Beyond Knowing Nature – 5 Pathways to Nature Connection

Once again I am reblogging an interesting post by psychologist Miles Richardson on connection with nature and well being.

Particularly interesting is the research finding that factual knowledge does not necessarily correlate with emotional connection with nature. As Richardson writes, “the brain feels before it thinks”, and by focusing too much on how well species can be identified, we can miss the potential of emotional, experiential connection.

Finding Nature

Owing to the benefits to both human and nature’s well-being, and wide spread disconnection, a connection with nature is something many people and organisations are keen to increase. So there is a need to know how best to do this. We’ve already developed specific interventions, such as 3 good things in nature, but our wider framework of effective routes to nature connection has just been published in Plos One. I’m excited about this work is it provides guidance for those seeking to re-connect people with nature, indeed it has been central to much of our recent nature connections work, for example, guiding the type of activities promoted as part of The Wildlife Trusts highly successful 30 Days Wild campaign.

General nature contact and knowledge based activities are often used in an attempt to engage people with nature. However the specific routes to nature connectedness have not been examined…

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Leandro Herrero – “The best contribution that Neurosciences can make to Management and Leadership is to leave the room”

A while back I reviewed I Know What You’re Thinking: Brain Imaging and Mental Privacy in the Irish Journal of Psychological Medicine, and discussed a couple of studies which illustrate the dangers of what could best be called neuro-fetishism:

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

I am becoming quite addicted to Leandro Herrero’s Daily Thoughts and here is another. One could not accuse Herrero of pulling his punches here:

I have talked a lot in the past about the Neurobabble Fallacy. I know this makes many people uncomfortable. I have friends and family in the Neuro-something business. There is neuro-marketing, neuro-leadership and neuro-lots-of-things. Some of that stuff is legitimate. For example, understanding how cognitive systems react to signals and applying this to advertising. If you want to call that neuro-marketing, so be it. But beyond those prosaic aims, there is a whole industry of neuro-anything that aggressively attempts to legitimize itself by bringing in pop-neurosciences to dinner every day.

In case anyone doubts his credentials:

Do I have any qualifications to have an opinion on these bridges too far? In my previous professional life I was a clinical psychiatrist with special interest in psychopharmacology. I used to teach that stuff in the University. I then did a few years in R&D in pharmaceuticals. I then left those territories to run our Organizational Architecture company, The Chalfont Project. I have some ideas about brains, and some about leadership and organizations. I insist, let both sides have a good cup of tea together, but when the cup of tea is done, go back to work to your separate offices.

It is ironic that otherwise hard-headed sceptics tend to be transfixed by anything “neuro-” – and Leandro Herrero’s trenchant words are just what the world of neurobabble needs. In these days of occasionally blind celebration of trans-, multi- and poly- disciplinary approaches, the “separate offices” one is bracingly counter-cultural…

Leandro Herrero – What I learnt from the monks: a little anthropology of leadership and space in one page.

Another Daily Thought from Leandro Herrero that I am tempted to simply cut and paste completely. The whole thing is worth reading. I have blogged on my other site a fair about both the positive side of monastic practice and the risk of romanticising monasticism with the attendant danger of spiritual pride.

Monasteries were, of course, key institutions in the development of Western institutional life and culture. We often like to think that we have moved way way beyond learning from the communal life of monasteries. Of course, the themes and patterns of human interaction recur in superficially different guises:

There is something special about creating space. For me, leadership is mainly architecture: create the conditions, find the spaces, protect them, make them liveable. Architects also have maps, and compasses. The leader needs to provide maps (frameworks, such as the non negotiable behaviours) and navigation tools (a value system). But, above all, it’s about space.

Providing spaces for people to breath, to growth, to deliver something, to get better, to think critically, to interact, to collaborate, to travel together. This is all about space. Space is the psychological sister of place. Space may be only, or mainly, mental. As such, it is a precious asset. No wonder the word space has been often associated to the word sacred. As in sacred spaces. To provide space, to create and protect spaces for others, is something a good leader does. It’s a great deal of his servant-ship.

But we, sometimes, are not very good at this. We take over other people’s spaces by insisting in discussing, wanting to ‘go deeper’, being intolerant with leaving things open, dictating our own terms and providing unreasonable borders to their spaces.

At a threshold point of two people living together in one place, they may come to inhabit one single space. It requires a lot of maturity to live in one single space with others. Occupying one single place, is the easier part, space is not. Indeed, that single space may end up being too much to ask. It may be better to have separate spaces to respect, often overlap. Psychotherapists have known for many years that a temporary split, or making tangential connections for a while, may be the solution to some problems. Un-bundle the spaces that have become blurred, that is.

