S. For example, California expected to see 1,429 deaths by suicide during this period, based on data from prior years; instead, 1,280 occurred.
We were surprised by how well many people weathered the pandemic’s psychological challenges. In order to make sense of these patterns, we looked back to a classic psychology finding: People are more resilient than they themselves realize. We imagine that negative life events—losing a job or a romantic partner—will be devastating for months or years. When people actually experience these losses, however, their misery tends to fade far faster than they imagined it would.
The capacity to withstand difficult events also applies to traumas such as living through war or sustaining serious injury. These incidents can produce considerable anguish, and we don’t want to minimize the pain that so many suffer. But study after study demonstrates that a majority of survivors either bounce back quickly or never show a substantial decline in mental health.
Human beings possess what some researchers call a psychological immune system, a host of cognitive abilities that enable us to make the best of even the worst situation. For example, after breaking up with a romantic partner, people may focus on the ex’s annoying habits or relish their newfound free time.
The pandemic has been a test of the global psychological immune system, which appears more robust than we would have guessed. When familiar sources of enjoyment evaporated in the spring of 2020, people got creative. They participated in drive-by birthday parties, mutual-assistance groups, virtual cocktail evenings with old friends, and nightly cheers for health-care workers.
Some people got really good at baking. Many found a way to reweave their social tapestry. Indeed, across multiple large data sets, levels of loneliness showed only a modest increase, with 13.8 percent of adults in the U.S. reporting always or often feeling lonely in April 2020, compared with 11 percent in spring 2018.
But these broad trends and averages shouldn’t erase the real struggles—immense pain, overwhelming loss, financial hardships—that so many people have faced over the past 17 months. For example, that 2.8 percent increase in the number of Americans reporting loneliness last spring represents 7 million people. Like so many aspects of the pandemic, the coronavirus’s mental-health toll was not distributed evenly.
Early on, some segments of the population—including women and parents of young children—exhibited an especially pronounced increase in overall psychological distress. As the pandemic progressed, lasting mental-health challenges disproportionately affected people who were facing financial issues, individuals who got sick with COVID-19, and those who had been struggling with physical and mental-health disorders prior to the pandemic.
The resilience of the population as a whole does not relieve leaders of their responsibility to provide tangible support and access to mental-health services to those people who have endured the most intense distress and who are at the greatest ongoing risk.
But the astonishing resilience that most people have exhibited in the face of the sudden changes brought on by the pandemic holds its own lessons. We learned that people can handle temporary changes to their lifestyle—such as working from home, giving up travel, or even going into isolation—better than some policy makers seemed to assume.
As we look ahead to the world’s next great challenges—including a future pandemic—we need to remember this hard-won lesson: Human beings are not passive victims of change but active stewards of our own well-being. This knowledge should empower us to make the disruptive changes our societies may require, even as we support the individuals and communities that have been hit hardest.
Lara Aknin is a psychology professor at Simon Fraser University and the chair of the Mental Health and Wellbeing Task Force for The Lancet’s COVID-19 Commission. Jamil Zaki is a professor of psychology at Stanford University and the director of the Stanford Social Neuroscience Laboratory. He is the author of The War For Kindness: Building Empathy in a Fractured World. Elizabeth Dunn is a psychology professor at the University of British Columbia and a co-author of Happy Money: The Science of Happier Spending.
The COVID-19 pandemic has impacted the mental health of people around the world. Similar to the past respiratory viral epidemics, such as the SARS-CoV, MERS-CoV, and the influenza epidemics, the COVID-19 pandemic has caused anxiety, depression, and post-traumatic stress disorder symptoms in different population groups, including the healthcare workers, general public, and the patients and quarantined individuals.
The Guidelines on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee of the United Nations recommends that the core principles of mental health support during an emergency are “do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems.”COVID-19 is affecting people’s social connectedness, their trust in people and institutions, their jobs and incomes, as well as imposing a huge toll in terms of anxiety and worry.
After years of starting the day with a tall morning coffee, followed by several glasses of green tea at intervals, and the occasional cappuccino after lunch, I quit caffeine, cold turkey. It was not something that I particularly wanted to do, but I had come to the reluctant conclusion that the story I was writing demanded it. Several of the experts I was interviewing had suggested that I really couldn’t understand the role of caffeine in my life – its invisible yet pervasive power – without getting off it and then, presumably, getting back on.
Roland Griffiths, one of the world’s leading researchers of mood-altering drugs, and the man most responsible for getting the diagnosis of “caffeine withdrawal” included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the bible of psychiatric diagnoses, told me he hadn’t begun to understand his own relationship with caffeine until he stopped using it and conducted a series of self-experiments. He urged me to do the same.
For most of us, to be caffeinated to one degree or another has simply become baseline human consciousness. Something like 90% of humans ingest caffeine regularly, making it the most widely used psychoactive drug in the world, and the only one we routinely give to children (commonly in the form of fizzy drinks). Few of us even think of it as a drug, much less our daily use of it as an addiction. It’s so pervasive that it’s easy to overlook the fact that to be caffeinated is not baseline consciousness but, in fact, an altered state. It just happens to be a state that virtually all of us share, rendering it invisible.
The scientists have spelled out, and I had duly noted, the predictable symptoms of caffeine withdrawal: headache, fatigue, lethargy, difficulty concentrating, decreased motivation, irritability, intense distress, loss of confidence and dysphoria. But beneath that deceptively mild rubric of “difficulty concentrating” hides nothing short of an existential threat to the work of the writer. How can you possibly expect to write anything when you can’t concentrate?
I postponed it as long as I could, but finally the dark day arrived. According to the researchers I’d interviewed, the process of withdrawal had actually begun overnight, while I was sleeping, during the “trough” in the graph of caffeine’s diurnal effects. The day’s first cup of tea or coffee acquires most of its power – its joy! – not so much from its euphoric and stimulating properties than from the fact that it is suppressing the emerging symptoms of withdrawal.
This is part of the insidiousness of caffeine. Its mode of action, or “pharmacodynamics”, mesh so perfectly with the rhythms of the human body that the morning cup of coffee arrives just in time to head off the looming mental distress set in motion by yesterday’s cup of coffee. Daily, caffeine proposes itself as the optimal solution to the problem caffeine creates.
At the coffee shop, instead of my usual “half caff”, I ordered a cup of mint tea. And on this morning, that lovely dispersal of the mental fog that the first hit of caffeine ushers into consciousness never arrived. The fog settled over me and would not budge. It’s not that I felt terrible – I never got a serious headache – but all day long I felt a certain muzziness, as if a veil had descended in the space between me and reality, a kind of filter that absorbed certain wavelengths of light and sound.
I was able to do some work, but distractedly. “I feel like an unsharpened pencil,” I wrote in my notebook. “Things on the periphery intrude, and won’t be ignored. I can’t focus for more than a minute.”
Over the course of the next few days, I began to feel better, the veil lifted, yet I was still not quite myself, and neither, quite, was the world. In this new normal, the world seemed duller to me. I seemed duller, too. Mornings were the worst. I came to see how integral caffeine is to the daily work of knitting ourselves back together after the fraying of consciousness during sleep. That reconsolidation of self took much longer than usual, and never quite felt complete.
Humanity’s acquaintance with caffeine is surprisingly recent. But it is hardly an exaggeration to say that this molecule remade the world. The changes wrought by coffee and tea occurred at a fundamental level – the level of the human mind. Coffee and tea ushered in a shift in the mental weather, sharpening minds that had been fogged by alcohol, freeing people from the natural rhythms of the body and the sun, thus making possible whole new kinds of work and, arguably, new kinds of thought, too.
By the 15th century, coffee was being cultivated in east Africa and traded across the Arabian peninsula. Initially, the new drink was regarded as an aide to concentration and used by Sufis in Yemen to keep them from dozing off during their religious observances. (Tea, too, started out as a little helper for Buddhist monks striving to stay awake through long stretches of meditation.) Within a century, coffeehouses had sprung up in cities across the Arab world. In 1570 there were more than 600 of them in Constantinople alone, and they spread north and west with the Ottoman empire.
The Islamic world at this time was in many respects more advanced than Europe, in science and technology, and in learning. Whether this mental flourishing had anything to do with the prevalence of coffee (and prohibition of alcohol) is difficult to prove, but as the German historian Wolfgang Schivelbusch has argued, the beverage “seemed to be tailor-made for a culture that forbade alcohol consumption and gave birth to modern mathematics”.
In 1629 the first coffeehouses in Europe, styled on Arab and Turkish models, popped up in Venice, and the first such establishment in England was opened in Oxford in 1650 by a Jewish immigrant. They arrived in London shortly thereafter, and proliferated: within a few decades there were thousands of coffeehouses in London; at their peak, one for every 200 Londoners.
To call the English coffeehouse a new kind of public space doesn’t quite do it justice. You paid a penny for the coffee, but the information – in the form of newspapers, books, magazines and conversation – was free. (Coffeehouses were often referred to as “penny universities”.) After visiting London coffeehouses, a French writer named Maximilien Misson wrote, “You have all Manner of News there; You have a good fire, which you may sit by as long as you please: You have a Dish of Coffee; you meet your Friends for the Transaction of Business, and all for a Penny, if you don’t care to spend more.”
London’s coffeehouses were distinguished one from another by the professional or intellectual interests of their patrons, which eventually gave them specific institutional identities. So, for example, merchants and men with interests in shipping gathered at Lloyd’s Coffee House. Here you could learn what ships were arriving and departing, and buy an insurance policy on your cargo. Lloyd’s Coffee House eventually became the insurance brokerage Lloyd’s of London. Learned types and scientists – known then as “natural philosophers” – gathered at the Grecian, which became closely associated with the Royal Society; Isaac Newton and Edmond Halley debated physics and mathematics here, and supposedly once dissected a dolphin on the premises.
