COVID’s mental health fallout will last a long time. Here’s how we’re targeting pandemic depression and anxiety



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Richard Bryant, UNSW

Although Australia is now largely COVID-free, the repercussions of the pandemic are ongoing.

As the pandemic enters its second year, many people will be continuing to suffer with poor mental health, or facing new mental health challenges.

The effects of recurrent lockdowns, fears about the effectiveness of the vaccines, restricted movement within and beyond Australia, and the bleak economic outlook are taking their toll on psychological well-being.

Now is the time to think about sustainable, evidence-based mental health programs that will serve Australians as we confront the mental fallout of the pandemic in 2021 and beyond.

The evidence is in

We now have incontrovertible evidence mental health has deteriorated during the pandemic. Large studies that assessed people’s mental health before and during COVID-19 have reported marked increases in anxiety, depression and post-traumatic stress since the pandemic began.

Although many experts predicted people with pre-existing mental disorders would be most vulnerable, we’ve seen even greater increases in psychological distress among those without a history of mental illness.

Unemployment and financial stress have exacerbated psychological problems during the pandemic. The major concern is that the increase in mental health problems will persist for years because of the economic downturn facing most nations.

Importantly, suicide rates increase during economic downturns. One study showed each 1% increase in unemployment was associated with a 1% increase in suicides.

The impact of unemployment and financial hardship on mental health is relevant for many Australians, as fears of reduced support from the JobSeeker and JobKeeper schemes loom. Although the government this week announced the JobSeeker payment will go up, welfare groups have warned it’s still not enough.




Read more:
Greater needs, but poorer access to services: why COVID mental health measures must target disadvantaged areas


So what can we do?

The question now facing many nations is how to manage the unprecedented number of people who may need mental health assistance. There are several challenges.

First, lockdowns, social isolation, and fear of infection impede the traditional form of receiving mental health care in clinics. These obstacles might now be greater in other countries with higher infection rates, but we’ve certainly seen these challenges in Australia over the past year.

Second, many people who have developed mental health conditions during the pandemic would never have had reason to seek help before, which can impede their motivation and ability to access care.

Third, many people experiencing distress will not have a clinical mental disorder, and in this sense, don’t require therapy. Instead, they need new skills to help them cope.




Read more:
Stressed out, dropping out: COVID has taken its toll on uni students


Since the pandemic began, there’s been widespread promotion of smartphone mental health apps as a remedy for our growing mental health problems.

While these programs often work well in controlled trials, in reality most people don’t download health apps, and even fewer continue using them. Further, most people who do use health apps are richer, younger, and often in very good health.

Evidence does suggest apps can play a role in delivering mental health programs, but they don’t represent the panacea to the current mental health crisis. We need to develop more effective programs that can be scaled up and delivered in an affordable manner.

One approach

A few years ago, the World Health Organization and the University of New South Wales (UNSW) jointly developed a mental health treatment program.

The program consisted of face-to-face group sessions teaching people affected by adversity new skills to manage stress more effectively. It has been shown to reduce anxiety and mood problems in multiple trials.

A young woman is on her laptop at home.
We’ve tailored a program to address the mental health challenges of the COVID pandemic.
Brooke Cagle/Unsplash

My team at UNSW has adapted this program during COVID-19 to specifically address the mental health needs of people affected by the pandemic. A clinical psychologist leads weekly sessions via video-conferencing over six weeks, with four participants in each group. The sessions cover skills to manage low mood, stress and worries resulting from the pandemic.

Typically, mental health programs have attempted to reduce negative mood and stress by using strategies that target problem areas. A newer approach, which we use in this program, focuses on boosting positive mood, and giving people strategies to optimally experience positive events and pleasure when faced with difficulties.

In controlled trials this strategy has effectively improved mental health outcomes, even more than a traditional program.

Trialling this tailored program around Australia in recent months, we’ve found it effectively improves mood and reduces stress. Although we haven’t yet published our results in a peer-reviewed journal, our preliminary data suggest the program results in a 20% greater reduction in depression than a control treatment (where we give participants resources with strategies to manage stress and mood).

This raises the possibility agencies could provide simple but effective programs like these to people anywhere in Australia. Delivering a program by video-conferencing means it can reach people in remote areas, and those not wishing to attend clinics.




Read more:
Is your mental health deteriorating during the coronavirus pandemic? Here’s what to look out for


One of the common patterns we’ve seen in previous disasters and pandemics is that once the immediate threat has passed, governments and agencies often neglect the longer-term mental health toll.

Now is the time to plan for the delivery of sustainable, evidence-based mental health programs.


Australians experiencing distress related to the pandemic can express interest in participating in the trial program here.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Richard Bryant, Professor & Director of Traumatic Stress Clinic, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Exhausted by 2020? Here are 5 ways to recover and feel more rested throughout 2021



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Peter A. Heslin, UNSW

For most of us, 2020 was an exhausting year. The COVID-19 pandemic heralded draining physical health concerns, social isolation, job dislocation, uncertainty about the future and related mental health issues.

Although some of us have enjoyed changes such as less commuting, for many the pandemic added extra punch to the main source of stress – engaging in or searching for work.

Here’s what theory and research tells us about how to feel more rested and alive in 2021.

Recovery activity v experience

Recovery is the process of reversing the adverse impacts of stress. Leading recovery researchers Sabine Sonnentag and Charlotte Fritz have highlighted the important distinction between recovery activities (what you do during leisure time) and
recovery experiences (what you need to experience during and after those activities to truly recover).

Recovery activities can be passive (such as watching TV, lying on a beach, reading, internet browsing or listening to music) or active (walking, running, playing sport, dancing, swimming, hobbies, spiritual practice, developing a skill, creating something, learning a language and so on).

How well these activities reduce your stress depends on the extent to which they provide you with five types of recovery experiences:

  • psychological detachment: fully disconnecting during non-work time from work-related tasks or even thinking about work issues

  • relaxation: being free of tension and anxiety

  • mastery: challenging situations that provide a sense of progress and achievement (such as being in learning mode to develop a new skill)

  • control: deciding yourself about what to do and when and how to do it

  • enjoyment: the state or process of deriving pleasure from seeing, hearing or doing something.

