Five ways to beat the January blues

I hate January. It’s dark, it’s cold and Christmas is over. I’ve gained Christmas weight and am distinctly poorer than I was in December. I sorely miss the Christmas decorations and feel robbed of the fairy lights which, only days ago, adorned windows everywhere. The next bank holiday is months away. It’s fair to say that I’m familiar with the January blues, a widely experienced phenomenon thought to peak on ‘Blue Monday’, the third Monday in January which is considered to be the most depressing day of the year. Since January is here again and will be happening every day until February, I thought it was a good time to write some evidence-based tips on how to beat the January blues.

1. Look for the silver lining 

Being able to look for the positives in situations, the ‘silver lining’, is a key feature of optimism. This is not about putting a positive spin on negative events or denying their dismal reality. Instead, it’s about being able to find even one positive element in an otherwise grey situation. Studies have suggested that taking a silver-linings approach to life helps boost creativity and could be useful for coping with disaster situations.

The truth is, alongside February, January is the most unpopular month of the year, for obvious reasons. However, it still comes with some silver linings. For example, January is lighter than December, with nearly 30 minutes more daylight each day on average. In that sense, the worst of winter has already passed. The sun still rises relatively late though – around 8am all month. So, if you’ve ever wanted to watch the sun rise from some beautiful location, now is a great time to do it. Leave it until June and you’ll have to get there before 4am for the same event.

January is also a good time for buying certain types of seasonal fruits and vegetables, including apples, pears and beetroot – they are usually cheaper in January than later in the year. In fact, the general lull of January also means that it’s a good time to buy – well – almost anything. It’s one of the cheapest times to travel, to buy a tv or to take out a new gym membership. In the next few months, the price of most things climbs. And, despite its general quietness, there are a handful of great events during January, including Chinese New Year, Glasgow’s Celtic Connections Festival and Burns’ Night. Overall, it’s fair to conclude that January pretty much sucks, but it has some silver linings.

how to beat the January blues

2. Build plus points into your day

If you’re still struggling to think of any silver linings to help beat the January blues, create some by building small positive events into your day. Cognitive Behaviour Therapists call this ‘positive event scheduling’ and it has been shown to effectively reduce the risk of depressed mood. These events should be small things which lift your mood and give you something to look forward to. Write them down and schedule when you’ll do them. For example, it could be as simple as promising yourself an 11am latte and making the time to fetch it. You might then plan in some time to read a magazine or take a brief walk at lunch time. In the evening, you might plan to catch up on a tv show you like, take a bath or spend some time on a hobby. The basic idea is: think of things you like doing and schedule them in. This way, you’re more likely to do them, and you might even look forward to them. Despite a general cultural push to spend January living austerely (think, New Year’s resolutions, dry January, Veganuary), it’s important to allow some small indulgences when you have the January blues. 

3. Focus your attention outside yourself

Feeling blue often comes with an excess of self-focused attention. In other words, being stuck in your own head. This can be in the form of rumination – going over and over past events, wondering ‘Did I do the right thing? Why did that happen?’ It can also be in the form of worrying – thinking about all the things that could go wrong in the future, and how you might cope with them. One way to combat this is to purposely focus your attention on other things that interest you. Depending on your personality, this might involve joining a new class or community group to learn a new skill or help a good cause. It might include going to the book shop and picking up some books about an issue or topic that interests you. One of my favourite ways to ‘get out of my head’ is to listen to podcasts, as I can listen to these when I’m commuting, cleaning up or doing almost any menial chore. Click here to see a round up of some of my favourite podcasts from 2019. The bottom line is – taking an interest in something new that captures your attention, even if only for brief periods, can help beat the January blues.

4. Exercise

Exercise has been touted by some as the ‘magic bullet’ for mental health. While this is definitely an overstatement, there is now strong evidence that it has a consistent, beneficial effect on lifting low mood. One study suggests that this may be because exercise reduces blood serotonin levels, similar to the effects of pharmaceutical antidepressants. If the thought of vigorous exercise makes you want to pull the curtains and switch on the TV though, it’s important to note that even gentle exercise like walking has benefits too. 

