Author: Aceso Under Glass

Impact of Depression and its Treatment on Productivity

Introduction

One argument for prioritizing treatment of mental illness is that the secondary effects (such as higher productivity and improved health-related behavior) may be especially impactful. Illnesses like depression and addiction are incredible drains on productivity, which can be reversed with treatment. In this essay I investigate the productivity cost of untreated (or unsuccessfully treated) mental illness and the impact of treatment on productivity.

How Bad is it?

World Health Organization Data

Alonso, et al. (2011) surveyed workers to determine how many days they missed work due to a variety of chronic illnesses, including depression and anxiety. Their sample included 63,000 people spread across 24 countries, with a range of cultures and income levels. Across all countries, the following disorders caused the average person with that disorder to lose the following days of work. Note that comorbidity is common and days-missed are additive- e.g. a person with depression and generalized anxiety in a lower income country would miss 26.6 days of work.
Days of Productivity Lost to Illness

Lower income countries Medium income countries Higher income countries All countries
Additional days Additional days Additional days Additional days
Mean s.e Mean s.e. Mean s.e. Mean s.e.
Depression 13.1 5 14.7 4.1 4.1 3.2 9 2.5
Bipolar disorder 36.5 15 23.2 9.6 9.6 5.8 17.3 4.9
Panic disorder 24.3 12.9 17.7 5.5 11.7 4.1 14.3 3.5
Specific phobia −6.6 5.2 4.2 4.7 6.7 3.3 3.9 2.5
Social phobia 5.7 10 9 8.4 7.5 2.9 7.3 2.8
GAD 13.5 9.1 24.6 8.4 7.6 4.9 7.7 3.6
Alcohol abuse −2.8 7.2 8.2 5 −0.3 4.5 1.9 3.2
Drug abuse 14.7 13.9 3.9 12.2 1.2 5.5 2.5 4
PTSD 15.3 11.3 −1.1 9.5 16.2 4 15.2 3.5
Insomnia 5.7 5.3 4.6 5.4 9.4 3.2 7.9 2.7
Headache or migraine 10 3.6 6.5 3.3 4.5 2.1 7.1 1.5
Arthritis 6.1 4.4 0.8 5 1.8 2.4 2.7 1.8
Pain 0.9 3.1 11 2.4 19.6 2.1 14.3 1.5
Cardiovascular 2.7 6.7 1 3.6 7.2 2.7 5.7 2.1
Respiratory 10.7 3 −1.1 2.6 0.9 1.4 2.6 1.3
Diabetes 4 6.4 0.5 5.6 9.6 3.8 8.6 2.8
Digestive −4.3 4.8 −0.4 4 16.6 4.8 7.6 3
Neurological 33.7 23 18.6 7 15.3 7.4 17.4 5.8
Cancer 19.4 17.9 −4.2 12.9 6.9 3.6 5.5 3.5

 

[Note that negative numbers mean the condition is associated with an increase in number of days worked.]

Alonso, et al (2011) did not attempt to measure workers who attended work but were less productive due to illness (presenteeism), or control for average number of days of work for a given country.

Chrisholm, et al. (2016) attempted to estimate the economic impact of depression and anxiety, including the cost of lost productivity, using primarily the data above. They estimate that treatment for depression leads to a 5% increase in attendance (in any country) and 5% increase in productivity while present. This implies a normal worker has 180 working days in high income countries and 260 in low income countries, which is low (see OECD data), meaning the 5% estimate for absenteeism is too high. However I believe their estimate for presenteeism is much too low. Just the diagnostic criteria of depression suggests more than a 5% drop in productivity.

 

Comparison to Sleep Deprivation

The effects of depression can be similar to sleep deprivation, in part because depression can cause either insomnia or a need for excess sleep, and in part because both produce a “brain fog” (weirdly, sleep deprivation may also treat depression). Given the paucity of information on the relationship between depression and productivity and the abundance of information on the relationship between sleep and productivity, I turned to sleep deprivation as a model for the effects of depression on productivity, contingent on a given a worker making it to their job. The following are mostly small studies but unsurprisingly all show sleep deprivation having a large negative impact on productivity.

 

Kessler, et al. (2011) estimate that insomnia causes presenteeism equivalent to 7.8 days of missed work per year, an estimated financial loss of $2,280 per person. This used the WHO Health and Work Performance Questionnaire, which relies entirely on workers self-reports of their productivity relative to co-workers. It is also designed only to measure whether someone is more or less productive than average, not the magnitude of the difference.

