When walls become wellness

Dr Luciano Magaldi Sardella and Professor Matteo Mantuano on how ‘Stramurales Participatory Street Art’ transforms urban mental health.

17 February 2026



On a sweltering afternoon in June 2018, we stood in the central square of Stornara, a small agricultural town in Puglia, Southern Italy, watching something extraordinary unfold. Local artist Lino Lombardi was facilitating a heated discussion among residents about which mural designs should adorn their town's crumbling walls. What struck us wasn't the art itself, but the transformation we witnessed in the eyes of people who, just months before, had described their hometown as a place to escape. These were individuals reclaiming their narrative, voting on their future, literally painting over decades of decline.

We are environmental and community psychologists who have spent over a decade studying how built environments shape mental health outcomes. Dr Luciano Magaldi Sardella's research focuses on participatory arts interventions in declining rural communities, while Professor Matteo Mantuano specialises in the psychological mechanisms of community empowerment and collective agency. When we first learned about the Stramurales festival in early 2018, we recognised it as a rare opportunity to observe participatory urban art as a potential tool for addressing the mental health crisis plaguing Southern Italy's depopulating towns.

Over the past seven years, we have conducted extensive fieldwork in Stornara – interviewing residents, documenting the festival's evolution, and analysing its psychological and social impacts. What we found in Stornara was something far more significant than an innovative community-led arts initiative. It was environmental psychology in action – reshaping how we understand the relationship between built environments, participatory arts, and mental health.
The crisis hiding in plain sight

Recent research reveals an alarming convergence of environmental and mental health crises that remains curiously underexamined in psychological discourse. Mental health research receives a mere 2.3 per cent of overall National Institute of Health funding. We cannot know how much of that concerns our environments – both natural and built – which fundamentally shape our psychological wellbeing. The newly proposed field of 'EnvironMental Health' emphasises that deteriorating built environments correlate significantly with elevated stress, social isolation, and worsening mental health outcomes.

Southern Italy's rural communities embody this crisis. Between 2002 and 2017, South Italy region lost approximately two million residents to migration, predominantly young adults aged 15-34. This exodus created what Johan Galtung described as 'structural violence' – systematic arrangements preventing communities from realising their potential. The mental health toll manifests not just in individual diagnoses, but in collective despair, eroded social capital, and communities watching their futures literally emigrate.

Stornara exemplified this trajectory. By 2017, this municipality of 6,000 residents faced the familiar spiral: economic contraction precipitating youth emigration, accelerating infrastructure deterioration, driving further decline. Walls crumbled. Businesses shuttered. Hope evaporated. Then something changed.
The Stramurales revolution: Democracy through design

What emerged in Stornara transcends conventional cultural tourism. The Stramurales International Street Art Festivalworks through three foundational democratic mechanisms that distinguish it from superficial beautification projects. Organised through Stornara Life APS – an open-membership association founded by Maestro Lino Lombardi – the festival prevents elite capture through voluntary property owner participation ensuring no coercion; democratic content selection through annual community voting on festival themes and mural proposals; and transparent, inclusive governance that gives all residents a voice in the festival's direction.

This participatory architecture facilitates what the World Health Organization describes as 'community empowerment' – processes enabling communities to increase control over determinants affecting their health. Recent field studies in Vienna demonstrate that urban art interventions reduce stress and anxiety while improving mood states, but Stramuralesgoes further by embedding art creation within democratic decision-making structures.

When residents voluntarily offer walls and vote on content, they perform acts of material and psychological investment. This restoration of collective agency – the belief that residents can shape their hometown's future rather than merely witnessing decline – directly addresses the structural violence that erodes mental health. Between 2020 and 2025, Stornara experienced a huge increase in tourism revenue despite pandemic disruption. New businesses opened. A Stornara-born emigrant who returned reluctantly in 2017 to provide parental care, now works as a tour guide and describes Stornara as 'the coolest town in Italy'.

These aren't just economic indicators. They're mental health outcomes.
The science behind the transformation

Contemporary research across multiple disciplines validates what Stornara residents experience viscerally. A 2024 systematic review examining 79 peer-reviewed articles identified how arts places – from permanent museums to temporary public installations – stimulate community engagement, enhance cultural identity, and foster social cohesion. Community-driven mural projects specifically strengthen local identity and pride, creating new routines for individuals to interact and build relationships.

Recent experimental research in Berlin found that sidewalk-level art exhibitions significantly altered visitors' connection to and satisfaction with their neighbourhoods, improving overall wellbeing. This aligns with emerging theories on art viewing's impact on mental health, which identifies five key mechanisms: affective processes regulating emotions and stress; cognitive processes providing sensory stimulation and learning; social processes creating shared experiences; self-transformation through reflection; and resilience building for coping with challenges.

Environmental psychology research demonstrates that built environments operate as therapeutic interventions. Studies on mental health inpatient facilities reveal that design elements affecting privacy, control, daylight access, and particularly the inclusion of artwork significantly impact patient outcomes. If hospital walls matter therapeutically, how much more do the walls we encounter daily in our communities?

The Stramurales model harnesses these mechanisms through the recent concept of 'visual health activism'. Several murals explicitly engage health and human rights themes: Alaniz Niz's 'Refuge for All Migrants' represents exploited African agricultural workers; Sabotaje al Montaje's 'Turning Our Backs on Migration' challenges exclusionary policies; Devil Art Design's 'African Child at Sunset' portrays migrant youth seeking dignified futures.

These works address social determinants of health through human rights advocacy. Migration policies denying basic rights create health vulnerabilities – including restricted healthcare access, hazardous working conditions, and psychological trauma from discrimination. The murals perform dual public health functions, in addressing residents' mental health while advocating for populations whose health rights face systematic violation.
Place attachment and community resilience

The relationship between environmental perception, cultural identity, and community resilience has received substantial scholarly attention in 2024-2025. Research in rural China demonstrates that environmental perception of public spaces influences community resilience through chain mediating effects of cultural identity and place attachment. When communities transform their physical environments through participatory processes, they simultaneously strengthen the psychological bonds that underpin resilience.