How to beat the January blues exercise

5. Get a good night’s sleep

In the winter months it is harder to sleep. This seems paradoxical to me: I would have assumed that long, dark nights mean ample time for undisturbed rest, but the opposite seems to be true. Studies show that in the northern hemisphere, winter increases the risk of delayed bed times, trouble falling asleep, trouble staying asleep and general poor sleep quality. It is thought that this is caused by the way that light effects our hormones – with the earlier morning light of spring ‘setting’ our biological clock earlier (and more effectively). Poor sleep is a risk factor for a wide range of mental health problems including depression and anxiety. To improve sleep quality there are a range of steps you can take, including taking time to relax in the evening and getting as much light exposure during the day as possible. See this article by healthline.com for a great list of suggestions.

Top healthcare and psychology podcasts from 2019

2019 was the year I discovered podcasts. I’m not alone – it’s estimated that there are currently 800 000 podcasts, an increase of 250 000 since the middle on 2018. Here, I share some of my favourites. While most of these aren’t targeted specifically at health or psychology audiences, they all tackle events or issues likely to appeal to people working or studying in these areas, including everything from healthcare scandals to recorded counselling sessions.

 

Dr Death

dr death podcast
This was the most shocking podcast I listened to in 2019. It charts the story of
Christopher Duntsch, a US neurosurgeon who claimed to be the best in Dallas. He has since been convicted of maiming one of his patients and sentenced to life imprisonment. Altogether, he is thought to have caused the death and maiming of 33 patients. The show has been criticised for sensationalising the story for entertainment and is certainly not told in the style of a documentary. However, for anyone interested in healthcare safety, it’s a horrifying, absorbing cautionary tale on what can happen when adequate safeguards are not in place to ensure professional standards. From Wondery, Dr Death is hosted by Laura Beil and is available to download from Apple podcasts and Spotify.  

 

PsychCrunch

PsychCrunch podcast

If you’ve ever wondered how you can improve your commitment to exercise, eat less chocolate, persuade others of your viewpoint or make yourself more attractive to others, PsychCrunch is for you. From the British Psychological Society’s Research Digest, each episode is around 15-20 minutes long and features interviews with experts on different topics. The podcast is published quarterly and is presented by Dr Christian Jarrett, Ginny Smith and Ella Rhodes. It’s snappy, informative and evidence-based – an easy and engaging way to keep up with developments across psychology. Psychcrunch is available to download on Apple Podcasts, Stitcher and Spotify.

 

The Drop Out 

From ABC Audio, The Drop Out explores the story of Elizabeth Homes and her company, Theranos. Holmes’ goal was to create the first blood test which could provide multiple test results using only a drop of blood – the amount that would result from a pin-prick. This technology would make testing cheaper and more convenient and was widely described as ‘revolutionary’. Her idea drew enormous investment and made her the youngest self-made female billionaire. The only problem was that it was never more than an idea: Holmes’ company Theranos did not even manage to produce blood testing devices which were as accurate as machines already on the market, using the standard amount of blood required. For anyone working in healthcare, the story is an insight into the world of healthcare technology innovation: how it can happen, and where it can go wrong. From a psychological perspective, it considers the mind and motivations of someone dedicated to a goal, regardless of the situation and the cost. The Drop Out is available to download from Apple Podcasts, Google podcasts and Spotify. 

