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Help Yourself Towards Mental Health

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A comprehensive guide to how an individual can help themselves resolve a wide variety of ordinary, everyday life problems and improve their mental health.'This is an extensive collection of self-help material, which has been written to provide resources to complement self-exploration or professional counselling. The knowledge has been built up through years of working in the field of mental health, listening to patients, and searching for the materials that could make a difference. The skill is in how the handouts have been put together to be easily accessible and helpful, and in a format that allows flexibility and tailoring to the individual. The attitude of current evidence-based guidelines is to support a range of self-help approaches and talking therapies to enable people to achieve better mental health, rather than turning to drugs. This is therefore a most welcome tool from which patients will benefit, and indeed, we could all use to help us achieve a better life/work balance and feeling of well-being.'- Dr Patricia Donald, MBE

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A definition of “mental health

ePub

This phrase “mental health” is used in a number of different ways. First, it can be a goal, something to be attained and retained. We all want to be physically and mentally healthy. We define physical health in terms of our abilities: the ability to move freely, eat well, enjoy our bodies, work, play, and rest, etc., or in terms of absence—the absence of any illness, medical condition, discomfort, etc. We could also similarly define mental health as the ability to contribute to relationships with other people; to function reasonably productively (given any limitations of age, or physical health or abilities); to enjoy the usual opportunities for pleasure in life; to care about others; to conform (mostly) to normal social and legal requirements; and to have a reasonable set of social and problem-solving skills, etc.

Given these definitions, I believe that one of the fundamental requirements for both physical and mental health is self-awareness. Without this, we are unaware of how we are, who we are, and what is happening to us: essentially we become lost. Stress and distress is often a key factor in “losing” ourselves, or losing touch with others and consensual reality. That is when things start to go wrong.

 

Stepped care and self-help

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A“stepped care” approach to mental health is now becoming the norm within the National Health Service. What this means is that there are various steps to be taken in assisting people with their mental health issues.

The first step is usually a combination of “watchful waiting” by the GP and, more importantly, encouraging the use of self-help techniques. In the NICE Guidelines for Anxiety (No. 22) and Depression (No. 23), “Bibliotherapy” (reading about your issues, or problems), and “Social Prescribing” are also considered important. All these come before psychological assistance or any medical treatment (medication).

Before considering any form of treatment for stress, depression, anxiety, low self-esteem, problems with bereavement or loss, or any other conditions of distress, a self-help approach should really be considered first. There is probably nothing actually wrong with you, just that much has happened to you. There may well have been a number of things that you, the “patient”, have done, or have tried to do, already, but they have not fully helped you yet. This does not mean that they are wrong, just that other things might also be helpful. There might also be information “out there” that you have not been able to access yet. There might be other resources— voluntary organizations, specialist support groups—that you are not aware of. These should probably be explored first, before you are referred to, or ask for, counselling, and especially before you get any medication. These latter options are now identified as being the second and/or third steps.

 

Basic information

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Stress is one the major problems facing all of us today. We were simply just not designed—we did not evolve—to live in cities, to work in offices and factories, and especially to live at the pace that we seem to live at now, and it is getting worse! Essentially, our bodies are not able to cope very well with the number, variety, and constancy of the stressors found in modern everyday life. They are able to do an amazing amount, but we work longer, commute further, shop more, stay awake longer, and sleep 20% less than we did 100 years ago. This eventually causes stress overload—physically, emotionally and mentally. In the UK, it is estimated that at least 40 million working days are lost each year because of stress. Psycho-physiological disorders (those concerning the body–mind) are nearly always caused by stress, or are considerably worsened by stress. Stress also damages our immune systems, and this then has further implications on our health.

Causes of stress

The causes of stress are numerous and include: major life changes and life events; noise; crowds; poor sleep, bad diet, unhealthy lifestyle; alcohol or drug misuse (also symptoms of stress); aggravation and abuse; pressure to perform (work, school, sports, etc.); traffic; chemicals; trauma; poverty; discrimination; frustration; pregnancy; work pressures; negative emotions; loneliness; family conflicts; money worries; alienation; uncertainty; illness; unemployment; sexual problems; identity problems; relationship difficulties; going to school or college; Christmas; loss of any kind, including theft, relationship break-up, divorce, redundancy, abandonment, death (of someone close to you)—anything can cause stress!