Of these, psychological detachment is the most potent, according to a 2017 meta-analysis of 54 psychological studies involving more than 26,000 participants.

Benefits of mentally disengaging from work include reduced fatigue and enhanced well-being. On the other hand, inadequate psychological detachment leads to negative thoughts about work, exhaustion, physical discomfort, and negative emotions both at bedtime and during the next morning.

Here are five tips, drawn from the research, to feel more rested and alive.

1. Follow the evidence

There are mixed findings regarding the recovery value of passive, low-effort activities such as watching TV or reading a novel.

More promising are social activities, avoiding work-related smartphone use after work, as well as engaging in “receptive” leisure activities (such as attending a concert, game or cultural event) and “creative” leisure activities (designing and making something or expressing yourself in a creative way).

Spending time in “green” environments (parks, bushland, hills) is restorative, particularly when these are natural rather than urban settings. “Blue” environments (the coast, rivers, lakes) are also highly restorative.

Time spent in natural green spaces is more restorative than in urban settings.
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Even short lunchtime walks and relaxation exercises lead to feeling more recovered during the afternoon.

Two of the surest ways to recover are to engage in physical exercise and get plenty of quality sleep.

2. Assess your ‘boundary management style’

Your boundary management style is the extent to which you integrate or separate your work and life beyond work. Work-life researcher Ellen Kossek has created a survey (it takes about five minutes) to help assess your style and provide suggestions for improvement.

The following table developed by Kossek shows physical, mental and social strategies to manage boundaries and separate your work and life beyond work.



CC BY-SA

3. Cultivate your identity beyond work

Many of us define ourselves in terms of our profession (“I’m an engineer”), employer (“I work at …”) and perhaps our performance (“I’m a top performer”).

We may also have many other identities related to, for instance, (“I’m a parent”), religion (“I’m a Catholic”), interests (“I’m a guitarist”), activities (“I’m a jogger”) or learning aspirations (“I’m learning Portuguese”).

Dan Caprar and Ben Walker suggest two useful ways to prevent being overly invested in work identity.

First, reorganise your physical space to reduce visual reminders of your work-related identities (e.g. your laptop, professional books, performance awards) and replace them with reminders of your other identities.

Second, do some “identity work” and “identity play”, reflecting on the identities you cherish and experimenting with potential new identities.




Read more:
Here’s why you’re checking work emails on holidays (and how to stop)


4. Make time for better recovery experiences

Document what you do when not working. Ask yourself how much these activities enable you to truly experience psychological detachment, relaxation, mastery, control and enjoyment.

Then experiment with alternative activities that might provide richer recovery experiences. This will typically require less time on things such as news media (especially pandemic updates and doomscrolling), TV, social media, online shopping or video games, gambling, pornography, alcohol or illicit drugs to recover.

Couple in bed looking at smartphones.
Passive leisure activities are less likely to provide the five key recovery experiences of psychological detachment, relaxation, mastery, control and enjoyment.
Shutterstock

You will make it easier to give up activities with minimal recovery value if you supplant them with more rejuvenating alternatives you enjoy.




Read more:
Three ways to achieve your New Year’s resolutions by building ‘goal infrastructure’


5. Form new habits

Habits are behaviours we automatically repeat in certain situations. Often we fail to develop better habits by being too ambitious. The “tiny habits” approach suggests thinking smaller, with “ABC recipes” that identify:

  • anchor moments, when you will enact your intended behaviour

  • behaviours you will undertake during those moments

  • celebration to create a positive feeling that helps this behaviour become a habit.

Examples of applying this approach are:

  • After I eat lunch, I will walk for at least ten minutes (ideally somewhere green). I will celebrate by enjoying what I see along the way.

  • After I finish work, I will engage in 30 minutes of exercise before dinner. I will celebrate by raising my arms in a V shape and saying “Victory!”

  • After 8.30pm I will not look at email or think about work. I will celebrate by reminding myself I deserve to switch off.

Perhaps the most essential ingredient for building better recovery habits is to steer away from feeling burdened by ideas about what you “should” do to recover. Enjoy the process of experimenting with different recovery activities that, given all your work and life commitments, seem most promising, viable and fun.The Conversation

Peter A. Heslin, Professor of Management and Scientia Education Fellow, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to outsmart your COVID-19 fears and boost your mood in 2021



It’s all about emotion.
Charles Postiaux/Unsplash, CC BY-ND

Laurel Mellin, University of California, San Francisco

After a year of toxic stress ignited by so much fear and uncertainty, now is a good time to reset, pay attention to your mental health and develop some healthy ways to manage the pressures going forward.

Brain science has led to some drug-free techniques that you can put to use right now.

I am health psychologist who developed a method that harnesses our rip-roaring emotions to rapidly switch off stress and activate positive emotions instead. This technique from emotional brain training is not perfect for everyone, but it can help many people break free of stress when they get stuck on negative thoughts.

Why the stress response is so hard to turn off

Three key things make it hard to turn off stress-activated negative emotions:

  • First, our genes make us worrywarts. Our hunter-gatherer ancestors survived by assuming every rustle in the grasses was a lurking hungry lion, not harmless birds hunting for seeds. We’re essentially programmed to be hyperaware of threats, and our brains rapidly launch stress chemicals and negative emotions in response.

  • Second, the chemical cascade of stress hormones in the brain associated with negative emotions impairs cognitive flexibility, goal-directed behavior and self-control.

  • Third, our tendency to avoid dealing with negative emotions puts people in a perpetual cycle of ignoring unpleasant feelings, which amplifies stress and the risk of emotional health problems.

Brain illustration
Thought vs. emotion in the brain.
Laurel Mellin, CC BY-ND

Traditional approaches for coping with stress were based on cognitive-behavioral therapy, which focuses on modifying patterns of thinking and behavior. It was developed before our modern understanding of stress overload.

Researchers at New York University discovered a paradox: Although cognitive methods were effective in low-stress situations, they were less effective when dealing with the high stress of modern life.

Emotional brain training works with these high-stress emotions in an effort to tame them, releasing negative emotions as the first of two steps in preventing stress overload.

