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kry.co.uk > Your health > Metainfo

Your health | KRY

##  Quick facts

- A fixation with food rules and overexercise can mask underlying anxiety
- People with orthorexia may become increasingly isolated 
- Help is available in the form of treatments like Cognitive Behavioural Therapy (CBT)

It’s healthy to be healthy, right? Yes, and in these times when stress levels and uncertainty are high, it’s totally natural to try and control what we can, like our diets and exercise.  

But it’s possible to become fixated with what you’re eating and your exercise levels to such an extent that other elements of your life suffer, like your relationships and need for rest and recovery — also essential to your wellbeing.

##  What is orthorexia?

Orthorexia nervosa was first defined in 1997 as ‘having a pathological obsession in pursuit of a healthy diet’.  The word orthorexia is from the Greek orthos (correct) and orexia (appetite or nutrition).  

‘Orthorexia nervosa is a disorder where you become obsessed and fixated with healthy eating,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry. Although it overlaps with eating disorders, it’s not yet recognised as an eating disorder in its own right in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), she explains, though it is increasingly recognised in scientific literature. 

##  How is it different from other eating disorders?

‘There’s a fine line between anorexia and orthorexia,’ Gauffin says. ‘The goals might be different, but the mindset is similar — there is a compulsion around food that simply isn’t healthy.’ 

Anorexia nervosa and bulimia are most often about a preoccupation with weight loss. Those with orthorexia, on the other hand, focus on the quality of food — though it’s likely that weight will play a part too.  

This may develop into ritualised patterns of eating — for example, spending an excessive amount of time thinking about, sourcing and preparing food and a rigid avoidance of foods they believe to be unhealthy or impure. 

Many people with orthorexia also become obsessed with keeping fit. So, exercising compulsively becomes just as important as eating the right foods. In a recent review it was found that there’s often a correlation between orthorexia and exercise addiction. 

‘For most people who eat healthily or exercise regularly, it’s fine to occasionally have some cake or a glass of wine, or skip a workout,’ says Gauffin. ‘But for people with orthorexia, any break in their regime makes them anxious. They’re obsessive about eating certain foods, for example vegan or gluten-free, and avoiding others, like refined sugars.’

##  What are the signs and symptoms of orthorexia to look for?

Orthorexia can be hard to spot — not only in others, but also in yourself — as it’s easy to justify under the umbrella of a healthy lifestyle. Giving up entire food groups without advice from a doctor or other qualified profession can be a particularly insidious sign. 

Here are some more signs of orthorexia: 
- Spending so much time thinking about, choosing and preparing healthy food that it interferes with other areas of life like family, relationships, creativity or work
- Feeling anxious, guilty, ashamed, impure or unclean after eating any food considered unhealthy 
- Judging others who eat foods regarded as unhealthy
- Being excessively dependent on food and exercise choices for a personal sense of peace or happiness
- Being unable to relax around food, even on special occasions
- Steadily eliminating more and more foods whilst repeatedly adding to a rigid list of eating and exercise rules
- Following a healthy eating regime that’s caused more weight loss than is healthy, or resulted in other signs of malnutrition like hair loss, loss of menstruation or skin problems

##  Am I at risk of developing orthorexia?

‘People you would describe as highly functioning, super-ambitious, perfectionist, disciplined, type-A personalities are most at risk,’ says Gauffin. ‘On the outside they appear competent and in control, but there’s nearly always an underlying feeling of not being good enough.’  

Orthorexics believe that they can only be loved if they’re perfect, and they equate this with looking and being healthy, Gauffin explains. ‘This often stems from childhood when they were expected to do well at school and in sport, and later to get the right job. The subliminal message they got was that you have to be successful to be loved. 

‘Life events like bereavement or divorce can also trigger orthorexia, with people using a healthy living focus as a way of coping with emotional pain to the point where it becomes obsession,’ says Gauffin.

##  Is it really that harmful to be obsessed with healthy eating?

‘For one, it can lead to nutritional deficiencies and related health problems,’  says Gauffin. 

But orthorexia can also exacerbate — sometimes even hide — psychological problems. ‘People who develop orthorexia tend to be highly anxious people who use an obsession with food and exercise as a way of blocking out their anxiety. That helps them stay in control of their emotions.’ 

Such mental health struggles can often become vicious cycles, Gauffin asserts. ‘The more time someone spends fixated on obsessively sticking to their rigid food and exercise rules, the more they withdraw into their own world, spending less time socialising and doing other activities. 

‘This can lead to feelings of loneliness and disconnection from family and friends. After a while they find it increasingly hard to step out of their isolation and this makes their anxiety worse.’ 

##  What help is available for orthorexia?

The problem of orthorexia often only emerges by talking about other issues. ‘Most people who seek help usually do so for some other reason such as anxiety, depression, sleep problems, or a relationship break-up,’ says Gauffin. 

What’s more, people with this disorder have often lost sight of just how much they’re missing out on in life, says Gauffin. 

‘So, I might ask them things like – “How alive do you feel? How much freedom do you have?” My aim is to gently help them realise that they don’t have very much freedom. When all your time is spent obsessing over and being controlling about food and exercise, you end up living in a very small box. 

‘Therapy can help someone take small, gradual steps out of that box, and realise what they’re missing out on by hiding in their high-achieving prison. The first step to overcoming orthorexia is to recognise there is a problem.’ 

If you think you may have orthorexia, Cognitive Behavioural Therapy (CBT) can be useful in helping to change the thoughts and behaviours that are leading to your obsession with food and exercise.  

Psychodynamic therapy, on the other hand, can help you explore and work through any emotional issues underlying the condition. 

A Kry GP can help you determine whether you need help with orthorexia or other eating-related issues. 

__This piece has been approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry.__


Kry.co.uk > Your Health > What is orthorexia? A therapist explains

What is orthorexia? A therapist explains

Healthy eating is essential to longevity and wellbeing. But when it becomes an obsession, it can result in a disorder known as orthorexia. Discover more from Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry

Kry.co.uk > Your health > What is orthorexia? A therapist explains

Family

Family health

Since the start of the coronavirus crisis last March, our lives have been different. With little sense of what the future may hold, and worn down by repeated lockdowns and restrictions, it’s not surprising our rates of anxiety have increased.