The conversation in London’s coffee houses frequently turned to politics, in vigorous exercises of free speech that drew the ire of the government, especially after the monarchy was restored in 1660. Charles II, worried that plots were being hatched in coffeehouses, decided that the places were dangerous fomenters of rebellion that the crown needed to suppress. In 1675 the king moved to close down the coffeehouses, on the grounds that the “false, malicious and scandalous Reports” emanating therefrom were a “Disturbance of the Quiet and Peace of the Realm”. Like so many other compounds that change the qualities of consciousness in individuals, caffeine was regarded as a threat to institutional power, which moved to suppress it, in a foreshadowing of the wars against drugs to come.
But the king’s war against coffee lasted only 11 days. Charles discovered that it was too late to turn back the tide of caffeine. By then the coffeehouse was such a fixture of English culture and daily life – and so many eminent Londoners had become addicted to caffeine – that everyone simply ignored the king’s order and blithely went on drinking coffee. Afraid to test his authority and find it lacking, the king quietly backed down, issuing a second proclamation rolling back the first “out of princely consideration and royal compassion”.
It’s hard to imagine that the sort of political, cultural and intellectual ferment that bubbled up in the coffeehouses of both France and England in the 17th century would ever have developed in a tavern. The kind of magical thinking that alcohol sponsored in the medieval mind began to yield to a new spirit of rationalism and, a bit later, Enlightenment thinking.
French historian Jules Michelet wrote: “Coffee, the sober drink, the mighty nourishment of the brain, which unlike other spirits, heightens purity and lucidity; coffee, which clears the clouds of the imagination and their gloomy weight; which illumines the reality of things suddenly with the flash of truth.”
To see, lucidly, “the reality of things”: this was, in a nutshell, the rationalist project. Coffee became, along with the microscope, telescope and the pen, one of its indispensable tools.
After a few weeks, the mental impairments of withdrawal had subsided, and I could once again think in a straight line, hold an abstraction in my head for more than two minutes, and shut peripheral thoughts out of my field of attention. Yet I continued to feel as though I was mentally just slightly behind the curve, especially when in the company of drinkers of coffee and tea, which, of course, was all the time and everywhere.
Here’s what I was missing: I missed the way caffeine and its rituals used to order my day, especially in the morning. Herbal teas – which are barely, if at all, psychoactive – lack the power of coffee and tea to organize the day into a rhythm of energetic peaks and valleys, as the mental tide of caffeine ebbs and flows. The morning surge is a blessing, obviously, but there is also something comforting in the ebb tide of afternoon, which a cup of tea can gently reverse.
At some point I began to wonder if perhaps it was all in my head, this sense that I had lost a mental step since getting off coffee and tea. So I decided to look at the science, to learn what, if any, cognitive enhancement can actually be attributed to caffeine. I found numerous studies conducted over the years reporting that caffeine improves performance on a range of cognitive measures – of memory, focus, alertness, vigilance, attention and learning.
An experiment done in the 1930s found that chess players on caffeine performed significantly better than players who abstained. In another study, caffeine users completed a variety of mental tasks more quickly, though they made more errors; as one paper put it in its title, people on caffeine are “faster, but not smarter”. In a 2014 experiment, subjects given caffeine immediately after learning new material remembered it better than subjects who received a placebo. Tests of psychomotor abilities also suggest that caffeine gives us an edge: in simulated driving exercises, caffeine improves performance, especially when the subject is tired. It also enhances physical performance on such metrics as time trials, muscle strength and endurance.
True, there is reason to take these findings with a pinch of salt, if only because this kind of research is difficult to do well. The problem is finding a good control group in a society in which virtually everyone is addicted to caffeine. But the consensus seems to be that caffeine does improve mental (and physical) performance to some degree.
Whether caffeine also enhances creativity is a different question, however, and there’s some reason to doubt that it does. Caffeine improves our focus and ability to concentrate, which surely enhances linear and abstract thinking, but creativity works very differently. It may depend on the loss of a certain kind of focus, and the freedom to let the mind off the leash of linear thought.
Cognitive psychologists sometimes talk in terms of two distinct types of consciousness: spotlight consciousness, which illuminates a single focal point of attention, making it very good for reasoning, and lantern consciousness, in which attention is less focused yet illuminates a broader field of attention. Young children tend to exhibit lantern consciousness; so do many people on psychedelics.
This more diffuse form of attention lends itself to mind wandering, free association, and the making of novel connections – all of which can nourish creativity. By comparison, caffeine’s big contribution to human progress has been to intensify spotlight consciousness – the focused, linear, abstract and efficient cognitive processing more closely associated with mental work than play. This, more than anything else, is what made caffeine the perfect drug not only for the age of reason and the Enlightenment, but for the rise of capitalism, too.
The power of caffeine to keep us awake and alert, to stem the natural tide of exhaustion, freed us from the circadian rhythms of our biology and so, along with the advent of artificial light, opened the frontier of night to the possibilities of work.
What coffee did for clerks and intellectuals, tea would soon do for the English working class. Indeed, it was tea from the East Indies – heavily sweetened with sugar from the West Indies – that fuelled the Industrial Revolution. We think of England as a tea culture, but coffee, initially the cheaper beverage by far, dominated at first.
Soon after the British East India Company began trading with China, cheap tea flooded England. A beverage that only the well-to-do could afford to drink in 1700 was by 1800 consumed by virtually everyone, from the society matron to the factory worker.
To supply this demand required an imperialist enterprise of enormous scale and brutality, especially after the British decided it would be more profitable to turn India, its colony, into a tea producer, than to buy tea from the Chinese. This required first stealing the secrets of tea production from the Chinese (a mission accomplished by the renowned Scots botanist and plant explorer Robert Fortune, disguised as a mandarin); seizing land from peasant farmers in Assam (where tea grew wild), and then forcing the farmers into servitude, picking tea leaves from dawn to dusk.
The introduction of tea to the west was all about exploitation – the extraction of surplus value from labor, not only in its production in India, but in its consumption by the British as well. Tea allowed the British working class to endure long shifts, brutal working conditions and more or less constant hunger; the caffeine helped quiet the hunger pangs, and the sugar in it became a crucial source of calories. (From a strictly nutritional standpoint, workers would have been better off sticking with beer.) The caffeine in tea helped create a new kind of worker, one better adapted to the rule of the machine. It is difficult to imagine an Industrial Revolution without it.
So how exactly does coffee, and caffeine more generally, make us more energetic, efficient and faster? How could this little molecule possibly supply the human body energy without calories? Could caffeine be the proverbial free lunch, or do we pay a price for the mental and physical energy – the alertness, focus and stamina – that caffeine gives us?
Alas, there is no free lunch. It turns out that caffeine only appears to give us energy. Caffeine works by blocking the action of adenosine, a molecule that gradually accumulates in the brain over the course of the day, preparing the body to rest. Caffeine molecules interfere with this process, keeping adenosine from doing its job – and keeping us feeling alert. But adenosine levels continue to rise, so that when the caffeine is eventually metabolized, the adenosine floods the body’s receptors and tiredness returns. So the energy that caffeine gives us is borrowed, in effect, and eventually the debt must be paid back.
For as long as people have been drinking coffee and tea, medical authorities have warned about the dangers of caffeine. But until now, caffeine has been cleared of the most serious charges against it. The current scientific consensus is more than reassuring – in fact, the research suggests that coffee and tea, far from being deleterious to our health, may offer some important benefits, as long as they aren’t consumed to excess.
Regular coffee consumption is associated with a decreased risk of several cancers (including breast, prostate, colorectal and endometrial), cardiovascular disease, type 2 diabetes, Parkinson’s disease, dementia and possibly depression and suicide. (Though high doses can produce nervousness and anxiety, and rates of suicide climb among those who drink eight or more cups a day.)
My review of the medical literature on coffee and tea made me wonder if my abstention might be compromising not only my mental function but my physical health, as well. However, that was before I spoke to Matt Walker.
An English neuroscientist on the faculty at University of California, Berkeley, Walker, author of Why We Sleep, is single-minded in his mission: to alert the world to an invisible public-health crisis, which is that we are not getting nearly enough sleep, the sleep we are getting is of poor quality, and a principal culprit in this crime against body and mind is caffeine. Caffeine itself might not be bad for you, but the sleep it’s stealing from you may have a price.
According to Walker, research suggests that insufficient sleep may be a key factor in the development of Alzheimer’s disease, arteriosclerosis, stroke, heart failure, depression, anxiety, suicide and obesity. “The shorter you sleep,” he bluntly concludes, “the shorter your lifespan.”
Walker grew up in England drinking copious amounts of black tea, morning, noon and night. He no longer consumes caffeine, save for the small amounts in his occasional cup of decaf. In fact, none of the sleep researchers or experts on circadian rhythms I interviewed for this story use caffeine.
Walker explained that, for most people, the “quarter life” of caffeine is usually about 12 hours, meaning that 25% of the caffeine in a cup of coffee consumed at noon is still circulating in your brain when you go to bed at midnight. That could well be enough to completely wreck your deep sleep.
I thought of myself as a pretty good sleeper before I met Walker. At lunch he probed me about my sleep habits. I told him I usually get a solid seven hours, fall asleep easily, dream most nights. “How many times a night do you wake up?” he asked. I’m up three or four times a night (usually to pee), but I almost always fall right back to sleep.
