Elite female tennis players less prone to choking under pressure than elite male players

By Christian Jarrett

While biological differences between the sexes might give men a physical advantage in many sports, it’s possible that they come at a mental cost. Men typically show a greater spike in the stress hormone cortisol when under pressure than women, and, given that high cortisol levels can interfere with mental processing, it’s feasible this could mean men’s performance is more adversely affected in high-stakes contexts than women’s.

A new analysis of elite tennis performance in the Journal of Economic Psychology is consistent with this account. Based on the outcome of thousands of games played across the four tennis grand slams in 2010, the researchers led by Danny Cohen-Zada at Ben-Gurion University of the Negev, found that men were adversely affected by high pressure by about twice as much as women. Extrapolating to the world of work, Cohen-Zada and his colleagues said this casts doubt on the argument that the gender pay gap is due to women’s inability to compete under pressure, though they acknowledged there are caveats to this conclusion.

The researchers accessed data on scores and players for over 1000 men’s and women’s matches played at Wimbledon, The French Open, The Australian Open and the US Open in 2010. They focused on grand slams because they offer the same prize money to men and women competitors ruling out differences in stakes as an explanation for any observed sex differences in performance under pressure.

The researchers used various statistical techniques to weight the amount of pressure in any given game (including assessing how important the game was for increasing the odds of winning the match) and they looked to see how this affected the server’s performance compared with how often the server typically wins a game (the server has a big advantage in tennis). The researchers also adjusted the numbers to account for the fact that women play best of three games at Grand Slams whereas man play best of five, meaning that early games are more consequential for women than men.

There was ample evidence of high pressure adversely affecting male players’ performance. With a given unit increase in pressure (one standard deviation in statistical terms), men’s likelihood of losing a game in which they were serving increased by 4.9 per cent. For women, the same increase in pressure was associated with an increased likelihood of losing their service game of just 2.8  per cent. This apparent sex difference in the effect of pressure held even after factoring out other influences such as fatigue and differences in ranking between competing players.

In an another analysis, the researchers focused on the effect of high pressure when both players had so far won an equal number of games (to help rule out strategic issues such as one player deciding to give up when they were too far behind). The detrimental effects of pressure were little changed for men in this context, but for women there was now no evidence of choking at all.

“Our robust evidence that women can respond better than men to competitive pressure is compelling,” the researchers said. “Our results do not seem to support the claim that gender differences in wages in the labor market can be attributed to the fact that women respond more poorly to competitive pressure.”

Among the caveats to this conclusion are the fact that in normal work situations men and women may be competing against each other (for sales targets, for instance), whereas the current results are based on men and women competing separately. In fact, there is past research to suggest that women’s performance under pressure may particularly suffer in mixed-sex competition. Of course, it’s also not clear how far the current findings pertain specifically to elite tennis or whether they reveal something about men and women’s performance more generally.

—Choking under pressure and gender: Evidence from professional tennis

Image: Serena Williams during the China Open on September 21, 2005 (Photo by Cancan Chu/Getty Images).

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12-Step Programs Plus Evidence-Based Care Show Promise for Young Adults

Combining the practices and philosophies of 12-step treatment programs, such as Alcoholics Anonymous (AA), with the motivational/cognitive-behavioral therapies currently being used to treat substance use disorders appears to produce better results in young people than the traditional program alone, according to a new study published in the journal Addiction.

It is common for drug treatment programs in the U.S. to link young patients to mutual-help organizations like AA, Narcotics Anonymous (NA) or Marijuana Anonymous (MA). But there has been no well-defined treatment protocol combining 12-step approaches with motivational enhancement/cognitive-behavioral therapies — and no evidence evaluating the effectiveness of such a pairing.

“In countries like the U.S., the greatest health risks for young people by far are from alcohol or other drug use,” said study leader John Kelly, Ph.D., director of the Recovery Research Institute in the Massachusetts General Hospital (MGH) Department of Psychiatry.

