Social Support and Health

Having a strong network of family and friends around us is generally perceived as a good thing, meaning we have people to talk to if we have a problem or help us when we are in need. However, what if there’s more to it, and having a social network (the real, not the Facebook kind) can actually improve our health, and make us live longer?

To start – how have scientists defined social support? Rather than just being about the number of people in our social network, “social support refers to the clarity or
certainty with which an individual experiences being loved, valued, and able to
count on others should the need arise” (Turner & Lewis Brown, 2010). Therefore the quality of our social relationships is important, not just quantity.

Friends-1-920x584

The health benefits of having strong social bonds have been studied for decades. One of the first studies to suggest a link between social support and health was conducted in America in the 1970s (Berkman & Syme, 1979). They studied a random sample of almost 7000 adults, and followed them up for nine years. The results showed that people with lower social ties were more likely to die in this follow up period than those with higher levels of social support. Importantly, this finding was independent of general health, socio-economic status, and lifestyle factors such as physical activity and smoking.

As well as improving our physical health, social support also has benefits for our mental health. Research has found that perceived social support is correlated with depression, with those perceiving higher levels of social support experiencing fewer depressive symptoms (Stice et al, 2004) One other aspect of mental health which is thought to be particularly improved through social support is stress. Social support acts as a ‘buffer’ to stress, influencing whether we see stressful events as a threat, and how well we are able to cope with them (Lakey & Orehek, 2011).

We’ve seen that increased social support can lead to an improvement in our physical and mental health, but how does this effect occur? Uchino (2006) hypothesises that social support could influence health via two different pathways. The first states that social support acts as a positive influence and promotes health behaviours, such as taking medication or going to the doctor when ill, having a balanced diet, or not smoking. The second pathway states that social support directly influences our mood and emotions, which in turn helps to keep us healthy.

As described above, social support can help to act as a buffer and make us more resilient to stress. A reduction in stress levels can help cardiovascular health: several studies have shown that higher social support is correlated with lower blood pressure (e.g. Gump et al, 2001). Social support could also improve our health through our immune system: one study found that cancer patients with higher levels of social support had higher levels of tumour-fighting cells than those with less social support (Levy et al, 1990).

Of course, having a strong social network isn’t going to guarantee perfect health and a long life. But there’s a strong case to suggest that investing more time in our real world friendships could improve our health, as well as the health of those around us.

 

References:

Berkman, L.F. and Syme, S.L., 1979. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. American journal of Epidemiology109(2), pp.186-204.

Gump, B.B., Polk, D.E., Kamarck, T.W. and Shiffman, S.M., 2001. Partner interactions are associated with reduced blood pressure in the natural environment: Ambulatory monitoring evidence from a healthy, multiethnic adult sample. Psychosomatic medicine63(3), pp.423-433.

Lakey, B. and Orehek, E., 2011. Relational regulation theory: A new approach to explain the link between perceived social support and mental health. Psychological review118(3), p.482.

Levy, S. M., Herberman, R. B., Whiteside, T., Sanzo, K., Lee, J., and Kirkwood, J. (1990). Perceived social support and tumor estrogen/progesterone receptor status as predictors of natural killer cell activity in breast cancer patients. Psychosom. Med. 52: 73–85

Stice, E., Ragan, J. and Randall, P., 2004. Prospective relations between social support and depression: Differential direction of effects for parent and peer support?. Journal of abnormal psychology113(1), p.155.

Turner, R.J. and Brown, R.L., 2010. Social support and mental health. A handbook for the study of mental health: Social contexts, theories, and systems2, pp.200-212.

Uchino, B.N., 2006. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. Journal of behavioral medicine29(4), pp.377-387.

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Self Care and Mental Health

Self care is a bit of a buzz word at the moment, with tonnes of articles about the benefits of taking time out to look after yourself. Sometimes, self care is used as another way to describe pampering, with things like bubble baths or face masks cited as a type of self care. Self care can also be more basic, for example simply eating regular, balanced meals, or getting enough sleep. This post will examine the science behind the magazine articles, to see what self care is, and whether it is really beneficial for your mental health.

