Magic in practice 2nd ed, p.38
Magic in Practice (2nd ed), page 38
The former proposes an infinite number of potential realities, only one of which materializes when a specific action is taken, and the latter is based on recent research suggesting that memories are ‘reconstructed’ each time we access them.284 The pattern has subsequently proved useful in a wide range of situations, both as a stand-alone intervention and adjunctively with other treatments. When introducing the concept of alternative realities, it may be useful to refer to several popular films, such as Sliding Doors and The Matrix, which explore the theme.
Set up in parallel formation several ‘potential’ past time lines, including one that incorporates the accident or incident perceived as having caused the problem (Figure 21.2).
Have the patient float up and over the causal incident and back down on to that time line some considerable distance before the event.
Set up a ‘switch’ (the analogy of the rail switches used to divert trains onto another line is useful) just before the problem event.
Select an alternative line that events can switch to instead of following the old route through the problem event and beyond. Elicit as much detail as possible about the chosen alternative reality.
Have the patient move rapidly up the old reality, then switch to the new version, and on.
Repeat this at least five times, and then test.
Figure 21.2 The alternative reality pattern (seen from above). Instead of running from C to C and into the future, this pattern diverts the past at the switch, just before the problem event, to the ‘alternative reality’: C to B.
Dealing with multiple conditions
Patients will sometimes present with several loosely related problems. The practitioner’s options are as follows:
Have the patient arrange the problems in order of importance and suggest starting with the most important one, leaving the others for further consultations.
Suggest you both explore all the problems for any underlying or common factors. This process utilizes chunking and reframing.
Write a brief description of each problem in its own column.
Chunk each in turn for its positive intention. Ensure this is a core issue—that is, that the patient is unable to proceed any further.
Find the commonalities that all the problems share.
Chunk and/or reframe until a single, shared intention is identified.
Select the appropriate intervention and apply.
Test to ensure that changes are reflected in each problem area. Ensure that the core change generalizes out into all.
Future-pace each outcome individually.
Test again to ensure the appropriate changes have been made.
Case history: The patient was clinically obese, and his knee pain was so intense that he could only walk with sticks. He complained that he was bored, had lost all interest in life, and, while he knew he had to change his diet, was unable to find the motivation to do so. He also felt his wife was becoming increasingly distant, and he worried that she might leave him. Together, the practitioner and the patient agreed that: (1) his eating was seeking to buffer him against his general feelings of malaise; (2) his lack of motivation protected him from failure; and (3) his wife’s apparent withdrawal could mean she didn’t want to add to his problems, not necessarily that she wished to leave him.
All three intentions were reframed in positive terms: (1) feeling good; (2) succeeding in his efforts; and (3) re-engaging with his wife. In exploring for commonalities, the practitioner asked, ‘When you’ve become slimmer and fitter [the presupposition here is that he would become slimmer and fitter, not that he might do so], what will you be doing that these problems have prevented you from even considering until now?’ (This last question prompted a spontaneous chunking process and the patient identified a commonality he believed all his problems shared.)
The man looked down at the floor and began to cry softly. He said, ‘We used to take lovely walks in the countryside. I really want to do that again.’
When the man had dissipated enough distress to allow him to resume, the practitioner redirected the patient towards a plan that would gradually reduce his intake of food and increase his activity.
He was instructed to seek out his wife’s help maintaining his lifestyle changes, and planning walks in the country.
The patient started to leave in buoyant mood, excited about ‘getting my life back again’ and anxious to speak to his wife. When he was at the door, the practitioner called him back—to hand him the sticks he’d forgotten at the side of his chair.
The challenge of ‘Yes’
The following pattern, developed and used with considerable success by UK-based general practitioner and surgeon Dr. Naveed Akhtar, gains its effectiveness by eliciting both a sense of playfulness and a commitment to change—both important contributors to putting movement back into a life that appears ‘stuck’.
‘It seems that some people who are depressed, struggle to make decisions, refuse to socialize, and lack motivation. So I present them with the “Yes Game” as follows,’ he says.
‘When I’m confident that I have enough rapport with them, I suggest they try this exercise to see for themselves how their mood can change with just a simple shift in mindset.
‘All they have to do, I tell them, is to say, “Yes” to every invitation or suggestion they receive during one week. Of course, it has to be appropriate…nothing dangerous or upsetting. All suggestions must be within reason. But, apart from that, they must agree not to turn down anything that is asked of them.
‘This means, any time anyone invites them out, to go to a movie, or dinner, or try a new hobby, whatever it may be—they have to say, “Yes”… and follow through on the commitment.’
Our own experience with this pattern is: the better your engagement with the patient, the better the outcome. Plus, it’s always worth pointing out to those who agree that they’ve already said their first, ‘Yes’.
Case history: The husband of a 60-year-old lady died rather suddenly and unexpectedly. For several months, she became very depressed and reclusive. Her job as a primary school teacher started to become affected. She was prescribed anti-depressants and had several counseling sessions but there seemed to be very little improvement in her mood.