He nodded gravely. “That’s really not good, all those interruptions. Sleep quality is just as important as sleep quantity.” The interruptions were undermining the amount of “deep” or “slow wave” sleep I was getting, something above and beyond the REM sleep I had always thought was the measure of a good night’s rest. But it seems that deep sleep is just as important to our health, and the amount we get tends to decline with age.
Caffeine is not the sole cause of our sleep crisis; screens, alcohol (which is as hard on REM sleep as caffeine is on deep sleep), pharmaceuticals, work schedules, noise and light pollution, and anxiety can all play a role in undermining both the duration and quality of our sleep. But here’s what’s uniquely insidious about caffeine: the drug is not only a leading cause of our sleep deprivation; it is also the principal tool we rely on to remedy the problem. Most of the caffeine consumed today is being used to compensate for the lousy sleep that caffeine causes – which means that caffeine is helping to hide from our awareness the very problem that caffeine creates.
The time came to wrap up my experiment in caffeine deprivation. I was eager to see what a body that had been innocent of caffeine for three months would experience when subjected to a couple of shots of espresso. I had thought long and hard about what kind of coffee I would get, and where. I opted for a “special”, my local coffee shop’s term for a double-shot espresso made with less steamed milk than a typical cappuccino; it’s more commonly known as a flat white.
My special was unbelievably good, a ringing reminder of what a poor counterfeit decaf is; here were whole dimensions and depths of flavour that I had completely forgotten about. Everything in my visual field seemed pleasantly italicised, filmic, and I wondered if all these people with their cardboard-sleeve-swaddled cups had any idea what a powerful drug they were sipping. But how could they?
They had long ago become habituated to caffeine, and were now using it for another purpose entirely. Baseline maintenance, that is, plus a welcome little lift. I felt lucky that this more powerful experience was available to me. This – along with the stellar sleeps – was the wonderful dividend of my investment in abstention.
And yet in a few days’ time I would be them, caffeine-tolerant and addicted all over again. I wondered: was there any way to preserve the power of this drug? Could I devise a new relationship with caffeine? Maybe treat it more like a psychedelic – say, something to be taken only on occasion, and with a greater degree of ceremony and intention. Maybe just drink coffee on Saturdays? Just the one.
When I got home I tackled my to-do list with unaccustomed fervour, harnessing the surge of energy – of focus! – coursing through me, and put it to good use. I compulsively cleared and decluttered – on the computer, in my closet, in the garden and the shed. I raked, I weeded, I put things in order, as if I were possessed. Whatever I focused on, I focused on zealously and single-mindedly.
Around noon, my compulsiveness began to subside, and I felt ready for a change of scene. I had yanked a few plants out of the vegetable garden that were not pulling their weight, and decided to go to the garden centre to buy some replacements. It was during the drive that I realised the true reason I was heading to this particular garden centre: it had this Airstream trailer parked out front that served really good espresso.
This article was amended on 8 July 2021 to include mention of the Turkish influence on early European coffeehouses.
Caffeine is a central nervous system (CNS) stimulant of the methylxanthineclass. It is the world’s most widely consumed psychoactive drug. Unlike many other psychoactive substances, it is legal and unregulated in nearly all parts of the world. There are several known mechanisms of action to explain the effects of caffeine. The most prominent is that it reversibly blocks the action of adenosine on its receptors and consequently prevents the onset of drowsiness induced by adenosine. Caffeine also stimulates certain portions of the autonomic nervous system.
Caffeine is a bitter, white crystalline purine, a methylxanthine alkaloid, and is chemically related to the adenine and guaninebases of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). It is found in the seeds, fruits, nuts, or leaves of a number of plants native to Africa, East Asia and South America, and helps to protect them against herbivores and from competition by preventing the germination of nearby seeds, as well as encouraging consumption by select animals such as honey bees. The best-known source of caffeine is the coffee bean, the seed of the Coffea plant.
Caffeine is used in:
Bronchopulmonary dysplasia in premature infants for both prevention and treatment. It may improve weight gain during therapy and reduce the incidence of cerebral palsy as well as reduce language and cognitive delay. On the other hand, subtle long-term side effects are possible.
Some people use caffeine-containing beverages such as coffee or tea to try to treat their asthma. Evidence to support this practice, however, is poor. It appears that caffeine in low doses improves airway function in people with asthma, increasing forced expiratory volume (FEV1) by 5% to 18%, with this effect lasting for up to four hours.
The addition of caffeine (100–130 mg) to commonly prescribed pain relievers such as paracetamol or ibuprofen modestly improves the proportion of people who achieve pain relief
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Physiologic and performance effects
• Amphetamines increase dopamine/norepinephrine release and inhibit their reuptake, leading to central nervous system (CNS) stimulation
• Amphetamines seem to enhance athletic performance in anaerobic conditions 39 40
• Improved reaction time
• Increased muscle strength and delayed muscle fatigue
• Increased acceleration
• Increased alertness and attention to task
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Koot P, Deurenberg P (1995). “Comparison of changes in energy expenditure and body temperatures after caffeine consumption”. Annals of Nutrition & Metabolism. 39 (3): 135–42. doi:10.1159/000177854. PMID7486839.
Warren GL, Park ND, Maresca RD, McKibans KI, Millard-Stafford ML (July 2010). “Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis”. Medicine and Science in Sports and Exercise. 42 (7): 1375–87. doi:10.1249/MSS.0b013e3181cabbd8. PMID20019636.
Doherty M, Smith PM (April 2005). “Effects of caffeine ingestion on rating of perceived exertion during and after exercise: a meta-analysis”. Scandinavian Journal of Medicine & Science in Sports. 15 (2): 69–78. doi:10.1111/j.1600-0838.2005.00445.x. PMID15773860. S2CID19331370.
Southward K, Rutherfurd-Markwick KJ, Ali A (August 2018). “The Effect of Acute Caffeine Ingestion on Endurance Performance: A Systematic Review and Meta-Analysis”. Sports Medicine. 48 (8): 1913–1928. doi:10.1007/s40279-018-0939-8. PMID29876876. S2CID46959658.
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van Dam RM, Hu FB, Willett WC (July 2020). “Coffee, Caffeine, and Health”. The New England Journal of Medicine. 383 (4): 369–378. doi:10.1056/NEJMra1816604. PMID32706535.
It can be scary when someone you love is sick. It can be especially scary if they’re diagnosed with a mental illness. It’s hard to see someone you love in pain and it’s confusing when someone you know well is not acting like themselves. You know how you would take care of them if they had a cold or flu, but what do you do for a mental illness? Like any other health problem, someone with a mental illness needs extra love and support. You may not be able to see the illness, but it doesn’t mean that you’re powerless to help.
How can I help?
Research confirms that support from family and friends is a key part of helping someone who is going through a mental illness. This support provides a network of practical and emotional help. These networks can be made up of parents, children, siblings, spouses or partners, extended families, close friends and others who care about us like neighbours, coworkers, coaches and teachers. Some people have larger networks than others, but most of us have at least a few people who are there for us when we need them.
There are a number of major ways that family and friends can help in someone’s journey of recovery from a mental illness:
Knowing when something is wrong—or right: Getting help early is an important part of treating mental illness. Family and friends are often the first ones to notice that something is wrong. See “How do I know when to help?” on the next page for signs to watch for. Finding a treatment that works is often a process of trial and error, so family members may also be the first to see signs of improvement.
How do I do this?
TIP: Learn more about the signs and symptoms of different mental illnesses. Also learn more about how treatments work so that you know what side effects you may see, when to look for improvements and which ones to look for first. A recent review found that when the family is educated about the illness, the rates of relapse in their loved ones were reduced by half in the first year.
Seeking help: Families and friends can be important advocates to help loved ones get through those hard, early stages of having a mental illness. They can help their loved one find out what treatment is best for them. They can also be key in letting professionals know what’s going on, filling in parts of the picture that the person who’s ill may not be well enough to describe on their own.
How do I do this?
TIP: Offer to make those first appointments with a family doctor to find out what’s wrong or accompany your loved one to the doctor—these steps can be hard if your loved one doesn’t have much energy or experiences problems with concentration. If you do accompany the person, work with them to write down any notes or questions either of you have in advance so that you cover all the major points. If your loved one wants to do it on their own, show them your support and ask them if there’s anything you could do to help.
TIP: You can’t always prevent a mental health crisis from happening. If your loved one needs to go to hospital, try and encourage them to go on their own. If you’re concerned that your loved one is at risk of harm, they may receive treatment under BC’s Mental Health Act. It may be necessary in certain cases, but involuntary treatment can be complicated and traumatic for everyone. To learn more about the Mental Health Act, see the “Coping with Mental Health Crises and Emergencies” info sheet.
Helping with medications, appointments and treatments: If you spend a lot of time around your loved ones, you can help them remember to take their medications. You may also be able to help tell a doctor why medications aren’t being taken as they should be. Similarly, you may be involved in reminding your loved one to do their counselling homework or use their light therapy treatment each morning, or reminding your loved one to make or keep appointments for treatment.
How do I do this?
TIP: If you notice that your loved one is having trouble taking their medication, you can encourage them to talk to their doctor or pharmacist. They can suggest ways to make pill taking easier. If there are other problems with taking medicine, such as side effects, encourage your loved one to write down their concerns and questions and talk to their doctor. If they don’t have a good relationship with their doctor, help them find a new one. If cost is a barrier, learn about BC’s no-charge psychiatric medication coverage called Plan G.