 

Where Should We Begin? With Esther Perel

Esther Perel is a Belgian-born couples therapist whose podcast episodes are unscripted, one-time counselling sessions. The names of the couples have been changed to help provide anonymity, but the voices and conversation are real. Perel now has a huge library of previous sessions, covering relationship challenges ranging from impotence too infidelity. Perel initially trained in psychodynamic therapy before training in family systems therapy. Her website states that she offers training in ‘psychodynamic, attachment, and systemic theories, as well as sex therapy, psychodrama, and body-oriented approaches’. In truth, as a UK-based, CBT-trained Clinical Psychologist, I’m not sure exactly what her approach is or how it is supposed to work, but it certainly makes for a good podcast. I’d recommend this show for anyone interested in relationships, the concept of one-time counselling sessions or the use of therapeutic models for couples therapy. From Audible, Where Should We Begin? can be downloaded from Spotify, Stitcher and Apple podcasts. 

 

I Hear Voices 

From BBC Radio 1, this podcast covers 27-year-old Alice’s experience of hearing voices. Alice has multiple voices, each of which has a different personality and may be more likely to occur in relation to different events that happen. For example, there is one set of voices that she only hears when she is cooking and another that occurs after she has self-harmed. Each episode is brief, lasting less than 10 minutes, and explains one of these voice-hearing personalities. The series is told entirely from Alice’s perspective and provides a window into what life is like when you hear voices which can be hard to ignore. Alice’s insight and perception into her own experiences are utterly illuminating for anyone working in mental health or psychology – highly recommended. I Hear Voices is available to download from BBC Sounds and Apple podcasts.

 

Bad Batch 

In the US, stem cells are big business. Touted as the cure-all for everything from joint aches to Parkinson’s, they can now be purchased in the form of non-controversial birth stem cells (taken from the umbilical cord blood of live born babies) and injected by medical professionals for just $5000 a pop. Bad Batch focuses on this industry, highlighting the lack of evidence to support the lofty claims made by stem cell distributors. It also highlights the risks, focusing on one company, Liveyon, which distributed stem cell vials which led to a group of treated patients falling gravely ill. They also happened to contain almost no active stem cells. Laura Beil, host and reporter, delivers some compelling insights into the factors which have enabled such an industry – and such a patient safety debacle – to occur. First, she highlights inadequate regulation of stem cells, as they are not treated as drugs by the Food and Drug Administration (FDA). Second, she highlights the nature of the profit-based US healthcare system, where treatments are marketed directly to patients using flashy advertising. For anyone interested in healthcare systems, it’s an engrossing insight into the problems that come when healthcare becomes a marketable commodity. From Wondery, Bad Batch is available to download from Spotify, Stitcher, Podtail and Apple podcasts.

 

The Last Days of August

Jon Ronson’s podcast, The Last Days of August investigates the death by suicide of porn star August Ames. Ames was aged just 23 at the time, and her death immediately followed a social media ‘pile on’ regarding a comment she made on Twitter. Ronson has long been interested in the effects of public shaming, and his investigation begins there. However, before long he moves away from viewing the Twitter storm as the main reason for Ames’ death. His investigation leads him to explore her childhood, adolescence, marriage to 43-year old porn producer, Kevin Moore and a recent traumatic film shoot she was involved in. As a Clinical Psychologist with a PhD in suicide research, I was a little frustrated that Ronson didn’t include any interviews with experts in suicide, which could have informed his investigation and provided a framework to put the puzzle pieces together. Despite this, it’s a deeply engaging podcast. Sensitively handled by Ronson and his producer Lina Misitzis, it had me gripped to the end. This podcast is likely to be of interest to anyone with a background in mental health or  suicide research. It suitably comes with a warning at the start of every episode though – listeners should be warned that it contains bad language and frequent sexual references, in addition to covering an extremely sensitive topic. From Audible, The Last Days of August is available to download from Stitcher, Apple podcasts, PlayerFM and Podbay.

 

The Shrink Next Door

From Bloomberg and Wondery, The Shrink Next Door tells the story of the relationship between Marty Markowitz and his therapist, Dr. Isaac Herschkopf. The story is told by long-time journalist Joe Nocera. Nocera had a house in the Hamptons and believed for years that the neighbouring house was owned by Herschkopf. He was invited to house parties by Herschkopf, who also happened to have his name on the mail box. Herschkopf was affluent enough to employ a handyman, whom Nocera regularly saw taking care of the pool and back garden when the Herschkopfs were not staying there. The first twist, of course, is that the house was never owned by Herschkopf: it was owned by Markowitz, who was also mistaken for being the handyman. The Shrink Next Door explores the progressively controlling, isolating and unhealthy ‘therapeutic relationship’ between Herschkopf and Markowitz which gradually saw Herschkopf taking control of Markowitz’s relationships, finances and business. As a mental health professional, this story made my jaw drop. I once agonised over whether it was appropriate to accept the gift of a DVD from a client who wanted to say ‘thank you’ at the end of therapy; the concept that a therapist could break every professional boundary going was utterly astounding to me. This podcast will interest anyone with a background in mental health or a concern for the oversight of therapeutic relationships in health systems. The Shrink Next Door is available to download from Stitcher, PlayerFM and Apple podcasts.

Is psychology a sexist discipline? Reflections on The Patient Gloria

In 1964, Gloria Szymanski was recruited by her therapist, Everett Shostrom, to take part in a series of films demonstrating psychotherapy. Shostrom also recruited three leading psychotherapists: Carl Rogers, creator of ‘person-centred therapy’ (widely known as ‘counselling’), Fritz Perls, creator of ‘Gestalt therapy’ and Albert Ellis, creator of ‘Rational Emotive Behaviour Therapy’. Shostrom told Szymanski the videos would be used solely for education purposes. He lied. He later turned the videos into a motion picture, ‘Three Approaches to Psychotherapy’ which was shown in cinemas and on TV. You can still watch it on YouTube today. Szymanski took legal action, but it was unsuccessful.

Last week, I went to see “The Patient Gloria” at Traverse Theatre; a production based on the videos and Szymanski’s experiences. The play combined re-interpretations of the therapy scenes with narration, music and dancing. It took a highly sceptical view of the therapies, highlighting each therapist’s stereotyped interactions with Szymanski (“Rogers is paternal, Perls aggressive and Ellis is predatory”, an information sheet handed out before the play explained). Gina Moxley played all three therapists and also narrated the play, comparing her own experiences of harassment and negative treatment by men with Szymanski’s experiences at the hands of Shostrom and the therapists.

The Patient Gloria

The play was, I think, intended to provoke thought about gender issues; about relationships between men and women and how the ill-treatment of women is often overlooked. As a Clinical Psychologist, my thoughts moved in a slightly different direction. Mainly I was struck by one thing: all three therapists in The Patient Gloria were men. They were therapists I was familiar with, though not the ones who created Cognitive Behaviour Therapy, the psychological approach I use. No: that therapy was created by another man, Aaron Tim Beck. In fact the more I reflected, the more I realised that male views have had a disproportionate impact on the field of psychology. I found this most troubling because psychology is a female-dominated discipline: 80% of undergraduates and around 85% of Clinical Psychologists are women. I began to wonder: is psychology sexist, and is the discipline disproportionately influenced by male views?

In brief: yes

A quick look at the statistics concerning men and women in education and academic psychology would suggest this is the case. While around 80% of psychology undergraduates and Master’s students are women, this drops to 69% at PhD level. It drops further to 63% at Lecturer level and then to 33% at Professor level*. I also did an analysis of the male:female ratio of heads of psychology departments at Russell Group universities (for my advanced spreadsheet, see below). Similar with the ratio of Professors, this suggested that only 36% Of current UK psychology department heads are women. This pattern is a classic version of the “leaky pipeline”: women seem to get lost along the career progression trajectory, until only a minority remain in the most senior positions.

psychology heads of school

No bias in education and training

To be clear, there does not appear to be any bias at the point of enrolling students into educational courses. For example, with undergraduates, females tend to be slightly more successful than males at the application stage, and this has been attributed to females achieving higher grades overall. Similarly, for psychology graduates seeking to enrol onto a competitive Clinical Psychology Doctorate programme, the statistics show no evidence of an anti-female gender bias.

