COVID-19 - James Gillard Osteopath

How to Build Healthy Habits

Ros Uncategorized 10/05/2020COVID-19, Habit, Health, mindfulness, Pandemic, Self Help, Sleep 1 Comment

With more than half of the world currently in some form of lockdown, many of us now have more free time. It is tough to not be able to live our lives how we usually do. I especially miss being able to see family and friends and play sport with others.

Seeing that change is inevitable right now, maybe we can use this time as an opportunity to establish healthy habits. What if we could get started on something we have always wanted to do, or stop doing something that we know is bad for us.

The author James Clear nicely summarises how to build healthy habits in his excellent book ‘Atomic Habits’:

The First Law: Make it Obvious.

Fill out a habits scorecard. Write down your current practices to become aware of them.
Use implementation intentions: “I will (BEHAVIOUR) at (TIME) in (LOCATION).”
Use habit stacking: “After (CURRENT HABIT), I will (NEW HABIT).”
Design your environment. Make the cues of good habits evident and visible.

If your plan is not apparent enough, write down what you will do at what time on what days in what specific location and how long you will do it for each time. You can build this practice on top of an already established habit. It might be after you brush your teeth, or as soon as you get out of bed, or before you eat breakfast or as soon as you get home from work. It just needs to be after something that you are already doing every day so that you can practice your new habit just after this every time.

Also, make sure that you have a reminder to do this task at this time each day, especially in the beginning, so that it will be evident that you need to do it. You may need to set an ongoing event in your calendar for a specific time every day. Or you could set a reminder in an app if you want to use one to help you build this habit. It will not guarantee that you will practice the behaviour, but you will not be able to say that you “just forgot” either.

The Second Law: Make it Attractive.

Use temptation bundling. Pair an action you want to do with an activity you need to do.
Join a culture where your desired behaviour is normal.
Create a motivation ritual. Do something you enjoy immediately after challenging tasks.

If your plan is not attractive enough, determine if you can do something enjoyable at the same time as the activity you want to do. It might be listening to an audiobook or podcast series, but only while you go for your daily morning run. You could also join a running group that meets every morning, and it will encourage you to begin running daily too. You could then take a warm shower or eat a tasty breakfast to increase the pay-off for successfully engaging in the new habit that you are trying to develop.

The Third Law: Make it Easy.

Reduce friction. Decrease the number of steps between you and good habits.
Prime the environment. Prepare your situation to make future actions easier.
Master the decisive moment. Optimise the small choices that deliver outsized impact.
Use the two-minute rule: Downscale your habits until you can do them in two minutes or less.
Automate your habits. Invest in technology and one-time purchases that lock in future behaviour.

If your plan is too difficult, reduce how many steps you need to take to engage in the new habit that you want to build. Let us say you want to go to the gym after work, put your gym shoes and clothes in the car, and maybe even change into them at work before you leave. Then all you have to do is go in on the way home and begin your workout. If you are choosing between the cheap gyms ten blocks away or the slightly more expensive one on your street, choose the one on your street. You are much more likely to go. Also, if you do not feel up to it, tell yourself that you will only go for ten minutes, and if you are still not feeling it, you can go home. Chances are, you will be doing well once you have started, and want to keep going. Lastly, commit to a monthly contract if you can rather than just paying each time. You will then be more motivated to go more as it becomes better value the more times you go.

The Fourth Law: Make it Satisfying.

Use reinforcement. Give yourself an immediate reward when you complete your habit.
Make “doing nothing” enjoyable. When avoiding a bad habit, design a way to see the benefits.
Use a habit tracker. Keep track of your habit streak and “don’t break the chain.”
Never miss twice. When you forget to engage in a habit, make sure you get back on track immediately.

If your plan is not satisfying enough, reward yourself as soon as you complete the habit, especially until you get into a groove with your practice. Remind yourself of the benefits of what you are doing and the negatives associated with not practising this habit. Keep track of how many times you do it, and see if you can do it every day to build up a streak. Try not to break the streak and never let yourself miss more than one day in a row, as the more days you lose, the harder it is to get back on track.