Supporting a healthy lifestyle: Families can also help with day-to-day factors such as finances, problem solving, housing, nutrition, recreation and exercise, and proper sleeping habits.
How do I do this?
TIP: See our Wellness Modules at http://www.heretohelp.bc.ca for practical tips on how to have a healthy lifestyle for both you and your loved one. Case managers and peer support workers at mental health centres in your community may be able to help with life skills training as well as connections to income and housing.
Providing emotional support: You can play an important role in helping someone who’s not feeling well feel less alone and ashamed. They are not to blame for their illness, but they may feel that they are, or may be getting that message from others. You can help encourage hope.
How do I do this?
TIP: Try to be as supportive, understanding and patient as possible. See our “Where do I go from here?” section for resources on how to be a good communicator.
TIP: Taking care of an ill family member or friend can be stressful. Remember that you need emotional support, too. Consider joining a support group for family members of people with mental illness. There, you can connect with other people going through the same things and they can help you work through your own emotions. It’s very important to make sure you are taking care of your own mental health as well.
How do I know when to help?
Some signs that a friend or family member may have a mental illness and could need your help are:
They suddenly no longer have interest in hobbies and other interests they used to love
They seem to feel angry or sad for little or no reason
They don’t seem to enjoy anything anymore
They have told you about or seem to be hearing strange voices or having unsettling thoughts
They seem emotionally numb, like they don’t feel anything anymore
They used to be healthy, but now they’re always saying they feel a bit sick
They eat a lot more or less than they used to
Their sleep patterns have changed
They seem to be anxious or terrified about situations or objects in life that seem normal to you and to others
They’ve been missing more and more time from work or school
They’ve been drinking heavily and/or using drugs to cope
They are talking about taking their life or feeling hopeless
They are avoiding their close friends and family members
“Tom’s recovery has been an exercise in patience, love and understanding. We take one step forward and stumble two steps back; baby steps—small increments of success, tiny improvements of things we would ordinarily take for granted—are things we celebrate. When Tom smiles, cracks a joke or declares that he wants to go for a run, they are positive, encouraging signs: baby steps forward.” —Family member from Family Toolkit
“The most important thing [families] have to do is accept you completely, with all your faults. Families can help by saying ‘You’re okay, we love you, and you’ll get better” —Mariam, 31 in recovery from clinical depression
If you need advice on how to get your loved one the help they need, there are a number of resources available to you.
Other helpful resources are:
BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories on supporting loved ones. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.
Alzheimer Society of BC
Visit www.alzheimerbc.org or call 1-800-936-6033 (toll-free in BC) for information and community resources for individuals and families with dementia.
AnxietyBC
Visit www.anxietybc.com or call 604-525-7566 for information, tools, and community resources on anxiety.
British Columbia Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for information and community resources on schizophrenia and other major mental illnesses and support for families.
Canadian Mental Health Association, BC Division
Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver) for information and community resources on mental health and mental illnesses.
FORCE Society for Kids’ Mental Health
Visit.www.forcesociety.com or call 1-855-887-8004 (toll-free in BC) or 604-878-3400 (in the Lower Mainland) for information and resources that support parents of a young person with mental illness.
Jessie’s Legacy at Family Services of the North Shore
Visit www.familyservices.bc.ca or call 1-888-988-5281 ext. 204 (toll-free in BC) or 604-988-5281 ext. 204 (in Greater Vancouver) for information and resources on body image and prevention of eating disorders.
Kelty Mental Health
Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.
Mood Disorders Association of BC
Visit www.mdabc.net or call 604-873-0103 (in the Lower Mainland) or 1-855-282-7979 (in the rest of BC) for resources and information on mood disorders. You’ll also find more information on support groups around the province.
Resources available in many languages:
*For each service below, if English is not your first language, say the name of your preferred language in English to be connected to an interpreter. More than 100 languages are available.
1-800-SUICIDE
If you are in distress or are worried about someone in distress who may hurt themselves, call 1-800-SUICIDE 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
Lucksted, Alicia (2008). “Benefits and changes for family to family graduates”. American Journal of Community Psychology. 42 (1–2): 154–166. doi:10.1007/s10464-008-9195-7. PMID18597167.
Yildirim, Arzu (March 13, 2013). “The Effect of Family-to-Family Support Programs Provided for Families of Schizophrenic Patients on Information about Illness, Family Burden, and Self-efficacy”. Turkish Journal of Psychiatry. 25 (1): 31–37. doi:10.5080/u7194. PMID24590847.
Roberts, LJ (1999). “Giving and receiving help: interpersonal transactions in mutual-help meetings and psychosocial adjustment of members”. American Journal of Community Psychiatry. 6 (27): 841–868.
“In Our Own Voice Living With Mental Illness NAMI Consumer Program Named In Honor of Nationally-Recognized Idaho Documentary”. Missing or empty |url= (help)
Perlick, D. A.; Nelson, A. H.; Mattias, K; Selzer, J; Kalvin, C; Wilber, C. H.; Huntington, B; Holman, C. S.; Corrigan, P. W. (December 2011). “In Our Own Voice–Family Companion: Reducing Self-Stigma of Family Members of Persons With Serious Mental Illness”. Psychiatric Services. 62 (12): 1456–1462. doi:10.1176/appi.ps.001222011. PMID22193793.
Pittman, JO (Winter 2010). “Evaluating the Effectiveness of a Consumer Delivered Anti-Stigma Program: Replication with Graduate-Level Helping Professionals”. Psychiatric Rehabilitation Journal. 33 (3): 236–238. doi:10.2975/33.3.2010.236.238. PMID20061261.
The first global study of its kind showed 745,000 people died in 2016 from stroke and heart disease due to long hours.The report found that people living in South East Asia and the Western Pacific region were the most affected.
The WHO also said the trend may worsen due to the coronavirus pandemic.
The research found that working 55 hours or more a week was associated with a 35% higher risk of stroke and a 17% higher risk of dying from heart disease, compared with a working week of 35 to 40 hours.
Often, the deaths occurred much later in life, sometimes decades later, than the long hours were worked.Five weeks ago, a post on LinkedIn from 45-year-old Jonathan Frostick gained widespread publicity as he described how he’d had a wake-up call over long working hours.
The regulatory program manager working for HSBC had just sat down on a Sunday afternoon to prepare for the working week ahead when he felt a tightness in his chest, a throbbing in his throat, jawline and arm, and difficulty breathing.
“I got to the bedroom so I could lie down, and got the attention of my wife who phoned 999,” he said.While recovering from his heart-attack, Mr Frostick decided to restructure his approach to work. “I’m not spending all day on Zoom anymore,” he said.
His post struck a chord with hundreds of readers, who shared their experiences of overwork and the impact on their health.Mr Frostick doesn’t blame his employer for the long hours he was putting in, but one respondent said: “Companies continue to push people to their limits without concern for your personal well-being.”
HSBC said everyone at the bank wished Mr Frostick a full and speedy recovery.”We also recognise the importance of personal health and wellbeing and a good work-life balance. Over the last year we have redoubled our efforts on health and wellbeing.
“The response to this topic shows how much this is on people’s minds and we are encouraging everyone to make their health and wellbeing a top priority.”
While the WHO study did not cover the period of the pandemic, WHO officials said the recent jump in remote working and the economic slowdown may have increased the risks associated with long working hours.
“We have some evidence that shows that when countries go into national lockdown, the number of hours worked increase by about 10%,” WHO technical officer Frank Pega said.
The report said working long hours was estimated to be responsible for about a third of all work-related disease, making it the largest occupational disease burden.
The researchers said that there were two ways longer working hours led to poor health outcomes: firstly through direct physiological responses to stress, and secondly because longer hours meant workers were more likely to adopt health-harming behaviours such as tobacco and alcohol use, less sleep and exercise, and an unhealthy diet.
Andrew Falls, 32, a service engineer based in Leeds, says the long hours at his previous employer took a toll on his mental and physical health.”Fifty to 55 hour weeks were the norm. I was also away from home for weeks on end.”
“Stress, depression, anxiety, it was a cauldron of bad feedback loops,” he says. “I was in a constant state of being run down.”After five years he left the job to retrain as a software engineer. The number of people working long hours was increasing before the pandemic struck, according to the WHO, and was around 9% of the total global population.
In the UK, the Office for National Statistics (ONS) found that people working from home during the pandemic were putting in an average of six hours of unpaid overtime a week. People who did not work from home put in an average of 3.6 hours a week overtime, the ONS said.
The WHO suggests that employers should now take this into account when assessing the occupational health risks of their workers. Capping hours would be beneficial for employers as that had been shown to increase productivity, Mr Pega said. “It’s really a smart choice to not increase long working hours in an economic crisis.”
Cohen, Yehudi (1974). Man in Adaptation: the cultural present. Aldine Transaction. pp. 94–95. ISBN0-202-01109-7. In all, the adults of the Dobe camp worked about two and a half days a week. Because the average working day was about six hours long, the fact emerges that !Kung Bushmen of Dobe, despite their harsh environment, devote from twelve to nineteen hours a week to getting food. Even the hardest working individual in the camp, a man named =oma who went out hunting on sixteen of the 28 days, spent a maximum of 32 hours a week in the food quest.
Ginès i Fabrellas, Anna; Luque Parra, Manuel (January 2016). “WORKING TIME AND FLEXIBILITY IN SPAIN”(PDF) (IUSLabor 1/2016): 54–65. Retrieved 30 April 2020.
Sleep deprivation has been linked to hypertension, obesity and diabetes and has long been suspected of having a connection to dementia. Now, a large new study has more clearly established that association by concluding that people who sleep less than six hours a night in midlife have a greater risk of developing late-onset dementia.
That doesn’t mean middle-aged short sleepers should panic, according to experts. Although the study is an important step forward, much about the connection between sleep and dementia remains unknown, they said. Still, it can’t hurt to work on your sleep habits while research continues, and you’ll find some strategies listed below.
In the study, European researchers followed nearly 8,000 people in Britain for 25 years, starting when subjects were 50. They found that those who consistently got six hours of sleep or less per night in their 50s and 60s were about 30 percent more likely to develop dementia later in life, compared to those who logged seven hours of sleep per night. That was independent of “sociodemographic, behavioural, cardiometabolic, and mental health factors,” the study authors wrote. Findings were published in the journal Nature Communications in late April.
“This is just another example of the importance of appropriate sleep for brain health,” said Michael V. Vitiello, a professor of psychiatry and behavioral sciences at the University of Washington at Seattle and member of the SleepFoundation.org medical advisory board, who wasn’t involved in the study. “It’s really important for people to be conscious of making sure that they sleep well. It’s not trivial, and it shouldn’t be the last thing you think about. It shouldn’t be the thing you sacrifice.”
Lack of sleep might increase dementia risk by impairing learning and memory development, said study author Andrew Sommerlad, an old-age psychiatrist at University College London, or it could affect the brain’s ability to clear harmful protein waste products.
Researchers have spent years trying to understand the sleep-dementia connection, a quest that becomes more urgent as the number of people with Alzheimer’s disease balloons. More than 6 million Americans are living with the disease, according to the Alzheimer’s Association, and by 2050, that number is expected to reach nearly 13 million. Yet, it’s a difficult area in which to draw conclusions.
Earlier this year, Charles Czeisler, chief of the sleep and circadian disorders division at Brigham and Women’s Hospital in Boston, co-authored a similar study that found that adults age 65 and older who got five hours or less of sleep per night had double the risk of dementia than those who clocked seven or eight hours per night. Results were published in the journal Aging.
“At this point, it’s too early to say that behavior X leads to Y,” Czeisler said. “But the association certainly reveals the importance of continuing to study the relationship.”
One of the challenges to studying the link between sleep and cognitive decline is that it’s difficult to determine what happens first: Is too little sleep a symptom of the brain changes that often begin decades before cognitive problems appear? Or does it cause those changes? So far, that’s still unclear, said Claire Sexton, director of scientific programs and outreach with the Alzheimer’s Association.
“There’s mounting evidence pointing toward the relationship between sleep and dementia,” she said. “But there are a lot of unanswered questions. There’s no one factor that would guarantee someone will develop dementia, and there’s no one factor that will guarantee someone won’t.”
Vitiello lauded the new study’s lengthy follow-up period and examination of people in their 50s (most similar research focuses on those 65 and older). But he emphasized that the findings estimate increased risk for the entire population, not for any one individual. “These are predictions,” he said. “On average, if you have this kind of disturbed sleep, your odds go up this percentage. It doesn’t mean that just because you’re a 55-year-old sleeping under six hours a night, you’re guaranteed to have an increased Alzheimer’s risk of 30 percent.”
Exactly why someone is a short sleeper — for example, if they have insomnia, hold multiple jobs that require odd hours or naturally need less sleep — likely plays a role in their unique risk, he added. The study didn’t account for those factors.
Study author Séverine Sabia, an epidemiologist at Inserm, the French public-health research center, acknowledged that her team’s findings only indicate an association between short sleep duration and dementia — not causation.
“Dementia is a multifactorial disease, which means that several factors are likely to influence its onset,” she said, including physical inactivity, smoking and social isolation. “Sleep duration is one of them, but even if a person has poor sleep, there are other important prevention measures.”
So, the takeaway for those with subpar snooze times? “No reason to panic,” Sabia said — pointing out that doing so might actually “worsen sleep quality,” but it’s a smart idea to work on getting better, and longer, sleep. Here are some strategies:
Be consistent. It’s best to wake up and go to bed at the same time every day on weekdays and weekends. Most importantly, “maintain your rise time, because that will partially set your going-to-bed time,” Vitiello said. He noted that there’s no need to force yourself into bed early, even if you have a special event the next day: “Biologically, your body is designed to sleep a certain amount, and if you extend your bedtime, it doesn’t guarantee you’re going to fill it with sleep.” You’ll likely toss and turn, wide-awake.
Make changes slowly. Like anything else, it can help to ease into healthy new habits. Jumping straight from, say, four hours of sleep a night to seven will be difficult for many people, Czeisler said. He recommends steadily increasing your sleep schedule by 15 or 20 minutes in the night and/or morning.
Develop a pre-sleep routine. Think of this as a ritual that helps you ease out of the day’s havoc and into a calm, sleep-inducing state. “You don’t want to just go directly from the evening news, and being depressed and anxious about it, to the bedroom,” Vitiello said. Different people will migrate toward different transitions — a book-lover might read, for example, though he recommends avoiding dramatic novels that could interfere with the ability to fall asleep. Others might take a warm bath or meditate.
Optimize your bedroom. Vitiello is based in Seattle — a high-latitude city that will soon experience light from around 4 a.m. to 10 p.m. So, if he were light sensitive, he’d install blackout curtains. Setting yourself up for optimal sleep also includes adjusting the room temperature to your liking, perhaps installing a white-noise machine and making your bed extra comfortable.
Cut back on artificial light. There are lots of tools that can help protect against exposure to blue light, which streams out of devices such as smartphones and computers and can disrupt sleep patterns. Various apps help to block blue light, and you can also dim the brightness on your phone.
Be mindful of lifestyle habits. Sleep is part of a healthy lifestyle, Vitiello said, along with following a healthy diet, getting enough exercise and paying attention to alcohol use. Alcohol might help you fall asleep more quickly, he said, but it can lead to a lower quality of snoozing. “I’m not saying you can’t drink a glass of wine before bed as part of your wind-down ritual, but if you feel your sleep is rocky in the second half of the night when you do that, then it’s not a good thing,” he said.
Prioritize it. Being aware of the importance of good sleep is often the most crucial factor to improving it — the key is not “being passive,” Vitiello said. And if you find you’re struggling to improve your slumber, or you don’t feel rested during the day? Talk to your doctor or set up an appointment at a sleep center. “Most sleep problems have a solution,” Vitiello said. “Not everything can be cured, but everybody with a problem can be helped.”
People who obsessively worry about their health have often been dismissed as hypochondriacs. But for some, coronavirus has fuelled a rise in a debilitating mental health condition known as health anxiety. As Andrew Kersley explores, it can lead to job losses and even suicidal thoughts.
In March 2020, Ben quit his job as a bus driver. Whenever he was off shift he couldn’t stop thinking about how one of his passengers must have had Covid-19 and infected him. Even though he was young and healthy and his chances of serious illness were low, he was fixated on the idea he would become infected and die.
Within a fortnight, Ben had moved out of his family home in Birmingham and into in an empty student house that his friends had left. “I kept thinking about being in a place where no-one was going in or out,” he says.
Despite leaving home and quitting his job, his anxiety about getting infected still dominated his thoughts. “I would wake up and check to see if my body was okay,” he says.
“I gave myself symptoms all the time – if I was tired I’d be completely convinced I had it. I was scared to go to the shops. I just avoided going out and seeing any people at all. It’s all about the ‘what if’ rather than the reality… and no-one can ever tell you that you’ll be fine.”
Ben was experiencing health anxiety.
‘It almost took my life’
While we all sometimes worry about our health, or google symptoms, health anxiety is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – known as the bible of psychiatry – as a condition in which obsessive fears about health become excessive.
It is defined by compulsively checking for symptoms, researching diseases, obsessing over normal bodily sensations or avoiding anything that could potentially lead to you being exposed to disease.
This little-known, yet widespread condition, has hit more people this year in the wake of the pandemic.
Many have been unable to leave their house or even open windows for fear of infection. Some, like Ben, have quit jobs. Others bleach their house for hours a day. Almost all have been plagued by uncontrollable thoughts about dying from Covid.
She first developed it three-and-half years ago after finding a small bump and convincing herself she had lymphoma. Once that was ruled out she spiralled through breast cancer, brain tumours and more. She wasn’t just worried about being sick, but certain she was dying and no-one was listening.
“I’m a relatively logical and intelligent person but health anxiety took all logic away from me,” she explains. The constant fixation got so bad she repeatedly ended up at her local mental health crisis centre as it increasingly left her unable to function.
“I became suicidal, which is strange because I was trying to avoid death,” she says. “But it got so bad that I couldn’t live with the thought process anymore. Nothing I did would calm me down.” And the pandemic made things worse.
My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it
“When we first got told about this virus, it was just my worst nightmare,” the 28-year-old says. “I know everybody was inside but I couldn’t even open my window. My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it.
“It makes you feel like an attention-seeker,” says Cherelle. “It really destroyed my life and I feel very lucky just to be here.”
Cherelle says her anxiety eased over the year because Covid started to feel more “real” and visible to her than the hypothetical illnesses she had previously convinced herself of having, but many others can’t say the same.
‘Enemy you can’t see’
Health anxiety generally covers two areas – fear that you are already sick or fear that you could become sick. During the pandemic, the latter impacted everyone. But like most mental illness, it is a spectrum.
While some people rarely think about it, for others it is all they think about. Yet the number of those experiencing health anxiety has skyrocketed.
Dr Rob Willson, a London-based cognitive behavioural therapist and health anxiety expert, says he has “never had more enquiries” about health anxiety. Another specialist told the BBC he was fully booked for the next few months.