In the UK, a recent study  showed that 57% of people were experiencing significantly more anxiety as a result of lockdowns. 

But rest assured, help is available. Start by gaining a better understanding of what makes you vulnerable to anxiety, and discover the options available to help you manage it.

Here our experts have answered some commonly asked questions about anxiety.

## What are the main symptoms of anxiety?

‘Anxiety can be mild or severe,’ says Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry. ‘Physical symptoms may include a fast heartbeat, dry mouth, tightness in your chest, a churning stomach, sweating, shallow breathing, light-headedness, nausea and restlessness. 

‘You may also develop aches, pains and headaches or grind your teeth at night. Mentally you could feel tense, nervous and unable to relax. It may feel difficult to stop worrying and with that can come feelings of dread or panic. You might also feel indecisive and find it hard to concentrate.’ 

##  What can anxiety do to your body?

‘When you’re anxious your body goes into “fight or flight” mode,’ says Gauffin. This is an automatic response, activated by the sympathetic nervous system in response to a real or perceived threat of danger. 

‘It causes your heart rate and blood pressure to go up, your breathing to increase and your adrenal glands to produce an excess of the stress hormones adrenaline and cortisol. 

‘If you’re always anxious, this puts you in a constant state of hyper-alert, which is exhausting for the body and not good for your health in the long term.’ 

Research suggests that experiencing long-term anxiety may increase the risk of developing physical health problems like heart disease,  high blood pressure and  type 2 diabetes.  

##  How can anxiety cause depression?

‘It’s fairly common for people with anxiety to also suffer from depression,’ says Gauffin. 

‘If you’re constantly living in a state of anxiety and fear, this can have a severe impact on your ability to focus on other things, and the quality of your life may start to suffer. 

‘This, in turn, may cause you to withdraw from friends and family, because you simply can’t handle communicating with anyone when you’re feeling anxious. 

‘It can also mean you find it hard to concentrate, which can then affect your performance at work, leaving you feeling hopeless or bad about yourself. This cycle can lead to depression.’ 

##  What kind of anxiety do I have?

‘There are several different types of anxiety disorders,’ says Gauffin. 

__Generalised anxiety disorder__
‘Generalised anxiety disorder (GAD) is when you feel anxious more or less all the time. There’s no one specific reason as anything can make you feel anxious. As soon as you stop worrying about one thing, you find something else to worry about. People with GAD live in a state of constant low-level anxiety and this can be very tiring.’ 

__Health anxiety__
‘Health anxiety is when you constantly worry about your health. You imagine that every little symptom could be a serious disease. For example, if you get a headache, you worry you might have a brain tumour. Health anxiety is often triggered when there’s some area of your life that you feel you can’t control. 

__Social anxiety disorder__
‘Social anxiety disorder (sometimes called social phobia) is the fear of being in social situations. This could include meeting or talking to people, speaking on the phone, eating or drinking in public, speaking in public, groups or meetings and feeling as if you’re being watched

__Phobias__
‘A phobia is an overwhelming fear of something like an object, animal or situation. As this triggers severe anxiety, you do everything you can to avoid it. 

__Panic disorder__
‘Panic disorder is when you experience [panic attacks](/your-health/6-causes-of-panic-attacks-and-expert-tools-for-how-to-cope/) out of the blue for no obvious reason.’ 

A GP can be the first port of call to help you identify whether you have anxiety and if so, the type you might have. 

##  Where does anxiety come from?

‘Anxiety disorders stem from all sorts of reasons,’ says Gauffin. ‘Some people are naturally very sensitive and prone to developing anxiety. It can also be an inherited trait, particularly if there’s a history of anxiety in your family. 

‘Anxiety is also often triggered by traumatic life events in the past. For example, if you were criticised or abused as a child, you’re more likely to develop an anxiety disorder as an adult. 

‘Too much stress can also trigger anxiety — for example, work stress, worrying about finances, having a health condition or serious illness, going through divorce or a bereavement. 

‘Also, lifestyle factors like not getting enough sleep, drinking too much, not exercising or eating healthily can cause or make anxiety worse.’

##  What can I do when anxiety hits? 

Although it’s important to talk to a doctor or psychologist about your anxiety, there are a number of tools you can use to cope in the moment when your anxiety feels overwhelming. Here are 4. 

#### 1.	Try a quick breathing exercise 
Next time you feel anxious, try this simple breathing exercise to help calm your nervous system and reduce stress in your body, Gauffin suggests:

- Sit or lie down comfortably
- Exhale completely
- Gently and slowly inhale through your nose for the count of 4
- Gently exhale through your mouth for the count of 4
- Pause and hold for the count of 4
- As you breathe, imagine your breath moving around the image of a square
- Repeat for 1 or 2 minutes, or until you feel calmer

#### 2.	Get active — even when you don’t want to
‘When you feel anxious, it can make you want to curl up in a little ball,’ says Gauffin. ‘Yet, the best thing is to do the opposite and get moving. For example, jumping, swaying, stretching or dancing to music can help shift your energy from an anxious state to a calmer one.’ 

[Exercise](/your-health/5-reasons-to-keep-exercising-outside/) is also one of the best ways to help you manage your anxiety in the longer term. ‘Exercise triggers the release of endorphins (“feel-good” chemicals in the brain) that enhance emotional wellbeing,’ Gauffin points out.

Recent research  showed that high intensity aerobic exercise like jogging, running or brisk walking, 2-5 times a week for at least 2 weeks, is effective in reducing anxiety. 

#### 3. Get into the habit of naming your fears
‘Anxiety is always about fear. So, when you feel anxious, acknowledge that it’s okay to feel afraid and soothe yourself with some self-compassionate understanding,’ says Gauffin. 

‘Notice where you feel your emotions most intensely in your body. This could be your chest, heart, throat or abdomen,’ she adds. 

