By Alessandra Borsini and Amelia St John Wallis Editors note: Congratulations to Dr. Alessandra Borsini, a neuroscientist in the SPILab, for winning the coveted Pyschonomic Society's Best Article Award 2021, for the systematic review underpinning this post - well done Dr Borsini! Anyone who has experienced anhedonia will know that it is not just inability to feel pleasure, as most commonly defined. Anhedonia takes away happiness from those small moments that give life meaning, like food, sex, relationships and achievements. You know what the occasion is, but you just can’t rise to it. To make this scenario even worse, anhedonia never comes alone. Anhedonia can occur together with other conditions, particularly depression, but also schizophrenia, Parkinson’s disease, anorexia nervosa and many other disorders. Anhedonia has received a lot of attention in recent years. The main reason for this being that it can predict how well someone with depression will respond to treatment. In fact, common antidepressants tend to be less effective for people who have depression with anhedonia, than for those who have depression without anhedonia. Also, some studies show that anhedonia increases the risk of taking your own life by suicide. Therefore, the debilitating impact that anhedonia has on quality of life, as well as its resistance to treatment, makes it an important scientific research topic to explore — especially for scientists like us. I am a senior postdoctoral neuroscientist who has been working in the field of mental health for now more than 10 years, and a member of the Stress, Psychiatry and Immunology Lab, the team who brings you InSPIre the Mind. Together with my student Amelia, a graduate psychologist with a keen interest in clinical psychology, we have recently written a systematic review investigating changes in brain function in patients with anhedonia, as well as the mechanisms underlying such changes. Considering our interest in studying anhedonia and our recent publication, we are very excited to be writing a blog on this topic. So, what is happening in the brain when we experience anhedonia? As with the investigation of any emotional response, the picture is quite complex. Anhedonia is not simply a reduced appreciation of pleasurable things; the underlying reward processing in the brain is impaired. Moreover, reward processing is not a single process per se, but rather a series of distinct and overlapping phases, commonly referred to: reward learning, reward wanting and reward liking. Imagine a mouth-watering chocolate bar in your cupboard: reward learning teaches you that opening the cupboard (and the wrapper!) gets you a chocolatey reward; reward wanting gives you the motivation to go to the cupboard; reward liking allows you to actually enjoy the chocolate bar. Research has shown that patients with anhedonia often have difficulties in all three reward processes. This might involve alterations in levels of interest, motivation, anticipation and expectation, all of which are processed by different but interconnected neural circuits. But, how can we study reward processing in the brain? One way could be via the use of Functional Magnetic Resonance Imaging (fMRI) techniques, which is a specific type of MRI scan that allows us to record the activity levels of different areas of the human brain, in real-time — or, in other words, how well the brain is functioning. For example, recording brain activity during a series of reward tasks — such as exposing the person to a favourite food or music stimulus — can easily discriminate specific brain activity changes, as well as the brain areas involved in such changes. With fMRI, you can also identify differences among different groups of individuals, for example in patients with anhedonia when compared with normal healthy individuals. Of course, changes in brain activity are often complex and vary across different brain areas, as well as from person to person, but at this stage fMRI measurement can be used to gather valuable clues. In our recent review article in the scientific journal of Cognitive, Affective and Behavioural Neuroscience, we collected findings from all published fMRI studies investigating changes in brain activity in depressed patients with anhedonia, when compared with healthy individuals, when using tasks assessing reward learning, reward wanting and reward liking. Combining all of this research together reveals very interesting patterns. For instance, these patients have lower brain activity in the striatum, an area important for reward processing, and located in the middle of the brain. And guess what? This is associated with reduced reward learning, reward wanting and reward liking, regardless of the rewards on offer: a bite of some tasty foods, a listen to their favourite music, even winning money! We came across one study, which in addition to fMRI, used another imaging technique called Positron Emission Tomography (PET), which measures brain metabolism of neurotransmitters, like dopamine. This study found that reduced reward wanting and liking are associated with decreased dopamine signaling in the striatum. So, lower brain activity in the striatum and a decrease in dopamine signalling are likely to be important changes involved in anhedonia. But, these findings are not exclusive to the striatum, of course. Patients also have lower brain activity in an area called the orbito-frontal cortex (OFC), located at the front of the brain — certain regions of the OFC area are involved in the experience of pleasure from rewards. In fact, patients with lower OFC activity also show reduced reward learning, wanting and liking. We also identified opposite activity patterns in other areas of the brain. For example, when investigating the medial (mPFC) and dorsolateral prefrontal cortex (DLPFC), areas located very closely to the OFC, the majority of the studies found a higher brain activity, but still reduced reward wanting and liking — as we saw before in studies focussing on the striatum and the OFC. This result is incredibly interesting and reminds us of how complex the reward processing in our brains is — with closely related brain areas (OFC, mPFC and DLPFC) having opposite brain activity patterns (low activity in OFC versus high activity in mPFC and DLPFC ), but all being involved in reward wanting and liking. But be aware — further investigations are required as not all studies (although the majority) have confirmed these findings, and so there is still some room for speculation. Given the brain’s infamous complexity, changes in brain activity associated with anhedonia are likely to be even more complex than what we currently think, and can differ a lot from individual to individual. So, what do these findings mean for patients? Understanding alterations in brain activity in patients with anhedonia will allow researchers like us to develop treatments focussed on “rebalancing” these alterations and returning them to a healthy level. At present there are no treatments able to specifically target anhedonia. In fact, it is commonly treated alongside the condition that it is part of. For example, individuals with depression and anhedonia often receive antidepressants as treatment. However, as mentioned above, there is evidence showing that antidepressant treatment is not so effective for anhedonia and, sometimes, it may even worsen the clinical scenario, causing emotional blunting or sexual anhedonia. This means we have to approach the problem from another angle — a possible therapeutic strategy could be that of targeting other systems. A working example: we could follow a clue we discussed earlier — that lower brain activity in the striatum is associated with anhedonia in depression via a reduced dopamine system — and develop a treatment that targets such system, ultimately increasing activity in the striatum. There is already some evidence showing that certain antidepressant-like treatments which target dopamine can reduce anhedonia and normalise brain activity in the striatum of patients with depression. Also, anesthetic and antidepressant drugs, such as ketamine, are considered for treatment of anhedonia. Trials in rodents show that ketamine decreases anhedonic behaviours and increases the production of glutamate (another neurotransmitter) in the prefrontal cortex of rats. A more recent study investigated whether ketamine could also have an effect on anhedonia in humans, and the authors concluded that ketamine can reduce anhedonic symptoms, and that this effect is mediated again by the production of glutamate — now added to our list of potential targets for treatment of anhedonia. What about inflammation? Not only neurotransmitters, but also other systems may be involved in anhedonia. One example is inflammation, and particularly inflammatory molecules called cytokines, which are known to cause anhedonia in animal studies, and to be elevated in patients with depression and anhedonia. I have already discussed in my previous blog about the ability for cytokines to decrease the number of new generated neurons in the brain, and indeed, this may be one of the mechanisms through which inflammation ultimately affects brain structures and circuits involved in anhedonia. However, the evidence is still in its early stages, and more time and research will tell us whether targeting these neurochemical and molecular systems will become an effective treatment option for anhedonic patients. But do not despair — tomorrow, or the next day, or the next, something will taste and sound amazing again. In the meantime, we will continue to relentlessly study new strategies to treat anhedonia in depression, and hopefully, one day, patients will finally regain their ability to enjoy life and to pursue happiness!