“Cognitive-behavioral and motivational programs are evidence-based, popular approaches for addressing youth substance-use disorder, and now these data suggest that integrating these approaches with 12-step philosophy and practices can further help reduce the impact of substance use in their lives and potentially facilitate higher rates of abstinence.”

The new intervention is based on motivational/cognitive-behavioral approaches but incorporates information from the kinds of discussions featured in 12-step program meetings.

“While all adolescents can improve when they receive well-articulated substance-use disorder treatment, we showed that adding a 12-step component to standard cognitive-behavioral and motivational strategies produced significantly greater reductions in substance-related consequences during and in the months following treatment,” said Kelly.

“It also produced higher rates of 12-step meeting participation, which was associated with longer periods of continuous abstinence.”

“Given the prevalence of substance-use disorders among young people, having treatments that are both effective and cost-effective — linking patients to free and ubiquitous community resources — is needed and welcome.”

The study involved 59 participants aged 14 to 21 who met substance-use disorder criteria and had been actively using within the past 90 days. Participants were randomly assigned to either a standard motivational enhancement/cognitive behavioral program or the Integrated Twelve-Step Facilitation (iTSF) program.

Both programs featured 10 consecutive weekly sessions; two individual sessions with a therapist and eight group sessions. The motivational enhancement/cognitive-behavioral approach was designed to enhance adolescents’ motivation for change towards remission and recovery. Sessions focused on teaching and practicing cognitive-behavioral relapse prevention and coping skills and included setting and reporting on weekly treatment goals.

Group sessions for the iTSF group included discussions of topics such as changing social networks and reducing relapse risk. Two of the sessions featured young members of NA or MA who shared their own experiences with addiction and recovery.

“That peer-to-peer aspect was probably the most powerful in disabusing young people of the negative stereotypes they often hold about 12-step members and about recovery more broadly,” says Kelly. “Similar-aged peers who are in recovery seemed much better able to capture the attention of participants than clinic staff.”

Along with the weekly reports at their sessions, the young people were formally evaluated at the onset of the study and then three, six and nine months later. By the end of the study, both groups showed similar improvements in the primary outcome, percent days abstinent.

However, participants in the iTSF group had greater attendance at 12-step meetings during the three months that included the intervention. This group also reported significantly fewer substance-related consequences, things like feeling unhappy, guilty or ashamed because of their substance use; neglecting responsibilities; taking risks; having money problems; damaging relationships with family and friends, and having under-the-influence accidents.

The fact that the higher rate of 12-step attendance among the iTSF participants was not maintained after the intervention program may indicate the need for a longer treatment program or regular, follow-up visits.

“We want to replicate and extend the testing of this treatment even further to determine the benefits of longer term care,” Kelly said.

“We know that the transition to adulthood is fraught with relapse risks for young people recovering from a substance-use disorder, so some kind of regular but brief ‘clinical recovery check-up,’ like what is common for other chronic conditions like diabetes or hypertension, could improve outcomes.”

Source: Massachusetts General Hospital

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Online Tool Trains Brain to Think Positive Thoughts

Researchers have developed a web tool designed to retrain the brain to think of positive outcomes to various scenarios.

The software aims to reduce the anxiety and depression that affects millions of people’s lives. Investigators note that in some cases, the mental disorders lead to isolation, poverty and poor physical health, things that often cascade to impact future generations.

University of Virginia researchers say the program hopes to shift the rigid, negative thoughts that come with mental disorders.

For many, anxiety is often intertwined with negative thoughts leading to stress. The mind-traps frequently lead to inaction which can be detrimental to social or professional relationships.

The new, online program being developed at UVA can train people to imagine different, positive outcomes to lots of different scenarios. Unlike other online applications that might seem similar, this program will go through continuous study and be refined as needed.

“It is four sessions long and each session is about 15 to 20 minutes,” said Dr. Bethany Teachman, a licensed clinical psychologist and a professor of psychology at UVA.

“People will see a variety of brief stories that are missing an ending. We encourage them to fill in those endings in different ways across the different sessions.”

In essence, Teachman said the program, which is anonymous, is designed to teach users to develop a new style of thinking.