 

Gibson & Shrader (2014) estimated that a one hour increase in average nightly sleep led to a 16% increase in wages (on average, $6,000). I will use that as my lower bound for the benefits of treating depression. I assume the actual increase productivity is larger than the increase in wages, because some of the benefit is captured by the employer. If we assume the employer and employee capture equal value, this implies an actual productivity increase of 32%. And if we assume depression is equivalent to 2-3x the cost of missing one hour of sleep, that is almost a halving of productivity (note that for actual sleep, the costs of missed sleep probably increase exponentially). This study is especially promising because it is rather large and used a natural experiment (distance from timezone line) to establish study conditions.

 

What Does Treatment Accomplish?

Strong Minds

[When not otherwise stated, data comes from Strong Mind’s 2015 report.]

Strong Minds is an NGO in Africa that runs 12 week group therapy classes in Uganda. Their three month month program produces a noticeable drop in depression.

Strong Minds monitors its effect on depression using a modified version of the PHQ-9 (Patient Health Questionnaire- 9). The scale of this test is unknown, making it hard to evaluate the absolute improvement, but lower scores are relatively better (less depression) than higher scores. This questionnaire is an accepted tool for monitoring severity of depression.

Of women participating in Strong Mind’s 12 week pilot program, 92% had reduced scores on the PHQ-9; 11% of the control group had reduced scores. Most of the other effects reported in Strong Mind’s report are given in absolute terms, with no reference to the control group. Based on the reduction in PHQ-9 scores, I will assume 88% of any result is due to participation in the program. Key results:

  • 15 percentage point increase in participation in primary occupation (79% -> 94%).
  • 40 percentage point reduction in families going 24 hours without a meal (53% -> 13%).
  • 17 percentage point reduction in medical care visits (58% -> 41%). This is likely to understate the improvement in health, as some participants probably had physical problems they had previously been too depressed to treat.
  • 18 percentage point increase in families sleeping in protected shelters (65% -> 83%).
  • 10 percentage point increase in school attendance (33% -> 43%).

Income is not reported in this study. The authors do not say this explicitly, but it is common in developing world studies to examine consumption, because income is so variable.

Qualms about data: the study recorded 46 variables, of which less than 10 were reported in their report (not all of which made it into this report). The report included different metrics from phase one studies (eating 3 meals/day, ability to save any amount of income).  Given that it appears this data was still collected in phase two, the absence of results in the report raises concerns about cherry picking. I included this study despite my qualms because so little data was available about the effect of treatment of depression in developing countries.

Cost: $240/12 women in the program = $20/person. This is almost certainly an underestimate of even the marginal cost of the program.

Schoenbaum, et al.

In The Effects of Primary Care Depression Treatment on Patients’ Clinical Status and Employment, researchers reported that six months after their intervention (treatment for depression by a primary care physician, in the USA), 24% (vs 70% in control group) were depressed, and 72% (vs 54%) were employed.

Summary

Translating these productivity impacts into dollars is difficult because we can’t assume they hit all incomes equally, however the WHO estimates that in aggregate depression and anxiety together cost one trillion dollars US/year in lost productivity worldwide, slightly more than 1% of total GDP. On an individual level, there is no satisfying answer here. Depression has a very broad definition: the worst cases can destroy all productivity. The typical case destroys somewhere between 5% and 50% of productivity. Treatment of depression can restore that lost productivity in some but not 100% of participants.  

 

Areas for Further Investigation

I used sleep deprivation to generate heuristics for how damaging depression might be, with the answer being “quite bad”. Those numbers are even more accurate for estimating the effect of sleep deprivation. Because the scope of this paper was limited to economic effects stemming from workplace productivity, I have left out many other costs of sleep deprivation, including health costs and developmental damage to children. Given the costs and prevalence of sleep deprivation, sleep-promoting interventions, especially in children and adolescents, may be a promising area for intervention.

TransTech Conference Round Up

My original intent in attending TransTech was to write up the talks; this proved to be a misunderstanding of what TransTech is. More than anything else, it is a vendor fair, with a mix of products looking for users and products looking for funding. This is not quite what I hoped for, and I feel reflects a general problem in America/capitalism/health care, which is looking for products you can buy to solve problems instead of public health type solutions or things you have to give up. But products are clearly what this conference was about, and I’m not going to get mad at it for being what it is. So in lieu of a science talk write up, please enjoy these descriptions of things I saw or tried in the vendor room.