“A beautiful mind” is the title of the critically acclaimed, unauthorised biography of the mathematician John Nash, who famously made great contributions to mathematics, in particular in game theory, while battling paranoid schizophrenia for decades and spending long periods of time in psychiatric hospitals. John Nash is a classic example often used in popular culture to illustrate the hypothesised link between mathematics and madness, or at least between mathematics and mental disorders. Kurt Gödel is one of the most important mathematicians in the history of the field of mathematical logic. By the age of 25, he had already authored and proved the incompleteness theorem that made him a celebrity. Throughout his life, however, Gödel suffered many periods of mental instability. When he was awarded the National Medal of Science, he refused to travel to the White House to the award ceremony, fearful that he might contract an illness. He had an obsessive fear of being poisoned and thus would only eat food prepared by his wife, Adele. When she was hospitalised for 6 months in 1977, he simply stopped eating and starved himself to death. His wife died three years later and was buried beside him. Grigori Perelman is a Russian mathematician, who solved a century-old mathematical problem in 2002 known as the Poincaré conjecture (about the characteristics of spheres), which most mathematicians thought was unsolvable. By the time he defeated the Poincaré conjecture, after seven years of concentrated and total dedication to the problem, he decided to quit his job and the world of mathematics while still in his 30's. He then stopped talking to people all together and became a recluse living with his mother in a small apartment in Saint-Petersburg. In 2006, he became the first (and only person so far) to turn down the Fields Medal, the top award in mathematics, and in 2010, he declined the Millennium Prize worth $1 million. He has been referred to as “the cleverest and craziest person on the planet”. John Nash, Kurt Gödel and Grigori Perelman are few of several examples of “beautiful minds” who could solve the most complex mathematical problems but whose lives and those of their inner circle were greatly shattered by their eccentric personalities and troubled behaviours. To this list, one could equally add the likes of Isaac Newton, Alexander Grothendieck, Georg Cantor, Yutaka Taniyama or Paul Erdos, the latter being the subject of a highly recommended biography entitled “the man who loved only numbers”. Do these examples point towards a general pattern linking the practice of mathematics to personality and behavioural disorders? John Nash himself blamed his mental problems on mathematics, when he said: “I would not dare to say that there is a direct relation between mathematics and madness, but there is no doubt that great mathematicians suffer from maniacal characteristics, delirium and symptoms of schizophrenia.” — JOHN NASH After all, to be able to search and find solutions to complex mathematical problems requires a certain degree of obsession, as the great mathematician David Hilbert stated: “Wir müssen wissen. Wir werden wissen. (We must know. We will know).” — DAVID HILBERT While there has been very little research on the connection between mathematics and mental illness, the existing evidence, though scarce, provides some interesting insights. A large study performed in Belgium answers part of our question. The authors analysed a group of 3,659 PhD students from sciences (the category to which mathematics belong), biomedical sciences, applied sciences, humanities, and social sciences, and found that there were no significant differences in the prevalence of mental illness between these disciplines. However, they also noticed that research students were at higher risk of mental illness than highly educated individuals, highly educated employees, and high-education students. This study indicates that it is the inherent nature of research, which is demanding for the mind, which seems to impact the person’s mental state, for all disciplines and not only for mathematics or sciences. Interestingly, the study also highlighted that it is the contextual factors, including work-family interface, job demands, and team decision-making culture, that ultimately make the difference when it comes to the occurrence of mental health problems such as depression and anxiety. Therefore, we will not reduce mental illness by switching research fields or by discouraging the practice of mathematics as some high-risk discipline for the mind, but by improving the conditions in which all research (in mathematics as well as in other fields) is carried out. Another study went one step forward and suggested there are potential mental health benefits in practicing mathematics. Undertaken at Duke University, the research found that engaging the brain in mental exercises involving mathematics is associated with better emotional health. For this, 186 participants underwent a type of brain scanning called functional imaging, while solving mathematical problems from memory, and then completed tests for assessing their mental health status and emotional coping strategies. The results showed that the participants had a higher ability to adapt their thoughts in relation to emotionally difficult situations when they activated specific regions of the brain while performing mental mathematic exercises. Matthew Scult, the main author of the study, says: “Our work provides the first direct evidence that the ability to regulate emotions like fear and anger reflects the brain’s ability to make numerical calculations in real time.” — MATTHEW SCULT For a long time, popular culture and mass media have concentrated their storytelling on the extremes of the distribution: stereotypical mathematicians who were romanticised because they were beautiful but also unhealthy minds. Nearly every movie that touched on the subject of mathematics in cinema (A beautiful Mind, Pi, Good Will Hunting, Enigma, Proof, and others) ended up portraying the eccentric mathematics genius who is ultimately driven to insanity. But we should not forget the vast and silent majority of mathematicians, for whom mathematics is a form of mental gymnastics that enhances their emotional resilience. They live their passion for mathematics while leading normal and balanced lives, far from the cameras of Hollywood, as beautiful and healthy minds. NOTE FROM THE EDITORS: We want to say a huge thank you to Karim Lekadir for writing this very interesting blog for us. Karim Lekadir is a researcher at the Department of Mathematics and Informatics at the University of Barcelona. It is wonderful to have a blog which combines mathematics and mental health. Thank you again Karim!

More than 80 years since it was first used as a psychiatric treatment, electroconvulsive therapy (ECT) still conjures up very strong images. The main topic I want to discuss in this blog is how ECT acts inside the brain but first, let’s talk about its clinical use and the stigma surrounding it. Because when we mention ECT, we think of Jack Nicholson in One Flew Over the Cuckoo’s Nest, strapped against his will to a table by a tyrannical nurse, conscious and awake through the entire procedure. We think of Sylvia Plath’s The Bell Jar, where Esther has a frightening experience of unmodified ECT, that is without anaesthesia, before later feeling “at peace” after modern modified ECT. Often, we think of images we encounter in the media, which tend to depict ECT at its beginnings. The media is right about one thing: ECT does stimulate the brain via electrodes placed on the head to induce a seizure. But it rarely represents the reality of ECT today. Today, ECT is used to treat depression. It helps relieve symptoms in cases of severe depression or in situations considered to be life-threatening for the patient. It is not used without the patient’s consent. The procedure, its benefits and risks are explained by a doctor before making any decision. General anaesthesia and muscle relaxants are used. The health of patients is closely monitored during and after ECT. There really are no reasons to keep the historically negative stigma surrounding ECT alive. Although a more recent systematic review has raised doubts on some of the evidence we have so far, current guidelines on depression treatment considers modern ECT a well-established and safe treatment. While it is never used as a first-line treatment, ECT has been demonstrated to be more effective than first-line pharmacological treatment, which is usually antidepressant medication. ECT is also a fast-acting treatment compared with antidepressants, which can take several weeks before improving symptoms. For this reason, it is indicated for patients with severe depression and who are, in some cases, treatment-resistant, meaning that they do not respond to first-line treatment. Patients who use ECT in combination with common antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs), are also less likely to relapse and have another episode of depression. For some treatment-resistant patients, ECT can be the difference between a recovery process and the risk of prolonged periods of severe depression. Such periods can lead to impaired quality of life and even life-threatening consequences, including suicidal acts and physical deterioration from lack of food and water intake. In addition, the most common side-effects, disorientation and memory loss, are temporary most of the time. They also seem to be more common as the severity of depression increases, because this can lead to more significant memory and cognitive dysfunctions. Even though there is evidence to demonstrate the treatment’s effectiveness and safety, curiously enough, scientists still have to solve the mystery of how ECT acts in the brain to lead to such quick improvements. As ECT triggers a generalised seizure, many biological mechanisms could be involved and affected. However, some theories are more popular and more widely studied than others. One of these is a topic very dear to me, the neuroplasticity and neurogenesis theory. You will have read about this topic if you saw some of our previous blogs on omega-3 fatty acids and blood inflammation. So get ready, we’re talking neuroscience. Here are the basics: neuroplasticity refers to the ability of the brain to remodel connections and networks, in response to changes in the environment or to a disease or injury. Neurogenesis is the process whereby neural stem cells (aka brain-cells-to-be), which are present only in specific parts of the brain in adulthood, proliferate, differentiate, and integrate into the existing networks. Neurogenesis is thus tightly associated with neuroplasticity because it determines how new neurons are born, mature and form connections within the circuitry. Here too, the environment and biological processes can have a great influence because stem cells can proliferate at different rates and can differentiate into several types of brain cells, not all of which are neurons. For example, stem cells can also become astrocytes, brain cells which support neurons and can propagate inflammatory signals, amongst many other functions. In adults, these processes mainly take place in a part of the brain called the hippocampus. This area is well-known for its established role in memory and learning. It is one of the focus areas in depression research because it plays a particular role in the cognitive aspects of the disorder, including the emotional memory dysfunctions. And indeed, when patients with depression have an MRI scan, researchers see that the volume of their hippocampus is reduced. This indicates that hippocampal degeneration is involved in depression. Animal studies have long supported this and show that dysfunctions in hippocampal neuroplasticity and neurogenesis are associated with depression-like behaviour. Where does ECT fit into all of this? ECT has been able to reverse reduced hippocampal volume and is thought to increase the ability of neurons to respond to electric signals in the hippocampus, where immature cells (aka baby neurons) might be particularly sensitive. So ECT comes in, boosts neurogenesis and plasticity then depression gets better? Of course not, that would be too easy. Depression can be associated with elevated levels of inflammation, which you can read more about in these previous blogs. Treatment-resistant patients, in particular, are known for having higher levels of inflammation. Right, but the problem with inflammation is that it typically is considered bad news for neurogenesis. Higher levels of inflammatory molecules cause reductions in proliferation of neural stem cells and lead to the manifestation of depressive-like symptoms, as shown in animal studies. This behaviour is also observed when the immune cells of the brain, called microglia, are activated. Interestingly, ECT has been reported to increase markers of inflammation in the blood of patients and seems to decrease these only in the long-term. Hmm, so how could ECT boost neurogenesis but also cause inflammation, which is known to impair neurogenesis? That was our question too, so we decided to tackle this in our recent paper, published in the scientific journal Journal of Psychopharmacology, last month. To get an answer, we left no stone unturned and searched for any study that measured the presence of any molecule related to neurogenesis and at the same time, the presence of any molecule related to inflammation or immune activation in the brain. This way, we could observe how both neurogenesis and inflammation were affected by ECT. To be more precise, our review focused on studies using ECS (electroconvulsive shock), which is the method used to model ECT in animals: like human patients, they are completely anaesthetised and electrodes are placed on their head to induce a seizure. The studies we found revealed that in the brain of these animals, ECS led to an increase in immune activation and inflammatory molecules, associated with an upsurge in growth and trophic factors, which are molecules promoting neurogenesis, in the first few hours. Even more interestingly, many of the studies we found also reported that astrocytes were also more activated. In depression, astrocytes are usually dysregulated and atrophied, meaning that they decline and reduce in size, so this may be one mechanism explaining the therapeutic effects of ECT in patients. However, studies showed that over time, the brain’s inflammatory response was dampened, while astrocytes remained activated and the proliferation of new brain cells continued, especially in the hippocampus (see our graph below). Interestingly, this mirrors the clinical finding showing that ECT leads to an increase in inflammation directly after treatment but tends to slowly lower baseline inflammation, meaning right before ECT, over the course of the sessions. It would then seem that an increase in immune activation initially helps with regulating neurogenesis processes. One of the hypotheses we formulated is that, considering that some molecules of the immune system can both heighten or dampen inflammation, they could actually benefit neurogenesis under the right circumstances. Have these studies helped to solve the ECT enigma? Not completely, but they give us one more piece of the puzzle and tell us what research should investigate. For example, the fact that inflammation is one mechanism modulated by ECT might explain why this treatment option is effective in treatment-resistant patients, who often have increased levels of inflammation. While writing this paper, we discovered that activation of the immune system and inflammation, which we originally thought would have negative consequences, did not cause damage to young brain cells after ECS overall. Perhaps this can make us think about the prejudice against ECT. It’s easy to think of it as a simply crude and brutal procedure, unless we look at the facts. Of course, it looks scary - it directly affects the brain, the organ we most strongly associate with who we are. Of course, we would prefer to know exactly how ECT works on the brain. But we know that ECT is effective. We know it is considered safe. If you had severe depression and antidepressants did not have an effect, would you not prefer to have at least an option?

