“Why didn’t I know all this years ago?”
I walk down the corridor with Mrs S and welcome her into the consulting room. She appears more relaxed and can talk openly and calmly; transformed from her previous fearful self-doubting low and tired self. This was not because of me. She felt empowered by new concepts and skills she had learned to better manage her mood. Not only therapy skills but life skills. “Why didn’t I know all this years ago?” she says.
When it comes to presentations of mental health people are often not tuned in with what is going on. How could Mrs S have realised there might have been an unmet need earlier? Often she would worry her friends didn’t like her (mind-reading), one thing might go wrong and the whole day was written off (overgeneralisation), she would look for clues that meant her fears were reality (the mental filter). She felt relentless expectations, I must be more this and I should feel that. These are called thought biases and we can train ourselves to manage these.
Often I reassure people in Mrs S’ position that mood fluctuations are normal. Nobody is happy all the time. Sometimes people get stuck in a downward spiral and can become depressed. But I have also come to realise how much people struggle with low mood and never tell anyone – their friends and family likely never know.
There are books and apps written on self-help. The game changer though is how we talk about and train ourselves to manage our mental health from the get-go. We all recognise that if we exercise or go to the gym we get stronger. It is the same principle when it comes to our brain “muscle.” If we can understand how our minds work and can manage our emotions in a healthy way, we build resilience and can grow and can better tolerate distressing emotions and life stresses. You don’t need to wait until you are struggling before you start this learning process!
Mindfulness is a state of mind that means paying attention to the present moment. This is an awareness of thoughts, feelings and body sensations that arrive in the now. Mindfulness helps to hone your awareness of the details of your experience so that you are more able to choose carefully how you respond. We should practice this skill every day.
The secret otherwise is about getting the basics right – Exercise, Sleep, Diet, Connecting. We tend to neglect the basics. The first thing Mrs S did when her mood dropped was withdraw from friends, drink too much alcohol or coffee, she then couldn’t sleep and she stopped exercising.
Exercise: science tells us that exercise has potent antidepressant effects. Exercise leads to higher circulating levels of dopamine as well as more dopamine receptors in the brain increasing your capacity for pleasure. This should be the focus rather than a concept of being a painful process to lose weight! Choose something you enjoy, and you increase your chances of keeping it going.
Sleep: has a profound effect on your mental health. When you haven’t slept everything feels one hundred times harder. Use the evenings for relaxation. Try a warm bath. Get as much natural light as possible first thing in the morning. Keep lights low in the evening. Make time in the day to tackle your anxieties and stresses. Don’t concentrate on sleep but try to relax, rest and stay calm. Avoid caffeine in the afternoon.
Diet: The science tells us that how you feed your brain influences how you feel. The Mediterranean diet shows the largest and best evidence. Often misinformation around food and the latest diet just means it is too confusing. So keep it simple. Have at least 5 fruit/vegetables daily.
Connection: We are pack animals. Nurturing good quality relationships is one of the most powerful tools we have in maintaining good mental health. When you feel low the thought of facing anyone can feel overwhelming. This is the trap of depression. It tells us to withdraw and hide away. When we feel low just being around people can help. Human connection is our inbuilt mechanism for resilience.
So hopefully we can all be a bit more like Mrs S and we can try to get some of the basics right and be even more resilient as we go on to our next adventure.
Dr Dan Lickman, GP Two Rivers Medical Partnership