Wednesday, 17 April 2019

A mindful worker is a happier worker

When I gave a talk at Google a few months ago about using mindfulness to help relieve anxiety, depression, and other common forms of psychological distress, I was impressed by the company’s commitment to taking care of their employees. From the organic juice bars in every building to the gyms and meditation and yoga facilities scattered around the campus, it was clear that they’re thinking a healthy employee will be a productive employee (not to mention an employee who needs fewer expensive medical services). In fact, they had a whole team devoted just to teaching mindfulness meditation, and offered regular practice sessions that workers could attend either in person or online throughout the day.

But can mindfulness practice really help employees’ mental health? Is it something that more businesses should be investing in, or just another fad for ex-hippies in Silicon Valley? The results of the best-designed study to date that addresses this question are just in, and the answer is impressive: mindfulness really can help workers, even those far from California.
What the study found

The new study comes from Taiwan, where researchers surveyed 3,270 factory workers to identify those with high levels of psychological distress. They then invited these particularly unhappy workers to participate in the study. The 144 workers who ultimately agreed to participate were assigned to either an active intervention group, in which they completed an eight-week mindfulness training program consisting of two-hour classes each week at work and 45 minutes of daily meditation homework, or a control group, who reported regularly on their psychological well-being but didn’t receive any mindfulness training.

What did they find? Compared with the control group, the workers who took the mindfulness class reported feeling much better. They had less prolonged fatigue — that feeling of exhaustion that doesn’t go away even after having a chance to rest. They also felt less stressed, reported reduced anxiety and depression, and had fewer sleep difficulties, aches and pains, and problems getting along with others.

So what exactly was this mindfulness training that helped them? Mindfulness involves bringing our attention into the present moment and accepting whatever is happening here and now. That sounds very simple, but when we begin to try to actually practice mindfulness — by picking a sensory experience such as the breath, bringing our attention to it, and working to accept whatever arises in our awareness — most of us find not only that our minds quickly wander off into all sorts of thoughts about the past and the future, but they also generate all sorts of negative judgments about what’s happening.

The good news is that like any skill, mindfulness can be learned. It just requires a bit of instruction, and setting aside some time to practice. Numerous research studies have shown that by practicing mindfulness, we can actually change both the structure and the functioning of our brains in ways that are consistent with feeling happier and more engaged in our lives. These changes also help us to have an easier time dealing with both physical and emotional pain.
How you can reap the benefits of mindfulness

So how might you begin if you wanted to become more mindful? One way that doesn’t require any extra time is to simply pick a few activities, such as walking the dog, showering, or eating a meal alone, and decide to do them as mindfulness practices. That means instead of checking our smartphone, going over our to-do list, or listening to music, we try to bring our attention to the sights, sounds, and bodily sensations occurring during the activity. Since mindfulness practice is very dose-related, the more we try to do this throughout the day, the more mindful we become.

While these informal practices will indeed help you to develop some mindfulness, to develop more, it’s helpful to set aside time for meditation practice, like they do at Google. Most studies documenting the effectiveness of mindfulness involve people meditating regularly. It’s easiest to begin a regular meditation practice by following recorded instructions. While there are many sources for these, you can listen for free to some that I recorded It is abundantly clear that smoking damages the heart, the lungs, and virtually every other body system. According to the Centers for Disease Control and Prevention, smoking remains the leading cause of preventable death in the United States.

So why do people do it?

It’s the nicotine. This stimulant, found in all tobacco products, makes smokers feel calm and relaxed — and it can quickly lead to addiction. The more you smoke, the more you need to smoke to feel good. It’s the pull of nicotine that makes quitting so difficult.

But what if you could reduce the amount of nicotine available in cigarettes to begin with? Would it help people quit — or might it cause them to smoke more to compensate?

Recently, a team of researchers set out to answer this question by following more than 800 adults who smoked at least five cigarettes a day. These study volunteers had no desire to quit smoking. They were asked to either continue smoking their regular brand of cigarette or to smoke one of six types of investigational cigarettes that had varying amounts of nicotine, ranging from 15.8 milligrams (mg) of nicotine per gram of tobacco (the amount found in most commercial brands) all the way down to 0.4 mg per gram. The smokers were followed for six weeks. The results of the study were published in today’s New England Journal of Medicine.