This explains why Stramurales succeeds where traditional economic development approaches falter. The festival doesn't just create economic value – though over 150 murals by international artists now attract thousands of visitors annually. It fundamentally reshapes residents' relationship with their environment, transforming narratives of decline into evidence of vitality. Each democratically selected mural becomes what resilience researchers call an 'anchor of hope' – tangible proof contradicting despair.

Contemporary resilience theory emphasises that strength resides not merely in physical infrastructure but in social cohesion. A recent analysis of resilient urban design in marginalised American neighbourhoods found that residents' message – 'We like our neighbours, we like the character of where we live' – revealed that resilience is fundamentally about people and community. Design interventions succeed when they preserve and strengthen these social bonds, rather than imposing external visions.

Stramurales embodies this principle. The democratic voting mechanisms ensure art reflects genuine community values rather than artist or curator preferences. This prevents the cultural displacement often accompanying urban regeneration, where improvements benefit newcomers while alienating existing residents. By centering resident agency, Stramuralesbuilds what researchers describe as 'critical resilience' – capacity addressing underlying inequalities rather than merely adapting to them.
The participation gap and universal access

These findings resonate profoundly with longstanding concerns about arts accessibility. The 2015 Warwick Commission documented that the wealthiest, most educated 8 per cent of the UK population accounted for 44 per cent of live music attendance and 28 per cent of visual art visits. This participation gap particularly affects communities that would benefit most from arts engagement for health and wellbeing.

But Stramurales challenges this narrative. Street art as public health infrastructure requires no admission fees, no advance booking, no cultural capital to appreciate. It exists where people live, transforming daily commutes into encounters with beauty and meaning. The democratic selection process ensures accessibility extends beyond consumption to co-creation – residents don't just view art, they determine what appears on their walls. Recent research on participatory arts and social cohesion emphasises that successful interventions share common features: delivery in local communities, non-stigmatising approaches, flexibility, promoting social engagement, involvement of exhibitions, and delivery within specific timeframes. Stramurales incorporates all these elements while adding genuine democratic governance.

This matters urgently. Mental health conditions among young people globally are rising, and traditional mental health services remain chronically underfunded. If we cannot scale clinical interventions to meet demand, we must invest in preventive public health approaches targeting social determinants.
From Stornara to the world: Implications for practice

The Stramurales model offers a replicable template requiring modest financial investment but substantial community participation. Essential elements include voluntary engagement, democratic decision-making, strategic social media use for marketing, and integration of local narratives with global artistic practices.

Several cities have implemented variations with promising results. Research on artistic interventions in urban spaces across Europe and Asia demonstrates that participatory art projects can serve as 'social prescribing', improving psychological resilience and enhancing public engagement. Tactical urbanism approaches – small-scale, low-cost interventions improving public spaces – increasingly incorporate art as core rather than supplementary elements.

The implications extend beyond individual communities. International frameworks including the International Covenant on Economic, Social and Cultural Rights enshrine rights to health and cultural participation. State obligations to conserve, develop and diffuse culture should support community-driven cultural initiatives demonstrably impacting health outcomes. As pandemic governance analyses emphasise, future health policy reforms must address not only biomedical preparedness but underlying vulnerabilities in community resilience and social cohesion. Street art operating through participatory structures directly strengthens these dimensions.
What Psychologists can do

We have roles to play at multiple levels. First, we must conduct research documenting the mental health impacts of participatory arts interventions. While promising evidence exists, methodologically rigorous studies with adequate sample sizes and long-term follow-up remain scarce. We need experimental designs, not just observational studies, examining mechanisms through which environmental transformations affect psychological outcomes.

Second, we should advocate for policy recognising arts engagement as health intervention. This means supporting public health funding for community arts initiatives, particularly in economically deprived areas where traditional development approaches have failed. We should work with urban planners, architects, and artists to integrate participatory arts into neighbourhood regeneration from inception, not as afterthoughts.

Third, we must ensure interventions embody genuine participation rather than tokenistic consultation. The Stramuralesmodel succeeds because residents hold real power. Without this, arts interventions risk replicating existing power structures and potentially accelerating gentrification that displaces the communities they ostensibly serve.

Fourth, we should employ arts-based research methods that centre community voices. Collaborative approaches like participatory theatre, photovoice, and collaborative poetics enable communities to articulate their experiences and aspirations in ways traditional psychological assessments cannot capture. These methods acknowledge that communities possess expertise about their own needs and potential solutions.

Finally, we must situate arts interventions within broader frameworks addressing social justice. Art should not function as a 'sticking plaster' masking underlying inequalities. Instead, we should harness arts' disruptive potential to promote what researchers term 'critical resilience' – capacity challenging systemic injustices rather than merely helping people adapt to them. This means addressing not just symptoms (mental distress) but causes (structural violence, economic abandonment, policy failures).
Reimagining health infrastructure

The Stramurales case compels fundamental reconsideration of what constitutes health infrastructure. We typically envision clinics, hospitals, pharmacies – biomedical institutions delivering treatments for diagnosed conditions. But what if the most effective mental health intervention for a declining community isn't a new psychiatric facility, but democratic processes enabling residents to transform their visual environment?

Walls covered with democratically selected art, created through genuine community participation, demonstrably improve community mental health while operationalising cultural rights described in international law. The modest financial investment required pales beside costs of clinical services treating preventable distress. For communities experiencing decline where traditional economic development has failed, participatory street art may offer the most cost-effective, accessible, and sustainable mental health intervention available.

This isn't about romanticising art or dismissing serious mental illness requiring clinical care. It's about acknowledging that population mental health requires addressing social determinants – and that participatory arts targeting built environments, social capital, and collective agency directly address these determinants.

The question facing psychology isn't whether art can function as health intervention – Stramurales and growing evidence demonstrate it can. Rather, the question is whether we possess imagination to rethink health infrastructure, recognising that effective mental health promotion may require democratic decision-making and community participation as much as clinical expertise.

