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What is ‘doll therapy’ for people with dementia? And is it backed by science?

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>The way people living with dementia <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-changes-perception">experience the world</a> can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/restlessness">agitation and distress</a>.</p> <p>One of the best ways to support people experiencing changes in perception and behaviour is to <a href="https://www.dementia.org.au/professionals/designing-dementia-friendly-care-environments">manage their environment</a>. This can have profound benefits including <a href="https://www.agedcarequality.gov.au/resource-library/reducing-use-sedatives-aged-care-video">reducing the need for sedatives</a>.</p> <p>One such strategy is the use of dolls as comfort aids.</p> <h2>What is ‘doll therapy’?</h2> <p>More appropriately referred to as “<a href="https://www.dementia.com.au/resource-hub/the-use-of-dolls-in-dementia-care">child representation</a>”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.</p> <p>Memories from the <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss#:%7E:text=Older%20memories%20%E2%80%93%20which%20have%20been,detailed%20memories%20from%20earlier%20life.">distant past</a> are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.</p> <p><a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/hallucinations#:%7E:text=Visual%20hallucinations%20are%20more%20common,hallucinating%20and%20how%20others%20respond.">Hallucinations or delusions</a> may also occur, where a person hears a baby crying or fears they have lost their baby.</p> <p>Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.</p> <h2>Some people believe the doll is real</h2> <p>A recent case involving <a href="https://www.theguardian.com/australia-news/2024/nov/06/deplorable-nurse-slammed-therapy-doll-dementia-patient-believed-was-real-baby-on-table-nsw-tribunal-hears">an aged care nurse mistreating a dementia patient’s therapy doll</a> highlights the importance of appropriate training and support for care workers in this area.</p> <p>For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.</p> <p>It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.</p> <h2>What does the evidence say about their use?</h2> <p>Evidence shows the use of empathy dolls may help <a href="https://www.sciencedirect.com/science/article/pii/S0197457223002677">reduce agitation and anxiety</a> and <a href="https://www.mdpi.com/2039-4403/14/4/200">improve overall quality of life</a> in people living with dementia.</p> <p>Child representation therapy falls under the banner of <a href="https://www.sciencedirect.com/science/article/pii/S0149763423004761">non-pharmacological approaches to dementia care</a>. More specifically, the attachment to the doll may act as a form of <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6494367/">reminiscence therapy</a>, which involves using prompts to reconnect with past experiences.</p> <p>Interacting with the dolls may also act as a form of <a href="https://www.health.vic.gov.au/dementia-friendly-environments/sensory-stimulation">sensory stimulation</a>, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13169?casa_token=ro96fxe2VPoAAAAA%3AKOS10VkTdcrf0yTI_F9p6cI5Kpbj85ZTFq13PQ56YHxi0i3-5BOnFQfW1WFWqiCZ8-mk5sp_EGkGtKM">support emotional well-being and aid commnication</a>.</p> <p>However, not all people living with dementia will respond to an empathy doll.</p> <p>The <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">introduction of a therapeutic doll</a> needs to be done in conjunction with careful observation and consideration of the person’s background.</p> <p>Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.</p> <p>Be guided by the person with dementia and how they respond to the doll.</p> <h2>Are there downsides?</h2> <p>The approach has <a href="https://pubmed.ncbi.nlm.nih.gov/33125455/">attracted some controversy</a>. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.</p> <p>Further, the attachment may become so strong that the person with dementia will <a href="https://www.dementiauk.org/information-and-support/living-with-dementia/doll-therapy/">become upset if someone else picks the doll up</a>. This may create some difficulties in the presence of grandchildren or when cleaning the doll.</p> <p>The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10180718/">cost-effective</a>.</p> <h2>Could robots be the future?</h2> <p>The use of more <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8247474/#:%7E:text=Therefore%2C%20an%20interactive%20baby%20robot,mental%20support%20for%20older%20adults.">interactive empathy dolls</a> and <a href="https://journals.sagepub.com/doi/full/10.1177/14713012231155985">pet-like robots</a> is also gaining popularity.</p> <p>While robots have been shown to be <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">feasible and acceptable in dementia care</a>, there remains some contention about their benefits.</p> <p>While some studies have shown <a href="https://academic.oup.com/innovateage/article/5/2/igab013/6249558?login=false">positive outcomes</a>, including reduced agitation, others show <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">no improvement</a> in cognition, behaviour or quality of life among people with dementia.</p> <p>Advances in artificial intelligence are also being used to help support people living with dementia and <a href="https://journals.sagepub.com/doi/full/10.1177/1471301221998888">inform</a> the community.</p> <p><a href="https://feel-lab.org/research_projects/ai-viv-and-friends/">Viv and Friends</a>, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.</p> <p>These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.</p> <h2>How should you respond to your loved one’s empathy doll?</h2> <p>While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.</p> <p>People living with dementia <a href="https://pubmed.ncbi.nlm.nih.gov/38325063/">may not perceive the social world the same way</a> as a person without dementia. But a person living with dementia is not a child and should never be treated as one.</p> <p>Ensure all family, friends and care workers are <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">informed about the attachment to the empathy doll</a> to help avoid unintentionally causing distress from inappropriate handling of the doll.</p> <p>If using an interactive doll, ensure spare batteries are on hand.</p> <p>Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243589/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-doll-therapy-for-people-with-dementia-and-is-it-backed-by-science-243589">original article</a>.</em></p> </div>

Mind

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Doctor defies terminal cancer diagnosis with breakthrough therapy

<p>Dr Tina Willits was told she had just 24 months to live after being diagnosed with breast cancer, but against all odds she is now in remission. </p> <p>The mother-of-five's disease was "everywhere" with three golf-ball sized tumors in her breast and cancerous masses in her ribs, spine, lymph nodes and legs.</p> <p>"When my cancer was detected, it was pretty past a stage four diagnosis and I was too far gone for a mastectomy," she told the <em>Daily M</em><em>ail</em>. </p> <p>She was placed on end-of-care chemotherapy and was told to "enjoy the time you have left". </p> <p>That was nearly three years ago. Now, the 53-year-old US mum is in remission thanks to a breakthrough cancer therapy that uses cold gases and the body's own cells to freeze and fight tumors. </p> <p>"I was devastated, but I was also like no, I was not ok with that diagnosis. I felt I had to do something," she recalled.</p> <p>"I was just really determined that I did not want to live my life with this cancer, even if they could stop it progressing, I didn't want that, I just wanted it gone."</p> <p>Dr Willits' cancer was HER2 positive, which account for about 20 percent of all diagnoses, and she had no family history of the disease.</p> <p>She underwent four rounds of chemotherapy before she sought alternative treatment at the Williams Cancer Institute. </p> <p>The institute sent her a list of supplements to begin taking and advised her to avoid sugar, which some researchers believe can help reduce inflammation and slow down the growth of cancer cells. </p> <p>She then underwent a treatment regimen that is not yet fully approved in the US, with cryoablation as the first step. </p> <p>Cryoablation is the process where doctors insert  a small metal probe through the skin and into the tumor, extremely cold gasses are then released directly into the mass to kill its cells.</p> <p>In the second phase of her treatment, she received immunotherapy, where eight drugs were administered directly into her tumor, which doctors say can prompt the immune system to recognise cancer cells as a threat and trigger an immune response. </p> <p>Dr Willits told the Dailymail that she was shocked when she got the results from her six-week scan after the treatment.</p> <p>"There were none, no tumors. They were just completely gone," she said. </p> <p>"All the metastasis (cancerous growths outside the breast) had completely healed, and the cancer in my lymph nodes was no longer there."</p> <p>After the treatment she had another four rounds of chemotherapy, and still undergoes PET scans every six months. </p> <p>So far the cancer has not been detected in her body since the treatment, and will need to wait for five years of clear results before she can be declared cancer free. </p> <p>Dr Williams, the founder of the institute, developed the treatment regimen over several years, and believes it could offer a better way to treat cancer.</p> <p>He is currently running a trial of the treatment in hard-to-treat prostate cancer patients, although he did not reveal how long the study had been going on for or how many rounds of treatment the patients had received. </p> <p>Since going into remission Dr Willits has travelled to Honduras and Colorado, tried mountain biking and is training for a 5k marathon for breast cancer awareness. </p> <p>"I wouldn't appreciate life like this if I had not gone through the cancer," she said. </p> <p>"No one on their deathbed says I wish I had worked more or got that job, you all say I wish I had spent more time with my parents and kids or gone to that place I had always wanted to." </p> <p><em>Images: DailyMail</em></p>

Caring

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How to know when it’s time to start therapy

