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This blog brings together content that is noticeable, important or otherwise interesting from a human givens point of view.

Friday, 6 January 2012

The BBC Stress Test - Results All in the Mind, BBC Radio 4, 20.12.11

The BBC Stress test was launched in June with BBC Lab UK, with the aim of answering one of the big questions in mental health - what is the cause of mental illness? More than 32,000 Radio 4 listeners took part, making this one of the largest studies of its kind in the world. The early results are in and Peter Kinderman, professor of clinical psychology at the University of Liverpool, tells Claudia Hammond what the findings reveal about the origins of mental health problems and the most effective coping strategies.
Extract from Claudia Hammond’s interview with Professor Peter Kinderman:

Peter Kinderman (PK): …we set out to find people who may or may not be stressed and then to look at what the causes of their mental health difficulties, their wellbeing were.

Claudia Hammond (CH): So what conclusions have you drawn about these bigger questions, about what causes mental health problems?

PK: The first thing to say is that we were testing out a theory that we had first expressed back in 2005 and we were looking at whether psychological factors were the consequence of high levels of stress, or whether they tended to cause high levels of stress. We’re still doing the analysis, so we’ve got a little bit of work still left to do, but it looks very much to us as if a family history of mental health problems, stressful life events, negative life events that you have experienced, and deprived social circumstances tend to make people ruminate and also blame themselves more for the negative events in their lives. And it’s that combination of self-blame and rumination that seems to be related to high levels of stress, and not as it might have been, the other way around.

CH: Ceri [one of the listeners who completed the ‘stress’ survey] mentioned that she often had a tendency to blame herself and that she would ruminate to an extent. How were you able to unpick what causes what in this, and how much it’s the events that have happened, how much it’s whether people blame themselves later, how much it’s whether they ruminate?

PK: Statistically, what we were looking at is how much of somebody’s stress levels were explained by different combinations of the different variables. So we were particularly interested in whether self-blame was more of a predictor than rumination. In fact, rumination seemed to be slightly more important than self-blame. But both self-blame and rumination were much more important than any of the other variables to be honest. So life events themselves were related to levels of stress, but they seemed to be related to stress only when people tended to ruminate or blame themselves. If you didn’t ruminate and didn’t blame yourself, then your levels of stress were much lower, even if you’d experienced many negative events in your life.

CH: So did you find that if people had many negative life events in the past, for example, difficult times growing up, if they then don’t ruminate a lot, are they then OK?

PK: Yes, basically what happened was that negative life events and very negative childhood events involving abuse were both related to mental health problems. But it seemed to be self-blame and rumination that were the pathway to those mental health problems. In scientific terms, very little of the variants was explained by the negative life events outside of the pathway through self-blame and rumination.  

CH: I see what you mean – so they can have those events, but if they don’t ruminate and self blame, they might be OK later on?

PK: Yes. And that’s important for another reason, which is it also suggests that if people are able to get a handle on rumination and self-blame, and to be honest, those other psychological processes such as where you place your attention, how your memory works, what you think about yourself, your self-concept. If people were to be able to get a handle on those psychological variables, then they might be able to improve their levels of stress and wellbeing. 

CH: Jan and Ceri were talking about rumination and their levels of stress there. What do you really mean by rumination? Does this mean worrying about those life events that happened in the past, those bad things that happen to people, or worrying more generally about everyday things?

PK: Well it can be both. It can be people having things going round and round in their heads about things that are coming up in the future. A typical example is someone who’s not sleeping because they’ve got a job interview the next day, and then thinking about what’s going to happen. It’s also people going over and over things that have happened in the past, ruminating about things that have happened, and they can’t shake these things out of their head. Interestingly, Jan made a distinction between productive and unproductive rumination, and I think that’s very important. We should plan for the future and we should reflect on the past: the question is to judge when it’s becoming unproductive and whether it’s just repetitive thoughts going round and round in our head.

CH: So you’re not saying all introspection is bad?

PK: I think introspection is good, but I think you need to be in control of it to the extent that it’s still useful to you, so you’re thinking about the future and preparing for it, rather than having thoughts about the ‘dreadful’ thing that’s coming up unproductively buzzing around in your head.

CH: So does this have implications for how psychological therapies should be shaped? I mean should they change to focus more on rumination and self-blame? Could you just look at those two things and make a difference?

PK: What I was doing was quite specifically testing out the question of whether psychological factors were causal of mental health problems, or whether they were the consequence of mental health problems. And I think that, although it’s only one study and other people will have other interpretations of it, I think it demonstrates that for this sample, rumination was a factor which caused mental health problems, in this sample.

CH: So it’s a bigger factor than say biological factors that people might think about?

PK: It was a much bigger factor than biological factors directly, although biological factors were related to your tendency to self blame. Everything was related to everything else, and it’s still quite difficult to tease that out. The important thing I think is that it gives an opportunity for people who are experiencing stress, who do feel as if their wellbeing is less than it should be, that there are things that can be done about that that don’t involve going back to the past and reversing the negative things that have happened but dealing with the consequences now, dealing with people’s tendency to ruminate, dealing with their tendency to self blame. And like I say, there will be other things like a tendency to jump to conclusions, how you evaluate your performance, what your self-concept is like, and a range of other psychological processes, that this experiment, amongst others, seems to demonstrate are important in determining how stressed you are.

CH: So these are your initial results. What are you going to be doing next?

PK: Well, one of the important things is to tease out the relationships between these variables in much more detail. So, for instance, one thing we have not yet analysed, but I think might be important, is the relationship between the two big explanatory factors: self-blame and rumination. It might be the case that rumination, if you don’t blame yourself for the events that have happened in your life, might be quite benign. It might be that it’s a particular combination of a tendency to ruminate and a tendency to blame yourself that’s particularly pernicious. Doing that analysis will take some time, it’s quite complicated. And so far we have tried it on three different computers and none of them have a big enough memory, so we need to increase the computing power.

CH: Because your sample is just too big – too many listeners you see.

PK: Yes, our sample is fantastically big.

CH: So if you found out that it was the self-blame that really mattered more, then in therapy you could just ignore rumination and teach people somehow not to blame themselves so much?

PK: Yes, I mean I think that Jan illustrated that a little bit when she said she tends to ruminate but she puts on the radio, and that’s OK. If you’re ruminating about toast, if you’re ruminating about what you might have for breakfast tomorrow morning, that might be easy to live with; if you’re ruminating about all of the mistakes you’ve made in your life and why you’re a bad person, that might cause you a great deal of stress.

CH: Listening to the radio as therapy – that’s what we like to hear. Professor Peter Kinderman. And the stress test is still there if you want to find out how you deal with stress. It takes about 20 minutes, it’s completely confidential, and you’ll find a link to it on the All in the Mind page of the Radio 4 website.   

(The programme can be downloaded from the Radio 4 website.)

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