Let’s be clear that this room was full of… let’s call it “speculative science.” I have two dilemmas around talking about the products. The obvious one is that I assume most of these are time wasters at best. Some of the science is atrocious, and much more is probably bullshit but I didn’t have time to investigate. Unfortunately, “time wasting woo bullshit” is where a lot of cool things start out, and if I dismiss everything out of hand I’ll lose the best things too. In a perfect world I would investigate the fundamental science of all of these and report on that, but I do not have that kind of time. So my choices are: report nothing or report everything and let G-d sort it out. Ultimately I think getting oxygen to the next good thing is more important than depriving all the bad things of oxygen, so I’m going to share.

If I don’t mention what a device claims to help, assume it is all of:

  • Sleep
  • Pain
  • Mood
  • Concentration
  • Stress
  • Aging

VIE LIGHT

The theory: by shining photons onto the brain via the scalp and nasal passages, you can activate a photosensitive mitochondrial enzyme in cells in the brain, improving cognition.

On one hand, I would be extremely surprised if this worked. It requires a photosensitive enzyme in an area that shouldn’t receive light. On the other hand, they were the only booth to have reprints of scientific articles backing their proposed mechanism. Most booths didn’t even mention the mechanism, just the effects, and the effects are always the same (relaxation, improved sleep, decreased pain, improved concentration, improved mood).

Somehow the line for the nose lasers was very long and I didn’t get to try this one.

OPEN MIND

A VR display of your internal state (heart rate, respiration, etc. ), in the hopes of training you to notice signals of your internal state (collectively known an interoception). Better interoception could open all kinds of doors, and I have vague recollections of data that this approach is sound. But it’s not going to de-age you beyond what improving interoception works.

I tried this one and didn’t get anything out of it.

NEUROPTIMAL

You’re hooked up to an EEG and headphones. When your brain waves exit a certain range, the system plays little blips in the music. This nudges your brain back to the desired range, even if you don’t know that’s what the blips mean. Their literature explained 0% of what they did or what the mechanistic goals were .

I definitely had a strong response to this. One layer of it was increased relaxation, but there was also a hard-to-describe fuzzy feeling.

 

SANA SLEEP MASK

A mask that blink lights and plays sounds to improve sleep (they also believe this could work for pain but are targeting sleep first). Planning FDA trials but haven’t actually done them yet.

The proposed mechanism is “something something neuroplasticity”.

This had a very mild effect on me, I was maybe I was more relaxed afterwords.

THE DREAM SPA

Kind of like a welding mask, but held further from your face. LEDs (red, blue, and infrared) litter the inside, and blink at you for thirty minutes. These are very bright lights- my eyes hurt a little even closed.

I wish I could quote the explanation directly, because any paraphrase introduces the possibility I’m exaggerating, and I am. This is exactly what they think it does:

  • Send light to face
  • Subatomic particles of energy are carried via the bloodstream and connective tissue to cells all over the body.
  • This energy helps mitochondria, boosting ATP production and increasing their cleaning function.
  • “Enhances” apoptosis. When I asked if she meant increased or decreased cell death, she clarified that she meant “enhanced” and explained what apoptosis meant.

Here are a few facts I know:

  • The mitochondria is the powerhouse of the cell. It is not involved in cellular cleanup
  • Certain wavelengths of light on your skin definitely produces vitamin D. It probably does something else, because light therapy treats Seasonal Affective Disorder in a way straight vitamin D does not.
  • Energy does not work that way.

 

 

Way to make the nose laser people look good.

Satisfyingly, this was the first/only product to do absolutely nothing for me. The most impressive thing about it is that I was able to lie there for half an hour with only small amounts of antsiness. Hypothesis: a large chunk of the effects of all of these machines come from providing the right level of sensory stimulus to keep people at a certain level of stimulation- not enough to overwhelm, but not so little your brain goes looking for more.

 

 

FOC.US

By far, Focus got closest to the maker vibe I wanted. They sell hardware that contains an EEG and is capable of a variety of outputs, including mild cranial electrical stimulation. The hardware has an API you can use to build other tools like the ones I’ve described here.

The downside of providing a platform not a product is that you don’t have a product to demo. But I like them and I want them to succeed. If this sounds awesome to you, they probably won’t mind you emailing me (elizabeth-at-this-domain) to get the conference discount code.

