I hear it often: A friend swears that her running practice staves off bouts of low spirits. Another says going to the gym before work keeps him mentally steady.

Perhaps you’ve heard similar stories; perhaps you believe it for yourself.

Those anecdotes prompt some questions. Is there evidence to support the idea that exercise can have an effect on depression? And if so, how much exercise? A number of research studies have been done to answer those questions and others.

One study assigned participants, 202 depressed adults at least 40 years old, to one of four groups. One group attended supervised group exercise sessions three times per week, where they monitored their heart rate as they walked or jogged on a treadmill for 30 minutes. A second group received similar instructions but were left to work out on their own at home. Groups three and four took pills: either the antidepressant medication sertraline or a placebo.

After 16 weeks, researchers rescreened participants for depression and found 45 percent of the people in the supervised exercise group no longer met the criteria for major depression. In the other groups, 40 percent of home exercisers, 47 percent of medicine takers and 31 percent of placebo pill takers were no longer depressed.

That’s right, the supervised exercisers did as well as the people who took an antidepressant. As promising as these results were, however, it was a small study.

James Blumenthal, a psychologist at Duke University who co-wrote the paper, says there are a number of studies that, like his, support the idea that exercise might be helpful in treating depression. Like his, most of the studies are small. “There are no large, multicenter clinical trials,” he says, which are typical for drug studies funded by pharmaceutical companies.

There are also issues with the design of experiments, says Chad Rethorst, a researcher at the University of Texas Southwestern Medical Center. “What is the comparison control condition?” A placebo pill prevents people from knowing if they’re getting medicine or not; it’s hard to come up with a placebo situation for exercise.

Still, a number of scientists have combined results from the many small studies to see if an overall effect can be described. These review papers generally find a small to moderate effect of exercise in the research studies. How does that evidence translate to the real world?

“Any treatment for depression works for some people, but not for everybody,” Blumenthal says. That’s true for medication, talk therapy and exercise alike.

Depressed patients, by the nature of their condition, are not motivated, Rethorst says, so engaging in a new and challenging activity can be tricky.

Mental health practitioners probably will mention exercise, along with other healthy behaviors such as sleep, to their patients, even as they prescribe talk therapy or medication as the main treatments. But it’s not clear how many psychologists or psychiatrists actually prescribe exercise as a treatment.

Some practitioners do advocate exercise.

Antonia Baum, a psychiatrist in private practice in Bethesda, says, “I always take an exercise history with my patients.” As for starting and sticking with an exercise program, she’ll talk through the basics and help people find an activity that they’ll enjoy.

“You need to find a way that’s sustainable,” she says.

A 2015 survey suggested that a majority of depressed patients would be interested to try “an exercise program designed to improve mood.”

Rethorst reviewed the studies to come up with guidance for providers on how to prescribe exercise, including what kinds of exercise, frequency, intensity, duration, and how to help people stick to a program.

How much exercise? The research studies suggest that at least 150 minutes of aerobic activity — walking, jogging or biking — per week is good. Conveniently, that’s in line with public health guidelines from the Centers for Disease Control and Prevention.

A few studies have found positive effects with resistance training or weight-based exercise, but there’s more evidence for aerobic activity.

For people who may want to try exercise as a treatment for low mood or depression, Rethorst says it’s still wise to seek a practitioner’s help.

“The optimal clinical practice will include regular monitoring of symptoms, as with the initiation of any treatment plan,” he says. Worsening of symptoms might prompt different or additional treatments.

In other words, don’t undertake exercise-as-treatment on your own. If you’re really depressed, you need treatment and oversight. For instance, exercise doesn’t always work. You may put yourself at risk of not having other treatments at the ready if you’re not seeing a provider of some kind.

Also, maintaining an exercise program is not easy — it’s time-consuming and it’s common to lose motivation at some point. Getting social support by joining a group or class of some kind can help. Baum says she sees her patients regularly enough, often weekly, that she can check in and encourage people to stick with it.

Blumenthal says he sees good adherence to exercise by the participants in his studies. But, he adds, “We do lots of monitoring. The accountability aspect may be critical.”

You may need patience. “The benefits occur within six to eight weeks — not right away,” Blumenthal says. “Meds work a little more quickly.”

And, of course, exercise is good for many other aspects of your health. “I believe in exercise personally and in my practice,” Baum says. “I endorse its beneficial efforts.”

This piece by Jill U. Adams was originally published on ‘The Washington Post‘ March 17 2019.

It’s touted to relieve pain, lower stress and anxiety, and bolster cognitive performance, but does the practice of mindfulness physically change the brain — and if so, how do we know?

Key points:

• Meditation practices that use mindfulness have been around for millennia
• Only recently have neuroscientists been able see exactly how the brain changes after mindfulness programs
• There are still plenty of questions to answer about the neuroscience of mindful meditation, including its long-term effects

First, it’s important to know that mindfulness programs can take many forms, from free mobile apps to highly structured, weeks-long guided sessions. So all these different habits are likely to produce different effects.

In neuroscience research circles, there are two major mindfulness regimens: mindfulness-based stress reduction and mindfulness-based cognitive therapy.

People undertaking the mindfulness-based stress reduction course receive eight weeks of intensive mindfulness training, which takes elements from practices such as meditation and yoga.

It’s been around since the 1970s and, as its name suggests, it was created to alleviate anxiety and stress.

Mindfulness-based cognitive therapy, on the other hand, was primarily designed for those with depression. It weaves aspects of mindfulness — like meditation — together with a type of psychotherapy.