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/simon-sherry-557487">Simon Sherry</a>, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a></em></p> <p>People go to therapy for many reasons. A challenging life event, trauma, volatile emotions, relationship problems, poor mental health: all can prompt someone to seek it out.</p> <p>Whatever the reason, it can be difficult to decide when and if therapy is right for you.</p> <p>If you’re reading this, now’s probably the right time. If you’re considering therapy, something is likely bothering you and you want help. Consider this your sign to reach out.</p> <p>If you’re still unsure, keep reading.</p> <h2>Why therapy?</h2> <p>Sometimes, our minds work against us. Therapy can help you understand why you think, feel, or act how you do <em>and</em> give you the skills you need to think, feel, or act in healthier ways.</p> <p>This includes helping you:</p> <ul> <li> <p>identify, understand, and overcome internal obstacles</p> </li> <li> <p>identify and challenge thought patterns and beliefs that are holding you back</p> </li> <li> <p>improve your mental health</p> </li> <li> <p>cope with mental illness</p> </li> <li> <p>and create lasting changes to your thoughts and behaviour that can improve all areas of your life.</p> </li> </ul> <p> </p> <h2>When your mental health is suffering</h2> <p>Everyone experiences negative emotions in difficult situations — like sadness after a breakup or anxiety before a big life event. But when do these feelings become problematic? When you have <a href="https://www.canada.ca/en/public-health/services/about-mental-health.html">poor mental health</a>.</p> <p>Mental health and mental illness <a href="https://cmha.ca/news/mental-health-what-is-it-really/">are distinct</a>, but related, concepts. <a href="https://dictionary.apa.org/mental-health">Mental health</a> refers to the inner resources you have to handle life’s ups and downs. You have good mental health if you enjoy life; feel connected to others; cope well with stress; and have a sense of purpose, a sense of self and strong relationships.</p> <p>If you have poor mental health, it can be hard to adapt to changes like a breakup, move, loss or parenthood. Therapy can help you improve your mental health, develop resilience and maintain a state of well-being.</p> <p><a href="https://www.canada.ca/en/public-health/services/about-mental-illness.html">Mental illness</a> refers to distressing disturbances in thoughts, feelings and perceptions that interfere with daily life. There are <a href="https://cmha.ca/brochure/mental-illnesses/">different kinds</a> of mental illness, each characterized by different thoughts, feelings and behaviours.</p> <p>Mental illness may feel like:</p> <ul> <li> <p><strong>Hopelessness</strong> — feeling stuck, unmotivated or helpless.</p> </li> <li> <p><strong>Apathy</strong> — feeling uninterested in things that used to give you satisfaction or pleasure.</p> </li> <li> <p><strong>Anger</strong> — feeling rage or resentment, especially frequently or disproportionately.</p> </li> <li> <p><strong>Stress</strong> — feeling overwhelmed, unable to cope, unwilling to rest or like everything is hard (even if you know it shouldn’t be).</p> </li> <li> <p><strong>Guilt</strong> — feeling ashamed, undeserving of good things or deserving of bad things.</p> </li> <li> <p><strong>Anxiety</strong> — worrying about what has or might happen or having disturbing intrusive thoughts.</p> </li> <li> <p><strong>Exhaustion</strong> — sleeping more than usual, having difficulty getting out of bed or lacking energy during the day.</p> </li> <li> <p><a href="https://doi.org/10.1016/S2215-0366(20)30136-X"><strong>Insomnia</strong></a> — having difficulty falling or staying asleep.</p> </li> </ul> <p>Both poor mental health and mental illness are equally good reasons to seek therapy.</p> <p>Ask yourself: Am I having trouble dealing with life challenges?</p> <p>If the answer is yes, therapy might be for you.</p> <p>People often cope with the feelings listed above in different ways. <a href="https://www.nami.org/wp-content/uploads/2023/11/NAMI-Warning-Signs-FINAL.pdf">Some gain or lose a lot of weight</a>. Others might seek out or do things that are unhealthy for them, like entering a toxic relationship, engaging in dangerous activities, developing an unhealthy habit or procrastinating. Others might isolate themselves from friends and family, or catastrophize and <a href="https://pubmed.ncbi.nlm.nih.gov/22468242">ruminate on negative experiences</a>.</p> <p>However it manifests, <a href="https://namica.org/what-is-mental-illness/">mental illness often gets worse if left untreated</a>. It can have very real impacts on your life, potentially leading to unemployment, broken relationships, poor physical health, substance abuse, homelessness, incarceration or even suicide.</p> <p>Ask yourself: Is mental illness negatively affecting my functioning or well-being?</p> <p>If the answer is yes, therapy might be for you.</p> <h2>What if therapy didn’t work before?</h2> <p>Many people put off going to therapy because they don’t think their problems are serious enough, but you don’t need a big, deep reason to start therapy.</p> <p>Some people go to therapy to learn more about themselves. Some, to improve their skills, relationships or productivity. Others go for help reaching their goals or because they aren’t happy and don’t know why. Any of these are good reasons to start therapy, even if they don’t seem like “problems” in a traditional sense. You can go to therapy just because there’s something about yourself or your life you’d like to explore.</p> <p>Therapy is a process. Whether psychotherapy works for you depends on many factors, such as time, effort and your psychologist.</p> <p>There’s no quick fix for mental health. Symptoms can take weeks, months or even years to improve. Although this can be frustrating or disheartening, for therapy to work, you have to give it time.</p> <p>Sometimes people go to therapy, but are skeptical or resistant. Therapy won’t work if you aren’t invested in it. For therapy to work, you have to put in the work.</p> <p>Therapy is a vulnerable process, so finding a psychologist you trust and relate well with is crucial. Psychologists also have different specialities and approaches. For therapy to work, you have to find the right therapist for you.</p> <h2>What if I’m not ready?</h2> <p>There are several reasons why now might not be the right time for you to start therapy. Maybe therapy isn’t in the budget. Maybe you have other priorities. Maybe you’re scared to relive trauma. That’s okay. Therapy can be expensive and difficult, but also rewarding. Just because now isn’t a good time, doesn’t mean there will never be a good time.</p> <p>If you don’t want to start therapy, don’t. However, it can be helpful to determine why you don’t want to.</p> <p>Maybe you don’t want to go to therapy because you’re worried what others might think. If so, remember that people are often <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">more understanding</a> than we anticipate, and there is nothing wrong with investing in your health or happiness.</p> <p>If you’re struggling with your mental health, know that you’re not alone. Mental health issues are common. Having them or attending therapy does not mean there is something “wrong” with you.</p> <p>Mental illness affects <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders">970 million people</a> and is the leading cause of disability worldwide. <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">One in five</a> <a href="https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/">adults</a> and more than <a href="https://doi.org/10.1001/jamapsychiatry.2023.5051">one in 10 children and youths</a> have mental illness. About <a href="https://health-infobase.canada.ca/datalab/mental-illness-blog.html">15 per cent of Canadians</a> use mental health services each year.</p> <p>Don’t let stigma keep you from bettering your life and well-being. Everyone deserves to live a healthy, fulfilling life. Therapy can help you get there.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234078/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/simon-sherry-557487"><em>Simon Sherry</em></a><em>, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-know-when-its-time-to-start-therapy-234078">original article</a>.</em></p> </div>

Mind

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Exercise, therapy and diet can all improve life during cancer treatment and boost survival. Here’s how

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p>With so many high-profile people <a href="https://www.theguardian.com/uk-news/2024/mar/23/cancer-charities-princess-of-wales-speaking-about-diagnosis">diagnosed with cancer</a> we are confronted with the stark reality the disease can strike any of us at any time. There are also reports certain cancers are <a href="https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html">increasing among younger people</a> in their 30s and 40s.</p> <p>On the positive side, medical treatments for cancer are advancing very rapidly. Survival rates are <a href="https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21763">improving greatly</a> and some cancers are now being managed more as <a href="https://www.cancer.org/cancer/survivorship/long-term-health-concerns/cancer-as-a-chronic-illness.html">long-term chronic diseases</a> rather than illnesses that will rapidly claim a patient’s life.</p> <p>The <a href="https://www.cancer.org/cancer/managing-cancer/treatment-types.html">mainstays of cancer treatment</a> remain surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and hormone therapy. But there are other treatments and strategies – “adjunct” or supportive cancer care – that can have a powerful impact on a patient’s quality of life, survival and experience during cancer treatment.</p> <h2>Keep moving if you can</h2> <p>Physical exercise is now recognised as a <a href="https://www.exerciseismedicine.org/">medicine</a>. It can be tailored to the patient and their health issues to stimulate the body and build an internal environment where <a href="https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.884">cancer is less likely to flourish</a>. It does this in a number of ways.</p> <p>Exercise provides a strong stimulus to our immune system, increasing the number of cancer-fighting immune cells in our blood circulation and infusing these into the tumour tissue <a href="https://jitc.bmj.com/content/9/7/e001872">to identify and kill cancer cells</a>.</p> <p>Our skeletal muscles (those attached to bone for movement) release signalling molecules called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288608/">myokines</a>. The larger the muscle mass, the more myokines are released – even when a person is at rest. However, during and immediately after bouts of exercise, a further surge of myokines is secreted into the bloodstream. Myokines attach to immune cells, stimulating them to be better “hunter-killers”. Myokines also signal directly to cancer cells <a href="https://www.sciencedirect.com/science/article/pii/S2095254623001175">slowing their growth and causing cell death</a>.</p> <p>Exercise can also greatly <a href="https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.884">reduce the side effects of cancer treatment</a> such as fatigue, muscle and bone loss, and fat gain. And it reduces the risk of <a href="https://doi.org/10.2337/diacare.27.7.1812">developing other chronic diseases</a> such as heart disease and type 2 diabetes. Exercise can maintain or improve quality of life and mental health <a href="https://www.hindawi.com/journals/tbj/2022/9921575/">for patients with cancer</a>.</p> <p>Emerging research evidence indicates exercise might increase the effectiveness of mainstream treatments such as <a href="https://aacrjournals.org/cancerres/article/81/19/4889/670308/Effects-of-Exercise-on-Cancer-Treatment-Efficacy-A">chemotherapy</a> and <a href="https://www.nature.com/articles/s41391-020-0245-z">radiation therapy</a>. Exercise is certainly essential for preparing the patient for any surgery to increase cardio-respiratory fitness, reduce systemic inflammation, and increase muscle mass, strength and physical function, and then <a href="https://www.jsams.org/article/S1440-2440(18)31270-2/fulltext">rehabilitating them after surgery</a>.</p> <p>These mechanisms explain why cancer patients who are physically active have much <a href="https://journals.lww.com/acsm-msse/fulltext/2019/06000/physical_activity_in_cancer_prevention_and.20.aspx">better survival outcomes</a> with the relative risk of death from cancer <a href="https://journals.lww.com/acsm-msse/fulltext/2019/06000/physical_activity_in_cancer_prevention_and.20.aspx">reduced by as much as 40–50%</a>.</p> <h2>Mental health helps</h2> <p>The second “tool” which has a major role in cancer management is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016045/">psycho-oncology</a>. It involves the psychological, social, behavioural and emotional aspects of cancer for not only the patient but also their carers and family. The aim is to maintain or improve quality of life and mental health aspects such as emotional distress, anxiety, depression, sexual health, coping strategies, personal identity and relationships.</p> <p>Supporting quality of life and happiness is important on their own, but these barometers <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1349880/full">can also impact</a> a patient’s physical health, response to exercise medicine, resilience to disease and to treatments.</p> <p>If a patient is highly distressed or anxious, their body can enter a flight or fight response. This creates an internal environment that is actually supportive of cancer progression <a href="https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet">through hormonal and inflammatory mechanisms</a>. So it’s essential their mental health is supported.</p> <h2>Putting the good things in: diet</h2> <p>A third therapy in the supportive cancer care toolbox is diet. A healthy diet <a href="https://www.cancer.org/cancer/survivorship/coping/nutrition/benefits.html">can support the body</a> to fight cancer and help it tolerate and recover from medical or surgical treatments.</p> <p>Inflammation provides a more fertile environment <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2022/reducing-inflammation-to-treat-cancer">for cancer cells</a>. If a patient is overweight with excessive fat tissue then a diet to reduce fat which is also anti-inflammatory can be very helpful. This <a href="https://www.frontiersin.org/articles/10.3389/fnut.2021.709435/full">generally means</a> avoiding processed foods and eating predominantly fresh food, locally sourced and mostly plant based.</p> <p>Muscle loss is <a href="https://onlinelibrary.wiley.com/doi/10.1002/rco2.56">a side effect of all cancer treatments</a>. Resistance training exercise can help but people may need protein supplements or diet changes to make sure they get enough protein to build muscle. Older age and cancer treatments may reduce both the intake of protein and compromise absorption so <a href="https://www.sciencedirect.com/science/article/pii/S0261561421005422">supplementation may be indicated</a>.</p> <p>Depending on the cancer and treatment, some patients may require highly specialised diet therapy. Some cancers such as pancreatic, stomach, esophageal, and lung cancer can cause rapid and uncontrolled drops in body weight. This is called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233663/">cachexia and needs careful management</a>.</p> <p>Other cancers and treatments such as hormone therapy can cause rapid weight gain. This also needs careful monitoring and guidance so that, when a patient is clear of cancer, they are not left with higher risks of other health problems such as cardiovascular disease and metabolic syndrome (a cluster of conditions that boost your risk of heart disease, stroke and type 2 diabetes).</p> <h2>Working as a team</h2> <p>These are three of the most powerful tools in the supportive care toolbox for people with cancer. None of them are “cures” for cancer, alone or together. But they can work in tandem with medical treatments to greatly improve outcomes for patients.</p> <p>If you or someone you care about has cancer, national and state cancer councils and cancer-specific organisations can provide support.</p> <p>For exercise medicine support it is best to consult with an <a href="https://www.essa.org.au/Public/Public/Consumer_Information/What_is_an_Accredited_Exercise_Physiologist_.aspx">accredited exercise physiologist</a>, for diet therapy an <a href="https://dietitiansaustralia.org.au/working-dietetics/standards-and-scope/role-accredited-practising-dietitian">accredited practising dietitian</a> and mental health support with a <a href="https://psychology.org.au/psychology/about-psychology/what-is-psychology">registered psychologist</a>. Some of these services are supported through Medicare on referral from a general practitioner.</p> <hr /> <p><em>For free and confidential cancer support call the <a href="https://www.cancer.org.au/support-and-services/cancer-council-13-11-20">Cancer Council</a> on 13 11 20.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226720/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, Professor of Exercise Medicine, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/exercise-therapy-and-diet-can-all-improve-life-during-cancer-treatment-and-boost-survival-heres-how-226720">original article</a>.</em></p> </div>

