Men are at greater risk of physical illness from chronic anxiety

ecnpA major research study from the European College of Neuropsychopharmacology (ECNP) and the University of Cambridge reported on its findings earlier this week. The study involved tracking over 16000 Britons over a period of 15 years and found that men who suffered from anxiety were more at risk of dying from cancer as those men who don’t suffer from anxiety. It also found that the correlation held true regardless of other risk factors to cancer such as the levels of alcohol consumption, smoking and the rate of physical activity. There were a few standout points from the study. One of which was that the association was not shared by women.

Why are men more likely to suffer greater physical risk from chronic anxiety?

The results of this new study lend another piece of evidence that links chronic fretfulness to  sickness and death in males. However, the evidence still leave doubts over why this should be. An obvious, and perhaps lazy, explanation might be that men tend to smoke and drink more alcohol and don’t look after themselves as well as women. However, after researchers compensated for those factors, the strong association remained.

There are other studies that could add weight to the recent study to show the greater risk of physical illness from chronic anxiety (thanks to a Times2 article on the subject by John Naish).

A Finnish study in 2014, that tracked middle aged men for over 23 years, found that men who scored highly for anxiety were more vulnerable to the risk of death from all causes, not just from cancer.

A recent University of Edinburgh study found that those with ‘subclinical’ depression or anxiety had a 29 per cent increased risk of dying from heart disease and stroke over a decade than those who did not. ‘Subclinical’ is a term used to define a scenario whereby sufferers thought it unworthy of medical attention. It must be said that Dr Tom Russ, who led the study, is not saying that anxiety actually causes illness. His point is that the results of the study may show an association but the proof for causation might not be present. For instance, it could be that individuals with undiagnosed cancers suffer from pains that cause anxiety, although that doesn’t appear to explain it fully.

men-and-anxietyIt could be that chronic anxiety in men causes physical reactions that ignite the body’s defences, thereby sparking long-term inflammation that in turn may cause a wide range of illnesses such as cancer. For example, psychiatrists at the VU University Medical Center in Amsterdam reported that  men who develop anxiety disorders in adult life show significantly raised levels of inflammatory chemicals in their bloodstream, such as C-reactive protein (CRP), a phenomenon not occurring with women. CRP is not in itself necessarily harmful, as it can play a very useful role in the immune system such as protecting against the threat of infections, but can be dangerous if they persist at chronic levels. In particular, they are linked to a raised risk of developing cancers, heart disease and even diabetes. The production of CRP can also occur from sleep disturbance associated with anxiety.

Furthermore, psychiatrists at the Emory University School of Medicine reported that chronically raised levels of inflammatory chemicals can cause the brain’s centres, that initiate our fight-or-flight response, to become overactive (an area of our brain called the hypothalamus).

gut-fear“Gut fear”, that wrenching physical symptom of anxiety when your body is telling you to watch out because there is danger ahead, seems to have a physical affect on the brain. Evidence points to how inflamed stomachs damage our mental states, through neurological links such as the vagus nerve, which links our gut and brain, and by changing the balance of the billions of bacteria that thrive in our guts. For a full explanation on the physical symptoms of anxiety see the Anxiety UK website.

Scientists at the University of Exeter found that when people with depression, a common result of chronic anxiety, were given drugs to block the effect of their bodies’ inflammatory chemicals, their symptoms were mildly alleviated.

Such evidence clearly demonstrates the need for men to take seriously the deadly impact of anxiety.  Therapy can be a lifesaver for men but they invariably only attend when things are at a crisis point in their lives. We all need to address why men find it so difficult to reach out for support and there are no easy answers.

For more information on what works for the treatment of anxiety see my most recent article on Manxiety: The Importance of Men addressing their anxiety.

See also:

The acute mental health needs of men
Engage with the power of imagination to ease anxiety
Help your brain to reduce anxiety
Self discipline exercises that will ease your anxiety
Anxiety UK – for information on symptoms

Why would hetrosexual men search for ‘shemale’ porn?

Whilst researching for my recent articles Why sexual fantasies can be healthy in a strong relationship and Are you he, she or non-binary in gender identity?, I came across some interesting data on human sexuality as a result of a recent publication on the search habits of men and women. Numerous authors over the years such as Nancy Friday and Jesse Bering have helped us to understand the importance of avoiding shame when fantasising about sex. More recently Ogi Ogas and Sai Gaddam have contributed another useful insight. They were given access to extensive AOL web search datasets for a period of time (anonymised, of course) and they tracked more than 1 billion searches by seekers of sexual excitement. Their book “A Billion Wicked Thoughts” is the result and it reveals some interesting insights.

FutanariHetrosexual men use the search term ‘penis’ as often as ‘vagina’ when looking for porn online. That might not be too surprising given that men might be keen to check out their competition. However, it becomes more interesting when the results of eye tracking studies are known. Straight men will look at the crotch area of other men more often than women will do. It gets more intriguing for the category of ‘shemale’ porn, sometimes known as futanari (see picture, opposite). This is primarily the interest of hetrosexual men, since women and gay men show little interest in it. (The authors are quick, quite rightly, to point out that the ‘shemale’ term is a derogatory term in the trans community, as it almost exclusively a term used in the adult porn world).

So, why would hetrosexual (not bisexual) men search for ‘shemale’ porn?  Well, the authors explain the phenomenon of this category of porn as combining the penis with the other main anatomical cues for desire amongst straight men (the other main cues being breasts, feet and backsides). Ogas and Gaddam believe that this represents an erotical illusion for straight men, thus creating a single gestalt. There is, for the most part, no obvious hidden gay or bisexual tendencies as such, but the fantasy finds expression in this form as it comprises biological cues for desire. The fantasy essentially tricks the male sexual brain (male erotical illusions are mostly visual, since the male sexual brain consists primarily of visual cues). Gay men are also as interested in the same anatomical cues as straight men, namely chests, feet, backsides and penis, obviously.

Intriguingly, the most common erotical illusion for women, by search terms, turned out to be vampires and the whole paranormal genre of romance. Perhaps the datasets comprised overwhelming numbers of American residents. Female erotical illusions are mostly psychological, since, generally speaking, the female sexual brain consists primarily of psychological cues.

Ogas and Gaddam have been heavily criticised by academics for their research methodology and for their generalisations (for example, of course, women can also separate their physical desire cues from their psychological cues and can also enjoy fetish) and for their interpretations based upon the datasets, which, for some, amounted to sexist and stereotypical attitudes. However, whilst some of the criticisms have been valid, their book is still a good read and a useful insight into the whole area of human sexuality.

Ogas and Gaddam explain the findings of their datasets more fully in the following clips:

Digital detox from smartphone addiction

ofcom-logoThe latest Ofcom research into internet usage informs us that fifteen million UK internet users have taken steps to ‘digitally detox’ in an attempt to establish a more healthy balance between technology and ‘real life’. The Communications Market 2016 (August) is Ofcom’s thirteenth annual Communications Market report.  The key findings from the latest report found that roughly one in three of adult internet users has specifically sought a period of time offline. For those unfamiliar with Ofcom, they are the communications regulator in the UK (similar to the Federal Communications Commision in the USA).

Noel Bell ITV Good Morning BritainITV’s Good Morning Britain featured the story in their edition yesterday and invited me onto the show to talk about addiction to smartphones and digital detox. They also invited a family who had undertaken an experiment of having dinner but only communicating by messaging around the dinner table as an attempt to understand how we miss out on social cues by engaging exclusively by electronic means.

I am often asked what constitutes addiction.  For me, addiction is a serious bad habit, can be highly condensed, reinforced and consolidated across many neural networks. Fear is a huge factor in all addictions and every addiction has a stress factor. Addiction can be present when you are doing something repeatedly and negative effects start to occur in other areas of your life. You find it very difficult to cut down the activity when you seek to regulate the behaviour. But according to the medical view, Gambling disorder is the only behavioural (non-substance related) addiction, as it’s the only one included in the Diagnostic Statistical Manual (DSM), currently in its 5th iteration.  DSM is how psychiatrists diagnose ‘mental disorders’. As an aside, pathological gambling had long been considered by the American Psychiatric Association to be an ‘impulse control disorder’, rather than an addiction. Internet gaming disorder (psychiatrists just love to pathologize with words like disorder, don’t they?) is, however, listed in section 3 of DSM-5 as “conditions for further study”. So, presumably there may be room for smartphone addiction in future iterations of the Manual.