In the past decade, high-resolution brain imaging has let us look beneath the skull and find out what effects these mindfulness programs have on the way the brain works.

How mindfulness shapes the brain

It’s still a burgeoning field, but a few different studies have suggested mindfulness interventions increase the volume of brain regions that help regulate emotion and attention.

One area that seems to get chunkier is called the anterior cingulate cortex, according to Neil Bailey, a neuroscientist at Monash University.G

“The function of this region seems to be related to choosing between competing brain processes,” he said.

“So if you’ve got a part of your brain that’s saying ‘eat the doughnut’ and another part of your brain that’s saying ‘no, do your homework’, the anterior cingulate cortex is the part that decides which to focus on.”

If the anterior cingulate cortex focuses attention, it’s the prefrontal cortex — responsible for complex cognition — that sustains that focus. It also seems to thicken up with a bit of mindfulness training.

The hippocampus and amygdala, which are primarily responsible for memory and emotional processing respectively, change as well — in the strength of their connections.

When the amygdala is activated, it can trigger the “fight or flight” response, the reflex that gets your heart pumping and your body ready to react to a threat.

It’s thought that some people with anxiety disorders have a hyper-responsive amygdala, eliciting fight or flight even when there’s no life-threatening danger.

After a bout of mindfulness training, the amygdala might still kick in, but messages feeding into it from the prefrontal cortex and hippocampus that give context to the situation — that it’s not a life or death scenario — may be stronger.

“What research has shown is that there’s less amygdala activity after a mindfulness intervention and that it’s related to the downregulation by the other brain areas,” Dr Bailey said.

Measurements aren’t perfect, but are improving

Dr Bailey uses a technique called an electroencephalogram, or EEG, to look at how mindfulness changes the brain’s function.

It’s a cap of electrodes that can pick up electrical activity in the brain’s outer layers.

The system has been used for many years and is very reliable, but relatively indirect.

To get right inside the brain and find out if its shape and size are changing, the best technique we have is magnetic resonance imaging or MRI.

These scans are the closest we can get to cracking open a person’s skull and taking a ruler to their grey matter. It’s the technique used in the studies, mentioned above, examining the cortex after mindfulness training.

An MRI machine records virtual slices through the brain (or any other squishy part of the body).

It was developed in the 1970s, but in recent years, MRI resolution has improved vastly thanks to more powerful electromagnets.

“The stronger the magnet, the better the image,” said Rebecca Koncz, a neuropsychiatrist at the University of Sydney who is also completing a PhD in brain imaging at the University of New South Wales.

MRI these days commonly operates with a 1.5- or 3-tesla magnet — around the strength of the electromagnets that hoist cars in scrapyards.

Newer, more expensive MRI models use a 7-tesla magnet or higher.

As well as more precise size-and-shape measurements, these superpowered magnets are proving useful for taking snapshots of the brain in action: a sort of whole-brain activity map called functional MRI.

This “fMRI” tracks oxygen in the brain’s blood supply, to see which parts are working harder. The idea here is that more activity needs more oxygen.

It’s the type of evidence which revealed, for example, that mindfulness training can dampen the activity of the amygdala.

Still, even top-shelf MRI machines have their limitations.

They divvy up images into 3-D pixels called “voxels”. Depending on the thickness of the slice, one voxel is usually around 1 cubic millimetre.

A morsel of brain tissue that size can contain tens of thousands of cells, so slight density or volume changes might go unnoticed.

And the difficult, indirect analysis required to quantify brain activity from fMRI data has led to criticisms about whether the results are meaningful.

There’s plenty left to discover

The neuroscience of mindfulness has drawn on all of these techniques — but is still in its infancy.

There are plenty of questions left to be answered, such as: Does the quality of mindfulness practice matter? Is there a dose-dependent effect (i.e. more mindfulness, more change)? And are there long-term effects on the brain?

Some evidence shows that compared to the wider population, long-time meditators have more brain volume in, for instance, the prefrontal cortex.

But there are no longitudinal studies as yet that have followed novice mindfulness practitioners to see if they maintained their newly gained brain bulk.

Even though the benefits of mindfulness can sometimes be overstated, there is likely to be a good reason it’s been around for so long, Dr Koncz said.

“Mindfulness and meditation have been practised for thousands of years. Perhaps science is just taking a bit of time to catch up.”

This piece by Belinda Smith was originally published on ‘ABC News‘ 19 February 2019.

New research led by researchers from The University of Western Australia suggests that poor mental health may be behind an increase in chronic disease in Australia.

The study, published in Social Science & Medicine, established strong associations between poor mental health and health behaviour and found that psychological distress caused unhealthy lifestyle behaviour in men.

Lead author Dan Hoang, who completed the study during his Honours year at UWA’s School of Population and Global Health, said the researchers found that unhealthy behaviour such as poor diet, smoking, binge drinking and lack of exercise, which contribute to chronic diseases, was a direct result of psychological distress, particularly in men.

The study used data from the nationally representative Household, Income and Labour Dynamics Australia Survey, for the years 2007 to 2013. In particular, the research looked at how an individual’s Kessler 10 score – a measure of one’s psychological distress – impacts the likelihood of a person having a poor diet or unhealthy lifestyle.

“Previous studies suggest that poor mental health is related to having poor lifestyle habits and our study has confirmed that large effects exist for men and women,” Mr Hoang said.

“However, what is of particular interest is what actually causes someone to develop poor health habits.

“Our research set out to explore whether a causal link from mental health to health behaviour existed. We found that poor mental health indeed caused people to participate in common behaviour that led to preventable chronic disease, such as diabetes and cardiovascular disease.