Self care is really just another way of saying ‘look after yourself’ or taking time to do things you enjoy. The mental health charity Mind list different ways self care can help improve your mental health. Their suggestions include being aware of your mental health, being kind to yourself, making sure you interact and feel connected with others. They also suggest taking time to relax, either through mindfulness or getting outside, as well as keeping physically healthy. If you’d like to find out more about self care strategies, click here for further information.

 

Self-care

 

But what is it about self care which improves our mental health? One hypothesis is that  taking part in these activities helps people have a sense of purpose and gives life more meaning, which in turn increases self-esteem (Deegan, 2005). Some participants in this study reported that taking part in self care activities which gave life more purpose (e.g. belonging to a singing group, or volunteering) had helped them stay well, decreasing symptoms and avoiding negative outcomes such as hospitalisation. Other more routine aspects of self care, such as shopping or talking on the phone were used as strategies to reduce anxiety or other unwanted symptoms.

Meditation, or mindfulness has also been explored as a way of using self-care to reduce burnout and stress in healthcare professionals. One study by Shapiro et al taught trainee therapists a mindfulness-based stress reduction programme, and found that participants who received the training had lower stress & anxiety levels, less rumination and higher levels of self-compassion than participants who didn’t receive the training. These results suggest that mindfulness is a way of improving the mental health of professionals at a high risk of burnout.

The evidence suggests that taking the time to engage in self care activities could be something we can all do to improve our mental health. Self care is more than just bubble baths; it includes look after our physical health, changing our diet or doing something like volunteering which gives us a sense of purpose. Have you tried self care before? Let me know in the comments if you think it worked for you!

References:

Deegan, P.E., 2005. The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health33(66_suppl), pp.29-35.

https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/self-care/#.WzPZQEgvy00

Shapiro, S.L., Brown, K.W. and Biegel, G.M., 2007. Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and education in professional psychology1(2), p.105.

image reference: Sacha Chua via http://ryersonian.ca/a-post-election-guide-to-self-care/

Not Ill Enough

Imagine living with depression. It affects every aspect of your life, from your work to the time you spend with your family. You experience intrusive negative thoughts. You begin to suffer from insomnia, which in turn increases feelings of anxiety. Imagine living with depression, but being told you are not ill enough to qualify for mental health treatment.

This scenario is unfortunately far too common in those seeking help for mental illness. Adult mental health services are often only able to treat the most severely ill, with their treatment focus on those with severe and enduring mental illnesses, such as psychosis or bipolar disorder (McGorry, 2007). This has led to strict eligibility criteria to be put in place when assessing whether someone is suitable to be cared for at their service, something thought to be in part due to a lack of funding and resources (Belling, 2014). If someone visits A&E with a broken arm we don’t wait for it to get worse before we treat it, so why does this happen if someone goes to their doctor with signs of an eating disorder? A recent investigation by the British Medical Associate found waiting lists of up to 2 years in some parts of the UK, (BMA, 2018). Once again this shows the disparity between our attitudes to physical vs mental healthcare.

According to the eating disorder charity BEAT, some people had to wait an average of 182 days to access care in some areas of the UK. This is despite all evidence pointing to the advantages of early intervention: an individual with an eating disorder is 50% less likely to relapse if they can access treatment early. Treatments have also been shown to be more effective if accessed at an early stage (BEAT, 2018).

beat

This problem isn’t just specific to the UK – one study of carers with mental illness in Australia found that they had to push for their relatives to access appropriate care, with one of the main barriers being that they were not ill enough to be admitted to hospital for their mental health, in some cases despite being suicidal (Olasoji, 2017). Another study looked at the treatment gap in different countries (the percentage difference between the numbers needed treatment and those receiving treatment for it) and found the treatment gap for major depression to be between 36% in the Netherlands to 73% in Finland (Kohn et al, 2004). The international nature of this disparity in mental health care shows how global attitudes to mental illness need to change to allow people to access appropriate treatment as soon as they need it.