‘Then, ask yourself, “What is it that I’m really afraid of? What is my body trying to tell me?” Think about what area in your life you feel overwhelmed by, scared about or lacking control over. Is there something — however small — you can do to change this? Or, perhaps talking to a friend or journaling about it could help you manage your fearful thoughts? Consider talking to a psychologist, or having a course of psychotherapy to help you too.’

#### 4. Look for self-help support
‘If your anxiety symptoms are mild, then a self-help course, book or mental health app may help you control and improve your symptoms,’ says Dr Rhianna McClymont, Lead GP at Kry. 

‘You can find a wide range of resources to download at the[ NHS Mental Health apps library](https://www.nhs.uk/apps-library/category/mental-health/). Simple lifestyle changes like increasing your exercise levels, improving the quality of your sleep, and reducing your alcohol and caffeine intake can also help anxiety.’ 

##  What treatment is available for anxiety? 

‘Psychological treatments for anxiety such as Cognitive Behavioural Therapy (CBT) are recommended and very effective,’ says Dr McClymont. ‘Your doctor can refer you to a psychological service that could provide this treatment. 

‘In people with severe symptoms, some medications can also be helpful. These include medications that can reduce the physical symptoms of anxiety, such as tremors, or drugs like antidepressants which can help to improve mood and anxiety symptoms.’  

##  How do I know I need help for my anxiety?

‘If your anxiety symptoms are interfering with your daily life and activities,’ says Dr McClymont. ‘Or, if you feel they are adversely affecting you in any other way, then you should always speak to your doctor, or a Kry doctor for further help.’ 

__This article has been approved by Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry, and Dr Rhianna McClymont, Lead GP at Kry.__


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Kry.co.uk > Your Health > Need help for anxiety? Here are your questions answered

Get help for anxiety

As the pandemic continues, so does its impact on our mental health. If you’re feeling more fearful or anxious than ever, Kry’s experts have advice that can help

Kry.co.uk > Your health > Need help for anxiety? Here are your questions answered

Need help for anxiety? Here are your questions answered

General health

General health and seasonal

##  Quick facts

- Omega-3 oils (found in oily fish like salmon and mackerel) could have anti-inflammatory effects on joints
- Eating a Mediterranean-style diet — rich in oily fish, wholegrains and vegetables —  can also be helpful  
- Regular exercise is considered the most effective, non-drug treatment for reducing osteoarthritis pain 

When the temperature drops, many people find that their hands, knees, feet, back or hips can feel stiff, tender, sore or ‘creaky’. For those with osteoarthritis – the most common form of arthritis – joints can also feel painful and inflamed.

Osteoarthritis most commonly develops in the mid-40s or older, and tends to run in families . It’s thought that more than 40 million people in Europe suffer from it,  with more women affected than men. 

##  What is arthritis?

There are two types of arthritis — osteoarthritis, which is more common and usually age-related, and rheumatoid arthritis which can affect people of any age. 

‘Osteoarthritis is often referred to as the “wear and tear” arthritis,’ says Dr Rhianna McClymont, Lead GP at Livi. ‘It’s caused by the protective cartilage inside joints, which acts as a ‘shock absorber’, becoming damaged and wearing down. This causes pain and swelling, which is normally most severe when moving the joint.’

Osteoarthritis pain usually lasts for less than 30 minutes at a time. It affects the smooth cartilage lining of the joint, making movement more difficult than usual. It most often develops in the hands, lower back and neck, and in weight-bearing joints like the knees, hips and feet. 

Rheumatoid arthritis (RA) on the other hand, is an auto-immune condition in which the immune system starts to attack the joints. Although it’s far less common, RA can affect anyone, including the very young, and the earlier you seek medical help for it, the better the outcome. RA causes prolonged pain in the joints, including stiffness and swelling. It commonly affects the small joints of the fingers and toes, the wrists, elbows, shoulders and knees and the neck and jaw. 

##  How is arthritis diagnosed?

If you have pain that gets worse the more you use your joints, a stiffness that’s not there in the mornings, or any of the symptoms above, talk to a doctor. 

##  Does arthritis pain really get worse in winter?

In the cold winter months, many people with osteoarthritis complain that their joints feel worse.  One study in 2019 suggested that those with the condition were 20% more likely to suffer pain on days when it’s windy and humid.  

‘Although I often hear from patients that their joint pain gets worse in the winter months, the exact science on this is unclear,’ says Dr McClymont. 

‘Some theories suggest lower atmospheric pressure  is the cause, others relate to increased sensitivity of nerves in cold weather  or reduced exercise/activity levels during winter months, leading to increased stiffness and pain. However, these are all hypothetical and at present we just don’t have a definite answer for this.’

Whatever the reason, while osteoarthritis is an incurable condition, the good news is that there are ways to manage the pain. 

## Here’s what can help winter arthritis pain:
__1.__	__Maintain a healthy weight__

‘If you are obese, and therefore carrying extra weight, that puts extra strain on the joints and can exacerbate osteoarthritis,’ says Dr McClymont. ‘Regular exercise and a healthy diet plan to [maintain a healthy weight and BMI](https://www.livi.co.uk/your-health/5-simple-tips-for-a-healthy-bmi/) are ideal.’ 

There’s strong evidence that losing weight can improve your overall health and physical function and this applies to those with osteoarthritis.  Losing just 10% of your weight — if you are overweight or obese — can lead to significant improvement in symptoms of osteoporosis and pain relief. 

A Livi doctor can help you with a plan toward achieving a healthy weight. 

__2.__ __Eat a joint-friendly diet__

Experts recommend that those with osteoarthritis aim to eat at least 1 portion of oily fish, like salmon or mackerel a week.  The omega-3 oils found within the fish have anti-inflammatory properties that may help those suffering with this condition.  

A Mediterranean-style diet that includes healthy oils, nuts and wholegrains may also help. One study found that patients with osteoarthritis had a significant reduction in pain after switching to a wholefoods, plant-based diet.  Patients in the study also lost weight without counting calories or limiting portions.  