She would visit the GP often, and during one consultation mentioned that several of her friends and family members had asked her to go out with them, but she always refused. She felt guilty for going out when her husband was not around to go out with her.
She was then asked to play the ‘Yes Game’ as described above. Within a few short weeks, she was going out with friends and work colleagues, had started dancing again and met a nice gentleman with whom she had struck a close friendship. By committing to a set instruction she no longer felt guilty, having ‘permission’ to enjoy herself, and was able to move forward with her life.
Notes
273. Ogden P, Minton K, Pain C (2006) Trauma and the Body. New York: Norton.
274. Epel E, Blackburn E, Lin J, et al (2004) Accelerated telomere shortening in response to exposure to life stress. PNAS 101: 17312-17315.
275. Jacobs TL et al (2011) Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology 36(5): 664-681.
276. For an easily accessible and impressive account of recent developments in research into neuroplasticity, we recommend Norman Doidge’s book, The Brain that Changes Itself (New York: Viking Penguin, 2007).
277. Feltz DL, Landers DM (1983) The effects of mental practice on motor skill learning and performance: a meta-analysis. Journal of Sports Psychology 5: 25-57.
278. Yue Guang, Cole K (1992) Strength increases from the motor program: comparison of training with maximal voluntary and imagined muscle contractions. Journal of Neurophysiology 67(5): 1114-23.
279. Moseley GL (2004) Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomized, controlled trial. Pain 108: 192-8.
280. Pascual-Leone A, Hamilton R (2001) The metamodal organization of the brain. Progress in Brain Research 134: 427-45.
281. Henningsen P, Zipfel S, Herzog W (2007) Management of functional somatic syndromes. Lancet 369: 946-55.
282. Scaer RC (2001) The Body Bears the Burden: Trauma, Dissociation and Disease. New York: Haworth Medical Press.
283. Bakal D (1999) Minding the Body: Clinical Uses of Somatic Awareness. New York: Guilford Press.
284. Koriat A, Goldsmith M, Pansky A (2000) Toward a psychology of memory accuracy. Annual Review of Psychology 51: 481-537.
22
Making Something of Your World: small changes, big returns
Even a soul submerged in sleep is hard at work and helps make something of the world.—Heraclitus of Ephesus
What could be more dangerous than eating glass, swallowing swords, or snacking on casu marzu, a Sardinian rotten cheese riddled with maggots that can launch themselves 15 cm into the air at every bite?
The answer may surprise you. According to Guinness World Records, it’s…going without sleep.
After high-level consultations, the famous arbiter of the furthest limits of human endeavor decided against including a category for the longest period without sleep. The decision was made on the grounds that going without sleep for extended periods could prove more dangerous than some of the most extreme, life-threatening challenges recorded around the globe, including glass-eating, sword-swallowing, and consuming putrid milk products.
It was a sensible decision. Growing evidence of strong links between sleep disorders and serious health problems highlights the need for health practitioners of all specializations to explore and apply effective treatments for insomnia.
We’ve known for thousands of years how important a ‘good night’s sleep’ is to health. But it is only relatively recently that researchers have highlighted the dangers of too little, or disrupted, sleep.
In our search for underlying principles of healing and health, and in the belief that relatively small changes can result in large rewards, we have added these thoughts on sleep to this edition of Magic in Practice. The aim is to instruct and inform those who might be unaware of the cost of sleeplessness. Also, since we subscribe to Heraclitus’s observation that the sleeping mind is still at work below the level of consciousness, we also suggest some simple changes that can optimize sleep and help make something vastly better of the individual’s world.
Disrupted sleep patterns, insomnia, and simply ‘burning the candle at both ends’ can all have calamitous results.
According to a report by the Institute of Medicine of the National Academies, sleep disorders represent an ‘under-recognized public health problem’, and have been associated with a wide range of health problems, including hypertension, type 2 diabetes, depression, obesity, and even cancer.285
It has been estimated that 5- to 7-million people in the United Kingdom, and possibly 10 times as many Americans, may suffer chronic sleep disorders that may directly and negatively affect their health and longevity.
Obesity
Most researchers agree that lifestyle factors, such as over-eating and lack of exercise, are driving the obesity epidemic. However, recent research involving 28,000 children and 15,000 adults suggests that lack of sleep may double the risk of becoming obese.
According to Professor Francesco Cappuccio, of the University of Warwick’s Medical School, a ‘silent epidemic’ of reduced sleep runs parallel to the obesity problem—a trend that has been noted in adults, as well as in children as young as 5 years.286
Lack of sleep, he believes, may trigger hormonal changes, including over-production of ghrelin, a known appetite stimulant, and reduction in the hormone, leptin, which suppresses the appetite.
Professor Cappuccio has called for more research into other possible mechanisms linking reduced sleep with increased chronic conditions in affluent societies.