Step 1: Release negative emotions

The only negative emotion in the brain that supports taking action rather than avoidance and passivity is anger.

Studies have shown that the suppression of anger is associated with depression and that suppressing anger doesn’t reduce the emotion. Healthy release of anger instead has been found to reduce other stress-related health risks.

Our technique is to switch off stress overload by using a controlled burst of anger to help the brain exert better emotional control and allow emotions to flow rather than become chronic and toxic. After that first short burst, other feelings can flow, starting with sadness to grieve the loss of safety, then fear and regret, or what we would do differently next time.

You can talk yourself through the stages. To experiment with the process, use these simple phrases to express the negative feelings and release your stress: “I feel angry that …”; “I feel sad that …”; “I feel afraid that …”; and “I feel guilty that …”

Step 2. Express positive emotions

After releasing negative emotions, positive emotions can naturally arise. Express these feelings using the same approach: “I feel grateful that …”; “I feel happy that …”; “I feel secure that …”; and “I feel proud that …”

Your mindset can quickly change, a phenomenon that has many potential explanations. One explanation is that in positive states, your brain’s neural circuits that store memories from when you were in the same positive state in the past can be spontaneously activated. Another is that the switch from negative to positive emotions quiets your sympathetic nervous system – which triggers the fight-or-flight response – and activates the parasympathetic system, which acts more like a brake on strong emotions.

Here’s what the whole stress relief process might look like like for me right now:

  • I feel angry that we’re all isolated and I can’t see my new grandson Henry.

  • I hate it that everything is so messed up! I HATE THAT!!!

  • I feel sad that I am alone right now.

  • I feel afraid that this will never end.

  • I feel guilty that I am complaining! I am lucky to be alive and have shelter and love in my life.

Then the positive:

  • I feel grateful that my daughter-in-law sends me photos of Henry.

  • I feel happy that my husband and I laughed together this morning.

  • I feel secure that this will eventually pass.

  • I feel proud that I am doing the best I can to cope.

After a daunting year, and with more challenges ahead in 2021, upgrading your approach to emotions can be a drug-free mood booster. Our COVID-19 fears need not consume us. We can outsmart the brain’s fear response and find moments that sparkle with promise.

[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter.]The Conversation

Laurel Mellin, Associate Professor Emeritus of Family & Community Medicine and Pediatrics, University of California, San Francisco

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘I felt immense grief’: one year on from the bushfires, scientists need mental health support



Daniella Teixeira

Daniella Teixeira, Griffith University

One night in January 2020, I couldn’t sleep. I kept waking to check my phone for news from Kangaroo Island, off South Australia. Fires had already burned through several sites where I’d researched the island’s endangered glossy black cockatoos, and now it was tracking towards two critical habitat areas.

The areas were crucial to the birds’ feeding and nesting. I knew losing these places would be a disaster for the already small and isolated population. At home in Queensland, I felt helpless and anxious.

As ecology students, we learn a lot about the problems facing the most vulnerable life on Earth, but not how to cope with them. And as conservationists, we front up to ecological devastation each day, but sometimes without the professional support to help us deal with the emotional consequences.

This was exceptionally clear to me during the Black Summer fires. I was in no way equipped to deal with the possible extinction of my study species.

The author, Danielle Teixeira, with a glossy black cockatoo.
The author, Daniella Teixeira, with a glossy black cockatoo.
Mike Barth

What chance of survival?

The fires destroyed almost everything on the western half of Kangaroo Island. Most of Kangaroo Island’s glossy black cockatoo population lived in the burnt areas, and I was anxious to know their fate.

A colleague on the island emailed with some news. One critical habitat area I was concerned about, Parndarna Conservation Park, had been destroyed. The fires reached the other habitat area, Cygnet Park, but thankfully most of it was saved.

The eastern end of Kangaroo Island was untouched. This offered a sliver of hope; if the remaining habitat could be saved, the glossy black cockatoos had a chance of surviving.




Read more:
‘This situation brings me to despair’: two reef scientists share their climate grief


I started urgently raising money and dealing with media requests. Taking these pressures off the team on the island was one way I could be useful from afar.

As the fires raged, and for weeks afterwards, I poured immense energy into this mission, spurred by the belief that conservationists must be strong and resilient in the face of disaster. But I was stressed and worried. How could the island possibly recover from such a fire? What is my role as a scientist in such a crisis?

At one point, a friend and fellow conservationist checked in. He reminded me that taking time out is OK. I was thankful to hear this from another scientist; it made me feel better about periodically stepping away from my inbox and the ever-expanding fire scar maps.

Burnt landscape on Kangaroo Island
Conservationists are not always well equipped to deal with the tragedies they face.
Daniel Mariuz/AAP

Heading back to Kangaroo Island

I returned to Kangaroo Island in late February. Until then, I had not grasped the gravity of the island’s condition. In many places, no birdsong remained. The wind no longer rustled through the needles of the she-oak trees.

The most difficult time was returning to a nesting site of the glossy black cockatoo which I knew well. I found nest trees burnt to the ground. Their plastic artificial nest hollows, built to encourage breeding, were a melted mess.

A nest box that melted in the fires.
A nest box that melted in the fires.
Daniella Teixeira

Remarkably, amid the charred remains I found an active nest. The female watched me intently; she didn’t flee or make a sound. I watched her, amazed, and hoped there was enough food to support the four-month nesting period.

I felt immense grief standing at the nesting site. I grieved not only for the glossy black cockatoos and other damaged species, but also the loss that would come in the future under climate change.

At that time, we didn’t know how many cockatoos remained. But thankfully, in the following months it became clear most cockatoos escaped the inferno. In 2016, 373 birds were counted on the island, and those numbers increased before the bushfires, thanks to conservation efforts. In spring this year, field staff and volunteers counted at least 454 birds on the island.

It was a wonderful but surprising result, which might not have been the case if the fires took place during the breeding season when the cockatoos would be reluctant to abandon their nests. The concern now is whether the remaining habitat can maintain the population over time.

