Will take cash for behaviour change

As anyone who’s tried to eat healthier or start exercising will know, changing health behaviour is hard. But it’s particularly important to target children and young people in policy and programs because unhealthy patterns/habits of behaviour starts in their period of life, is likely to continue into adulthood and have serious impact on lifelong health.

Which is why I was interested to read about a new research project from HopeLab, who developed the highly successful and innovative Re-Mission game to help young people manage their cancer. Their new project is Zamzee, which again uses the intrinsic motivation of a game, and tracking technology, to motivate young people to exercise more.

However, they also use cash payment to reward behaviour (intervention group received either no case, $5 or $20 – it’s not exactly clear how much an individual received but seems like it was reward for hitting specific targets). Their research found a 59% increase in exercise over the 6 month study period – and improvements in biological measures such as cholesterol and blood sugar. Those who received cash incentives showed the most improvements in exercise.

While $20, and even $5, might be effective motivation for children and young people, what about adults? Well, the research seems to suggest that yes, it does work. A systematic review published in 2004 analysed 47 randomised control trials and found that cash incentives are effective for motivating people to engage in preventive health behaviours, at least in the short term. 

But how much? And for how long? Well, this is unclear. My initial reaction to cash incentives is to resist this idea (‘people need to take responsibility for their own behaviour!’). However given the millions of dollars spent on treating people with preventable chronic illnesses – not to mention the insidious and persistent negative influences constantly shaping our behaviour (fast-food/gambling ads, our largely sedentary work), it may actually end up being a smart investment in health.

It’s also interesting to read Hopelab are targeting GPs to prescribe this game as prevention which I think is very clever. There is certainly a real opportunity for GPs to integrate new technology into their practice – particularly tracking devices – to help provide a much richer understanding of patients. And a need to evaluate its effectiveness in this setting.


what exactly does having anxiety doing a phd mean anyway?

Having disclosed having anxiety, I realised that some of you may not really have a clue about what this means, particularly in the context of doing a PhD. I don’t necessarily see this blog as being just about this aspect of my PhD journey, but it is a constant challenge so figure that it’s important to incorporate it into this blog.

Basically, anxiety feels like having persistent, ongoing terror that something terrible is going to happen at any given moment. So in terms of doing something as isolating (and major) as a PhD it means a constant fear that you are going to fail, that you are not ‘good enough’ to do a PhD, that any work you do or writing you submit to your supervisors (or a journal or conference) will be deemed inadequate, even laughable. And you can’t feel you can share this within anyone because, on some level, you recognise them as untrue and irrational. It can undermine everything you and is like having the most unfair critic whispering nasty and unhelpful things in your your ear all the time (nb without actually hallucinating). And, of course, the less work you do, the more guilty and anxious you feel. Like many who experience mental illness, it can sometimes be very hard to separate yourself from the anxiety.

Needless to say, at times it makes it *very* difficult to stay motivated and have productive days/extended periods – or enjoy the process and myriad of opportunities that doing a PhD in the wonderful university environment provides. (I know this is for depression but this animation is also relevant for giving a sense of what living with anxiety is like I think.)

Having come off long term medication a few months ago, I have seen these symptoms gradually creep up on me again (coinciding with the last months before confirmation which was always going to be hard anyway!), so an internal early warning system seems to click on somewhere (‘warning, warning, warning’). So I feel like I’m needing to relearn or strengthen techniques to keep the anxiety in check. And generally it’s been okay – I recognise joys and wonder in everyday life outside of the PhD (and hell, even within the PhD if I’m lucky! 😉 ).

Unfortunately, all perspective goes out the window in the middle of an acute anxiety experience or attack. At these times it seems like riding it out as much as anything, accepting it will pass, taking pleasure in the little things (bike-riding, my cats, gardening, sunshine, books, horseriding), and, perhaps above all else, showing compassion to myself (and if that’s not a lifelong task, I don’t know what is!).

We interrupt your normal broadcast….