As we watched Stornara residents voting on murals that June afternoon, we witnessed people exercising a fundamental human capacity too often denied in our field: the power to shape their own environments and, through that shaping, to heal. Perhaps that's the most vital lesson Stramurales offers psychology – that sometimes the most therapeutic intervention isn't administered by professionals, but created by communities reclaiming their agency… one democratically selected wall at a time.

Dr Luciano Magaldi Sardella holds a PhD in Cognitive Leadership at Aspire Institute, Harvard Business School.

Professor Matteo Mantuano is Professor of Social Sciences and Psychoeducational Health, Unitré University of Milan, Italy.

Photo: 'Kid trapped in a box' mural by Leticia Mandragora
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Autistic women and that ‘weird therapist magic’

Zoe McFarlane with perspectives on good practice.

16 February 2026



'Autistic people have a high chance of developing mental health problems, but a low chance of receiving effective help.' As a late-diagnosed autistic woman myself, Dr William Mandy's words were extremely thought-provoking. I thought of the therapist I'd initially dreaded working with. We'd met on a course 18 months earlier, and I'd found her immensely irritating. When I was assigned to her for therapy, I groaned and called a friend to vent. I thought it would be a waste of time for both of us. It turned out to be some of the best therapy I've ever had.

We developed an amazing rapport, far stronger than with other therapists who'd looked perfect on paper. Later, I worked with a male therapist I connected with almost immediately… equally brilliant, but with almost nothing in common with the first therapist. What created that 'weird therapist magic', as one of my research participants later called it?

This question led me to conduct formal research as part of my MSc in Psychology: I interviewed 12 late-diagnosed autistic women about what made therapy feel genuinely positive for them. The research, which has been published in Autism in Adulthood and draws on appreciative inquiry methodology, revealed something important: good therapy for autistic clients isn't necessarily about special techniques or autism-specific interventions. It's about taking what we already know works and making it genuinely accessible. I think that this is essential knowledge for all therapists, not just those who specialise in autism.
Why should mental health practitioners care about autism?

Around 70 per cent of autistic people live with at least one mental health condition, compared to 17 per cent of non-autistic people. Yet for those who start therapy but don't complete it, two-thirds said that a lack of adjustments was a major factor: not because it wasn't working, but because the therapy wasn't accessible to them.

Here's the challenge: it's thought that 90 per cent of autistic people over 40 are undiagnosed. Many of your clients may be autistic without realising it. This is why I've tried to follow the maxim 'helpful to many, essential for some, harmful to none' in thinking about the following adjustments.
It's not all about autism, but autism matters

Autism isn't a mental health disorder to be fixed. None of my participants had sought therapy for their autism. One woman explained that autism affected "every aspect of that person's life", perceptions, experiences, and interactions with the world. It couldn't be parcelled up and put aside while focusing only on anxiety or depression.

As one person put it: "He accepted that I think differently to most of his other clients, and that it was OK. It was up to him to work out how to work most effectively with me."

Some research suggests practitioners provide less challenge to autistic clients, but my participants wanted to be challenged. They also needed therapy to provide what one described as a "safe and validating space":

"It felt really positive to have a place and time to go and just talk… it was completely non-judgmental and a welcoming environment where I felt accepted. I didn't always want to talk about traumatic things that have happened. Even if I was paying just to go to a completely accepting place where they didn't judge – that felt the most positive for me."
Building relationships

Social communication issues, including a difficulty in developing and maintaining relationships, are part of the core criteria of autism. The belief that autistic people lack empathy or theory of mind has pretty much been replaced by the theory of a double or even a triple empathy problem. Autistic people communicate differently; several studies have shown that in autistic only groups, many of the communication difficulties disappear. The problem isn't a deficit on behalf of the autistic person but a difference in communication styles.

My participants were clear about what helped them build therapeutic relationships. First, reliability mattered:

"She was always on time for appointments and did what she said she would do."

"He made sure to communicate that he was running late as soon as possible, because he knew that it would be an issue for me."

They wanted explicit boundaries and transparency:

"To build rapport I need honesty, transparency, detailed explanation and patience while I question that as much as I need to."
Empathy and collaboration

Whilst empathy is a core condition in mental health support it not only has to be shown but also perceived by the client. One of the points that my research highlighted was a difference in communicating and perceiving empathy which seems to be linked to autism.

Within the autistic community that autistic people often show empathy by sharing similar stories, something that can be misinterpreted as rude or attention-seeking. However, every single participant mentioned 'personal disclosures' as essential to the relationship. Not in an unboundaried way, but the careful sharing of some personal information:

"For them to share a bit about themselves too so that I can get to know them as a person a little before sharing so much of myself."

Hearing the practitioner had similar experiences built empathy and alliance:

"It made the therapist more human and easier to connect with."

Importantly, practitioners didn't need to be autism experts, with the wide range of autism presentation, what mattered was the willingness to work collaboratively:

"It feels collaborative. That's also how we work through misunderstandings, as there is the assumption that she might not know and we are there working it out together."

"She's open to not knowing something or wondering whether x or y"

"During my year-long therapy … I discovered that I''m autistic. My therapist embarked on the voyage of discovery with me … we worked out together which aspects of CBT were useful for me and they borrowed techniques from other modalities when appropriate"
Understanding autism without pathologising it

"Understand that every neurodivergent person is different and that there is no one thing that is true for all autistic people. Make sure you have an understanding of the fact that being autistic will affect every aspect of that person's life. It will just manifest very differently depending on who that person is and their experiences."

We all carry unconscious biases and internalised ableism. One study showed that whilst courses and training on autism reduced explicit bias, it was personal development, reflection, and supervision that had the greatest effect on implicit biases.

Participants mentioned this from both directions, helping clients recognise their internalised bias, and therapists recognising their own:

"He consistently picked up on the aspects of myself I saw as negative because they didn't conform to neurotypical norms and gently reminded me that those aspects weren't negative or 'bad', just different."

"[Therapists] need to recognise their own inevitable internalised ableism and work to dismantle that."

One practical example that was shared was:

"It isn't my thoughts or anxiety, for example, that make supermarkets or loud places overwhelming, it's because I'm Autistic, and it's upsetting when therapists don't seem to understand that part."