Coping with ecological grief

In the year since the fires, my acute grief at the plight of nature has lifted. But an underlying sadness, and concern for the future, remains. From my discussions with other conservationists, I know I’m not the only one to feel this way.

glossy black cockatoos on a branch
The fires destroyed critical habitat for glossy black cockatoos.
Dean Ingwersen

Black Summer was a wake-up call for me. As an early career scientist, I will inevitably face more crises, and dealing with them effectively means keeping my mental health in check. I believe conservationists should be offered more mental health education and support. I don’t have all the solutions, but offer a few ideas here.

Universities and workplaces offer limited counselling services, but they may not be enough when grief is an inherent part of your job. I believe there is scope for more ongoing support for conservationists, which should be integrated into regular workplace practices and training.

Regular discussions with supervisors and colleagues can also help. I find such open and honest discussions very beneficial. There is a shared sense of grief, as well as purpose.

Importantly, we should all work to break down the culture that says action is the only response to environmental disasters. Some conservation scientists feel they are risking their reputation or career progression by taking time out. But they must be given space to process emotions such as grief and anger, without guilt or shame.




Read more:
Hope and mourning in the Anthropocene: Understanding ecological grief


And scientists are easily overworked and overwhelmed in workplaces, such as universities, when productivity and output takes priority over the welfare of staff.

Since Black Summer, I have made a concerted effort to spend more time in nature. I listen to birdsong and the wind, and marvel at the complexity of life. I do this not to remember what I’m fighting to save, but simply because it brings me joy.

The author with a nestling cockatoo
The author, with a nestling glossy black cockatoo, says conservation scientists need more mental health support.
Mike Barth



Read more:
I’m searching firegrounds for surviving Kangaroo Island Micro-trapdoor spiders. 6 months on, I’m yet to find any


The Conversation


Daniella Teixeira, Researcher, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A mental disorder, not a personal failure: why now is the time for Australia to rethink addiction



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Dan Lubman, Monash University

The year 2020 has challenged us all. The bushfires and then the pandemic forced us to reflect on what’s important, how we respond to crises as a community, and the ways we connect and support each other.

We’re still grappling with what the long-term mental health effects of this period of fear, insecurity and social disconnection might be.

At the start of the pandemic we saw a surge in alcohol sales and reported drinking. Almost one-third of people who purchased more alcohol expressed concerns about their own drinking, or that of someone in their household.

People often turn to alcohol or other drugs to help cope with stress, financial pressures, loss and trauma. Increases in drinking are consistently reported after natural disasters, acts of terrorism and economic crises.

It’s therefore timely to reflect on our perceptions of addiction, who is affected, and how we respond.

What is addiction?

In simple terms, addiction is the inability to stop consuming a drug or cease an activity, even if it’s causing physical or psychological harm.

A common misconception is that it’s a result of a lack of willpower or poor self-control. But in reality, addiction is a complex health disorder with a range of biological, developmental and environmental risk factors, including trauma, social isolation or exclusion, and genetics.

Around one in four Australians will develop an alcohol, drug or gambling disorder during their lifetime, and around one in 20 will develop addiction, the most severe form of the disorder.

Despite common stereotypes, addiction doesn’t discriminate. It affects people of all ages and from all backgrounds.

A group therapy session. One woman is standing and addressing three others.
It often takes people experiencing addiction a long time to seek treatment.
Shutterstock

Stigma is disabling

Addiction remains one of the most stigmatised of all health conditions globally. We grant compassion to people with health conditions like cancer, heart disease or diabetes, yet society doesn’t offer that same concern to someone with an addiction.

Too often, we blame the individual, believing the addiction is their fault. But addiction is an unfortunate consequence of something much more complex.




Read more:
Drug rehab: what works and what to keep in mind when choosing a private treatment provider


As a consequence of feeling shame and judgement, it can often take people many years to seek help. This is compounded by multiple barriers to treatment (such as geography, cost, waiting times and concerns about privacy).

Yet our refusal to have an honest conversation about how we respond to tobacco, alcohol, drug and gambling-related harm comes at a significant cost to the Australian community, exceeding A$175 billion annually.

A broken system

Across Australia, treatment for addiction remains fragmented, with limited opportunities for ongoing care. There’s no consistent national planning, despite evidence that for every $1 invested in treatment, society gains $7.

The situation is exacerbated by a health workforce that has had limited opportunities for undergraduate and postgraduate training in addiction, meaning emergency and primary care systems frequently struggle to respond.

This is in stark contrast with other chronic health conditions, such as diabetes, asthma and heart disease, where there are clear training pathways, clinical guidelines and national models of care.

A man holds a small packet with white powder in one hand, and his phone in the other hand.
Addiction continues to have stigma attached to it.
Shutterstock

So, many individuals suffering from addiction and their families are left to navigate their own pathways to treatment.

A tragic consequence of this fragmented and failing system is that we continue to see preventable deaths associated with different types of addiction.




Read more:
How a simple brain training program could help you stay away from alcohol


Tackling the stigma

The recent SBS documentary series Addicted Australia follows ten brave Australians and their families as they seek professional help for addiction over a six-month period. It’s an important step in challenging prevailing myths and stereotypes around addiction.

The series opens the door to the realities of addiction, providing viewers with a deeper understanding of the disorder, the devastating effect it has on individuals and families, and what effective treatment and recovery looks like when people have access to a holistic model of care.

The hope is that this series will help change community perceptions about the reality of addiction, elevate expectations about what treatment should look like, and alter the narrative such that recovery is not just a possibility, but like for other health conditions, is a realistic goal.

Addicted Australia, which recently aired on SBS, is now available on SBS On Demand.

A call to action

Treating addiction like any other health disorder has to start with strong public policy reform and intervention to ensure the health system is adequately supported and resourced, so accessible and timely treatment is available to people who need it.

Until we change how we view addiction — from personal failure to a mental disorder, something we cannot control any more than we can control cancer — Australians, and millions globally, will continue to suffer.

We’ve partnered with more than 40 organisations to develop a national campaign, “Rethink Addiction”, that calls for a national action plan for addiction treatment and advocates for a change to Australia’s attitude and response to addiction.

We encourage anyone who has been touched by addiction or is passionate about reducing stigma to share their story and get involved in making the case for change.

After the year we’ve all had, there’s no better time to rethink addiction.