Caring

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5 reasons art therapy is great for your mental health as you age

<p><span style="background: white;">We know how important it is to look after our<strong> </strong></span><a style="color: blue;" href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/healthy-and-active-ageing"><strong><span style="color: black; background: white; text-decoration-line: none;">physical health</span></strong></a><span style="background: white;"> as we age, but our mental health is equally important. </span><a style="color: blue;" href="https://aifs.gov.au/resources/short-articles/normalising-mental-illness-older-adults-barrier-care"><strong><span style="color: black; background: white; text-decoration-line: none;">Studies have shown</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">that besides the immediate impact on wellbeing, older people with untreated mental ill health are at risk of poorer overall health, increased hospital admissions, and an earlier transition into aged care.</span></p> <p><span style="background: white;">Art therapy is an excellent way to boost our mental wellbeing. In a nutshell, this type of therapy is when visual art, such as drawing, sculpting, or collage, is used in a<strong> </strong></span><a style="color: blue;" href="https://www.rtor.org/2018/07/10/benefits-of-art-therapy/"><strong><span style="color: black; background: white; text-decoration-line: none;">therapeutic context</span></strong></a><span style="background: white;">. And don’t be put off if you haven’t picked up a paintbrush since you were a kid. Art therapy is not about creating works of beauty but about the process. It’s a completely </span><a style="color: blue;" href="https://cata.org.au/faqs-myth-busters/#:~:text=The%20focus%20of%20Creative%20Art,%2C%20growth%20and%20self%2Dawareness.&amp;text=Reality%3A%20Creative%20Art%20Therapy%20does,to%20affect%20change%20and%20growth."><strong><span style="color: black; background: white; text-decoration-line: none;">judgement free zone</span></strong></a><strong><span style="background: white;">!</span></strong></p> <p><strong><span style="background: white;">Emotional release:</span></strong></p> <p><span style="background: white;">Growing up, many of us were never taught that it was okay to express how we’re feeling, especially emotions like anger and sadness. In that way, art therapy can be ideal us older folks who often feel stuck when it comes to expressing ourselves. Art therapy provides the opportunity to express our<strong> </strong></span><a style="color: blue;" href="https://creativityintherapy.com/2017/06/expressing-emotions-creativity-6-step-art-process/"><strong><span style="color: black; background: white; text-decoration-line: none;">inner experiences</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">in a visual way. Through the act of creation, we can release pent-up feelings, reduce stress, and experience emotional release.</span></p> <p><span style="background: white;">Another challenging emotion that art therapy can help with is grief. As we age, we are more likely to experience the<strong> </strong></span><a style="color: blue;" href="https://www.nari.net.au/the-impact-of-prolonged-grief-in-older-people"><strong><span style="color: black; background: white; text-decoration-line: none;">loss of a loved one</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">and we don’t get ‘used to it’. The hole it leaves in our hearts is just as dark. Through<strong> </strong></span><a style="color: blue;" href="https://www.vivianpaans.com.au/blog/healing-through-art-how-art-therapy-can-help-with-grief-and-wellbeing"><strong><span style="color: black; background: white; text-decoration-line: none;">creating art</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">we can explore the feelings of grief and sadness in a safe, judgement-free space. It can also foster a sense of self-compassion and when we have more compassion for ourselves, it becomes easier to accept our emotions.</span></p> <p><strong><span style="background: white;">Stress relief:</span></strong></p> <p><a style="color: blue;" href="https://www.sane.org/information-and-resources/facts-and-guides/facts-mental-health-issues"><strong><span style="color: black; background: white; text-decoration-line: none;">Anxiety, depression, and past traumas</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">can heavily impact on our daily lives. Risk factors over our lifespans may change but they don’t magically disappear once we hit a certain age. Illness, grief, financial stress, social isolation, and life transitions such as menopause can all be </span><a style="color: blue;" href="https://www.healthdirect.gov.au/older-people-and-mental-health"><strong><span style="color: black; background: white; text-decoration-line: none;">contributing factors</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">of poor mental health for older adults. Creating art can ease symptoms as we refocus on what we’re creating and move thoughts away from overthinking and worry.<strong> </strong>Creating art releases </span><a style="color: blue;" href="https://www.rtor.org/2018/07/10/benefits-of-art-therapy/"><strong><span style="color: black; background: white; text-decoration-line: none;">dopamine</span></strong><span style="color: black; background: white; text-decoration-line: none;">,</span></a><span style="background: white;"> the chemical responsible for allowing us to feel pleasure and satisfaction. This further reduces bothersome symptoms of anxiety and depression.</span></p> <p><span style="background: white;">Also, participating in art therapy leads to a more creative brain. A creative brain is better equipped to create stress-relieving techniques for other areas of our lives. Through creating art, we draw the fears that are inside our minds. This takes them out of our heads and places them away from us, helping us feel more in control.</span></p> <p><span style="background: white;">Recovering from<strong> </strong></span><a style="color: blue;" href="https://www.interrelate.org.au/news-media/blogs/november-2021/how-art-can-heal-trauma"><strong><span style="color: black; background: white; text-decoration-line: none;">trauma</span></strong></a><strong><span style="background: white;"> c</span></strong><span style="background: white;">an be a lifelong process for many, and it’s important for someone dealing with it to find tools that will help this process. Art therapy can be one of those as it can give a sense of agency and self-understanding through the ability to express feelings symbolically. This can give </span><a style="color: blue;" href="https://anzacata.org/About-CAT"><strong><span style="color: black; background: white; text-decoration-line: none;">new perspectives</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">of ourselves and our worldview which is essential in the recovery process. It can also help connect with deeply stored emotions and help process them.</span></p> <p><strong><span style="background: white;">Self-discovery:</span></strong></p> <p><span style="background: white;">When we are younger we are often so busy working, socialising, and raising a family many of us never get a chance to take the time out for<strong> </strong></span><a style="color: blue;" href="https://www.visionpsychology.com/starting-the-process-of-self-discovery/"><strong><span style="color: black; background: white; text-decoration-line: none;">self-discovery</span></strong></a><span style="background: white;">. Self-discovery is important in our lives as it gives us a clearer sense of purpose and direction in life. In turn, this leads to making better decisions that lead to our overall happiness.</span></p> <p><span style="background: white;">Some of us see our kids leave home and suddenly we’re left wondering, who am I when I don’t have a family to care for? Creating art can help us acknowledge and recognise feelings that have been suppressed in our subconscious. Through learning to use different techniques of art our minds open up to thinking more freely. Self-discovery comes from both the finished product we create as well as the process of making it.</span></p> <p><strong><span style="background: white;">Self-esteem:</span></strong></p> <p><span style="background: white;">As we age, it’s easy to look in the mirror and struggle to recognise the person we see. Our bodies are changing, and it can often feel like society doesn’t value us as much as when we were young. It can be a major shift in the way we view ourselves and lead to poor self-esteem. Art therapy teaches us how to use a variety of media to create something new. We can develop talents and see strengths as we master new materials and see the completion of projects. This sense of accomplishment can be a big leg up to our<strong> </strong></span><a style="color: blue;" href="https://artbusinessnews.com/2022/01/benefits-of-art-therapy/"><strong><span style="color: black; background: white; text-decoration-line: none;">self-esteem.</span></strong></a></p> <p><strong><span style="background: white;">A sense of community:</span></strong></p> <p><a style="color: blue;" href="https://likefamily.com.au/blog/what-is-loneliness-and-how-does-it-affect-someone/"><strong><span style="color: black; background: white; text-decoration-line: none;">Loneliness</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">is a big contributor to poor mental health.<strong> </strong></span><a style="color: blue;" href="https://www.psychiatrist.com/news/study-why-older-people-feel-so-lonely/"><strong><span style="color: black; background: white; text-decoration-line: none;">Studies</span></strong></a><strong><span style="background: white;"> </span></strong><span style="background: white;">show two groups of people are most at risk: young adults and older people. With factors at our age such as children leaving home, not working as much or at all, living alone, and chronic illness, it’s easy to see how loneliness can creep into our lives. Group art therapy is a wonderful way to connect with others. We share a space with those who have similar interests, and it gives us a sense of belonging. For those who can't make a session in person due to distance or illness, some therapists offer </span><a style="color: blue;" href="https://www.artandplaytherapytraining.com.au/art_therapy"><strong><span style="color: black; background: white; text-decoration-line: none;">online group art therapy</span></strong></a><strong><span style="background: white;">.</span></strong></p> <p><span style="background: white;">You don’t need to see an art therapist to get the mental health benefits of creating art. But the advantage of that is they have the skills to work out what best suits your needs. They’ll also work with you through any tough emotions that may arise from your art therapy.</span></p> <p><span style="background: white;">So maybe it’s time to hide those new coloured pencils from the little ones, crack them open, and enjoy them yourself!</span></p> <p><span style="background: white;">If you’d like to find out more about art therapy sessions, the links below are helpful. They offer online, in person and group sessions.</span></p> <p><a style="color: blue;" href="https://www.zevaarttherapy.com/" target="_blank" rel="noopener"><span style="background: white; text-decoration-line: none;">https://www.zevaarttherapy.com/</span></a></p> <p><a style="color: blue;" href="https://www.alliedarttherapy.com.au/" target="_blank" rel="noopener"><span style="background: white; text-decoration-line: none;">https://www.alliedarttherapy.com.au/</span></a></p> <p><a style="color: blue;" href="https://www.solacecreativetherapies.com.au/" target="_blank" rel="noopener"><span style="background: white; text-decoration-line: none;">https://www.solacecreativetherapies.com.au/</span></a><span style="background: white;"> </span></p> <p><a style="color: blue;" href="https://cata.org.au/programs-ndis/online-creative-art-therapy/" target="_blank" rel="noopener"><span style="background: white; text-decoration-line: none;">https://cata.org.au/programs-ndis/online-creative-art-therapy/</span></a><span style="background: white;"> </span></p> <p><span style="background: white;">And for some more ideas on dabbling in art therapy on your own (or with a friend), check out Shelley Klammer’s amazing resources. She is US-based but has some online workshops that are also amazing:</span></p> <p><a style="color: blue;" href="https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/" target="_blank" rel="noopener"><span style="background: white; text-decoration-line: none;">https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/</span></a></p> <p><em>Article written by Kylie Carberry</em></p> <p><em>Image: Shutterstock</em></p>