Participants wanted to build positive autistic identities, recognising strengths and celebrating positives:

"They will remind me that [autism] affects aspects of my life that I wouldn't have thought that it does, and so I feel completely accepted and understood as an autistic person in that room, and that it's completely acceptable for me to be the autistic person that I am."
Explicit acceptance of autistic behaviours

Rather than interpreting stimming or other autistic behaviours as having "unconscious meaning," therapists who built strong relationships offered simple, explicit acceptance:

"In the beginning I was often dissociated and very stimmy in sessions and this was met with complete acceptance, which was a new experience and built trust massively."
Managing transitions

Transitions, between sessions, and at the end of therapy, needed careful handling:

"What I found most difficult was literally putting the lid down on my laptop at the end of a session, which sometimes had been really challenging, and just being in my own house, without any change of scenery/walk/drive to help me mentally move out of the therapy session and back into everyday life."

Creating short, predictable routines for the start and close of the session, and having a (silent) clock visible can help autistic clients to prepare for the transition
Sensory differences

Up to 90 per cent of autistic people experience differences in sensory perception, creating challenges that can distract from therapeutic work:

"A sensory issue for me is wearing shoes, and I didn't feel I could take them off or ask to take them off as she would think it was weird."

This shows why conversations about adaptations need to be practitioner-led. Many clients will be embarrassed to ask or may not recognise the cause of their discomfort without prompting.

Cluttered noticeboards, ticking clocks, scents, and bright lights can all cause intense distraction or physical discomfort. Many areas now have 'expert by experience' groups who can audit spaces for sensory accessibility.

Sensory behaviours are often misunderstood. One participant said her therapist "would often interpret what I now understand as perfectly normal and common autistic responses as having 'unconscious meaning,' which made me feel othered and faulty."

The therapists who built strong relationships did simple things: they provided fidgets, explicitly gave permission to move furniture or take shoes off, and remembered sensory preferences from session to session.

"I think a bigger factor is the willingness to understand what I need."
Other adaptations that work

Processing time: "She also gives plenty of space and time for me to think and process. I never feel rushed. Minutes can pass by with me staring off somewhere trying to burrow down into something and she just waits until I ask her for help."

Alternatives to verbal communication: "Initially I did this by sending her emails before sessions about what I wanted to talk about because I found it too hard to verbalize."

"On bad days when I was struggling to speak, I wouldn't be pressured. He said to let him know when I was ready to talk, and he sat there quietly – or he would hand me a pen and paper and suggest that I draw or write instead."

Even physical positioning mattered: "We created a timeline of my life. To do this we sat at a desk side by side rather than facing, and I think this made it much more comfortable for me to open up and talk."
Good practice, made accessible

What encouraged me most in this research was the diversity of positive experiences participants shared. They described ten different therapeutic modalities. Six had positive experiences within NHS services. Both neurodivergent and non-neurodivergent therapists were described as providing excellent support.

This isn't about inventing new approaches or becoming an autism specialist. It's about recognising that the core conditions of empathy, congruence, and unconditional positive regard work for autistic clients too. They just need to be especially clear, transparent, and explicitly communicated.

The adaptations participants valued aren't burdensome accommodations, and as with the curb cut effect, they're often helpful to many other clients.

SIDEBAR: MAKING THERAPY ACCESSIBLE: FIVE PRACTICAL SHIFTS

Before the first session
Send information about what will happen, where to go, what to expect. Include details like: Is there a waiting room? Will they speak to a receptionist? How long will it last?

In the physical space
Offer options. Can lights be dimmed? Chairs without armrests? Less stimulating spaces available?

In communication
Be explicit. Ask directly about preferences rather than expecting clients to request accommodations. Use clear, concrete language. Check understanding frequently.

In planning
Suggest a focus for the session rather than asking open-ended questions. "I was thinking we could work on X today – how does that sound?" or "We could continue with X, or move to Y – which feels right?"

In follow-up
Offer written summaries or key points. This supports processing and reduces anxiety about "Did I understand correctly?"

Zoe McFarlane is Director of Coaching South West, providing CPD training for mental health professionals and coaching for autistic adults. She holds an MSc in Psychology and is a member of the British Psychological Society and the Association for Coaching. Her research, "A Qualitative Study Investigating the Positive Experiences of Therapy and Therapeutic Relationships of Late-Diagnosed Autistic Females" is published in Autism in Adulthood (2025).

SOURCE:

https://www.bps.org.uk/psychologist/autistic-women-and-weird-therapist-magic(accessed 16.2.26)

Winter Olympics 2026: How the brain handles high-speed fear

Olympians’ brain activity differs from that of non-Olympians when facing stress and competitive environments.


Mikaela Shiffrin racing at the FIS Alpine Skiing World Cup in Soldeu, Andorra on March 18, 2023.





By Hande Naz Kavas
Published Tuesday, February 10, 2026


The Winter Olympics 2026 officially began last Friday in northern Italy. From ski jumping to curling, figure skating to snowboarding, lots of athletes will reach extraordinary speeds over the course of two weeks. As we perch on the edge of our seats, waiting for the start gun to fire or the start gate to drop, these athletes prepare to push the limits of physics. While their professionalism may deceive us into thinking we could do the same, we should remind ourselves of the fear we had when skiing ourselves down a snowy mountain for the first time or competing in front of an audience far smaller than a global one.

Recent studies suggest that Olympians’ brains function differently, enabling them to manage high-speed fear more effectively. Stories conducted on various Olympians show that they develop individual mechanisms to cope with fear and that their brain activity differs from that of amateur athletes.

In 2003, the South African Journal for Research in Sport, Physical Education and Recreation published an article titled “The Experience of Fear in High-Risk Sport,” in which researchers interviewed 12 athletes from six countries — South Africa, Namibia, Zimbabwe, the Czech Republic, the U.S. and Canada — to examine how they respond to and manage fear and anxiety.