How to Break Unhealthy Habits

James Clear again provides an excellent summary in ‘Atomic Habits’ on what steps to take:

Inversion of the First Law: Make it Invisible

Reduce exposure. Remove the cues of your bad habits from your environment.

If reminders for the thing you are trying to stop doing are around everywhere, try to make them less visible. If you want to drink less alcohol, throw out any drinks that you have in your house and any alcohol-related memorabilia too. If you are going to stop eating ice cream every time you watch TV, do not have any ice cream in the house and put the remotes away in a drawer or the bedroom too.

Inversion of the Second Law: Make it Unattractive

Reframe your mindset. Highlight the benefits of avoiding your bad habits.

If the thing that you are trying to stop doing seems too attractive, make it less appealing. Write down the negatives of drinking or eating ice cream, and write down the benefits of not doing this. Then leave this written information somewhere that you will regularly see it. It may be on your desk, or near the mirror in your bedroom or bathroom.

Inversion of the Third Law: Make it Difficult

Increase friction. Increase the number of steps between you and your bad habits.
Use a commitment device. Restrict your future choices to ones that benefit you.

If the thing you want to stop doing is too easy to see, increase how many steps you need to take to engage in the behaviour. Let us say you usually buy alcohol or ice cream on the way home from work after a tough day. If you do not bring any money or credit cards to work with you, you will need to drive home first. Assuming you don’t have any alcohol or ice-cream at home, you will need to get your credit cards, then go to the bank, get out money and go to the store and buy these products. That is a lot of effort for someone who has had a tough day and wants to take it easy.

Inversion of the Fourth Law: Make it Unsatisfying

Get an accountability partner. Ask someone to watch your behaviour.
Create a habit contract. Make the costs of your bad habits public and painful.

If the thing you want to stop doing seems too satisfying, ask for help. It could be from your partner, family, or friends. Ask them to hold you accountable and help you avoid engaging in this habit. Tell people that you are not drinking or eating ice cream, and let them know of a painful consequence that you will have to do if you engage in this habit or they see you do it.

To download a printable version of the habits cheat sheet, go to www.atomichabits.com/cheatsheet.

If you do try to break a habit or build one, remember that behavioural change is hard. Don’t try to make too many changes all at once, and do try to be kind to yourself if you slip up. That’s a normal part of the change process. The key is to keep trying and get back on track after a bad day. I wish you all the best during this extremely difficult time, and I am happy to offer extra support to anyone who needs it.

About the Author

Dr Damon Ashworth Clinical Psychologist who completed his doctoral research on the effectiveness of Cognitive Behavioural Therapy for Insomnia (CBT-I); and is considered an expert in the field of sleep and insomnia. After 18 months volunteering as a mental health specialist in Vanuatu, he has returned to Melbourne and is now available for in person consultations and online via Telehealth . In addition to sleep problems Dr. Ashworth, also has an interest in treating depressed mood, anxiety, trauma, addiction and relationship issues.

www.damonashworthpsychology.com

www.deliberatelybettersleep.com.au

Are we utilising all our resources in fighting this pandemic?

James Uncategorized 10/04/2020COVID-19, Health, Immunesystem, osteopathy 3 Comments

Spanish flu: the killer that still stalks us, 100 years on | World ... — The Spanish Flu

There is no denying that the impacts of COVID-19 are omnipresent in all of our lives right now. At the time of writing this, the death toll has nearly reached 96,000 people and unprecedented public health measures have been initiated around the globe. In Australia, we have rapidly mobilised the healthcare system in the best way we know how to prepare for the forecasted peak to come, but is there more that we could possibly be doing?

It’s Easter weekend, a time for family, friends and celebration. In Victoria, stage 3 restrictions have recently been enforced, outlining only four reasons you can leave the house; medical appointments, food, exercise and travelling to and from work. Gatherings of more then 2 people are strictly prohibited and outdoor gyms and playgrounds have been closed. None of these restrictions are terribly compatible with traditional Australian easter celebrations.

This may seem drastic and in direct opposition to the freedoms we have become so accustomed to. However, when you consider that social distancing and voluntary self isolation are some of the most effective means we know of for helping to mitigate the spread of infection during a pandemic perhaps your perspective starts to change.