Mind

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What are the most common symptoms of menopause? And which can hormone therapy treat?

<p><em><a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.</p> <p>Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.</p> <p>So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.</p> <h2>Remind me, what exactly is menopause?</h2> <p>Menopause, simply put, is complete loss of female fertility.</p> <p>Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).</p> <p>Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.</p> <p>Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).</p> <h2>What are the most common symptoms of menopause?</h2> <p><a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:</p> <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> <p>However, none of these symptoms are menopause-specific, meaning they could have other causes.</p> <p>In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.</p> <p>But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.</p> <p>So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>.</p> <p>Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.</p> <p>The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>.</p> <p>The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>.</p> <h2>Who might benefit from hormone therapy?</h2> <p>The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).</p> <p>In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.</p> <p>Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).</p> <p>However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.</p> <p>Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.</p> <p>Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.</p> <h2>What are the risks?</h2> <p>The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.</p> <p>Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk.</p> <p>Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use.</p> <p>Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a></p> <h2>What if I don’t want hormone therapy?</h2> <p>If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.</p> <p>In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).</p> <p>Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>.</p> <p><em>The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.</em></p>

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What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p>If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months).</p> <p>There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles.</p> <p>We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>.</p> <p>But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again.</p> <h2>People are often given the wrong advice</h2> <p>People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis.</p> <p>But these findings are very common in people <em>without</em> low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain.</p> <p>Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain.</p> <p>In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress.</p> <p>It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves.</p> <h2>So how should low back pain be treated?</h2> <p>A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety.</p> <p>Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language.</p> <p>They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities.</p> <p>An example of this type of care is cognitive functional therapy.</p> <h2>What is cognitive functional therapy?</h2> <p><a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out.</p> <p>The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it.</p> <p>It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>.</p> <p>Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required.</p> <h2>What’s the evidence for this type of therapy?</h2> <p>Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments.</p> <p>We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”.</p> <p>We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care.</p> <p>The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>.</p> <p>People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group.</p> <p>The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work.</p> <h2>What does this mean for you?</h2> <p>This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success.</p> <p><a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up.</p> <p>The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.</em></p>

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What is a relationship ‘boundary’? And how do I have the boundary conversation with my partner?

<p><em><a href="https://theconversation.com/profiles/raquel-peel-368041">Raquel Peel</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p>Text messages showing actor Jonah Hill asking his ex-girlfriend Sarah Brady to consider a dot point list of relationship “boundaries” have sparked an important conversation.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Jonah Hill’s ex-girlfriend Sarah Brady accuses him of emotional abuse.</p> <p>🔗: <a href="https://t.co/LwSnkpnehT">https://t.co/LwSnkpnehT</a> <a href="https://t.co/3B6I86uwNV">pic.twitter.com/3B6I86uwNV</a></p> <p>— Pop Crave (@PopCrave) <a href="https://twitter.com/PopCrave/status/1677755077249859586?ref_src=twsrc%5Etfw">July 8, 2023</a></p></blockquote> <p>Two different interpretations of these texts are dominating the discussion.</p> <p>Some have understood Hill’s dot points as a reasonable set of relationship expectations or “preferences” for a partner. Others see Hill’s list of relationship deal-breakers as a controlling behaviour.</p> <p>So what is a relationship “boundary” and how do you have this conversation with your partner?</p> <h2>What are relationship boundaries?</h2> <p>Boundaries are personal and influenced by one’s values. They can be emotional, physical, sexual, spiritual and cultural.</p> <p>The purpose of creating, understanding and respecting boundaries is to ensure one’s mental health and well-being are protected. Used well, they can keep relationships healthy and safe.</p> <p>Setting boundaries can also reinforce values and priorities important to you.</p> <h2>Some ‘boundaries’ are controlling and go too far</h2> <p>That said, relationship boundaries can become unsafe for the people involved. Some cross the line into coercive control.</p> <p>For instance, one might be able to justify to themselves they need to know where their partner is at all times, monitor their communications and keep tabs on their partner’s friendships because they just want to keep their partner safe.</p> <p>But these are not boundaries; this is coercive control.</p> <p>If your partner is describing these as their relationship boundaries, you should feel comfortable to say you are not OK with it. You should also feel comfortable explaining what boundaries you need to set for yourself and your relationship to feel safe.</p> <p>In fact, <a href="https://www.tandfonline.com/doi/abs/10.1080/01639625.2017.1304801">research</a> has found that even cyberstalking offenders might struggle to acknowledge how their behaviour can be perceived as intrusive by their partner. They may also have trouble understanding how it contributed to their break-up.</p> <p>My research on how people can sabotage their own relationships revealed a <a href="https://link.springer.com/article/10.1186/s40359-021-00644-0#Tab1">lack of relationship skills</a> is often a key factor in relationship issues.</p> <p>The same <a href="https://www.cambridge.org/core/journals/journal-of-relationships-research/article/abs/defining-romantic-selfsabotage-a-thematic-analysis-of-interviews-with-practising-psychologists/35531B41927851905281C7D815FE4199">research</a> highlighted how people who fear their relationship is at risk can end up indulging in controlling behaviours such as partner monitoring, tracking how a partner spends their money and emotional manipulation.</p> <p>In other words, people can sometimes employ unhealthy behaviours with the intention of keeping their partner but end up pushing them away.</p> <h2>Understanding partner and relationship expectations</h2> <p>We might have a vision in mind of an “<a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.91.4.662">ideal partner</a>”. But it’s highly improbable one person can ever meet such high standards.</p> <p>Rigid partner and relationship standards, just like unreasonable boundaries, can cause distress, hopelessness and resentment.</p> <p>So healthy romantic relationships need clear communication and negotiation. Sometimes, that involves being flexible and open to hearing what the other person has to say about your proposed boundaries.</p> <p>Relationship boundaries are a life skill that needs constant learning, practice and improvement.</p> <h2>Having a conversation about healthy relationship boundaries</h2> <p>Some mistakenly believe having any relationship boundaries at all is unreasonable or a form of abuse. That’s not the case.</p> <p>In my <a href="https://www.tandfonline.com/doi/full/10.1080/15332691.2020.1795039">research</a> on relationship sabotage, many people spoke about how being able to clearly communicate and set relationship expectations has helped them maintain their relationships over the long term and dispel <a href="https://scholarworks.uni.edu/facpub/1397/">unrealistic</a> standards.</p> <p>Communicating expectations can also help people deal with common relationship fears, such as getting hurt, being rejected and feeling disrespected.</p> <p>But for an important conversation about boundaries to take place, you first need the environment for an open, honest and trusting discussion.</p> <p>Partners should feel they can talk freely and without fear about what they are comfortable with in a relationship. And, be able to discuss how they feel about a boundary their partner has proposed.</p> <h2>Clarify and discuss</h2> <p>If you’re having the boundary conversation with your partner, clarify what you mean by your boundary request and how it might work in practice. Examples can help. Understanding the nuances can help your partner decide if your boundary request is reasonable or unreasonable for them.</p> <p>Second, negotiate which boundaries are hard and which are soft. This will involve flexibility and care, so you’re not undermining your or your partner’s, freedom, mental health and wellbeing. A hard boundary is non-negotiable and can determine the fate of the relationship. A soft boundary can be modified, as long as all parties agree.</p> <p>What constitutes a healthy boundary is different for each individual and each relationship.</p> <p>Regardless, it is a conversation best had in person, not by text message (which can easily be taken out of context and misunderstood). If you really must have the discussion over text, be specific and clarify.</p> <p>Before setting boundaries, seek insight into what you want for yourself and your relationship and communicate with your partner openly and honestly. If you’re fearful about how they’ll react to the discussion, that’s an issue.</p> <p>An open and honest approach can foster a productive collaboration that can strengthen relationship commitment.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209856/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/raquel-peel-368041">Raquel Peel</a>, Adjunct Senior Lecturer, University of Southern Queensland and Senior Lecturer, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-a-relationship-boundary-and-how-do-i-have-the-boundary-conversation-with-my-partner-209856">original article</a>.</em></p>