“We want to give people practice in learning how to think about those situations in new ways, because we think that people who are prone to anxiety, depression and negative mood tend to have a pattern of thinking that things will turn out badly, and that can have really serious, negative consequences.”

People can access the free program using a computer, smart phone or tablet. The ability to participate where and when users want is deliberate.

“We really want people to incorporate it into their lives and say, ‘Oh, this is a time where I really need to work on that negative habit that I have in my thinking style and see if I can make a shift. Let me grab 15 minutes and see if I can turn that around a little bit,’” Teachman said.

The program’s public launch continues a study piloted by 201 college students at UVA including a control group.

The students who took the online training reported relatively more positive expectancies about the future, an increased belief that one can effectively achieve one’s goals and the belief that a person can change and grow.

That work was done in collaboration with Teachman’s graduate students, Nauder Namaky and Jeff Glenn.

One of those 201 participants was Eileen Hernon, a fourth-year student majoring in psychology and elementary education. She took the four-session program two years ago as part of a psychology course requirement.

At first skeptical, Hernon said after participating that she didn’t feel like the future was out of her control any more. In fact, the work inspired her to study more about positive psychology, a recent subfield that looks at what helps people experience more happiness.

Is she still feeling pretty positive about things? “Oh, definitely. I just finished this book called ‘The Happiness Project,’ and it changed my whole summer,” she said.

Teachman said now that the program is open for general consumption, she and her team will continue to analyze and refine its design as necessary.

“This is still a research study to find out for whom it will work best, in what ways, and what is the best way to deliver this,” she said. “We think some people are going to do it on their phone as they are sitting outside their boss’ office.

For other people, they’ll prefer to do it on the computer in the privacy of their own home. There are a lot of ways that this can work for people, and we want to find out how people can benefit most from it.”

Many online applications purport to offer relief to people with mental health illnesses, but Teachman said most are untested.

“A recent review identified 52 apps to treat anxiety, and there were a total of two studies done – total – on any of them – and those were two preliminary studies,” she said.

“That’s really, really alarming, because we know lots of things don’t work and some interventions can even cause harm. We are committed to doing evidence-based approaches to working on these problems.”

 

Source: University of Virginia

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Letting Go of the Past: Why Memories Remain Painful Over Time

Why memories hurt

When an experience is recorded as a memory, it goes through the emotional and cognitive filters, assumptions and interpretations of the person. This is one of the reasons why different people can have quite different recollections of an event they all witnessed.

As records, memories are not a great problem even if they do not accurately reflect the experience. It is the emotional charge of a memory that makes it so potent. For example, events that do not invoke any particular emotion (passing strangers in the street) do not create significant memories. But if an event involves harm, pain, distress, anger or other strong feelings, the memory and the feelings associated with it will be stored as one.

The emotional charge of a memory comes mostly from the stories we tell ourselves about a difficult experience. One person might say, Well, it happened and although it hurt me, I can’t do much about it now. Better get on with things and deal with the new situation. Another person, on the opposite end of the spectrum, might say, It’s a catastrophe, I’m totally devastated and will never recover from this, ever.

What effect will their memories have on their lives? Neither of the two people will likely forget what happened. But for one person it will be the factual record of a difficult time while for the other it will remain as emotionally charged as the actual experience and keep them trapped in suffering.

Memories are not fixed

Memories are like video and audio recordings that can be modified, enhanced, played louder or softer, rearranged, edited, with special effects added, reissued in new versions. The facts of an event cannot be changed but the emotional charge of a painful memory can be ‘edited’ by facing the emotions associated with it and changing the stories you tell yourself about the event..

Some people need time to get into the right headspace before they can deal with things. Perhaps you have heard someone say, I can’t deal with this right now; or, I am not ready to face it. It is sensible to take charge of your own rate of progress, even it means switching off temporarily.

But when avoidance becomes ingrained and maintained by self-destructive behaviours, the emotional darkness of a memory needs to be transformed. Instead of trying to outrun the memory and its associated pain, a light needs to be shone on it until the emotional charge dissipates and a calmer recollection of the experience is possible.