 

 

 

Transformative Technology Conference

As part of project get-out-of-the-bubble, I’ll be at the TransTech conference this Friday and Saturday.  As bubble escapes go, it scores very highly in certain dimensions and not so great in others. If you’ll be at the conference and would like to talk, you can reach me using their app or at email elizabeth-at-this domain.  If you are just hearing about this and would like to join me, here’s a code for $150 tickets.

Tim Schafer Videogame Roundup

On one hand, I try to stay away from negative reviews.  Insulting things is easy, creating things is hard.  On the other hand, mentioning a game on this blog makes its purchase tax deductible to me.  You see my dilemma.

So let’s talk primarily about Psychonauts, which is an excellent game.  It is one of those nebulous “puzzle platformers”, meaning it involves both jumping and carrying things around until they can be used as keys.  But where it really shines is the meta game: most levels take place inside people’s heads, and reflect their inner damage.  For example, the drill sergeant camp counselor’s brain is a fairly standard 3D platformer.  Occasionally you have to knock a wall down, but there aren’t even real enemies.

Later on you enter the mind of a woman who clearly has bipolar disorder, and you work her through her abandonment by her stage mother by enacting a series of plays.  Then you shoot down the real villain, her inner critic. You also help a guy with multiple personality disorder defeat his inner Napolean by entering a ~chess board to run errands for medieval peasants.

It’s hard to convey how much this works in context, but it really does.  The gameplay is fun (most of the time.  Don’t judge by the first level), the puzzles are solvable (most of the time), the narrative is rich, and they all go together really well.  I might occasionally look up the solution to a particular puzzle and I will definitely look up where to find the collectibles because I’m an adult with a job work to do, but this feels more like hacking the game to my style.

FYI, this game is currently available on HumbleBundle.com for free until 9/16.

The creative power behind Psychonauts is Tim Schafer.  Schafer made himself famous making point and click adventure games for LucasArts.  My older friends regaled me with tales of Day of the Tentacle and Grim Fandango, but they were old and unavailable, even on gog.com.

I contented myself with new Tim Schafer games.  Stacking‘s movement mechanic made me motion sick but otherwise it was reasonably fun.  And eventually Shafer’s old games were not only remastered and released, but I waited them out until they appeared in Humble Bundles, which is very nearly free (although not entirely, IRS).  And even more eventually, I had time to play both Day of the Tentacle and Grim Fandango.

Sadface.

I tried with these, I really did. I was afraid they were hidden gems I was failing because I couldn’t give them enough attention.  But ultimately?  They’re not fun.  It’s not that the puzzles don’t make sense- they don’t, but I’d forgive that if exploring the solution space was cheap.  Then I’d get to feel clever for figuring something out.  No, both games’ sin is that they are slow.  Walking across a room to pick something up is slow.  Moving between environments is slow.  Going through dialogue trees is extremely slow. Retrying a strategy with a slight variation requires going through the first six steps over again.

I thought maybe I just didn’t have the attention span for games anymore, which was a little terrifying. Then I played Massive Chalice, from the same studio but a different lead designer.  MC is great.  It’s a tactical RPG, where you move your dudes around to shoot things, but also a creepy eugenics simulator, where you breed your heroes to produce better heroes next generation.  This game was frustrating and unfun at first, but in a way I immediately recognized would become fun if I put enough thought into it.  So I did the natural thing and recruited my friends to play it too, so we could talk about it and share the burden of finding out how to play.  This was a mixed success as far as “learning to play” went, as people disagreed violently over the best strategies, but it was fun.

Massive Chalice’s breeding minigame is not what one might hope.  Inbreeding is disallowed, there aren’t many families, and the long period of reproductive senescence creates big gaps in the ages of your heroes in each family.  You end up throwing in whoever is least bad, rather than carefully crafting a strategy.  Also, I don’t like hard choices.  I make enough hard choices in my day, when I’m playing games I just want to build things.

Recognizing how creepy this sounds: I spent a long time looking for a game with the breeding elements of Massive Chalice or Crusader Kings 2, but where that was the entirety of the game.  There’s nothing. There are some pet reproduction games but not with the depth I want.  Basically I’m looking for AKC: The Video Game.