How do you know if you have a problem with mobile devices?

Here are a few general questions you could explore about your relationship with your smartphone:

  • Do you use your smartphone more than you are comfortable with?
  • Do you panic when there is no cell coverage or wifi connection?
  • Do you neglect social interaction with friends and family by spending excessive amounts of time on your device?
  • Do you use your smartphone to gamble and spend more time (and money) than you had planned?
  • Do you sext with strangers and regret it afterwards?
  • Have you been the victim of revenge porn?
  • Do you compulsively use adult chat rooms, even when you don’t want to?
  • Do you start to feel lonely or depressed as a result of excessive engagement with social media?
  • Do you bring your phone to bed?
  • Do you feel increasingly stressed from feeling the need to answer work emails beyond the contracted work hours?
  • Is your sleep disturbed from excessive smartphone usage?
  • Do you spend excessive time on dating apps?
  • Do you lose interest in having sex with your partner?

You may have a problem if you are finding it more difficult to concentrate on daily tasks at home or at work, if you are concealing the amount of time spent on mobile devices, if you have a fear of missing out (FoMo) and have a sense of dread or panic if you leave your phone at home. Common withdrawal symptoms from smartphone addiction are anger/irritability, restlessness, sleep problems, difficulty concentrating and craving access to your device.

Treatment options

We all need to use online services from statutory services so a complete abstinence based approach is problematical. Indeed we need to be online to progress in careers and to connect with people. However, we can take steps to reduce our reliance on our devices. We can try to set goals for device-free times. We can set our phones to airplane mode during the day and especially at night. We can try to avoid reading work emails beyond certain times,as well as turning devices off two hours before sleep so we comply with sleep hygiene requirements.

If you think you have a problem, you could also consider not bringing mobile devices to bed and removing social media apps from phones. Maybe you could try to refrain from the constant checking of social media updates. See how you cope. If you begin to feel empty, moody and depressed as a result of putting in boundaries you could be experiencing a form of withdrawal.

Considering doing these steps might tell you all you need to know. How does it feel to potentially implement some of these suggestions? Does it seem reasonable or do these suggestions fill you with dread?

Seeing a therapist can be useful to motivate you to set boundaries with your mobile device usage and to address problem behaviour. You could explore what is behind your intense need to feel connected and learn to cope better with everyday anxiety. Therapy could be a means of building your coping skills to better help you to deal with boredom, rejections, loneliness and worry. There can, of course, be underlying issues with depression which might be worth exploring so it may be appropriate to go and see your GP too.

Making better decisions

making better decisionsI always find it interesting when people not trained in psychology adopt tools, techniques and insights from the field and start to practice them in their particular area. Sports coaches are increasingly using psychological insights to improve elite performance in individual and teams sports.  Another area is the investment sector to boost one’s ability to improve upon their decision making. Michael J. Mauboussin, an investment strategist, has written a well researched book entitled ‘Think Twice – Harnessing the Power of Counter Intuition’ and has produced an interesting set of statistics, case studies and self-help tips to help improve the way we make decisions.

The power of intuition was an influential theme running through my psychotherapy training.  But, intriguingly, whilst Mauboussin encourages us to trust our intuition in the decision making process, he also cautions against overly relying upon it.

We all make poor decisions in all aspects of our lives from time to time. Even the people with the finest brainpower regularly make mistakes. The 2008 financial crisis is a classic example of that. Nobody embarks upon their day with the intent of making poor decisions. Poor decisions can emanate from cognitive biases and a failure to spot when we are acting from a blind spot. So, how might a person prevent new distortions from arising and bring more awareness to their distorted thinking?

The business of decision making can be highly complex. However, by instigating a few simple, yet counterintuitive habits, we can position ourselves to make better decisions.  See my article on Counselling Directory for some ideas to help improve your capacity to make better decisions more often.

My interview with Robin Shohet

Yesterday I had the opportunity to chat with Robin Shohet  and discussed with him consultative supervision, how he understands appreciative enquiry and the nature of personal therapy and clinical supervision.

Robin’s publications in the field of psychotherapy include the hugely influential book Supervision in the Helping Professions, which he co-authored with Professor Peter Hawkins, first published in 1989. In 2007 he edited Passionate Supervision and Supervision as Transformation in 2011. More recently he co-edited Clinical Supervision in the Medical Profession with Dr David Owen, and contributed a chapter on resistance.