Relationships

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Essential money conversations retirees should have with family

<p>Discussions about funding retirement, aged care and inheritances may be uncomfortable. However, not having them risks your wishes going unmet and family conflicts where details aren’t clear. </p> <p>Hence having discussions about money while you are able to is one of the best (and cheapest!) investments you can make – for both you and your family.</p> <p>Precisely what those discussions entail will depend on your circumstances – and theirs. Yet many points apply almost universally:</p> <p><strong>What matters to you</strong></p> <p>Even the best laid plans mean nothing if those responsible for enacting them don’t know what they are or understand your reasoning behind them.</p> <p>Your will provides a legal overview of who gets what upon your death, while nominated beneficiaries determine how assets are divided from superannuation and some other structures.</p> <p>A separate letter of wishes can informally share your wishes, covering more than just legalities. Sharing this before your death allows family to clarify your wishes and ask questions. </p> <p><em>Go through:</em></p> <ul> <li>How your money should be managed now and longer term (e.g., you may want money set aside for grandchildren’s education, or have instructions for a dependent’s ongoing care).</li> <li>Funeral arrangements; cremation or burial; where you will be laid to rest.</li> <li>Plans for anyone other than direct family, charities etc.</li> <li>Any non-negotiables among your wishes.</li> </ul> <p><strong>Partner protections</strong></p> <p>Ensure your partner knows how they will be looked after if they outlive you. Similarly, your kids should know what if any support they will need to provide – especially important for blended families. </p> <p>Where beneficiaries have divorced/separated, will you exclude their ex from your estate? Are your records updated to reflect this?</p> <p>Ensure everyone knows the difference between joint tenants and tenants in common for property owners – only one automatically leaves your share of the property to your co-owner. </p> <p><strong>Health matters</strong></p> <p>How do you want to be looked after in your final years? Don’t assume your loved ones already know everything.</p> <p>Communicate your wishes, small and large – medications, dietary requirements, retirement living, palliative care, resuscitation.</p> <p>Discuss whether power of attorney and enduring guardianship are needed should you be unable to make decisions over your health and finances (e.g., due to dementia or stroke), and who will assume those responsibilities.</p> <p><strong>Family legacy</strong></p> <p>Consider the legacy you want to leave and whether this aligns with your family’s expectations.</p> <p>Is dividing assets equally among your children really fair if one is well-off while another struggles or has complex needs? </p> <p>Do your plans on inheritance unwittingly create headaches for the recipients – such as leaving property to someone who cannot afford to maintain it, or tax liabilities that eat into any financial gain?</p> <p>Discuss non-financial legacy too: do your offspring know about your (and hence their) heritage? Are there special family mementos/stories to pass on? This knowledge may be lost if you don’t share it now.</p> <p><strong>Place to call home</strong></p> <p>Given their financial, logistical, and emotional implications, living arrangements are crucial to discuss before things need to change (and change can be imposed suddenly, such as by a health emergency). </p> <p><em>Consider:</em></p> <ul> <li>Where would you want to go if you need high-level care?</li> <li>Is your current home suitable in your advanced years? How would any required modifications be paid for?</li> <li>Would you move nearer your kids? Downsize, upsize or sea/treechange?</li> <li>If you move, would you need to sell your current home? Could it be retained somehow?</li> <li>Do you want/expect kids to care for you? Are they capable of doing so? </li> <li>Could/would you live with one of your children? If so – such as paying to build a granny flat on their property – how does this affect your will? Would they be forced to sell so their siblings receive their inheritance?</li> </ul> <p><strong>Team united</strong></p> <p>Having everyone on the same page helps things to run smoothly – especially during difficult times such as a death or serious illness in the family.</p> <p><em>Stay aligned by:</em></p> <ul> <li>Introducing adult children to your financial adviser, lawyer, and accountant.</li> <li>Ensuring everyone knows where to find your will and who is your executor.</li> <li>Disclosing what is and is not up to date.</li> <li>Providing contingency access to passwords, important documents, keys etc.</li> <li>Sharing relevant policy details (e.g., life insurance).</li> </ul> <p>These discussions may be sensitive and difficult to initiate, but are crucial to ensure your wishes are known and enacted. Plus, they may encourage your loved ones to think about their own wishes – and give you all peace of mind for the future!</p> <p><strong><em>Helen Baker is a licensed Australian financial adviser and author of the new book, On Your Own Two Feet: The Essential Guide to Financial Independence for all Women (Ventura Press, $32.99). Helen is among the 1% of financial planners who hold a master’s degree in the field. Proceeds from book sales are donated to charities supporting disadvantaged women and children. Find out more at <a href="http://www.onyourowntwofeet.com.au">www.onyourowntwofeet.com.au</a></em></strong></p> <p><em>Image credits: Getty Images  </em></p>

Retirement Income

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Fun ways to boost memory in seniors

<p dir="ltr">Memory issues can seriously deteriorate the quality of life for seniors. To reverse the typically progressive process of memory loss, many solutions have been put forward. These include creative leisure activities aimed to work on the senior’s brain while providing relaxation.</p> <p dir="ltr">To work on a senior’s memory, it’s optimal to have them work on a project, focusing and seeing the work being done. There are plenty of games and activities available to help memory.</p> <p dir="ltr"><strong>Paint by Numbers</strong></p> <p dir="ltr">Paint by Numbers is a creative art form that involves painting a pre-drawn sketch on a linen canvas with reference numbers. It helps stimulate the intellect and senses. They’re available in colour books as well, you can find them at your local Kmart and select supermarkets.</p> <p dir="ltr"><strong>Diamond painting</strong></p> <p dir="ltr">Diamond painting is a manual activity where the senior creates beautiful pictures using rhinestones to stick onto a self-adhesive canvas. It calls for concentration, reflection, memorisation, and patience from the practitioner, which is beneficial for working on memory.</p> <p dir="ltr"><strong>Scratch painting</strong></p> <p dir="ltr">Scratch painting is a fun activity that involves scratching a picture with a coin or stylus, like a lottery scratch-off. It requires interest and concentration from the individual, who will enjoy the final picture and benefit their memory.</p> <p dir="ltr"><strong>Music therapy</strong></p> <p dir="ltr">Music therapy is used to treat and alleviate disorders, such as relational, behavioural, and communication difficulties. It also has benefits for seniors with memory problems, as it allows them to mobilise concentration, emotions, and memory in a playful way.</p> <p><span id="docs-internal-guid-70e6c7d1-7fff-2c54-f0e3-9408829a216a"></span></p> <p dir="ltr"><em>Image credit: Shutterstock</em></p>

Mind

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Conversation starters for solo travellers

<p>We all know of stranger danger but when you’re a solo traveller the ability to talk to strangers (safely, though) is one of the most important skills to have under your belt. Chatting with strangers will not only add to your travel experience but it might even lead to life-long friendships. Here are a few conversation starters to keep up your sleeve.</p> <p><em>A note on safety</em>: Don’t be afraid to tell people you are a solo traveller. People are often more keen to chat and talk to those travelling alone, however it’s important to exercise caution. Look for clues to see if the person can be trusted and stay in public places.</p> <p><strong>When eating out, sit at a communal table or at the bar.</strong> Chat to people sitting next to you. If they are a local, you can ask them about the restaurant and any local recommendations. If they are a fellow traveller, ask them where they’re from and how their trip is going.</p> <p><strong>Ask someone to take your photo.</strong> Be mindful of the fact there are some scammers targeting tourist destinations to steal cameras so use your judgement but this is an easy and natural way to strike up a conversation. A family or a group of tourist can usually be trusted and counted on to take your Start with the sight you’re getting photographed.</p> <p><strong>Comment on a tourist destination.</strong> If you’re wandering around a museum/gallery/popular site, keep a look out for other solo travellers. Keep it simple and introduce yourself, following up questions about how their enjoying where you both are. Be aware that not everyone wants to chat but most solo travellers have an open mind and want to meet new people.</p> <p><em>Image credits: Getty Images</em></p>

