FOBTs and the review of the Gambling Act 2005

Gambling disorderOften dubbed the ‘crack cocaine of gambling’, Fixed Odds Betting Terminals (FOBTs) are electromechanical devices most commonly found in UK betting shops and allow players to bet on the outcome of various games, of which the most common are roulette and blackjack, and events with fixed odds.They have been in betting shops since 2002.

The Government recently announced a review into the legislation governing gambling adverts and FOBTs, and,more broadly, the functioning of the Gambling Act 2005. Tracey Crouch, the sports minister, said the review would consider the maximum stakes and prizes for gaming machines and, in particular, FOBTs because of concerns that they can be addictive. The Gambling Act had allowed betting shops to increase the number of FOBT machines allowed in betting shops, up to four, depending on size of shop. The review will also investigate the impact of advertising of betting websites on daytime television.

The Gambling Commission, set up under the Gambling Act 2005, is the body that regulates commercial gambling in the UK in partnership with licensing authorities. Its latest statistics show that in the 12 months to March 2016 punters lost a record £1.8 billion on FOBTS. Interestingly, the figures also show that online gambling is now the largest gambling sector in the UK.

FOBTs are also known as ‘electronic morphine’, because of their highly addictive nature. It is true that journalists often seek to sensationalise the story with such descriptions but the words are probably a fair portrayal because repeat players will become addicted to this form electronic gambling more rapidly than other forms of gambling such as sports betting and card games (reference: Dow Schull, Addiction by Design: Machine Gambling in Las Vegas 2014 Princeton University Press). The devices allow punters to bet £100 every 20 seconds. There are proposals that could see the minimum stake reduced to £2, as in the case of Australia. They are banned from betting shops in Ireland.

The extent of problem gambling

The British Gambling Prevalence Survey 2010 was the last bespoke gambling prevalence survey commissioned by the Gambling Commission.   From 2013 the body has pursued a decoupled approach to the collection of adult gambling prevalence data (i.e. the separate collection of participation and problem gambling data) through the Health Survey for England and the Scottish Health Survey. The rate of problem gambling in the adult population for England is estimated to be 0.5% or  0.4%, depending on how it is measured.   The latest combined data shows the overall problem gambling rate to be 0.7% but this would appear to be consistent with combined data from 2012 (0.6%). However, it should be noted that these are indicative figures and the new Health Survey data is due to be published in early 2017.

Derek Webb, who provides funding for the Campaign for Fairer Gambling and the Stop the FOBTs Campaign, advocated in The Time’s Thunderer (“Lower the stake on betting machines for addicts’ sake“, Oct 7) that there should be such a minimum staking policy on FOBTs. He argues that whilst Ireland banned the machines, UK players can stake up to £100 per spin and this puts users are grave risk.

According to the Gambling Commission the problem gambling rate has increased from 0.4% in the year to June 2013 to 1.5% in year to June 2016 amongst the 16-24 age group (these are, however, indicative figures taken from quarterly short-form PGSI data, whereas the full health survey results will be released in 2017).

Views of the industry on FOBTs

The Association of British Bookmakers Ltd  (ABB) dispute the view that FOBTs cause gambling problems. They are also against cutting stakes on FOBTS as such a decision to potentially solve problem gambling would be akin, in their minds, to cutting the alcohol level in whisky in the hope that this might stop individuals from becoming alcoholics. The ABB disputes that there is any evidence to demonstrate that FOBTs create problem gambling. They claim that independent research clearly shows that most people who develop a problem with gambling use different types of products.  They also claim that the level of problem gambling in the UK have remained unchanged over the past 15 years.

I checked the ABB claims with the Gambling Commission who told me the following:

We do not have data collected to a consistent methodology covering the last 15 years. Our most robust estimates of problem gambling, based on the largest sample sizes and comparable to the BGPS 2007 and 2010, will be published next year (2017) in our combined report on gambling behaviour, where the data will be taken from the Health Survey for England 2015, the Scottish Health Survey 2015 and our own Welsh Problem Gambling Survey 2015”.

The industry might claim that they should not be held responsible for problem behaviour in the same way as licenced vintners should not have to restrict selling whisky in case a person becomes alcoholic. However, the Gambling Act 2005 places social responsibility requirements on UK based gambling operators who are also required to contribute to research, education and treatment of problem gamblers (the Act essentially enshrined the principle of ‘polluter pays’ regarding gambling treatment).

A view from the legislators

Carolyn Harris MP, chair of the FOBTs All-Party parliamentary Group (APPG), believes that there is evidence to suggest that reducing stakes on FOBTs can help to reduce instances of problem gambling and such steps should be implemented immediately.

There appears to be stand-off between the industry and legislators, however,  since the ABB failed to show up for the latest APPG meeting in November 2016 stating that it’s ‘nothing but a kangaroo court.’

Newham Council in London, has, along with many other local authorities,  proposed a £2 maximum stake under the terms of the Sustainable Communities Act.

The treatment of gambling addiction

The three most common models of addiction are disease, choice, and self-medication and the most effective recovery programmes are dependent on how addiction is viewed. The disease model is advocated by Gamblers Anonymous (an off shoot of Alcoholics Anonymous) and holds that ‘recovery’ must entail abstinence for good, albeit one day at a time. Dr David Sack, a leading advocate of the disease model, argues that addiction is a disease and needs to be treated as such. A big critic of the disease model for treating addictions is Marc Lewis and he argues that treatments based on this model are ineffective. The choice model takes the view that addiction is free choice and that treatment should address different choices. Vietnam vets stopped taking heroin when they returned to their families and to their safe environment, for example. Trauma is the root cause of the self-medication model. PTSD, depression and anxiety disorders all hinge on an overactive amygdala but drugs, booze, gambling and so forth take you out of yourself and calm the amygdala down.