Most of us think that a cat purrs when it is happy, however, there is much more behind it, from communication to healing properties. As much as having a cat in our homes requires a lot of work, we can all agree that they add even more than they take. Let me introduce myself, I’m Nicole, a researcher at the Stress, Psychiatry & Immunology (SPI) lab at King’s College London, and a cat lover. I have been surrounded by cats since I was a kid and, ever since I moved to London 7 years ago, I have always been missing my feline friends. Finally, last year I managed to convince my partner to have one here too (keep reading until the end to see his fluffy face). Our furry friend has improved our lives so much: there is nothing better than a nice cosy evening on the sofa with him next to you, or waking up in the morning with him purring. Recently I came across an article that explained how cats’ purrs could help human health and anxiety thanks to their wavelengths. That made me really curious and, using my researcher’s skills, I started digging in and reading more about it. There is a lot more going on with the cat’s purr than you might reasonably expect! With this article, I want to share what I have learnt with you. Let’s begin with a bit of history: The relationship between cats and humans began around 10,000 to 12,000 years ago during the development of early human civilization in the Middle East. As people started to settle, farm the land and store grains, they attracted rodents. The gathering of rodents, of course, was appealing to wildcats ( also known as felix silvestris lybica) who decided to stick around. This was not only convenient for the cats but also for humans and led to a partnership of convenience that evolved into a mutual connection. From the African wildcat to the domesticated house cat, the fascinating journey and history of the cat touch almost all corners of the world. More recently it has been shown that having and loving a cat is not only good for our mood or for getting rid of rodents but also for our health. In fact, studies have shown that people are less likely to die of a heart attack if they own a cat. Even more interesting, are studies reporting that cats’ purrs help people heal. Why do cats purr? How cats purr is still not 100% clear and different theories have been proposed. It seems most likely that the noise is produced by the constriction of the glottis — the part of the larynx (voice box) which surrounds the vocal cords — due to the dilation of the muscles in the cat’s larynx and the air vibrates every time the cat breathes in or out. Cats’ purr is perhaps the most recognisable sign of animal contentment that erupts whenever a cat is tickled or petted. But that’s not quite the full story… Purring has communicative, appeasing, and healing properties. It is also known that sometimes cats purr when they’re nervous, very often when they’re hurt, and sometimes when their caregiver is hurt or sick. In fact, several species of felids vocalise in this way. However, scientists don’t know the exact answer to why cats purr yet. How do their purrs help us? While scientists are still trying to better understand if cats’ purring can be really healing or not and how that can happen, here are some of the speculations. When a cat purrs, it releases endorphins within its brain Endorphins are the body’s natural pain relievers and they can boost your mood too. In fact, they are hormones that cause feelings of happiness, sociability, affection, excitement, and much more. They are naturally produced by the body during pleasurable activities, as well as painful experiences, such as twisting your ankle. It is interesting that purring not only releases endorphins in cats but can also induce the same thing in humans too. Endorphins help decrease stress hormone levels. Lowered stress hormones are helpful for healing, lowering blood pressure, and helping people cope with illness. The frequency of cat purring is between 25 and 140 Hz We all know that cats are able to heal quickly from their own broken bones, and incidences of joint problems and bone cancer in cats are rare. Is it possible that cat purrs can help humans heal faster too? The frequency of cat purring has been shown to fall between 25 and 140 Hz. The same frequency has been shown to aid in the healing of broken bones, joint and tendon repair, and wound healing. A study by Dr Clinton Rubin and his team showed that bones of older sheep started showing signs of repair after being exposed to 30 Hz of vibrations for 20 minutes, five days a week. Similarly, in humans, vibrational therapy with a frequency between 10–50Hz has been found to not only benefit bone repair but also strengthen tendons and joints. In fact, vibration therapy uses whole-body vibration to enhance physical health and overall well-being. Cats’ purrs are believed to have similar effects on the human body. Purring helps the cat breathe more easily Clinical observations of cats that are suffering from upper respiratory conditions resulting in dyspnea or trouble breathing, indicate that purring helps the cat breathe more easily. In fact, respiratory distress related to heart disease isn’t nearly as common in cats as it is in dogs and humans. It seems that a person with respiratory problems might also be able to breathe easier if a purring cat is nearby. But what has the science to say about this? One study found that cat ownership is associated with a reduced risk of heart attacks and strokes. Purring as anti-stress and anxiety If these “healing powers” were not enough, the combined effects of their relaxing presence and their purr make cats powerful against stress and anxiety. Studies have shown that if a person suffering with anxiety listens to the sound of a cat’s purr it may help to distract from the source of their anxiety and will be calmed by the purring sound. Purring helps with migraines Moreover, there are many stories of people with migraines whose headaches are eased or extinguished when they lie with their heads close to purring cats. The reality is that behind all of the warm cuddles and purring, there is an animal that improves mental health by decreasing stress, offering companionship, purring the pain away, and serving as a therapy animal.

Nowadays, everyone is talking about mental health, yet do they understand what this is? Let’s begin this blog by first understanding what ‘mental health’ actually means. At least to me, a blogger and final year undergraduate at the Indian Institute of Technology in Bombay. Many people sometimes refer to mental health as the “absence of mental disorder”. But it’s not just an absence of mental disorder. According to the World Health Organisation (WHO): ““Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.”” The WHO stresses the fact that mental health is not just an absence of mental disorder or disabilities, but rather mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices everyday. Mental health is important at every stage of life right from your childhood to adolescence and through adulthood. Peak mental health is about not only avoiding active conditions but it also includes looking after ongoing wellness and happiness. So, to narrow it down, in my opinion people who are mentally healthy would have: A sense of contentment A zest for living and the ability to laugh and have fun The ability to deal with stress and bounce back from adversity A sense of meaning and purpose, in both their activities and relationships The flexibility of learning new skills and ability to adapt to change Self-confidence and self esteem For some of you reading, these things may seem trivial, but there are also many people out there who are struggling in more than one of the above. According to WHO, one in four people will be affected by mental health at some point of their lives. According to WHO, around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide. The thing that’s most troubling is that people often choose to neglect their mental health issues, and some can be reluctant or unable to address problems they are having. Why, you ask? One of the biggest reasons may be due to poor understanding and empathy from others; in many societies, mental and emotional issues are often seen as less legitimate than physical issues. They can be seen as a sign of weakness or somehow as being our own fault. Some people mistakenly see mental health problems as something we should know how to deal with it ourselves. Men, especially, would rather prefer to bottle up their feelings than seek help. As per a research done by National Centre for Health Statistics (NCHS) on 21,000 American men, nearly one in ten men reported experiencing some form of depression or anxiety, but less than half sought treatment and men die by suicide 3.5x more often than women. In the modern age, we’re obsessed with seeking simple answers to complex problems instead of finding out the root cause. We look for an out with others by compulsively checking social media instead of reaching out to people in the real world. We should look for an outlet for our feelings not on social media but by building deeper connections with our friends and family. Burying your feelings inside can lead to a spiral down into depression and anxiety issues. As said by Beth on bustle: For people in depression, it’s like being in a dark room where the light switch and door handle is missing. — — — Coming back to the title of this blog, we all know that this ongoing pandemic has taken a toll on the mental health of almost everyone in society. With all the traumatic things that are going on around the world, the situation is getting worse and has been affecting our mental health negatively. Let’s understand how all this is affecting our mental health by using an analogy. Assume life in pandemic is an internet browser and you have a million and one browser tabs open, all demanding different thoughts. Some of these tabs are making different noises such as several social media tabs shouting negative and anxiety-provoking news and thoughts at you. Some are playing those little annoying tunes that get stuck in your head on repeat. Some tabs are things you genuinely need to worry about in the sense they demand genuine attention like deadlines at work, looking after the dog, keeping the house tidy, or appointments. Others are detrimental. The pop-ups that come up in front of everything else telling you that you are going to fail or you can’t do it or tell you other people think badly of you or that someone is better than you, are the most concerning. Sometimes, these pop-ups are so demanding and just keep appearing no matter how many times you try to click on the little ‘x’ to try to get them to go away. But you need to click ‘x’ every single time and block that pop up. Sometimes, your browser may also hang or stop working due to reasons beyond your control, like losing your job or having a serious accident or getting hospitalized. In these situations, you need to be patient, have faith in yourself, not overthink on the cause of the reasons, and just restart the browser. Also, one of the main reasons why this pandemic is affecting our mental health negatively is because, what we are fighting, we can’t completely control. And, as the psychiatrist Paola Dazzan says in her Inspire the Mind blog: “We are used to having control in many aspects of our lives; I know I certainly am. We decide what books we read, which movies we see, which friends we go out with, which jobs we prefer and even which cities we would like to live in.” Suddenly, we find ourselves stuck in a situation over which we have little control left. Our brains are not wired to tolerate this type of uncertainty, but rather to evaluate the threat and decide what actions to take. The numbers of COVID-19 cases in India, where I live, have been rising exponentially and the curve is not flattening anytime soon. Even after this, the government decided to lift the lockdown to revive the economy. But the pandemic has definitely had a major impact on everyone. Many people have lost their jobs, businesses are facing losses and there is so much uncertainty everywhere. I live in a city where the cases are constantly increasing day by day. And the fear increases when new cases are emerging every week in your society itself. These things definitely take a toll on our mental health and the atmosphere of fear is still there, everywhere, even though the lockdown has lifted. But there are ways to keep our mental health strong during this pandemic. Well, I do not have that silver bullet, but if you keep reading, perhaps you will find some understanding of how you can make it work for you. Take part in some form of physical activity It has been proven that exercising daily can give your mental health a boost. A study showed that people who exercise regularly say that it gives them an enormous sense of well-being. According to helpguide, they feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives. It also relieves stress, improves memory, helps you sleep better, and boosts your overall mood. And you don’t have to be a fitness fanatic, you can join an online yoga class, start gardening, go for 15-minutes walks or jog. Just rejuvenate yourself through physical activity. Furthermore, in times like these it is even more important as there is evidence which suggests that physical exercise can improve the function of you immune defenses — you can read more about this in a recent InSPIre the Mind blog. Practice mindfulness in everything you