The following is an extract from Chapter 2 of the book ‘Psychological Aspects of Polycystic Ovary Syndrome’ (pages 38-39).
“In PCOS, obesity typically starts in adolescence and weight loss can be difficult. Bazarganipour et al. (2013) assessed 300 adult women with PCOS in Iran and found that higher BMI was associated with poorer body satisfaction. As well as the quality of life (QoL) impact of obesity(see Chap. 3), obese women tend to have lower self-esteem scores (Açmaz et al. 2013). Depression is often associated with obesity in PCOS (e.g. Cinar et al. 2011; Rasgon et al. 2003; Stapinska-Syniec et al. 2018) and in otherwise healthy women (Stunkard et al. 2003).
There are exceptions, and some studies of PCOS and obesity have not found this relationship (McCook 2002; Hahn et al. 2005; Månsson et al. 2008) so we should be careful not to presume that all women with PCOS who are obese find their weight depressing, let alone are clinically depressed because of it.
The meta-analysis by Barry et al. (2011a) found that when obesity was accounted for, depression was reduced by a Hedge’s g of 0.15, which is modest, given that a g of 0.2 is considered a ‘small effect size’. Similarly, the meta-analysis by Cooney et al. (2017) found that when BMI was taken into account, the odds of women with PCOS being depressed was reduced from 4.18 times more than healthy women to 3.15 times more. This means that the increased prevalence of depressive symptoms in PCOS is not entirely independent of BMI, but BMI contributes a modest amount—an odds ratio (OR) of 1.03. As the authors of a seminal review of mental health in PCOS stated: ‘obesity likely plays a part in the greater depression of women with PCOS, but it is clearly not the only contributor’ (Himelein and Thatcher 2006, p. 724).” (Barry 2019, pp 38-39).
The book ‘Psychological Aspects of Polycystic Ovary Syndrome’ by Dr John A Barry can be accessed here https://www.palgrave.com/gp/book/9783030302894
eBook ISBN: 978-3-030-30290-0
Hardcover ISBN: 978-3-030-30289-4
Originally published on the University College London (UCL) website here
Taking an evidence-based approach, Dr Barry (UCL’s Division of Psychology and Language Sciences), explores the ways in which PCOS causes anxiety and depression, impacts quality of life, and is associated with other psychological phenomena.
“Polycystic ovary syndrome impacts at least 10 per cent of women. One of key features is elevated testosterone, and this is related to the other problems often seen in PCOS such as fertility problems, obesity, skin problems, and type 2 diabetes.
“Although the medical impact of PCOS is relatively widely known, the field of psychology has been very slow to recognise the psychological significance of PCOS,” said Dr Barry.
An important feature of this book is its fresh insight into the ways in which testosterone, a defining characteristic of PCOS, impacts psychology. The textbook maps out the complex ways in which biology impacts psychology in PCOS, and new evidence of how psychology can be harnessed to impact biology in a positive way.
The psychological impact of fertility problems is also explored, and the relationship between insulin resistance and eating disorders. Of particular interest to psychologists and other health professionals, the book summarises the evidence base for treating mental health issues in PCOS.
Even for people who are familiar with PCOS through work or personal experience, this textbook – spanning psychology, endocrinology, and gynaecology – aims to introduce new perspectives on this usually overlooked topic.
The new Palgrave Handbook of Male Psychology (Barry et al, 2019) consists of 32 chapters from 50 authors from all over the world. The final chapter of the book summarises the elements that make for an effective therapy with men. It demonstrates that many of the features seen in hypnotherapy are ideal for men. Three of the key elements are listed below:
1/ Tailor therapy to the client’s personality
Most therapists will agree that therapy should meet the needs and capabilities of the client. An extension of this principal was created by US psychiatrist Dr Milton Erikson, who is sometimes called ‘the father of modern hypnosis’. His technique of utilisation harnessed the characteristics of the client to help make therapy more effective. The interesting thing was that he could do this even when characteristics did not appear, at first glance, to be useful to therapy. An example of how this relates to men is male-typical patterns of communication, such as banter; instead of taking a client’s banter as being a sign of avoidance of emotional contact (as many therapists might do), Erikson used what his client said and the way it was said to develop rapport and facilitate other therapeutically useful phenomena.