Australia are preparing for between 50,000 and 150,000 deaths. No matter how many dedicated health professionals we have fighting the virus, the Australian public has the most important role in preventing deaths. The longer this thing goes on, the more chance our medical system and its resources have of saving lives. We have 100,000 reasons to stay at home and #flattenthecurve.

Despite our public health measures we are still expecting between 5 million and 15 million cases Australia wide. Of these cases, based on what we’ve learned from China, 26% will require a bed in ICU and 17% will require mechanical ventilators.

Screen Shot 2020-03-30 at 3.41.28 PM — Source: ABC news

Our health care system is also doing what it can to make changes, as it prepares for the onslaught that is likely to ensue. We are now in the process of recommissioning purpose-built facilities (closed hospitals) and taking over suitable alternatives such as hotels. This creates extra beds for sick patients and a space for observation and quarantine as diagnosed cases begin to improve. Hospital staff are also undergoing additional training to operate equipment, triage or provide specific patient care.

Among these, are physiotherapists being deployed on the frontline. Their roles include assisting the weaning of patients from ventilation machines, ensuring proper positioning to increase oxygen intake efficiency and help to recondition patients breathing and muscle function following disuse.

This is a fantastic use of highly trained health professionals to help deal with a crisis. The question is, could we be doing more to collaborate and support a health system under strain? Are we utilising all of our available resources?

As more and more allied health clinics across the country begin to close, ensuring they aren’t vectors for the spread of infection, many highly trained health professionals are left under-utilised. Of course, many are using technology to support patients via telehealth, an important means to help reduce the load on the healthcare system. Although for practitioners who are trained to treat people with their hands, is this the best use of their skill sets?

Does osteopathy have a role to play?

Treatment of a sick child.jpg — Osteopathic treatment of a sick child

Since the late 1800’s, osteopaths have been treating patients with their hands. They treated all kinds of ailments and illnesses, as well as pain and disability. Osteopaths don’t cure, or fight disease, they use manual therapy to treat restrictions in the the musculoskeletal system to help provide an environment that supports the body’s natural tendency towards health.

In the context of a virus like COVID-19, this means treating the ribs to help patients breathe more easily, releasing tight muscles to allow for better local tissue circulation, or using techniques to help boost immune responses.

This isn’t a new concept, with osteopathy playing a role in pandemics of the past. During the Spanish flu, it was estimated that the death rate was 40 times lower with osteopathic care when compared with only conventional medical treatment. Although the figures are impressive, no doubt there would be shortcomings when evaluated by today’s rigorous standards of research. In addition, osteopaths recording these statistics were osteopathic physicians (DO). In the USA DO’s have full medical practice rights and are licensed to prescribe medications or perform surgery. The difference between traditional medical doctors and a DO is an understanding of osteopathic philosophy and manual therapy. Although in Australia osteopaths do not receive conventional medical training, they are trained extensively in osteopathic philosophy and manual therapy. So where does this leave Australian osteopaths for the COVID-19 Pandemic?

Desperate times call may call for desperate measures. However, it is no time to introduce practitioners who are unfamiliar with hospital protocols to provide hands on treatment with low level evidence of it’s efficacy in this setting. Perhaps in the aftermath of this pandemic we can reflect upon how to greater utilise all of our resources in healthcare to provide the best patient care possible and to reduce strain on the system.

Osteopaths could be used in conjunction with standard medical care in primary medical centres or rural hospitals, where resources are less robust. Osteopathic treatment of elderly populations with pneumonia has shown reduction in IV antibiotic use, length of stay in hospital and mortality. Likewise, osteopaths helped to reduce duration of hospital stay and associated costs in preterm infants and support patient’s recovery following heart surgery.

This of course would require osteopaths to undergo some training in a hospital or general practice setting. Some of which has already taken place at Victoria University and RMIT, where senior students have worked alongside orthopaedic surgeons and physiotherapists in Indian hospitals. Could this training occur outside an orthopedic realm to include other areas of speciality?

It would be a paradigm shift, but we are increasingly finding that multidisciplinary care helps to improve health related outcomes. The unprecedented nature of COVID-19 could be an opportunity to reassess how we can incorporate all our healthcare resources to work together in the future.