We interrupt your normal broadcast for an important message: In my 20s I was anorexic. Recovering from that I experienced major depression in my 30s. I now have anxiety (though it’s likely I have always been anxious). Geez, that makes my life sound very sad! And I guess it has been a struggle at times. But I feel the need to assure you that while life has been difficult at times I have also been proud at what I’ve achieved, not to mention the fun and laughter I’ve had along the way.

But I still find it hard to know when and where to disclose my anxiety. I do disclose about the anorexia occasionally if it seems relevant, probably because quite a bit of time has passed – and perhaps because it is in the past it almost seems like it happened to someone else or a different version of myself.

There are many reasons I don’t disclose. Embarrassment, shame, fear of being judged or treated differently because of it. I also fear that talking about being anxious will just make me more anxious!

But now that I am a year into my PhD and feel like I have a grip on uni life (after an extended break) and my place in it, I wonder: Where are the other PhD students who are struggling with mental illness? (research suggests mental illness is highly prevalent in university students) They seem to be very silent (and of course I have been one of those silent ones!). The exceptions I have found are an Anxious PhD twitter account, and @JessicaRdctd, who blogs here (and who in fact decided to withdraw from her PhD).   Am I just not looking in the right place? (that said, I also wonder this when at work too – having now worked at a number of different mental health organisations it’s kinda amazing just how little acknowledgement there is that 1 in 4 staff will be experiencing a mental illness)…

My feeling is that supervisors are very aware and understanding of how personal issues may impact on the mental health of their students (which is really positive!). Universities also allow phd students to take a leave of absence for a range of issues and of course there are accessible counselling services available on campus. However, there seems little acknowledgement of more longer-term mental illness issues and practical ways to minimise symptoms and issues that arise because of it. Certainly no mention in PhD orientation, nor is the PhD handbook that I could see. Is it that there is simply a culture of acceptance or perhaps a preference to remain ignorant (and thus unaccountable)? Or is it just too hard? 

I can’t help but feel that the current situation is unacceptable.

Workin’ It

Financial commitments mean that unfortunately my scholarship is not enough to live off. So I work 2 days per week (my supervisor accepted this reality when she took me on, though with some reservation). In the early months of my phd I managed to mostly not work on the weekend. What a luxury! Reality took hold about six-months in when I realised that a full-time phd is actually full-time! For at least the last few months coming up to confirmation it’s meant working and studying 7 days a week. It’s been a slog.

Now on the other side of confirmation, and a one-week blissful holiday in Queensland, I have the opportunity to reflect on my phd journey so far and prepare for the remaining 2 (or so) years. Having spent 15 odd years working full-time, 5-days a week with 2 days off, it’s been a shock to the system but, I suspect, a new regime I will need to get used to.

It’s given me a new and increased respect to those who have and raise children while doing a phd (or while employed in paid work for that matter). And it’s a sobering thought that many, many people around the world work multiple jobs and/or long hours purely to earn enough for food and shelter. I am doing this phd – and these extra hours – purely by choice.

But how do you sustain working 7 days a week without major burnout? Is it possible to produce outstanding work at both my job and my phd? Having the deadline of confirmation made the additional hours bearable and seem temporary (and a sweetener of a holiday at the end helped too). How can I engage with other activities at uni, when every department meeting or working group takes precious hours away from my core work? How do I ensure I meet other needs to ensure I stay healthy? (relationships, exercise to name a few, let alone others like keeping a relatively clean home). Then again, should I just quit my moaning? It is only a limited time and, really, 2 years is not a long time in the scheme of things.

I’m not sure what the answer is. Perhaps confirmation is a taste test – to give you an understanding of the work load required for thesis submission, enabling you to then make adjustments, changes moving forward in a realistic way. I think a major barrier to me was anxiety and imposter sydrome, not believing in myself, that I had the skills or talent to actually *do* a phd (I must admit that it was both relief and a little surprise that I realised I passed confirmation). I’m hoping that passing confirmation will diminish these thoughts and enable me to just Get On With It.

Perhaps I’ll continue to work it out as I go (and that’s ok too).