 

Epistemic Spot Check: Exercise for Mood and Anxiety (Michael W. Otto, Jasper A.J. Smits)

Introduction

Everyone knows exercise (along with diet and sleep) makes a big difference in depression and anxiety.  Depressed and anxious people are almost by definition bad at transforming information about how to improve their lives into actions with large up front costs, so this data is not as useful as it might be.  Exercise for Mood and Anxiety (Michael W. Otto, Jasper A.J. Smits) aims to close that gap by making the conventional wisdom actionable.  It does that through the following steps:

  1. Present evidence that exercise is very helpful and why, to create motivation.
  2. Walk you through setting up an environment where exercise requires relatively little will power to start.
  3. Scripts and advice to make exercise as unmiserable as possible while you are doing it.
  4. Scripts and advice to milk as much mood benefit as possible from a given amount of exercise.
  5. An idiotic chapter on weight and food.

 

Parts 3 and 4 use a lot of techniques from cognitive behavioral therapy and mindfulness, and I suspect there’s a second order benefit of learning to apply these techniques to a relatively easy thing, so you can apply them to the rest of your life later.

Epistemic Spot Checking

Claim: “a study of 55,000 adults in the United States and Canada found that people who exercised had fewer symptoms of anxiety and depression.” (Kindle Locations 103-104). 

Correctly cited, paper has no proof of causation.  (abstract) (PDF) The study does in fact say this, but it also says “Despite the fact that none of these surveys [of which this paper is a metaanalysis] was [sic] originally designed to explore this association… “.  I’m not saying you can never repurpose data, but with something like this where the real question is causality, it seems suspicious.  The authors do consider the idea that causation runs from mental health (=energy, hopefulness, executive function) -> exercise and dismiss if, for reasons I find inadequate.

Claim: “Other studies add to this list of mood benefits by indicating that exercise is also linked to less anger and cynical distrust, as well as to stronger feelings of social integration.” (Kindle Locations 104-106). 

Correctly cited, paper has no proof of causation. (Abstract).

Claim: And these benefits don’t just include reducing symptoms of distress in people who have not been formally diagnosed with depression or anxiety. The benefits of exercise also include lower rates of psychiatric disorders; there is less major depression, as well as fewer anxiety disorders in those who exercise regularly. (Kindle Locations 107-109). 

Correctly cited, paper has no proof of causation.

The dismissal of causality goes on for another three citations but I’m just going to skip to the intervention studies.  Otto gives these population studies more credence than I would but does note that the intervention studies are more informative.

Claim:  study summarized 70 studies on this topic and showed that adults who experience sad or depressed moods, but not at levels that meet criteria for a psychiatric disorder, reliably report meaningful improvements in their mood as they start exercising. (Kindle Locations 116-117).

Correctly cited, study accuracy undetermined.  (Full paper). My fear (based on spot checking a similar book you’ll see in the rejects post) is that each of these studies consists of 15 people.  All the metaanalysis in the world won’t save you if you do 100 small studies and only publish the 50 that say what you want.  The studies included go all the way back to 1969: I can’t decide if that makes them more informative or less.

Claim:  The latest estimates are that about 17% of adults experience a major depressive episode in their lifetimes and that about half who have it experience recurrent episodes over time. (Kindle Locations 124-126). 

True. (Full paper).  The same study is cited for both facts, but I can only find the 50% statistic in the paper.  The data is kind of old (started in 1981), but of course you can’t get 30-year data except by starting 30 years ago.  This paper says the lifetime prevalence of mood disorders (depression, bipolar 1 and 2, and their baby siblings) is 20%; this study puts prevalence in the US at 16.9%.

Claim: As is the case with major depressive disorder, anxiety disorders are common, affecting more than 1 in 4 (28.8%) adults in their lifetimes” (Kindle Locations 136-137).

True. (Full paper).  He cites the same paper I did for the 20% mood disorder statistic.

Claim: [Anxiety disorders] tend to be especially long-lasting when people do not receive treatment. (Kindle Locations 137-138).

True, although not particularly specific.  (Full paper)

Claim: Exercise in itself is a stressor—it requires effort, and it forces the body to adapt to the demands placed on it.  (Kindle Locations 141-142). 

True.  (Full paper).

Claim:  A study examined firefighters reaction to stress, and then gave half a 16 week exercise course.  The study group showed improvements in stress responses. (Kindle location 148)

True.  (Abstract) (PDF).  I really like this study.  The group presumably had a high baseline fitness level, so this isn’t the difference between couch potato and a walk.  And they have before and after metrics.  The study is marred only by the small sample size (53).