 

Self-help for stress

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The main anti-stress self-help principles are laid out below in a twelve-point plan.

1. Exercise more. The important features are not what you do, but how much, and how often. Regularity is essential, and so is making it aerobic (getting out-of-breath and a bit hot and sweaty). Try to vary the pace and the type of aerobic exercise. There are some suggestions later on. Exercise that is enjoyable is also probably much better for you: a forty-minute stiff walk to the nearest hilltop is sometimes nicer than pounding away on a running machine in a gym for the same period. Playing football in the park with the kids is usually more fun (even if you lose) than bench-pressing weights with macho bodybuilders in the gym. Remember that these are all principles of de-stressing: so don’t stress yourself too much doing any type of exercise. Just do it! Ideally, about five times per week, forty-five minutes minimum.

2. Regular relaxation. An absolute minimum of twenty minutes once a day or ten minutes twice a day. Look for deeper, regular breathing first, then an absence of “busy” thoughts, and then try for an inner feeling of warmth and relaxation throughout the body. Try to keep wiping out invasive thoughts. Whether your relaxation method is called “deep relaxation”, “heart coherence”, “Autogenic Technique” or is some form of meditation, the method is relatively unimportant: the regular experience is essential. Lying on the sofa listening to Chopin or Mozart can also bliss you out, so can a Radox bath. Do whatever works for you!

 

Stress and modern life

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Our modern lifestyles involve us in less physical activity than ever before throughout the five million years of human evolutionary history. Our patterns of life and work have never been more stressful. Stress levels have rarely ever been higher. The reason is that whenever we get upset or threatened in any way, our basic “fight-or flight” mechanism, based on adrenalin and cortisol, is activated. This has been mentioned before.

If we do not fight or run away (like one of the animals), because we are “civilized”, then the stress hormones, the by-products and companions of adrenalin, like cortisone, remain unused and stay in our systems. Then they can start to build up and this causes us additional problems: more stress; increased heart-rate; tense muscles; aggressive emotions; startle-patterns; poorer sleep; increased weight; reliance on de-stressors (drugs and alcohol); and poor digestion—among other problems. Stress also restricts our ability to rebalance ourselves, internally as well as emotionally; our immune systems and self-regulatory functions can become seriously compromised. We suspect that as much as 70% of all disease and illness is linked to high levels of stress. So much for being “civilized”!

 

Fitting exercise into your life

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As explained, aerobic exercise is a very important tool in the struggle to defeat stress, and it is also very good for anxiety and depression. In fact, it is excellent for all forms of mental health. It is great for general health as well: it can help to cut down on the risk of your developing major illnesses and it can help you to live longer. Much of ageing is due to decreased mobility as a result of an increasingly sedentary lifestyle.

Regular exercise makes you feel and look better. It helps to release serotonin and endorphins—the “happy” hormones, responsible for the “feel-good” factor. It boosts your energy levels, reduces tension and anger, improves concentration, improves your sleep, increases heart and lung capacity, increases bone density, and has many other benefits for specific illnesses.

A little exercise goes a long way. You do not have to take out a subscription to a gym (that is how they make their money), run a marathon, or become a health freak. However, it is usually necessary to fit more exercise into your life—somehow—and then try to keep on doing it regularly.

 

Different types of exercise

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There are several different types of exercise, done for different reasons. Check some of these out for yourself: they might suit you.

Aerobics for the immune system

There are specific benefits to different forms of exercise that are now being realized. Not only does aerobic exercise burn off stress hormones, but it helps protect you from diabetes and heart disease. It can also reduce the likelihood that you will get periodonitis (gum disease) or other inflammatory ailments, as exercise boosts your immune system and reduces inflammation throughout the body.

