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Screened for depression

Should everyone be screened for depression?

Smoking, weight loss and anxiety are the most common problems seen by hypnotherapists. But many of the problems that clients seek help with are actually symptoms of depression. Depression is the leading cause of disability worldwide (WHO, 2017), If it is so common, should everyone be screened for depression?

Why not screen everyone?

On the face of it, this would seem like a very sensible option. At the very least we could screen pregnant women and teenagers. Early intervention would seem to be very desirable. And it has been proposed many times by many organisations. So why is it not being done?

The main reason is the fear that it would lead to overtreatment. This concern is so prevalent that medical associations in Canada and the UK have a policy of opposing routine mental health screening for everyone.

It is argued that routine screening has not proved to be effective. In fact, it can prove to be counter-productive. Someone going through a temporary session of "the blues" might acquire a lifelong label. They may actually get depressed through worry, and may spend time and money seeking treatment they don't actually need. Giving people SSRIs that they don't need opens up to unnecessary side-effects of the drug. Too many false positives might make the problem worse.

This is not to suggest that doctors should not screen patients they suspect have depression. However they should not routinely apply it to everyone who presents to them.

Publication bias

The research that has been done on the benefits of screening have not shown good results. Screening has proved effective at identifying problem cases, but the outcomes have been very modest. Medical associations worry that the results show "publication bias". This is the tendency to only report positive or significant research. Editors of medical journals prefer to fill their journals with reports of success. For every successful trial, there may be three or four unsuccessful trials. The trials where the results were just not very clear don't get published. So when looking through published results it appears that the situation is much better and much clearer than it actually is.

Another reason for not doing routine screening is that it would be captured by the pharmaceutical companies. They would see this as a bonanza for their products. In fact, at least one of the most used questionnaires for depression was developed with funding from a pharmaceutical company.

I am not a supporter of the conspiracy theories against "Big Pharma". Pharmaceutical companies produce wonderful products that keep the population healthy and well. They are entitled to make a profit and to market their products. However, routine screening of 100% of the population would lead to a blowout of virtually every health authority's budget.

Without a guarantee of a clear and measurable benefit it is just not worth it.

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NLP anchoring

Does NLP Anchoring work?

NLP Anchoring

I have recently had an exchange of emails about NLP Anchoring.

I’m interested in receiving an NLP anchor, but first need some evidence that others are using one. Can you give me the names of 3 to 6 well known folks who are using an NLP anchor?

I am told I can create a unique touch, e.g. touch my left thumb against the upper most crease of my left index finger and associate that touch to a time when I was very productive, and/or feeling very successful, and/or feeling very confident. That touch is called an "anchor".  I can access that anchor whenever I want to feel those feelings, again. But if it's so successful, who is using it whose name I would recognize?

Does NLP anchoring work?

My reply was:

You are quite right to be skeptical. Your question should be, "If it is so successful, why isn't everyone using it?"
NLP is a collection of techniques and ideas from many other disciplines wrapped up in a load of marketing. In my opinion, the parts of NLP that work are all taken from somewhere else, the parts that are original are interesting, but not particularly useful in therapy.

If all we had to do was to pinch our skin and think of a time we were successful then the whole world would be doing it. Everyone would be blissfully happy all the time. Doctors' offices would be empty. It doesn't happen.

Scientific tests have shown that anchoring does make the person feel better for a short time, but it is a placebo. The feeling wears off in minutes. There are no studies that show that it works except as self delusion. It is promoted heavily to gullible people in order to sell NLP courses and NLP 'treatments'. As far as I know, no one in the world has ever made it work for them on an enduring basis.

What about not calling it an "anchor" to recall and re-live and re-experience a certain state (feeling) but use it as a memory recall button? Take the onus off of re-creating a past state, but simply use it as a memory jogger when those states were experienced? Not unlike looking at an award certificate or a trophy. Simply associate certain memories with a specific stimulus, (a word, sound, image, or in this case a unique touch) ?

What about using the behavior science behind classical conditioning (https://en.wikipedia.org/wiki/Classical_conditioning) (also Pavlovian or respondent conditioning, Pavlovian reinforcement) which is a form of associative learning? Can you create a powerful memory jogging tool?

From me:

I know what you are getting at, but sadly, it doesn't work. Or at least it can not be summoned consciously.