2/ You can take a horse to water…
Some psychologists are catching up with what Milton Erikson used to great effect in his therapy. Recent research shows that although men and women both benefit from sharing feelings, men are less inclined to want to do this. Trying to force men to talk about their feelings risks making them shut down, but talking can often be facilitated by using indirect methods, for example, starting therapy with techniques that allow men to talk without forcing them to share their feelings in a way that is uncomfortable to them. There are many ways in which this principal can be used in hypnotherapy.
3/ Focus on fixing the problem
Research shows that when men are distressed, in general they are less inclined than women to want to talk about their feelings and more inclined to want to fix their problem. This means that the traditional ‘talking cure’, with an emphasis on sharing uncomfortable feelings, may be less appealing to men than to women. In contrast, hypnotherapy is probably the most solution-focused therapy you could wish for, and usually focuses less on talking about feelings and more on fixing the problem.
To improve therapy with male clients, hypnotherapists, psychologists, psychiatrists and counsellors are encouraged to study Chapter 32 of the Palgrave Handbook of Male Psychology & Mental Health.
Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health. London: Palgrave Macmillan
Liddon L, Kingerlee R, Seager M & Barry JA (2019). What are the factors that make a male-friendly therapy? in Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health. London: Palgrave Macmillan
The Handbook (or single chapters) can be purchased here https://www.palgrave.com/gb/book/9783030043834#aboutBook
By Dr John Barry
About a third of men experience difficulty in getting or maintaining an erection, and this percentage increases in older men. Around 85% of men find that sildenifal (Viagra) improves their erections. This is a good success rate, but it doesn’t address any underlying psychological issues the man might have in relation to sex or relationships. In fact the success of Viagra has led researchers to focus almost entirely on organic factors in erectile dysfunction (ED) rather than psychological factors.
Research shows about 40% of cases of ED are caused by psychological (psychogenic) factors alone, though psychological and physiological (organic) causes can interact. If you can achieve an erection through masturbation but not with a partner, then the cause is probably psychogenic. If you can’t achieve an erection at all, the cause is probably organic.
The main causes of psychogenic ED are depressed mood, low self-esteem, anxiety, and stress. The causes can be grouped into three categories: performance anxiety, recent stressful life events, and vulnerabilities from childhood and adolescence.
The main organic causes of ED are: cardiovascular disease (blood pressure, cholesterol), diabetes, surgery to prostate (prostatectomy), loss of T (e.g. due to ADT androgen deprivation therapy in prostate Ca), drug & alcohol intoxication or side effects.
We know that Viagra has a good success rate, but how well does ED respond to psychological therapies? Well, hypnotherapy has been found to be successful in 70% of cases of ED. A meta-analysis of 11 randomised controlled trails (RCTs) of 398 men found that group therapy improves ED compared to no-treatment, and combining Viagra with group treatment caused a significant improvement in ED compared to those who received Viagra alone. Psychological interventions also compared well to local injection and vacuum devices for ED. The success of group interventions echos evidence that group therapy and educational (information-sharing) interventions a sometimes more successful in ED than more traditional one-to-one psychological approaches, and this would be in line with other research on gender differences in preferences for therapy.
So what should you do if you experience ED? First of all, try not to worry about it because effective therapies are available, and worry can become a vicious cycle. Try to establish the cause by asking yourself questions such as: can you achieve and erection by yourself but not with a partner? Do you have an undiagnosed medical condition such as heart disease or diabetes? Are you under a lot of stress at work? If in any doubt visit your GP. And remember that although most men don’t exactly brag about it, ED is a pretty common condition, and one that can be successfully treated.
About the author
Dr John Barry is a Chartered Psychologist and co-founder of the Male Psychology Network and Male Psychology Section of the British Psychological Society. He is one of the editors of, and contributors to, The Palgrave Handbook of Male Psychology and Mental Health
The Palgrave Handbook of Male Psychology and Mental Health will be released in April 2019.
From the back cover:
“This handbook brings together experts from across the world to discuss men’s mental health, from prenatal development, through childhood, adolescence, and fatherhood. Men and masculinity are explored from multiple perspectives including evolutionary, cross-cultural, cognitive, biological, developmental, and existential viewpoints, with a focus on practical suggestions and demonstrations of successful clinical work with men”.
Depression is relatively common in PCOS. Christmas can often feel like a time when we should be happy, so any sources of unhappiness – such as the troubling symptoms of PCOS – can seem especially hurtful at this time of year.
I hope everyone has a fantastic Christmas, but you don’t have to be a psychologist to realise that this time of year can have stressful for people with medical conditions, or other stressful things to deal with. For women with PCOS, some typical Christmas stressors are:
Most people overeat at Christmas. However, women with PCOS – many of whom already are overweight – might experience feelings of guilt due to overeating.