A deficiency in vitamin K  (found in olive oil and margarine) may increase the risk of osteoarthritis, so there is some suggestion that increasing this vitamin may help — talk to a doctor about this option first.  

Vitamin D is also needed for bone cartilage and health. Although it’s found in egg yolk, liver and oily fish, it’s mainly absorbed via sunlight so most people should consider taking a supplement of around 10mg per day, especially during winter months.  

__3.__	__Cut down on pro-inflammatory foods__

Some foods are believed to be pro-inflammatory for joints, which means they could make symptoms worse. These include omega-6 polyunsaturated fats found in corn, sunflower and safflower oils, as well as saturated fats found in animal products. It may be helpful to remove as much fat from meat as possible before you cook and replace omega-6 fats with oils and spreads rich in mono-unsaturated fats like rapeseed and olive oils. 

__4.__	__Prioritise exercise__

Research shows that people with osteoarthritis can benefit from exercise, though they may be concerned about their pain getting worse.  In fact, exercise is considered the most effective, non-drug treatment for reducing pain and improving movement for patients with osteoarthritis. Brisk walking, swimming, jogging, yoga and strength-training are all beneficial. The weekly recommendation for aerobic exercise is 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise a week.  

__5.__	__Keep your joints warm__

‘Keeping joints warm may help alleviate pain as warmth relaxes muscles and reduces stiffness,’ says Dr McClymont.

Warm showers and baths, heating pads, electric blankets and covering joints with gloves or even wrapping hands around hot drinks can all help with keeping your pain at bay in winter. 

__6.__	__Talk to a doctor about your pain__

It’s important to have a dialogue going with a doctor about how your arthritis is affected and your pain levels.

There are different pain-relief medicines you can take for osteoarthritis, depending on the severity of the condition and other health concerns. 

These include over-the-counter drugs like paracetamol or your GP may prescribe a non-steroidal anti-inflammatory drug (NSAID) or opioid. 

In the UK, a doctor may also prescribe capsaicin cream, which works by blocking the nerves that send pain messages to the brain. 

‘If over-the-counter medications like paracetamol or ibuprofen have not been sufficient to control osteoarthritis pain, then a doctor may prescribe stronger painkillers,’ says Dr McClymont. 

__7.__	__Consider shock-absorbing footwear__

If the pain is in your hips, knees or feet you might want to consider special footwear.  ‘Supportive footwear with shock-absorbing properties is excellent to help with osteoarthritis, as this reduces the strain through the joints of the foot and leg,’ says Dr McClymont. 

‘Shoe insoles that have foot-arch support and shock-absorbing cushioning can usually be bought from a pharmacy,’ she explains. 

‘An NHS podiatrist would also be able to carry out a biomechanical foot assessment and provide appropriate insoles if osteoarthritis symptoms indicate this is necessary.’

A consultation with a Livi doctor may be helpful to assess your joint symptoms and recommend the best next steps. 


Livi.co.uk > Your Health > 7 ways to help arthritis pain in winter

 7 ways to help arthritis pain in winter

kry.co.uk > medical reviewer

IMG 20200730 224911 865[33] (1)

Dr Rhianna McClymont

Lead GP at Kry

Most GPs would agree that prevention is better than cure. Doctors have worked and studied hard to help give patients the best care they can, but what they really want is for us all to be well-informed and on top of our health, to minimise the risk of becoming unwell. 

We spoke to __Dr Rhianna McClymont, Lead GP at Kry__, who shares some important advice about what doctors really want their patients to know.

## 1. Get it checked ASAP
Don’t ignore any symptoms that have been worrying you – even if it turns out to be nothing, always let a doctor make that call. ‘I often hear “I didn’t want to bother you, doctor” – but if something’s concerning you, especially if it’s been there a while, it’s best to get it checked out,’ says Dr McClymont.

During the pandemic, many patients have put off seeing a doctor about their symptoms because they’re worried about contracting the virus, or they don’t want to burden the health system. That’s totally understandable, but since the pandemic began, doctors have been seeing an increase in late presentations of serious conditions like strokes and heart attacks. So if you have a new problem or symptom, see a GP.

By using an app like Kry, you can usually get a video appointment within minutes of registering. Kry GPs can offer medical advice and the reassurance you need for most symptoms, and can refer you to see a specialist if you need to see one.

## 2. Antibiotics aren’t always the answer
Antibiotics are an incredible tool we have to treat a whole host of bacteria. But they can’t be used for everything, and will have no effect at all on viruses. So no matter how under the weather you feel when you have flu or another viral infection, antibiotics aren’t the answer.

‘It’s so important that you don’t use antibiotics when they’re not needed. If you do, you’ll likely increase bacterial resistance to them, so they don’t work as well when you really need them to. What’s more, antibiotics can have unpleasant side effects, so sometimes it’s not worth running the risk’ advises Dr McClymont.

## 3. Mental health should be a priority
‘The fact we need to get physical symptoms checked out is a given, but don’t forget to get help or advice for your mental health, too. Doctors genuinely care about your wellbeing, and mental health is just as important as physical,’ says Dr McClymont.

‘Mental health symptoms can even show physically. Anxiety, for instance, can cause palpitations, shortness of breath or dizziness, and depression can augment pain.’ 

If you suspect you might be struggling with your mental health, you can speak to a Kry GP, who can help you better understand your problems, and give you advice and support on how to deal with things that feel difficult.

## 4. Family history is important to know
Many conditions, like eczema, asthma, high cholesterol and certain types of cancers, run in families. So if your parents or siblings are affected by something, you may have a higher chance of getting it too.

‘It may be uncomfortable to talk to your parents or family members about health, but knowing their medical history will help you be more aware of any future risks,’ says Dr McClymont.

‘Get to know your family history and try to have more open conversations about health – you’ll be glad you did once you’re older’.

## 5. Please, don’t be shy!
‘Many patients – men and women – put off coming to the doctor because they’re feeling awkward or consider their symptoms embarrassing,’ Dr McClymont highlights.

Whether it’s a cervical cancer screening, a prostate exam or a discussion about poo, there’s nothing too intimate for a doctor or nurse – they’ve seen it all before!

‘I’ve lost count of the number of times a patient has apologised to me that she hasn’t trimmed her pubic hair. This is a classic example of something that I wouldn’t even take notice of,’ says Dr McClymont.

The truth is, doctors don’t mind. They just want to help treat your symptoms, or give you the right advice to prevent illness occurring in the first place. If you have a symptom you need to get checked out, you can see a GP through Kry without having to leave your home. 


Kry.co.uk > 5 things doctors want patients to know

Kry.co.uk > Your Health > 5 things doctors want patients to know

CEC8187.jpg 1

Reviewer > Dr Rhianna

5 things doctors want patients to know

Depression affects around 264 million people worldwide.  Recent UK figures  show that almost 1 in 5 adults (19.2%) experienced depression during the coronavirus crisis in 2020 — a figure that almost doubled from around 1 in 10 (9.7%) before the pandemic. People most affected included younger adults aged 16-39 years, women, those with financial worries and people with disabilities.  

‘There are many factors  that may contribute to depression,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry. ‘But social isolation, lockdowns, money and health worries during the pandemic are further factors, causing more people to feel depressed.’

There are some simple, daily practices that science has shown may positively affect your mood, if you practice them regularly. Here’s a toolkit to get you started.

## 1. Find time to head outside every day

‘Lack of sunlight can cause seasonal affective disorder (SAD) in some people,’ says Gauffin. ‘This is a type of recurring depression with a seasonal pattern.’ It’s not certain what causes SAD, but some theories suggest a lack of light in winter may affect mood-regulating chemicals in the brain. Typical symptoms include persistent low mood, irritability, feelings of despair, lack of energy, sleeping for longer than normal, craving carbohydrates and weight loss or gain.   

__Tools to use daily__ 

- Get as much daylight as possible.  Even a short daily walk can be beneficial. Natural light is the most important cue for maintaining circadian rhythms (the body’s natural sleep/wake cycle).  A lack of sunlight can throw this internal body clock out of sync and by affecting sleep and appetite, make symptoms worse
- Spend time in nature. One study showed that just 10 minutes spent sitting or walking in a natural environment can have a positive impact on mental wellbeing  

## 2. Get moving (and your heart pumping)

Exercise can support your mood if you have depression and is especially useful for people with mild to moderate depression. 

This doesn’t have to mean sweating for hours. It could be as little as a daily 20-minute walk. According to a recent meta-analysis, exercising for a total of 150 minutes each week can reduce the risk of depression by a third.

‘Exercise is important if you’re feeling depressed,’ says Gauffin. ‘Moving physically has an energising effect,’ she explains. ‘The less you move, the more lethargic you feel. Try and do some exercise that gets you out of breath every day such as dancing, stretching, walking or running. If you find it hard to motivate yourself, arrange to meet a friend for a socially distanced walk.’  

__NHS recommends...__
- Each week, aim to do 150 minutes of moderate activity (like brisk walking, gardening, rollerblading) or 
- 75 minutes of intense activity (including jogging, aerobics, walking up the stairs) weekly or
- A combination each week — to maintain your health

## 3. Connect with friends and family as often as you can

‘One of the reasons people are finding it hard to cope during the coronavirus crisis is because they can’t spend time with friends and family in the same way as they did before,’ says Gauffin.  

A US study found that confiding in friends and social connection generally has a protective effect against depression (it also found that reducing time watching TV and napping in the day also help to lower depressive symptoms).

__Tools to use daily__

- Talk to friends regularly on the phone or Zoom
- If you don’t feel like talking, check in with friends over text
- Join an online art, book or music club. Or, find a local mental health support group
- See friends in person where possible, depending on the restrictions in your area

## 4. Avoid processed foods and sugar

‘If you’re feeling low or depressed, you’re less likely to cook healthy meals,’ says Gauffin. ‘And, if you eat a lot of processed foods, sugar and carbohydrates, you may feel worse.’ One of the reasons for this is that processed and sugary foods can lead to blood sugar highs and lows, which many people find affects their mood. 

A recent review of the scientific literature on food and depression  reported that the most beneficial diet to reduce depression contained plenty of vegetables, fruit, fibre, fish, wholegrains and legumes and was low in processed foods and sugar. 

__Tools to use daily__

- Make sure you eat a wide variety of whole foods
- Aim to get enough of the micronutrients magnesium (like green leafy vegetables, low-fat dairy, nuts and seeds), folate (including legumes, asparagus and beetroot) and B vitamins (such as eggs, seafood, dairy products and leafy greens) as these were found to be associated with lower rates of depression 
- Try to avoid cutting out entire food groups, unless advised to do so by a doctor or dietitian. This was associated with higher rates of depression. It’s not possible to prove causality but cutting out food groups can affect your health in other ways too, so it isn’t a good idea to do so before discussing it with a medical professional 

## 5. Consider Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that can help you to change the habitual thought patterns that might be playing a part in your depression.  

‘CBT can be very helpful in treating depression,’ says Gauffin. In fact, a large body of scientific evidence has shown that CBT is effective in treating low mood.  In one recent meta-analysis  of 91 studies, it was shown that CBT interventions showed a larger short-term decrease in depression compared with other treatments. 

‘When you start CBT, you write down your thoughts, feelings and behaviours and then look for connections between these and your depression,’ says Gauffin. ‘This helps you to become more aware of your thoughts and actions.’

__Tools to use daily__

- A GP can refer you for CBT on the NHS. This can teach you the behaviours and practices you can use every day to help stop the thought patterns that may be affecting your mood. These include challenging thinking patterns, breathing techniques and journaling

## 6. Explore the art of mindfulness  

Mindfulness is about paying attention to the present moment. It involves observing your breath, thoughts and emotions, without any judgement. 

By focusing on your breath and bodily sensations, even if a negative thought creeps in, you can let it go. ‘You can apply mindfulness to any situation, including making a cup of tea and washing the dishes, right through to meditation,’ says Gauffin.

‘Mindfulness can help with depression,’ says Gauffin. ‘But it requires consistency, consciousness and commitment. To be effective you need to commit to practicing it daily. Even 10 minutes every day will make a difference but it may take a couple of weeks to notice improvements.’