Travel Tips

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Don’t let financial shame be your ruin: open conversations can help ease the burden of personal debt

<p>Nearly <a href="https://www.ipsos.com/en-nz/19th-ipsos-new-zealand-issues-monitor">two-thirds of New Zealanders</a> are worried about the cost of living, and a quarter are worried about <a href="https://www.canstar.co.nz/wp-content/uploads/2023/03/Consumer-Pulse-Report-NZ-2023-Final-4.pdf">putting food on the table</a>. But the <a href="https://visionwest.org.nz/food-hardship-part-one/">shame</a> that can come with financial stress is preventing some people from seeking help. </p> <p>According to a recent survey, a third of New Zealanders were not completely truthful with their family or partners about the state of their finances, and 12% <a href="https://www.stuff.co.nz/business/money/129477493/financial-infidelity-research-finds-kiwis-hiding-debts-from-their-partners">actively hid their debt</a>. This shame and worry about money can spill over into <a href="https://www.nzherald.co.nz/bay-of-plenty-times/news/concerns-buy-now-pay-later-schemes-could-fuel-addiction-as-kiwis-spend-17b-last-year/VOV3VIDIG2MZBGJEGPMLGWDMJI/">addiction</a>, <a href="https://www.newsroom.co.nz/i-had-serious-concussion-bad-credit-and-15000-debt-abuse-survivor">violence</a> and <a href="https://corporate.dukehealth.org/news/financial-strains-significantly-raise-risk-suicide-attempts">suicide</a>. </p> <p>Considering the effect of financial stress on our wellbeing, it is clear we need to overcome the financial stigma that prevents us from getting help. We also <a href="https://www.apa.org/topics/money/family-financial-strain">owe it to our kids</a> to break the taboo around money by communicating our worries and educating them on how to manage finances better. </p> <h2>The burden of growing debt</h2> <p><a href="https://www.stuff.co.nz/business/money/300817697/mortgage-pain-homeowners-facing-repayment-hikes-of-up-to-900-a-fortnight">Ballooning mortgage repayments</a> are compounding the financial distress of many New Zealanders. At the beginning of 2023, an estimated 11.9% of home owners were behind on loan payments, with more than <a href="https://www.rnz.co.nz/news/business/485045/data-shows-430-000-new-zealanders-behind-in-credit-repayments-in-january">18,400 mortgagees in arrears</a>. </p> <div data-id="17"> </div> <p>Given the <a href="https://www.treasury.govt.nz/publications/an/an-21-01-html">majority of household wealth</a> in New Zealand is in property, our financial vulnerability is closely linked to the ebbs and flows of the <a href="https://content.knightfrank.com/research/84/documents/en/global-house-price-index-q2-2021-8422.pdf">second most overinflated property market</a> in the world. </p> <p>There are also cultural reasons for growing financial distress. Many households have taken on significant debt to “<a href="https://www.stuff.co.nz/business/7616361/Keeping-up-with-the-Joneses">keep up with the Joneses</a>” and to pursue the quintessential <a href="https://www.interest.co.nz/property/99890/westpac-commissioned-survey-suggests-many-new-zealanders-still-pine-quarter-acre">quarter-acre dream</a>. Social comparison and peer pressure act as powerful levers contributing to problem debt and over-indebtedness. </p> <p>The average household debt in New Zealand is more than <a href="https://tradingeconomics.com/new-zealand/households-debt-to-income">170% of gross household income</a>. That is higher than the United Kingdom (133%), Australia (113%) or Ireland (96%).</p> <h2>The rise of problem debt</h2> <p>And we are digging a deeper hole. Over the past year, <a href="https://www.rnz.co.nz/news/business/485045/data-shows-430-000-new-zealanders-behind-in-credit-repayments-in-january">demand for credit cards increased by 21.7%</a>. The use of personal debt such as personal loans and deferred payment schemes <a href="https://www.nzherald.co.nz/business/demand-for-personal-credit-rises-arrears-also-up-as-cost-of-living-bites/YCEM74CII5FQBPJXO3UOG4Y3GY/">is also climbing</a>. There is a real risk this debt could become problem debt. </p> <p>Problem debt can have severe and wide-reaching consequences, including <a href="https://theconversation.com/over-300-000-new-zealanders-owe-more-than-they-own-is-this-a-problem-173497">housing insecurity</a>, <a href="http://www.socialinclusion.ie/publications/documents/2011_03_07_FinancialExclusionPublication.pdf">financial exclusion</a> (the inability to access debt at affordable interest rates), <a href="https://www.tandfonline.com/doi/full/10.1080/07409710.2012.652016?journalCode=gfof20">poor food choices</a> and a plethora of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-489">health problems</a>. </p> <p>Yet, the hidden <a href="https://spssi.onlinelibrary.wiley.com/doi/10.1111/sipr.12074">psychological</a> and <a href="https://link.springer.com/article/10.1007/s11205-008-9286-8">social cost of financial distress</a>remains often unspoken, overlooked and underestimated.</p> <p>Even before the pandemic, <a href="https://www.scoop.co.nz/stories/BU1909/S00616/research-shows-financial-stress-impacts-mental-wellbeing.htm">69% of New Zealanders were worried</a>about money. The share of people worrying about their financial situation was higher for women (74%), and particularly women aged 18-34 (82%). It is no coincidence that the latter are particularly at risk of problem debt through so-called <a href="https://acfr.aut.ac.nz/__data/assets/pdf_file/0008/691577/Gilbert-and-Scott-Study-2-Draft-v10Sept2022.pdf">“buy now, pay later” schemes</a>. </p> <p>The stigma of financial distress extends beyond the vulnerable and the marginalised in our society. A growing number of <a href="https://www.rnz.co.nz/news/political/467417/middle-income-families-hoping-for-help-in-budget-as-rising-costs-sting">middle-class New Zealanders </a> are quietly suffering financial distress, isolated by financial stigma and the taboos around discussing money. When pressed, one in two New Zealanders would rather <a href="https://www.scoop.co.nz/stories/BU2203/S00384/research-shows-wed-rather-talk-about-politics-than-our-finances.htm">talk politics over money</a>. </p> <h2>Time to talk about money</h2> <p>Navigating financial distress and <a href="https://digitalcommons.law.seattleu.edu/cgi/viewcontent.cgi?article=2526&context=sulr">stigma</a> can feel overwhelming. Where money is a taboo subject, it may feel safer to withdraw, maintain false appearances, be secretive or shun social support. </p> <p>This tendency to avoid open discussions and suffer in silence can lead to <a href="https://loneliness.org.nz/lonely/at-home/financially-struggling/">feelings of isolation</a> and contribute to <a href="https://theconversation.com/how-financial-stress-can-affect-your-mental-health-and-5-things-that-can-help-201557">poor mental health</a>, such as depression, anxiety and emotional distress. </p> <p>Sadly, the trauma of living in financial distress can also <a href="http://irep.ntu.ac.uk/id/eprint/39442/1/1307565_Wakefield.pdf">break up families</a>. Losing the symbols of hard-gained success and facing the prospect of a reduced lifestyle can be tough. It often triggers feelings of personal failure and self doubt that deter us from taking proactive steps to talk openly and seek help. </p> <p>But what can families do to alleviate some of this distress?</p> <h2>Seek help</h2> <p>First, understand that <a href="https://www.ft.com/content/86767aac-98e0-4dae-8c5a-d3301b030703">you are not alone</a>. Over 300,000 New Zealanders <a href="https://theconversation.com/over-300-000-new-zealanders-owe-more-than-they-own-is-this-a-problem-173497">owe more than they earn</a>.</p> <p>Second, seek help. There are many services that help people work through their financial situation and formulate a plan. In the case of excessive debts, debt consolidation or <a href="https://goodshepherd.org.nz/debtsolve/">debt solution loans</a> may help reduce the overall burden and simplify your financial situation. </p> <p>For those struggling with increasing interest on their mortgages, reaching out to your bank early is critical. During the 2008 recession, banks in New Zealand <a href="https://www.beehive.govt.nz/release/banks-exchange-letters-crown-support-distressed-mortgage-borrowers">worked with customers</a> to avoid defaulting on mortgages, including reducing servicing costs, capitalising interest and moving households to interest-only loans. It is essential to understand that the <a href="https://www.stuff.co.nz/life-style/homed/real-estate/130677426/are-we-on-the-brink-of-a-wave-of-mortgagee-sales">banks do not want mortgagees to fail</a>, and that options exist.</p> <p>To help future generations avoid debt traps, we need open communication about money – also known as “<a href="https://link.springer.com/article/10.1007/s10834-020-09736-2">financial socialisation</a>”. This includes developing values, sharing knowledge and promoting behaviours that help build <a href="https://files.eric.ed.gov/fulltext/EJ1241099.pdf">financial viability and contribute to financial wellbeing</a>. </p> <p>The lessons about handling money from family and friends are crucial for <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2020.02162/full">improving our children’s financial capability</a>, helping them be <a href="https://www.fsc.org.nz/it-starts-with-action-theme/growing-financially-resilient-kids">more financially resilient</a> and better able to survive the stresses we are experiencing now – and those <a href="https://www.stuff.co.nz/business/money/300836616/heres-how-much-household-costs-are-expected-to-increase">yet to come</a>.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/dont-let-financial-shame-be-your-ruin-open-conversations-can-help-ease-the-burden-of-personal-debt-202496" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Retirement Income

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Ed Sheeran shoots for the stars with daughter’s name reveal