Young people can also experience disruption to care due to not meeting the eligibility thresholds in adult services, despite being eligible in the children’s service. In contrast to adult mental health services having high thresholds for care, those at children and adolescent mental health services can be much lower. Children’s services are generally perceived as being more supportive and nurturing than adult services, with a focus on treating emotional and developmental disorders, including autism and ADHD (McGorry, 2007). However this means that when young people reach the upper age limit of children’s services (at around 16-18 years old), they cannot be transitioned to adult care, as they do not meet the eligibility threshold. Therefore at this transition boundary, young people can ‘fall through the gap’ between services despite still being unwell. One study in Ireland estimated that two-thirds of young people do not receive a referral to adult services, despite still being unwell when they reached the upper age limit of children’s services (McNicholas et al, 2015). Those who do receive a referral can still experience a gap in care: adult services can have waiting lists of up to 6 months (Hovish et al, 2012).

It is clear that something needs to change to ensure that people with mental illness are able to access timely and appropriate support, without having to wait for their condition to get worse in order to qualify for treatment.

Please share and let me know your thoughts using the hashtag #MHAW18 and help raise awareness.

 

References:

image reference: https://www.beateatingdisorders.org.uk/early-intervention-strategy [accessed 13/05/18]

Belling, R., Mclaren, S., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. & Singh, S. P. 2014. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. Journal of health services research & policy, 19, 169-176.

https://www.bma.org.uk/news/2018/february/the-devastating-cost-of-treatment-delays %5Baccessed 13/05/18]

Hovish, K., Weaver, T., Islam, Z., Paul, M. & Singh, S. P. 2012. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study. Psychiatric rehabilitation journal, 35, 251.

Kohn R, Saxena S, Levav I, Saraceno B (2004). The treatment gap in mentalhealth care. Bulletin of the World Health Organization 82, 858-866

McGorry, P. D. 2007. The specialist youth mental health model: strengthening the weakest link in the public mental health system. Medical Journal of Australia, 187, S53.

McNicholas, F., Adamson, M., Mcnamara, N., Gavin, B., Paul, M., Ford, T., Barry, S., Dooley, B., Coyne, I. & Cullen, W. 2015. Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland. Irish Journal of Psychological Medicine, 32, 61-69.

Olasoji, M., Maude, P. and McCauley, K., 2017. Not sick enough: Experiences of carers of people with mental illness negotiating care for their relatives with mental health services. Journal of psychiatric and mental health nursing24(6), pp.403-411.

 

Gut Microbiomes and Mental Health

One exciting and emerging field of mental health research which is gaining in popularity is the relationship between microbiomes in our gut, and our mental health. Our gut microbiome contains up to 1 trillion bacteria, as well as viruses and fungi, which form a kind of ‘eco-system’. Our microbiome begins forming after birth, and can be influenced by factors such a environment, diet, travel, hormones and illness (D’Argenio & Salvatore, 2015). It is crucial in digestion and our immune system, and recent research suggests that having a healthy microbiome is important for a healthy brain and nervous system (Foster & Neufeld, 2013).

Research into the link between the gut and brain (known as the microbiota-gut-brain axis – see image below) has found links between dysfunction in the microbiome and mental illness such as depression and anxiety (Foster & Neufeld, 2013).

Gut-Brain-axis

For example, one study carried out at Stellenbosch University compared the gut microbiomes of people with and without Posttraumatic Stress Disorder (PTSD) after experiencing a traumatic event. They found that three bacteria were different in people who did and did not have PTSD, with those with PTSD showing lower levels (Hemmings et al, 2017).

Lots of research in this area has also been carried out using mice, which has shown that the microbiome can directly affect behaviour. For example, one study transplanted bacteria from mice who had high anxiety to mice who had low anxiety. The mice who had received the transplant then started to show symptoms of anxiety (Bercik et al., 2011a).

The interaction between the gut and brain can also work the other way, as stress and emotions can influence the microbiome via the hypothalamus–pituitary–adrenal (HPA) axis (Montiel-Castro et al., 2013). The HPA axis is involved in cortisol production and controls our immune system. Stress results in increased inflammation, which impacts the equilibrium of the microbiome which can lead to diseases, allergic reactions or risk of infection (Glaser & Kiecolt-Glaser, 2005).