Read more:
We’re told to ‘gamble responsibly’. But what does that actually mean?


The Conversation


Dan Lubman, Executive Clinical Director, Turning Point & Director of Monash Addiction Research Centre, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID has presented unique challenges for people with eating disorders. They’ll need support beyond the pandemic



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Laura Hart, University of Melbourne and Andrea Phillipou, Swinburne University of Technology

COVID-19 has changed the way we live, work and interact with one another. It has also changed the way we move, exercise, shop, prepare food, and eat.

During the pandemic, we’ve seen marked increases in reports of mental distress across the board. But Australian and international research suggests lockdown measures have presented unique challenges for people living with eating disorders.

Eating disorders are complex mental illnesses

Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder and other diagnoses. They centre around disordered eating (for example, fasting and dieting, binge eating, or purging behaviours), and often include problems with body image.

Eating disorders are frequently associated with high levels of depression and anxiety.

For some people with these conditions, rigid routines (around exercise, food preparation or eating habits), are a way of coping with symptoms and distress.

It’s no secret the pandemic has significantly disrupted our usual routines. For example, working from home may have led people to be more sedentary, or allowed more time for exercise. Social distancing has meant we’ve spent less time seeing others and sharing meals.

A man and a woman are eating in a cafe, but the man is disinterested in his food.
People of different ages, genders and backgrounds can develop eating disorders.
Shutterstock

COVID-19 restrictions and social distancing measures, though imperative to reduce the spread of the virus, have resulted in a significant rise in psychological distress, especially for people experiencing social isolation, reduced or uncertain employment, financial strain, or health concerns.

We know people with existing mental health problems have been particularly vulnerable. However, people with eating disorders are vulnerable not only to these mental stressors; but also to the physical changes to everyday routines, and social conversations about eating and body weight which have popped up during lockdowns.




Read more:
How many people have eating disorders? We don’t really know, and that’s a worry


What does the research say?

Research published early in the pandemic predicted COVID-19 and the associated restrictions may increase eating disorder risk in a few important ways:

  • disruptions to daily routines and reduced access to social supports

  • increased exposure to anxiety-provoking media (messages about possible links between high body mass index and COVID, or joking on social media about weight gain during lockdown)

  • increased use of videoconferencing where people are exposed to their own image on camera

  • anxiety about contracting COVID-19 — the authors suggested this may lead people with eating disorders to engage in dieting for perceived immune system benefits.




Read more:
Greater needs, but poorer access to services: why COVID mental health measures must target disadvantaged areas


Australian researchers conducted what was to our knowledge the first published study on disordered eating behaviours during COVID-19. Participants with eating disorders reported a worsening of symptoms — they were restricting their food consumption, binge eating and engaging in purging behaviours more often. They also reported doing more exercise, and high levels of depression, anxiety and stress.

Studies from around the world have since shown similar results. They’ve also found people with eating disorders have reported increased fears about not being able to find foods consistent with meal plans, while disruptions to routine have led to heightened psychological distress and worsening of eating disorder symptoms.

It comes as little surprise demand for eating disorder support has increased significantly. The Butterfly Foundation — Australia’s leading support organisation for people affected by eating disorders and body image issues — has reported a 57% increase in calls to its helpline over the course of the pandemic.

Similarly, inpatient and outpatient services around Australia — particularly in Victoria where residents experienced a prolonged second lockdown — have seen demand increase, resulting in longer wait lists for eating disorder services.

A group counselling session.
People with eating disorders are likely to need extra support beyond the pandemic.
Shutterstock

Looking ahead

Although we still don’t know what the long-term psychological effects of COVID-19 will be, previous pandemics such as SARS have taught us these sorts of crises can result in long-term mental health impacts, and may trigger the onset of mental illness, including depression and anxiety.

We don’t know yet conclusively whether the pandemic has triggered the onset of eating disorder symptoms or increased the incidence of these conditions. It doesn’t make it any easier that our understanding of the prevalence of eating disorders in Australia was poor to begin with.

But it does seem highly likely that we will see such increases. The information we have so far suggests pandemic-related challenges can increase the risk for people with eating disorders, or those who may be vulnerable to developing them, in many and varied ways.




Read more:
People with eating disorders saw their symptoms worsen during the pandemic – new study


In addition, some research suggests food insecurity is associated with increases in eating disorders, and binge eating in particular.

So even if the pandemic is brought to an end with widespread vaccination, if the associated economic recession results in ongoing disruptions to food supply chains, or in impoverished households having limited or unreliable access to food, we may see further increases in eating disorders, well beyond the life of COVID-19.

It’s critical clinical services and support organisations provide extra support to these groups, not only during the pandemic, but for a significant amount of time after the crisis has resolved. This includes increased access to treatment, as well as online eating disorder supports like chatbots, and telephone hotlines.


If this article has raised concerns about body image or eating disorders, please contact the Butterfly Foundation national hotline on 1800 334 673, or visit their website.The Conversation

Laura Hart, Senior Research Fellow, University of Melbourne and Andrea Phillipou, Senior Research Fellow, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Young people are exposed to more hate online during COVID. And it risks their health



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Joanne Orlando, Western Sydney University

COVID has led to children spending more time on screens using social networks, communication apps, chat rooms and online gaming.

While this has undoubtedly allowed them to keep in touch with friends, or connect with new ones, during the pandemic, they are also being exposed to increased levels of online hate.

That’s not just the bullying and harassment we often hear about. They’re also being exposed to everyday negativity — Twitter pile-ons, people demonising celebrities, or knee-jerk reactions lashing out at others — several times a day.

This risks normalising this type of online behaviour, and may also risk children’s mental health and well-being.

What are children exposed to?

Hate speech can consist of comments, images or symbols that attack or use disapproving or discriminatory language about a person or group, on the basis of who they are.

It can even be coded language to spread hate, as seen on the world’s most popular social platform for children, TikTok. For example, the number 14 refers to a 14-word-long white supremacist slogan.




Read more:
TikTok can be good for your kids if you follow a few tips to stay safe


People can be exposed to hate speech directly, or witness it between others. And one study, which analysed millions of websites, popular teen chat sites and gaming sites, found children were exposed to much higher levels of online hate during the pandemic than before it.

