This is the second of 11 blog posts about going to Morocco to walk "mindfully" in the Sahara desert.  This post covers the arrival in Marrakech.

5.00am - the calls of the muezzin increase in volume. This seems a good time to meditate. All around, here in the Marrakech medina, many others will be praying.

... and now it's over an hour later. I sat quietly listening. The cocks crew lustily as the muezzin calls ebbed away. Normally in Edinburgh I would be up at this time. It's quite a solitary, quiet time of day. Interesting just now, comforting in a way, to feel the sincere activity of many in this city at that early hour.

This is the first of 11 blog posts about going to Morocco to walk "mindfully" in the Sahara desert.  This post gives a bit of background to the trip.

6.00am - the old clock has just sounded in my cousin's house in London. We arrived yesterday evening, flew down from Edinburgh, came across London, had a great meal with my cousin, his wife, their daughter, and dear Kieran, our son, who'd cycled over from his flat further East. I woke this morning an hour or so ago and lay thinking about the trip ahead. At 8.00am, Catero, my wife, and I are due to head down to Victoria and take a train out to Gatwick airport. Hopefully we'll meet up with four friends there and catch a plane to Marrakech. We should then get together with a couple more friends at the little hotel we've booked in the Medina. Tomorrow we're due to be picked up by two 4x4's and driven over the Atlas mountains down towards the Sahara desert.

I wrote a post yesterday introducing some of the ideas and research on implementation intentions.  Today I extend this in more practical how-to-do-it directions:

what are implementation intentions?
"Goal intentions" involve aiming for some desired future outcome.  They are of the form "I intend to attain goal X".  Unfortunately we know only too well that making such intentions does not necessarily mean that we will reach our goals.  As the old saying goes "There's many a slip between cup and lip".  A major review of 422 relevant research studies found that goal intentions accounted for only an average 28% of the variance in achievement of successful outcome (Sheeran, 2002).  Subsequent research suggests that even this figure of 28% is an overestimate (Webb and Sheeran, 2006).  The conclusion is clear - forming a strong goal intention to achieve some desired outcome in no way guarantees success. 

Here are five papers on childhood, the effects childhood experience can have on adulthood, and the effects adults may then have on their own children.  The first paper by Brody et al. is the encouraging one.  It demonstrates how caring parenting can combat genetic vulnerability - "involved-supportive" mothering greatly reduced the link between vulnerable genes and subsequent youth substance abuse.  The Van Meurs et al study shows the reverse - how problem behaviours in one generation of children increases the likelihood that, when these children become parents themselves, their own children will develop similar problem behaviours.

Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below.  As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer.  Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline.  Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... "  This is superbly useful information.  Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.

Here are five papers on difficulties experienced by adolescents.  A couple of the papers are follow-up studies.  Colman et al looked at the multiple negative personal & relationship outcomes in a UK national cohort of adolescents with conduct problems followed over 40 years.  Wentz et al studied the somewhat more encouraging 18 year outcomes of a group of adolescents suffering from anorexia. 

A couple of the papers are about depression.  Kennard and colleagues report again on the well-known Treatment for Adolescents with Depression Study (TADS) comparing antidepressants, cognitive-behavioural therapy and combined treatment.  By about six months there was little difference between the three forms of treatment.  At nine months the remission rate for intent-to-treat cases was 60% overall.  Primack et al investigated the association between electronic media use in adolescence and subsequent depression in young adulthood.  They reported "Controlling for all covariates including baseline Center for Epidemiologic Studies-Depression Scale score, those reporting more television use had significantly greater odds of developing depression."

Here are a few handouts that I've put together over the years to provide background information about depression.  The development & maintenance diagram is probably the handout here that I use most - both to explain issues about depression and also for many other psychological disorders as well. 

Development & maintenance of distressed states - I use this Powerpoint diagram a lot when discussing with people why they are in a distressed state.  The diagram applies to depression but it also applies to nearly all other distressed psychological states as well.  It can be helpful in highlighting the importance of maintaining, precipitating and vulnerability factors.  I also point out that therapeutic gains can be made working with all three of these general sets of factors - for example, emotional processing work for past experience (both precipitating and vulnerability factors) and more standard cognitive-behavioural approaches for maintaining factors. 

The excellent UK Food Standards Agency  has recently launched a campaign (see the TV ad) to encourage people to cut down their intake of saturated fats.  As the FSA points out on their webpage about saturated fats most people in the UK eat about 20% more than the maximum recommended amount.  They list examples of foods that are high in saturated fats, including:

• fatty cuts of meat and meat products such as sausages and pies
• butter, ghee and lard
• cream, soured cream, crème fraîche and ice cream
• cheese, particularly hard cheese
• pastries
• cakes and biscuits
• some savoury snacks
• some sweet snacks and chocolate
• coconut oil, coconut cream and palm oil

The FSA recommend checking food labels for saturated fat content.  More than 5gm of saturated fat per 100gm of the food is a high level, while less than 1.5gm per 100gm is low.  Their ten tips to help reduce your saturated fat intake are:

Here are five papers on lifestyle and the benefits of making healthy choices.  The first by Cohen et al on sleep habits and susceptibility to the common cold, showed increased risk of developing a cold after infection for those with shorter sleep duration.  Interestingly the increased risk was even greater for those with poor sleep efficiency.  Sleep efficiency is calculated by dividing the time spent asleep by the time spent in bed trying to sleep.  The Good Knowledge section of this website contains useful information on assessing and treating sleep difficulties.