Claim: “stress plays a key role in both the development and the continuation of depression and anxiety disorders.” (Kindle Locations 152-153). 

Accurate citation, very complicated topic. (Abstract).

Okay, it is becoming clear I don’t have the time to check every one of these citations and you don’t have time to read it.  From here on out please assume a baseline of very dense citations, all of which accurately report the study results, if with a little more confidence than the study design merits, and I’m only going to call out things that deserve special attention on account of controversy or importance.

Claim: exercise increases serotonin just like the primary class of anti-depressants, selective serotonin update inhibitors.

True but less relevant than implied.  They’re relying on a model of how SSRIs treat depression that is fairly outdated.  SSRIs definitely increase serotonin, it’s just that there’s no evidence that’s their mechanism of action against depression except that they do it and they treat depression.  “Depression is caused by a serotonin deficiency” is a lie simplification told to patients and their families to allay fear and shame around psychiatric treatment.  This doesn’t undercut their point that exercise is good for you, but does indicate this is not a great book to learn brain chemistry from.

Claim:  Both aerobic (prolonged moderate exercise such as running, cycling, or rowing over time) and anaerobic (like weight lifting or short sprinting) exercise have been found to be effective for decreasing depression, (Kindle Locations 239-241).

True. (Study 1 PDF) (Study 2 abstract).

 

Empirical Results

The theory behind this book is very well supported; the prescriptions it makes flow naturally from the theory, but the authors present no direct evidence that they work.  I’m torn about this.  I don’t want to engage in RCT worship; having a systemic understanding of a problem is even better than evidence a particular solution worked better or worse than another solution in a different population.  On the other hand, humans are very complicated and it’s easy to identify the problem but guess the wrong solution.

I couldn’t test any of this on myself because I already enjoy exercise for a lot of reasons, so I scrounged up an unscientific sample from my wider social network to try it.

14 people filled out the pre-book survey.  3 people filled out the post-attempt survey.  None of them exercised more.

Summary

The theory sections of this book are my high water mark for scientific rigor in a self-help-psych book.  I’m currently reading a lot of those with the goal of finding out how much rigor is reasonable to expect, so that’s high praise.

The book walks the very fine line between reassuring and condescending, which is pretty unavoidable with CBT and mindfulness.

I did not like the last chapter and recommend skipping it.  It feels like they tried to stuff all the usual diet-and-exercise stuff in at the end.  Some of my problem is I think their recommendations are wrong, and some is that I believe that even if they were correct, throwing them in at the last minute undercuts the message of the book.

The first part of this is that, in America, at least in certain subcultures, any mention of weight makes the whole thing About Weight.  Too many people use health or mood as a socially acceptable way to say “you’re not hot enough”, so any mention of weight in the context of diet or exercise automatically makes weight the real topic of the conversation.  If the improvements in mood are enough of a reason to exercise, let them be enough, and the weight loss can be a pleasant surprise or not happen, and both are okay because you got what you came for.

The authors compound this problem by using Body Mass Index as a guide for goal weight.  BMI is completely unsuited for use in individuals, even more so for people who just started gaining muscle mass.  If you must talk about fat in the context of health use body fat percentage or certain circumference ratios (e.g. wrist:stomach).

The second problem is the speed with which EFMaA tries to address nutrition.  The book (correctly) treats exercise as a thing that is challenging to start despite all its benefits, and spends 10 chapters explaining why it’s worth trying and providing scripts to make it workable for you, for the sole benefit of mood, ignoring everything else you might get out of exercise.  I don’t know why the authors thought that that required an entire book but the even more complicated of nutrition for every possible benefit of nutrition could be squeezed into half a chapter.  I would be have been very excited for another book by the same authors about how to implement healthy eating, but the half assed treatment here makes me pause.

They also present a particular diet as the settled science, when there is no such thing in nutrition.  “Eat produce and fish” is fairly uncontroversial, but they recommend a lot more refined grains than many other people.  I don’t know who is correct, but it was disappointing to see a book that had been so rigorous up to that point blithely paint over controversy.

[I have emailed Michael Otto about the handling of nutrition and have yet to hear back].

Speaking of which Exercise for Mood and Anxiety mentions that both aerobic (cardio) and anaeorbic (weights) are good for mood, but every single example is cardio, with an occasional cardio + core strength.

Mixed in through the book are tales of how Olympic athletes motivate themselves.  This feels spectacularly irrelevant to me.  I don’t want to win a gold medal, I want to climb V2s and be happy.