This field of research could influence therapies for mental illness, with anxiety and depression treated by interventions targeted to alter the microbiome, as well as traditional drug or talking therapies. What are your thoughts about this new branch of medicine? Let me know in the comments below!

 

References:

Bercik, P., Park, A. J., Sinclair D. Khoshdel, A., Lu J. Huang, X., Deng, Y., Belnnerhassett, P. A., et al. (2011a). The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut–brain communication. Neurogastroenterol. Motil. 23, 1132–1139.

D’Argenio, V. and Salvatore, F., 2015. The role of the gut microbiome in the healthy adult status. Clinica Chimica Acta451, pp.97-102.

Foster, J.A. and Neufeld, K.A.M., 2013. Gut–brain axis: how the microbiome influences anxiety and depression. Trends in neurosciences36(5), pp.305-312.

Glaser, R., and Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: implications for health. Nat. Rev. Immunol. 5, 243–251. doi: 10.1038/nri1571

Hemmings, S.M., Malan-Müller, S., van den Heuvel, L.L., Demmitt, B.A., Stanislawski, M.A., Smith, D.G., Bohr, A.D., Stamper, C.E., Hyde, E.R., Morton, J.T. and Marotz, C.A., 2017. The microbiome in posttraumatic stress disorder and trauma-exposed controls: an exploratory study. Psychosomatic medicine79(8), pp.936-946.

Montiel-Castro, A.J., González-Cervantes, R.M., Bravo-Ruiseco, G. and Pacheco-López, G., 2013. The microbiota-gut-brain axis: neurobehavioral correlates, health and sociality. Frontiers in integrative neuroscience7, p.70.

image reference: https://www.nature.com/news/the-tantalizing-links-between-gut-microbes-and-the-brain-1.18557

Effects of Sleep Deprivation

How are you feeling today? If you’re anything like me and my friends the answer might well be ‘tired’. In modern society it can seem as though everyone is trying to cram as much as possible into their day, with work, family commitments, studying, exercising and fitting in a social life. This coupled with increased smart phone use (hands up if you scroll through Instagram before you go to sleep..), especially in the evenings can lead to people just not getting as much sleep as they should be.

Sleep deprivation is defined as having less that 7-8 hours of sleep a night for adults (Colten, & Altevogt, 2006). However, a recent survey in the UK found that 70% of adults say they sleep for less than 7 hours each night and over 25% said they regularly slept badly (Sleepcouncil.org.uk).

In today’s society it appears to be normal to be sleep deprived. What effect is this having on our mental health?

2017-05-15-Sleep-deprivation-and-your-body-1

Perhaps unsurprisingly, sleep deprivation has been shown to impair our ability to focus. Studies which have examined the effects of sleep deprivation on driving and found participant’s ability to stay in lane was as impaired as a group who were over the legal alcohol limit (Fairclough & Graham, 1999).

Another study looked at the effects of sleep deprivation in students and found that those who had gone without a night of sleep performed significantly worse at a cognitive task than those who had 8 hours sleep the night before (Pilcher & Walters, 1997). Interestingly, the sleep deprived participants in this study rated their performance on the task as higher than those who weren’t sleep deprived! This suggests that when we’ve not slept enough we might not always realise the effect it can have on our performance the next day.

As well as affecting your ability to focus, sleep deprivation has the largest effect on mood (Pilcher & Huffcott, 1996). One study asked participants to go without two nights of sleep, and compared scores on a personality trait questionnaire at baseline and again after they had been awake for 56 hours. When they were sleep deprived, participants showed higher scores of anxiety, depression and paranoia (Khan-Greene et al 2007). Another study has shown than just losing one night’s sleep can increase anxiety scores (Sagaspe et al, 2006). These research suggests that going without sleep can affect the parts of your brain involved in mood regulation such as parts of the prefrontal cortex.

For tips on how to improve your sleep – the full report by the Sleep Council has some useful tips (and more surprising stats) here: https://www.sleepcouncil.org.uk/wp-content/uploads/2013/02/The-Great-British-Bedtime-Report.pdf

 

References:

Colten, HR.; Altevogt, BM. Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: The National Academies Press: Institute of Medicine; 2006.

