Give and take

If the world were split into “givers” and “takers”, many people I know would put themselves into the “givers” category. These people have a tendency to spend their time doing things for other people, often putting the needs of others above their own.

In some cases, this has negatively impacted them, contributing to problems with their own health – either because of the increased stress of continually worrying about other people, or the lack of time left over to take care of themselves. Being a “giver” has come to be seen as almost a negative thing. But it isn’t, and not only because giving to people around you can benefit those you love.

Adam Grant, a psychologist at Pennsylvania University in the US, has written a book and given a TED talk on the subject. As part of his research he identified givers in various areas of work and study, and ranked them against their colleagues or classmates in terms of performance. He found, perhaps not surprisingly to many people, that the givers tended to perform the worst – presumably because they were spending so much of their time and energy helping others.

However, the givers were also the group which performed the best – it turned out that all the takers, and the people who didn’t fit either definition, sat somewhere in the middle. Grant determined that givers can sink time in the short term, but cause huge benefits to a team or company in the long term.

His findings are surprising, and combat the view that giving is a negative attribute. Instead, Grant argues, it’s important to manage that giving tendency appropriately – by preventing burnout, asking for help, and surrounding yourself with the right people.

His advice rings true when I think about the givers I know. It is not the giving nature that is the problem – the world would be a better place if everyone acted like this. But givers need to protect themselves, by setting boundaries, or limiting the amount of time and resources spent on others for example.

It is also vital for givers to be surrounded by the right people. Grant argues that if even one person on a team is a taker, while the rest are givers, it disrupts the team dynamic. In the examples that come to mind of givers blaming themselves for the difficult situations they end up in, there is always another person – a taker – without whose actions there would be no problem at all. So it looks like giving is to be encouraged, so long as it is to the right people.

Easy does it

Welcome to the first blog of 2023! Very best wishes to you for the year ahead.

Over the festive period, I was racking my brains to think of a fun challenge we could do as a family for the first few months of the new year. The idea would be a set goal for each day, and we would share updates to a group chat on how we were all doing. It was inspired by virtual family challenges we used to do during Covid lockdowns, and which I have written previous blogs about. It’s a nice way to have a bit of fun, connect with family members you might not be able to see in person, and maybe do something good for you in the process.

We decided to run the challenge from mid-January for 100 days. But the problem was, when discussing it with family members we just couldn’t agree on a goal to set. Walking 10,000 steps a day? Spending one hour outside in the fresh air? Running 5km? Reading 20 pages of a mind-expanding book?

In the end, the problem was obvious. The targets were too difficult. We had forgotten that age-old advice of not setting goals which aren’t achievable. It was deemed by a family council that if we set these kinds of blanket goals for everyone, we would all just end up miserable because we weren’t able to do them – or worse, sacrificing other areas of our lives in order to hit them out of a negative sense of competition. After all, this was supposed to be fun.

So we changed tack, and now everyone is going to set their own goal, which they know is achievable, and the emphasis will be on connection and sharing our progress with each other. Rather than pressure to complete whatever task it is every single day, we’re going to celebrate the days that we do get there.

Let it snow

It’s been a challenging year. Another challenging year, I should say. It feels as though each year after

the Covid pandemic struck we’ve been hoping for a wonderful reprieve, when everything suddenly

becomes much easier. It seems that isn’t going to happen just yet.

Last week I was travelling from Dublin Airport for work. We got stuck because of the cold weather,

and were held at a gate underground for hours, in the freezing cold, until well past midnight. It

wasn’t ideal. There was a lot of grumbling going on, as we were all very cold. But then my sister-in-

law sent through a picture of a cheery snowman my nephew had made. The cold weather clearly

wasn’t causing so much upset to everyone.

It all sounds a bit cheesy, but it made me stop and think for a bit and try to look at the situation

differently. I began to think how much worse things could be – at least I wasn’t in Ukraine facing the

prospect of cold and blackouts all winter. I was certain to reach a warm bed at some point. It’s just a

few weeks until New Year, which can bring a fresh start. In the meantime, I’m looking forward to a

few days off, and hope you all get the chance for a rest or a change of routine. And I’ll be thinking

about all the wonderful things which have come out of the past year, and that 2023 has the

potential to bring.

We won!

As many of you may know, I recently worked on a study about Pregnancy-related Pelvic Girdle Pain (PPGP) with two colleagues, Alex Frankham, a physiotherapist based in Jersey, and Dr Sinéad Dufour, at McMaster University in Canada. We looked into perceptions of the causes and treatment of PPGP among physiotherapists based in the UK, using an online survey. It was a larger form or a previous study we did in Ireland, and produced similar results, with a few differences.

In the past the prevailing view of PPGP among experts has been that it has mechanical causes – things like pelvic instability, back pain or lack of core strength, or a high BMI. But some experts think the causes may be psychological – like fear or emotional stress - or physiological, like an imbalance of the autonomic nervous system.