“For women however, a causal link was less clear. Our data suggests that causality may be cyclical for women – that is, poor mental health causes poor health habits, which in turn worsens poor mental health and so on.”

Co-author Dr Ian Li said policy focused on encouraging people to quit smoking, reduce alcohol consumption, exercise regularly and eat a balanced diet was a valid method of reducing the burden of chronic diseases on the healthcare sector and the economy.

“However, now that another root cause of such behaviour have been found, it is necessary to include a policy response to reducing psychological distress as part of the plan to tackle chronic disease,” Dr Li said.

Mr Hoang said increasing awareness and destigmatising mental health issues among clinicians, friends and family members could help not only improve the mental health of an individual, but may also lessen the likelihood of them acquiring a chronic disease.

This piece was first seen on ‘The University of Western Australia‘ 26 February 2019.

Media references

Dan Hoang (UWA School of Population and Global Health)                                        0421 242 498

Simone Hewett (UWA Media and PR Adviser)                                                         (08) 6488 7975

They recommended a massive expansion of the $1.5 billion Better Access program, which enables Medicare-subsidised visits to psychologists and other health professionals.

But simply striving to get more people into face-to-face care with health professionals is a limited and expensive strategy.

If we’re serious about improving access to mental health care, we need to look to online therapies. The evidence says they can be effective instead of, or as well as, seeing someone face-to-face.

Digital approaches to mental health care

Some studies have found online therapy to be as effective in reducing symptoms as therapy delivered face-to-face by a clinician. This evidence is strongest in relation to depression, stress and anxiety.

One meta-analysis of data from 3,876 adults found those who underwent internet-based cognitive behavioural therapy to treat symptoms of depression had better outcomes than those who didn’t use online therapies. They were also more likely to stick to their treatment.

So self-guided internet-based cognitive behavioural therapy is a viable alternative to current first-step treatment approaches for symptoms of depression and anxiety.

Online approaches vary, but they commonly present a course of psychological therapy structured so the participant can track their progress over time and seek further assistance if their situation deteriorates.

As an example, Mindspot offers a three step online process of therapy, beginning with information, followed by assessment, and finally, treatment.

Treatment consists of online courses across several areas, depending on the user’s needs. These courses might cover mood issues, obsessive compulsive disorder, and post-traumatic stress disorder.

People can elect to do a course independently, or could be referred by a health care professional, such as their GP. When health practitioners refer their patients into Mindspot they receive patient progress reports.

These online therapies can be critical for reaching traditionally under-serviced groups, such as young people and people living in rural areas.

Other key advantages of these stand-alone digital approaches include 24/7 availability of care, and the absence of the fees that would otherwise be paid out-of-pocket for a face-to-face consultation.

The range of online mental health tools available has expanded enormously over recent years. This has spawned review sites that help users navigate to online mental health therapies that best meet their needs.

And new research is looking at how digital technologies can be used for the prevention of mental illness as well as its treatment. The Black Dog Institute’s Future Proofing Study will engage 20,000 year 8 students to see how they can use their smartphones to prevent anxiety and depression.

We can facilitate team-based care online

Perhaps the greatest opportunity for enhanced mental health service delivery is to start to use digital technologies to drive new models of care specifically designed to meet the needs of each individual.

For people with more complex, disabling and persisting conditions, the international evidence clearly indicates bringing together a team of professionals is best practice.

For example, a person with an eating disorder is likely to benefit from integrated, multidisciplinary care provided by a GP, a nurse, a dietitian, a psychologist, a peer worker, and so on.

There are already some efforts to foster this online. An example of this can be found in the InnoWell platform, which service providers can use to bring together different professionals and resources tailored to suit each patient’s needs.

Using online assessment tools at the point of service request, those with milder needs are connected to a range of evidence-based apps and e-tools matched to their needs. Meanwhile, those with more complex needs are connected to care which will benefit them, including face-to-face services.

As a proportion of the total, new clients into Better Access were 68% in 2008, 57% in 2009, and just 32.6% in 2016-17. This increase in repeat customers suggests two things. First, perhaps people did not get the help they needed or had problems too complex to be managed within the program. And second, there may be limits on the extent to which the program can continue to meet its stated goal of increasing access to mental health services.

While the Medicare review relegated online therapies to “longer-term” reform, new digital and team-based approaches are key to driving improved models of increased access, at relatively low individual cost, to high quality mental health care.

Australia’s e-Mental health strategy needs action. The Medicare review into mental health represents a significant opportunity to get future investments right.

This means shifting from a focus just on access to instead considering how best to provide high quality, individualised services at scale – particularly to those who are disadvantaged economically, socially or geographically.

This piece by Sebastian Rosenberg and Ian Hickie on The Conversation, 5 March 2019.

Horticultural therapist Thomas Erskine enjoys a “sense of connection” when he works outdoors. Being wholly absorbed in an activity – taking in the immediacy of the environment – enables him “to lose the frenetic noise of a speeding world”.

Erskine runs gardening projects for people with learning disabilities and physical and mental health problems. He began his social care career in residential settings but found the environment frustrating and lacking meaningful activity. “I have always felt that social care is at its best when it’s focused and activity-based,” he says, “as these are often the times when people loosen up and start to have a more positive focus.”

After setting up a cooking and gardening group in a home for young homeless people, he took on the running of a walled garden in Alfreton Park, Derbyshire, that had become part of a day centre for adults with learning disabilities. Over the next 10 years, he turned it into a thriving community garden, running the project as a small social enterprise, selling plants and produce, and creating welcoming and accessible spaces, including a large outdoor cooking area with a pizza oven and a sensory yurt made by the garden group.