Robin mentioned a couple of links in the interview, one being Zoe Cohen and shame in supervision and Benjamin Zander on the Art of Possibility.

To-do lists and how to help your brain run more efficiently

listsI have often wondered whether the compiling of to-do lists merely fuel our anxiety or help to ease our worry in an era of information overload. If you are anything like me you might fret about the unfinished tasks on a list rather than rejoice about the accomplishment of the tasks that you do manage to finish. There is no doubt that it feels good to tick a task as completed but what about the ones that get left as unfinished at the end of the day? It is interesting what Daniel Levitin, author of The Organized Mind, has been saying about how we can help our brains run more efficiently by devising categories within lists so that we are more productive. Apparently, our brains can only hold between four to seven pieces of information at any one time. This is when lists, containing categories of tasks, can help to offload a lot of the difficult work of the brain into the environment. Index cards, with short lists, can be very useful when making presentations or preparing for exams.

Andy Murray motivational speechThe current Wimbledon tennis champion Andy Murray was once a little bit wayward with the disclosure of his list in the form of motivational tips. A journalist at the Rotterdam Open in 2015 snapped a list of his motivational tips courtside (see picture, opposite) which contained some of the following:

  • be good to yourself
  • try your best
  • be proactive during points
  • focus on each point and the process
  • try to be the one dictating
  • stay low on passes and use your legs.

Sir Richard Branson once said “I live by to-do lists” but the key, for him, was to actually do them.  So, can lists help to make your brain run more efficiently for you and are you curious about the possibility of boosting your levels of productivity? Why not give it a try. What’s the worst that can happen?

Learning to cope with having unfinished tasks on your to-do list at the end of the day might be your biggest challenge. For more information on lists see my article: How to organise your brain more efficiently

The acute mental health needs of men

men and depressionThe Men’s Health Forum men’s health week takes place this week and when one considers the mental health risks for men the statistics are alarming.Take, for example, the male suicide rate. The latest official figures for male suicide in the UK show 16.8 deaths per 100,000 of the population in 2014 (social researchers compare populations per 100,000 in order to offer a like for like comparison across countries of different demographic sizes). The rate for men is more alarming when you realise that the suicide rate for women was 5.2 deaths per 100,000 of the population.

The reasons for the disparity in rates of suicide between the sexes can be complex and multifaceted. However, I wonder how the psychotherapy profession can better target the specific mental health needs of men since two thirds of those seeking counselling in the UK are women (source NHS Improving Access to Psychological Therapies). I feel it is a worthy question to ask what more can be done to better attract men. As an aside, I was always intrigued during my psychotherapy training why so many trainees excluded men in their recruitment of participants for their workshops (workshops were part of the route to qualification in the final year of the study programme). Time and time again one would see workshop facilitators advertise for participants, invariably seeking to hold yet another workshop on contacting the inner goddess, and excluding men from participating in their experiential workshops. It is worth speculating if this ingrained bias against the inclusion of men might be a reflection of a greater bias in the provision of support services in counselling and psychotherapy.

I am reminded of this when considering the critical issues affecting men and ask myself whether men really feel heard.  Take, for example, depression, which in men can be difficult to spot since it can often be signalled by displays of angry behaviour in social situations. Can their anger be contained in therapy sessions or are men seen as a threat and better referred on to ‘anger specialists’ for their therapy?

Men are so often taught to believe that any problem must be solved by them, alone. In spite of the acute mental health needs of men, they are often reluctant to engage with the process of therapy. When they finally find themselves actually seeking therapy it is usually when things have reached crisis levels in their lives, when their jobs, relationships and homelife are at risk. They might also be coming as they are being pushed in the door by an insistent partner, often offering an ultimatum. Addressing the acute mental health needs of men must be a priority for us all.

See my article on how Therapy can be a lifesaver for men.


The Samaritans also offers a crisis listening service. Their telephone number is 116 123, which thankfully is now free, having previously been an 0845 number.
Men’s Health Forum offer a range of health promotion support materials for men.