Disarm painful memories

Be mindful of your inner state as you apply any of the strategies below. Temporary discomfort and distress may be inevitable but usually recedes as you stay with the feeling, experience and acknowledge it rather than fighting or trying to suppress it. However, if you fall into a pit of such despair that it overwhelms your own coping abilities, do not continue. Professional help may be needed.

If you choose to proceed, do so at a time and place that allow privacy without distractions. Some people go to a place of significance in the original painful event that triggers the emotions associated with their memory. Do it your way – whatever that is. Proceed at a pace comfortable to you and take time out from your inner work as needed.

Work with the body.  

In this technique you are not addressing the memory and its emotional charge directly. You work indirectly through the body. The memory will remain but your body’s reaction to the memory can be changed.

Recall the memory. Feel the place in your body where that memory affects you the most. Focus on that part, let it soften and gently breathe into it until the tension or discomfort  recede. When that part feels better, again tune into the memory and find another place where the memory affects your body. Repeat as many times as needed. The process will be complete when you can recall the memory calmly or it now seems far away.

Watch a movie of the event.

This strategy uses imagination and visualization. If you find that difficult, do it in your thoughts. When ready, close your eyes and imagine (think) watching yourself in a movie. See (think) yourself as if performing on a screen, safe and okay in a situation before the traumatic experience. Then start the film of the event as you remember it. See what happened, how you and other people acted and anything else that deeply affected you.

You might cry or feel other intense emotions. Let them be but don’t get drawn into them. Just sit and watch it all unfold on-screen. At the end, imagine (think) the film being rewound at very fast speed to the safe starting point, i.e. return to the situation when you were okay. Let your emotions settle and realize the event has not destroyed everything. You still have a life right now and ahead of you. You may be different to before the experience, but you are okay.

Tell your story.

Journalling, writing a book, giving lectures, presenting workshops can neutralize painful memories and have a cathartic effect in the storyteller’s life.

Final words

There are other ways of working with memories. How have you been able to diminish your painful recollections? Or would one of the above strategies work for you?

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Ketamine for depression encouraging, but questions remain around long-term use

A world-first systematic review into the safety of ketamine as a treatment for depression, published in the prestigious Lancet Psychiatry, shows the risks of long-term ketamine treatment remain unclear.

Led by researchers from UNSW Sydney and Black Dog Institute, the review examined all prior published studies of ketamine treatment for depression, and finds few existing studies effectively report the safety of repeated doses or sustained use.

Ketamine research leader UNSW Professor Colleen Loo, who is based at the Black Dog Institute, said these major gaps in the literature must be addressed before ketamine is widely adopted as a clinical treatment for depression.

"Despite growing interest in ketamine as an antidepressant, and some preliminary findings suggesting its rapid-acting efficacy, to date this has not been effectively explored over the long term and after repeated dosing," said Professor Loo, a co-author of the study.

"As ketamine treatment will likely involve multiple and repeated doses over an extended time period, it is crucial to determine whether the potential side effects outweigh the benefits to ensure it is safe for this purpose."

The review follows research revealed earlier this week, which provided preliminary evidence of promising results for ketamine delivered to elderly patients in repeated intravenous doses.

Globally, ketamine is increasingly being used off-label to treat severe and treatment-resistant depression. Also known by its party drug name 'Special K', ketamine is not approved for use in Australia, but has Therapeutic Goods Administration (TGA) approval as an anaesthetic.

Researchers in the current study trawled the literature on ketamine for depression to identify its main side effects and whether these differed between single or repeated dosing. They analysed 288 articles, of which 60 studies met the inclusion criteria, which encompassed a total of 899 patients who had received at least one dose of ketamine.

The results show that despite acute side effects commonly occurring after a single treatment of ketamine, not all studies actively monitored for or reported on them. Side effects were more likely to occur when ketamine was given intravenously, and were usually reported on immediately following a single dose.