Tai Chi for stress

The slow, meditative practice of Tai Chi generally produces a mental state of calm, and results in reduced anxiety and stress. It is a low-impact form of aerobic exercise and thus suitable for older people, or those with some limb ailments or disabilities. Research studies (in USA) also show that it lowers blood pressure, benefits arthritis, and boosts the immune system. There are also some ongoing studies about the positive effects of Tai Chi on cancer patients.

 

Relaxation

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Besides doing exercise, it is really important to relax as well. However, only try relaxing first thing in the morning, or some time after you have exercised. Done regularly, this will help you to rebalance your basic bodily functioning (the autonomic nervous system), which is what gets overstressed. For most people under stress, it is very difficult to relax—for two main reasons: (1) they think they cannot afford the time; and (2) they are so stressed that they cannot relax easily. It is therefore necessary to build in a programme of relaxation (ideally once or twice a day for twenty minutes). There are many different ways to relax. Here are several suggestions:

•  Progressive relaxation. You can get booklets, tapes or CDs of (usually) progressive relaxation exercises that tell you how first to tense, then to relax, progressively, all the various sets of individual muscle groups in your body (feet, calves, thighs, buttocks, etc.). As you do this, you tend to relax generally more and more. It is sometimes called “differential relaxation”.

 

Meditation and mindfulness

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Avery powerful form of relaxation is meditation. This does not have to be religious, or based on a particular faith. Essentially, it is sitting still, breathing regularly, and quietening your mind. When you do this, your body slows down and you shift more into the parasympathetic (see p. 38). Eventually, your mind will slow down, too, and you will become more peaceful and relaxed. This is extremely good for many medical conditions, such as hypertension (high blood pressure), or for reducing the stress that can aggravate many conditions, both medical and psychological.

Meditation position

Make sure you are not going to be disturbed: switch the ringer on the phone off, turn off the mobile, hang a note on the bedroom door, and tell others in the house you are going to meditate for (say) twenty minutes. Settle into a comfortable sitting position, either on a straight-backed chair, with your feet flat on the floor, or sitting cross-legged on a soft surface on the floor. Your spine should be vertical, your body fairly relaxed, your weight supported and balanced.

 

Symptoms of stress

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Some of the most frequently experienced physical symptoms of people in anxiety or stress are headaches and migraines. There are many other symptoms of stress, but these seem to top the list. It is very easy to reach for an analgesic (pain-killer): there are plenty to choose from. However, these can also be symptoms of something starting to be seriously wrong. Would you ignore a little flashing light on your car dashboard display?

Headaches

Headaches and migraines are very different. Headaches are usually experienced as an ache or pain in the head, or as if there is a tight band around the head. You can usually carry on doing things with a headache, though you might need to use some medication. They may arise from a short-term problem: stress, worry, too much alcohol, etc. Headaches can also be a symptom of an underlying problem and so, if you experience constant or persistent headaches, go to see your GP.

Here are a couple of background checks: is the headache part of a hangover? Too much alcohol dehydrates you and destroys your reserves of vitamin C: so try drinking a couple of large glasses of orange juice, or have a smoothie, and the headache may well disappear relatively quickly. Have you had too much chocolate, coffee, etc? People who are sensitive to caffeine can easily experience headaches because of this. Again, caffeine dehydrates. Drink plenty of water. Drink plenty of water anyway: at least 1.5–2 litres per day.

 

Other anti-stress exercises

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Seek a larger connection

We all need to feel a part of something larger than ourselves; whether it be a community group, a church, a sports team, an interest group or political party, a large close-knit family, or helping out with a charity or a fund-raising event. Again, the method is unimportant, but the wider contact is pretty essential for human, social animals. Maybe there are new belief systems, philosophies or spiritual practices that you would like to explore: join a group whose members are studying these. Maybe greater and deeper self-awareness will help: try a meditation or “mindful-ness” group. Contact with nature is also very therapeutic, via the garden, the hills, the sea, wilderness holidays, or the local woods and fields. You might even want to consider a form of pilgrimage or a retreat at a significant point in your life: many people do this.