Notably, the researchers emphasized a distinction between fear and anxiety, arguing that unlike situations of fear — in which “perceived threat is known and can therefore cause a specific action” — anxiety alone “cannot produce specific avoidance behaviours.” This distinction was central to their research, as they sought to understand how athletes continue participating in high-speed sports despite instinctual fear that might otherwise encourage caution.

The researchers observed seven psychological “themes” within the athletes’ psyches that helped them perform well despite the stakes. One key observation was that athletes draw motivation from reflecting on their “peak” performances. While similar moments are often portrayed in action films, cinematic portrayals can obscure the real danger in such scenarios. This observation relates to another finding of the study: that high-risk athletes have “misconceptions and denial about the intrinsic danger of the activities.”

The sixth theme highlighted that high-risk athletes “express the need for stimulation, change and creativity.” This creativity helps them manage the fear of pushing the boundaries of physical possibility to deliver extraordinary performances. The seventh theme reinforces this notion, noting that high-risk athletes “view their sport as being unique and misunderstood by the general population.”This mindset may contribute to record-breaking performances, even as athletes feel that spectators struggle to fully grasp the risks involved.

A more recent study — “Anxiety and Fear in Sport and Performance,” published in the Oxford Research Encyclopedia of Psychology in 2018 — examined the role of anxiety and fear in athletic performance. The researchers argued that athletes who are repeatedly exposed to fear-inducing environments can gain a performance advantage over those who struggle to cope with stress. The study emphasized that anxiety and fear often work together in shaping performance in extreme sports, helping explain why non-Olympians may find it more difficult to start an extreme sport compared to seasoned athletes.

While psychological theory provides a strong foundation for understanding high-speed performance, examining brain anatomy offers insight into how these differences manifest physiologically.

A 2021 case study titled “Neural Oscillation During Mental Imagery in Sport: An Olympic Sailor Case Study” examined the neural activity of a 32-year-old two-time Olympic sailor. Researchers tested how the athlete responded to guided versus self-generated multisensory imagery related to their sport. The researchers used an electroencephalogram, commonly known as an EEG, to measure the participants’ low and high alpha waves and sensorimotor rhythm activity. High alpha and SMR waves corresponded with heightened focus and attention, while low alpha waves indicated a more relaxed mental state.

The study found that multisensory imagery, often used in mental training, can enhance athletic performance. The researchers compared the sailor’s brain activity with existing research, the authors concluded that “an elite athletes’ brain is characterized by more efficient resources distribution, more economic activity or hypoactivation.”

With these studies in mind, it is clear that the Winter Olympics represent more than two weeks of entertainment. They are a scientific challenge of both mind and body. We can only imagine the fear and anxiety these athletes face as they attempt the extraordinary.

SOURCE:

https://www.tuftsdaily.com/article/2026/02/winter-olympics-2026-how-the-brain-handles-high-speed-fear(accessed 11.2.26)

The continuity of consciousness

Cardiologist Pim van Lommel on his interest in Near Death Experience, the research, and what it might mean for Psychologists and our understanding of consciousness.

02 January 2026




'This blessing experience was decisive in convincing me that consciousness lives on beyond the grave'

As a medical student, I learned that it was obvious that consciousness was a product of a functioning brain, and as a young cardiologist, I was still convinced that death was the end of our consciousness. But after reading George Ritchie's 1979 book Return From Tomorrow, a psychiatrist's account of his own Near-Death Experience (NDE) as a medical student in 1943, I started to ask patients who had survived a cardiac arrest if they had memories from their period of unconsciousness.

As a cardiologist, I was privileged to meet patients who survived their period of 'clinical death' – a period of unconsciousness caused by lack of oxygen in the brain due to the arrest of circulation and breathing that happens in cardiac arrest during an acute myocardial infarction. These patients will ultimately die from irreversible damage to the brain if cardio-pulmonary resuscitation (CPR) is not initiated within 5 to 10 minutes. It is the closest model of the process of dying.

To my great surprise, within two years, 12 patients out of 50 survivors of cardiac arrest told me about their NDE. That piqued my scientific curiosity. According to our current medical concepts, it is not possible to experience consciousness during a cardiac arrest, when circulation and breathing have ceased, and the electrical activity in the brain, normally thought to be essential for conscious experiences, has ceased as well. Those patients should have no memories at all!

And so the phenomenon of NDE raised a number of fundamental questions for me: What are NDEs? How and why do they occur? Why does a person tend to change so radically after an NDE? And what does all this mean for the traditionally materialistic view of the relationship between the brain and consciousness?


An introduction to NDEs

Experiences of enhanced consciousness have been mentioned across all times and all cultures, usually called 'experiences of enlightenment' or 'mystical experiences'. Raymond Moody's 1975 book Life after Life associated those experiences with the possibility of imminent death and popularised the term 'Near-Death Experiences'. Interestingly, though, the equivalent French term expérience de mort imminente was used as far back as the 1890s by the psychologist Victor Egger.

The NDE can be defined as the reported memory of a range of impressions during a special state of consciousness, including several commonly occurring elements such as an out-of-body experience, unusually happy feelings, seeing a tunnel, a (being of) light, beautiful colours or a celestial landscape, hearing music, meeting with deceased relatives, having a life review, approaching a border of no return, and finally a conscious return into the body. NDEs are reported during many situations such as cardiac arrest, shock after loss of blood, coma, near-drowning or asphyxia.

However, NDE-like experiences can also be reported during severe depression, imminent traffic accidents, meditation, or without any obvious reason. So, apparently, you don't always need a non-functioning brain to report experiences associated with an NDE. Some polls suggest that at least 4 per cent of the total population in the Western world are likely to have experienced an NDE (Gallup, G. & Proctor, W., 1982). and modern techniques of resuscitation and better treatment for cerebral trauma may make them more likely.

NDEs are always transformational, often causing profound changes in life-insight, the loss of fear of death, and enhanced intuitive sensitivity (Van Lommel, 2010). So why do psychologists or physicians hardly ever hear a patient talk about their NDE? For the simple reason that patients are reluctant to share their experience, given the negative responses they are likely to get. Patients must feel that you trust them and that you can listen without any comment or prejudice. But for most psychologists and other healthcare workers, the NDE is still an incomprehensible and unknown phenomenon.