Accessing past states

We can all access past states when exposed to the right stimuli. Everyone remembers being transported back in time when you hear a song you haven't heard for a long time. However these are the result of unconscious associations. These are in fact the basis of most psychological problems.

When you consciously and deliberately recall a state you weaken it. Take your example of looking at a trophy. The first time you look at the trophy you get the memory/feeling/state strong and clear. However, the act of looking at it occurs in a certain environment, and that gets mixed in with the original feelings of the trophy. Sometimes you will be looking at the trophy while you are angry, sometimes when you are feeling bad because your team lost. The down feelings will now be mixed with the original feelings. The more often you look at it, the more diluted it gets. Over time the association fades. It is inevitable.

There is no way round this.

Much of hypnotherapy work is centered on trying to find hidden associations and remove them.  What you are after, it seems to me, would be achieved by altering your unconscious programming, your core beliefs about yourself, your capabilities and world around you. Simple anchoring won't do it.

There is no magic bullet in this business.

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treating fussy eaters

Fussy eaters are created, not born

Fussy eaters are created, not born

Fussy eaters can be a problem. Kids are always making comments on their food and declaring that they don't like this or they don't like that, but by the next time they see that food they have forgotten all about it. Except where an overanxious mother feels she needs to try to please the child all the time. The basic anxiety in this situation is the mother's fear that the child will not love her if she forces the child to eat something. The child then uses food to start controlling the mother. Then a tussle of wills begins with the child always the winner.

Most mothers recognize this behavior for what it is and distract the child and the matter is forgotten. Some mothers go in for the 'you will eat this or won't leave the table till you do!' style of management and set the child up for eating disorders in adulthood.

And some mothers give in to every demand, and then reinforce it by constantly reminding the child 'Oh you don't like beans do you?' The mother tells anyone who will listen 'No, he can't eat ...' whatever it is. This sets up a reinforcing cycle in which the child is brainwashed into believing that they can't eat certain foods and so they don't get offered them, so they don't eat them and so on. In one reported case the child would only eat orange juice and crackers.

Satisfying fussy eaters

The solution is to work on the child's psychology. A good approach is to use every child's belief in magic to convince the fussy eater that they can eat something new. Hypnotize the child and tell them a story about a boy who ate a special soup. Describe the magic soup as being some particular color, or having some noticeable ingredient like corn kernels. Then get the mother to make a soup that matches the description of the magic soup.This gets the child eating whatever it is that is missing for their health. The hypnotist can suggest that once the boy drank the soup he was able to eat anything at all.

Then the mother can reinforce the idea of the magic soup to empower the child to try new things. As soon as the child has tried a new food the mother can use this to give the child  a unique sense of importance.

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ask the expert

Ask the expert what to do

When I am working with a client, I am often not sure what to do next. Clients come to me with all sorts of problems, and expect me to know how to fix them. Quite often I don't know. Over the years I have come to realise that there are two sources you can go to for help. They both involve asking the expert. So who is this expert? Actually there are two. One is your own unconscious mind, and the other is the client.

Asking the expert - the client

Always bear in mind that the client comes to for a reason, and knows exactly what they want, even if you don't.  And the client is the expert. Nobody knows more about their problem than they do. So I ask the expert what to do.

The way I do this is to use the equivalent of the My Friend John induction as hypnotherapy.

I ask the client to tell me what they would do if they were in my seat.

I ask them 'How would you go about dealing with this problem?'. 'What would you able to try to make you feel better?'. 'How could the situation be seen differently if you took different perspectives?'

You can also ask the client the Miracle Question 'If everything you wanted happened to you overnight, what would be different when you woke up? What would see, what would you feel, how would you know that it had happened?'.

You will be surprised at how inventive your client can be. Even if they don't come up with a complete solution, they will often suggest a way forward that you haven't thought of.

Ask the expert - Your own subconscious

The other expert is you. At least the part of you that holds all your expertise and intuition. Part of hypnotherapy professional practice is being comfortable with ambiguity, and uncertainty. Therapists don't have all the answers. You sometimes have to wing it. And that is exactly what I do.

I listen to the client describe what they want, what they feel, what they have tried. Even if I'm not aware of it, my unconscious mind is thinking about this and assessing various possibilities. As the client talks, various words and phrases will strike you as being of particular interest and importance. When I consider how to go about the therapy part, I read over my notes. And I take a moment to think about those words and phrases. This primes my unconscious mind, and sets up images and associations at the unconscious level.