Erskine now works in woodland therapy or, as he describes it, “wild horticultural therapy”, which includes hands-on making, working with natural materials using hand tools. He’s also in negotiations with his local council to develop an accessible forest therapeutic project in Amber Valley, Derbyshire.

Horticultural and woodland therapies are attracting attention thanks to the increasingly well-documented value of the outdoors for people’s mental health and wellbeing. In fact, research has shown that the flexible nature of gardening projects allows service users to feel empowered in a non-threatening space. It also helps develop nurturing skills and is thought to boost mindfulness, as well as increasing serotonin and dopamine levels.

“The direct connection between physically doing something and the progress made, can be a good antidote for those who find being inside restrictive,” says Erskine. He gives the example of a young woman who “had a very limited vocabulary, but when she worked with her hands she became one of the most expressive people in the group, bringing in pictures of garden woodcraft projects she wanted to do next”. Another woman showing signs of early onset dementia became proficient with a draw knife (used to peel a hazel coppice), responding with a growing dexterity to a new skill she was learning later in life.

As one volunteer at community volunteering charity The Conservation Volunteers (TCV), puts it: “The garden slows you down and brings you into the moment: you can’t hurry it along.” She adds: “When you’re suffering from depression, it’s hard to think about the future. But gardening means you’re planning for the future, and seeing the results.” Advertisement

It’s clear that therapeutic horticulture is a growing area. Erskine says: “Health services in particular are leading the way in seeing the outdoors as a green prescription that works in delivering outcomes, especially around mental health and in the area of the early stages of dementia.” Indeed, projects are emerging all over the country. Chilypep (Children and Young People’s Empowerment Project) and the Sheffield and Rotherham Wildlife Trust have just completed a Secret Sanctuaries project to encourage young people into the outdoors. Kent charity Blackthorn Trust offers medical care, specialist therapies and rehabilitation through work placements in its Blackthorn Garden.

It stands to reason that to work in therapeutic horticulture you need to have a love of the outdoors. You also need to be creative and resourceful, says Erskine, who adds that “coming up with and responding to new interests can help keep a project fresh and relevant.”

Unlike the slightly more formal journey into occupational therapy and speech and language therapy, the route into horticultural therapy can differ according to area and need. Avon Wildlife Trust in Bristol runs a 12-week Grow Leader course aimed at anyone working in community projects and Reading-based charity Thrive works out of three regional centres in Berkshire, Battersea Park in London and Kings Heath Park, Birmingham, running outreach programmes at schools, hostels, hospitals, care homes and other community settings. For professionals and volunteers, Thrive offers courses such as Step Into Social and Therapeutic Horticulture and Connecting People With Dementia to Nature and Gardens.

Laura Hillier is a horticultural therapist at Thrive’s Birmingham centre, working with people who have had a stroke. She first trained as a mental health nurse and worked in a variety of roles, including as an NHS staff nurse. She’d always loved gardening and started volunteering at Thrive, before getting a part-time job with the charity. She says: “As I got older I became more aware of how nature and being outdoors contributes to our mental and physical wellbeing.”

She adds: “Horticultural therapy is much more than gardening – it offers people a chance to take part in something meaningful and build their skills and confidence.” And being a horticultural therapist is much more than being a gardener: “Seeing the difference it makes, the increase in confidence and connections made is very rewarding.”

This piece by Hazel Davis was first seen on ‘The Guardian‘, 26 July 2018.

How much impact does nutrition have on our mental health? There’s a wealth of research on the link between diet and depression, including a groundbreaking new study out of the University of St. Louis that points to a 33% lower risk of depression for adherents to the world-famous Mediterranean diet.

That study, published in the Molecular Psychiatry journal, also broke down the results of five previous studies investigating the link between a poor diet and depression in 32,908 adults from France, Australia, Spain, the U.S. and the U.K. The researchers point particularly to the omega-3 fatty acids that are found in vegetables, fruits, nuts, legumes, fish and healthy oils like olive oil.

The phenomenon is something that’s fascinated nutritionist Galit Goldfarb for years. The Israel-born nutritionist has made a career of touting the medicinal power of food, having published a series of books on the “ideal diet for humans” and counseling clients on how to heal their bodies using food. She’s also a motivational speaker, blogger and health and wellness coach.

Though she’s found success, Goldfarb wasn’t always the picture of health we see today. A few years ago, Goldfarb was an unhappy, divorced, overweight and unhealthy young mother of two special-needs children who found herself utterly confused about what to eat to improve her health, restore her energy and heal her body.

“I knew that what we eat has a grave impact on our health more than anything else does, but what is right to eat?” Goldfarb told us. “Is it individual – do we each have an ideal diet? What does it depend on? … I decided to put together the research from all of the scientific fields to get my answer, (and) my life changed and so did the lives of my clients, family and children. People healed from diseases or improved their situation for conditions that I never even knew existed.”

Indeed, the medicinal power of food became a passion for Goldfarb, who now sells numerous self-help products including “The Guerilla Diet” book series, superfood dietary supplements, DVDs and kitchen tools. Recently, she’s been examining the properties of the Mediterranean diet that contribute to mood and overall health.

In an interview with From The Grapevine, Goldfarb explained eight key factors that make the Mediterranean diet ideal for combating depression:

BDNF: The Mediterranean diet is rich in leafy salads and fish, which are rich in omega 3 fatty acids that play a critical role in brain function and mood. They also support Brain-Derived Neurotrophic Factor (BDNF) production. BDNF plays a vital role in brain health and the flexibility of the central nervous system as well as supporting adult neurogenesis (the growth of new brain cells in adulthood) and maintaining brain circuits (through neuroplasticity). Lack of BDNF has been shown to lead to depression and many other mental disorders.