do throughout the day According to this blog, mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us. Mindfulness improves your well being, mental health as well as physical health. Some ways to practice mindfulness are basic mindful meditation, body sensation, sensory and emotional check. Above all, practicing mindfulness involves accepting whatever arises in your awareness at each and every moment. It involves always being kind and forgiving toward yourself. One tip to keep in mind is to gently redirect to the action you are currently performing. If your mind wanders into daydreaming, or criticism, or negative thoughts notice where it has gone and gently redirect it to sensations in the present. By focusing on the present actions, many people find that they are less likely to get caught up in worries about the future or regrets over the past, are less preoccupied with concerns about success and self-esteem, and are better able to form deep connections with others. Again, you can read more about this in another InSPIre the Mind blog. Make social connection a priority, especially face to face After all humans are social creatures with emotional needs for relationships and positive connections with others. We’re not meant to survive, let alone be happy, in isolation. Our social brains crave companionship, even when experience has made us shy and distrustful of others. But why is face to face communication so important? Phone calls and social networks have their effect, but nothing can beat the stress-busting, mood-boosting power of quality face-to-face time with other people. Of course, this isn’t as simple as today’s life so, have those zoom or Skype happy hours with your friends and family, this will make you feel wanted and lighten up your mood instantly. Also, please keep in mind that reaching out is not a sign of weakness and it won’t make you a burden to others so you should also consider sharing your feelings. Most people are flattered if you trust them enough to confide in them. If you don’t feel that you have anyone to turn to, there are good ways to build new friendships and improve your support network. Reduce your screen time Our screen time has definitely increased during this lockdown period and with all the rumors and negative news that floats around on social media, it affects our mental health indirectly, and more than you think. Negative news can get stuck in our minds and we can keep pondering over it for days and weeks to come only to find that the news was fake. So, stick to some few reliable sources and feed yourself information only from those sources. And try to reduce your screen time as much as possible. Start reading those books you always wanted to read, listen to podcasts (there are very interesting podcasts out there) or create something yourself. Be grateful Be grateful for what you have currently. You are very lucky if you are at home, have food on your table and getting a good sleep. There are many people out there who aren’t at their home in this lockdown, don’t have food to eat and can’t even get a comforting place to sleep at night. You must be thankful for whatever you have. Being grateful will help you focus on what you have, have a positive outlook on life and boost your mental health. Change the meaning of the lockdown in your head. The way you perceive it will influence your emotional state. Think of it as an opportunity to slow down from the madness of a hurried life. A chance to connect with yourself — to pause, to re-evaluate and to reset your life. It is perhaps nature’s way of giving us a wakeup call! It is important to remind yourself that you are not alone in this and this will not last forever. As Dr. Dazzan says in her blog: “This thing will be over soon and one day we will say “Do you remember those months during the coronavirus crisis?”. Let’s get to that day as soon as possible.”

Through this whole corona virus-lockdown ‘end of the world’ situation, a few things have kept my mental health afloat: coffee, impromptu ABBA karaoke performances sung with feelings, my cats’ habit of napping in the crook of my neck, and deep conversations about life, the universe and everything (yes, this is a reference from the Hitchhiker’s Guide to the Galaxy). And running. I love running. And yet, my first memory associated with running is me, aged 9, fainting at the back of an ambulance because I had to race despite suffering from bad respiratory allergies. After that, the dislike I had for running only blossomed into disgust because I was forced to do it at school. I developed an impressive history of fainting. I badly sprained my ankle. I apprehended each physical education class with an anxiety that, I realise now, was far from average. I tried to get sick to avoid the yearly cross-country race with so much diligence that I got whooping cough. I was the friend who dreaded runs. To this day, I still have terrifying flashbacks at the words “Cooper test” — a gym class test that requires running as far as you can for twelve minutes, uninterrupted. No offence, Mr Cooper, but who enjoys that? Now I have a Spotify playlist dedicated to my runs. But this blog isn’t to convince you to go and get your sports shoes on. It is to explain how and why, sometimes, your brain and body need to be tricked into it as a unit, rather than as two uncooperative partners. We will more specifically look into how negative emotions, or physical perceptions, can play a role into having a negative experience of exercise. However, between my days of loathing running and now, I became a (neuro)scientist. Which makes it hard to deny that, objectively, exercising has its advantages. Regular physical activity leads to several health benefits, such as lower blood pressure and enhanced insulin sensitivity, meaning that less insulin will be required to lower blood glucose levels. These are associated with decreased risk of developing cardiovascular or metabolic diseases. And of course, your brain pretty much loves exercise, too. As described in a recent InSPIre the Mind blog, physical activity reduces the release of the stress hormone cortisol, as well as levels of inflammation, while promoting the production of trophic factors. Trophic factors are molecules supporting the growth and survival of brain cells and are also thought to underlie the effects of anti-depressants. Essentially, exercise acts against a trio of ingredients forming a fool-proof recipe for depression: stressed, inflamed brain cells with reduced life support. It comes without surprise then, that regular exercise decreases symptoms of depression, as confirmed by a meta-analysis of clinical trials. Similarly, it also reduced the risk of developing dementia by 28% in a meta-analysis of prospective studies, likely because the recipe for dementia involves some of the same ingredients. Is that why people are suspiciously cheery and upbeat after a workout? You’re probably thinking of runner’s high, this euphoria sensation experienced after prolonged low-to-moderate intensity endurance exercise. If you must know, yes, evidence points towards your brain literally being a little bit high. That’s because the brain has the wonderful ability to produce molecules very similar to those drugs people are taking. Except that it occurs in ways that do not require taking drugs. Isn’t the human body neat? The most popular theory is that β-endorphins, your homemade opioids, are responsible for this by acting on brain structures associated with pain and emotion regulation. That would explain the “I feel no pain and I’m happily invincible” sensation. However, opioids are not released after all types of physical exercise. Scientists aren’t fully sure they can easily get access to the brain either, since it is protected at medieval fortress-levels. This led researchers to discover that there was also a role of endocannabinoids, the brain’s own brand of molecules acting on the same receptors activated by tetrahydrocannabinol (THC) and cannabidiol (CBD), the active principles of cannabis, in this effect. But… is exercise always this good for mental health? While this can be true most of the time, there are many ways in which exercise and mental health don’t influence each other positively. For instance, exercise motivation related to weight and appearance is linked with lower self-esteem and more eating disorder symptoms. While it may seem obvious that using exercise as a mean to look a certain way isn’t healthy, there remain numerous insidious ways in which we are led to associate it with harmful ideas. “Fitspiration” hashtags on social media, used by some young users to set the “healthy ideal” they want to achieve, most typically contain pictures depicting thin, athletic girls and muscular boys. So much for promoting realistic body expectations. How many times have you heard the sentences “No pain, no gain”, “Oh you only ran 3k? It’s okay”, “I don’t want to be skinny, I want to be strong” or, jokingly or not, “You’re such a wimp”? Taking this into account, can we really expect everyone to have a positive disposition towards physical activity? Unsurprisingly, physical activity motivated by weight and appearance is related to decreased measures of well-being and exercise engagement. It was also shown that that participants with a positive emotional response after exercise were more likely to continue exercising. This emotional response is determined by cognitive factors, including your perceived competence and expectations, and interoception, which is your perception of the internal state of your body. This means that if you think you can’t do it, have unrealistic expectations or goals, or feel physically bad during exercise, you’re likely to have a negative emotional response and not keep doing it. These factors become progressively more important in determining the emotional response as the intensity of exercise increases. For this reason, self-paced workouts would be more effective in maintaining participant engagement because they approach, but do not exceed, their ventilatory threshold, which is essentially when breathing becomes really laboured. The influence of subjective and psychological factors on performance is even more widely studied in athletes, who despite enjoying exercise, must pay attention to their mental health in relation to their body. Athletes perform better if they have better emotional regulation, concentration, and coping strategies. For example, athletes who were asked to suppress their emotions before exercising perceived higher levels of exertion. In addition to biological changes in the body and the brain, emotions, motivation, and memory seem to determine fatigue and perceived exertion levels. Moreover, athletes can be at increased risk for mental health disorders depending on the demands placed on them. And because stigma is higher in this particular population, they are also less likely to seek psychological help. However, the bottom line here isn’t that exercise is something negative because it can be associated with harmful ideas and behaviour. Neither is it that everyone who doesn’t enjoy exercise should try and get started. Because maybe they tried and hated it. Maybe they feel negative emotions if they anticipate exercise. Maybe they haven’t found the right motivation, or the right environment that would allow them to start appreciating it. The bottom line is that you should factor in and check in on your emotions and motivation when it comes to exercise. As beneficial as physical activity is for your mental and physical health, the relationship between mind and body goes both ways. Personally, I started thinking that, perhaps, running wasn’t some form of hellish torture when my flatmate took me for a run, one evening, and at the right pace, I could do it. I didn’t feel as if my lungs were collapsing and nobody cared whether I did a kilometre or three. Running became more regular when it turned out to be the best excuse I had to take a break from studying and to try to deal with all the emotions I had. If I focused on putting one foot in front of the other, on making sure I could take one breath and then the next, it was easier to process all my negative thoughts. Now I run to give some space to intense emotions and preoccupations, take a step back and let go of what I don’t need. I run when I’m frustrated, when I’m stupidly anxious, when I’m angry. I run when I don’t know how solve a problem, when I’m disappointed one of my lab experiments didn’t work, when I’ve been hurt. I ran so much that I now also run simply to enjoy a crisp winter morning. I never run with hard goals in mind or with the pressure of having to smash my record. I don’t time all my runs because life is not a Cooper test. Mostly, I just want to run. (Alright, sometimes I want runner’s high too). It took a lot of listening to what my brain and my body were telling me to eventually, find it in me to take the first uncomfortable baby step, to find a way of exercising that felt right and a reason to keep doing it. So maybe, if you just wish you could enjoy exercise, but you really don’t, sit for a little bit with your mind and body. Think about how they respond to exercise and how they influence each other. And in case you decide to give it a go, remember that pushing doesn’t always mean pushing your body’s limits. Sometimes, pushing is finding it in you to get up and try, to reconsider what you think and to learn how to work with your body, instead of against it. Remember, there’s a lot going on underneath “just doing it”.