Existentialism and integral studies

Existential thinkingIncorporating existential thinking into an integrative approach to psychotherapeutic practice has always been a huge influence for me.  An existential approach may have its limitations but there are a number of ideas within the approach, not that the approach is always coherent and uniform, that can be of enormous benefit when seeking to view the whole person in therapy. Take, for example, the ‘ultimate concerns’ or also known as the givens in life; inevitability of death, isolation/aloneness, freedom/responsibility and a search for meaning. It can be beneficial to view life struggles and associated psychological stress from the framework of how we relate to these concerns.  Do we, for example, engage in addictive behaviour as attempts at making connection and forging meaning in our lives? Do we stay in unhealthy relationships to avoid the fear of aloneness? Do we stay busy to avoid the anxiety associated with these concerns? Have we reconciled ourselves to the inevitability of our own physical demise?

Sometimes these questions are forced upon us, such as at times of great distress due to health matters, but it need not be that way. Once we begin to align ourselves to the challenges presented by the ultimate concerns we can achieve a new freedom in the present moment. New energy is found to live more meaningfully today. This is what it means to be truly present. An old sage once said that it is crucial to avoid the danger of getting to the day of your death only to realise that you have never lived.

See also my latest article on aligning to the four givens in life as a way of setting yourself free.

The concept of unconscious competence and how to avoid meltdown at work

Pressure to outperformI recall a lecturer from my psychotherapy training saying during a lecture that experiencing anxiety when about to give a presentation was due to incompetence and a failure to prepare.  I remember thinking at the time that this view seemed a bit harsh.  What about people suffering the symptoms of GAD, I thought, when physical symptoms of anxiety could pervade for no apparent reason, no matter what level of competence one had, or how well one prepared?  However, I see now that there can be times when we focus on what can go wrong rather than on what can go right and that this can contribute to our anxious state of mind. That’s when we allow our thinking to induce a meltdown. It is perfectly normal to feel nervous when facing challenges such as delivering an important presentation or completing an extensive set of important tasks at work. However, the real problem comes when we focus on the things that might go wrong.

Dave Alred‘s new book The Pressure Principle deals with how to boost performance and how to avoid meltdown.  Alred calls himself an elite performance coach (he was previously the personal coach to Jonny Wilkinson)  and maintains that we can use pressure (his term for stress) to perform as a vitalising energy to improve performance.  For footballers about to take a penalty kick, according to Alred, the key in achieving optimum performance is not to think about the fans reaction or the hostile press coverage in the event of missing, but to keep the focus on the one crucial moment which will help to stay in the moment and deliver. In that instance the focus needs to be on making connection between boot to ball, and nothing else.

Sports psychologists are not really saying anything new. Their attraction is in repackaging certain concepts in a digestible manner appropriate for the setting. For example, in psychology, there is the concept of the conscious competence learning model, or sometimes referred to as the four stages of competence. When learning a new skill this model helps inform us of the psychological states involved in the process of progressing from incompetence to competence.  The theory is that individuals are initially unaware of how little they know, so are unconscious of their incompetence. However, as they become aware of their incompetence, they acquire a skill on a conscious level, and consciously use that skill. Following more practice, the skill can be used without having to think it through. This is when someone has acquired “unconscious competence”; when they direct their focus on one tiny process it frees their unconscious mind to concentrate on the delivery. Think of when you are driving a car, you are in that mode. You are not consciously thinking of foot to pedal and co-ordination with the steering wheel, you do it seamlessly.

It is this concept of ‘unconscious competence’ that sports psychologists maintain is crucial in order to perform as champions. This is why sports teams try not to think too much about the preparation but rather to switch off mentally before the event. It is also when individuals go and do what they are best at doing, without thinking too much about it. They are in the zone. Sian Beilock has recently contributed to this field with her book Choke: What the Secrets of the Brain Reveal about Getting It Right When You Have to which explains the neuroscience of performance.

One example of choking can be seen here when World number 1 Rory McIlroy imploded and suffered a meltdown by missing simple shots in a major tournament.

Choking can also apply to performances in the arts and in business, or in any sector requiring peak performance. So, when giving a presentation you can avoid a meltdown by learning to cope with the physical symptoms of anxiety and avoid choking. For example, your focus should be on projecting your voice to the person in the back row (so that the whole room can hear you) rather than worrying about what could go wrong in your presentation.

For useful tips on how to avoid meltdown and to better understand the concept of “unconscious competence” see my article How to more easily avoid a meltdown at work.