Resveratrol: The anti-inflammatory and Mediterranean diet is also rich in fruits especially berries and grapes, including wine, which is rich in resveratrol, widely used in the treatment of neurodegenerative diseases. Resveratrol has neuroprotective effects by increasing levels of BDNF.

Turmeric: Turmeric is a spice commonly used in the Mediterranean diet known for its health benefits. Turmeric has also been found to increase brain levels of BDNF.

Fiber: The Mediterranean diet is rich in legumes, beans, green vegetables, and whole grains all which are rich in fiber. Fiber helps stabilize the insulin response which contributes to balancing cortisol levels. If cortisol levels are frequently high (from chronic stress, it will lead to estrogen dominance, leading also to mood swings and depression. With enough fiber in the diet, the body will eliminate excess estrogens.

Carbohydrates: The Mediterranean diet is rich in carbohydrates. People who are rigid in their eating habits or follow a very low-carbohydrate diet or a very high protein diet may be at risk for developing symptoms of depression, because serotonin, a brain neurotransmitter, is obtained from carbohydrate-rich foods. Almost all anti-depressant drugs work by increasing uptake of serotonin. Evidence suggests that eating a whole grain carbohydrate-rich meal with sufficient protein will increase the tryptophan available to the brain, because when carbohydrate-rich foods are consumed, the body releases insulin, which diverts other amino acids to the muscles but leaves tryptophan untouched. This provides a better ground for tryptophan to enter the brain and promote its effect on the brain. Tryptophan-rich foods include Spirulina, chia seeds, sesame seeds, watermelon seeds, flax seeds, cashews, pistachios, almonds and soy beans, all common in the Mediterranean diet.

Vitamin D: Vitamin D from sunlight is plentiful in the Mediterranean due to its location. Vitamin D deficiency is very common in the northern hemisphere. People are not getting enough sunlight or when they do; they have a sunscreen that does not allow the UV rays to penetrate the skin. Vitamin D deficiency is linked to depression.

Magnesium: Magnesium deficiency is common in the Western world. Too much phosphoric acid found in carbonated soft drinks, alcohol, salt, coffee, sugar, chronic stress, antibiotics and diuretics all reduce magnesium levels. Magnesium participates in over 300 enzymatic reactions in the body and helps us feel more at ease. Magnesium is found in abundance in foods very common in the Mediterranean diet including pumpkin seeds, brazil nuts, sesame seeds, almonds, dark green leafy vegetables, soy beans and brown rice.

Exercise: Walking is common practice in the Mediterranean region due to the comfortable weather. Exercise has a major influence on mood through the production of europeptides such as endorphins, which make us feel good.

This piece by Jaime Bender was first seen on ‘From the Grapevine‘, 26 February, 2019.

According to recent studies, mental health problems have been on the rise in the United States, with particular increases in cases of anxiety and depression.

The reasons behind this worrying trend are as numerous as they are complex, ranging from the evermore stressful demands of modern-day life, such as being constantly “on call” through email, phone, and social media, to environmental factors, such as pollution.

Researchers from around the world have been trying to disentangle each of these risk factors, so as to get a better idea of what changes are necessary to prevent mental health problems from developing into an increasingly serious, society-wide issue.

Now, a new study from postdoctoral researcher Kristine Engemann and colleagues from Aarhus University in Denmark has found a link between growing up in a natural environment and enjoying better mental health in adulthood.

Green spaces may safeguard our minds

In their research — the findings of which appear in PNAS — they used satellite data from 1985 to 2013 to identify the green spaces in close proximity to the childhood homes of more than 900,000 Danes.

They then correlated these data with this population’s risk of developing one out of 16 different mental health conditions throughout adulthood.

The researchers found that people who grow up surrounded by green areas have an up to 55 percent lower risk of developing mental health problems as adults than others.

These results remained in place even after the team adjusted for potentially modifying factors, including a person’s socioeconomic status, their family history of mental health problems, and migration from rural to urban areas.

“Our data is unique,” notes Engemann. “We have had the opportunity to use a massive amount of data from Danish registers of, among other things, residential location and disease diagnoses and compare it with satellite images, revealing the extent of green space surrounding each individual when growing up,” she explains.

The Danish study also reveals that the longer someone spent surrounded by nature during their childhood — from early infancy until the age of 10 years old — the more likely they are to experience good mental health later in life.

“With our dataset, we show that the risk of developing a mental disorder decreases incrementally the longer you have been surrounded by green space from birth and up to the age of 10. Green space throughout childhood is therefore extremely important.”

Kristine Engemann

Our cities must align with our mental needs

The researchers further argue that their findings suggest city authorities should pay more attention to safeguarding existing green spaces, and developing further green areas.

Previous research, note the investigators, has already pointed out striking links between levels of air and noise pollution in urban areas and a decline in mental health. They argue that the current findings provide further evidence that nature is an important ally in our pursuit of psychological well-being.

“There is increasing evidence that the natural environment plays a larger role for mental health than previously thought,” says Engemann, adding that, “Our study is important in giving us a better understanding of its importance across the broader population.”

Since people across the globe are increasingly moving from rural to urban areas in search of better life opportunities, we need to pay special attention to how our cities align with our psychological needs, the study’s researchers stress.

According to recent data from the United Nations Department of Economic and Social Affairs, 55 percent of the world’s population lives in built-up areas, and this number is likely to increase to 68 percent by 2050.