According to the Royal College of Psychiatrists there is no medication that is licensed for the treatment of problem gambling in the UK. However, antidepressants can be prescribed to help with low mood. Cognitive Behavioural Therapy (CBT) has been cited by the College as showing some effectiveness in helping gamblers reduce the amount of time and money they spend gambling and once stopped to stay stopped. In therapy, the therapist can be the detoxifying agent for the gambler’s toxic mentations.

Psychiatrists, such as Dr Henrietta Bowden-Jones, lead psychiatrist of the NHS National problem Gambling Clinic, has called for all gambling treatment service provision to be integrated within the existing network of drug and alcohol treatment services since gambling disorder is now acknowledged as a valid psychiatric condition. She points to the particular vulnerability of young people to problem gambling. She believes that this could be due to later maturation of the prefrontal cortex which can lead to higher levels of impulsivity, poor decision-making and a preference for immediate gratification. Television gambling adverts, she claims, shown during sporting events could be seen as priming the brain of the young.

When Donald Winnicott said there was no such thing as an infant (a baby is his environment), perhaps there is no such thing as just a drug user. It could be fruitful to ask what is happening in the user’s world? Bion described drug addiction as a ‘hatred of reality‘ and I wonder if a similar description could be applied to gambling addiction. There is certainly a loss of connection when gamblers recount stories of feeling empty and lonely.

‘The zone’ has been described by Natasha Dow Schull, in her book Addiction by Design, which showed how an electronic slot machine random number generator provides a reinforcement schedule that keeps the user in a trance-like state.  She describes this state of mind in greater detail in the attached presentation below. The ‘zone’ is akin to nothingness where the user relies on the comfort that the machine is forever present.  Once in the zone, problem gamblers use the machines not necessarily to win but rather to keep playing, for as long as possible. They continue to stay in this state in spite of physical and financial exhaustion. In this state, users have described even forgetting the names of their children, such is the hypnotic-like environment in which they exist.  The machine and person enter a form of emotional intimacy where fear and worries appear to fade away.

Betting shop machines have been designed with the maths in mind and digital machines now offer multiple-line betting, unlike the traditional analogue gaming machines which did not offer such opportunities.  An FOBT random number generator provides a reinforcement schedule that keeps the user in ‘the zone’ as machine designers have worked out how to harness gaming productivity to the optimum.

It seems to me that an abstinence based approach should form part of a robust treatment plan for problem gambling regardless of one’s addiction model. Reconnecting to one’s creative and vibrant self could form the basis of one’s therapeutic journey.

The evidence to claim that FOBTs create problem gambling might not be conclusive. What is fair to say, in my opinion, is that there was no proper impact assessment carried out when the decisions were taken to allow the expansion of FOBTs in betting shops in 2005 (and for pre-watershed gambling television advertising). That is perhaps the core of the issue that the Government’s review will need to contend with. It will be interesting to see what the review comes up with.

See also my article on FOBTs and how they are the crack cocaine of gambling

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The drama triangle and asking for your needs

I believe that transformation in psychotherapy is when insight is achieved into one’s historical ways of operating in the world, that are not serving well, and personal qualities are harnessed to bring about change and a different way of behaving with other individuals. Therapists from different modalities will often seek to accuntuate the theoretical differences between each other and point to their own particular (and unique) training but ultimately, however, I believe we are all behaviourists. After all, we are all trying to help our clients to bring about changes in their behaviour so that they can enjoy more effective relationships – whether that is in their personal, family or business lives.

Stephen Karpman, a student of Berne’s Transactional Analysis, coined the term ‘drama triangle’ when he outlined the roles of persecutor, rescuer and victim. My latest article is on the drama triangle and asking for your needs so that you can avoid the victim role.

For more information and background on the drama triangle see this video below:

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There’s No Place like Phone

Noel Bell Channel 5 newsThe sixth annual Deloitte report There’s No Place like Phone, which analyses the mobile usage habits of more than 4,000 UK consumers, was released today.

The report was covered widely across the national media. Channel 5 News covered the story on their main news and spoke to consumers, journalists and myself about the issue. See below for the embedded link to the news item (I spoke briefly at 1:03).

The UK public has never been more ‘addicted’ to smartphones, according to the survey. The report uses June 2016 as a foundation to claim that four out of five UK adults (81%) have a smartphone. This percentage rises to 90% when the 18-24 year olds cohort is reviewed.

The key findings of the report are:

  • Nearly 50% of the age group 18-24 check their device in the middle of the night.
  • The adoption rate of 4G usage has more than doubled in the past 12 months (up from from 25% to 54%).
  • 31% of those smartphone users surveyed did not make any traditional voice calls in a given week. (This contrasts with 25% in 2015, and just 4% in 2012).
  • The majority of those who participated have downloaded 20 or fewer apps.

The word ‘addiction’ is difficult for many clinicians in the medical world. Strictly speaking it is a misnomer to call even heavy smartphone usage an addiction. Psychiatrists recognise Gambling Disorder as the only behavioural (non-substance related) addiction. Their bible is the Diagnostic Statistical Manual (DSM), the American Psychiatric Association (APA) diagnostic tool, currently in its 5th iteration, and does not include smartphone usage as a problem. Internet Gaming Disorder is, though, listed in section 3 of DSM-5 as “conditions for further study”. However, in common with other behavioural problems like sex addiction, counsellors and therapists have lots of anecdotal evidence that alludes to a growing problem of preoccupation and obsession.

If you think you have a behavioural problem with your smartphone take a look at whether you identify with some of the points to consider in the need for digital detox and how to set boundaries around your engagement with technology.

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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

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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:

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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.

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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.

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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.

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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

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