Even for healthy people, just a single day of binging on high-fat foods is enough to impair glycaemic control and reduce insulin sensitivity (Parry et al, 2017). This obviously has important implications for women with PCOS, many of whom are prone to developing insulin resistance and type 2 diabetes.
Women with PCOS also are prone to hypoglycaemia (low blood sugar levels), which is made worse by feasting on the type of high sugar / high carb foods that we see at Christmas. Low blood sugar can cause low mood (Barry et al, 2011), so for women with PCOS, the foods that usually make us happy at this time of year can, paradoxically, make us sad. (For the new year, women with PCOS could consider trying Marsh et al’s low-GI diet).
PCOS can have an impact on fertility, and reduce the ability to have children. It is often said that Christmas is a time for families and especially children, so women with PCOS might feel the additional strain of fertility problems over Christmas.
How can hypnotherapy help?
Hypnotherapy can help with both the emotional, behavioural, and even some of the biochemical aspects of PCOS (Barry et al, 2017). Christmas is a time for miracles, and while hypnotherapy does not offer a miracle cure, it certainly offers the chance of improvement for many women with PCOS.
Barry JA, Bouloux P, Hardiman, PJ (2011). The impact of eating behavior on psychological symptoms typical of reactive hypoglycemia: a pilot study comparing women with polycystic ovary syndrome to controls. Appetite, 57, 73-76
Barry, J. A., Leite, N., Sivarajah, N., Keevil, B., Owen, L., Miranda, L. C., … & Hardiman, P. (2017). Relaxation and guided imagery significantly reduces androgen levels and distress in Polycystic Ovary Syndrome: Pilot study. Contemporary Hypnosis and Integrative Therapy, 32(1), 21-29.
Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome–. The American journal of clinical nutrition, 92(1), 83-92.
Parry S, Woods R, Hodson L, Hulston C. A single day of excessive dietary fat intake reduces whole-body insulin sensitivity: The metabolic consequence of binge eating. Nutrients. 2017;9(8):818.
Hypnotherapy for weight loss is one of the most popular requests for therapists. For people who find they don’t have the time or motivation to stick to a diet & exercise regime or find medication has too many side effects, hypnotherapy is often the answer. But how does hypnotherapy compare to other methods of weight loss?
Weight loss should always be done in a sensible way, and drastic measures are not the solution. However hypnotherapy, either as an adjunct to other approaches or as a treatment in itself, has a good evidence base.
Research shows that one of the key predictors of psychological well-being is job satisfaction. When people are stressed at work, this not only impacts their productivity but can make the other areas of their life miserable too.
One of the most rewarding parts of my job is using hypnotherapy for work-related stress to become happier and more productive in all areas of their lives. For many people, having job satisfaction is the key to their overall wellbeing (Barry & Daubney, 2017), so it is vital that stress at work is recognised and addressed in an effective way.
Many people start using e-cigarettes as a way to stop smoking but then end up addicted to vaping.
A survey of 12,000 British adults found that 40% of people use e-cigarettes to help them stop smoking cigarettes, with a further 17% doing so to help them cut down on cigarettes (ASH, 2017). This is said by some to be a good idea, though many of these people find that they need help to stop smoking e-cigarettes. A large survey found no overall benefit of using e-cigarettes to help stop smoking (Bose et al, 2015). A randomised controlled trial published in The Lancet of 657 smokers, demonstrated that quitting e-cigarettes was just as hard as quitting ordinary cigarettes.
Q: ‘Will I lose control of myself under hypnosis’? A: No.
Many of my clients want me to use hypnosis to reduce anxiety, but ironically one of their anxieties is that during hypnosis they are under the mysterious spell of the therapist. Those who try hypnosis usually find it one of the most empowering things they have ever done.
People generally prefer to feel in control of their lives, and although we voluntarily give up control in many aspects of our lives (e.g. when we go under general anaesthetic, or when we are a passenger in a plane) there can be something a bit sinister about the idea of our minds being under the control of another person.
As a Chartered Psychologist and member of the British Psychological Society (BPS), I was very interested to stumble across a review of hypnosis by the BPS.
The review was led by the renowned psychologist Professor Michael Heap and other experts. It was published in 2001, shortly after I started practicing hypnotherapy in London. The findings of the report are very interesting and I quote in full below the section on the effectiveness of hypnotherapy for anxiety and many other conditions: Read More