Then I start on the induction. I guide the client into trance, deepen, and test to make sure the client is somnambulistic. I find that by the time I put the client into trance, there is always something that occurs to me as a way forward. Something will suggest itself to me from the workings of my unconscious mind. It may be an image, and I was start describing the image. Usually this turns into a metaphor that I develop for the client. Sometimes I would just repeat the word or phrase, and again something will resonate with me and my unconscious mind will guide me in what to do.

It's always good to ask the expert in the room.

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Hypnotherapy pain relief

Hypnotherapy pain relief – peer-reviewed research

Modern hypnosis has its origin in medical research. One of its first uses was hypnotherapy pain relief. However there is still considerable resistance in medical circles to accepting hypnotherapy as a valid technique.

Hypnotherapy pain relief is beginning to be accepted a valid therapy more and more in mainstream medicine. A recent research study at the University of Queensland goes some way towards showing that the benefits of hypnotherapy for pain relief are very real.

The University of Queensland's Child Health Research Centre carried out an investigation into the effect of hypnotherapy on anxiety, pain and stress. The research objective was to test whether hypnotherapy had a measurable effect on the distress of burns patients. 

The trial

The patients were children with extensive burns, who had to have their dressings changed frequently. Changing burns dressings is often very painful. Children who know that their dressings are going to be changed soon often show raised levels of anxiety and stress.

There is some evidence to suggest that the pain and anxiety can manifest itself in later life as PTSD and other psychological problems. Anything that can reduce the stress and anxiety of the hospital treatment can have long-term benefits.

The study involved 62 burns patients aged between four and 16 years old. Half the group had hypnotherapy, half the group had standard burns care. Anxiety, pain, stress and wound healing were measured at each change of dressing.

The results

The results were very clear. At the second change of dressing, children in the hypnotherapy group reported a reduction of 70%  in their pain levels compared with children in the standard group. The hypnotherapy group also had only one third of the stress levels of the other group. At the third change of dressing the results were even more dramatic. The hypnotherapy children had a 90% reduction in pain, and 84% less anxiety. 

The pain and stress levels were estimated by asking the child how they felt. But this was backed up by heart rate monitors. The hypnotherapy children has significantly lower pulse rates before and after the third dressing. Pulse rate gives an objective method of measuring pain and stress.

Hypnotherapy has been used on adult burns patients before. Children and teenagers usually show much stronger responses to hypnosis. This research has confirmed that.

The medical benefits of hypnotherapy could be used in other areas of children's medicine. Children get very anxious when treated for asthma and fractures, and when approached with a needle. Hypnotherapy might prove very effective in all these areas.

Source: Chester et al. 2016 Trials 17:233 

DOI: 10.1186/s13063-016-1346-9

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After stopping smoking

What to do after stopping smoking?

After stopping smoking

Smokers who want to quit often do not really think through what they are going to do after stopping smoking. Smoking 20 a day at 5 to 8 minutes each takes up nearly two hours. That is a lot of time to fill. If you don't give them something to do after stopping smoking, they will start to think about cigarettes again.

Usually, the smoker needs to find something to substitute for the action of smoking, because the desire for a smoke is often triggered by outside circumstances. The external event can be anything. Smokers reward themselves with a cigarette when they finish something: when they get a coffee: and when they just need to get away from a situation. The substitute needs to be something that is socially acceptable, can be done almost anywhere, and takes about the same time as a smoke.

Design a substitute for after stopping smoking

They need some physical thing that can act as a substitute for a cigarette. Specifically, the smoker needs something that will give them a stimulus in their mouth, something to do with their hands, and something that lets them move physically to some other place. Their behaviour after stopping smoking needs to mimic what they did before stopping smoking.

The easiest thing to do is to get them to brush their teeth. The act of brushing their teeth means they have to put something in their mouth, and they get a tingle from the toothpaste. They also have to hold the toothbrush. This gives them something to do with their hands for a few minutes. They have to go to some place with water. This means that they are taken away from whatever trigger was reminding them to smoke.

For the more determined smoker, you can set them a challenge. Tell them that every occasion they used to smoke, what they now do is go outside and run around the block. This takes about the same length of time. This will really take their mind off it, and will remind them of why they want to stop.

