Tuesday, November 4, 2008

Pets are Therapeutic

It can be beneficial for mental and physical health to have a pet, for the following reasons:

1) pets offer companionship, and therefore may help people to cope with loneliness. At times I have seen relationships with pets be strong protective factors against suicide.
2) many pets, particularly dogs, may help their owners get outside regularly for exercise
3) dogs in particular may act as social catalysts, making it more likely to meet and converse with new people (this could happen while dog-walking).
4) the requirements of caring for a pet may add some structure and an external focus to daily activities, which can be healthy

For some people, having a pet can be more problematic, particularly if it is not possible, for health or economic reasons, to care for the pet adequately. And some people may have pets for unhealthy reasons (e.g. acquiring a large, vicious dog, encouraging its aggressiveness, or failing to train it adequately for safety).

The evidence on health benefits from pet ownership is actually a bit weak. I think part of this is due to inadequate studies on the subject. Also, in order for a pet to have a healthy emotional effect, there would have to be a good "match" between pet & owner, and adequate support for a healthy relationship to develop. Just as in human-human relationships, some people may choose a type of relationship that is not healthy or sustainable for them.

Here's a link to a review on pet ownership and human health:
http://www.ncbi.nlm.nih.gov/pubmed/16308387

Contact with animals can be therapeutic in other ways. There is a lot of anecdotal evidence about the merits of therapy animals. Dogs and cats are examples, but so are large animals such as horses.
Here are references to papers describing the benefits of "animal assisted therapy" with larger animals:
http://www.ncbi.nlm.nih.gov/pubmed/17444990

http://www.ncbi.nlm.nih.gov/pubmed/18405352

Here are some references about the benefits of therapy dogs:
http://www.ncbi.nlm.nih.gov/pubmed/17714002

http://www.ncbi.nlm.nih.gov/pubmed/15293482

I could not find very much in the research literature about "therapy cats"--but I think having a pet cat can be therapeutic.

Sunday, November 2, 2008

How to make friends

There are many reasons why a person could have trouble making friends; here are a few:

1) shyness (social anxiety)
2) depression (with resulting lack of energy & motivation)
3) difficulty with social skills (in initiating contact or communication with new people, with continuing on after an introductory contact, or with maintaining healthy ongoing friendships)
4) difficulty finding a community of accepting peers, despite having addressed other factors, such as #1-3 above. So, for example, a person with a particular lifestyle or cultural interest may not be able to find many people with whom to share this in the local community.
5) sometimes there may be qualities about a person's behaviour that cause others not to want a friendship (e.g. recurring temper tantrums or other overt manifestations of hostility).
6) lack of time, energy, or money

Here are some ways to address the problem of making friends:

1) treat shyness. Pharmacologically and psychotherapeutically. Strong effort needs to be spent on practicing cognitive-behavioural techniques. I encourage all who believe they may be shy to start by reading some of the many books on the subject of shyness.
2) treat depression
3) Learn about social skills. This can start with reading. A therapy group of almost any sort can be a good resource. Psychotherapy can be a setting to practice social skills. Other activities can be great places to practice, such as taking a class, joining a group, Toastmaster's, etc. Skills have to be practiced. The skills need to be practiced in all three domains (initiating communication with new people, continuing on to the next step following an introduction, and maintaining ongoing positive communication and activity within existing friendships).
4) Identify individual lifestyle and cultural interests, and deliberately seek out groups that can share in this (for example, regarding music, the arts, orientation/identity issues, hobbies, sports). Be willing to at least slightly expand your horizons of cultural interest & involvement. If you have a healthy solitary interest, try to make it a healthy group interest.
5) Identify factors within oneself that may make it hard for someone to befriend you (e.g. temper problems, refusal to allow closeness, etc.) Be very honest with yourself about this. The gentle feedback or support from a therapist can help. It needs to be emphasized, though, that in a depressed state, many people believe they are unattractive for a variety of reasons, and this type of thinking about self can be a symptom of the depression. If you falsely believe that people don't like you -- for any reason -- then your social actions may lead you to become more isolated and alone.
6) Time, energy, and money may need to be set aside, to allow for the development of a social life. There are many community resources that are free, or that may specifically welcome and try to help those in economic need. Maybe your community does not have enough of these types of resources--if this is the case I hope there is the possibility that you can find a different community that does have enough.