But seeking medical attention doesn’t always ease the anxiety. “Reassurance never reassures, that’s what we always say,” explains clinical psychologist Dr Marianne Trent, who runs a private mental health practice in Coventry. “Their world gets very small, but their distress is still very high.”
When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down
Coronavirus in particular poses problems for those with health anxiety. Symptoms like shortness of breath can be symptomatic of both anxiety and Covid, and the two can create a vicious cycle. The more anxious you become the more “evidence” you have that you are sick.
Plus there’s the uncertainty over infection. “When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down,” says Dr Trent. For Myra Ali, in north London, the past 12 months have felt very long. “I haven’t really been out the house for a year,” she says. “All we’ve heard is how easily you can catch Covid, so it’s embedded in your mind.”
The 33-year-old is low risk, but an intense fear about getting hospitalized with Covid controlled her thoughts. She even put off surgery for a chronic condition as a result. Just ordering a takeaway one night was enough to trigger an episode. “The next day I had to phone a doctor because I kept thinking ‘what if I’m getting symptoms?’.”
The way we talk about health anxiety in society only makes it worse. Terms like hypochondriac can dismiss those who worry too much about their health, and few people are aware that health anxiety is a genuine condition.
That attitude even filters into the medical community and Dr Willson says it can be difficult to get help from doctors due to their own negative perception of it. The condition was previously called hypochondriasis, but the stigma drove professionals to call it health anxiety instead.
Dr Willson, who co-authored a book on the condition, says there is a shortage of doctors specializing in it even though the condition can have a life-changing impact. Two of his patients have taken their own lives and he says it dominates the lives of many others.
But he, along with Dr Trent, agreed health anxiety could be managed through cognitive behavioural therapy (CBT), a talking therapy which helps change the way you think and behave as well as exposure therapy, where, with professional support, people slowly expose themselves to the things making them anxious – like going outside – in small doses.
Dr Trent says she appreciates the detrimental impact it can have. “It’s real life and death stuff. It can definitely be as debilitating as any other mental health condition.”As society opens up, life may resume for many, but for those with health anxiety a full return to normality is unlikely. It is thought the number of health anxiety patients will continue to rise long after the pandemic ends.
Dr Willson says: “It has been long enough for them to develop habits of checking for symptoms, googling and obsessing. The brain is not quick to give up those kind of habits.” If you need any advice about health anxiety, the NHS has a dedicated page containing tips and guidance, or you can contact charities including Anxiety UK, Mind or Rethink Mental Illness.
Anxiety disorders are common, affecting about one in ten with persistent, excessive worrying that can hinder their ability to function. They may worry constantly about things that do not warrant it or that may never happen.
In this video clip, participants discuss the various forms of treatment and support they have received from medical professionals as well as from other sources. Some of the strategies for managing anxiety are explored, including techniques such as physical activity, breathing exercises, and sticking to a routine.
After a year of lockdown, many of us are finding it hard to think clearly, or remember what happened when. Neuroscientists and behavioural experts explain why
Before the pandemic, psychoanalyst Josh Cohen’s patients might come into his consulting room, lie down on the couch and talk about the traffic or the weather, or the rude person on the tube. Now they appear on his computer screen and tell him about brain fog. They talk with urgency of feeling unable to concentrate in meetings, to read, to follow intricately plotted television programms.
“There’s this sense of debilitation, of losing ordinary facility with everyday life; a forgetfulness and a kind of deskilling,” says Cohen, author of the self-help book How to Live. What to Do. Although restrictions are now easing across the UK, with greater freedom to circulate and socialize, he says lockdown for many of us has been “a contraction of life, and an almost parallel contraction of mental capacity”.
This dulled, useless state of mind – epitomized by the act of going into a room and then forgetting why we are there – is so boring, so lifeless. But researchers believe it is far more interesting than it feels: even that this common experience can be explained by cutting-edge neuroscience theories, and that studying it could further scientific understanding of the brain and how it changes.
I ask Jon Simons, professor of cognitive neuroscience at the University of Cambridge, could it really be something “science”? “Yes, it’s definitely something science – and it’s helpful to understand that this feeling isn’t unusual or weird,” he says. “There isn’t something wrong with us. It’s a completely normal reaction to this quite traumatic experience we’ve collectively had over the last 12 months or so.”
What we call brain fog, Catherine Loveday, professor of cognitive neuroscience at the University of Westminster, calls poor “cognitive function”. That covers “everything from our memory, our attention and our ability to problem-solve to our capacity to be creative. Essentially, it’s thinking.” And recently, she’s heard a lot of complaints about it: “Because I’m a memory scientist, so many people are telling me their memory is really poor, and reporting this cognitive fog,” she says.
She knows of only two studies exploring the phenomenon as it relates to lockdown (as opposed to what some people report as a symptom of Covid-19, or long Covid): one from Italy, in which participants subjectively reported these sorts of problems with attention, time perception and organisation; another in Scotland which objectively measured participants’ cognitive function across a range of tasks at particular times during the first lockdown and into the summer. Results showed that people performed worse when lockdown started, but improved as restrictions loosened, with those who continued shielding improving more slowly than those who went out more.
Loveday and Simons are not surprised. Given the isolation and stasis we have had to endure until very recently, these complaints are exactly what they expected – and they provide the opportunity to test their theories as to why such brain fog might come about. There is no one explanation, no single source, Simons says: “There are bound to be a lot of different factors that are coming together, interacting with each other, to cause these memory impairments, attentional deficits and other processing difficulties.”
One powerful factor could be the fact that everything is so samey. Loveday explains that the brain is stimulated by the new, the different, and this is known as the orienting response: “From the minute we’re born – in fact, from before we’re born – when there is a new stimulus, a baby will turn its head towards it. And if as adults we are watching a boring lecture and someone walks into the room, it will stir our brain back into action.”
Most of us are likely to feel that nobody new has walked into our room for quite some time, which might help to explain this sluggish feeling neurologically: “We have effectively evolved to stop paying attention when nothing changes, but to pay particular attention when things do change,” she says.
Loveday suggests that if we can attend a work meeting by phone while walking in a park, we might find we are more awake and better able to concentrate, thanks to the changing scenery and the exercise; she is recording some lectures as podcasts, rather than videos, so students can walk while listening.
She also suggests spending time in different rooms at home – or if you only have one room, try “changing what the room looks like. I’m not saying redecorate – but you could change the pictures on the walls or move things around for variety, even in the smallest space.”
The blending of one day into the next with no commute, no change of scene, no change of cast, could also have an important impact on the way the brain processes memories, Simons explains. Experiences under lockdown lack “distinctiveness” – a crucial factor in “pattern separation”. This process, which takes place in the hippocampus, at the centre of the brain, allows individual memories to be successfully encoded, ensuring there are few overlapping features, so we can distinguish one memory from another and retrieve them efficiently.
The fuggy, confused sensation that many of us will recognize, of not being able to remember whether something happened last week or last month, may well be with us for a while, Simons says: “Our memories are going to be so difficult to differentiate. It’s highly likely that in a year or two, we’re still going to look back on some particular event from this last year and say, when on earth did that happen?”
Perhaps one of the most important features of this period for brain fog has been what Loveday calls the “degraded social interaction” we have endured. “It’s not the same as natural social interaction that we would have,” she says. “Our brains wake up in the presence of other people – being with others is stimulating.”
We each have our own optimum level of stimulation – some might feel better able to function in lockdown with less socialising; others are left feeling dozy, deadened. Loveday is investigating the science of how levels of social interaction, among other factors, have affected memory function in lockdown. She also wonders if our alternative to face-to-face communication – platforms such as Zoom – could have an impact on concentration and attention.
She theorises – and is conducting a study to explore this – that the lower audio-visual quality could “create a bigger cognitive load for the brain, which has to fill in the gaps, so you have to concentrate much harder.” If this is more cognitively demanding, as she thinks, we could be left feeling foggier, with “less brain space available to actually listen to what people are saying and process it, or to concentrate on anything else.”
Carmine Pariante, professor of biological psychiatry at King’s College London, is also intrigued by brain fog. “It’s a common experience, but it’s very complex,” he says. “I think it is the cognitive equivalent of feeling emotionally distressed; it’s almost the way the brain expresses sadness, beyond the emotion.” He takes a psycho-neuro-immuno-endocrinological approach to the phenomenon – which is even more fascinating than it is difficult to say. He believes we need to think about the mind, the brain, the immune and the hormonal systems to understand the various mental and physical processes that might underlie this lockdown haze, which he sees as a consequence of stress.
We might all agree that the uncertainty of the last year has been quite stressful – more so for some than for others. When our mind appraises a situation as stressful, Pariante explains, our brain immediately transmits the message to our immune and endocrine systems. These systems respond in exactly the same way they did in early humans two million years ago on the African savannah, when stress did not relate to home schooling, but to fear of being eaten by a large animal.
The heart beats faster so we can run away, inflammation is initiated by the immune system to protect against bacterial infection in case we are bitten, the hormone cortisol is released to focus our attention on the predator in front of us and nothing else. Studies have demonstrated that a dose of cortisol will lower a person’s attention, concentration and memory for their immediate environment. Pariante explains: “This fog that people feel is just one manifestation of this mechanism. We’ve lost the function of these mechanisms, but they are still there.” Useful for fighting a lion – not for remembering where we put our glasses.