The most common side effects reported in the literature were headache, dizziness, dissociation, elevated blood pressure and blurred vision. This is consistent with side effects reported in existing user groups - recreational drug users or those prescribed ketamine for chronic pain. However, most studies only reported on side effects in an ad-hoc way, with a lack of conclusive data available into ketamine's longer-term or cumulative effects.

"Despite low ketamine doses currently being used in depression studies, urological toxicity, liver function abnormalities, negative cognitive affects and risk of dependency may limit the safe use of ketamine as a long-term antidepressant treatment," the authors state.

Previous studies have linked longer-term ketamine use to bladder inflammation, liver damage, cognitive changes like memory loss, and craving or addiction. Very few studies have examined human ketamine dependence, with less than 15 cases described in the scientific literature over the past 20 years. "Our study also raises questions over the risk of administering ketamine in patients with pre-existing or co-morbid medical conditions, such as those with a history of high blood pressure or heart disease," said Professor Loo.

"For instance, we know that when used to treat chronic pain, ketamine is associated with acute blood pressure changes, and experts recommend lower doses administered through slower-acting, non-intravenous means accordingly."

Future ketamine-related depression studies should focus on assessing the safety of repeated dosing regimes, consider co-morbid physical health factors, and actively assess and report on potential side effects in a systematic way, the authors recommend.

The research team are now developing a new tool to standardise future reporting on these side effects, called the Ketamine Side Effect Tool (K-SET) and Ketamine Safety Screening Tool (KSST), to address inconsistencies in the literature.

Professor Colleen Loo is also currently leading the world's largest independent trial of ketamine to treat depression, testing its effects after twice-weekly treatments over a period of four weeks amongst 200 participants.

The Lancet Psychiatry study was a collaboration between UNSW Sydney, Black Dog Institute and the University of Otago.

Article: Side-effects associated with ketamine use in depression: a systematic review, Colleen K Loo et al., Lancet Psychiatry, doi: 10.1016/S2215-0366(17)30272-9, published 27 July 2017.

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Having depression and heart disease could double death risk

While the mechanism behind the association is unknown, a new study finds that depression after being diagnosed with coronary artery disease doubles the risk of mortality.

A new study has examined the risk of premature death in patients having been diagnosed with both depression and coronary artery disease.

Coronary artery disease (CAD) is the most widespread form of heart disease. And recently, more and more studies have been pointing to the effect of psychological distress or depression on the risk of mortality among patients with CAD.

Now, a team of researchers at Intermountain Medical Center Heart Institute in Salt Lake City, UT, have conducted a large-scale study to investigate the link between being diagnosed with CAD and afterward receiving a diagnosis of depression.

The team was led by Heidi May, Ph.D., a cardiovascular epidemiologist at Intermountain Medical Center Heart Institute, and the findings were published in the European Heart Journal: Quality of Care & Clinical Outcomes.

Studying depression in CAD patients

Dr. May and team examined a total of 24,137 patients with CAD, as diagnosed by an angiography. Using the International Classification of Diseases codes - a standard diagnostic tool - the researchers determined whether or not the patients had depression.

They then used Cox hazard regression models to adjust for the different periods of time that had elapsed between being diagnosed with CAD and being diagnosed with depression. These lengths of time differed from patient to patient.

Overall, 3,646 (15 percent) of the patients received a diagnosis of depression during CAD follow-up. These patients tended to be younger and female, compared with their depression-free counterparts. They were also more likely to have diabetes and to have been previously diagnosed with depression.

Additionally, they were less likely to develop a myocardial infarction, or heart attack, during follow-up.

Of all the patients diagnosed with depression, 27 percent received their diagnosis within a year of the CAD diagnosis, 24 percent within 1 to 3 years after the heart disease diagnosis, almost 15 percent between 3 and 5 years, and almost 37 percent more than 5 years after the heart event occurred.

Depression doubles risk of death

Having adjusted for all of these factors, the researchers found that "post-CAD depression was the strongest predictor of death."

In fact, being diagnosed with depression at any point after receiving a CAD diagnosis raised the risk of dying prematurely by twofold.