You might find this book valuable if:

  • You want some ideas (although not conclusive proof) around how exercise helps mood.
  • You want to want to exercise, and want scripts and tools to transform that into “want to exercise right now.”
  • You find exercise unpleasant and want to get the best trade of unpleasantness-for-benefits possible.
  • You would like to treat a mood issue with exercise (whether it reaches the level of official disorder or not).
  • You want to change how you think about exercise (for improving your mood or something else).
  • You are interested in CBT or mindfulness and want to practice with the large print version before tackling them directly.
  • You think you are different than my test audience.

You probably won’t find this book valuable if:

  • You already have an exercise program you are happy with.
  • You have body image or eating disorder issues (last chapter only, and a single section of the 10th,  the rest of it is fine).
  • You want prescriptions for a particular exercise program, as opposed to general principles.
  • You want to learn the nitty gritty of how exercise affects mood.
  • You are similar to my test audience.

 

 

Post supported by Patreon.

Public Service Announcement

If you have dental anxiety (perhaps because a series of dentists gave you ever worsening nerve damage, but also if because reasons), you can ask for both acute anxiolytics to take during the cleaning and local anesthetic so it doesn’t hurt so much.  This is not wussing out.  It is making it easy for you to receive highly necessary medical care. Dental cleanings are one of the most important preventative measures you can take for your health, do what you need to to get them.

Tracking Flow State

I would like to spend more time in flow state.  There’s a number of possible interventions, but I don’t have a good way to measure the effects of any of them besides “that felt more flow-ey”.  That’s not going to hold up.  So I’m turning to you, the internet, for advice.  What app or plugin will let me designate block of time to be “serious work time” and record the number of times I initiate interrupty things during that block (including checking my work email for projects unrelated to my current one, but excluding checking FB because there was a critical piece of information in a chat)?

The low tech solution here is a post it with tally marks, but for obvious reasons I’d prefer something that didn’t require intervention on my part.

The ideal solution would be for Toggl to track how often I interrupt myself, because I already track my time using Toggl and it’s already both a phone and browser app, it would just need to notice interruptions.

Things that will not work:

  • Measuring how much time I spend on facebook/tumblr/email/candycrush/dopamine.com in a day.  I don’t care how much time I spend on any of those.   I care how many distinct instances of going to them occur while I want to be concentrating on something.  AFAIK, This rules out RescueTime and TagTime.
  • Measuring how often I check dopamine.com in a day.
  • Things that require more intervention than turning the “concentrating now” button on and off. There are tally counter phone and presumably web apps, but the last thing I want to do is require more executive function and willpower of myself to count the number of failures of EF and willpower. 

Bonus features:

  • Let me designate specific facebook or e-mail visits as work-related.
  • Work on all of: my OS X laptop, my windows laptop, my android phone.

Any suggestions?

Things I Have Gotten Wrong

Originally I trusted Animal Charity Evaluators and recommended them to others (although apparently I never wrote this down in public).  Later I realized they were making up numbers.

I used to think Raising for Effective Giving was a cost effective way to raise money for good charities.  I still think that, but now I know they’re negative utilitarians and what they’re doing now is maybe a wedge to nuking the entire world so no one can suffer more.

I thought Charity Science was a mess that would never do anything, until they produced a new charity that at least has the potential to be hugely effective.  At a minimum it is actually doing something, in a subculture that seems to respond to every problem by going meta.

[In an ideal world I would have said this publicly before I started doing contract work for them, but I do have witnesses as to my mind change before then.]

I thought Tostan had nearly ended female genital cutting in Senegal.  I was wrong, and I could have learned I was wrong at any time by checking wikipedia.  They may still be making good strides and have been very cooperative in answering my questions, but I should not be being caught by surprise by wikipedia.  And I don’t even know if I still think poverty is important relative to existential risk.  Although I’m not sure how much I care about future humans either.

I thought epistemic spot checks would be really easy, but it turns out it doesn’t correlate much with how useful people find things.

I’m making this public so that “saving public faith in my judgement” or “present coherent position” stop being goals I can reasonably have, so I can focus on actually fixing the problem.   Everything on here is epistemic status: exploratory until further notice.

 

ETA: I’ve gotten some positive response to this, which is great, but not unexpected.  I would like to give props to my subculture/readership for being so consistently good about rewarding people for admitting big mistakes that even highly anxious me feels able to count on it.