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Perfectionists worry away their holiday

Go on, have a few days off. Take a week – you’ve certainly earned it! Clear your mind, take a break – things will tick over until you return...
Easier said than done, of course. But respites from work are valuable, replenishing resources and preventing negative loads (mental fatigue, adrenaline build-up) spiralling out of control. Sadly, the positive gloss of the holiday itself tends to slip quickly when we return to work. What makes you more likely to fall prey to the ‘fade-out’? The quest for perfection, new research suggests.

Researcher Paul Flaxman and colleagues canvassed academics before, during and on two occasions after an Easter break, measuring changes in well-being. The 77 participants also completed a tool that measures self-critical perfectionism; this form of perfectionism centres around high standards and doubting your actions are sufficient to reach them. As this attribute is triggered by achievement-related stressors, such as deadlines or presentations, the researchers suspected the holiday itself would likely be a genuine respite for all, but that those high in this attribute could quickly crash once they returned to work.

Pre-holiday, perfectionists were worse off in terms of well-being: more exhausted, anxious and fatigued than their colleagues. During the holiday, their well-being rose and fell in line with colleagues. Yet, at return to work, they quickly reported higher exhaustion, giving way
to higher anxiety a few weeks later, with consistently higher fatigue across both time points. The finding accounted for differences in respite well-being, length of respite, and how much participants worked during the respite.

What’s driving this? Participants reported on holiday cognitions, and it turns out that time spent ruminating about the correctness of past judgements and repeatedly worrying about future events led to more emotional exhaustion and anxiety on return to work. The effect that perfectionism has on the various well-being measures was partly due to the mediating influence of these ‘perseverative cognitions’, which explained at least a quarter and in one case (fatigue) two thirds of the effect.

Why didn’t these thoughts drag holiday well-being down, too? Flaxman’s group conjecture that these cognitions are functional in the short-term, staving off uncomfortable feelings (‘I should be doing something!’) by rehearsing intentions in your head. However, by preventing psychological detachment from work, this strategy forgoes any chance to shake things off and lighten the load.

If you feel that the world might collapse if you took the invitation at the top of this piece, you might want to explore holiday activities that are extremely absorbing and take you well away from the work mentality; previous research suggests you might also want to switch off your work mobile. The researchers also note that interventions such as CBT and mindfulness-based training may be effective in cushioning perfectionist beliefs from harming quality of life.

This post is taken from the Society’s Occupational Digest, written by Dr Alex Fradera. See www.occdigest.org.uk and follow on Twitter @occdigest

Introducing ‘therapy genetics’
In the May issue of Translational Psychiatry

There’s a thriving research field – pharmacogenetics – looking at whether a person’s genetic profile can predict their chances of responding to drug treatment. Can the same approach be applied to therapy?

In one of the first papers published on ‘therapy genetics’, Kathryn Lester and her Institute of Psychiatry colleagues, including Thalia Eley, took swabs from hundreds of white children with anxiety, aged 6 to 13. The researchers were specifically interested in the genes the children had that code for Nerve Growth Factor (NGF) and Brain Derived-Neurotrophic Factor (BDNF) – proteins involved in the survival and development of neurons. The children, some based in the UK and some in Australia, then underwent a CBT programme designed for helping anxious children.

There were no genetic associations with the children’s immediate response to the treatment. However, at follow up (assessed at 3, 6 or 12 months), the children’s particular NGF genotype was related to their therapeutic responsiveness.

We each have two copies of the NGF gene, rs6330, which can come in two versions, known as the T allele or the C allele. Lester and her team found that among children with two copies of the T allele version, 76.7 per cent were free of their primary anxiety diagnosis at follow-up, compared with 63.5 per cent of children with one C version and one T version, and just 53.2 per cent of children with two copies of the C allele. These associations held, even after controlling for other clinically relevant factors such as age, gender and geographical location.

Lester and her colleagues argued that the finding makes sense based on what we already know about NGF being involved in the growth of new neurons and in changing connections between existing neurons – known as ‘neuroplastic changes’ in the scientific jargon. The authors wrote: ‘Significant learning experiences of the kind undertaken during CBT may very well be underpinned by neuroplastic modifications in brain activity and function.’

This new result follows  a recent paper from the same research group, finding that anxious children responded more successfully to CBT if
they had a particular version of a gene involved in the activity of the neurotransmitter serotonin. However, Lester and her team caution that ‘clinically significant prediction by genetic markers is likely to be best achieved by combining multiple genetic markers (perhaps in combination with clinical predictors) into predictive indices or algorithms.’

Without a no-treatment control group of anxious children, it’s also not possible to say for sure that NGF genotype is specifically associated with therapeutic responsiveness rather than an advantageous tendency to recover regardless of treatment. ‘These findings should be considered preliminary,’ the researchers said.


Total recall: The man who can remember every day

In Neurocase

For most of us, it’s tricky enough to remember what we were doing this time last week, let alone on some random day years ago. But for a blind 20-year-old man referred to by researchers as HK, every day of his life since the age of about 11 is recorded in his memory in detail. HK has ‘hyperthymesia’ and his is only the second case ever documented in the scientific literature (the first,a woman known as AJ, was reported in 2006).

Brandon Ally and his team have completed comprehensive tests with HK and they’ve scanned his brain and compared its structure with 30 age-matched controls. They found that HK has normal intelligence, that he performs normally on standard desktop tests of short-and long-term recall, and that he has normal verbal learning skills. It’s specifically his autobiographical memory that’s phenomenal.

The researchers assessed HK’s autobiographical memory by choosing four dates from each year of his life since his first memory (that was from 1993 when he was aged three and half). For each of these dates, they gathered at least three facts from HK’s family, medical records and the historical records for his neighbourhood in Nashville.
HK was then interviewed about each of these 80 dates. His answers, often detailed, were transcribed and fact-checked.

HK’s recollection of days from his life between the ages of 9 and 12 grew dramatically more accurate and detailed, reaching nearly 90 per cent accuracy for memories at age 11, rising to near perfect accuracy thereafter.

HK told the researchers that his autobiographical memories are rich in sensory and emotional details and feel just as vivid regardless of whether they’re from years ago or from yesterday. Ninety per cent of the time he experiences these memories in the first-person, compared with rates of approximately 66 per cent in the general population. HK said that most days he wakes up thinking about what he’s done on that day in previous years. Bad memories come to mind just as often as positive ones, but he chooses to focus on the positive.

In terms of brain structure, overall HK’s brain was smaller than average (likely related to his having been born prematurely at 27 weeks). By contrast, his right amygdala was larger, by about 20 per cent, than in the controls. He also has enhanced functional connectivity between his right amygdala and hippocampus and in other regions. As the amygdala is involved in emotional processing, the researchers think this could lend a deeper personal salience to his experiences than is normal, thus making them more memorable.

Ally and his team acknowledged that unique case are not easily generalisable to the normal population, but they argued their results provide further evidence for the role of the amygdala in autobiographical memory. ‘Further, perhaps the present findings can help guide future regions of brain stimulation in memory-disordered populations, with the goal of improving memory function,’ they speculated. ‘Indeed, brain stimulation to deep, subcortical memory-related structures has shown very early promise in patients with Alzheimer’s.’

The material in this section is taken from the Society’s Research Digest blog at www.researchdigest.org.uk/blog, and is written by its editor Dr Christian Jarrett. Visit the blog for full coverage including references and links, additional current reports, an archive, comment and more.

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