Our studies

So, in 1988, we started a prospective study of 344 consecutive survivors of cardiac arrest in ten Dutch hospitals, which aimed to investigate the frequency, cause and content of an NDE. Our study was published in The Lancet (Van Lommel et al., 2001). We wanted to know if there could be a physiological, pharmacological, psychological, or demographic explanation for why people experience enhanced consciousness during a period of cardiac arrest.

We found that 82 per cent of patients had no recollection of the period of cardiac arrest, i.e., of their period of unconsciousness. However, the remaining 18 per cent of patients reported some recollection during the time of clinical death. Of these patients, 41 (12 per cent of the sample) had a 'core experience' with a score of 6 or higher, and 6 per cent had a superficial NDE. Across the group, all the well-known elements were reported.

We found, to our surprise, that neither the duration of cardiac arrest (between 2 minutes and 8 minutes) nor the duration of unconsciousness (from 5 minutes to 3 weeks in coma), nor the need for intubation in complicated CPR, nor a brief, induced cardiac arrest during electrophysiological stimulation (EPS), had any influence on the frequency of NDE.

So, the degree of the lack of oxygen in the brain (anoxia) appeared to be irrelevant and could, therefore, be excluded as an explanation. Moreover, all patients had been unconscious due to anoxia of the brain, and only a small percentage of patients reported an NDE. Nor could we find any relationship between the frequency of NDE and administered drugs, fear of death before the arrest (a psychological explanation), nor foreknowledge of NDE, gender, religion (being a Christian or atheist did not matter at all), or education.

We additionally performed a longitudinal study with taped interviews 2 and 8 years following the cardiac arrest of all long-term survivors with NDE, along with a matched control group of survivors of cardiac arrest who did not report an NDE. This study was designed to assess whether any psychological changes were the result of having an NDE, or just of the cardiac arrest itself. This had never been studied before in a prospective design.

Only patients with an NDE showed the typical transformation – loss of fear of death, transformation in attitude toward life, and enhanced intuitive sensitivity. This transformation seemed the most potent and objective evidence for this subjective experience. People were less afraid of death and had a stronger belief in an afterlife.


'It is outside my domain to discuss something that can only be proven by death. For me, however, this blessing experience was decisive in convincing me that consciousness lives on beyond the grave, and I know now for sure that body and mind are separated. Death was not death, but another form of life'.

We saw in them a greater interest in spirituality and questions about the purpose of life, as well as a greater acceptance of and love for oneself, in combination with a feeling of oneness with others and with nature. The conversations we had in our longitudinal study revealed that people, often to their own amazement and confusion, had acquired enhanced intuitive feelings after their NDE.

For me, it was quite a remarkable and unexpected finding to see a cardiac arrest lasting just a few minutes give rise to such a lifelong process of transformation. The longer the interval between NDE and our interview, the more positive changes are usually reported, and, ultimately, integration of the NDE will follow (Van Lommel, 2021). But I have also met people who had been silent about their NDE for more than 50 years!


'I couldn't even talk about it, or I would have been committed to an institution'.

And the integration and acceptance of an NDE is a process that may take a long time, because of its far-reaching impact on people's pre-NDE understanding of life and value system. Despite its mostly positive content, the NDE is also a traumatic event in itself. There is hardly any acceptance by physicians, psychologists and nurses, as well as friends, family members and partners, with a divorce rate subsequent to an NDE of more than 70 per cent (van Lommel, 2010), which makes the process of acceptance and integration very difficult.

The NDE is, for most patients, then, a real psychological trauma. Unfortunately, there seems to be hardly any knowledge about NDE by most psychologists, presumably because of a widespread unfamiliarity with the scientific literature on NDE. More knowledge about the NDE amongst psychologists could be helpful for the significant number of people who have experienced one.
Other studies and their significance

Other researchers – psychiatrists, physiologists and medical scientists – have reported around the same prevalence of NDEs in prospective studies on NDE in survivors of cardiac arrest as in our study, and they have all concluded that no one physiological or psychological model by itself could explain all the common features of an NDE.

American Psychiatrist Bruce Greyson writes that the paradoxical occurrence of heightened, lucid awareness and logical thought processes during a period of impaired cerebral perfusion raises particular perplexing questions for our current understanding of consciousness and its relation to brain function. A clear sensorium and complex perceptual processes during a period of apparent clinical death challenge the concept that consciousness is localised exclusively in the brain.

In the UK, Sam Parnia and Peter Fenwick wrote that the data from several NDE studies suggest that the NDE arises during unconsciousness, and that this is a surprising conclusion, because when the brain is so dysfunctional that the patient is deeply comatose, those cerebral structures, which underpin subjective experience and memory, must be severely impaired. Complex experiences such as are reported in the NDE should not arise, nor be retained in memory. Such patients would be expected to have no subjective experience at all.

British biomedical scientist Penny Sartori concludes that, according to mainstream science, it is quite impossible to find a scientific explanation for the NDE if we 'believe' that consciousness is only a side effect of a functioning brain. And perhaps because of this, the conclusion about conscious experiences during a flatline EEG is often called impossible and unscientific.

How do we really know that with cardiac arrest, the EEG, the registration of electrical activity of the cortex, is flat? Many studies have shown that during cardiac arrest, there is complete cessation of cerebral flow within one second, causing sudden loss of consciousness within seconds, loss of breathing, loss of all body reflexes (a function of the cortex), along with the loss of all brainstem reflexes like the gag reflex, the corneal reflex, and fixed and dilated pupils.

In studies of human cardiac arrest, EEG activity has also been shown to be absent after 10-20 seconds. This is important because in an acute myocardial infarction, the duration of cardiac arrest is always longer than 20 seconds, as successful CPR usually takes at least 2-4 minutes. So, all survivors of cardiac arrest in the several prospective studies on NDE must have had a flatline EEG. In spite of this, about 20 per cent of those patients reported an NDE (van Lommel, 2010).