“The coupling between mental health and access to green space in your local area is something that should be considered even more in urban planning to ensure greener and healthier cities and improve mental health of urban residents in the future,” study coauthor Prof. Jens-Christian Svenning also advises.

This piece by Maria Cohut was originally published on ‘Medical News Today‘, 28 February 2019.

Cognitive Behaviour Therapy or CBT is a type of psychotherapy that helps change unhealthy habits of thinking, feeling or behaving.

CBT is commonly used to treat anxiety, depression and drug dependence, as well as everyday problems like difficulty sleeping, relationship issues and job dissatisfaction related to clinical mental health issues. It’s regarded as one of the most successful treatments for some mental illnesses.

As CBT is a versatile treatment method, it can be used by anyone, of any age, to improve general happiness, even if it’s not needed for clinical reasons.

CBT operates by working with three key elements — cognition, behaviour and therapy.

Cognitive Therapy

“Cognitive refers to the thoughts and beliefs that we all hold, which can influence how we see the world,” Professor Nicole Lee told HuffPost Australia.

Essentially, negative thoughts can be self-destructive and therefore, affect a person’s feelings and behaviours. The cognitive element of CBT aims to challenge these negative thoughts and give the person strategies to form healthier thinking processes.

Behaviour Therapy

“Behaviour is about our actions and responses,” Lee said.This element of CBT teaches skills to change the counter-productive way a person behaves. For example, if someone experiences anxiety in a social situation, they may be taught conversational skills to help with their confidence at a party. This will work to reduce negative thoughts about themselves in a practical and proactive way.

CBT is known for teaching people helpful strategies and skills, where the professional adopts a coaching-style role to teach the client how to be their own therapist.

So, what are these skills and how can we use them to improve our mental health and general happiness? Well, it really comes down to recognising our own internal thought processes and understanding where they come from.

Let’s go back to the party or social situation example.

“CBT takes a practical problem solving approach to issues. CBT works by addressing thoughts and beliefs that drive behaviours and feelings,” Lee explained.

“For example, someone with social anxiety at a party might think, ‘Everyone is looking at me. They all think I’m an idiot. Noone will want to talk to me’ — these are cognitions– this leads them to feel anxious– these are the feelings — which leads them to withdraw — these are the behaviours — making it less likely that someone will talk to them, which in turn creates more anxious thoughts and feelings.”

CBT works to identify what drives this negative thought and behaviour cycle.

“Some of the strategies we use … are identifying and understanding these types of thoughts that tend to just pop into our heads without us being aware of them, noticing the internal dialogue and chatter that is unhelpful, reframing those thoughts — finding another more realistic way to look at the situation — and testing out assumptions. These types of thoughts are called automatic thoughts,” Lee said.

CBT can be used by anyone to help their general mood, even if it’s not needed for clinical treatment.

“CBT is suitable to resolve non-clinical problems and to improve well being and happiness. The principles are the same. There are many programs that are online or accessed through self help books — referred to as bibliotherapy. Or they can have a few sessions with a private psychologist or other CBT practitioner,” Lee told HuffPost Australia.

As we all have basic beliefs that are developed during childhood, CBT relates to us all.

“The other important ‘cognitions’ in CBT are ‘core beliefs’ — these are fundamental beliefs or rules that we use to understand the world. We all have beliefs that have been developed since childhood. ‘I’m unloveable’, I’m not good enough’, ‘I’m useless’. They aren’t always negative but it’s the negative ones that cause the most problems.

“Usually these beliefs just sit under the surface and we don’t notice them, but sometimes they are triggered off by events. For example, if someone with a core belief ‘I’m not good enough’ is criticised at work, it might cause them to think ‘I’m hopeless’, ‘I can’t do anything right’ — the cognitions — and feel negative about their abilities — the feelings– and give up –the behaviour.

“CBT helps people recognise, understand or change those beliefs so they have less impact on their lives.”

If you need help in a crisis, call Lifeline on 13 11 14. For further information about depression contact beyondblue on 1300224636 or talk to your GP, local health professional or someone you trust.

This piece by Siobhan Kenna, was first seen on ‘The Huffington Post‘ 21 September, 2017.

Travelling is meant to be an exciting, refreshing and overall enjoyable experience — and most of the time it is.

Leaving your world to immerse yourself in another, discovering new places, and learning about new customs can help you discover more about yourself.

While it can be transformative, travel can be challenging if you’re struggling with your mental health.

If you’re planning a road trip — or a trip around the world — here are four ways to maintain your mental health while you’re away from home.

Sink some time into research

Social media and travel blogs can give us an unrealistic idea of what travelling is like, especially when it comes to visiting exotic locations.

But it isn’t all #wanderlust — travelling can throw up some unexpected challenges too.

Grant Blashki, head clinical advisor for beyondblue, says that when it comes to travel, our eyes can often be bigger than our common sense.

“It’s so easy to just book a flight and go these days,” he says.

“It’s common to see people become quite overwhelmed when they throw themselves into a really foreign and challenging situation. We often see symptoms start as a result of this.”

What to remember:

• Dr Blashki recommends really doing your research when it comes to your travel destination(s), and being realistic when it comes to your capabilities to cope.
• Chatting to others who have been there, discussing your trip with your doctor or therapist, and making use of free resources such as the government-run Smart Traveller which can help you make informed travel choices that work for you.

Plan and prepare an itinerary

While packing a bag, booking a flight and getting lost in the world sounds romantic, it’s worth putting some effort into planning if you’re worried about how you’ll manage.