Why Our Connection with Nature Matters

More from the Finding Nature blog – a very interesting post on nature and human well-being, which obviously relates to themes I have blogged about here. I am always a bit leery of overly therapeutising (sic) nature but admire how the author has managed this dynamic here….

Finding Nature

Nature is good for us, but why? There’s plenty of evidence that exposure to nature is good for people’s health, well-being and happiness – with green spaces even promoting pro-social behaviours. However, less is known about why nature is good for us. Simply put, nature is good for us, because we are part of nature. We are human animals evolved to make sense of the natural world. This embeddedness in the natural world can often be forgotten and overlooked, mentally we can become disconnected from nature because we’re now deeply embedded in a human-made world. Emerging research is showing that knowing and feeling this connection with nature is also good for us, and it helps bring about the wider health benefits of exposure to nature. Knowing your place in nature brings meaning and joy!

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My research is focussed on understanding and increasing this connection with nature, an interest that…

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Review of I Know What You’re Thinking: Brain Imaging and Mental Privacy, Irish Journal of Psychological Medicine, February 2016

Original here

I Know What You’re Thinking: Brain Imaging and Mental Privacy, Edited by Richmond , Rees  and Edwards

 

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

This may sound like a parody, or a debunking of neuroimaging, but in fact it was intended to point out the considerable challenge of neuroimaging research, and more specifically how the vast number of potential variables inherent in this research pushes ‘traditional’ statistical methodology to its limit.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

The title of this book alone leads one to expect that it is an exploration of one widespread popular notion about neuroimaging; that it is a way of reading thoughts. Some of the essays do explore this theme; but most don’t, at least not that directly. Notwithstanding the inclusion of an essay by the former editor of this journal, the book is something like the proverbial curate’s egg, good in parts (without any partiality, Professor Kelly’s contribution is one of the good parts).

There are four sections to the book. First, an overview of the state of the art of neuroimaging and of the conceptual questions raised. Second, a focus on medical applications of mind reading through brain imaging. Third, a section on criminal justice, and finally one on mind reading and privacy.

Among the contributors, practitioners of neuroimaging-based research alternate with (relative) skeptics of the approach. It is interesting to observe the actual researchers, rather than being zealots, are tentative and provisional in their suggestions; the skeptics are more forthright. For instance, Colin Campbell and Nigel Eastman baldly evoke the ghost of phrenology – evidently a nearby shade for many contemplating this area – in the conclusion of their essay on neuroimaging on the law. Although this is a valid point – and undoubtedly some commercially promoted ‘mind reading’ technologies are pure hokum – it is rather jarring conclusion to their essay.

There is nevertheless much useful and stimulating material here. John-Dylan Haynes provides a useful overview of brain imaging technology itself and some of the possibilities and limits of the field. The second section, rather alarmingly titled ‘Medical applications of mind reading through brain imaging’, is generally comprised of thoughtful, nuanced discussions of the issues in non-responsive patients, pain, and mental health.

However, the essays are overall quite mixed in tone and content. Some bear the hallmarks of generic essays on particular topics with relatively little directly on the topic of the book (for instance, Annabelle Lever’s chapter on ‘Neuroscience versus privacy’ which is rather an extended discussion of privacy with some mentions of neuroscience). Contributors often rehash discussions that are covered at greater length, sometimes rather tediously so, in other essays.

The Hastings Centre Report ‘Interpreting neuroimages: an introduction to the technology and its limits’ – available at http://www.thehastingscenter.org/Publications/SpecialReports/Detail.aspx?id=6841 – covers much of the same ground as this book but more concisely and more accessibly, particularly Martha J. Farah’s essay in the ‘Brain images, babies, and bathwater: critiquing critiques of functional neuroimaging’. With the Hastings Centre Report freely accessible in the public domain it is hard to advise readers to part with their money for this volume.

” Further studies are needed in which patients are instructed to watch the fish.”

I previously noted a brief reference in a book on high rise life to the role of aquaria in fighting loneliness. There is a fair amount written about the calming effects of contemplating aquaria. This paper attempts to study the phenomenon empirically in a (very) particular patient group. It is also an example of an abstract selling a result in the way the paper doesn’t support… “trend towards significance” indeed!