All this, as you know, closely relates to my work. My colleagues and I wanted to find out what chartered physiotherapists thought of the issue, as this would tell us how they would be most likely to assess and treat patients.

Our results from just over 100 physiotherapists told us that they considered both mechanical and psychological factors to be causes of PPGP. They also selected both mechanical and psychological treatment options, although the latter (including explaining pain, addressing fear, and lifestyle factors) were the most popular options.

We presented our results to the Journal of Pelvic, Obstetric and Genealogical Physiotherapy’s 2022 research competition, and I’m thrilled to say we won! We were invited to present our work at the POGP virtual study day at the beginning of November. It was a great opportunity to discuss our findings, and also a wonderful reward after a lot of hard work!

If you’d like to see the poster, you can find it on the research page of the website or by clicking here.

Standing out

One of my children recently came home to visit. She moved out some time ago, but as seems to be the way with children, never quite managed to remove all of her belongings from her parents’ house. Every now and again we threaten to throw some of these things away, in the hope that our children will come and free up some space in our attic. It never seems to work. But this time, at the end of her visit she appeared in the kitchen with a heated clothes drying rack. It belonged to her, but was so big, awkward and bulky that she’d never managed to take it to her own home.

She looked at me, and said determinedly: “It’s time.” The prospect of rising energy costs in winter had finally forced her to bite the bullet, and bring home the drying rack which had been languishing at our house for I don’t know how long. The problem, it transpired, was not so much the actual carrying of the rack – it’s large, but very light, and because it has built-in handles it’s possible to carry it under one arm.

Instead, the reason my daughter had left it in our house for so long was that she couldn’t face what people would think of her. The journey back to her home involves several forms of public transport, and a connection walking through busy streets. She imagined people staring at her, judging her, and grumbling about how her enormous drying rack was taking up too much space and getting in the way. But now it had become too important, so she had to take a deep breath and bravely venture out with her luggage in one hand, and a heated drying rack in the other.

Of course, nobody noticed. Nobody judged, nobody grumbled. During her entire journey I don’t think anyone even looked at her twice. When she told me – indignant, after getting home, that she had needlessly waited so long to relocate her drying rack, based on unfounded fears – it made me laugh. Not only because of her adventures, but because I recognised something so common to all of us – we all think everyone else is much more interested in us than they really are.

It's so easy to feel embarrassed, to feel like everyone is looking at you, and to avoid doing things because you’re afraid of what other people will think. But more often than not, other people don’t even notice. While it may be a bit humbling to realise you’re not as much the subject of everyone else’s attention that you thought you were, it’s also incredibly freeing.

Building resilience

Years ago I met a woman whose job title was “resilience trainer”. I thought it sounded a little bizarre, and of course her job involved working for a big company and being sent around to regional offices to speak to staff who were being made redundant. At the time it sounded like a somewhat cynical profession, but I was reminded of it some years later, when speaking to another friend who had been made redundant early in her career.

She had been working as a manager in retail, but then used her redundancy pay to begin a master’s course in another field, which led to her next job and a thoroughly enjoyable second career. In our conversation she said she had a theory that everyone should be made redundant at least once in their lives, to teach them how to cope when things go wrong.

I don’t quite agree with the blanket statement, as I remember too many stories of devastating redundancy after the financial crash. It’s one thing when young and single with plenty of opportunities for moving on, and quite another when an entire family might be relying on one income stream.

But I do think my friend had a point – difficult or painful life events can create resilience. While of course it would be much better if they didn’t happen, everyone faces some kind of upheaval at some point or other. Sometimes the only good we can take from it is resilience.

Burning out

The concept of “burnout” has become more popularised recently. People now mostly use it to refer to professional burnout, after a difficult period at work. But it can happen to anyone, from any cause of stress, including the pressures of raising children or negotiating difficult relationships. And it can lead to chronic pain.

One popular solution offered for burnout is rest and relaxation. This is absolutely valid, and in some cases can work wonders. But in others it is not a good remedy, as a person either cannot take a break (for example from caring responsibilities), or as soon as they return to normal, the symptoms of burnout begin again.

I recently came across a book by two American sisters, Amelia and Emily Nagoski, who have an interesting take on burnout. They argue that the way to deal with it is to tackle your stress, not your stressors, by which they mean the factors that cause stress, such as work, caring responsibilities, or a difficult relationship.

To do this, they say, you need to complete the cycle of the stress response, rather than leaving your body in fight, flight or freeze mode. For example this could be by doing jumping jacks when home from a stressful commute, to communicate to the body that it is now safe.

The sisters describe emotions as “tunnels” – you need to feel them, however difficult and scary that might be, in order to process them and combat the stress they are causing. The concept has a lot of resonance with one of the phases of the Resolving Chronic Pain approach.