When I have experienced brain fog, I have seen it as a distraction, a kind of laziness, and tried to push through, to force myself to concentrate. But listening to Loveday, Simons and Pariante, I’m starting to think about it differently; perhaps brain fog is a signal we should listen to. “Absolutely, I think it’s exactly that,” says Pariante. “It’s our body and our brain telling us that we’re pushing it too much at the moment. It’s definitely a signal – an alarm bell.” When we hear this alarm, he says, we should stop and ask ourselves, “Why is my brain fog worse today than yesterday?” – and take as much time off as we can, rather than pushing ourselves harder and risking further emotional suffering, and even burnout.
For Cohen, the phenomenon of brain fog is an experience of one of the most disturbing aspects of the unconscious. He talks of Freud’s theory of drives – the idea that we have one force inside us that propels us towards life; another that pulls us towards death. The life drive, Cohen explains, impels us to create, make connections with others, seek “the expansion of life”. The death drive, by contrast, urges “a kind of contraction. It’s a move away from life and into a kind of stasis or entropy”. Lockdown – which, paradoxically, has done so much to preserve life – is like the death drive made lifestyle.
With brain fog, he says, we are seeing “an atrophy of liveliness. People are finding themselves to be more sluggish, that their physical and mental weight is somehow heavier, it’s hard to carry around – to drag.” Freud has a word for this: trägheit – translated as a “sluggishness”, but which Cohen says literally translates as “draggyness”. We could understand brain fog as an encounter with our death drive – with the part of us which, in Cohen’s words, is “going in the opposite direction of awareness and sparkiness, and in the direction of inanimacy and shutting down”.
This brings to mind another psychoanalyst: Wilfred Bion. He theorised that we have – at some moments – a will to know something about ourselves and our lives, even when that knowledge is profoundly painful. This, he called being in “K”. But there is also a powerful will not to know, a wish to defend against this awareness so that we can continue to live cosseted by lies; this is to be in “–K” (spoken as “minus K”).
I wonder if the pandemic has been a reality some of us feel is too horrific to bear. The uncertainty, the deaths, the trauma, the precarity; perhaps we have unconsciously chosen to live in the misty, murky brain fog of –K rather than to face, to suffer, the true pain and horror of our situation. Perhaps we are having problems with our thinking because the truth of the experience, for many of us, is simply unthinkable.
I ask Simons if, after the pandemic, he thinks the structure of our brains will look different on a brain scan: “Probably not,” he says. For some of us, brain fog will be a temporary state, and will clear as we begin to live more varied lives. But, he says, “It’s possible for some people – and we are particularly concerned about older adults – that where there is natural neurological decline, it will be accelerated.”
Simons and a team of colleagues are running a study to investigate the impact of lockdown on memory in people aged over 65 – participants from a memory study that took place shortly before the pandemic, who have now agreed to sit the same tests a year on, and answer questions about life in the interim.
One aim of this study is to test the hypothesis of cognitive reserve – the idea that having a rich and varied social life, filled with intellectual stimulation, challenging, novel experiences and fulfilling relationships, might help to keep the brain stimulated and protect against age-related cognitive decline. Simons’ advice to us all is to get out into the world, to have as rich and varied experiences and interactions as we can, to maximize our cognitive reserve within the remaining restrictions.
The more we do, the more the brain fog should clear, he says: “We all experience grief, times in our lives where we feel like we can’t function at all,” he says. “These things are mercifully temporary, and we do recover.”
Loneliness is not just a feeling; it is also a public health problem that has been linked to increased risk of mental health issues, heart disease and even death. With rates of loneliness on the rise in the U. S. and around the world, people are addressing this crisis using everything from companion robots to social networking sites and apps. A new study in JAMA Psychiatry suggests that a better solution may lie in a much older, more ubiquitous form of technology: phone calls.
Even before the COVID-19 pandemic forced people into isolation, separating them from friends, co-workers and loved ones, experts were beginning to consider loneliness an epidemic—one affecting an estimated three out of five Americans. A study from the National Academies of Sciences, Engineering, and Medicine (NASEM), published last year, recognizes the health risks social isolation and loneliness present—and the limited interventions available to address them.
“There is a lot of variability in terms of the types of interventions, the level of evidence to support them and the rigor of evidence,” says Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, who was a member of the NASEM committee that published the report.
Some potential solutions, such as grassroots-based pen-pal programs for socially isolated adults, sound promising based on anecdotal evidence, but researchers have not adequately studied them. Other experiments are still ongoing: Holt-Lunstad, in collaboration with the social-networking service Nextdoor and researchers in the U.K. and Australia, conducted a study (currently being prepared for publication) that suggests that performing small acts of kindness for neighbors reduced the likelihood of feeling lonely and socially isolated.
Now a new paper published in JAMA Psychiatry shows that a program of phone calls focused on empathetic conversation can help. Over the course of four weeks, the experiment saw an overall reduction in symptoms of loneliness, depression and anxiety in at-risk adults aged 27 to 101. “It makes sense,” says Linda Fried, dean of the Mailman School of Public Health at Columbia University, who was not involved in the study. “In an emergency time like the pandemic, phone calls can make a big difference in allaying feelings of fright and anxiety.”
“A lot of care went into designing the protocol so that it was all about the person at the other end,” says Maninder Kahlon, lead author of the study and executive director of Factor Health, an organization for developing health care programs at the University of Texas at Austin. For example, the experiment customized each person’s program depending on how frequently they wanted to receive calls—from two to five times per week—and the best time of day for them to talk.
The researchers also considered how to make the phone conversations more empathetic. Steven Tomlinson, co-author of the study and an associate professor of leadership and administration at Seminary of the Southwest in Austin, Tex., drew on his experiences reviewing successful sales calls to identify which variables could be applied to the intervention to help callers connect with other people.
These characteristics included asking open questions, making one point at a time to allow the call receiver to talk and following up on “clues” in the conversation to demonstrate understanding. Instead of writing a script, the researchers trained 16 callers, aged 17 to 23, in these techniques and instructed them to discuss any topic the call receiver wanted to talk about, such as an ongoing home-improvement project. “It’s not just calling up on people to check in,” Kahlon says. “It’s the deliberate thinking about how you build trust.”
Although it remains unclear if the effects last beyond the four-week study period, the researchers hope the study serves as a model for an ongoing program. If health care systems and public health agencies start building a workforce of empathetic callers, it could do more than alleviate loneliness, Kahlon suggests. Similar programs might help people with mild to moderate symptoms of depression and anxiety and complement patients’ management of chronic diseases such as diabetes and heart disease.
A phone-based intervention involving layperson callers would be accessible and scalable, but it would still require callers to undergo training and take on a lot of work. “It’s important that [the intervention] is simple and intuitive,” Kahlon says, but “simple does not mean easy.” Holt-Lunstad, who was not involved in the new study, also points out that loneliness has different sources and thus may need varying solutions. “One approach may not be appropriate for all, particularly if it’s not sensitive to the underlying causes,” Holt-Lunstad says. “Getting a phone call may work for one person, but participating in a group activity may be better for others.”
COVID has emphasized the need to address growing feelings of loneliness and isolation. For instance, Japan recently appointed a minister of loneliness in the wake of increasing rates of suicide in the country; the U.K. created a similar official position in 2018. “It may take some time to understand the long-term effects of the pandemic [on loneliness and social isolation],” Holt-Lunstad says. “One of the key takeaways from this past year is there is greater awareness of how important social connection is for our well-being.”
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I’ve said before the first 3 hours of your day can dictate how your life turns out. And this often begins with the very first thing that you decide to put in your brain. You can either start you day with junk food for the brain (the internet, distracting apps, etc) or you can start the day with healthy food for the brain (reading, meditation, journaling, exercising, etc). When you start the day with junk food for the brain, you put yourself at a self imposed handicap that inhibits your ability to get into flow and prevents you from doing deep work. When you start the day with health food for your brain, the exact opposite happens.
Anytime I start my day with junk food for the brain, the quality of the day goes down. I’m less happy, focused, and productive. I spend a ton of time on the internet and don’t get any real work done. But if I start my day with health food for the brain, I find that my mood is better, I’m happier, more focused and productive.
Why Junk Food for the Brain is Toxic
If you woke up in the morning, smoked a cigarette, ate 2 donuts, and washed it down with 2 cups of coffee, it wouldn’t be surprising that your physical performance is subpar. You’re probably not going to go out and run 2 miles or win a prize fight after that kind of breakfast.
But when it comes to our brain, we’re not nearly as mindful about the idea that we should treat the information we consume like the food we eat.
“When you wake up you’re in this theta alpha state and you’re highly suggestible. Every like, comment, share, you get this dopamine fix and it’s literally rewiring your brain. What you’re smart device is doing especially if that’s the first thing you grab when you wake up and you’re in this alpha theta state, is rewiring your brain to be distracted.” — @Jim Kwik
If we start our days by checking email, instagram, or the internet, we keep reinforcing the behavior of distraction until it becomes our new habit. Some of the smartest behavioral scientist and designers in the world have worked really hard to make sure that their products are addictive, habit forming, and only provide you with a temporary sense of fulfillment so the you are always jonesing for your next fix. As Mark Manson so brilliantly said, cell phones are the new cigarettes, And a significant amount of what’s on the internet is nothing more than junk food for the brain.
Why Healthy Food for the Brain is So Powerful
If you woke up in the morning and had a really healthy breakfast, that revitalized and energized you, you’d likely hit the gym or a morning run expecting to be at your peak. The same goes for our brains.
When we start the day with health food for the brain, instead of a self imposed handicap, we give ourselves a massive competitive advantage. On the days when I religiously follow through on the 8-step daily routine that allowed me to write multiple books and 100’s of articles, my productivity goes through the roof, flow happens effortlessly, and I end up doing a lot of deep work. The idea for this article was actually the result of giving my brain some health food to start the day.