Fairclough, S.H. and Graham, R., 1999. Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study. Human Factors41(1), pp.118-128.

Kahn-Greene, E.T., Killgore, D.B., Kamimori, G.H., Balkin, T.J. and Killgore, W.D., 2007. The effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep medicine8(3), pp.215-221.

Pilcher, J.J. and Huffcutt, A.I., 1996. Effects of sleep deprivation on performance: a meta-analysis. Sleep19(4), pp.318-326.

Pilcher, J.J. and Walters, A.S., 1997. How sleep deprivation affects psychological variables related to college students’ cognitive performance. Journal of American College Health46(3), pp.121-126.

Sagaspe, P., Sanchez-Ortuno, M., Charles, A., Taillard, J., Valtat, C., Bioulac, B. and Philip, P., 2006. Effects of sleep deprivation on Color-Word, Emotional, and Specific Stroop interference and on self-reported anxiety. Brain and cognition60(1), pp.76-87.

https://www.sleepcouncil.org.uk/wp-content/uploads/2013/02/The-Great-British-Bedtime-Report.pdf

Dialectical Behavioural Therapy

Talking therapies such as cognitive behaviour therapy (CBT) are well-known treatments for some mental illnesses including anxiety and phobias. Today’s post is about a type of CBT which isn’t as well known: dialectical behaviour therapy, or DBT.

CBT focuses on changing unhelpful thoughts and behaviours which cause the continuity of illness – for example changing the obsessive thoughts in OCD through talking and challenging beliefs in therapy (for more about CBT, read my post here). DBT also does this, but with an additional focus on accepting who you are as a person at the same time. ‘Dialectical’ just means to resolve differences and find a balance in patterns of behaviour. It has been developed to treat individuals who experience intense emotions, and is one of the recommended treatments for symptoms of Borderline Personality Disorder such as self harm, impulsivity, and unstable relationships (Mind, 2014).

The figure below from the Psychiatric Times shows the 4 sets of primary skills taught as part of DBT: mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. This training is usually in groups, in addition to 1 to 1 therapy sessions.

DBT

 

DBT has been shown to be more effective at reducing symptoms associated with borderline personality disorder than standard group therapy (Soler et al, 2009). In this experiment, participants were randomly assigned to either receive standard group therapy or DBT over 13 weekly sessions. The group who received DBT had greater improvement in depression, anxiety, emotion regulation, irritability and anger than the group who received standard therapy. It also showed almost twice as high retention rate of participants throughout the programme, suggesting it is an acceptable intervention for the treatment of borderline personality disorder.

Another study which compared DBT to usual treatment for women with borderline personality disorder found that participants in the DBT group showed lower levels of self harm than those who received standard treatment (Verheul et al, 2003). The authors hypothesised that this result could be due to specific features of DBT such as monitoring of self-injury with early sessions focusing on modifying these behaviours, patients being encouraged to phone their therapist before carrying them out, and more support for the therapists themselves resulting in less burnout (and so improved patient outcomes).

Overall, this evidence shows the effectiveness of DBT in treating symptoms of borderline personality disorder. More recently, research has moved to test whether DBT is an effective treatment for other conditions such as traumatic brain injury, substance abuse, depression, eating disorders and conduct disorders. However, one recent review concluded that more evidence needs to be collected to establish whether it is the best treatment for other types of mental illness (Valentine et al, 2014).

Thanks for reading this overview of DBT, if you’d like to find out more then Mind have some great online resources – see the link below.

https://www.mind.org.uk/media/1594506/ms_dbt_2014.pdf

References:

Mind (2014) https://www.mind.org.uk/media/1594506/ms_dbt_2014.pdf

Soler, J., Pascual, J.C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M.J., Gich, I., Alvarez, E. and Pérez, V., 2009. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour research and therapy47(5), pp.353-358.