These results were unexpected. The people given the lower-nicotine cigarettes smoked 23% to 30% fewer cigarettes per day than those who smoked the cigarettes with 15.8 mg of nicotine per gram. Perhaps even more surprising, the low-nicotine cigarette smokers also had reduced dependence on nicotine — and fewer cravings for cigarettes when they weren’t smoking.

This study lasted only six weeks, so we’ll need longer trials to help us really understand whether low-nicotine cigarettes are a “safer” option for people who are determined to smoke (as many as one in five Americans is a current smoker). However, these findings do suggest that if the nicotine content in commercial cigarettes could be lowered, users would smoke less and be less likely to get “hooked,” which could mitigate the health risks associated with smoking.

For those who do want to cut out nicotine, there are good options that can help them meet the challenge. They come in many forms, from nicotine patches and gums to lozenges and nasal sprays — not to mention e-cigarettes, which work by vaporizing nicotine. E-cigarettes have become wildly popular, but to date, we don’t know for sure that they are safer than regular cigarettes, or that they can actually help people quit. Prescription drugs like bupropion (Zyban) and varenicline (Chantix) can also help smokers quit. All of these methods work especially well when combined with behavioral supports, such as talk therapy. Of course, it often takes multiple attempts to quit before succeeding — but it can be done. Being an overweight child is no picnic — it can be hard to keep up with your friends on the playground, you can’t wear some of the same styles of clothing other kids do, and the teasing can be merciless. New research published in The New England Journal of Medicine shows that the damage goes beyond the social and emotional, too.

This study, entitled “Cardiometabolic Risks and Severity of Obesity in Children and Young Adults,” enrolled almost 9,000 children and adolescents ages 3–19 who were either overweight or obese (severely overweight). Doctors tested these young people for high blood pressure and cholesterol, diabetes, and other important risk factors for heart disease. On average, the most severely obese children and teens had higher blood pressures, worse cholesterol profiles, and higher blood sugar levels than those who were just overweight. This association was true even when taking into account race, ethnicity, gender, and age.

This was a cross-sectional study, meaning that it did not follow patients forward in time to see what happened to them. Rather, it examined each patient “in the moment” and identified factors that doctors believe affect the risk for future heart disease. So, based on the information in this study, we can’t tell which of these young people eventually went on to develop heart disease. However, we do know that, for adults, controlling blood pressure, cholesterol, and blood sugar are critical to preventing heart disease. It is reasonable to infer that this would also hold true for children.

The majority of the study volunteers were ages 12–19. So it also seems reasonable to conclude that the more severely obese a teenager is, the greater the likelihood that he or she will go on to develop heart disease. The study also found that the boys and young men tended to have more concerning test results, raising the concern that childhood obesity might be particularly hazardous for them.

This study is incredibly important because it supports what pediatricians have feared for many years now, ever since we noticed rising rates of obesity among our younger patients: if we don’t find ways to help our kids achieve and maintain a healthy weight, we are going to see them become adults who suffer from heart disease at higher rates and at younger ages than ever before.
Helping children achieve a healthy weight

The great news is that we can do something about this! Weight loss interventions do work for younger patients, and are becoming more accessible.  Most importantly, we should realize that even a little bit of weight loss can go a long way to living a healthy life, and this is important at every age.

If your child is overweight, I hope that learning about this study encourages you to talk to your pediatrician about helping him or her (or yourself!) lose weight. Ideally, make a plan as a family. Make it a goal for Mom, Dad, and all the kids to get lots of exercise and eat a healthy, well-balanced diet.

Before placing your child on a diet, or enrolling him or her in a weight-loss program, talk it over with your pediatrician. Don’t be embarrassed to do so! I can guarantee you that your doctor has seen many kids struggle with weight and has some expertise on the subject. Together you can create a plan of action that is right for your family and your child.

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