A complex picture

So, when and how do women get lost along the way? The Athena Swan Charter was created in 2005 to address issues of gender inequality in higher education, and academic schools now monitor and report their action on gender equality in order to gain awards (Bronze, Silver, Gold). Some of these reports are available online, and show that the issues are not straightforward. As the School of Psychology at the University of Birmingham reported in their Athena Swan Silver Application, they have tended to receive far more applications for professorial positions from men than women. In fact, over a 3-year period, they reported receiving 3 applications from women, compared with 29 from men.

Part of a wider academic problem?

One possibility is that the inequalities seen in psychology are part of a wider gender bias in academic outcome indicators. For example, an analysis of grants submitted to the Gates Foundation found that those led by women were 16% less likely to get funded than those led by men. Furthermore, where grants are awarded to women, they tend to be for smaller amounts of money. An analysis of funding awarded by the Engineering and Physical Sciences Research Council (EPSRC) found that on average, grants awarded to women were 40% smaller than those awarded to men. There is also some evidence to suggest that research papers written by women are less likely to be accepted by journals.

Part of a wider societal problem?

Another possibility is that the gender patterns present in psychology careers simply reflect patterns present in wider society. For example, an analysis of the Foreign and Commonwealth Office found that women were overly represented in junior grades; only 30% of employees in senior management were women. Furthermore, those women who were employed in senior management earned on average 6.5% less than men in the same category of job. Nationwide, the hourly wage gender pay gap for full-time employees has been estimated to stand at around 8.6%. About 40% of the pay gap between men and women is unexplained, indicating that it could be due to bias.

What has all of this got to do with Gloria Szymanski?

The three approaches to psychotherapy demonstrated in The Patient Gloria involved four prominent men: Carl Rogers; Fritz Perls, Albert Ellis and the instigator, Everett Shostrom. All men benefited in having their ideas broadcast worldwide, gaining international recognition for their work. Szymanski, the only woman in the equation, paid a high price for their gain. Her personal views and experiences were laid bare for public dissection. Furthermore, none of this was necessary. I have made several successful videos on YouTube which aim to demonstrate therapeutic techniques; these have been viewed over a million times and are now used by healthcare organisations and universities internationally. Crucially, none of these has sought to demonstrate therapy with a real patient. ALL of the demonstration videos have used actors. Contrary to the concept behind the Gloria videos: most people can’t tell. If you don’t believe me, just read the number of comments underneath where someone is asking if the clients are real. So the question I am left with is: if the gender balance of leading psychologists was more equal, would Szymanski have suffered in the way that she did? Furthermore: would the videos have been created and promoted, at all?

 

The Patient Gloria is showing at Traverse Theatre in Edinburgh until August 25th.

 

*I have taken these statistics from the Athena Swan Gold application submitted by the School of Psychology at Queen’s University Belfast. While the report said it took the figures from 2014-15 HESA data, I was unable to locate the original data online, and so have relied upon second-hand reporting of these.

Four tips for building psychological resilience

Life is often stressful. These stresses can come in all shapes and sizes, from the burden of financial debt to the hassle of a fender-bender; from the heartache of a sick parent to the irritation of a late train. The bottom line is that whatever form it comes in, we can’t avoid stress. So what can we do about it? One obvious suggestion is to reduce the amount we’re exposed to: pay that bill a.s.a.p. and be careful to avoid other cars when parking in multi-storey car parks. This is good advice, but the reality is that not all stress can be avoided. For these types of stresses, it can help to increase our capacity to cope: our ‘psychological resilience’. But how can we do this? Here, I offer four tips based on research I have conducted into the factors that confer resilience.

1. Know your strengths: build your confidence. My research has shown that having high self-esteem helps people be resilient to stressful events. In a previous blog post, I outline one evidence-based technique for building self-esteem. Briefly, this works by encouraging you to consider your personal ‘strengths’ and then getting you to think of specific pieces of evidence which show that you have this strength. For example, if your strength is that you’re a good listener, a piece of evidence might be that a friend from work confided to you about their recent break-up last week. 