Even among patients who had no history of depression diagnosis, this correlation was just as strong.

Furthermore, the correlation persisted regardless of whether depression occurred right after being diagnosed with CAD or years later.

"We've completed several depression-related studies and been looking at this connection for many years," says Dr. May. "The data just keeps building on itself, showing that if you have heart disease and depression and it's not appropriately treated in a timely fashion, it's not a good thing for your long-term well-being."

Although this is an observational study that cannot explain causality, the lead author of the study ventures a hypothesis, saying, "We know people with depression tend to be less compliant with medication on average and probably, in general, aren't following healthier diets or exercise regimens."

"They tend to do a poorer job of doing things that are prescribed than people without depression. That certainly doesn't mean you're depressed, so you're going to be less compliant, but in general, they tend to follow those behaviors."

Another possible explanation, the researcher says, may involve the physiological changes that tend to happen as a result of depression.

In fact, studies have pointed to a wide range of symptoms that sometimes accompany depression, indicating that this psychological disorder and its bodily symptoms are deeply connected on a biological level.

Finally, Dr. May urges clinicians to continue to test for depression and treat it where necessary, even years after the patient has been diagnosed with heart disease.

"I hope the takeaway is this: it doesn't matter how long it's been since the patient was diagnosed with coronary artery disease. Continued screening for depression needs to occur [...] After 1 year, it doesn't mean they're out of the woods."

Heidi May, Ph.D.

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Dealing with grief

Losing someone in our lives is a deeply personal event – one that has the potential to affect us in many ways. Whilst most of us will share the same range of emotions and reactions through our grief, this isn’t always the case.  

But one thing that is certain, is that simply ignoring the pain and hoping it will go away doesn’t lessen the grief. If you keep feelings buried, it can make it a lot harder to eventually deal with the trauma and lead to deep-rooted heartache.

Of course, there is no textbook way to deal with grief, but if you are finding it difficult to deal with bereavement or loss, there are a number of things you can try to aid the grieving process.

We discuss some ways to help you process your feelings, and help you move forwards when you are ready.

Tell the story

Talking out loud can be a big healer. So often we are trapped with the thoughts inside our own heads, but it doesn’t need to be this way. Sometimes, it helps to tell someone your story – allowing you time and space to discuss loss and to think about how you really feel now – without any false pretences of being ‘fine’.

If the bereavement is a relative, it can often be difficult to turn to another family member for support – you can feel pressure to remain strong, to support them. If this is the case, or if you feel genuinely uncomfortable in talking about it to others, try writing your feelings down. Exploring your emotions in a journal or blog can be just as effective – and you can choose whether or not you share it with anyone.

Explore every emotion

It is important to grieve in your own way. Finding a way to understand your loss and processing how you are going to move forwards is a very personal thing. Whether that means laughing, crying, or screaming and shouting, you will find a way that helps yourself to heal. Try not to compare how you are coping with those around you – just because someone is coping differently to you doesn’t mean they are coping any better, or worse.

A helpful task to explore a range of emotions can be to look through photographs. This can trigger both happy and sad feelings, prompting you to confront a range of emotions.

Give it some time

For some people, time can be enough to help them come to terms with their loss. There will be good days, bad days, and some days when you feel indifferent. Don’t be afraid to let people know that you’re having a bad day – whether you want to be given some time alone, or you want to take your mind away from the pain for a little while, don’t keep your feelings bottled up.

So how can hypnotherapy help with grief?

Grief is not just feeling sad – there are so many other symptoms of grief that can make life very difficult. Issues such as anxiety, insomnia and depression can arise as a result of grief. You may also experience physical symptoms of grief – loss of appetite, weight loss or weight gain, sickness, fatigue or sleeplessness.

Hypnotherapy is a popular treatment option which can give you positive suggestions to help cope with these issues – as well as many other symptoms you might be experiencing through your grief. It can reduce feelings of guilt and blame, and help you to find ways of coping in the future.

Remember, it might be hard right now, but you will get through this.

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