__Tools to use daily__

- Practice daily mindfulness of breathing meditation — even if it’s only for 10 minutes a day. This will help you observe your thoughts and emotions and, in time, see that they will pass and cannot hurt you 
- A mindful pause and deep, belly breath is available to you at any time of the day. This can help you stop and observe your emotions when you’re feeling overwhelmed by them
- Try to be more mindful in everyday life by focusing on one task at a time, be that washing the dishes or finishing a report for work. This helps you become more grounded in the present moment. That in turn may help reduce the catastrophising and ‘what ifs?’ that can lead to depressive thoughts

Read more about how to [deal with a panic attack](/your-health/6-causes-of-panic-attacks-and-expert-tools-for-how-to-cope/)

## 7. Practice yoga 

Yoga’s psychological benefits have been proven to help increase mental energy and improve mood.  In one study, it was shown that doing yoga for 60 minutes three times a week increased  levels of gamma-aminobutyric acid or GABA, a chemical in the brain that helps regulate nerve activity and mood.

__Tools to use daily__

- Start with a little and often approach if you’re just beginning yoga, such as a few sun salutations each day. A recent study showed that when participants practised the Sun Salutations (12 physical postures done as a flowing sequence) every day for just 20 minutes, they felt mentally calmer, more relaxed, well rested, refreshed and joyful after 14 days 

## Should you see a doctor about your mood?

Sometimes, all the lifestyle changes in the world won’t impact the way you’re feeling — and that’s okay. Don’t beat yourself up, there is help available so seek it sooner, rather than later.

See a doctor if you experience symptoms of depression for most of the day, every day, for more than 2 weeks.  

Symptoms of depression  include:
- Continuous low mood or sadness
- Feeling hopeless and helpless
- Feeling tearful
- Feeling irritable, guilty and intolerant of others
- Having no motivation or interest in things
- Difficulty making decisions
- Moving and speaking more slowly
- Changes in appetite and weight
- Sleep disturbances
- Lack of energy 
- Low sex drive
- Unexplained aches and pains
- Feeling suicidal – if you feel like this, you must always seek help

If you think you have depression, a Kry doctor can assess your symptoms and suggest a plan of action to help you feel better.

__This article has been approved by Dr Rhianna McClymont, Lead GP at Kry and Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry.__


Kry.co.uk > Your health > Help for depression — 7 daily tools to improve your mood

original (17)

If the pandemic or winter’s dark days have affected your mood, these simple tools have been shown to help day-to-day mental health

Help for depression — 7 daily tools to improve your mood

##  Quick tips
- Reassure your child that dreams are not real — this is vital
- Nightmares are not the same as night terrors, and should be handled differently

The longer the coronavirus crisis continues, the greater the impact on our emotional health. And that includes children. 

A survey by children’s charity World Vision has shown that almost a third of UK parents have noticed negative changes in their children’s behaviour since the start of the pandemic, including tantrums, fighting, crying, even physical symptoms like stomach aches — and nightmares.

The global lockdowns, social distancing and daily restrictions have disrupted our lives and children are just as likely as adults to feel emotions such as anxiety, worry and sadness. 

But unlike adults, children might not have the language to express their feelings. So an increase in nightmares may occur. The good news is, there are many things parents and caregivers can do to help.

##  Why do children have nightmares?

Nightmares are common in children aged 3-6 years and most will grow out of them. 

Like dreams, nightmares occur during the part of the sleep cycle known as rapid eye movement (REM), when the brain is more active. REM sleep first occurs about 90 minutes after falling asleep, with cycles becoming increasingly longer throughout the night.

‘In the same way as dreams, nightmares are often a way to process the events and emotions happening in our daily lives,’ says Martin Forster, Child Psychologist at Kry. 

‘For example, if something has upset them earlier in the day, is traumatising or causing them to worry, it can come out later in a nightmare,’ says Forster. 

##  Nightmares or night terrors — what’s the difference? 

Nightmares are often confused with night terrors, but the two are different. Night terrors are common in children aged 3-8 years old. They occur during deep sleep, when the body is relaxed and we usually don’t dream.

A child who experiences night terrors might scream, shout and thrash around in extreme panic, but they’re unaware of what’s happening because they’re still asleep. 

‘It’s a bit like sleepwalking. The child might appear distressed but in the morning they’ll have no recollection of what happened,’ says Forster. 

‘It’s best not to wake a child when they’re having a night terror, or they will wake up and feel fearful,’ Forster recommends. ‘If they’ve got up while having a night terror, just gently guide them back to their bed.

‘A nightmare is quite different, as the intense emotions will inevitably cause the child to wake up, usually in a state of distress and fear,’ he adds.

##  What’s the best way for you to respond when a child has a nightmare?

‘If your child wakes up having a nightmare, make sure you comfort them and make them feel safe and secure,’ says Forster. 

‘Reassure your child that dreams aren’t real — this is important. But don’t go into the content of the dream. The idea is to calm them down. 

‘If they’re really distressed, you can let them sleep in your bedroom. In fact, if a child is having recurring nightmares, this might be better for a few days or so. Some parents worry that it might establish a pattern that will be hard to break. But, once your child is sleeping normally again, they will usually be fine to sleep in their own bedroom again.’  

##  What’s normal and what is not?

‘It’s normal for children to have the occasional nightmare and usually this is nothing to worry about,’ says Forster. 

‘But if your child starts to experience nightmares regularly, this needs to be looked into. Is something causing them to feel stressed or worried? It’s not always the case, but there may be some issues that need to be addressed, perhaps at school or with their friends. 

‘Also, if a child is frequently waking up in the night feeling terrified, this will disrupt their sleep so they feel tired the next day. Or it could be that, after a while, they start dreading falling asleep. So bedtime becomes an issue,’ he says.

##  What can cause nightmares?

‘It could simply be a one-off after watching a scary film,’ says Forster. ‘Or perhaps a friend has done something to upset them. Perhaps someone close has been ill or they’re worried about something bad happening to a parent or sibling. 