<p dir="ltr">When Ed Sheeran and his wife Cherry Seaborn announced the birth of their second child in May 2022, they kept things simple. </p> <p dir="ltr">In a post to social media, Sheeran shared a picture of socks on a crochet blanket, with a caption reading “Want to let you all know we’ve had another beautiful baby girl. We are both so in love with her, and over the moon to be a family of 4”.</p> <p dir="ltr">The couple shared no ‘face reveal’ - opting to keep their children far removed from the public eye - and did not share their youngest daughter’s name with Sheeran’s 42.8m followers. </p> <p dir="ltr">But in a March interview with <em>Rolling Stone</em>, the 32-year-old singer-songwriter took everyone by surprise, opening up about his family life, and revealing the out-of-this-world moniker bestowed upon their youngest, Jupiter. </p> <p dir="ltr">“Me and Cherry were talking earlier about how it’s so lovely,” he told the publication, opening up about the little things in life that he and his family cherish the most. “We had an entire day. We did nothing but this. It’s so nice and wholesome having family on tour. </p> <p dir="ltr">“On the last tour, I’d party till 7 am, sleep till 4 pm, get up, and do the gig. But I was like, 26. It’s very different.”</p> <p dir="ltr">Jupiter’s birth, and establishing their new “lovely” life, were no easy feats for the couple. In February 2022 - a month that was already proving determined to knock Sheeran down - when Cherry was six months along in her pregnancy, she was diagnosed with a tumour. Surgery was required, but couldn’t be performed until she had given birth. </p> <p dir="ltr">As Sheeran wrote in a post outlining plans for his album <em>Subtract</em>, “Within the space of a month, my pregnant wife got told she had a tumour, with no route to treatment until after the birth. My best friend Jamal, a brother to me, died suddenly, and I found myself standing in court defending my integrity and career as a songwriter. </p> <p dir="ltr">“I was spiralling through fear, depression and anxiety. I felt like I was drowning, head below the surface, looking up but not being able to break through for air.”</p> <p dir="ltr">“There’s nothing you can do about it,” he confessed to <em>Rolling Stone</em>. “You feel so powerless.”</p> <p dir="ltr">Over the course of his interview, Sheeran toyed with a chain bracelet - one gifted to him by his wife, with their daughters’ name engraved. </p> <p dir="ltr">“It felt symbolic,” he said of the swap to the silver from the rubber bands that had previously adorned his wrist, “to take off those bracelets and put on one for my family.”</p> <p dir="ltr">After the slew of tragedies to hit Sheeran in such a short span of time, it was Cherry who realised that he was in need of professional help, leading to the singer seeking out a therapist. </p> <p dir="ltr">“No one really talks about their feelings where I come from,” he said. “People think it’s weird getting a therapist in England … I think it’s very helpful to be able to speak with someone and just vent and not feel guilty about venting. Obviously, like, I’ve lived a very privileged life. So my friends would always look at me like, ‘Oh, it’s not that bad.’ ”</p> <p dir="ltr">“The help isn’t a button that is pressed, where you’re automatically okay,” he added. “It is something that will always be there and just has to be managed.”</p> <p dir="ltr">And as Sheeran himself <a href="https://www.oversixty.com.au/health/caring/writing-songs-is-my-therapy-ed-sheeran-reveals-further-heartbreak">wrote in his <em>Subtract</em> post</a>, “Writing songs is my therapy. It helps me make sense of my feelings … in just over a week I replaced a decade’s worth of work with my deepest darkest thoughts.”</p> <p dir="ltr"><em>Images: Getty</em></p>

Family & Pets

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"Writing songs is my therapy": Ed Sheeran reveals further heartbreak

<p>In the wake of the tragic news of the <a href="https://www.oversixty.com.au/news/news/tragedy-strikes-ed-sheeran-tour" target="_blank" rel="noopener">heartbreaking loss</a> suffered by his co-writer and touring partner, Ed Sheeran has taken to Instagram to share his struggle following a series of life-changing events – and how this has altered the course of his new album, Subtract.</p> <p>The singer shared how he “spiralled” into depression last year after his wife, Cherry, was diagnosed with a tumour during her second pregnancy, which couldn’t be treated until after she gave birth.</p> <p>The star explained that he was "trying to sculpt the perfect acoustic album" for almost a decade, when the series of events changed everything.</p> <p>“Writing songs is my therapy. It helps me make sense of my feelings. I wrote without thought of what the songs would be, I just wrote whatever tumbled out.</p> <p>“And in just over a week, I replaced a decade’s worth of work with my deepest darkest thoughts," he captioned.</p> <p>“Within the space of a month, my pregnant wife got told she had a tumour, with no route to treatment until after the birth.</p> <p>“My best friend Jamal [Edwards], a brother to me, died suddenly and I found myself standing in court defending my integrity and career as a songwriter. I was spiralling through fear, depression and anxiety.</p> <p>“I felt like I was drowning, head below the surface, looking up but not being able to break through for air".</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CpPY7qyI6XB/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CpPY7qyI6XB/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Ed Sheeran (@teddysphotos)</a></p> </div> </blockquote> <p>The four-time Grammy award winner shared that this album was a "trapdoor" into his soul, and a way for him to make sense of everything he's been through.</p> <p>Sheeran announced the birth of his second daughter, Jupiter, in May of last year.</p> <p>Subtract will be released on the 5th of May 2023, through Asylum/Atlantic.</p> <p><em>Image: Getty</em></p> <p> </p>

Caring

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Hugh Jackman reveals why he is now in therapy

<p dir="ltr">Hugh Jackman has revealed he is undergoing therapy to help him come to terms with the trauma he experienced as a child.</p> <p dir="ltr">The Aussie actor opened up about his healing process in a new interview with Who magazine, telling the publication he recently began treatment.</p> <p dir="ltr">"I just started it recently. It's helped me a lot," he said. "We all need a village."</p> <p dir="ltr">"You need a friend you can unload everything – having someone really smart, who's a little a bit removed from your world can be really helpful."</p> <p dir="ltr">In his sessions, Jackman discussed his longstanding pain from being abandoned by his mother, Grace, and sisters Zoe and Sonya, who left Australia for the UK when he was just eight.</p> <p dir="ltr">Jackman remained in Sydney with his father, Christopher, and brothers Ian and Ralph. It wasn't until he was about 12 years old that he realised she was not coming home.</p> <p dir="ltr">However, therapy has allowed Jackman to accept the past and make peace with loved ones.</p> <p dir="ltr">"Understanding my past and how it's informing my thinking unconsciously – getting to really understand some of the patterns that I was unconsciously just repeating," he said.</p> <p dir="ltr"> </p> <p dir="ltr">However, Jackman has been fortunate enough to reconnect with his mother over the years, previously telling <em>The Sun</em>: "As I grew older I gained an understanding of why Mum did leave … and we have definitely made our peace, which is important. I was always quite connected with my mum. I have a good relationship with her."</p> <p dir="ltr">Sadly, Jackman's father passed away in September last year, on Father's Day in Australia.</p> <p dir="ltr"><em>Images: Instagram</em></p>

Mind

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"An arts engagement that’s changed their life": the magic of arts and health

<p>In 2007, a life-changing encounter at South Australia’s Flinders Medical Centre became the catalyst and symbol for a national arts and health movement. </p> <p>A young woman, Becky Corlett, was being transported through the hospital where an artist-in-residence, Rebecca Cambrell, was painting a mural. Becky had suffered a stroke and cardiac failure. She had stopped eating and was non-responsive even to family. When Becky passed the mural, however, she made a noise of interest. </p> <p>Cambrell instinctively drew Becky closer and gave her a paint brush. To everyone’s surprise, Becky started adding dabs of paint to the canvas, and then she smiled. The wonder of this moment only dawned on Cambrell when she turned around. </p> <p>“Her parents were convinced that the moment she touched that paintbrush, something was triggered inside Becky that made her want to live”, remembers Cambrell.</p> <p>Becky’s story is just one of many collected in our new report <a href="https://apo.org.au/node/321047">Telling the Story of Arts in Health in South Australia</a>.</p> <h2>What is ‘arts and health’?</h2> <p>Arts and health is broadly defined as using arts practice to deliver health outcomes, be they specifically targeted interventions or general wellbeing benefits. </p> <p>Arts and health work comes in many forms. It can be <a href="https://statetheatrecompany.com.au/shows/euphoria/">play</a> about mental health issues in rural areas. It can be a <a href="https://www.visualisingmentalhealth.com/">university competition</a> to design solutions to community wellbeing challenges. It can be the <a href="https://celsus.net.au/a-hospital-within-a-park/">integration</a> of art throughout an entire hospital to create a calming environment.</p> <p>In an interview with us, design researcher Jane Andrew said the breadth of arts and health work means participant involvement can range “from passively viewing to making to being in the environment”. </p> <p>The benefits are diverse. A <a href="https://www.who.int/europe/publications/i/item/9789289054553">2019 World Health Organisation study</a> looking at over 900 peer-reviewed publications found arts and health can do everything from encouraging health-promoting behaviours to supporting end-of-life care.</p> <p>The diversity of the arts and health field is represented by the perspectives of our report’s 47 interviewees. We spoke to arts therapists, managers of hospital-based arts and health programs, government arts agency staff, CEOs of local health networks and former ministers. We asked them about their past experiences with arts and health, the present challenges and opportunities for the field, and how best to advance this work in the future.</p> <h2>Art and health in Australia</h2> <p>Although benefits of the arts to health have been recognised <a href="https://academic.oup.com/book/9415/chapter/156246455">for millennia</a>, the formal field of arts and health work <a href="https://www.tandfonline.com/doi/abs/10.1080/17533010903421484">first emerged</a> across South Australia and the rest of the nation through the community arts movement of the 1970s and the rise of health promotion in the 1980s. </p> <p>The establishment of the Flinders Medical Centre’s Arts in Health program in the late 1990s provided a major step for the field into health settings, and the program remains an <a href="https://anmj.org.au/the-art-of-healing-inside-flinders-medical-centres-pioneering-arts-in-health-program/">innovative leader today</a>. </p> <p>The former director of the program, Sally Francis, recalled how, “on a regular basis” the program would have “three, four, five stories of someone who has been critically ill and had an arts engagement that’s changed their life.”</p> <p>But Becky Corlett’s story had, as Francis describes it, a “huge and far-reaching effect” on arts and health in Australia. Days after Becky’s first painting experience, former South Australian Minister of Health and Assistant Arts Minister, John Hill, visited the hospital "I was just walking along, and I saw the painting going on and there was this little girl busily doing art. […] Her parents came up to me and had tears in their eyes. […] She was reconnected with life."</p> <p>Inspired by this encounter, Hill and Francis led a push to have arts and health formally recognised by the state and then federal government. The <a href="https://www.arts.qld.gov.au/images/documents/artsqld/Research/National-Arts-and-Health-Framework-May-2014.pdf">National Arts and Health Framework</a> was officially endorsed in 2014. </p> <p>This historic statement declared the Australian federal, state and territory governments’ recognition of and support for the field. The framework aimed to raise awareness of arts and health, and to encourage government departments and agencies across the country to integrate arts and health work into their services. </p> <p>However, it did not make any funding or legislative requests, meaning no permanent arts and health policy followed its endorsement.</p> <h2>What next for arts and health?</h2> <p>Next year marks ten years since the framework’s endorsement. </p> <p>While there is continuing good work in this space across the country, our interviewees believe arts and health remains underutilised. Community artist Lisa Philip-Harbutt told us there is a lack of “connection between all the various things that people are doing” – different arts and health projects often aren’t speaking to each other.</p> <p>To regain momentum for the field, interviewees recommend developing educational pathways for prospective arts and health workers, conducting a review and update of the National Arts and Health Framework to embed it in policy, and establishing research partnerships between universities and arts and health programs. </p> <p>The hope is that the next generation of leaders will be inspired by witnessing arts and health’s life-changing power. </p> <p>According to Deborah Mills, a key driver of the National Arts and Health Framework, "If you want passionate advocates, they have to have a visceral understanding of what creative activity does."</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/an-arts-engagement-thats-changed-their-life-the-magic-of-arts-and-health-196212" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Art