Anti-stress foods

Certain nutrients have been shown to help with stress. The “fighting five” are the vitamins A, C, and E and the minerals zinc and selenium. These disarm those “nasty” free radicals produced under stress. Foods containing such antioxidants include: plums, tomatoes, kiwi fruits, dark green vegetables (cabbage, kale, broccoli, spinach), seafood, sesame seeds, and pumpkin seeds. With continued stress, it might also be worth getting a nutritionist to check your levels of DHEA (dehydroepiandosterone) and cortisol: stress decreases the former and increases the latter, and a nutritionist can help you rebalance these. Vitamin C supports the adrenal glands and can be most easily found in black and red berries, kiwi and citrus fruits. The adrenal glands also need magnesium, found in grains, green leafy vegetables, soya beans, almonds, wheatgerm, cod, and mackerel. Cutting down on sugar (and alcohol) helps the liver to detoxify the body. Stimulant drinks (coffee and caffeine drinks) encourage adrenalin production and should be cut down or eliminated totally. Please do not drink anything with aspartame (a sweetener used in many soft drinks, and even in flavoured mineral water) in it.

 

Stress and life events

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Most people who come to their GP with stress, or anxiety and/or depression, are suffering from a combination of stressful life events. This has happened, then that happened, then the other. An accumulation of very stressful life events in a relatively short period (e.g., 12–18 months) can really increase one’s vulnerability to anxiety or depression, or can even bring it on, essentially due to an emotional “overload”. These creep up on you and accumulate without you necessarily noticing. Yes, of course you know that it was stressful when “X” died, and that there was also “stuff” going on at the office. But you might not have realized that the depression six months later or the panic attacks were all connected to these events.

Several life events are suggested in Table 1, and some sample scores (rated up to 100) are given. If you want to calculate your life event stress score, please use the relevant column in the table and write in your stress scores for those events that you have experienced over the last (say) eighteen months, or the eighteen months immediately before the time that you became depressed.

 

Self-help for depression

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Between about 12% (one person in eight) and 25% (one person in four) of the population are treated for depression at some time or other in their life. The average age of onset is usually between forty and fifty, though almost any age is possible. Depression is more common in women than in men. It is much more common in lower socio-economic classes, and in more disadvan-taged people. Periods of major depression can also recur. Anxiety is sometimes an aspect of depression.

Depression is more of a “state” or (technically) a “mood” disorder, and is only very occasionally severe enough to be considered a mental illness. Major (psychotic illness) depression has a prevalence of only about 4–5% of those already diagnosed with “ordinary” depression (i.e., present in less than 1% of the population).

Sources of depression

There are very many different ways in which someone can become depressed, and there are several different views on depression that are presented later. Often a series of overwhelming life events coming soon, one after the other, will result in a depressive reaction; or it can come (most frequently) from a build-up of general life stresses. If the source is essentially outside of the self, it is called “exogenous” or “reactive” depression. With other people, depression can occur after a particular illness (flu or a viral infection), or after a pregnancy, or as a result of the menopause, or as a side effect of medications, all of which indicate a more internal origin (endogenous). Some people are slightly more genetically disposed to having a depression. It can also be an aspect of their character that they have developed during the course of their life. For most people it is a combination of things that accumulate, with possibly one major event (like bereavement or a loss) that will trigger the onset of the depression.

 

Working with depression

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People in a depression often feel that everything compounds their condition. They are feeling low, so they don’t want to go out, so they lose touch with their friends, so they feel alone, so there is no point in going out, and this all adds to their depression.

The depressive spiral

Continuous, automatic, negative thoughts that are typical of a depression can actually distort one’s thinking patterns and perpetuate errors such as “all or nothing” thinking, “catastrophizing”, “personalizing”, focusing on “the negative”, and “jumping to conclusions”. These “thinking distortions” can result in, or even create, a low mood. This leads to decreased activity, which leads to a less rewarding existence. This leads to more negative thinking. Therefore, we go steadily downwards into a depressive spiral.

There are several ways how to stop this sort of spiral, the main ones being listed below. Try all of them and see which works for you.

1.  Understand the problem. Identify your pattern; increase awareness of when you are doing it; begin to stop any behaviour habits that really do not work for you.