In today's world, we of course have access to "virtual communities" and other types of relationship-building that can be done on the internet. I think the internet is a powerful resource, and can be very helpful for making friends, or practicing social skills. But the medium of the internet can itself be addictive, so this needs to be watched for. Some people may spend so much time on internet relationship sites that their non-internet relationship life may be shrinking rather than growing.

A brief google search on the internet with the name of your city or town plus "social networking" or "meetup" may yield a variety of possible real-life social groups to consider joining, some of them geared towards simple friendship, others may be oriented towards a particular activity, others especially for people who are shy, etc.

Here are some of the explanations people have given me about their difficulty making friends:

1) "I'm not attractive enough"
2) "This city is unfriendly"
3) "I can't be bothered"
4) "It's not worth the risk"
5) "I'm too busy"
6) "I'd rather be alone"
7) "I would be/am a burden on other people"

All of these explanations need to be addressed and challenged.
1) Beliefs about unattractiveness are a powerful social obstacle, because they cause the person who feels unattractive to withdraw, assume in advance that others don't like them, etc. Also a belief about innate unattractiveness can cause a person to be resigned to this false belief, such that actual esthetic enjoyments--including superficial but important things such as choice of attire, "spa treatments", etc.--may be unnecessarily avoided
2) While it may well be true that certain cultures or parts of the world have more or less social opportunities and a more or less socially engaging style, I find most complaints about the "unfriendly city" to be projections of one's own social frustrations onto the fairly neutral ground of the geographic city. I would encourage people to do what they can, with an open heart and mind, right where they are geographically, rather than contemplate a move right away to some supposedly more friendly place.
3 - 5) Friendship-building requires energy, and can be frustrating. There is a component of risk, at the very least of being disappointed. I stand by the advice that friendship-building is a necessary health activity for everyone, as is daily exercise of some sort. So it is necessary for your health to bother with it.
6) We all require solitude. Some of us are most comfortable alone. Many of us desire more closeness or intimacy, but have become resigned, such that we tolerate having very little. It can be a symptom of depression to become more and more isolated. Isolative resignation is a problem that needs to be worked on in the treatment of depression.
7) Belief in being a burden is another depressive assumption, just like feeling unattractive. It is time to let go of this kind of belief. Every relationship does require give and take, though, and it can be part of the process of practicing social/relationship skills to be observant of the general balance in your friendships, so that no one feels that the relationships are one-sided.

Tuesday, October 28, 2008

Statistics

Most research findings include a lot of statistical analysis of data, and many of the conclusions or assertions made in research papers are based on the statistical analysis.

This is a major advance in the science of analyzing and interpreting data.

Yet, there are a few complaints I have about the way statistical analyses are reported:

The application of statistics is meant to give the reader a very clear, objective summary of what data show, or what data mean. The spirit is neutral objectivity, without the biases of arbitrary subjective opinion or judgment, of people "eyeballing" the data and concluding there is something meaningful there, when in fact there is not.

Yet, in most statistical summaries of research data, the words "significant" and "not significant" are frequently used. The criterion for "significance", however, is arbitrarily determined. It is part of the research, or the statistical, culture, to consider that a "significant" difference means that the data shows a difference that could be due to random chance only 5% of the time or less. If the data show a difference which could be due to randomness with a probability of 6%, then the difference would be reported as "non-significant".
This is an intrusion of human-generated arbitrariness into what is supposed to be an objective, clear analysis of data.

What I feel is a much more accurate way to report on a statistical analysis in a research paper is the following:

the probability ("P value") of a difference being due to chance, rather than to a real difference, should always be given prominently in the paper, and in the abstract, rather than the words "significant" or "non-significant". The reader can then decide whether the finding is significant or not.