The Lockdown experience from a neurodivergent perspective: Pre-lockdown a perpetual rhythm of Go! Push, rest, repeat across different sectors, timelines, social and neuro-tribes, the pace relentless, the intersectional finish lines? Rolling. Lockdown has presented —  an isolating yet unifying awakening that has allowed much needed time, space and quiet to consolidate the various splices of myself, each aspect authentic but also fragmented. The change of pace has afforded me the time to consider the various sections and sectors traversed during pre-lockdown; ranging from educational, professional, cultural, social to biological and neuro-tribes all being simultaneously straddled. The lockdown brought each carefully moderated stream crashing together — when various types of marginalisation’s meet at the intersection, the only option is to embrace the complexities. One into many, the conclusion I came to in the first week of isolation, the pre-lockdown construct was a little tight across the shoulders, with little room for manoeuvre at the best of times — the vertical bones and blood existence jockeying for position with the horizontal ‘invisible’ neurodivegence, but finding a space that had room for the whole self proved to be an ongoing challenge. My brain and way of being often extremely aware of mainstream ‘comfort levels’ and how to deploy self-taught social recipes, drawing on internal resources to facilitate navigation of mainstream terrain, by that I mean day to day living, communicating, commuting and working (masking for health and safety reasons when required, always a last resort and involuntary auto-masking). Embracing the complexities involved a form of self-confession to enable the navigating and narrating of pre and current lockdown trauma and triumphs; using various ways to get it out of the body and mind through crafting, speaking, moving and vocalising. This creative process looked like: Condensing feelings and embodied experiences into 2-dimensional key words, followed by expanding them into tangible objects, creating and translating this into song or poetry to enable access to the borderlines between the intricate sections of the intersectional lived experience of a 3rd generation West Indian, neurodivergent, woman, professional, devoted family member. What’s next? Returning to the world with joined up sections will be the next challenge, post lockdown. I have been working within my fields for some years, spanning special Educational needs (SEN), research and Inclusive Design, and have advocated for a more joined up cross-sector approach at all given opportunities. What has become apparent through this lockdown is not only the unifying and to an extent equalising force with differentiated access to information and offerings ranging from science, technology, engineering arts and math (STEAM) to cultural heritage; including formats that in some cases were previously categorised as not possible or unreasonable (requested pre-pandemic) by members of my community, now being rolled out in a matter of days for the mainstream (with many raised neurodivergent eyebrows). There has also been stress inducing changes impacting the wider disability community. This concerns article 41, that essentially destroys the UK’s compliance with the UN convention, along with changes to SEN law, that will impact the duty of care exclusively for SEN children, coupled with not entirely positive changes to London focused commuting and restrictions on Freedom passes. This has caused stress and anxiety in my communities; many of us are justifiably worried and feeling unwelcome all over the UK, in places that we comfortably called home, pre-pandemic. Currently, I am working with an agile team trying to create a digital conduit to aid the processing of these lived experiences. Over the past week there have been great and inspiring online conferences, rallying cries such as ‘unlocking lockdown’ and ‘building back better’; these have merits and are well intentioned however, this is based on the challenges faced by my communities to fully address the pain points. We will need to ‘build back different’ —  protecting and preventing the purging and erasure of rights related to marginalised groups and all forms of tangible and intangible erasures; ‘building back different’ with equitable principles that facilitate inclusion, social justice and universal compassion as a foundation would be a positive start. How can we each embrace all of the above on a personal level? By weaving this into our day to day lives, being an ally, deep listening, reaching out to marginalised groups impacted (to know what type of allyship is needed), through mainstream work and the community — this could include formal and informal learning, engagement, and sideways communication. Moving away from the top down bottom up to meet in the middle method; instead adopting a sideways approach in its place. To conclude this blog I would like to share with you this poem I have written that explores the inner and outer worlds running parallel; the ups, downs and in-between places experienced during the lockdown. Poem Hope Love Faith The silence rings out in city capitals, Oxford Circus is so quiet and it seems as though Times Square has lost its soul, but despite all this brave London is still open. Hyper connectivity beyond borders, offline transitions, transactions, interactions, shoulder to shoulder; a hazy memory of how it use to be. The good old days were, quite literally yesterday nonetheless were still standing firm today, in our own myriad ways. Through the looking glass we go, I think Alice went here once before; everything’s different and yet it all looks the same; mirror reflections, the informal is formal, the private is political, yellow and black lines on the floor mark the space, keep it safe, distancing, sterile and cautious, yet we are more attentive, we are listening, voices in an equalised landscape. Flipped and reversed, everyday gestures mean something else, frozen in place, masks on our faces, working together; gallant and selfless; so brave. 2 metres to the sky, 2 metres to the ground, 2 metres between you and I. Suspended animation to contain the contamination; an outpouring of love, a stay from visiting loved ones. Withheld IRL kisses ad infinitum, with generous sprinkles of courage and true grit, endless hugs banked, their currency building, hand to hand interactions put on hold countless weeks and months. So near yet so far, away from those we love. one universal declaration of devotion, crossing the divide; flattening the curve together weathering the invisible storm every night, each life touched, we won’t give up. Using love for shelter and hope for sustenance, we rise in unison with each triumph, every tear drop adding to a rising tide of compassion and understanding for a safe landing. The recipe is bittersweet but shall improve with time, let’s follow the instructions, they need no introductions. Take physical rest schedule this in, mark the start and the end of each day you are blessed with, take mental rest with zeal, I know this is surreal — do it your way, you could get your household involved — even make it a habit that is long term, social media rest — something every Millennial, Boomer, Gen X and Gen Z can do with; it’s time for a new rhythm, confuse the algorithm and set-up new boundaries, a healing new foundry. Put a pause on production creative or STEM, give your ears and eyes the space to unsee and unlisten through sensory rest, journaling can help to unpack a busy mind and lay the foundation for emotional release, treat yourself as a friend and be kind. Take from this what’s useful and leave what is not, add this to your time to heal, let it marinade if required. Continue sharing the same sun and moon like we always have done. All eyes fixed on the horizon. By Natasha Trotman Copyright © 2020 NOTE FROM THE WRITER: Natasha Trotman is a neurodivergent, Inclusive Designer and Researcher; her work examines different ways of experiencing and processing the world. NOTE FROM THE EDITORS: We would like to say thank you to Natasha for giving us some of her valuable time to write her second blog for InSPIre the Mind. Thank you Natasha!

In these recent months of lockdown, I have felt drawn towards — or, better, hypnotized — by the nature around me. I have surrounded myself with a dozen houseplants and been on daily walks in the most remote areas I could find. I have felt that, now more than ever, since I have not been able to connect with the ones that I love in person, I needed to connect with nature. Plus, trees don’t ask you “you’ll be 30 soon, when do you plan to settle down?”, which makes interacting with nature a lot easier than with family! During lockdown, we saw our freedom to spend time outside our homes limited to one hour a day. A necessary measure that thankfully only lasted a few weeks, as lack of sunlight, social isolation and limited time in nature are known risk factors for the development of common mental health issues. Now that lockdown is finished (or partially finished) I thought I would share my experience of connecting to nature and finding a new sense of inner calm, beyond my yoga practice. If you read my previous blog on InSPIre the Mind, ‘Yoga philosophy and mental health: dare to go beyond the downward-facing dog’, you will know that yoga permeates all aspects of my life. Yoga’s sister science, Ayurveda, teaches us that humans are made of five elements (earth, water, fire, air and ether), as is everything in the universe. This means that we are no more than an expression of nature ourselves — fluid like water, transformative like fire. These five elements are materialised in our sensory organs. Our perception of the world is made possible through our five senses. Consequently, our internal world, our mind, is directly affected by these. I therefore believe that we are able to influence the state of our minds by choosing our surroundings. Several studies, including this 2018 study focusing on UK households, have shown that rates of anxiety and depression in adults is higher in urban areas than in rural ones — and these findings account for socioeconomic status, employment status and household income. Further examples include this multi-study analysis that showed that physical activity in the presence of nature brings benefits to mood and self-esteem. Another study argued that more green areas in a neighbourhood are linked to lower rates of depression, anxiety and stress. Even if we are not fully aware of these effects of the outdoors, we have found clever ways to cope. Raise your hand if you have dreamed of leaving the city for a little cottage? ‘Cottagecore’ is a nostalgia or a longing for leaving urban life and living a slow, ideally sun-filled, rural life. Following the government’s strict lockdown measures, a lot of us have spent hours dreaming of a life without supermarket queues, unlimited outside space, hills, meadows, and homemade sourdough bread. I even had a look on Zoopla (like all of London it seems) for a dainty property with a garden outside of London, close enough that I could commute to the office. Spoiler alert: I am a millennial and of course I can’t really afford anything like this. On par, there has been an unprecedented surge on the sale of seeds and plants to curb the urge to move out of the city. I would know, I was that person who waited seven weeks for a few plants to be delivered from an online retailer. Find peace and stillness in nature and you will find it within yourself. There is a beautiful quote by the 13th century poet Rumi that reminds me exactly of this. ““Do not feel lonely, the whole universe is inside you”” — RUMI In my research for this blog I stumbled across a fantastic form of therapy that I didn’t know existed — ecotherapy — a treatment that involves outdoor activities in nature, such as gardening, farming, walking or cycling through nature. Ahead of the curve, the Japanese have been practicing shinrin-yoku, translated as ‘forest bathing’. This practice, backed up by science, is not exercise but instead consists of taking in the forest with our senses, aimlessly and technology-free . This practice can even be done in more urban settings, like parks or gardens, as long as you have trees. I have a little confession to make: before lockdown, a few times a week I would take a break from my office chair in the afternoon and would go for a short walk in Ruskin Park, the closest green space to our office in Denmark Hill. I would make a conscious effort to look at the trees, the little communal garden, smell the cold air and look at the clouds in the sky, without headphones, without letting my mind wonder too far. I would then come back to my desk more relaxed and feeling refreshed for the last couple of hours of work that day. The app Headspace has some fantastic mindful walk meditations that invite you to watch, hear, feel and touch your surroundings during walks. A mindful walk is a fantastic way to bring you to the present moment! If this doesn’t seem like your kind of thing, or you are not able to get out into a green space, there are other practices that the UK charity Mind suggests, such as growing or picking your food, having plants and flowers inside your home, doing outdoor activities, helping the environment or connecting with animals as ways to enjoy nature. My tip: I love surrounding myself with leafy tropical plants and frequently play wave or forest sounds in the background while I work. See some of my plants below: In conclusion, research has gathered really strong evidence on the benefit of nature in mental health. Even if you live in a busy city you can find ways to reap these benefits…You don’t need to move to the sticks and keep chickens! I will continue to look after my Monstera deliciosa, go for daily walks in the park and I swear to pet every animal that crosses my way — even though I was once bitten by a rabid cat in the jungle, but that’s a story for another blog.