The often proposed objection – that a flatline EEG does not rule out any brain activity, because it is mainly a registration of electrical activity of the cerebral cortex – misses the mark. The issue is not whether there is any brain activity of any kind whatsoever, but whether there is measurable brain activity of the specific form regarded by contemporary neuroscience as the necessary condition of conscious experience, with visible activities in many neural centres, the so-called global neural workspace.

It has been proven that there is no such specific and dynamic brain activity at all during cardiac arrest. Given this, one has to be open to the possibility that, during NDE, enhanced consciousness is experienced independently from the normal body-linked waking consciousness.


The Out-of-Body Experience and the Life Review

I would now like to reconsider certain elements of the NDE which might be of particular interest to psychologists. First, the Out-of-Body Experience, or OBE. In this experience, people have veridical perceptions from a position outside and above their lifeless body.

People have the feeling that during their NDE they have apparently taken off their body like an old coat, and to their surprise they appear to have retained their own identity with the possibility of perception, emotions, and a very clear consciousness. This out-of-body experience is scientifically important because physicians, nurses and relatives can verify the details of the reported perceptions, and they can also corroborate the precise moment the NDE with OBE occurred during the period of CPR.

In two reviews with a total of more than 200 corroborated reports of potentially verifiable out-of-body perceptions (Holden, 2009; Rivas et al., 2016), it was found – through the verification of those in the operating theatre – that more than 95 per cent of the reported perceptions during coma, cardiac arrest or general anaesthesia were about details that really had happened. Can an OBE really be a hallucination, delusion or illusion, given these veridical aspects? And doesn't one need a functioning brain to have a hallucination, delusion, or illusion?

Next, another common experience, the Life Review. During such a life review, one feels connected to the memories, emotions and consciousness of those with whom they have interacted in the past, thereby experiencing the consequences of their own thoughts, words, and actions and more generally, their interconnectedness with others.

Patients also report experiencing their whole life in one glance and that time and space do not seem to exist during such an experience ('nonlocality'). All that has been done, said and thought seems to be significant and stored forever.


'And all the time during the review, the importance of love was emphasised. Looking back, I cannot say how long this life review and life insight lasted; it may have been long, for every subject came up, but at the same time, it seemed just a fraction of a second, because I perceived it all at the same moment. Time and distance seemed not to exist. I was in all places at the same time, and sometimes my attention was drawn to something, and then I would be present there.'

These, and other commonly occurring elements of an NDE – like the tunnel experience, light, a meeting with deceased relatives and a conscious return in the body – have been described in greater detail in the literature (van Lommel, 2010; van Lommel, 2021).


Other experiences of enhanced consciousness

Scientific study of NDE pushes us to the limits of our medical and neurophysiological ideas about the range and potential of human consciousness and the mind-brain relation. Based on the scientific literature about NDE, and on our Dutch prospective study on NDE in survivors of cardiac arrest, my own view is that an NDE might be considered a changing state of consciousness that continues in spite of a non-functioning brain, in which memories, identity, and aspects of emotion, cognition and perception function independently from the unconscious body.

An NDE, or an experience of an enhanced or nonlocal consciousness during a life-threatening situation like cardiac arrest, coma or during general anaesthesia, makes it extremely unlikely that consciousness could entirely be a product of the function of the brain. Based on these experiences, I suggest that there will be a continuity of consciousness after death.

Other reported forms of enhanced consciousness just before, during or after death also support this conclusion. These include the frequently occurring end-of-life experiences, or ELE, during the terminal phase of illness; terminal lucidity, which is the unexpected return of mental clarity and memory shortly before death in the end-stage of Alzheimer disease; shared-death experiences which can be reported by healthy people who are present at the bedside of a dying relative; and after-death communication, or ADC, which is the feeling or inner knowing to be in contact with the consciousness of a deceased loved one in the first days, weeks or months following their death.

According to research, about 125 million people in Europe, and more than 175 million people in the USA, must have had an ADC (Guggenheim & Guggenheim, 1995; Tevington & Corichi, 2023). These experiences of enhanced consciousness just before, during or after death have been described in greater detail in the literature (van Lommel, 2010; van Lommel, 2021).
A paradigm shift

The phenomenon of the NDE can no longer be scientifically ignored. An NDE during a cardiac arrest of only a few minutes' duration can change people permanently. It is an authentic experience which cannot be simply reduced to imagination, fear of death, hallucination, psychosis, the use of drugs, or oxygen deficiency. It is my belief that the current materialistic view of the relationship between the brain and consciousness held by most physicians, philosophers and psychologists is too restricted for a proper understanding of an NDE or of another experience of enhanced consciousness.

Remarkably, in a representative social poll in Europe, about 55 per cent of the population believed in some kind of personal survival beyond death, and in the USA this percentage is even higher (Halman, 2001). These figures are in sharp contrast with the opinion of most Western scientists, who systematically ignore and ridicule the possibility of personal survival after physical death (Larson & Witham, 1998). We desperately need a real paradigm shift in science – to expand our scientific minds to include subjective experiences.

Given the evidence of those experiences of enhanced consciousness, it seems at least plausible to suggest that there may be a continuity of consciousness after death – a clear challenge to the materialist-reductionist paradigm! Consciousness seems to be our essence. Could it be that once we leave our body and our physical world, we exist as pure consciousness, beyond time and space, enfolded in pure, unconditional love?

Pim van Lommel, Cardiologist, former Rijnstate Hospital, Arnhem, The Netherlands.
Email: pimvanlommel@gmail.com. Website: www.consciousnessbeyondlife.com

This is part of a January/February 2026 consciousness special.


References

Gallup, G. & Proctor, W. (1982). Adventures in Immortality: A Look Beyond the Threshold of Death. McGraw-Hill, New York.

Greyson, B. (2003). Incidence and correlates of near-death experiences in a cardiac care unit. General Hospital Psychiatry 25, 269-276.

Greyson, B. & James B (Eds) The Handbook of Near-Death Experiences. Thirty Years of Investigation. pp. 185-211. Praeger / ABC-CLIO, Santa Barbera, CA.