‘Some children are very sensitive and it could be that they’re picking up on worries in the family. 

‘In most cases, nightmares will go. Sometimes there’s no specific reason. Some children just naturally dream more than others, and they are also more likely to experience nightmares. 

##  Should your child see an expert?

‘If your child is still having nightmares a few times a week, after a month ask your doctor for a referral to a child psychologist,’ says Forster.  ‘This can help identify more complex issues at play such as problems within the family that are causing the child anxiety.’

##  Is there anything you can do to minimise nightmares?

‘A good tactic for young children to make them feel safe before they go to bed is to reassure them that they are protected,’ says Forster. 

‘If they have a favourite teddy bear, you could say, “Teddy is always here to protect you. He’s watching over you and nothing bad can happen.”’ 

If a child keeps waking up in the night, you can help to ‘reprogramme’ what happens in their nightmare. The way to do this is to talk about — or draw — what’s happening in the nightmare and ask them to come up with a new ending, Forster recommends. 

‘You could, for example, get them to imagine what would happen if Superman flies in to catch the bad guys. In this way, you’re helping your child to create a new story that has a positive ending. The more you talk about or draw it, the more you reinforce the new ending in their mind, until eventually they start to dream in a different way.’

##  How can you help children process big life changes?

The coronavirus crisis has made us all think about sickness and death more, and even very young children are picking up on this. They may even have lost a relative to Covid.  

‘If your child has a lot of questions about illness and death and is worrying about it, don’t ignore it,’ says Foster. 

‘It’s healthier to address their fears. Unfortunately, sickness and death are part of life and by talking to your child about them, you can help them cope.’ 

‘For example, if someone in the family has died, it’s important to involve the children in the procedures and rituals and not to hide it away,’ he says. ‘Helping your child navigate their way through difficult emotions such as sadness and grief can help them to cope better.’

##  Can you do anything to help prevent child nightmares?

‘Images can be powerful and children respond more intensely to something they’ve seen, rather than what they hear,’ Forster explains. 

‘So, if your child is prone to nightmares, make sure they’re not exposed to distressing images on the news or in a movie. Seeing images of people in hospital as a result of the pandemic, for example, can make them more anxious and fearful about people they love getting ill. Try to protect your children from images and programmes that may distress them.’

__This article has been approved by Martin Forster, Child Psychologist at Kry.__


Kry.co.uk > Your health > Children and nightmares — advice from a child psychologist 

Children and nightmares — advice from a child psychologist 

Nightmares in children are common around the ages of 3-6. If you’re confused about what to do, Martin Forster, Child Psychologist at Kry, has great advice

##  Quick takeaways
- During upsets, pausing before you respond is more constructive than reacting immediately
- Managing your own emotional reaction can help you see and hear things more clearly
- Showing you understand another person’s point of view is useful during arguments 

Spending a lot of time with people – even our loved ones – can be tricky at times. As we continue to stay with our immediate households, a build-up of frustration and uncertainty from the past year may bring more heightened emotions than usual.

But it doesn’t have to be this way. Life is pretty tough for many people right now. So, the last thing we want to do is fan the flames of division within our own families and relationships.

Instead, take a deep breath, and pre-empt any potential pitfalls by planning your conflict management toolkit in advance.

##  Learn the art of constructive conflict

Not all disagreements are bad. Having different opinions is what makes us grow and see things from different perspectives. This constructive conflict can sometimes even be a positive thing – but only if you ‘fight clean’. 

##  Tools for ‘clean’ arguments

- __Don’t make it personal.__ No name-calling, character judgements, swearing or insults  
- __Explain how a situation makes you feel.__ For example, ‘Lately I’ve been feeling quite sad when I feel you’re ignoring me’ 
- __Avoid the phrases ‘you always’, ‘you never’.__ These exaggerations are bound to make someone jump to defend themselves and get upset 
- __Pause, then respond.__ If someone upsets you, don’t react immediately as you might give a knee-jerk reaction. For example, you might say, ‘You’re always checking your phone.’ But, what you really mean is you want them to pay you more attention. That opens up a new conversation, rather than just arguing about how your partner is always on the phone
- __Recognise the difference between anger and aggression.__ Anger can be a healthy emotion that alerts you something is wrong. But shouting, screaming and being intimidating is aggression, which is hurtful and abusive 
- __Take responsibility for your emotions.__ You might feel angry and frustrated with someone — but, it’s down to you to choose your emotional state. By managing your emotional reaction, you will see and hear things more clearly

##  Take the time-out option

If you’re feeling overwhelmed by your emotions, avoid getting into a discussion. Of course, this can be difficult, especially if you’re feeling wound-up.  

If you want to avoid the situation escalating, it’s better to say, ‘This is something I want to talk about, but now isn’t the best time. I’d like to take time out.’

Wait until you feel calmer to get back to the discussion. Also, check when would be best to talk with the other person. If you’re feeling inflamed, go to another room or even go for a walk. Let your friend or family member know what you’re doing, so it doesn’t seem like you’re storming off.

##  Tools for diffusing a situation

- __Stop when you sense a situation building up.__ Do everything you can to try to stay calm. For example, go for a walk, count to 10, call a friend or do a short breathing meditation – anything that helps you to stay calm 
- __Find out the other person’s ‘why’.__ Ask someone to explain their opinion in more detail, so you can better understand. This is a useful negotiation tactic. Asking someone to explain how they think and feel takes the emotion out of the situation and allows them to feel they are being heard. Hopefully, in turn they’ll reciprocate by listening to your views too, which can lead to a more peaceful resolution
- __Listen.__ Try to put yourself in someone else’s shoes. Most people stop listening during arguments. That means you’ve got two parties where no one is hearing what the other is saying. Sometimes when you show you understand where someone is coming from, it’s enough to help create a shift. Try saying someone’s point of view back to them with the words, ‘So, as I understand it…’
- __Know that you don’t always have to be right.__ Simply conceding that you can see the other person’s point; that you made a mistake or will do things differently next time, can work wonders. Remember, you don’t always have to be right or have the last word

##  Use respect when dealing with children

It’s normal for children to squabble at times. But if they are really playing up, look at what’s really causing them to behave this way.  