My name is Grace Gatera. I am 27 years old. In those years, I have attempted suicide twice, and have had countless episodes of panic disorder, I have been depressed, I have had PTSD triggers and I experience anxiety almost daily. Lady Fear sits on my shoulder like a companion, pointing out random things for me to be terrified of; over the years, these have included phone calls, taxis, visiting people, eating, not eating, wooden floors, certain really safe parts of my house, the dark, light, music, books, and endings. Oh, and Freddie Krueger (but this is very justified.) The older I grow the more I can curb these urges, to contain my fear. I used to have panic attacks regularly, but now I have them once in a blue moon. I no longer get PTSD triggers regarding the genocide against the Tutsi, but now I get them for sexual abuse. Yes, that happened to me too. In recent times, these too had subsided, from full on shut-downs to tangy metallic aftertastes in my mouth, but recently the pandemic happened. Growing up with mental illness is quite the experience because there exists a distinction between you and everyone else. You know even as a child that there are some experiences prohibited for you. For me, it ranged from small things like never watching any movies that had violence of any kind in them, which of course negated even some cartoons, to knowing that you are causing a commotion and being desperately embarrassed and deeply resentful of the person you are. I cannot breathe in fully because our school nurse broke a bone in my rib cage giving me CPR during a panic attack. I cannot sleep without some form of light because I experience visuals of suffocation. I am overweight, a physical reminder of my coping mechanism consuming my life after sexual abuse. I am also an activist. Actually, I would rephrase that to say that I am a lived experience mental health advocate. Which means that I use whatever means necessary to advocate for affordable and accessible mental health care for specifically young women and girls in low and middle-income countries. In my country, I am a youth division lead for Yego Rwanda, an NGO dedicated to the mental health of genocide survivors and the families of perpetrators. I concurrently serve as a young leader on the youth campaign for the Lancet Commission on Global Mental Health and Sustainable Development. I also work with the Wellcome Trust as a youth advisor. All these roles are geared towards disseminating a clear and simple message, that the mental health crisis that young people are facing right now is important, and it is important that the people in positions of power, nationally or globally should focus dedicated energy and resources to address it. These roles to me would mean nothing if they did not stand for a complete and thorough revolution in the way mental health care for young people is viewed. I am lucky that the organizations I have mentioned above champion these causes. To me, an acceptable outcome from all this work is that specialized mental health care is made accessible to all young people, regardless of geographical location, race, and creed. I have lived on the extreme end of not receiving mental health care, both clinically and socially, and I do not want anyone, especially little queer black girls like me, to ever go through what I went through growing up. I believe in affordable, accessible and specialized mental health care for all, but specifically for poor black Africans in sub-Saharan Africa. I have dedicated my life to the pursuit of this goal. Lived experience like mine informs my every goal, my every move, and I know this to be true for other activists like me, and that is why we should be at the forefront of the movement for mental health. When you read up on how mental health care has been transformed in the space of a few years, to move from punitive restriction (asylums and inappropriately administered shock based therapy) to recovery-based care, one has to marvel at how many people have worked in the shadows to make this accessible. How many lived experience activists have given their lives, and yet it is still not enough. Mental health research and care is still incredibly western-centric. This is to be expected, western countries have more resources to spend on the improvement of mental health care. However, there has to be a time to shift energies to equip younger, less resourced nations to handle this growing epidemic. This must start with a shift also in thinking. Racism still informs the world’s perspective on under resourced nations, and, for many, countries like mine, Rwanda, is still just a vague picture of savages, with dirty snotty nosed children with flies on their eyes, or statistics, numbers of poor and diseased. We are still dealing with pandemics like malaria, HIV/AIDs and malnutrition, not to mention with war and political instability, so there is no need to think about mental health care for us, yet. Right? No! We are people too, we deserve the same kind of care, or even more specialized care for the centuries of harm our countries have been forced to endure. The voices of young people (or relatively young like me) are speaking up now, more than ever to demand change, to demand a revolution in thinking. Maybe in the next century, people like me will not have to suffer through broken ribcages and near deaths to finally receive the care they so richly deserve. It is time. It is past time, actually. NOTE FROM THE EDITORS: Grace is a lived experience, youth mental health advocate, living in Kigali, Rwanda. She serves as a Strategic Advisory Board Member for the Wellcome Trust, and is a young leader for My Mind Our Humanity, a youth campaign for the Lancet Commission on Global Mental Health and Sustainable Development. Grace truly is an inspiring young woman and we would like to take a moment to thank Grace for taking the time to share this powerful piece with us. Thank you, Grace — we look forward to seeing what’s next!

“Art washes away from the soul the dust of everyday life” said the painter Pablo Picasso. In the last few months, this quote came to my mind very often, particularly when my thoughts and heart felt particularly dusty, due the covid-19 situation. During this time, as with other difficult times, the healing power of art, in the form of a book, an inspiring painting, or music, has helped me to find new energy and positive thoughts when I was feeling down. One day, I experienced a similar effect after talking to an inspiring woman, Baroness Deborah Bull, and I think this is because she is a woman of the arts, among other things. As a doctor and a scientist, I have always thought that science is not something separate or opposite to art. On the contrary, I feel that scientists could (or should) be a bit like artists, and that, alongside logic and methodical research, creativity and inspiration are what often make the difference in scientific discoveries. With her long and diverse career, Deborah embodies the dialogue between art and science in all its potential. She danced professionally with the Royal Ballet for 20 years, before becoming creative director of the Royal Opera House. Currently, as Vice President and Vice Principal at King’s College London, she is the sponsor of an important research project on the effect of art on physical and mental health. Moreover, to add to her impressive resume, since 2018, she has sat in the House of Lords as Baroness Bull. Having discussed inclusion with the clinician Paola Dazzan, and the impact of women in basic science with Francesca Cirulli, now is the time to talk with Deborah and the rising power of connecting art, science and politics. By the end of this blog, we will see how artists can fit into scientific and political environments and make the most of their “diverse voice”. I started by asking Deborah how her career as an artist, or more precisely, a dancer, had begun. Deborah: My passion for dancing started when I was very little. I could probably dance before I could walk- or so my Mother said- and I had always known that I would become a ballet dancer. After years of hard training, when I was 18, I was offered a place in the Royal Ballet and I had 20 years of a ballet career, ending up as a principal dancer. Me: I know that you gradually gained higher positions involving more responsibility, like when you became creative director of the Royal Opera House in your late 30's. You know, in academia we don’t have so many women in senior roles or in positions of power, is it the same for the arts? D: Yes, there are some aspects in common. In the ballet world, there are more women than men, but in positions of power, the situation is inverted. In particular, many women are ballet dancers or teachers, but not choreographers or company directors. In the art world in general, like in academia, the percentage of women falls as you go up the ladder, probably for some of the same reasons. (If you want to know more about this, Deborah talked in detail about this in her speech at the House of Lords on the occasion of Women’s International Day 2020). Me: This was not the case for you, though, as you gradually gained leadership positions. How did you make the transition from being a ballet dancer to the subsequent parts of your career? D: I stopped performing in my late 30s, having found a series of opportunities presenting themselves alongside my career: I started writing, participating in TV and Radio shows, and undertaking a range of activities at the Royal Opera House, which then became a formalized job. I feel very fortunate because it’s not always easy to move forward from a career that has been very consuming, like the career of a ballet dancer. Me: It looks like you built up a career through the development of different skills apart from dancing, like communication and creativity, and it seems that you have been able to be flexible. Can this be an ingredient for a successful career? D: Yes, for me, it is the ability to connect across subjects and to be ready to flex, together with a certain amount of bravery to step away from the conventional path and think things differently. You can’t keep doing things in the same way - the world around you changes, and in order to keep achieving, you need to change as well. Sometimes, I think it is about having developed a body of knowledge that is transferable to different domains. In my case, through the process of becoming a dancer, I learnt about resilience, dealing with failure, leadership skills and so on, and this creates a body of knowledge that is useful for what you do next. Me: How did this body of knowledge bring you to King’s College London? D: After 11 years as part of the Royal Opera House executive team, a position at King’s came along, in 2012. King’s was bold enough to appoint me even though my curriculum vitae was different from other senior people in the institution. King’s really does recognize the value of people who are able to make connections between the university and the world around it — in this case, it was London’s cultural landscape. I was able to build on a long history of partnership at King’s to extend its relationships across the cultural sector and to bring many excellent initiatives together under a strategic framework. Now, Deborah is the executive sponsor of the world’s largest-ever study of the impact of arts intervention on physical and mental health- SHAPER. The project, funded by a £2m grant from the Wellcome Trust, will study three interventions: movement and music sessions for stroke patients, singing for women with postnatal depression and dance for people with Parkinson’s disease. We covered the launch of this project in another InSPIre the Mind blog, here. Me: The core idea of this big project is that art can boost both physical and mental health. When did the epiphany about this hypothesis come and how did you manage to translate it into a big research project? D: When I was a ballet dancer, there was a project to bring pairs of dancers to hospitals and hospices to perform for the patients. Once, at the end of the visit, I had a pleasant chat with a patient, mainly about things like my costume and my experience as a dancer. Afterwards, the ward sister thanked me, and told me that the patient had not spoken at all since she arrived. That raised in me a question: what was it about that experience that had made a difference for that person? Over the following years, I witnessed how the art experience had a positive effect in different settings. In schools, I saw that children who struggled to achieve made real improvements after engaging in arts activities. Similarly, in prisoners, arts and creative activities can develop important skills like communication, discipline and the ability to work as a team. One of the joys of coming to King’s was the chance to connect with researchers who could bring new insights to all this. Eventually, with a brilliant group of researchers and arts partners, King’s has secured the grant to deliver the SHAPER project. The research project is in partnership with Guy’s and