Guggenheim, B., Guggenheim, J. (1995) Hello from Heaven: A New Field of Research- After-Death Communication- Confirms that Life and Love Are Eternal. Bantam Books, New York, USA.

Halman, L. (2001)The European Values Study: A Third Wave. Sourcebook of the 1999–2000 European Values Study Surveys. Tilburg University, The Netherlands..

Holden, J.M. (2009) Veridical perception in near-death experiences. In Holden, J.M., Greyson, B. & James B (Eds) The Handbook of Near-Death Experiences. Thirty Years of Investigation. pp. 185-211. Praeger / ABC-CLIO, Santa Barbera, CA.

Larson, E. J. Witham, L. (1998). Leading Scientists Still Reject God. Nature 394 (1998).

Moody, R.A. Jr (1975). Life after Life. Mockingbird Books, Covington, G.A..



Parnia, S., Waller, D.G., Yeates, R., & Fenwick, P. (2001). A qualitative and quantitative study of the incidence, features and aetiology of near-death experience in cardiac arrest survivors. Resuscitation 48, 149-156.



Rivas, T., Dirven, A., Smit, R.H. (2016). The Self does not die. Verified paranormal phenomena from near-death experiences. IANDS, USA.

Ritchie, G.G. (1978). Return from Tomorrow. Chosen Books of The Zondervan Corp., Grand Rapids, Michigan.



Sartori, P. (2006). The Incidence and Phenomenology of Near-Death Experiences. Network Review (Scientific and Medical Network) 90, 23-25.

Tevington, P., Corichi, M. (2023) https://www.pewresearch.org/short-reads/2023/08/23/many-americans-report-interacting-with-dead-relatives-in-dreams-or-other-ways/



Van Lommel, P., Van Wees, R., Meyers, V., Elfferich, I. (2001). Near-death experiences in survivors of cardiac arrest: A prospective study in the Netherlands. Lancet 358, 2039-2045.



Van Lommel, P. (2010). Consciousness Beyond Life. The Science of the Near-Death Experience. Harper Collins, New York.

Translation from: Van Lommel, P. (2007). Eindeloos Bewustzijn. Een wetenschappelijke visie op de bijna-dood ervaring. Kampen,

Van Lommel, P. (2021) The Continuity of Consciousness. A Concept based on scientific research on Near-Death Experiences during cardiac arrest. Bigelow Institute for Consciousness Studies. Winning Essays 2023. Proof of Survival of Human Consciousness beyond Permanent Bodily Death, Volume Two, pp 1-75. https://www.bigelowinstitute.org/docs/2nd.pdf

SOURCE:

https://www.bps.org.uk/psychologist/continuity-consciousness(accessed 11.2.26)

Acute and chronic depression appear differently in the brain

New research finds differences in inflammation and microstructure in a mood-, motivation-, and reward-related brain region between acute and chronically depressed people.

23 January 2026

By Emma Young



Inflammation is known to play a role in depression. But there's debate about what, exactly, that role is — and whether it might be different for people with a long-term history of depression versus those in the throes of an acute depressive episode.

To explore this, Sarah Khalife at the University of Queensland, Australia and colleagues analysed markers of inflammation in MRI scans of the brains of 32,495 participants in the UK Biobank study. Of these, 3,807 had been diagnosed with depression.

Their work, in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, focused specifically on a brain region called the ventral tegmental area (VTA). This area plays a critical role in regulating mood, motivation, and reward — all of which are altered in depression. But, because of the small size and complexity of the VTA, it has been relatively neglected in neuro-imaging research, the team writes.

When conducting their analysis, the team didn't just consider whether a participant had been diagnosed with depression or not. They also looked at the participants' scores on a survey of levels of depressive symptoms that they had completed on the day of their brain scan. This questionnaire asked about levels of depressed mood, a lack of enthusiasm/disinterest, tenseness/restlessness and tiredness/lethargy over the past fortnight.

The team used the participants' total scores on this survey to identify those with 'acute' depression — irrespective of whether they had ever been diagnosed with depression. This led them to compare VTA data on three main groups: healthy controls, participants with acute depression, and participants with chronic depression.

When the team then analysed the MRI data, they found that those with chronic depression had clear signs of neuro-inflammation in the VTA, compared with the healthy controls. There were no changes to the microstructure of the VTA, however.

The pattern of results for those with acute depression was different. Whether or not they had received a diagnosis of depression, they showed signs of VTA inflammation — though there were slight differences in the specific inflammation signals compared with those in the participants diagnosed with depression. There were also micro-structural changes within the VTA, with the MRI data suggesting a greater density of brain cells, for example.

"This dissociation suggests that these two states of depression — historical diagnosis of major depression versus acute depressive symptoms across the general population – may reflect distinct biological processes and inflammatory states," the researchers write.

Earlier work has shown that the VTA is highly susceptible to inflammation, they note, and that by interfering with dopamine signalling in this region, inflammatory chemicals may tip the balance in favour of prioritising the conservation of energy — perhaps triggering the withdrawal behaviours typical of depression, rather than reward-seeking behaviours — such as going out and meeting up with friends.

More work is clearly needed to elucidate how the VTA changes associated with acute versus chronic depression affect symptoms. Also, the cross-sectional design of the study means it cannot show that certain types of neuro-inflammation cause microstructure changes — longitudinal type studies would be needed to explore this.

But the identification of specific, and also different, changes in the VTA in people with acute versus chronic depression suggest new potential approaches to treatments. "These findings could ultimately inform more targeted therapeutic approaches that consider the distinct biological processes underlying depression," the team concludes.

Read the paper in full:
Khalife, S., Bollmann, S., Zalesky, A., & Oestreich, L. K. L. (2025). MRI-Derived Markers of Acute and Chronic Inflammatory Processes in the VTA Associated with Depression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. https://doi.org/10.1016/j.bpsc.2025.09.003

SOURCE:

https://www.bps.org.uk/research-digest/acute-and-chronic-depression-appear-differently-brain(accessed 5.2.26)