 In the Resolving Chronic Pain process there comes a time when the pain has reduced somewhat and the pent-up energy produced by stress makes itself known. That is the point when each individual decides how they want to vent that energy. Options include boxing a punch bag, yelling at the wind or the sea, singing loudly (and possibly out of tune!) to your car radio or favourite playlist, dancing with abandon, or running. The list goes on… thank you to everyone who has added to it over time. Are there any ideas I’ve missed? If so, add them in the comments below.

Prescribing fun

“Fun is a health intervention”. I heard this recently in a TED talk from American journalist Catherine Price, who has previously written about the importance of separation from your phone and other devices.

It struck me just how true it is: fun, as Price points out, is good for us. On one level we all know this – we all know that getting out and enjoying time with friends can give us a boost during a low period, for example, or that hospital patients have been shown to benefit from entertainment and enjoyment. But it’s surprising how often we seem to forget. Do you make sure you are getting enough fun in your life, just as you might consider whether you are getting enough exercise, or vegetables? When was the last time you truly had fun?

For some of us, it might be a while ago. All too often our busy, stressful lives crowd out any possibilities for fun. And parties, events and other activities, while being enjoyable enough, so often fall short of being really, truly fun. 

So how to have more fun? It’s a tall order if you are already facing pressures at work and home, perhaps with a busy and stressful job and constant caring responsibilities. Having fun shouldn’t be yet another thing you’re trying to tick off an already-crammed to-do list: that somewhat defeats the point.

The best advice Price has is to actively prioritise fun, recognising it as something which is good for you and worth making space for. She suggests spending time with someone you know you have fun with. I would add that it can be valuable to actively think about which activities you associate with having fun – as opposed to those where you feel like you’re supposed to having it.

For some people this might be things we wouldn’t normally think of as fun, like exercise or even some elements of work. For others it might be more traditional fun activities. Whatever they are, it’s important where possible to make sure you get those opportunities for fun. Recently I went for a swim in the sea - it was chilly, and the other people on the beach thought I was mad… but it was a lot of fun!

Looking forward

September is a strange month, isn’t it? The end of summer and “back to school” feeling can be a bit gloomy, and yet the weather more often than not grants us a few improbably sunny days, while falling leaves and crisp morning air is a promise of all the best things about autumn.

Last year I went away for a weekend in autumn – not very far, just a night, to do some walking. It was still just warm and light enough, even if I did have to trudge through the rain on one day. The break was lovely, and it tided me over through the darker winter months, giving me something nice to remember – and perhaps to look forward to, in the form of a repeat adventure in the spring.

I never got around to it due to the Omicron wave of Covid, but I’m planning to go on another walking mini-break this autumn as well. I’ve written before about trying to arrange nice things to look forward to during difficult periods - I’m very lucky to have the chance to get away for a night, but if you’re not able to do this, could something smaller-scale be possible? Perhaps a one-hour walk, or meeting a friend for a chat.

Rather than mourning the loss of summer, I’m now looking forward to beautiful damp autumn days, even if it does mean trudging through the mud!

No silver bullet

A recently-published paper about treatment of depression made a bit of a splash. The review, led by Joanna Moncrieff from University College London and published in the peer-reviewed journal Molecular Psychiatry, looked at evidence around the “chemical imbalance” theory of depression – that it is caused by low levels of serotonin. It found there wasn’t enough evidence to say the two things are definitely linked.

The chemical imbalance theory has been around for decades, but some researchers have doubted it for a long time. Some experts have said this review proves that treating depression with SSRIs (a common type of anti-depressant which increases serotonin levels) does not work, and that the only reason many doctors prescribe these drugs is because of encouragement from pharmaceutical companies wanting to increase profits.

On the other hand, the fact is that SSRI anti-depressants seem to work to resolve depression in some people. It may be that there is some link between serotonin levels and depression after all, but given other research into placebos, I personally would not be surprised if in cases where they have worked it may have been due to placebo, or the other factors such as talking therapy or lifestyle changes that the medication was combined with.

As all of my research for the textbook, Psychophysiologic Disorders, showed, there are cases when a doctor taking an interest, speaking to a patient and prescribing medication can work wonders, even if the medication itself is not effective. But as the review author points out, it is not ethical to prescribe drugs if you are sure their only effect is as a placebo.

The issue is still uncertain, and there is a lot that psychologists and other medics don’t fully understand about depression. It is a very common condition, and may have a variety of contributing factors and treatments – each of which tends to be unique to the individual concerned. This review serves to highlight the fact that regardless of whether these anti-depressants are effective or not, depression has never been an illness which can be “fixed” with one magic pill. Doctors often take a broad approach, including medication, talking therapy and lifestyle changes.

These findings may lead to more conversations about the efficacy and ethics of SSRIs. However, they will not change the fact that the only way to have a chance of treating depression is on a case-by-case basis, taking into account each person’s unique situation, symptoms, and possible treatments.