St Thomas’, King’s College hospital and South London and Maudsley NHS foundation trusts, arts organisations and community centres in Lambeth and Southwark. The ambition is to see these arts-based interventions embedded in NHS treatment pathways and recommended by the NHS funders, the Clinical Commissioning Groups. Me: Why do you think the arts have this unique ability to help people and make them feel better? I think that this question is even more crucial in this particular period, with the covid-19 and social distancing rules significantly impacting on people’s mental health. Now, the positive effect of the arts is needed more than ever. D: It is a very complex question with several answers! Art communicates without words, so it enters the body via a different language which provokes a different response, an emotional one. It can also offer a safe space for expression and to deal with some personal issues. It allows us to recognize the common element of being human, the fact that we fear and celebrate the same things. We also know that different types of arts can have a different beneficial effect on the body: dancing provokes the release of endorphins, singing can be good for lung function and an art experience can help in different ways, often providing a sense of achievement which leads to wellbeing. And it is not surprising that during the lock-down period, people were finding ways to make music, or to read together. At that moment, my mind pictured the image of my Italian compatriots singing together from their balconies at the start of lockdown. I remember how, in that period, art became a relief for them, and, at the same time, watching them performing was a big relief for me. Deborah and I then went onto talking about her experience as politician in the House of Lords. It was during this conversation that important aspects regarding the role of women came up. D: The House of Lords is a fascinating place, with many expert voices across science, medicine, law and civil society. In parliament, women are very active. However, sometimes it looks like there are “gendered” speaking lists. For example, if there is a debate about social care or wellbeing, you can see more women speaking. In some other debates, like those about Brexit, there are not so many female voices as you would expect. This also made me realize that there was no particular mention in the debates about the impact of Brexit on women. That is why I did a speech on the topic, highlighting how, in 7-days of transcripts of debates about Brexit, counting 280,000 words, the word “women” appeared only 13 times. Here, you can also find the link to another speech that Deborah gave last year, highlighting gender disparities in political roles. I concluded our conversation by asking her whether there is a particular project she is promoting in the House of Lords at the moment. D: Yes, one of the things that I am working on is the problem of weight discrimination or stigma. My interest comes from the potential impact of long-term bullying in young people and whether this can lead to eating disorders or other mental issues. There is a growing stigmatization of obese people, but there is no legal protection for this discrimination, so I am raising awareness of this and I am also bringing together colleagues from the policy area, obesity community and the psychiatry community, to look together at whether there is a need for legislation and, if so, what would be the best route to get there. As a psychiatrist myself, and one who has worked with patients with eating disorders, this is a topic that really captured my interest. I know from clinical experience how bullying, and in particular weight teasing, can be a risk factor for the development of these diseases. Also, from a research point of view, we know that obesity is often associated with depression. That is why I find Deborah’s work important to tackle crucial environmental factors behind this comorbidity, like stigma and discrimination. I thank Deborah for our long and fascinating conversation, and I will certainly follow closely her work in the future! We are now at the end of this story and this blog, which I like to think of as a little piece of art in itself. I personally believe that the unique ability of art is to provoke and engage people, and to generate feelings, reactions (good or bad) and passion. This is what I hope this article has done for you, providing a stimulating diversion from the worries of our current situation.

As of June 23rd, there have been more than 9 million cases and more than 475,000 deaths from COVID-19, with cases confirmed in 213 countries around the world. All of these alarming outbreaks may have one intriguing factor in common: bats. As a researcher in traditional Chinese medicine in Shanghai, I was really interested in understanding whether or not COVID-19 really has anything to do with bats — and if so, what is the relationship. To investigate, I set out to write this blog. So, is it actually true? Based on the existing scientific research, there are three points that strongly suggest a link between the new coronavirus (COVID-19) outbreak and bats: 1. Previous studies have shown that some bat SARS-CoV viruses have the potential to infect humans. Genetic information from five patients at an early stage of the outbreak was almost identical and shared almost 80% of the genetic sequence of SARS-CoV, the virus identified in bats. The International Committee on Taxonomy of Viruses has given the virus the official name, SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus-2). As mentioned by Anna McLaughlin in a recent blog, a study back in 2015 found that 3% of Chinese villagers living close to bat caves were carrying antibodies to a similar, though less contagious, version of coronavirus, similar to SARS-COV-2. Likewise, in 2012, six miners in China contracted a pneumonia-like disease and two died, from a mine shaft infested with different bat species and bat coronaviruses. Through later testing, researchers discovered a diverse group of coronaviruses in six bat species in these cave systems. 2. All coronaviruses use their spike proteins — which are not only the sharpest weapon of the virus but also its Achilles’ heel — to gain entry into human cells, through a complex, multi-step process. If one imagines the spike’s mushroom shape, the cap acts as a molecular key, fitting into our cells’ locks (receptors). In Covid-19, the cap binds perfectly to a receptor called the ACE-2, which can be found in various parts of the human body, including the lungs, suggesting that the CoV 2 strains use the same host receptor for cell entry as the original bat SARS-CoV. 3. Researchers at the Wuhan Institute of Virology found that the new coronavirus is 96 % genetically identical to a bat virus (BatCoV RaTG13) — which was previously detected in the bat Rhinolophus affinis originating in Yunnan in Southern China. According to the above evidence, scientists speculate that the natural host of the new coronavirus is indeed bats. However, the discovery of multiple lineages of pangolin coronavirus, and their similarity to SARS-CoV-2, suggest that pangolins should also be considered as possible hosts in the emergence of new coronaviruses. In addition, other wild animals such as snakes may also carry COVID-19, but no comprehensive results have been reported so far. This appears to follow a similar pattern to previous coronavirus outbreaks like SARS-CoV and Middle East Respiratory Syndrome (MERS-CoV) which started in bats and was passed onto both civet cats and camels, respectively. Research indicates that while bats do carry viruses, such as the rabies virus, that can be directly transmitted to humans, this is not necessarily the case for coronavirus. Here, coronavirus from bats does not generally directly infect people. It needs to go to the intermediate host to complete the mutation and become a virus susceptible to humans before it can enter the human cells. But the identity of the species which served as an intermediate host for the virus is still uncertain. However, it is important to note that the virus carried by bats can also evolve within the bat population, and even during frequent contact with humans there is a risk of mutation and thus direct infection to humans — therefore, we should try to reduce most contact with bats. Did it really jump to humans from Huanan seafood market in Wuhan? Chinese wet markets are simply places that offer a wide range of fresh produce, as opposed to dry markets which sell non-perishable goods such as grain or household products. Some wet markets, but not all, also sell live animals. They are referred to as “wet” because floors are often hosed down after vendors wash vegetables or clean fish. The narrative of the origin of coronavirus infection goes something like this: in late 2019, someone at the Huanan seafood market in Wuhan, which is now an infamous “wet market”, was infected with a virus from an animal. As a result, it has since been assumed that there are bats or pangolins for sale there. However, bat meat was never sold in the market, and in fact, bats are not a common food source in the city of Wuhan. As reported in Nature, pangolins were also not listed on the inventory of items being sold in Wuhan. So far, there is still uncertainty about several aspects of the COVID-19 origin story that scientists are trying hard to unravel. However, it cannot be ruled out that the Wuhan seafood market did not give wild animals the opportunity to be in touch with farm animals that are routinely used for food, nor that people were not at any point in direct contact with wild animals. In response to the coronavirus pandemic, all wildlife trade in China, including bat meat, was banned in January 2020. Why do people eat wildlife? “Bats are a food source for humans in some areas. Bats are consumed in various amounts in some regions within some Asian, African, European, and Pacific Rim countries and cultures, including Vietnam, Seychelles, Indonesia, Palau, Thailand, China, and Guam”, Wikipedia writes. While it is true that a small percentage of Chinese people have been known to eat some wild animals, it should be emphasised that this is not mainstream: in fact, an online survey by Peking University Center for Nature Society found that nearly 97% of Chinese people are against eating wild animals. For the few people who do eat wildlife, there are probably two main reasons for this, historically. The first reason is food demands. Chinese society suffered from famine during 1959–61, and as a result, wildlife was used as a source of protein and fat. As Hu Xingdou puts it in an article for the Bangkok Post, this history has left its mark on many, and grown to be “an unforgettable part of the national memory,”. Although nowadays this is no longer the far-reaching problem that it once was, “eating novel food or meat, organs or parts from rare animals or plants has become a measure of identity to some people.” In a way, this has become a thing of nostalgia; I’ve had conversations about this and at its core, for many, eating wildlife today might be used as a way to reach for ‘childhood taste’, especially one that was seen as a ‘lifesaving taste’. Those with memories of the famine and hunger in China are getting older and the number of these individuals is gradually decreasing. This memory will naturally disappear. Wildlife Conservation in China by Richard B. Harris provides a great look into the impact of the famine on China and its people, if you’re interested in learning more. The second reason is that many medicinal needs in China have traditionally come from certain wild animals. Traditional Chinese medicine has nothing to do with taste. Unsurprisingly, the medicinal value of wildlife is advocated because of its ‘tonic’ quality. There is a traditional Chinese medicine called Ye Ming Sha, which is derived from the dry faeces of bats and, in traditional Chinese medicine, could be used to benefit nyctalopia (also called night-blindness) and child malnutrition. However, these qualities have not been confirmed by modern medicine. Moreover, in China but also across the world, the greater short-nosed fruit bat is hunted for medicine — not as food. Of course, there are people eating wildlife in many different countries and you can easily find information on western websites about hunting and eating. Thus, the risk of humans getting in contact with viruses from wildlife animals is not restricted to China or other Asian countries. At present, humans know little about viruses carried by wild animals, which is a potential threat to human life and health. We should be in awe of nature, stay away from wild animals and stop illegal wildlife trade, if we are to reduce the risk of human infection with deadly viruses in nature. NOTE FROM THE EDITORS: Fei is a visiting researcher in psychopharmacology working in our lab at King’s College London. She is an Associate Professor from the Shanghai University of Traditional Chinese Medicine. Thanks, Fei for writing this wonderful blog for us!