###  Tools for managing arguing children
- __Check yourself first.__ Is their behaviour something they’re picking up from you? Be honest with yourself. Children are sensitive and if they are picking up on tension between you and your partner or sensing that you’re in a bad mood, their behaviour is often a reflection of what’s going on with you
- __Parent by example.__ Children are more likely to be helpful and cooperative if they see the adults around them treating each other with kindness and respect
- __Give children the cooling-off option.__ If your kids are arguing, suggest they do something else for 20-30 minutes and talk about it when they get back. After that, encourage each child to speak and the other to listen 
- __Plan the chore roster in advance.__ Have a family meeting and write down what each member is expected to do on a daily or weekly basis. Make it clear what everyone’s role is and work out a rota. That way, everyone feels part of a team and knows what they have to do

__This article has been approved by Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry__


Kry.co.uk > article page > How to manage arguments at home — a therapist’s toolkit?See a Kry GP in minutes or book up to 7 days ahead. Download the Kry app now. > call out

Kry.co.uk > Your health > How to manage arguments at home — a therapist’s toolkit

14 ways to communicate better with loved ones — a therapist’s toolkit

With many of us spending more time at home, there might be more arguments than usual. This communication toolkit will help you survive with a smile

How to manage arguments at home — a therapist’s toolkit

## Quick facts
- Fat around the middle, known as visceral fat, fuels inflammation in the body
- A high waist-to-hip ratio (WHR) may indicate higher risk
- The WHO says that women should have a WHR of 0.85 or less, and for men it should be 0.9 or lower
- You can calculate your WHR by dividing your waist measurement by your hip measurement

It’s no secret that being overweight or obese is not good for your health. Not only can excess weight increase your odds of developing diabetes, heart disease and many other serious health problems, it can also add to your chances of complications from Covid-19.

## Why does where you carry your weight matter?

There’s now a body of evidence which shows that being an ‘apple shape’ and having additional fat around your belly is more dangerous than being a ‘pear shape’ and carrying excess fat on your buttocks and thighs.

This is because it’s now known that fat produces healthy — and unhealthy — body chemicals. This cocktail of body chemicals varies, depending on where you tend to deposit your body fat.

The most dangerous is abdominal or ‘visceral’ fat. It’s sometimes called intra-abdominal fat, because most of it is hidden away in the abdominal cavity. This fat also builds up in an apron-like flap of tissue called the omentum, located under the diaphragm, which blankets and protects the intestines and other organs. 

‘Visceral fat is important as it increases the risk of health problems such as type 2 diabetes and heart disease,’ Dr Rhianna McClymont, Lead GP at Kry explains. 

It also produces inflammatory chemicals called [cytokines](/your-health/what-is-cytokine-storm/). These are associated with severe illness from Covid-19, as well as with increased blood pressure and pushing up levels of free fatty acids in the blood and organs, which may contribute to heart disease risk. 

## Why your waist-to-hip ratio is important

The most obvious clue that you have too much visceral fat is having an ‘apple’ body shape, in which your waist seems wider than your thigh area. That’s why measuring waist to hip ratio (WHR) can be a useful tool for assessing your weight-related health risks. This is often done in addition to calculating your [body mass index (BMI)](/your-health/5-simple-tips-for-a-healthy-bmi/), which doesn’t account for where excess weight is distributed on the body. 

To calculate your WHR, divide your waist measurement by your hip measurement. If your waist is 80cm and your hips are 90cm, your ratio is 0.89. The World Health Organization (WHO) says that women should have a WHR of 0.85 or less and for men it should be 0.9 or lower.

## How do you know if your measurements put you at risk?

If calculating WHR is confusing, you can simply measure your waistline (around the belly button).

The NHS and Sweden’s Karolinska Institutet advise losing weight if your waist is more than 94cm (37in) for men, or 80cm (31.5in) for women. 

Men with a waist measurement of more than 102cm (40in) and women measuring 88cm (34.5in) or more are at high risk of health problems and should speak to a doctor.

## Do age, genes and stress play a part?

Lots of factors beyond your control will influence your tendency to store visceral fat. These include your genes, getting older and hormones. Visceral fat for example, may increase after menopause. 

But stress also plays a key role. ‘Studies have also shown that stress can play a role in obesity through the increase in a hormone called cortisol,’ says Dr McClymont. ‘This is released in response to periods of chronic stress. Cortisol causes increased deposits of visceral fat and has been shown to increase appetite and a preference for energy-dense foods.’

## Why shifting belly fat isn’t as hard as you might think

The good news is that it’s easier to reduce visceral fat with diet and exercise than it is to shift fat from the hips and thighs.

Exercises like sit-ups will tighten abdominal muscles but won’t target visceral fat. The best ways to shift it are through a combination of healthy diet and increased exercise. 

The NHS recommends 150 minutes of moderate physical activity like walking, swimming or gardening or 75 minutes of vigorous activity like aerobics, rowing, strength training or jogging each week. 

‘[Reducing alcohol intake](/your-health/6-health-benefits-of-drinking-less/) can also be a good way of reducing waist size,’ adds Dr McClymont. ‘[Getting plenty of sleep](/your-health/4-ways-to-sleep-better-during-the-pandemic/) and reducing stress levels can also help,’ she says.

## How Kry can help

‘Certain people who are very obese and have not managed to reduce their weight with diet and exercise may benefit from a medication to help with weight loss, or a referral to a bariatric clinic to discuss weight-loss surgery,’ says Dr McClymont. If you’re concerned about your waist size or impact of visceral fat, speak to a doctor for medical advice.

__This article has been medically approved by Dr Rhianna McClymont, Lead GP, Kry.__


Kry.co.uk > Your health > Is your waist size putting your health at risk?

Is your waist size putting your health at risk?

Excess fat around your middle can raise your risk of type 2 diabetes and heart disease. We explain why, and how shifting abdominal fat may not be as hard as you might think

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