Valentine, S.E., Bankoff, S.M., Poulin, R.M., Reidler, E.B. and Pantalone, D.W., 2015. The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature. Journal of clinical psychology71(1), pp.1-20.

Verheul, R., Van Den Bosch, L.M., Koeter, M.W., De Ridder, M.A., Stijnen, T. and Van Den Brink, W., 2003. Dialectical behaviour therapy for women with borderline personality disorder. The British Journal of Psychiatry182(2), pp.135-140.

Resilience – innate or acquired?

Hi everyone, and Happy New Year! I’m back after having a few weeks off blogging, and plan to stick to my schedule of 1 post a week in 2018 (usually posted on Thursdays, 4pm GMT).

To start off this year, I thought I’d talk about a concept in psychology which is being applied more to mental health – resilience. Whilst the idea of something being resilient probably isn’t new to you, you may not be aware of how people can be resilient, and what the benefits are of this personality trait.

In psychology, resilience means that someone is able to cope and adapt to difficult life events or stressful situations such as serious health problems or losing their job. It is therefore able to protect against negative outcomes of the stressful event and enable individuals to ‘bounce back’ quicker.

The protective factor model of resilience states that a protective factor such as social support, or self-esteem, interacts with the stressor to reduce negative outcomes such as anxiety or depression (O’Leary et al, 1998). People who have higher levels of social support are more likely to cope with stressful situations, with one study showing that social support moderated the effect of stress on depression scores (Pengilly & Dowd, 2000). Another well-studied protective factor is hardiness, which was identified by Kobasa in 1979. He compared personality traits in executives, and compared who did or did not get ill after stressful life events. He found that those who did not get ill showed more hardiness, which he defined as having a ‘commitment to self’ – an active participation in activities and the outside world; an ‘internal locus of control’ – the idea that you are in control of events that happen to you; and a sense of meaningfulness.

resilience-3
image from https://help4hd.org/on-being-resilient/

As resilience has been shown to have several protective factors on stressful life events, there has been some debate about whether resilience can be taught to improve how people cope, and therefore improve their mental health. One study carried out in college students compared scores on stress levels between a control group and a group who received a resilience intervention (Steinhardt & Dolbier, 2008). The intervention focused on teaching problem solving, coping strategies and awareness of the different responses to stress. Participants in this group were also encouraged to take responsibility and self-leadership (actions coming from the self). Results showed that the group that took part in resilience training had higher resilience scores and scores of protective factors such as self-esteem. They also showed more effective coping strategies and lower scores on tests assessing depression and stress than the control group who did not receive the intervention. This effect was found with only 4 2-hour teaching sessions, showing that resilience can be taught in a relatively short space of time.

Several other studies have shown that resilience can be taught, something which is now gaining in popularity and can be applied to several populations from students to soldiers. Healthcare professionals are also taught resilience techniques as a way of coping with long term stress in emergency situations (McAllister & McKinnon, 2009).

There are some things you can try if you want to improve your resilience. Taking a break, using your support network, and looking after your physical health are all things which could improve how you cope with pressure or stressful situations. For more information on these tips and more, check out Mind.org’s advice here.

 

References:

O’Leary, V.E., 1998. Strength in the face of adversity: Individual and social thriving. Journal of Social issues54(2), pp.425-446.

Pengilly, J.W. and Dowd, E.T., 2000. Hardiness and social support as moderators of stress. Journal of clinical psychology56(6), pp.813-820.

Kobasa, S.C., 1979. Stressful life events, personality, and health: an inquiry into hardiness. Journal of personality and social psychology37(1), p.1.

Steinhardt, M. and Dolbier, C., 2008. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American college health56(4), pp.445-453.

McAllister, M. and McKinnon, J., 2009. The importance of teaching and learning resilience in the health disciplines: a critical review of the literature. Nurse education today29(4), pp.371-379.

Seasonal Affective Disorder

It’s that time of year – the clocks have gone back, it’s cold, and already getting dark on our commute home. Whilst many people moan about this time of year, for some it can trigger symptoms of low mood and depression.

