Five facts about mental health for practitioners and patients
Ellen Lake, Richard Modderman, Beth Fuller, Georgie Davidson, Rosalie Russo, Rachel Peck-Israel and Ruth Lira contribute five facts to help physiotherapists look after their own mental health in times of stress and uncertainty. These facts can also help with interactions with patients.
1. Mental wellness is as important as physical wellness
In the same way that exercise, healthy eating and restful sleep benefits our physical health, there are behaviours, tools and strategies that can increase our sense of wellbeing and help us ‘bounce back’. These capabilities are essential components of psychological resilience and growth. They are learnable and reinforceable through the principles of neuroplasticity, repetition and practice.
Here are a few.
- Connection: social distancing, working from home, reduced work hours and job loss can contribute to feelings of loneliness, uncertainty and isolation.
- Staying connected with family and friends via phone and video calls and within social distancing guidelines is important.
- Gratitude and kindness: helping others and expressing gratitude through writing supports a longer life and better mental health (Post 2005, Wong et al 2018). Gratitude fosters adaptive coping, and kindness to others includes self-kindness and acceptance.
- Humour: laughter has been called the ‘best medicine’ and there is evidence for the positive role of humour in wellbeing. Social laughter has been shown to trigger endogenous opioid release, increase pain threshold and improve pleasurable feeling and social bonding (Manninen et al 2017). Producing and being exposed to humour are adaptive ways of coping, and may help reframe perspective and think differently.
2. Movement is good for your mental health
Being active has substantial positive impacts on physical and mental health, wellbeing and quality of life for all people. Physical activity is associated with mood-elevating effects and studies exploring the association between physical activity and mental health describe increased wellbeing, less stress, anxiety and feelings associated with depression. During times of stress, maintaining physical activity is paramount for good mental health and extends to a sense of personal accomplishment, with social benefits as well as preventive health benefits (eg, blood pressure, heart attacks, longevity).
There is consensus that 30 minutes of moderate activity on most days will give health benefits. Whether considering exercise for yourself or your clients, physical activity ‘prescription’ should be guided by assessing readiness to change and garnering an appreciation of influences on self-efficacy.
Physical activities are more likely to be initiated and sustained if individuals perceive a net benefit to themselves. Exercise regimes that instil a sense of personal accomplishment and provide opportunity for social interaction and physical health benefits are factors that may influence participation. It is important to ensure any exercises are enjoyable and can be easily accessed without unacceptable financial or social cost. Walking is generally regarded as suitable, providing low impact activity that is inexpensive and encourages social contact.
3. Mindfulness reduces stress
For centuries, mankind has explored mindfulness as a way of living well. Over the past 30 years there has been considerable research on the practice of mindfulness as a way of promoting health, happiness and wise decision-making in the face of stress and challenge. Neurophysiological research has demonstrated changes in the brain in regions responsible for attention and emotional regulatory processes, memory, self-referential processing, empathy, self- compassion and perspective taking (Holzel et al 2011). Mindfulness is now recognised as one of the five factors of wellbeing.
‘Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgementally’ (Kabat-Zinn 1990). Often, we are caught up in thoughts of the past or future, unaware of tension in the body and patterns of emotional reactivity. When we reconnect with the present via our senses and to the inner world of sensations, thoughts and feelings, we interrupt the cycle. Automatic reactivity is replaced with clarity, broader perspective-taking and greater choice in taking care of ourselves.
Although mindfulness is a natural human trait, it can be developed as a skill through regular practice. As a dedicated practice we can set aside time for mindfulness meditation in sitting, lying, walking or moving. It is an exercise for the body and mind.
4. Mastering new skills gives some sense of control during times of crisis and a sense of achievement
A maxim from the motivational speaker William Arthur Ward reads: ‘The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails’. Humans frequently exhibit elements of each of these characteristics during times of crisis but focusing on passive behaviours such as prolonged rumination on the negative or impracticable expectations of a miracle are not helpful coping behaviours.
The behaviour of the realist who adjusts the sails provides some sense of control. It has been shown that having some sense of control in a crisis reduces the chances of developing an anxiety disorder. Mastering a new skill to help survive a crisis and/or prepare for the way out of crisis is one way to engender a sense of control.
Mastering a new skill can strengthen mental focus, engender a feeling of accomplishment, be a source of pleasure and fun, contribute to brain growth and health, and improve mental clarity and concentration. A new skill may be related to personal or professional growth; it may help you weather the storm or prepare for a future which, because of a crisis, may differ from the one you envisioned. Mastering a new skill can help bring positive growth in mental health in any crisis.
5. Meaning in life has been linked to resilience and better mental health
Meaning is something that is constructed in our minds. We derive meaning from the value we place on our relationships, work, actions and morality or creative expression. With a meaning or purpose in life (PIL), one is driven intentionally towards other facets of psychological wellbeing, such as longing for personal growth, self-acceptance, autonomy and mastering our environment, as well as forming positive relationships with others (Schaefer et al (2013).
In wartime, Viktor Frankl observed those who survived had maintained a sense of humanity by helping others, keeping in mind their families at home, and thus retaining some PIL (Frankl 1946).
In modern society, work is often linked to personal identity and self- esteem and respect from others, which is important for mental health (Australasian Faculty of Occupational & Environmental Medicine).
Having a meaningful life has been linked to better mental health and resilience. It is associated with better physical health including lower cardiovascular risks, better neuro- endocrine regulation and decreased inflammatory markers, and having a positive effect on symptoms of depression.
Studies correlated with depression (Word Health Survey) describe lower levels of PIL with resultant lower levels of psychological wellbeing (Schaefer et al 2013). Characteristics associated with a medium and high level of PIL may include having social support, resilience or belonging to certain faith/ church. Other factors include having ‘high health literature and good health status’ (Musich et al 2018).
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APA Mental Health Group Queensland chair Ellen Lake is a Brisbane-based physiotherapist who works in community and hospital healthcare, which includes people living with mental illness and chronic disease. Ellen is completing her Master of Cognitive Behaviour Therapy at Flinders University, Adelaide.
APA Mental Health Group Queensland committee member Richard Modderman works as senior physiotherapist in mental health at the Princess Alexandra Hospital. Richard also works in musculoskeletal private practice and has an interest in primary prevention and chronic disease management.
APA Mental Health Group New South Wales chair Beth Fuller advocates that gathering stories and promoting resilience are central in working with consumers. Beth’s research has focused on finding what makes for interesting and fulfilling lives, and how to strengthen connections to the community.
APA Mental Health Group South Australia chair Georgie Davidson is an APA Musculoskeletal Physiotherapist and an APA Pain Physiotherapist working as senior physiotherapist for the Northern Pain Rehabilitation Service in Adelaide. Georgie is also director of Mindful Movement Physiotherapy, which provides mindfulness training to health professionals, educators, leaders and workplaces.
APA Mental Health Group Victoria chair Rosalie Russo is a cardiorespiratory physiotherapist at Epworth Richmond and Community Complex Respiratory Discharge Service. Rosalie holds a Postgraduate Certificate in Supervision and Managing People Performance and is an experienced clinical educator and supervisor.
APA Mental Health Group Tasmania chair Rachel Peck-Israel, APAM, works in a regional private practice and rehabilitation. Rachel is keen to encourage more understanding of mental health conditions in the local community, and explore strategies for mental health and wellbeing.
APA Mental Health Group Western Australia chair Ruth Lira is a private practice clinician who provides local and remote physiotherapy services in Perth and the Wheatbelt. Ruth’s commitment stems from her work experiences with depression, post-traumatic stress and anxiety disorders in war veterans and people who have experienced motor vehicle and work injuries.
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