As far as I'm concerned, any P value less than 0.5 (50%) carries some degree of significance to it, and the reader of a paper or abstract deserves to see this value prominently given. And it seems absurd to me that results showing a P value of 0.06 would be deemed "non-significant" while results with a P value of 0.05 would be "significant".

**note: there are more rigorous and precise definitions for the statistical terms above, I use a somewhat simplified definition to make my general point more clear and accessible; I encourage the interested reader to research the exact definitions.

Another thought I've had is that, when it comes to clinical decision-making, "eyeballing" the data-- provided the data are fairly represented (for example, on a clear graph which includes the point {0,0} ) --can often lead to more intuitively accurate interpretations than some kind of numerical statistical summary. There is more information represented visually in a graph than in a single number which summarizes the graph, in the same way that there is more information in a photograph than in a number which summarizes some quality about the photograph.

The biggest advantage of sophisticated statistical summaries lies in optimizing research resources, such that we can re-direct our attention away from treatments that work less well, and focus instead on treatments that work better, particularly if there are limited resources, and if a given treatment could determine survival (or not). Also, if there is abundant data, but little way of understanding the data well, then a good statistical analysis can guide treatment decisions. It may help to choose the best chemotherapy drug for cancer, or the best regimen to manage a heart attack. For depression, though, and perhaps other mental illnesses, the statistical analyses can often add more "fuzziness" and distortion to clinical judgment, unless the reader has a sharp eye to recognize the many sources of bias.

Monday, October 27, 2008

Sugar

Many people believe that sugar (sucrose) intake causes behavioural problems. The two most common specific beliefs are that eating sugar causes worsened hyperactivity; or that eating sugar causes a rush of energy, followed by a plunge into fatigue as the sugar level "crashes".

In fact there have been a lot of very good studies looking at this, and the evidence is quite clear that sugar does not cause hyperactivity. There is an association between high sugar intake and antisocial behaviour, but the relationship is probably not causal. It is much more plausible that those with more antisocial behaviour in the first place happen to choose to consume more sugar.

In some of the prospective, randomized studies, in fact, individuals consuming sugar (instead of a placebo) did better, particularly in terms of learning tasks.

The evidence is also very clear that so-called "reactive hypoglycemia" is very rare, even in people who insist that they have it. However, there may be some individuals who become more irritable as their blood glucose level drops, even if the drop is not down to clinically hypoglycemic levels.

There is evidence that some individuals may respond adversely, in terms of their behaviour, to certain foods, but actually sugar is not a common such food, according to well-controlled studies.

I do affirm that moderating sugar intake, and also eating meals with a lower glycemic index, is part of overall good long-term health.

But most of the claims about sugar influencing behaviour adversely are part of a myth, not supported by clear evidence.

For an excellent review of the evidence on this matter, see this article by David Benton (May 2008):
http://www.informaworld.com/smpp/content~db=all?content=10.1080/10408390701407316

Friday, October 24, 2008

Chocolate is Good for You

There is evidence that dark chocolate is healthy for you in a variety of ways:

1) May reduce high blood pressure and improve other cardiac risk factors:
http://www.ncbi.nlm.nih.gov/pubmed/18716168

http://www.ncbi.nlm.nih.gov/pubmed/18827977


Here's a reference to an article in JAMA, one of the world's leading medical journals:
http://www.ncbi.nlm.nih.gov/pubmed/17609490

2) Here's a whimsical reference to a study suggesting that pregnant women who eat chocolate end up having babies with more positive temperaments, also these women may be more resilient to stress during the pregnancy
:
http://www.ncbi.nlm.nih.gov/pubmed/14757265

However, it should be acknowledged that many people have trouble moderating their chocolate intake. For some people with atypical depression or eating disorders, excessive chocolate consumption can be part of their unhealthy eating behaviours. Yet, it pleases me to know that chocolate (dark chocolate, or cocoa, in particular) is good for you (in moderation of course)