The Power of Conversation

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It’s a well known fact that a problem shared is a problem halved, right? But when you’re feeling down or worried sometimes talking about your feelings can seem too hard. For some people it could be easier to bury these feelings and try and carry on regardless, or for others admitting how they truly felt would seem a sign of weakness.

As you may know it’s Mental Health Awareness week in the UK, so this year I’ve decided to write about the power of conversation, and why you don’t have to deal with everything on your own.

Talking to others about their feelings is something men can be particularly bad at, especially when it comes to any concerns about their physical or mental health. To quote the columnist and campaigner Bryony Gordon in her recent article “Women are encouraged to talk about their problems. Men just have football.” Prince Harry was recently praised for his honesty in talking about his mental health – something which will hopefully change the stereotypical view that British men should have a ‘stiff upper lip’ and not show any sign of emotion.

This gender divide has led to inequality in mental health. In 2016, 3 times more men committed suicide than women. Suicide takes more lives of men under the age of 45 than accidents or disease.

Why is it that men are more at risk of suicide than women, when more women are diagnosed with a common mental illness? One explanation is that men aren’t as good at accessing healthcare as women – for example in the first 3 quarters of 2015, only 36% of those who accessed Improving Access to Psychological Therapy (IAPT) services were male*. Men are also less willing to let others know if they have a problem, with one survey finding that only a quarter of men said they had disclosed a mental health problem to a friend within a month, compared to a third of women. Almost 30% of men said they never tried to access help for their last mental health problem, compared to just under 20% of women **.

Accessing the correct care early is vital in the successful treatment of mental illness. For most common mental illnesses, talking therapies are used as a form of treatment (possibly in conjunction with medication). These include Cognitive Behavioural Therapy (CBT), Psychotherapy, Dialectic Behaviour Therapy, or Counselling – just to name a few. Having the opportunity to talk about thoughts and behaviours with a trained professional can give you the space to work out the cause of your worry or identify any patterns in your thinking which contribute to negative feelings. Therapies such as CBT also try to change behaviours using set goals agreed between the patient and professional which can lead to an improvement in mental wellbeing.

This evidence shows that the culture has to change. Why should it be taboo for men to speak about their feelings in the pub with their mates, as I do with my girlfriends over dinner? Anyone should feel like they have someone to talk to about their problems, even if that person is a healthcare professional – they’re there to help.

On a final note – one project I’m proud to be involved in which is aiming to reduce the stigma of mental illness is a zine called ‘do what you want’. This includes articles from a range of writers and has been featured in the Guardian, BBC and Grazia. All proceeds go to mental health charities, and the ebook (and print version whilst it’s still in stock!) can be ordered here: http://dowhatyouwantzine.co.uk

* https://www.menshealthforum.org.uk/key-data-mental-health

**https://www.mentalhealth.org.uk/news/survey-people-lived-experience-mental-health-problems-reveals-men-less-likely-seek-medical

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Behavioural Activation

This week’s post is about a technique used as part of cognitive behavioural therapy for people with depression. As you probably know already, symptoms of depression include low mood, low self-esteem, feelings of anxiety and helplessness, and having low motivation and interest in activities which they previously enjoyed.

Behavioural activation focuses on the ‘B’ of the CBT model, in this case on the last symptom in particular – the withdrawal from usual activities and friends. For example, they may start to avoid social engagement and ignore invites from friends or make excuses as to why they can’t meet up, whereas before they would have been happy to go. Although in the short term this avoidance causes a temporary relief, such as a lowering of anxiety, it simply reinforces feelings of low mood or low self-esteem. This maintenance of the condition is illustrated by this diagram below:

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Therefore, in order to break this cycle, behavioural activation aims to change the unhelpful behaviours which continue the cycle of low mood. It does this by gradually building up activities that the person can do, which is turn will improve their mood, and lead eventually to them getting back to activities they used to enjoy. This progression is important, as the change in mood is needed before larger behavioural changes can occur.

Key features of Behavioural Activation are as follows (taken from Jacobson et al, 2001):

  • Firstly, the model is presented to patients by their clinician, who explain a bit about it and why it works. This is called a treatment ‘rationale’ and it is important for the patient to feel confident that this will work. A good relationship and trust with the therapist is also important.
  • Developing treatment goals through collaboration between the patient and the therapist – these goals are new behaviours rather than moods or emotions.
  • Analysis of causes and maintenance factors of the depression
  • Graded task assignment – e.g. starting with something small such as walking to the corner shop. This is scheduled in between sessions, and a hierarchy is discussed with the therapist.
  • Establishing a routine, in the hope this results in improved mood.

Ultimately, the aim of Behavioural Activation is to help the patient re-engage and find joy in activities which they have been avoiding. This will raise mood, and therefore help someone recover from depression.