First though, you have to be willing to allow yourself to do this. When I deliver resilience training, many people I speak with are embarrassed to acknowledge the things they’re good at, for fear of appearing egotistical or narcissistic. This belief is both misleading and detrimental, as some individuals who are highly narcissistic in fact report low levels of underlying self-esteem. The reality is that knowing your strengths can help you to build a quiet confidence that will improve the way you work, and will not make you appear egotistical.

resilience

2. Learn to let yourself off the hook. Being a perfectionist is one of the worst things you can do for your mental health. It’s linked with higher levels of depression, anxiety and self-harm and it’s terrible for psychological resilience. What this tells us is that reducing our perfectionism could boost our psychological wellbeing and levels of resilience. There are misconceptions around perfectionism though, with people sometimes fearing that being less perfectionistic could make them less effective or high achieving. This isn’t the case. Perfectionism is about rigidity: it’s when people push themselves hard, no matter what. Being less perfectionistic involves self-awareness. It’s about knowing when to strive and push forward, and when to let yourself off the hook. If you’re a fitness enthusiast, this might involve knowing when it’s time to take a couple of days off training. If you’re a dedicated student, it might be knowing when it’s time take the afternoon off revision to see friends. For detailed suggestions on tackling perfectionism, see my previous blog post.

3. Focus on the future. When the present is no fun, it’s important to have things to look forward to, and research shows that having hope for the future can help us be more resilient. These don’t have to be big things, but they need to be clear in your mind. For example, you might enjoy going for a coffee and reading the paper, going for a walk in a park, or reading books. This practice is often incorporated into cognitive-behaviour therapy (CBT), and is called ‘pleasant event scheduling’. A recent study which tested the impact of pleasant event scheduling when done in isolation, without any of the other aspects of CBT, found it was effective in reducing risk of depressed mood. It’s not rocket science though – you can easily do this yourself by making a list of things you’d like to do and then scheduling these in your diary.

resilience

4. Don’t beat yourself up when things go wrong. There are three main ways that we explain negative events in our lives. First is how much we blame ourselves, compared with other people or the situation. Second is how permanent our explanations are: whether the problem that caused this one event is likely to keep on causing negative events in our future. Third is how all-encompassing are explanations are: whether this cause is going to make trouble in other areas of our life, as well. For example, if we were to fail an exam, we could think, “This is all down to my own general stupidity. I knew I’d never get through it”. This explanation is negative as we’re taking the blame entirely on ourselves. We’re also doing it in a permanent, all-encompassing way: if we’re stupid, it’s probably going to affect everything we do, forever.

The way we tend to explain events is habitual and it’s called ‘attributional style’. Resilient people explain events in a way that is more positive. In an exam failure situation, a resilient person would acknowledge any stress they’re under, or any other factors that could have affected their performance. Furthermore, they’ll do this in a way that doesn’t leak into other areas of their life and gives them hope for the future. In this example, a resilient person might think, “It was a stressful time with my mum being ill. I haven’t had to manage this kind of situation before, and the result was that I didn’t allow enough time to revise. I’ve learned for the future though: I know what I’ll do differently next time”. Not only will this person feel less bad about the exam failure, they’re also more likely to pass next time. It’s possible to change the way that you explain events with cognitive-behaviour therapy. For a do-it-yourself approach to improving your attributional style, I’d encourage you to ask yourself three questions when you know you’re beating yourself up about something:

  1. What range of factors contributed to this event? When things go wrong, they can rarely be pinned on just one thing. List all the things you know contributed to the event, to help yourself create a balanced perspective.
  2. What else has gone right recently? Think about other things that went to plan, no matter how small. This might be, for example, a friend’s birthday that you remembered, a work task that you completed well or a tricky conversation that you handled sensitively. It’s important to remember that this negative event doesn’t define you.
  3. What can you do to reduce the chance that a similar event will occur in future? Think about anything you’ve learned from this. Think about any actions you can take, whether this is personal (e.g., allowing more revision time in future) or external (e.g., asking for input from a tutor).