Seasonal Affective Disorder is defined as “a type of depression that comes and goes in a seasonal pattern.” (NHS Choices). It’s typically worse from December to February, getting better in spring and summer. For SAD to be diagnosed, there has to be clear evidence of worsening symptoms during winter, which can’t be explained by other circumstances (DSM-IV). In addition, there needs to be evidence for part or full remission during the summer months. Symptoms of SAD are similar to those of depression: low motivation and self-esteem, sleep problems, changes in appetite, withdrawing from social interactions and persistent negative thoughts.

Medicap-Pharmacy-sad

Estimates of the prevalence of SAD range from 0 – 9.4% of the population, depending on who is being studied (Magnusson, 2000). One study compared rates of SAD at 4 different latitudes in the USA and found that is was most common in the northern latitudes (Rosen et al, 1990), which would be expected as SAD can be triggered by lower levels of natural light. This study also found higher rates of SAD in females than males (this finding is in line with overall levels of depression between men and women). It is thought to be caused by the lack of sunlight in winter months disrupting our circadian rhythm, which can be described as our internal body clock. This can affect the serotonin system in the brain, which is responsible in part for mood regulation.

There are various different treatment options for SAD, including light therapy, cognitive behavioural therapy, or antidepressants (Lurie et al, 2006). I’ve spoken about CBT before on this blog (see here for more information), so today I’ll just focus on light therapy and antidepressants as treatments for SAD.

sadimage

Light therapy involves sitting by a specialised lamp, which emits a specified wavelength and brightness of light (at least 2500 lux). It is thought to work by encouraging the brain to produce serotonin – a neurotransmitter which is linked to feeling happy. Sitting by a lamp for 30 minutes to an hour each morning is the recommended ‘dose’ of light (NHS.uk). One meta-analysis has shown that light therapy is as effective as drug therapy in treating SAD (Golden et al, 2005).

Some antidepressants also work by increasing our serotonin levels. Known as SSRIs (selective serotonin reuptake inhibitors), they work by stopping as much serotonin from being reabsorbed at synapses in the brain and therefore leading to an increase in our mood. For antidepressants to be optimally effective in SAD, the NHS recommend starting to take them before winter and continue until spring.

 

A week of Mindfulness

I’m sure by now you’ll have heard of mindfulness. It seems to have exploded in popularity in recent years, and is recommended as everything from a cure for severe depression to improved concentration.

Mindfulness can be described as being aware of the present, in particular how we feel on the inside. It generally involves bringing focus back to the body and how it feels at that time. Focus is directed towards the present moment, as opposed to worrying about past or future events. Eyes are typically closed, and attention is directed towards the breathing as opposed to any outside stimuli. Rather than try and block out our thoughts, mindfulness aims to help us acknowledge our thoughts and feelings, but lets them pass without paying them too much attention, which can lead to stress or anxiety.

 

mindfulness-2

 

For someone with an interest in all things psychology and mental health, I’m almost ashamed to say I’ve never properly tried mindfulness myself, with the exception of a couple of group sessions at conferences. I definitely find it easier when I take part in a led session rather than try and do it myself, so I downloaded the Headspace app and decided to give it a go. Here’s how I got on:

 

1st session: It’s been a few months since I’d had last had a guided session at work – I did try to practice a couple of times recently but found it hard to keep my focus. I started off using the Basics package in Headspace, which starts with an introduction to mindfulness and a few tips to get started. I began with a short 3 minute session, and afterwards I felt noticeably more relaxed, I’m definitely looking forward to the next one. The 3 minutes went by really quickly, I found it quite easy to concentrate on my breathing. No massive change but only day 1!

2nd session: Another short 3 minute session. I found it harder to stop myself focusing on thoughts that popped into my head during the session today. I started it as soon as I’d finished studying and found thoughts kept popping into my head – I know this is okay and you’re meant to acknowledge them and move on but that’s quite difficult in reality! I think I’ll try it at a different time tomorrow and see if that makes it easier.

3rd session: I completely ran out of time so ended up practicing just before I went to bed. I switched to the 5 minute session today, and the focus of this session was on letting thoughts pass. This is definitely the bit that I find most difficult, but it was easier than yesterday. I found the session very relaxing, it really put me in the mood for sleep!