The study, run by a company that uses artificial intelligence to detect and filter online content, found a 70% increase in hate between children and teens during online chats. It also found a 40% increase in toxicity among young gamers communicating using gaming chat.

Of particular note is the rise of hate on TikTok during the pandemic. TikTok has hundreds of millions of users, many of them children and teenagers. During the pandemic’s early stages, researchers saw a sharp spike in far-right extremist posts, including ideologies of fascism, racism, anti-Semitism, anti-immigration and xenophobia.

Children may also inadvertently get caught up in online hate during times of uncertainty, such as a pandemic. This may be when the entire family may be in distress and children have long periods of unsupervised screen time.




Read more:
Social media can be bad for youth mental health, but there are ways it can help


Witnessing hate normalises it

We know the more derogatory language about immigrants and minority groups people are exposed to (online and offline), the more intergroup relations deteriorate.

This leads to empathy for others being replaced by contempt. Terms like “hive mind” (being expected to conform to popular opinion online or risk being the target of hate) and “lynching” (a coordinated social media celebrity hate storm) are now used to describe this online contempt.

Being exposed to hate speech also leads young people to become less sensitive to hateful language.
The more hate speech a child observes, the less upset they are about it. They develop a laissez-faire attitude, become indifferent, seeing hateful comments as jokes, minimising the impact, or linking hateful content to freedom of speech.

Teenage girls playing soccer outside, both trying to kick the ball.
In real life, people are sent off the pitch for bad behaviour. But there is no such consequence in online gaming.
Shutterstock

There is also little reputational or punitive risk involved with bad behaviour online. A child playing soccer might get sent off the field in a real-life sporting game for “flaming”, or “griefing” (deliberately irritating and harassing other players). But there is no such consequence in online gaming.

Social platforms, including Facebook and TikTok, have recently expanded their hate speech guidelines. These guidelines, however, cannot eradicate hate speech as their definitions are too narrow, allowing hate to seep through.

So kids are growing up learning “bad behaviour” online is tolerated, even expected. If what children see every day on their screen is people communicating with them badly, it becomes normalised and they are willing to accept it is part of life.




Read more:
Technology and regulation must work in concert to combat hate speech online


Witnessing hate affects children’s health and well-being

Prince Harry recently warned of a “global crisis of hate” on social media that affects people’s mental health.

It impacts the mental health of all involved: those giving out the hate, those receiving it, and those observing it.

If a young person has negative, insulting attitudes or opinions, this is often put down to having unresolved emotional issues. However, channelling pent-up emotions into hate speech does not resolve these emotional issues. As hate posts can go viral, it can encourage more hate posts.

And for people who are exposed to this behaviour, this takes its toll.
The increased mental preparedness it takes to deal with or respond to microaggressions and hate translates into chronically elevated level of stress — so-called low-grade toxic stress.




Read more:
6 actions Australia’s government can take right now to target online racism


In the short term, too much low-grade toxic stress lowers our mood and drains our energy, leaving us fatigued. Prolonged low-grade toxic stress can lead to adverse health outcomes, such as depression or anxiety, disruption of the development of brain architecture and other organ systems, and increases in the risk of stress-related disease and cognitive impairment, well into the adult years.

It can also cause a child to develop a low threshold for stress throughout life.

Children growing up in already vulnerable, stressed environments will be more impacted by the stress they are also exposed to long-term online.




Read more:
With kids spending more waking hours on screens than ever, here’s what parents need to worry about


What to do

Unfortunately, we can’t eradicate hate online. But the more we understand why others post hate speech and the strategies they use to do this helps a child be more in control of their environment and therefore less impacted by it.

Hate speech is driven not only by negativity, but also by the simplicity in how groups are portrayed, for instance, boys are superior, girls are side-kicks. Teach children to notice over-simplicity and its use as a put-down strategy.

An aggressor (the one dishing out the hurt) can also easily hide behind a non-identifying pseudonym or username. This type of anonymity allows people to separate themselves from who they are in real life. It makes them feel free to use hostility and criticism as a viable way of dealing with their pain, or unresolved issues. Teach your child to be aware of this.


Resources on the impact of toxic stress on young people, mental health support and what to do if you experience or witness online hate are available for parents and children.

If this article has raised issues for you, or if you’re concerned about someone
you know, call Lifeline on 13 11 14.
The Conversation

Joanne Orlando, Researcher: Children and Technology, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Bushfires, drought, COVID: why rural Australians’ mental health is taking a battering



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David Perkins, University of Newcastle and Hazel Dalton, University of Newcastle

Among the Bushfire Royal Commission’s 80 recommendations, released last week, was a call to prioritise mental health support during and after natural disasters.

The Australian Medical Association this week called on the federal government to implement the recommendations to lessen the health impacts of future disasters, noting the ongoing mental health fallout from the 2019-20 Black Summer bushfires.

The Royal Commission’s report comes as Australia heads into a bushfire season during a pandemic. Some farmers have this year lost their crops due to unseasonal rain and hail, as many rural communities anticipate further “big weather” events. Certain local economies, which are reliant on exports like wine and barley, are concerned about strained trade relations with China.

The combined effects of these adverse events is taking a toll on the health and well-being of rural people.

A year of cumulative stress

Australian Bureau of Statistics figures released last month showed rural suicide rates are much higher than those in the big cities.

The causes of psychological stress for rural people are many and varied, depending on who you are and where you live. Many are facing environmental and weather events at increasing frequency and intensity. Some of these events happen rapidly, such as fire and floods, whereas others are long-lasting and uncertain, like drought.

The effects of these events include direct losses such as injury and death, as well as loss of livestock and buildings. Indirect losses include declines in businesses and employment, and the disruption of social fabric when friends or family leave town.

Recovery or adaptation can take many years.




Read more:
Distress, depression and drug use: young people fear for their future after the bushfires


These stresses of course come in addition to life’s normal challenges likes illness, bereavement and relationship breakdown.

For rural people, COVID has likely compounded these cumulative stresses and contributed to higher levels of trauma, mental ill-health and in some cases, suicidal behaviour.

Band-aid policies

In most rural communities, access to mental health services is relatively poor.