Anthrozoös Vol. 16 , Iss. 3,2003

Abstract:

This study investigates the effect of an aquarium on pre-treatment anxiety, fear. frustration, and depression in electroconvulsive therapy (ECT) patients. Forty-two patients consecutively referred for ECT were rotated between rooms with and without aquariums. Self report measures of depression, anxiety, fear, and frustration were obtained, along with heart rate and blood pressure measurements. Preliminary mixed-model, repeated measures analysis of variance (ANOVA) revealed no significant differences between the aquarium and control conditions on any of the dependent measures. A trend toward significance was found for self reported anxiety (p=0.08) and further data were collected. Subsequent mixed model, repeated measures ANOVA confirmed the trend toward differences (p=0.08) in anxiety between the aquarium and control conditions. Factoring out demographic factors, the average patient experienced 12% less anxiety in the presence of an aquarium.

The authors describe how ECT is an effective, evidence-based psychiatric treatment, but that pre-treatment anxiety is an issue. Prior interventions have not been found significantly effective:

Educational interventions have been primarily developed to address this fear and anxiety; however, conflicting results have been reported regarding their effectiveness. One study focused on the effect of emotional support, provided by a psychiatric nurse in an educational context, on the anxiety levels of 32 ECT patients (Cohen 1970). The results revealed no significant difference in anxiety levels between patients receiving the intervention and those who did not. Another study involving 37 veteran psychiatric patients reported that while knowledge and behavioral intent showed positive changes following an educational ECT video, there was no reduction in fear (Battersby, Ben-Tovim and Eden 1993). Contrary results were reported using a continuous quality improvement model in which an educational video and written information were found to reduce anxiety. These findings are based on follow-up telephone interviews from15 patients (Harrison and Kaarsemaker 2000).

The authors describe animal-assisted therapy:

One environmental intervention, animal-assisted therapy (AAT), has been found to calm patients in some circum-; the benefits of interacting with companion animals are receiving increased attention in the healthcare industry. Studies have documented an association between pet ownership and reduced cardiovascular risk factors,improved one-year survival rates following myocardial infarction, reduction in minor health problems, and lower physician utilization (Friedmann et al.1980; Siegel 1990; Serpell 1991; Anderson, Reid and Jennings 1992). More recently, randomized controlled studies have shown a positive effect of pet ownership, or the presence of pets, on physiological indicators of reactivestress (Allen et al. 1991; Allen 2000; Allen, Shykoff and Izzo 2001; Allen,Blascovich and Mendes 2002). Interacting with companion animals has also been associated with reduced anxiety levels for non-psychiatric as well as inpatient psychiatric populations (Wilson 1991; Barker and Dawson1998). A significant reduction in anxiety was reported in a study involving 241 hospitalized psychiatric patients with a broad range of diagnoses fol-lowing 30 minutes of animal-assisted therapy (Barker and Dawson 1998).A more recent study found a significant reduction in fear following a 15-minute interaction with a therapy dog and its handler for 35 psychiatric patients waiting for electroconvulsive therapy (Barker, Pandurangi and Best 2003). No significant differences were found for anxiety or depression.

The authors describe the limitations of this study. One strikes me as fairly fundmental – patients were not asked to look at, or engage with the aquarium…. and in fact couldn’t, by and large, actually see it :

Similar to the results reported by Katcher, Segal and Beck (1984),blood pressure and heart rate readings were not significantly different for the patients in the aquarium and control conditions: the presence of an aquarium was not associated with reduced physiological measures of anxiety in patients waiting for ECT. However, unlike the earlier Katcher, Segaland Beck study, patients in this study were not asked to look at, or in anyway attend to, the aquarium, nor was it suggested to them that the aquarium would have a calming effect. Instead, the purpose of this study was to assess the impact of the mere presence of a fish aquarium. Further studies are needed in which patients are instructed to watch the fish.

The lack of significant findings in the present study may also be in part due to the background role of the aquarium. As patients were not seated in front of the aquarium or asked to look at it, they were not intentionally exposed to the potentially calming effect of watching the fish, unless they deliberately chose to do so. Most patients tended to lie down while in the holding rooms. In order to view the fish in this position, they would have to deliberately lie on one side. It may be necessary for patients to focus on the aquarium to derive benefit; a task that may be difficult for severely depressed patients. Also, the aquarium may not represent a powerful enough stimulus to distract patients from thoughts of their upcoming ECT treatment.

As neither study resulted in a significant reduction in anxiety, it maybe that the anxiety related to the ECT procedure is not amenable to the calming effects of animal-assisted activities. Also, the global nature of the visual analog scales used in both studies may not be sensitive to anxiety changes resulting from animal-assisted activities.

It does strike me that, as ECT is now reserved for specific indications and, by definition, those most severely ill, the anxiety and distress associated is likely to be at the more severe end of the spectrum – and less likely to respond to the passive presence of an aquarium.