With all of these tips, it’s important to know that having good relationships with friends or family can help. Talking to others about stress you’re experiencing can help you to realise when it’s time to take action and can help you to change your perspective. Have you ever moaned to a friend about a rough day at work, and appreciated it when they pointed out that it wasn’t all your fault? Well, that’s an example of them helping you to develop a more positive attributional style for that event. The take home message is: talk about it! It’s easier than trying to do it alone.

This article was originally posted on the Psychreg website on 14 June 2019.

Breaking bad news in healthcare: why we shoot the messenger

Breaking bad news is a cornerstone of healthcare delivery. From the doctor delivering blood test results in cancer services to the sonographer communicating the discovery of a pregnancy loss, healthcare professionals regularly find themselves in this challenging situation.

But why is it so challenging? In theory, the healthcare professional is simply the messenger: the person relaying information about an event they did not cause and had no influence over. The reality is nothing like this, though. Research tells us that healthcare professionals find these situations highly stressful, particularly when the news is unexpected or seems unusual or unjust. Some end up coping in unhelpful ways; distancing themselves from the patient by using technical language, delaying the communication of the news or avoiding it altogether and passing the task on to someone else. These coping tactics often backfire by creating a more negative experience for the patient and further increasing the stress the healthcare professional feels.

breaking bad news

A recent study has shed light on these conversations, identifying some of the underlying reasons for why these events are quite so difficult for healthcare professionals. This study conducted a series of 11 experiments, which together showed that:

  • After receiving bad news, people feel a need to try and ‘make sense’ of it
  • To help them ‘make sense’ of bad news, people dislike the person who told them, even if they clearly are not to blame for what has happened
  • People dislike the messenger even more if the news is unexpected, or if it is particularly unjust or unusual
  • The reason that people dislike those who tell them bad news is because they think these messengers have bad motives: they mean badly
  • This effect is reduced if recipients of bad news have reason to think the messenger has benevolent motives or means well

This study used a range of news delivery scenarios, including one where a person was told that they had not won a $2 bonus and another where their scheduled flight was running late. However, I think this study has important implications for healthcare settings for three main reasons:

  1. It brings a new perspective to why these events are so challenging for healthcare professionals. It’s not logical, but the truth is that patients will like professionals less when they deliver bad news, and consciously or subconsciously, professionals know this. Building good professional-patient relationships is a key part of healthcare delivery, and having to deliver bad news works against this.
  2. It highlights the situations where delivering bad and difficult news is going to be most challenging. Specifically, these are likely to be where the news is unexpected or where it is particularly unusual or unjust. I think that two key settings where staff should be better supported with this task are obstetric ultrasound and maternity services more broadly, as the news is often unexpected and paediatrics, where bad news could be more likely to be perceived as unusual and unjust. In these situations, the recipients of bad news may have to work harder to make sense of the information they have received, and as such, may be more likely to ‘shoot the messenger’.
  3. It offers a suggestion for how healthcare professionals can reduce the ‘shoot the messenger’ effect: namely, by communicating their benevolent intentions. For example, this could involve saying ‘I’m so sorry, I hoped to bring you better news than this. This must be so difficult for you to hear’. However, doing this requires professionals to be forthcoming and open. Unhelpfully, the impact of stress often has the opposite effect: it inhibits people, making them more careful and wary of saying ‘the wrong thing’; therefore increasing the chance that they’ll say very little. What this research shows is that by going against the natural instinct to say little in stressful situations, healthcare professionals can reduce the ‘shoot the messenger’ effect and help create a better experience for both themselves and their patients. It is also consistent with findings of a review I conducted which showed that training healthcare professionals in breaking bad news works: it enhances their confidence of how to manage these difficult situations and improves their skills.