Home.  Catching up.  Acting on some of the thinking/planning I did while I was away.  The most obvious new initiative has been reviewing my intention to train in Mindfulness Based Cognitive Therapy (MBCT).  When I got back from walking in the Sahara at the end of March, I wrote in a blog posting    

"And I want to follow up mindfulness-based cognitive therapy (MBCT) more.  I've been teaching forms of inner focus since the 1970's.  I am however drawn to pretty much anything that has a better evidence base supporting its helpfulness in relieving suffering.  MBCT is currently the meditation variant that has the best - and increasing - support." 

I applied for various forms of training.  However coming back from the Glen Affric adventure, I reversed this decision and wrote cancelling an MBCT course I'd booked saying:

Heading home.  Up quite early this morning.  Eventually left the hostel about 9.00am.  I drove up to Inverness before looping round to head down the A9.  I've just stopped in Aviemore at the Mountain Cafe  for old time's sake.  I came here a year ago on the way back from a trip camping and walking in the Fainnichs.  I was here again last October with my son-in-law and a friend after we'd walked north through the Lairig Ghru  - the marvellous pass through the Cairngorms.  This is a great cafe.  Eating their "Fresh fruit glass with runny honey and natural yogurt" more to justify my place at a table than anything else.

Last night I slept in a hostel rather than a tent.  In fact the predicted gales and lashing rain never materialised.  Some rain, some wind, but I woke in a comfortable bed feeling a little foolish, and very much recharged.  Last night, good pub food, a shower, and a mattress rather than a sleeping mat.  Yup and today's walk  was beautiful.  When I got back this evening, a girl working here at the hostel, said "Well someone's caught the sun.  You look as though you've been in the Caribbean."  And it was a lovely day.  I drove back out to the start of Glen Affric, then walked up Gleann nam Fiadh for about 4 km before heading north up beside the stream and then angling west to climb the south-east ridge of Tom a' Choinich (hill of the moss).  Extraordinary views back to yesterday's walk and the beauty of Mam Sodhail/Mam Soul, Carn Eige and Beinn Fhionnlaidh.

Today was huge.  I woke early, cold.  It had been such a clear, starlit night.  My socks, that I'd washed through in the stream and tried to dry a bit yesterday, had frozen solid.  So too my walking boots with hard frozen laces.  Rub and mould the socks till I can get them onto my feet, and back into the sleeping bag to warm them a bit.  

Well here I am, eight or so miles up Glen Affric, lying in a little one man tent in the rain.  I'm 59 today.  I woke at 2.30am wanting a pee and murmured a quiet "Happy birthday" to myself before choosing a moment between showers to stumble out to relieve myself.  I could see a few stars through the clouds.  Since then it's been raining pretty much every time I've woken.  So comfortable, toasty in a sleeping bag on a self-inflating mat in this beautifully designed Hilleberg Akto tent.  Amazing.  I came in on a mountain bike yesterday along the Forestry track south of the loch, bumping and occasionally having to get off to push the bike ... but such an improvement on walking and having to backpack in all supplies, tent, sleeping things - everything I need for three days.  It would have been heavy and slow to have carried it.  As it was, I arrived pretty quickly and pretty easily.

I'm at my friend Larry's flat in Glasgow.  We're doing one of our three-to-four monthly check-ins -  reviewing and planning how our lives are going.  I arrived here from Edinburgh yesterday evening and we spent time catching up and looking ahead.  This morning though, when I woke, I found it hard to think clearly about the time between now and early August when we next plan to meet like this.  The mountains of Glen Affric are beginning to grow closer and fill my immediate field of vision.

Looking back over relevant research papers that caught my attention last month, some stand out for me more than the others.  Here are three on depression that stood out and got me thinking.  The Fergusson et al paper looks at links between alcohol abuse and major depression.  There has been debate for years on whether alcohol dependence leads to depression or depression leads to alcohol dependence.  In this kind of debate, it's usually a good bet that both pathways contain some truth.  What this study adds is that often it is the alcohol dependence that is primary.  As the authors state " ... the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD." 

For many years my work split fairly evenly between helping people with psychological difficulties and helping people with pain problems.  Quite a few people were troubled with both.  In the last several years I have done much less work with pain, although I still see some people for overall pain management.  This has been partly because I was trying to keep up-to-date with too many fields, so stepping back from pain work made sense.  It has also been partly because the flourishing of research into happiness & wellbeing has fascinated me and taken up time.  Here are a collection of pain-associated assessment and information sheets that I accumulated over the years.  They are obviously relevant for work with pain, and some (e.g. one year symptom diary) can be adapted for work with stress & psychological difficulties. 

IBS severity score & background - this is a scale that was used by Professor Whorwell and his research team in Manchester.

In 2001 the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) WCRF/AICR set themselves the task of systematically assessing all good research on diet, physical activity and cancer and publishing a report that would be the largest study of its kind with conclusions that would be best the evidence could demonstrate.  Over 100 scientists from 30 countries were involved.  An expert panel of 21 of these scientists worked for 5 years to produce the report "Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective."  The follow-up companion Policy Report "Policy and Action for Cancer Prevention"  was published a little over a month ago and has recommendations for a series of different groups and organizations including government, industry, the media, schools, and work places. 

Here are five papers mostly looking at aspects of overweight.  The first, published recently in the Lancet, is a huge study on the effects of body-mass index (BMI) on subsequent mortality in nearly 900,000 adults.  It shows progressive excess mortality above the BMI range 22.5-25 kg/m2.  (To calculate your BMI click here).  At 40-45 kg/m2, the reduction in life expectancy of 8-10 years is comparable to the effects of being a smoker.  The second paper, by Neovius et al, also involved large numbers - over 45,000 older adolescents.  Again it showed excess mortality at long term follow-up, and commented "Obesity and overweight were as hazardous as heavy and light smoking, respectively".  The third study by Katseva et al looked at modifiable risk factors in European patients with cardiac disease.  The findings were depressing with obesity, for example, increasing stepwise from 25% at first survey, to 32.6% at second, to 38% at third survey.  Overall the authors concluded "These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease ... To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention."