[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. It was a really interesting weekend I had the past weekend. It was the first one since the pandemic where I went back to a music festival where there were large groups of people and I used to love going to music festivals, so I was really excited. At that it was actually the first big event where vaccine cards and masks weren't required for entry, so I'll be honest, it felt a bit odd, but also it felt really great. You know what, maybe it's the psychologist for me, I don't know but as much as I was enjoying all the music and the food and the great weather, there was something that felt different and not in a bad way, it just was different. It was, I couldn't really figure it out but it was on the car ride home that I was discussing all this with a friend who also happens to be a psychologist that I realized what it was. I remember going out before the pandemic and being amongst people and it being pretty common to see people holding hands or walking or kissing or hugging or sitting close to each other. But what I found interesting was that after three long fun days, both of us distinctly remember one young couple who were standing in front of us and sharing a very long passionate kiss. Now I mentioned this because I know in the past before the pandemic, this would not have been something that would've stood out to me. I'm not saying that pre-pandemic, everyone is out there showing lots of PDA for the whole world to see, but I do know that at events such as the one I was at this past weekend. A couple kissing in front of me would not have been something that would've been an isolated event that stood out. Certainly not noteworthy enough for me to remember three days later and even more. It definitely would not have been something that stood out as an anomaly to both of us. So the more we were talking about this, the more we realized that although we were not actively analyzing anyone's behavior during the event, when we took a moment to reflect back on things, neither one of us could really recall seeing much human connection going on even amongst the couples we were with at various times throughout the event. So you may be wondering, why on earth am I bringing this up? Well, it's because I realized that something about our physical closeness and the manner in which I saw people, people in general just touching or rather not touching, it's changed since the pandemic started. Now again, this is my personal perception based on one event that I went to for three days. I'm certainly not going to be writing up any journal article making broad statements affect about human interactions during Covid or post pandemic but it got me wondering if all those months of social isolation has somehow had an impact on the way we physically connect with and touch each other. Like, did we get used to not having it and now we don't need or want it? Or does it feel awkward to engage in more physical touching? Are people more hesitant to reach out and grab someone's hand whether they're walking or sitting next to them because of contracting the virus or maybe because they're so used to engaging in that behavior with people like they were before? Maybe they're not used to engaging it like they were before. So is it just a matter of us getting more used to being around each other and then we'll naturally go back to how we were before? I don't know. Again, maybe it's just I'm overthinking things and it's just my perception and nothing's really changed, but it got me going on a search to see if there's been any investigation into the impact that the pandemic has had on social interactions and the way we physically connect with one another. So what I've found is that there's been a lot out there discussing touch deprivations since the onset of the pandemic. Some people now they're just plain uncomfortable with what used to be normal greeting touches like handshakes, hugs, or even kisses. There have been some people mentioning that they feel engaging and physical touch feels abnormal now. Others have said their skin actually feels more sensitive to touch, so they're just avoiding it. So you may be listening wondering, okay doc, why does this even matter? What if the pandemic had an effect like this? What if people touch each other less than they did before? Why would that matter? Well, it matters because the importance of human connection was one of the very first things I recall learning about when I was first studying psychology. if I'm being honest, there was this very sad and very disturbing experiment that was done decades ago by this researcher Harry Harlow. I bring up this study because a sad and disturbing and yes, even at the time and now is controversial. It's also an experiment that had a huge impact. I'll tell you a little bit about it. In his first experiment, it involved Reese's monkeys and he chose these monkeys because of their many similarities to humans. So what he did is he isolated and deprived these monkeys, baby monkeys from their mothers and raised them in a lab. Fortunately, these monkeys showed very disturbing behaviors. Compared to a control group or monkeys who weren't taken from their moms, all the infant monkeys who were denied maternal care presented social awkwardness. They were aloof and they would cling to their soft cloth diapers they were given. What was surprising was that even after these monkeys were no longer isolated, but were around other monkeys, they continued to isolate themselves to the point of starvation and death. Now, his most famous experiment involved giving young Reese's monkeys a choice between two different mothers. One was made of soft terry cloth, but provided no food and the other simulated mother was made of wire but provided nourishment from an attached baby bottle. So what he did was he removed these young monkeys again from their natural mothers a few hours after birth, and left them to be raised by these mother surrogates. The baby monkey spent significantly more time with their cloth mother than with their wire mother. So in other words, the infant monkeys went to the wire mother only for food, but preferred to spend their time with the soft comforting cloth mother when they were not eating. What does this mean? Well, from his research, he concluded that affection is the primary force behind the need for closeness and that there are devastating psychological and emotional distress, effects and even death from long-term deprivation. So his work led to a claim and generated honestly a wealth of research on love, affection, and interpersonal relationships. But since then, the potential benefits of touch have been studied across many fields ranging from animal studies to developmental and adult psychological and neuroscientific studies in humans. For instance, research shows that physical affection has health benefits. So stimulating touch receptors under the skin can lower blood pressure and cortisol levels, which reduces stress. In one study from the University of North Carolina, they found that women who hugged their spouse or partner frequently, even just for 20 seconds, had lower blood pressure. They concluded that this was possibly because a woman brace increases oxytocin levels in the brain and that over time the lower blood pressure can decrease person's risk for heart disease. Now that's pretty cool. Now let's look at babies for a minute. Interesting stuff here. Shortly after birth, premature babies often go for extended period time without touch. Results from numerous studies show that even being fed exactly the same amount, the premature babies who are lightly massaged several times a day gained significantly more weight than the premature infants who are not touched. So touch for the human baby, even when not a preme is important. Human babies actually die from lack of touch. In the 19th century, most institutionalized infants in the United States died from this thing called mirasmus, which means wasting away, which is very sad. Institutions surveyed in 1915, but I know that's a long time ago, but this is important to think about, reported that a majority of infants under the age of two had died due to failure to thrive, which was related to the lack of touch and affection. There's so many studies that could bring up but I just want to touch base about ones that I think are interesting. So when we look at low socioeconomic status, mothers who were given either a soft baby carrier or a plastic infancy to use on a daily basis, at three and a half months of age, the soft carrier infants looked more frequently at their mothers and cried less. These mothers were more responsive to their babies' localizations and at 13 months, these in infants were more likely to be securely attached in comparison to the infancy group. I also remember when I was taking an advanced training to do couples therapy and the instructor told us that if couples touch each other before starting a heavy conversation or touch each other during an argument, like putting your hand on your partner's leg or holding their hand in yours, something like that, but touching them will sync up their brainwave and hold both of them to a level where they feel more connected. But we're talking about when there is touch, but let's also talk about what happens if there's a lack of touch. Research shows that there are negative consequences. So for example, children touch deprivation is associated with struggles in learning to speak, sleep problems and school performance, and sometimes even aggression. In adults, adults who are deprived of touch, it's associated with higher mood and anxiety symptoms, depression and perceived loneliness. So I got to thinking about all this. Specifically, to the pandemic Covid-19 related restrictions, we were restricted, we were socially distanced. This allowed for us to really see what happens when we are socially distanced. One study actually looked at this and looked at the effects of touch experiences on mental health. So in this study there were over 1700 participants who completed an online survey to examine intimate, friendly and professional touch experiences during Covid-19 related restrictions and the impact that that had on their mental health and the extent to which touch deprivation results in craving touch. What they found was that intimate touch deprivation during Covid-19 related restrictions is associated with higher anxiety and greater loneliness. Now this is also a podcast that focuses on eating disorders and body image. So that got me thinking about that too, because I want to relate it to what this podcast is about. So I did some searching and research at the University of Michigan Medical School concluded that from one study when comparing data between a group of subjects who had eating disorders with those who did not, the eating disorder group reported greater body image concerns and perceived greater touch deprivation, both during their childhood and their current life than the nonclinical group. So the researchers noted that according to developmental literature, touching, holding, and hugging play an important role in the child's formation of body image. Then interesting, so maybe any of you listening ask yourselves if you're struggling with body image, how was your childhood in terms of did you feel like you got enough touch? Did you feel like you got enough holding, hugging? Was this something to think about? I'm not saying that's the cause of it, but they were saying it's associated. Now also interesting, about a decade ago, research began incorporating massage therapy into the treatment of eating disorders. What they found was that massage boosted dopamine and that's the neurotransmitter that gives you a feeling of pleasure and serotonin, which is the neurotransmitter that gives you the feeling of being calm and happy and lowered stress hormone levels resulting in happier, calmer patients who could better cope with recovery. Yes, they said that. They found that anorexia neurosis symptoms were reduced by massage therapy. This massage therapy had another effect that the researchers hadn't counted on, it decreased many patients’ dissatisfaction with their bodies and improved their self image. So when massage was added to therapy for people who had bulimia nervosa, it decreased their drive for thinness and focused on perfectionism significantly more than therapy alone, even long after the massage treatment stopped. So they concluded that massage was so effective because of touch. Now isn't that interesting? I know I started off talking about my weekend and how I was noticing that people were just not touching each other as much as I was used to seeing before the pandemic started. That just brought me down a rabbit hole about touch and how important it is and I really do think that it's something we shouldn't be ignoring because we're social beings. So given physical distancing and isolation most, if not all of us experienced, at least to some degree during the pandemic, I do think it's important to know how this could have impacted us. Pandemic or not I think it's important to take a minute to think about if we're all getting enough human connection, affection and touching our lives and if we're not, how that is affecting us? As I mentioned today, there have been so many studies that have shown how important touch is and that if we don't get it, there are negative consequences. So I truly do hope that whatever information I bring here on the podcast maybe it can be helpful to your overall health and wellbeing, not just for eating disorders. So maybe just take a few minutes and think about if you were someone who got enough physical affection and touch growing up or if you're getting that now. If you did not get it growing up or you're not now think about how that might be affecting you in any way. While I mentioned massage earlier while discussing you did this sort of treatment, I do just want to mention that I remember very early on in my career consulting with a colleague who suggested that for any of my patients who experienced depression or feel lonely, it really is worth asking them when the last time they were touched was, last time they got a hug, a kiss, anything because it's surprising to me just how long so many people go without human touch and connection. He said one of the best things to suggest would be for them to go get a massage. That really stuck out to me. I thought that was odd but then now as I've gone into my career and even talking about this today, I'm like, oh, that is such a great thing to have the human touch because human touch is necessary for our health and wellbeing. I believe it was Virginia who says here, and for any of you who don't know who she is, she's a world-renowned family therapist who said, we need four hugs a day for survival, we need eight hugs a day for maintenance, and 12 hugs a day for growth. Just something to think about. All right, I will leave you with that. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.