There’s longstanding evidence Medicare Benefits Scheme expenditure for mental health services is skewed towards metropolitan services.

State expenditure is focused on hospital services and care for those with high and complex needs. Consequently, many rural people with mild to moderate needs are under-served.

Traditionally, governments respond to crises reactively and by treating these events as short-term and disconnected. But this isn’t the experience of rural people.

Each adverse event is accompanied by (usually short-term) funding announcements by governments and agencies for new Headspace centres, expanded telephone helplines, websites, counsellors, or coordinators in the most affected areas.

Sometimes there’s overlap of effort across different government departments, federal and state jurisdictions or from different disaster responses, potentially wasting resources.

For example, in NSW, the longstanding drought has recently broken. But the social and economic recovery will take longer — possibly up to five years with consistent rain as it did following the Millennium drought.

Counsellors were funded to support rural residents during the drought in 2018, with more counsellors funded in response to the bushfires. And now additional services are being offered due to COVID.

While the extra support is welcome, the fragmentation and temporary nature of the funding means rural people may not know what services are available, and accessing services becomes confusing.

What’s more, with short-term contracts, it may be the same staff moving between roles and agencies, therefore not actually adding new staff to support local rural communities. This funding instability makes it difficult to retain a stable rural mental health workforce.




Read more:
Budget funding for Beyond Blue and Headspace is welcome. But it may not help those who need it most


What can be done?

In the first instance, policymakers need to ask people living in rural areas what they need and involve them in the process of developing appropriate and accessible services.

Second, we need to adopt a systemic approach that examines the full range of adverse events that affect the mental health and well-being of individuals, families and communities. This means going beyond treating illness, to addressing environmental, economic, social and personal factors.

As part of this, we need people on the ground to support communities through preparedness activities such as educating people about mental health and how to access services, while stepping into disaster response and recovery as needed. Continuity and building on what already exists locally is key.

The Rural Fire Service is a good example of such a structure. It has a clear role in disaster response, but also works to prepare communities between disasters (for example, by conducting back-burning and educating about bushfire plans).

Localised support is important because preparedness and response look very different depending on where you live in rural Australia. For example, Lismore on the northern NSW coast experiences regular flooding, whereas Broken Hill in the state’s far west contends with more frequent drought, and fierce dust storms.

Third, to fully understand and plan for the diversity of rural communities, we need sophisticated data planning, collection and analysis systems. Beyond health data, we need to look at the social, economic, environmental factors which all contribute to mental health and the way people access care.

If we can do this well, local planning will become easier, more transparent and tailored to need.

Finally, rural communities need support to develop local leadership, so they’re empowered to lead local responses. This is unlikely to succeed with short-term band-aid solutions, but rather with long-term investment and strategic policy to build and sustain capacity to cope with adversity.




Read more:
Collective trauma is real, and could hamper Australian communities’ bushfire recovery


The Conversation


David Perkins, Director, Centre for Rural and Remote Mental Health and Professor of Rural Health Research, University of Newcastle and Hazel Dalton, Research Leader and Senior Research Fellow, Centre for Rural and Remote Mental Health, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We’ve been tracking young people’s mental health since 2006. COVID has accelerated a worrying decline



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Zlatko Skrbis, Australian Catholic University; Jacqueline Laughland-Booy, Australian Catholic University, and Jonathan Smith, Australian Catholic University

We have been following more than 2,000 Queenslanders from their adolescence into adulthood. The aim of the Our Lives study is to investigate how young people think about their future and how they master their trajectories in a world of rapid change and uncertainty.

In 2006, our research team began tracking more than 7,000 students who began high school in Queensland at the age of 13. Since then, the study has become the largest and longest of school leavers in Australia post the global financial crisis. The cohort turns 27 this year.

Every two years, we survey this cohort about their developing aspirations and experiences in work, study, housing, relationships and family. We also explore changes in their social attitudes and mental and physical health.

We did a special survey in June 2020 in response to COVID-19. We wanted to understand how the cohort had been affected since the previous survey six months earlier, in late 2019.

Among our findings are a sharp decline in mental health between 2019 and June 2020, especially among respondents living in urban areas and those without secure work. Marriage or de facto partnerships seem to be a buffer against sharper declines seen in young people who are single or living with housemates.

A decline in mental well-being

At the age of 22, in 2015, 82% of respondents described their mental health as excellent, very good or good. This fell to 70% at the age of 26 in 2019 — a drop of three percentage points per year.

But, only six months into the next year 2020 (in June), this figure had already fallen by a further four percentage points, to 66%. These data suggest changes in the young people’s lives during the COVID-19 pandemic have accelerated the existing downward trend in their mental well-being.



How different demographics have fared

Research has indicated women are more adversely affected than men by recessions, both economically and psychologically.

In line with this, the female participants in our study displayed significantly worse mental health during COVID than their male counterparts. The proportion of 27 year old males who described their mental health as excellent, very good or good in June 2020 was 70.5% compared to 63.5% for females.




Read more:
Young women are hit doubly hard by recessions, especially this one


Young adults living in major city areas, where COVID cases have largely been concentrated, experienced a decline in mental health — from 68.7% in 2019 to 62.2% in 2020. But the proportion of those living in rural areas actually rose from 70.9% in 2019 to 72.2% in 2020.

By their mid-twenties, a major gap emerged in the well-being of people with and without secure work. In 2015, when participants were 22 years old, 82.4% with permanent, ongoing work rated their mental health good to excellent, compared to 68.5% in 2020. The results were 77.6% in 2015 for those who were unemployed compared to 54.1% in 2020.

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Emergency welfare measures, such as the JobKeeper wage subsidy and increase to JobSeeker, may have temporarily prevented this gap from widening.

One of Australia’s top mental health experts, Professor Ian Hickie, has argued an extension to JobKeeper and greater financial support for students in post-school education and training are critical for mitigating the predicted surge in youth mental illness.



What about relationships?

Security in young adults’ housing and relationships appears to provide a key buffer against the negative psychological impacts of COVID-19. Our data show young adults living out of home, or with a partner (married or de facto) report substantially better mental health in June 2020 than those who are single and living with parents.