 

Foods for depression

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Food influences our brain chemistry. Some foods promote a feeling of well-being, others can suppress positive emotions. Ironically, many foods that make us feel good are not especially beneficial to our health: we call these “comfort foods”. Therefore, we need to find a healthy balance between what is good for us and what makes us feel better.

Nerve impulses in the brain are carried by neurotransmitters. One of those needed is serotonin and the SSRI-type of anti-depressants, such as Prozac, inhibit the re-uptake of serotonin, allowing it to remain available and thus produce a feeling of well-being. Your body manufactures serotonin. Vitamin B6 is necessary to the synthesis of serotonin and B6 can be found in certain whole grains (millet, buckwheat, oats) as well as shellfish (prawns, shrimp, lobster, and mussels). Ensure that you have enough B6 to make the serotonin you need.

However, we often crave carbohydrates and sweet foods when we are in a depression, and these also affect the chemicals in our brain—though in the short term only (“quick fix” “sugar high”). So it is better to avoid these, and avoid putting on weight, and aim for the longer-term effects. Good blood sugar management is important in fighting depression. Try taking in complex sugars from complex carbohydrates and also from proteins, and a little of the more natural sugars (fructose and glucose) rather than the added sugar (corn syrup) in many processed foods. Check the labels carefully.

 

Somatic aspects of depression

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Depression and the body

Many people who are anxious or depressed feel out of contact with their bodies. When we become frightened, anxious, depressed, or distressed, we contract emotionally and also we contract physically. We shrink a little and tighten up. When we are feeling depressed, our heads drop and our chest area becomes more concave: we slouch a bit. We may not make proper eye contact. We will probably walk a bit more slowly, or do less physically. These contractions, although fairly minor, can accumulate, especially over time, and stop the healthy flow of pleasure, excitation, and feeling within our bodies. We then start to feel out-of-touch with ourselves, and also with others. Our ability to communicate with other people and to express our emotions is decreased. These types of physical reaction can actually enhance our depressive symptoms.

If these reactions turn into patterns that become persistent and chronic, then, even if our external circumstances change for the better, our bodies have become habituated into these contracted patterns. It then becomes very difficulty to feel genuinely better, as we have become “stuck” somatically as well as emotionally. Effective therapeutic work with anxiety and depression may mean looking at these habitual and contracted body-holding patterns, and trying to work with them also. Trying to cure depression just by changing our thought patterns makes things very difficult, even almost impossible, as our physical energy levels are still quite depressed, or even blocked by our muscular tensions.

 

Different views of depression

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Overview

Depression has been part of the human condition for many thousands of years, Plato and Aristotle wrote about it. Over this time it has been viewed in many different ways. In medieval days, it was believed that bad or noxious influences could infect the body and spirit with “melancholia” (Greek: black bile) or there was an imbalance in one of the four “humours” of the body (phlegmatic, sanguine, choleric, or melancholic).

More modern views tend to see depression as a medical problem, or an illness, which may be appropriate for your particular situation but is far more likely not to be, because very few people actually have depression as an illness. Depression is much more commonly a state or a mood, and this can be caused by a whole variety of very different factors—mostly nothing to do with medicine.

Biological components of depression

There are several internal (biological) sources of depression. Most common of these is a hormonal imbalance. This can be after giving birth (post natal depression), or during adolescence, or during the menopause (in both men and women).

 

Emotional expression in depression

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Basic principle

One significant aspect of depression is often the lack of emotional expression. When we do not, or are not able, to express some of our emotions, they can build up inside of us. This can create agitation and pressure, a little like being a pressure cooker. Then, there is even less of an incentive to “take the lid off”. Further build-ups of emotion can lead to these turning “sour” and “black” we can even become bitter and cynical. We can begin to alienate ourselves from those around us, or we can even turn these emotions against ourselves and, instead of being negative to others, we can become negative towards ourselves: self-deprecating, self-hating, or even self-harming.

Further build-up of inner tension from unexpressed feelings can become untenable after a while, as we cannot hold all these feelings in forever. We can then either “blow up” into some form of anxiety disorder, or we can eventually collapse under all of this unexpressed “stuff”. This is usually a collapse into depression.

 

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