You can think up other substitute activities to fit each individual smoker.

These simple techniques will help smokers get over the unfamiliarity of the first few days. And leave them fit or with lovely fresh breath as well!

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Boxes inside boxes

Boxes inside boxes: a metaphor therapy case

I had another very interesting client today. This client allowed me to get an insight into how the human mind works, and gave very clear metaphors of how she saw her problem.

 This client was a woman in late middle age who had suffered from anxiety most of her life. She came to see me because she is having trouble playing the card game Bridge. She is actually a good and skilled player. But whenever she has to partner with someone she does not know, her game falls apart. She is sure that her new bridge partner will be better than her. My client gets anxious at the thought of what the other person might think about her play. She then worries about this until by the time she gets to the card table she is a nervous wreck, and she plays terribly badly. This therefore fulfils her own prophecy and the whole cycle repeats with the next new player.

Metaphor therapy

 I decided to use metaphor therapy. I got her to take some deep breaths to calm herself. Then I asked her to think about the last bridge game she had when she felt she just could not deal with it. I got her to associate into the feeling. "Think about the shape of the feeling," I told her. "What shape is that feeling?"

She is one of those clients who fidgets a lot, and moves around in the chair. I began to wonder if this method was going to work. Then she surprised me by saying "it's ovalish.". So I asked, "How  big is it?" She guested with her hands to indicate that it was about the size of a dustbin lid. I asked some more clarifying questions and she told me "it's a big piece of coal."

I then started developing the metaphor of the "big piece of coal". She describes in detail has been black and shiny and heavy with lots of sharp angles. I then asked "can you make it a little bit bigger?" "Yes," she said. "And a little bit bigger still?" "Yes," she said. This told me that she actually had some control over it.

I then asked "can you make it a little smaller?" "And a little smaller still?" There was a period of silence until she said "no, it won't get any smaller. It is just getting more dense."

Changing the first mental block

She had now found her subconscious blockage. When a client says they cannot change a metaphor it means that there is something in their unconscious mind which is defending that. This is usually a fear of being unable to handle the change that might come afterwards.

So I changed my approach. I started to suggest to her ways that this thing could change. The idea was to keep suggesting things until I suggested something that her mind would accept. I tried suggesting hammers, drills, crushers, anything that would break up that "piece of coal".

Nothing seemed to work. She steadfastly refused to think of anything that could affect this "piece of coal". I was running out of ideas until remembered that it was actually a piece of coal. Coal burns! So I suggested it might go on fire. She immediately said "No. No, that can't happen."

I wasn't sure what to do next and just waited for her to say something else. And then she said "it could be heated, and give off gas." Somehow, this was acceptable to her mind. I told her to go ahead and heat it.

I then asked her "what is it like now?"

She said "it is grey and porous and quite weak."

I then went back to suggesting hammers, drills et cetera. And while I was going through the list of possible tools she said "It is all dust now."

And I thought to myself "Job done."

So I asked her to think back to the bridge game and the feeling she had about not being good enough for her partner. "How does that seem to you now?"

"Just the same," she said.

Changing the second mental block

Okay… I had seen this behaviour before. Her unconscious mind would not let me anywhere near the real problem. Instead it had offered me some minor metaphor and allowed her to work through that. Her unconscious mind knew that it was safe to change that.  But, it also means that her mind is now receptive to change, because it had experienced some change without any psychological kickback.

So I started the whole process again. I got her to associate back into the original problem, to imagine being in that situation where she was sure that she was going to disappoint the other person and feel embarrassed.

This time I had to work a lot harder to get past her defences. Eventually she told me "there is a big wooden box." Once again I got her to describe the object in detail. She told me that it was "very old, and very strong."

I then set about trying to find ways I could get her to destroy the box. Nothing seemed to work. I sensed that this time was up against a major piece of resistance. I suggested it might go transparent, that it might get wet and rot, it could get eaten by worms and fall apart. None of these produced any response.  

Boxes inside boxes

So I asked "what do you think might be in the box?"

After a long period she said "more boxes. There are more boxes inside."

"How many boxes?"

"There are five boxes", she said. I then got her to describe each of the boxes. She told me "the big one is made of cardboard. Then there's another one made of metal. And one made of glass. And another cardboard one. And a wooden one." It was now obvious from her demeanour, that she had gone deep into trance, and was actually experiencing these things directly.