Travel blogger Michael Turtle, 38, has been travelling the world full time for the past seven years. For him, being organised limits the kind of stress that can overwhelm him in unfamiliar situations.

“I try to be organised and have things booked further in advance, so I don’t have last-minute stresses about where to stay,” he says.

“Knowing where I’m going to be ahead of time takes away some of the feelings of transience that can be a bit unsettling.”

What to remember:

• Dr Blashki agrees that organisation can limit some of the anxiety that can come with travel. Having a set itinerary, knowing all your transport and accommodation arrangements, and even planning where you might eat can help you feel a little more in control of what’s going on around you.
• If you’re new to travelling overseas, or travel in general, he recommends dipping your toe in with an organised tour.

Get some sleep and watch the booze

Amykate Moroney, 24, from the Central Coast of NSW has been travelling for the past nine months, visiting as many countries in that time.

At times she’s struggled with the ‘cocktail’ of travelling and partying.

“Too much alcohol mixed with lack of sleep, shaken with feelings of worthlessness and garnished with loneliness. Now amplify this by not having any homely comforts,” she says.

“This would send anyone into a spiral, let alone someone that struggles with a looming black cloud.”

What to remember:

• Dr Blashki says that lack of sleep can have a negative effect on your mental health, which may come with being jet-lagged, late-night partying, or just trying to sleep in an eight-person hostel room. He recommends trying to maintain a healthy sleep/wake cycle while travelling to avoid burn out. You might also consider breaking up long-haul flights with stopovers and forming good sleep habits in the weeks before you leave.
• When it comes to partying, Dr Blashki has this advice: “People need to be cautious of how much alcohol they are drinking, and any recreational drugs they may be taking.” “While this is good advice for anyone, it is particularly important when travelling as these things can make you feel even more out of your depths.” Not sure if your habits are problematic? beyondblue has a number of checklists to guide you.

Consider what you’d need in an emergency

If you are currently dealing with mental health issues at home, it can be tempting to feel like travel is off the table.

But Dr Blashki says travel can be beneficial as part of a considered treatment plan with your doctor.

“Travel, like many things that we do, stretches our comfort zone, makes us more flexible and adaptive,” he says.

“You can become more comfortable in rolling with the ups and downs of life. From that point of view, I think that travel is highly beneficial.”

That said, if you’re taking medication or travelling overseas, it’s worth considering a few extra things before you leave.

What to remember:

• If you’re taking medication, Dr Blashki recommends packing an adequate amount, along with a letter from your GP that lists what you’re currently taking, to avoid any issues with customs and local laws.
• Heading overseas? “Get to know the local health system and embassy contact. You should also ensure that your travel insurance covers mental health as many will include it as an add-on,” he says. “Make sure that you have people at home who know your medical history and your travel arrangements.”People who need to access talking therapies or emergency help can contact the Australian Department of Foreign Affairs and Trade who may be able to assist in arranging appointments with local mental health professionals. The Consular Emergency Centre can transfer you to Australian mental health services such as Lifeline, beyondblue and headspace.

This article contains general information only. It should not be relied on as advice in relation to your particular circumstances and issues, for which you should obtain specific, independent professional advice.

This piece by Matt Ryan was first seen on ‘ABC Life‘, 19 February, 2019.

Australia’s peak body for psychologists says it will consider developing new practice guidelines for psychologists working with boys and men after the American Psychological Association announced its own set of guidelines for the group last month.

The APA guidelines, which say that “traditional masculine ideology has been shown to limit males’ psychological development … and negatively influence mental health”, were designed to provide psychologists with an “evidence-based approach” for responding to the particular needs of boys and men.

“The guidelines support encouraging positive aspects of ‘traditional masculinity’, such as courage and leadership, and discarding traits such as violence and sexism, while noting that the vast majority of men are not violent,” the APA wrote on Twitter.

“Traits of so-called ‘traditional masculinity’, like suppressing emotions and masking distress, often start early in life and have been linked to less willingness by boys and men to seek help, more risk-taking and aggression — possibly harming themselves and those with whom they interact.”

Ros Knight, president of the Australian Psychological Society, said the APS had been highlighting the “quiet crisis around men’s mental health” since 2012.

“What we’ve done is address it through ethical guidelines — so things [psychologists] need to think about when treating men,” Ms Knight said.

“But there is an opportunity for us to consider whether making specific practice guidelines for boys and men would be a sensible thing to do.

“I think as a result of the APA really bringing this much more to the fore, it’s something that we’re going to think about doing in 2019.”

Taking a ‘gendered’ approach

While the APA guidelines were released in August last year, they captured widespread attention in January when the APA published an article (and subsequent tweet) about the guidelines.

It sparked controversy on social media, and attracted negative comments from conservative US media.

The health body has released several guidelines in the past for psychologists working with people belonging to certain groups, including members of racial and ethnic minorities, the LGBTI community, and women and girls.

But for boys and men, who have historically been considered the norm in psychological practice, no such guidelines existed.

Lead author Fredric Rabinowitz, a psychologist at the University of Redlands, said the purpose of the guidelines was to help boys and men lead happy, healthy lives.

“We see that men have higher suicide rates, men have more cardiovascular disease and men are lonelier as they get older,” he told The New York Times.

“We’re trying to help men by expanding their emotional repertoire, not trying to take away the strengths that men have.”

Michael Flood, a researcher from Queensland University of Technology who specialises in gender, masculinities and violence prevention, said the guidelines were “long overdue”.

“We’ve known for a long time, probably 40 years, that norms of masculinity shape boys’ and men’s behaviour, including in unhealthy and negative ways,” Associate Professor Flood said.