The COVID-19 pandemic continues to have a devastating impact on health, society and the global economy. Worldwide infections are now over 7.5 million with over 420,000 deaths. Unemployment rates have soared and the livelihoods of millions of people are under threat. Government shelter-in-place orders and social distancing guidelines have restricted the movement of ~3 billion people around the globe, separating us from our loved ones and the daily social connections to which we have become accustomed. This comes with additional challenges to our health and well-being. Feelings of isolation and confinement, coupled with threats to our livelihood, lower our self-esteem and increased feelings of depression, anxiety and distress, which can lead to higher rates of substance use, domestic abuse and suicide. As an exercise immunologist, I have spent a great deal of time thinking about how exercise can optimize our immune systems to help fend off the threat of this devastating and highly contagious virus. While exercise is widely regarded as a type of medicine in and of itself, our daily activity and exercise routines have been massively impacted by the lockdown and social distancing restrictions that are in effect across the globe. Gyms and parks, where we would normally participate in our exercise and activity routines, have been closed for some time and have no doubt affected our ability to stay active during this pandemic. As these facilities slowly start to reopen, social distancing guidelines remain in effect and, with the threat of COVID-19 still looming large, many people will remain reluctant to rejoin these facilities and engage in physical activity practices while in close proximity to others. While it is important to continue practicing social distancing and to take extra precautions with regards to hand-washing and wearing personal protective equipment, it is equally important that we try to stay active during this pandemic. Regular physical activity exerts a multitude of beneficial health effects but, perhaps more importantly during this pandemic, is its ability to both enhance immune defense and offset the damaging effects that stress can have on our immune systems. Can exercise protect us from COVID-19? This has been a topic of great interest since the outbreak of this novel virus, and while no specific studies have thus far been conducted, we do know that higher levels of cardiorespiratory fitness and exercising regularly can improve immune responses to vaccination, lower inflammation and improve immune function in several disease states including cancer, HIV, cardiovascular disease, diabetes, cognitive impairment and obesity. We also know that physically active people are less likely to report symptoms of upper respiratory illness, and there is evidence that exercise can protect us from many types viral infection, including influenza and rhinovirus. For instance, mice that exercise after being given a lethal dose of influenza live longer and exhibit more favorable immune cell profiles and less inflammation in the lungs. The reactivation of a latent virus we have previously been infected with but now lies dormant in our body, is a global indicator that our immune system has become weakened. This can occur due to feelings of stress and anxiety brought on by prolonged periods of isolation, confinement and inactivity. Viruses such as herpes-simplex-virus-1, which causes cold sores, or varicella-zoster virus, which causes shingles, tend to reactivate when we are experiencing increased levels of stress. A recent study in astronauts, who experience great levels of isolation and confinement stress when in space, found that physical fitness reduced the risk of a latent herpesvirus reactivation during a 6-month mission to the international space station, particularly if they were able to maintain their fitness levels throughout the mission. Both cardiovascular fitness and muscle strength/endurance were found to be beneficial, and even in those astronauts that did reactivate a virus, the fitter astronauts had lower levels of detectable virus in their saliva indicating they were also less contagious. Prolonged exposure to stressful situations puts our biological stress response into overdrive, increasing the production of stress hormones such as cortisol that can inhibit many critical functions of our immune system. Specifically, stress causes our immune cells to become less efficient at responding to infectious agents, impairs our ability to mount a protective antibody response, and impairs the trafficking of specific immune cells that patrol through our bodily tissues to hunt for and kill cells that have been infected. There is a large body of evidence demonstrating that regular exercise of moderate intensity can enhance immune function and it is, therefore, imperative that we strive to maintain recommended physical activity levels during the COVID-19 pandemic. How does exercise actually improve immunity and reduce our risk of infection? There are many levels by which exercise can boost our defense system, but a key component is the massive redistribution of immune cells that occurs each and every time we engage in moderate intensity exercise, particularly if the exercise is dynamic and causes sustained elevations in heart rate (e.g., running, cycling or rowing). This is akin to large numbers of soldiers being mobilized so that they may patrol vulnerable areas in our body (e.g. the upper respiratory tract and the lungs) with the mission to hunt and destroy an infectious enemy. Exercise also has the knack of preferentially mobilizing those highly specialized immune cell sub-types that are particularly effective in migrating towards the tissue and in recognizing and killing damaged or infected cells. This can prevent viruses and other pathogens from gaining a foothold, and may also increase the rate of virus elimination should our immune barriers be breached and we become infected. When we exercise our muscles release hormone-like proteins called cytokines, which play a key role in regulating many aspects of immunity. These cytokines can direct immune cell trafficking toward areas of infection, increase the production of new immune cells, particularly T-cells, or maintain the existing immune cell compartment to increase our immune defense network. How much exercise is good? Physical activity guidelines provided by many governing bodies throughout the world recommend 150–300 minutes of moderate to vigorous intensity cardiorespiratory physical activity per week and two sessions per week of muscle strength training. While this can be challenging following social distancing and hygienic guidelines with limited access to gyms and parks, there are many creative ways for us to stay active at home. Home-based exercise platforms, such as online instructor-led classes and ‘exergaming’ (video games which are also a form of exercise), are becoming increasingly popular and are very effective in helping us maintain our activity levels while being confined to our homes. Specialized technology and equipment is not necessary; keeping active indoors or outdoors through brisk walking, stair climbing, yard/house work and/or playing active games with the family can be just as effective. What is important is that we avoid prolonged periods (>60-minutes) of time sitting and try to implement even a few minutes of activity at regular intervals throughout the day, all of which count toward achieving these weekly goals. Exceeding recommended physical activity levels should be avoided as there are strong viewpoints that excessive exercise (e.g. those activities performed by highly athletic individuals) might impair immunity and increase infection risk. Meeting the recommended guidelines for physical activity might not prevent us from getting COVID-19. However, the direct improvements in immunity coupled with lower levels of stress, would indicate that those of us who are physically active will be less likely to develop severe symptoms, have shorter recovery times, and may be less likely to infect others we come into contact with. Even when infectious symptoms are mild, low levels of physical activity should still be encouraged to hasten recovery and ameliorate symptoms, provided that adequate social distancing and infection mitigation measures are taken. Exercise is known to improve immune responses to vaccination, especially in older adults who are particularly vulnerable to severe COVID-19 disease. Boosting immunity through exercise now could pay dividends later when a COVID-19 vaccine becomes available or if a second wave or large spikes in infection rates occur in the near future. It is important to recognize that exercise is medicine and it can be prescribed in specific doses and formulations in a highly personalized manner. The specific exercise doses and formulations that will be most effective in boosting immunity and lowering risk of viral disease in certain individuals and populations needs to be determined. Until then, my own personal goal is to make physical activity a daily priority as we continue moving forward through this pandemic. By simply moving our bodies often and limiting the amount of time we spend sitting, our immune systems will be better prepared against the threat of COVID-19. OTE FROM THE EDITORS: We would like to say a big thank you to Richard for writing this wonderful blog for us. Dr Richard Simpson is an Associate Professor and Exercise Immunologist at the University of Arizona. It is a privilege that he was willing to share his expertise with our readers at InSPIre the Mind and to teach us all about the benefits of exercise for our immunity, especially during this time. Thank you Richard! Header image source Gustavo Fring from Pexels