And then she said "and there are papers, and files scattered around." I did not know quite what to make of that, so I decided to explore the five boxes.

"And what do you think is in those boxes?"

And one by one she began to tell me about the contents of each box. The wooden box contains soil. The glass box contained a red light. The small cardboard box contained a wooden puzzle. The metal box took a long time to uncover. It turned out to be in two sections. The top section has five compartments, and each compartment was filled with a liquid colour. Each colour was different. I asked, "what do you think the are for?" She said, "I don't know."

So I suggested, "perhaps you can make something out of those things?"

She said, "yes, I think I might."

She then said "those papers have all the things I have done wrong in my life written on them. They are all neatly organised into files."

Burning her old anxieties

I took a while to appreciate the startling development.

So I asked her "what would you like to have happen to those papers and files?"

She said "I suppose I could get rid of them?"

I asked her "what would you use to get rid of them?"

She said, " I could use the red light to burn them."

So I encouraged her, "and you can use the red light to burn them all up."

And a lovely smile came over her face. I asked "what's happening in that place now?"

She said, "they are all getting burned up, and I'm putting the ashes in the soil."

The time between her responses got longer and longer. And the smile on her face got broader and broader. She was clearly enjoying burning up all her old mistakes.

The time between responses got so long, that I went off and made a cup of tea.

When I came back she was sitting there with her eyes open, smiling.

She said, "I didn't want to come back. I was having such a good time playing with the red light and I can still feel it swirling around me."

I asked her, "And what about that old feeling of not being good enough?"

And she said, "well, actually I think it's gone."

 

I finished the session then. I felt that she had undergone a profound change

And on the way out she said, "I'm looking forward to finding what's in the other compartment of that metal box."

 

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Technology assisted hypnosis

Technology assisted Hypnosis

Hypnosis in the digital age

As of next month, I will be hosting a monthly online meeting of all hypnotherapist members in the New Zealand Association of professional hypnotherapists. We will be discussing cases, problems, and upcoming events. The online meeting can also be used for one-to-one or group sessions as professional supervision.

I will be using a software called Zoom. This is completely free and allows me to run a meeting with any number of people. The software works on all types of computers and even on cell phones and telephones. It is a great example of what technology can do. It also got me thinking about how else I can use technology in my hypnosis practice.

Standard technology assisted hypnosis

Most therapists will be familiar with Skype. I have used Skype for many years and I have hypnotised a client in the Middle East over the Internet. I treated him for sexual problems. Online was the only way to do it, because there is absolutely no such service in the Middle East.

However, there are many other technologies that I could be using. Compared with other types of businesses, hypnotherapy uses very little in the way of digital technology. Of course, everyone uses computers, and the Internet, and email. I have an online booking system which interfaces to my email system. This makes booking and reminders very easy. I also use a service to handle orders and downloads of the scripts I sell.

But in my office, dealing directly with clients face-to-face, there really is very little difference between me and what was happening in a hypnotherapist's office 100 years ago. In fact, a hypnotist from that time would most likely have more technology than I use. A client at that time would expect to see a rotating spiral machine, a lantern with multicoloured lights, and an assortment of pendulums.

Useful and not so useful technology

There are some biofeedback machines that are used in hypnosis. There are facemasks that emit pinpoints of different coloured light that our said to induce hypnosis. Some hypnotherapists use brain wave scanners to monitor what is going on in the client's brain. Personally, I'm not convinced that these are particularly useful. However, the people who use them seem to like them.

One thing my Victorian counterpart would not have had is digital music. Many therapists play background music in their office. I suppose that counts as technology.

The most useful new technology may well be a computer tablet, like the iPad. Tablets can display, record, and communicate.
The tablets can be used to show video clips to the client if you need to make a point or allay any fears pre-talk.

Display The tablet screens are big enough to be able to read without effort. The tablet is light enough to hold while you are doing a hypnosis session. This means that you can call up any script on the screen. You can have hundreds of scripts and metaphors at your finger tips in full color. And you don't have the problem of the noise of rustling paper, or the danger of actually dropping all the sheets.

Recording You can also use the tablet to record the whole session in audio so that you can go over the details again later. Many hypnotherapists give the client a copy to take away and listen to again.

Communicate You can also make appointments right there and then, using the calendar function; make reminders to yourself during the session; and connect to payments systems.