Post for CCIO blog 20/02/17 – The “technodoctor” and putting stories at the heart of healthcare

Here is a post on the CCIO blog which I guess crystallises some of the thoughts I have posted here inspired by Cecil Helman. So this marks a culmination of sorts of engagement with his work.

The “technodoctor” and putting stories at the heart of healthcare

Cecil Helman was a South African-born GP who died in 2009 of motor neurone disease. He was also an anthropologist whose textbook, Culture, Health and Illness, remains a key reference and teaching text for medical anthropology. His approach to medicine, and life, is summed up in the words of one of his obituaries:

For Cecil literature and art were as important as the science of medicine. He was fascinated by people, their cultural and ethnic backgrounds, the narratives of their illnesses, their interaction with practitioners, and the role of traditional healers in many different societies. As he said, to be an effective healer, a doctor needs to ‘understand the storyteller as well as the story’.

Cecil_HelmanWhile his academic works have had a major influence on healthcare education and training, his most popular book was 2006’s Suburban Shaman a “mosaic of memories” of storytellers/patients and their stories, informed by his anthropological knowledge and approach. A posthumous sequel, An Amazing Murmur of the Heart, is a sort of sequel, in which Helman discusses the often-dehumanising process of medical education, during which the patient becomes something denatured, disconnected from their narrative. And in this book Helman identifies a new kind of doctor – the “technodoctor”:

Young Dr A, keen and intelligent, is an example of a new breed of doctor – the ones I call ‘techno-doctors’. He is an avid computer fan, as well as a physician. He likes nothing better than to sit in front of his computer screen, hour after hour, peering at it through his horn-rimmed spectacles, tap-tapping away at his keyboard. It’s a magic machine, for it contains within itself its own small, finite, rectangular world, a brightly coloured abstract landscape of signs and symbols. It seems to be a world that is much easier for Dr A to understand , and much easier for him to control, than the real world –  one largely without ambiguity and emotion.

Helman further identifies that this attitude marks a further step along the road of reductionism and dehumanising in medical care:

Like many other doctors of his generation – though fortunately still only a minority – Dr A prefers to see people and their diseases mainly as digital data, which can be stored, analysed, and then, if necessary, transmitted – whether by internet, telephone or radio – from one computer to another. He is one of those helping to create a new type of patient, and a new type of patient’s body – one much less human and tangible than those cared for by his medical predecessors. It is one stage further than reducing the body down to a damaged heart valve, an enlarged spleen or a diseased pair of lungs. For this ‘post-human’ body is one that exists mainly in an abstract, immaterial form. It is a body that has become pure information.

I was reminded by Robert Wachter’s speech at the 2016 CCIO Network Summer School in Leeds, on unintended consequences in health IT. He gave the example of hospitals where doctors are no longer to be found on the wards interacting with patients and other staff, but in a room full of doctors on computers, interacting with the EHR. The most stark illustration he used, however, was a child’s picture of a visit to the doctor, showing the doctor’s back turned to the child and her mother, tap-tapping away at the screen.

“A body that has become pure information” is how Helman describes the end process of the dehumanisation he decries. While I think the “technodoctor” is something of a straw man, Helman is certainly pointing to a genuine risk. “An Amazing Murmur of the Heart” is full of wisdom about the importance of connection, of physical touch, of attending to the story the patient brings, and the meaning of their symptoms for them. It would be a pity if this kind of rich, truly humanistic approach to medicine is somehow placed in opposition to the world of the “technodoctor.”

One way of avoiding the development of this false dichotomy into something tangible lies in Helman’s emphasis on the need to “understand the storyteller as well as the story.” What Helman doesn’t discuss in these passages is how paper-based information systems in healthcare can obscure the story and the storyteller in a welter of disjointed confusion. My own experience of paper notes is all too often wading through pages of confusing, if not illegible, notes, searching for something typewritten or printed. In this circumstance, the story the person is bringing to the encounter is utterly lost.

Initiatives like the EHR Personas allow for the conscientious, judicious use of narratives in planning and executing a major health IT change, one that could radically alter not only how healthcare is delivered but also how the personal story that is at the heart of all this activity is told.

Helman is, from the grave, issuing a warning, however, about what could go wrong. It is the same warning as that Bob Wachter gives with the child’s picture. It is fortunate that “narrative medicine” has become an academic subject in its own right, although perhaps this development indicates that something has been lost. In planning health IT interventions, we must ensure that they allow the story to be told and the storyteller to be heard. Let us focus on ensuring that the human stories that are the real stuff of every single clinical encounter are never lost, and that we turn our faces not to the screen but to those human stories.