Young people in who were living with housemates during the COVID-19 period experienced the sharpest decline in positive mental health.



Social distancing took its toll on the Our Lives cohort during the national restriction period, with 39% reporting feelings of loneliness or isolation. There were also signs of strain and conflict in the young people’s relationships with those in their household.

Around one-quarter of the sample reported a lack of personal space or alone time, while 16% reported experiencing greater tension and conflict in the household. These outcomes increased young adults’ chances of experiencing a major decline in mental health during the lockdown period.

However, the effects of stay-at-home restrictions were not inherently negative. For many young adults, restrictions provided more time for themselves (38%) and encouraged stronger relationships with partners or family (33%). These outcomes were associated with significantly lower chances of a decline in mental health.



It’s vital young people have good access to youth mental health services in the months ahead so their mental health doesn’t continue to drastically decline. This is particularly the case for young people who may be less able to turn to parents, partners or friends for help.

Research has consistently found young people with mental health issues are the least likely to seek out mental health information and access professional help when they need it.




Read more:
As ‘lockdown fatigue’ sets in, the toll on mental health will require an urgent response


There is hope that the collective experience of social distancing during COVID-19 may have helped reduce some of the stigma associated with seeking help. If this is the case, we must seize the opportunity to learn from the experience of the young people in our cohort and the Australians they represent.

For mental health, go to Lifeline Australia on 13 11 14 or Beyond Blue 1300 22 4636The Conversation

Zlatko Skrbis, Provost, Australian Catholic University; Jacqueline Laughland-Booy, Research Fellow in Sociology, Australian Catholic University, and Jonathan Smith, Postdoctoral Research Fellow, Australian Catholic University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social activity can be good for mental health, but whether you benefit depends on how many friends you have



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Ziggi Ivan Santini, University of Southern Denmark; Paul E. Jose, Te Herenga Waka — Victoria University of Wellington; Robin Dunbar, University of Oxford, and Vibeke Jenny Koushede, University of Copenhagen

We know having friends is generally good for your happiness and mental well-being. Likewise, keeping socially active and engaging in formal social activities like volunteering has been linked to better mental health.

But it is also possible to have (or do) too much of a good thing. In a recent study, we tracked people aged 50 and older from 13 European countries over a two-year period to explore how volunteering, education, involvement in religious or political groups, or participating in sport or social clubs influenced their mental health.

We also looked at how many close social relationships people had — the kind of relationships in which they would discuss important personal matters. We found social activities especially benefited individuals who were relatively socially isolated (with three or fewer close relationships).

For people with a higher number of close relationships, engaging in social activities did not appear to enhance mental health. It could even be detrimental for some.

Who benefits from social activities

Social isolation is a major health issue. Apart from compromising the mental health of isolated individuals, it is linked to many other adverse health outcomes, including dementia, heart disease and stroke and premature death. But people who experience social isolation can take steps to improve their situation – for example, by engaging in formal social activities.




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Among individuals who were relatively socially isolated (people with three or fewer close relationships), we found more engagement in social activities was linked to improved quality of life and fewer symptoms of depression.

On a population level, our estimates suggest if such people were to engage regularly in social activities, we would see a 5-12% increase in people reporting better quality of life and a 4-8% reduction in people experiencing symptoms of depression. This would be a substantial change to population mental health, given more than 70% of people in our sample (aged 50+, in Europe) have three or fewer close relationships.

There are many reasons being socially active is linked to better mental health and well-being. Social activities can be a way to establish new relationships, provide opportunities for social support and foster a sense of belonging within a community.

People clearing weeds
Social activities can increase a sense of belonging within a group.
Shutterstock/Syda Productions

‘Too much’ social activity

While research so far has suggested having more social relationships is always better, our study indicates this may not be the case. Just like too much physical activity can compromise mental health, too much social activity can also backfire.

When we looked at how the study variables (quality of life, symptoms of depression) mapped against our two variables of interest (number of social activities, number of close relationships), we found U-shaped curves. That is, poor mental health at low levels of social activity, good mental health at moderate levels of social activity, and again poor mental health at high levels of social activity.




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Depression appeared to be minimised when people reported having four to five close relationships and being engaged in social activities on a weekly basis. Any more social activity than this, and the benefits started to decline, disappear or turn negative.

This downturn was particularly clear among individuals reporting seven or more close relationships. For these very busy people, engaging in social activities was linked to an increase in depressive symptoms.

Woman under stress.
Too much social activity can backfire and lead to exhaustion.
Shutterstock/Maksim Shmeljov

People typically report having an average of five close friends. Extroverts tend to report having more friends, but pay the price of having weaker friendships.

Because our social capital (essentially the time we have to devote to social interactions) is limited and roughly the same for everyone, extroverts in effect prefer to spread their social efforts thinly among many people. This is in contrast to introverts who prefer to focus their social efforts on fewer people to ensure those friendships really work well.

This trade-off is at the core of our capacity to engage in social activities. If you engage in too many, your social time is spread thinly among them. That thin investment might result in you becoming a peripheral member of numerous groups in the community rather than being embedded in the social centre where you can benefit from the support of your connections.

Another possibility is that too much social activity becomes a stress factor. This can lead to negative outcomes, such as social over-commitment, emotional and cognitive exhaustion, fatigue or feelings of guilt when social relationships are not properly nurtured because of limited time.

This raises another important consideration, albeit one we were not able to investigate empirically in our study. Family is an important part of our social world, not least in terms of the emotional and other support it provides. Devoting too much time to community activities means less time for family. That bottleneck might well prove to be detrimental to well-being because of the strain it could impose on family relationships.

So what’s the take-home message? Perhaps just this: if you want to live a happy and fulfilled life, be actively social — but do so in moderation.The Conversation

Ziggi Ivan Santini, Postdoctoral associate, University of Southern Denmark; Paul E. Jose, Professor of Psychology, Te Herenga Waka — Victoria University of Wellington; Robin Dunbar, Professor of Evolutionary Psychology, Department of Experimental Psycology, University of Oxford, and Vibeke Jenny Koushede, Head of the Department of Psychology, University of Copenhagen

This article is republished from The Conversation under a Creative Commons license. Read the original article.