I did 20 minutes of meditation
I did almost an hour of reading
I wrote in my journal for 30 minutes
When I turned on my computer, I blocked distractions and started writing.
When you start the day with health food for your brain, you don’t end up depleting your willpower, and as a result you get more done in far less time.
So how exactly do you start the day with health food for your brain? To wean ourselves off of junk food for the brain, we have to actually replace it with something else.
Don’t use your devices in the morning
Smartphones distract us whether they are on, off, in our pockets, or on a table, and they command our attention even when they are not our own. The best solution for preventing smartphone distraction is to remove it from the picture altogether — Steve Magness
If your refrigerator or pantry is filled with junk food, you’re going to be much more likely to eat it. Same goes for your devices. If you turn them on first thing in the morning, you’re going to be much more likely to give into the sources of distraction that they make accessible. The only thing that I use my phone for in the morning is a 20 minute meditation with the Calm app. After that, I take it out of the room I’m working in.
Set aside 20 minutes to meditate
Reality as we know it occurs in the space between stimulus and response. An event happens and we make it mean something. But this happens so fast that we don’t question the validity of the meaning we’ve assigned to an event, situation or circumstance. The way to take control of the meaning is to slow that process down, and the way to slow that process down is with meditation.
I have a natural tendency to overreact or make situations more stressful than they really are. But as my meditation practice has deepened, I’ve noticed a profound energetic shift. Many of the things that would have previously rattled me don’t. On the mornings that I follow through with my 20 minutes of meditation, I’m able to focus more easily, and I don’t crave sources of distraction nearly as much
The most successful people I’ve interviewed on Unmistakable Creative, all of the peak performance books I’ve read, spiritual teachings, and many billionaires all reference the role that a daily meditation habit is played in their life. That was convincing enough evidence for me to make it a daily habit.
Read books, not the internet
When we read on the internet, we tend to scan more than we read. How often do you sit around at a dinner party discussing the amazing article you read on the internet? Almost all of my ideas for what I want to write about have come from books. Almost none of them have come from reading articles on the internet. I’ve even found in my cases that when I read a physical book that I previously read on Kindle, I tend to get far more value out of it.
Years ago when I interviewed Julien Smith, he said “I don’t read blogs. I read books.” And he had one of the most popular blogs on the internet. I stopped reading blogs, started reading books, and as a result became a more prolific writer. After watching the prolific career that Ryan Holiday has built, and observing his reading habits, I decided to follow his lead. Believe me the irony that you’re reading this on the internet is not lost on me.
Do 1 hour of Deep Work
One hour of deep work is a form of self care. It’s incredibly fulfilling. It’s an affirmation to yourself and to the universe that you value yourself and your time. You can accomplish extraordinary things in just one focused hour a day of uninterrupted creation time. With deep work, you get disproportionate results from your efforts. It’s the 80–20 rule at work. 80% of your output will come from 20 percent of your effort.
Just some food for thought. When I started writing this article I set my distraction blocker for 45 minutes. As I wrote this sentence I decided to do a check on my word count and realized I’d written over 1200 words in about 35 minutes. That’s what happens when you combine flow and deep work together
One last thing to consider. What are you really getting out of checking Facebook, instagram, or anything on your phone when you wake up in the morning? Is it making you happier or more successful in any way at all? If you added up all the time you possibly waste over the course of a year on this behavior, it’s likely you could write a book, build a business, or learn an instrument, all of which are going to do far more for the quality of your life than the temporary dopamine fix your phone provides.
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Everyone experiences headaches. From dull throbbing dehydration headaches to incapacitating migraines, a sore head is an extremely common complaint. This is perhaps especially true at the moment. COVID-19 can cause them, as can sitting at desks for too long and not getting out of the house enough.
When headaches strike, many people’s reaction is to reach for a painkiller. And these can do the job. But a better solution is often to probe the reasons behind the pain – especially if you get similar types of headaches a lot.
Even though they all entail pain, where the pain is can clue us into what type of headache we are experiencing. Pain in the face and forehead are markers of sinus-related headache whilst the sensation of a pneumatic drill somewhere in our cranium is often migraine.
But ultimately, all headaches are caused by vasodilation in the head – the widening of blood vessels near the brain. This stretches sensory receptors in the vessel wall and we feel that sensation as pain.
To understand why we need to think about the constraints the contents of our head are working under. Blood is toxic to brain tissue and so is kept separate through the blood-brain barrier. If a blood vessel leaks or breaks, this results in a haemorrhage and the death of the brain tissue the blood seeps into. So, if our blood vessels dilate beyond comfortable limits, the sensory receptors will fire off signals to the brain, which we interpret as pain.
Headaches are an early warning system. The best way to counteract them is to work out what they are warning us about.
1. Think beyond your head
This means thinking beyond your head. Yes, headache pain is generated somewhere in our head and we feel it in our head and that is why it is called headache. But headache is so much more than that – which is why I’m fascinated by them, have studied them for the past 20 years and recently published a book on the subject.
It’s a two-way street. The cause of our headache can sometimes come from our body or our behaviour. And of course headaches affect both our body and our behaviour. If we see headache as something isolated to our cranium then we will never truly understand its cause, our experience of it, or how we can best mitigate it.
Frequent migraine sufferers intimately understand this and often religiously track their food intake and their activities as well as the weather in order to work out what triggers them. But the normal headache sufferer is often less in tune with the causes of their pain.
Tension headache is a really good example of how this works. It feels like a tight band squeezing around your head with a tonne weight sitting on top for good measure. We are all aware of their occurrence at times of great emotional stress (lockdown homeschooling anyone?) but they can equally be caused by the stress we put on our body, with bad posture for example, or recovery from injury.
Both entail over-activity of the musculature around the head and neck, which sets up an inflammatory response involving prostaglandins and nitric oxide, both of which are chemicals that act to widen blood vessels. Inflammatory chemicals also directly activate the trigeminal nerve – the most complex of the cranial nerves and the one responsible for sensation and movement in the face.
Taking too many things on, rushing around trying to get things done in negative time, and trying to be all things to all people are common behavioural markers that will predict a tension headache. That and the actions we take when the pain begins.
2. Listen to the pain
If you have a pain in your leg, it might stop you from playing in that tennis match or turning up for five-a-side football. You know that if you play on it, you might do more damage and your recovery will take longer. But we don’t tend to do that with headache. We take a painkiller or an anti-inflammatory and carry on as normal even though our pain receptors are screaming at us that there is something wrong.
Taking paracetamol or ibuprofen will act to avert the danger, reducing the inflammation, the dilation and the perception of pain, but the headache will reoccur unless we can address the cause. Sometimes it’s obvious – if you have a sinus headache you’re just going to have to wait for your sinuses to clear, so taking a painkiller or a decongestant may be a good approach – but sometimes our coping strategy can make things worse.
We may decide a bottle of wine and a takeaway is just the kind of treat we need to relax and de-stress. But both lead to dehydration, another ubiquitous cause of headache. With your brain made of more than 70% water, if your kidneys need borrow some to dilute alcohol or salts and spices, it usually comes from this oasis. The brain loses water such that it literally shrinks in volume, tugging on the membranes covering the brain and triggering pain.
3. Use the brain’s natural painkillers
So what else can we do? One way is to lean into the brain’s natural painkiller system and to boost neurochemicals associated with happiness (such as serotonin and oxytocin) and reward (dopamine). Having a laugh at a comedy, enjoying a good friend’s company or indulging in some intimacy with a partner will all boost these hormones to various degrees.
Each block pain signals coming from the body, not only helping you get a handle on your headache but also redressing the balance of neurochemicals that were the mechanism of your upset emotional state.
The knowledge that we can leverage our behaviour and our body to keep our brain’s neurochemicals in balance gives us a way to break the headache cycle. So next time you have a headache for which the causes aren’t glaringly obvious – you’re not otherwise sick and you’ve been keeping hydrated – take a look at your life and see what you can change there. The pain, after all, is trying to tell you something.
By: Amanda Ellison Professor of Neuroscience, Durham University
“Famous” Physical Therapists Bob Schrupp and Brad Heineck discuss an approach to stopping your headaches using a new neuroscience approach. Adriaan Louw Headache Book available at https://bobandbrad.com/favorite-books and on our Amazon list. Make sure to like Bob and Brad on FaceBook https://www.facebook.com/BobandBrad/
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Transcript The question I would like to discuss with you today is “How to get rid of headaches?” Okay, I will be completely honest with you before we start […]
If you’d like to get rid of a headache without relying on medication, then read on.Here are three ways to soothe a painful head you may encounter while at…
HOW TO get rid of headaches: Whether it’s a dull ache, throbbing pain or a piercing feeling, natural remedies can help to eas […] Want to know more on How to get rid of headaches: Three natural remedies to relieve the tension click here go to health tips source […] Author: … Want to know more on How to get rid of headaches: Three natural remedies to relieve the tension click here go to health tips source […]
[…] READ MORE: Arthritis pain: Taking a plant protein could help relieve pain felt in the joints How to get rid of headaches: Apply peppermint oil to your temples and forehead, research suggests The NHS recommends th […] How to get rid of headaches: Avoid drinking alcohol Another study investigated the use of a treatment gel for migraines […]
All of us get headaches and the vastmajority of them and nothing to worry about on this video i’m going to coach you the best way to eliminate them and whilst you must seek medical awareness ……
Headaches may occur due to various reasons and almost everyone experiences headaches at some point.Luckily, there are ways of stop and soothe the pain with…
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