The latest technology assisted hypnosis

I have been experimenting with the newest technology: Voice Recognition. I recalled the whole session on the Recorder function on my cell phone. (I used to use a specialist dictation machine, but that is no longer necessary). Then, when I start the actual hypnosis part of the session, I put on my headset. This has a built-in microphone and earphones. It is a noise reducing, wireless gaming headset.

It interfaces directly to Word on my computer. And as I speak the NaturallySpeaking software converts my speech into typed words. The recognition and accuracy is better than 98%. I have had to learn to speak more clearly, and to speak a bit more loudly, but having done that it is just like typing my sessions straight into the computer. I still have to edit it and tidy it up, but that is a very minor thing compared with the problems I used to have in transcribing my sessions.

I believe that we are just at the beginning of voice recognition software development. I think that as time goes on the software will get better and more powerful. I also firmly believe that this technology is a game changer. It will not be too long before everyone can speak into their cell phone and have there words transcribed into text. And then, have that text transcribed into any language they want to.
The next step then is to have the computer turn the text back into speech. In any language you want.

The possibilities are fascinating.

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Archimedes spiral induction

Archimedes spiral induction

Hypnosis is associated in the public's mind with two things: a swinging watch, and a rotating spiral. The hypnotic spiral is actually called an Archimedes spiral. Whether it actually has any connection to Archimedes is unknown. 

It is also known as Plateau's spiral, after the Belgian physicist Joseph Plateau (1801–1883.) Plateau published a description of its use in 1878. The spiral is generally mounted on a card about 15 cm in diameter, with a little motor behind it that causes it to rotate slowly. The original spiral, in the mid-19th century, was driven by a sort of windmill affair, by the hot air given off by a spirit lamp.

Archimedes spiral induction

The Archimedes spiral induction is quite  effective. It is caused by a physical effect called a "spiral motion after-effect". After staring at the spiral for a while, if you look at something stationary, it appears that the stationary object is actually turning. If you look at the hypnotist's face, it appears to expand or contract, depending on the direction the spiral was turning.

The Archimedes spiral induction uses this optical illusion to put people into trance. The hypnotist tells the person that what they are seeing is their mind taking them into trance. The hypnotist suggests that every time the face expands and contracts the person will go deeper into trance. The effect is quite strong, so the suggestions are easily believed. The listener cannot deny what they are seeing. Therefore the suggestion that "this means that you are going into trance" is accepted by the unconscious mind. Most people will sink into trance immediately.

The Archimedes spiral was an immensely popular scientific toy in the mid-19th century. This is probably why it was picked up by hypnotists. The spiral, and other mechanical aids, has fallen out of use. Those objects were associated with the "direct command" style of authoritarian hypnosis. That style has largely been replaced by more permissive styles of hypnosis.

 

 

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not who you think you are

You are not who you think you are

We can all remember ourselves as children. Most of us think that we are still essentially the same as we were then. This is part of a basic belief that we all stay pretty much the same person all through life.

Not who you think you are: different beliefs

There are other beliefs which disagree with this view. Buddhists in particular, believe that the "personality is an illusion." The Buddhist philosophy believes that we all change constantly, and that our belief that things stay the same is wrong.
It is well known that our body replaces all of its cells many many times in our life time. Some cells are replaced in a matter of days, some cells survive for years before finally being replaced. Even if you stay the same weight and height, there is a constant turnover of the physical matter that makes you up.

Science is now beginning to discover that is not just your body that changes. Your mind, your thoughts, your ideas, your beliefs, – they all change too. How you think can be changed by meditation. The basic functioning of your own unconscious mind can also be changed.

The evidence

A recent study compared the personality of a set of schoolchildren measured in 1950 with those same schoolchildren 63 years later. The study found no correlation between how teachers assessed the children's personality at the time, and how close friends assess their personality now. It appears that every one of these children had changed their personality over their lifetime. Other studies have suggested that for shorter periods, tens of years, your personality stays pretty constant. But this study shows exactly the opposite.

I'm sure that we are all familiar with meeting an old school friend after many years, and being amazed at how much they had changed. Well, it seems that the same applies to you.

Source:
Harris, et al. Personality Stability From Age 14 to Age 77 Years. Psychology and Aging. 2016 Dec; 31(8): 862–874. doi: 10.1037/pag0000133

 

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