Type 2 diabetes
Independent research at the University of Chicago Medical Centre suggests that suppression of slow-wave sleep in even healthy young adults significantly decreases their ability to regulate blood-sugar levels and increases the risk of type 2 diabetes.287 Researchers interrupted the restorative sleep stage known as ‘slow-wave sleep’ of a group of lean, healthy volunteers between the ages of 20 and 31. After only three nights of interrupted sleep, their sensitivity to glucose became significantly reduced.
While their bodies needed more insulin to cope with the same amount of glucose, insulin secretion did not alter to compensate for their reduced tolerance to glucose after only three nights of selective slow-wave sleep suppression. In that short time, the young, healthy subjects became clinically at risk of developing type 2 diabetes.
The University of Chicago researchers estimated this decrease in insulin sensitivity to be comparable to that caused by gaining 44 to 66 kg in bodyweight.288
Happily, though, the risk of developing type 2 diabetes can be significantly reduced with just three hours of ‘catch-up sleep’ a week.
Until now, it has been believed that sleep deprivation could not be redressed by weekend ‘lie ins’. Research by Dr. Peter Liu, of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), has demonstrated that men’s insulin sensitivity, or ability to clear blood sugar or glucose from their bloodstream, significantly improved after three nights of catch-up sleep at the weekend.289
‘We all know we need to get adequate sleep, but that is often impossible because of work demands and busy lifestyles,’ says Dr. Liu.
‘Our study found extending the hours of sleep can improve the body’s use of insulin, thereby reducing the risk of type 2 diabetes in adult men.’
Type 2 diabetes, the seventh leading cause of death in the US, affects nearly 26 million Americans and costs the nation an estimated $174 billion a year.
Metabolic syndrome
Obesity and type 2 diabetes, along with high cholesterol and increased blood pressure, are co-factors of the condition known as ‘metabolic syndrome’—also now linked with interrupted or inadequate sleep. One of the biggest studies yet carried out suggests that too little sleep can nearly double the conditions leading to heart disease.
A University of Pittsburgh School of Medicine study of 1,214 adults between the ages of 30 and 54 has demonstrated that both too little and too much sleep can trigger metabolic syndrome. Those who slept between seven and eight hours a night were 45% less likely to suffer these symptoms than those who slept fewer, or considerably more, hours each night.
Professor Martica Hall emphasized that the link with sleep had been established independently of other factors previously associated with metabolic syndrome, including smoking, over-eating, and lack of exercise.
Depression
Excessive, shallow, non-REM sleep may, at least in part, also explain the undisputed link between sleep disorders and depression. Recent studies have noted excessive REM in anxious and depressed patients. But, rather than causing insomnia, depression has been shown to follow periods of chronic sleeplessness. Both younger and older people are affected, and behavioral disorders among juveniles appear to have a direct link with short or interrupted sleep.290,291,292
Studies presented at the 19th Annual Meeting of the Associated Professional Sleep Societies (APSS) in Denver, and published in the Journal of Behavioral Sleep Medicine, give credence to the theory that insomnia could contribute to, or be a predictor of, depression, and that resultant and prolonged bouts of sadness, hopelessness, and loss of interest in life activities make patients less likely to recover. One study has shown that sufferers of insomnia were more than 10 times more likely to be still depressed after six months, compared with those not suffering from insomnia. The insomniac group was 17 times more likely still to be depressed after a year.
Treatment targeting insomnia is therefore likely to improve the recovery rate from major depression, the researchers conclude.
Cancer
Groundbreaking research at Stanford University Medical Center suggests that melatonin, one of a class of antioxidant compounds produced during sleep, might be implicated in a suspected link between sleeplessness and cancer. When circadian rhythms are disrupted, less melatonin is produced, fewer free-radical compounds are mopped up, and the DNA of the sufferer’s cells may become more prone to cancer-causing mutations.
The researchers, led by Dr. David Spiegel, also propose a link between suppressed melatonin production and ovarian and breast cancer. Oestrogen prompts cancerous cells to continue proliferating. Shift workers and others with disrupted sleep patterns may produce less melatonin and more oestrogen.293
The second link lies with a hormone called cortisol, which normally reaches peak levels at dawn then declines throughout the day. Cortisol is one of many hormones that help regulate immune system activity, including the activity of a group of immune cells called natural-killer (NK) cells that help the body battle cancer.
One study found that people who are at high risk of breast cancer have a shifted cortisol rhythm, suggesting that people whose cortisol cycle is thrown off by troubled sleep may also be more cancer-prone. In past work, Spiegel and his colleagues found that women with breast cancer whose normal cortisol cycle is disrupted (peaking levels in the afternoon rather than in the early morning) have a lower survival rate. These women also slept poorly.
Spiegel also cites recent findings that night-shift workers have a higher rate of breast cancer than women who sleep normal hours. This is reflected in animal studies. Mice whose circadian rhythms have been interrupted show much more rapid tumor growth than normal mice.
These theories have since received strong support from a study, published in the British Journal of Cancer, which suggests that women who get by on less than six hours’ sleep have a significantly increased risk of breast cancer.294