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Sounds great: Scientists are manipulating dreams to prevent nightmares

<p>It’s  estimated that at any given time, around 4% of adults suffer <a href="https://cosmosmagazine.com/health/one-side-of-your-brain-might-be-giving-you-nightmares/" target="_blank" rel="noreferrer noopener">chronic nightmares</a> but researchers in Switzerland have a new approach which will be music to the ears of night-terror-sufferers.</p> <p>Basing their study on the relationship between the types of <a href="https://cosmosmagazine.com/science/biology/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal/" target="_blank" rel="noreferrer noopener">emotions experienced in dreams</a> and our emotional well-being, researchers have investigated how to help people by manipulating emotions in their dreams.</p> <p>Traditional methods to help chronic nightmare patients involves ‘imagery rehearsal therapy’, during which they are coached to rehearse the dream scenario during the day and redirect it towards a more positive ending. A <a href="https://link.springer.com/article/10.1007/s11818-021-00320-w" target="_blank" rel="noreferrer noopener">2021 study</a> of 28 participants showed 3 in 5 patients benefitted from this approach, however, it doesn’t work for everyone.</p> <div class="newsletter-box"> <div id="wpcf7-f6-p220659-o1" class="wpcf7" dir="ltr" lang="en-US" role="form"> <form class="wpcf7-form mailchimp-ext-0.5.62 spai-bg-prepared init" action="/health/sounds-great-preventing-nightmares/#wpcf7-f6-p220659-o1" method="post" novalidate="novalidate" data-status="init"> <p style="display: none !important;"><span class="wpcf7-form-control-wrap referer-page"><input class="wpcf7-form-control wpcf7-text referer-page" name="referer-page" type="hidden" value="https://cosmosmagazine.com/health/" data-value="https://cosmosmagazine.com/health/" aria-invalid="false" /></span></p> <p><!-- Chimpmail extension by Renzo Johnson --></form> </div> </div> <p>In a <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(22)01477-4" target="_blank" rel="noreferrer noopener">study from Geneva University</a>, over a two-week period, researchers asked a group of 18 patients to create an association between the positively redirected version of their dream and a sound during an imagination exercise. The patients then wore wireless headbands during night which would play the specific sound during the REM (Rapid Eye Movement) stage of sleep – when <a href="https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515" target="_blank" rel="noreferrer noopener">nightmares typically occur</a>.</p> <p>When compared to 18 patients who undertook only the image rehearsal therapy, those who received the combined rehearsal and sound therapy had fewer nightmares. This trend continued even after three months post-intervention, with those receiving combination therapy also reporting experiencing more positive emotions such as ‘joy’ in their dreams.</p> <p>“We were positively surprised by how well the participants respected and tolerated the study procedures, for example performing imagery rehearsal therapy every day and wearing the sleep headband during the night,” says Lampros Perogamvros, senior author of the study and a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva. “We observed a fast decrease of nightmares, together with dreams becoming emotionally more positive. For us, researchers and clinicians, these findings are very promising both for the study of emotional processing during sleep and for the development of new therapies.”</p> <p><!-- Start of tracking content syndication. Please do not remove this section as it allows us to keep track of republished articles --></p> <p><img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=220659&amp;title=Sounds+great%3A+Scientists+are+manipulating+dreams+to+prevent+nightmares" width="1" height="1" /></p> <p><!-- End of tracking content syndication --></p> <div id="contributors"> <p><em><a href="https://cosmosmagazine.com/health/sounds-great-preventing-nightmares/" target="_blank" rel="noopener">This article</a> was originally published on Cosmos Magazine and was written by Clare Kenyon. </em></p> <p><em>Image: Getty Images</em></p> </div>

Mind

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New study to “give hope” to childhood trauma survivors with depression

<p dir="ltr">A new study has challenged our understanding of how to treat adults with a history of childhood trauma, revealing that using psychotherapy, medication or a combination of the two are effective treatments for those with depression.</p> <p dir="ltr">Childhood trauma, defined as abuse or neglect of a person before they are 18 years old, is a known risk factor for major depressive disorders in adulthood. It often results in symptoms that start earlier, last longer and are more frequent, and increases the risk of developing co-occurring diseases and conditions.</p> <p dir="ltr">The study, published in <em><a href="https://doi.org/10.1016/S2215-0366(22)00227-9" target="_blank" rel="noopener">The Lancet Psychiatry</a></em>, found that adult survivors of childhood trauma who receive these common treatments experience improved symptoms at the same rate as those without childhood trauma.</p> <p dir="ltr">While previous studies have indicated that common treatments for major depressive disorders are less effective for people with childhood trauma, the team argues that these findings are inconsistent.</p> <p dir="ltr">The team then examined data from 29 clinical trials of psychotherapy and pharmacotherapy (the use of prescribed medications) among adults with major depressive disorders to determine whether those with trauma were more severely depressed before treatment, had more unfavourable outcomes after treatment, and whether they were less likely to benefit from treatment in comparison to those without trauma.</p> <p dir="ltr">Among the 46 percent of participants with childhood trauma, the team found that they showed more severe symptoms at the start of treatment and after treatment in comparison to the control group (those without trauma).</p> <p dir="ltr">But, they found that both groups experienced an improvement in symptoms at a similar rate.</p> <p dir="ltr">Erika Kuzminskaite, a PhD candidate and the first author of the study, said that this finding could be a source of hope.</p> <p dir="ltr">“Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma,” Kuzminskaite said.</p> <p dir="ltr">“Nevertheless, residual symptoms following treatment in patients with childhood trauma warrant more clinical attention as additional interventions may still be needed.”</p> <p dir="ltr">Antoine Yrondi, a professor at the University of Toulouse who wasn’t involved in the research, wrote that the study provides a message of hope for patients.</p> <p dir="ltr">“This meta-analysis could deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” Dr Yrondi said.</p> <p dir="ltr">“However, physicians should keep in mind that childhood trauma could be associated with clinical features which may make it more difficult to reach complete symptomatic remission and, therefore, have an impact on daily functioning.”</p> <p dir="ltr">According to <a href="https://blueknot.org.au/resources/blue-knot-fact-sheets/trauma-classification/what-is-childhood-trauma/" target="_blank" rel="noopener">Blue Knot</a>, childhood trauma can have a wider and more extreme impact than trauma we experience as adults because a child’s brain is still developing. If the trauma is unresolved, coping strategies developed during childhood can become risk factors for poorer psychological and physical health in adulthood.</p> <p dir="ltr">But, it is possible to recover from childhood trauma, with this latest study going to show that common treatments can be effective.</p> <p dir="ltr"><em>If you’re in need of support, you can contact Lifeline on 13 11 14 or Blue Knot on 1300 657 380.</em></p> <p><em><span id="docs-internal-guid-62551377-7fff-7a7f-9e23-d352d2c29923"></span></em></p> <p dir="ltr"><em>Image: Getty Images</em></p>

Mind

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The truth behind the healing power of music

<p>If you’ve suffered anything from a bad day to a devastating loss, you probably know that one of the first and best places to turn to is music. According to recent studies, there’s a reason for that: it’s scientifically proven to be healing and cathartic.</p> <p>According to a study performed by the University of Missouri, people are actually able to lift themselves out of a low emotional state by playing contrastingly cheerful music if they consciously attempt to feel happier while doing so. Significantly, study participants who were instructed to attempt to raise their moods while listening to upbeat music were able to achieve this in the immediate short term period and even increased their overall happiness over the course of two weeks.</p> <p>On the other end of the spectrum, another study, conducted by the University of California and Berkely, found that even sad songs can help to heal a “broken” heart. According to the researchers, "Under certain circumstances, consumers in negative moods might choose aesthetic experiences consistent with their mood even when more pleasant alternatives are also available." So basically, music can be a self-indulgent means of experiencing and working through our emotions.</p> <p>So whether your choice of music is The Rolling Stones’ melancholy <em>Out of Tears</em>, Zeppelin’s heart breaking, <em>Baby Come on Home</em>, The Beatles’ optimistic <em>Getting Better</em>, or Clapton’s rebellious <em>Cocaine</em>, your impulse to turn to music in hard times is actually backed up by science.</p> <p><em>Image credits: Getty Images</em></p>

Music

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