4th session: Again ended up practicing just before bed, and I almost feel asleep! Today I found that I was better at paying attending to my breathing (counting helped) and it meant that I couldn’t really focus on other thoughts which popped into my head. The 5 minutes went so quickly too.

5th session: Getting into more of a routine and practicing at the end of the day. Not much change on this session, but I am definitely enjoying it and look forward to practicing.

6th session: Today I really wasn’t feeling in the mood for practicing mindfulness, I’d had a really busy day and it just felt like another thing I had to do. I did feel so much better afterwards and was glad I did, a bit like going for a run! I found my mind didn’t wander too much but things I need to do tomorrow kept popping into my head, which I found hard to ignore.

7th session: The last one in my week’s trial! It feels like the time during the session seems to go quicker every day, and I always feel much calmer by the end of it. This session started with a short animation using the analogy of the calm mind as a blue sky, and thoughts as clouds which pass across it, which I quite liked. I know the app recommends practicing first thing in the morning but for me I think I’ll probably do it more in the evenings. I’ve got a bit more time, and I think it’s a nice thing for me to do at the end of the day – I’m someone who can find it hard to switch off at night so practicing before bed could help me relax.

 

By the end of the week I can’t say I’ve noticed any significant changes but I have looked forward to the sessions. I do have to admit – there were a couple of days in between where I didn’t end up practicing, usually if I was out in the evening and got back too late to want to practice. On reflection. these busy days were probably the ones where I should have made sure to take the time out for it – it’s only a few minutes and makes me feel more relaxed afterwards. By the end of the week I felt like I was better at concentrating on my breathing instead of letting my mind wander, although I still slipped up from time to time. In particular, I kept finding myself thinking about things I could say in this post, so now it’s written maybe I’ll find it easier to focus!

 

I’d definitely recommend giving mindfulness a go, especially if you haven’t already, just to see whether you notice any changes after each session. Have you tried mindfulness before? Let me know in the comments!

World Mental Health Day 2017

Today, Tuesday 10th October is World Mental Health Day – a day aimed to raise awareness of current mental health issues affecting society. The theme this year is mental health in the workplace.

I’ll start by asking you a question: Would you tell your boss you were going to take a day off work due to a mental health problem?

Sick days should be used equally for both mental and physical health, however recent data shows that isn’t the case. In the UK last year, workers took 137 million sick days, with 15.8 million of these being for a mental health problem. To put this into perspective, 34 million sick days were taken for coughs and colds1. One in five people are estimated to be suffering with mental illness at any one time, so why don’t the figures reflect this?

Of course one of the reasons the figure for mental illnesses looks comparatively low could be because they are under-reported – some people may prefer to call in and say they have the flu if they are worried about prejudices at work. People may also be reluctant to take a day off at all if they are struggling with an illness like anxiety, feeling instead like they should be able to carry on. If you had hurt your back and couldn’t move, most people would view this as a legitimate reason to take some time off. But what if you’re struggling to get out of bed due to depression?

 

world mental health day

 

There are several reasons why it makes sense for us to be more open about our mental health at work, without it affecting our rights or how we are treated. The recent positive response of a director when one of his workers took some days off for her mental health shows how actually having the conversation around this topic at work can break down some of the perceived stigma around it. Hopefully the publicity surrounding cases such as these will encourage others to take time off to deal with their mental health when they feel as though they need a break.

As well as the obvious advantages of creating a supportive working environment there are also economic benefits of improved mental health in the workplace. It has been estimated that 91 million work days are lost each year due to mental health problems, with a total cost to employers of £26 billion – or £1035 for every worker in the UK2. This isn’t just due to sick days, but staff turnover and reduced productivity too. When people are happier and healthier their performance will improve – these figures show it pays for companies to care about their employees mental health.

If you’re struggling with your mental health at work, or work as a manager and want to make your workplace a more supportive environment then Mind have some great resources – find them here. 

 

 

  1. http://www.bbc.co.uk/news/uk-40593256
  2. https://www.centreformentalhealth.org.uk/employment-the-economic-case