“There’s literally decades of research pointing to the fact that conformity to traditional masculinity is associated with poor health among men, high levels of suicidal thoughts and behaviour, poor relationships and parenting, and involvements in violence against women and other men.”

Associate Professor Flood said there had been growing recognition in the fields of psychology and social work, since the mid-1990s, that a “gender-sensitive approach” to men’s health was needed.

“That began with a recognition that women’s lives are gendered — women’s health and wellbeing are shaped by stereotypes and norms regarding what it means to be a woman,” he said.

“But it took some time before that same insight was applied to men, with the recognition that men’s lives too are gendered.”

Men less willing to seek help

According to the guidelines, several factors influence the way men construct ideas of masculinity, including race, ethnicity, age and socio-economic status.

“Although there are differences in masculinity ideologies, there is a particular constellation of standards that have held sway over large segments of the population, including: anti-femininity, achievement, eschewal of the appearance of weakness, and adventure, risk and violence,” the guidelines state.

It is these cultural lessons, according to the APA, that have led to boys and men being overrepresented in a variety of psychological and social problems, in part because they’re less willing to seek help.

“Research shows that boys and men are at a disproportionate risk for school discipline, academic challenges, health disparities, and other quality of life issues,” the APA wrote.

In Australia, men have more accidents, are more likely to take their own life and are more prone to lifestyle-related chronic health conditions than women and girls at the same age.

Andrea Fogarty, a research fellow at the Black Dog Institute, said the cultural expectations placed on men to be “tough” and emotionally stoic meant that many men avoid seeking help.

“We know that for pretty much any mental health problem, men are not accessing health services at the same rate as women,” Dr Fogarty said.

A 2014 Black Dog Institute report found “unhelpful conceptions of masculinity” were among four factors — alongside acute stress, depressed mood and ineffective coping strategies — that increased men’s risk of suicidal behaviour.

“What we found in our research was that for some men, particularly those who adhered to a conception of masculinity that was quite traditional, they were less likely to seek help earlier in the course of illness,” Dr Fogarty said.

Similarly, a 2016 study from the University of Melbourne found men who strongly identified with being self-reliant were significantly more likely to have experienced suicidal thoughts.

“In addition to self-reliance, the men in our study didn’t want to be seen as a burden to their families and support networks … which often drove them further away,” Dr Fogarty said.

“That might be a way of temporarily managing distress … but in the long term, it’s not helpful.

“It comes through in alcohol use, substance use, withdrawal and isolation, and sometimes aggression.”

This is part of the reason there is a lower incidence of mood disorders yet a higher rate of suicide among young men — they are being misdiagnosed, according to a report from Orygen, the National Centre of Excellence in Youth Mental Health.

Impact of masculinity on relationships

In addition to looking at the impacts of traditional masculinity on men’s mental health, the APA guidelines also encourage psychologists to focus on how ideas about masculinity can influence men’s interpersonal relationships.

“If we socialise boys and men to avoid vulnerability, to be stoic, strong and avoid showing weakness or dependency … that plays itself out in a whole series of ways in men’s friendships, in their intimate and sexual relationships, and in their parenting,” Associate Professor Flood said.

He said while it was important to acknowledge how traditional masculinity can be “limiting for men”, it was also important to talk about how it can be harmful, or indeed lethal, for women.

“There is a very well-established link between agreement with traditional masculinity and men’s use of violence, whether that’s domestic violence, sexual violence, or violence against other men.

“It’s not the only factor that shapes men’s use of violence … and it’s not just any kind of traditional masculine norm. So, we need to look at what bits of traditional masculinity are at stake.”

He added that there were times and places where some traditional masculine qualities were “highly desirable”.

“The problem is, in part, that we tell boys and men to show these traditional masculine qualities all the time — to always be stoic, to always be tough, to always be in control,” he said.

“That can sometimes leave men emotionally stunted, even crippled, in contexts where showing weakness, asking for help, or being nurturers would be much better for them.”

Guidelines not an ‘attack’ on men

Some of the negative responses to the guidelines, including that they conflate traditional masculinity with “being a pig, or a creep or a Harvey Weinstein kind of person”, misunderstand what they’re about, Associate Professor Flood said.

“This is not an attack of men. It’s an attack on one particular set of ideals about how to be a man — a set of ideals which are actually pretty harmful to men themselves,” he said.

“What’s been criticised is a particular version of masculinity, based on sexism, rigid homophobia, and narrow emotional stoicism.”

Zac Seidler, a psychologist who specialises in the treatment of boys and men, said the idea that traditional masculinity is “fundamentally dangerous” was not the case, and not what the guidelines were suggesting.

“What the literature has shown is that if you are to enact traditional masculine norms — like stoicism, aggression and competitiveness — to an extreme, in a way that is extremely restrictive and rigid, that you are more likely to be depressed, and less likely to seek help,” said Mr Seidler, who is undertaking a PhD at the University of Sydney.

He said that when it came to men’s mental health, pretending that boys and men were not “socialised in certain ways” was “a dangerous way forward”.

“I think people have their eyes shut when they think this stuff isn’t happening anymore,” he said.

“We know these traditional norms are slowly dying off, but everyone has a bit of it — myself included.”

Both experts agreed that the guidelines were driven by a “profound compassion and concern” for men.

“It’s a shame that [the guidelines] have been misconstrued, but if anything, the fact that this is out in the public domain means that we’re heading in the right direction, in understanding that masculinity, and gender on the whole, is a cultural competency that all psychologists need to understand,” Mr Seidler said.

This piece by Olivia Willis was first seen on ‘ABC News‘, 5 February 2019.