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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