Mental Health

Defining Health: 

• WHO definition Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  

• It is in a constant state of change, changes can occur quickly or slowly (dynamic) e.g A person could be experiencing optimal physical functioning and then contract an infectious disease making them feel sick.
  

• It means different things to different people (subjective) e.g An elderly person may view their health and wellbeing as good if they can live independently and look after themselves.
  

Dimensions of Health:

• Categories: physical, social, emotional, spiritual and mental health.

A good acronym is SPEMS: Social, physical, emotional, mental, spiritual

• Physical health: optimal physical health and wellbeing. healthy body weight, having good levels of energy and physical fitness, absence of illness and disease, capacity to do daily tasks, well functioning organs and systems, optimal blood pressure

• Social health and wellbeing: optimal social health and wellbeing. effective communication with others, able to react/manage/adapt appropriately in social situations, has strong relationships: supportive and well-functioning family supportive network of friends, and productive relationships with others. 

• Emotional health and wellbeing: optimal emotional health and wellbeing. Experience appropriate emotions in given situation, high levels of resilience, recognise and understand emotional actions and reactions, express and manage emotional actions and reactions appropriately

• Mental health and wellbeing: optimal mental health and wellbeing. Low levels of anxiety/stress, high levels of confidence and good self esteem, ability to think and process info, use logic and reasoning for informed decision making/opinion forming, positive thought patterns

• Spiritual health and wellbeing: optimal spiritual health and wellbeing. Acting according to values and beliefs, developed values and beliefs, sense of belonging and connection to world, place and purpose in life- positive meaning, peace and hope.

Identify basic emotions in self 

• Define emotions: Are subconscious/conscious  mental reactions subjectively experienced as strong feelings usually directed toward a specific object.

• Emotions vs feelings: emotions are subconscious/or conscious, sensations in the body. Feelings are conscious generated thoughts about emotions

• Emotion examples: e.g happy, sad, angry, surprised fearful, disgust, contempt

• Physiological vs psychological: effects on body vs effects on mind

Examples

• Disgust: Effects on your body (physiological): Covering sensory areas, Nausea, Vomiting/gagging. Effects on your mind (psychological), Avoidance of the trigger, Revulsion

• Anger: Effects on your body (physiological), Churning feeling in stomach, Rapid heart rate, Tense muscles / Grinding of teeth, Hot / sweating, Shaking / trembling. Effects on your mind (psychological), Unable to relax, Easily irritated, Overwhelmed, Loss of self-control, ‘Seeing’ red

• Sadness: Effects on your body (physiological), Tightness of chest, Heaviness of limbs, Stinging in the throat, Watery eyes, Headaches. Effects on your mind (psychological), Trouble sleeping, Loss of appetite, Crying, Grumpy or irritable

• Happiness: Effects on your body (physiological), Feeling light/uplifted, Energetic, Buzzing/tingling, warm, Grounded. Effects on your mind (psychological), Willingness to take life as it comes, Enjoying positive, healthy relationships, Satisfaction, Open to new ideas/experiences, Gratitude

• Fear: Effects on your body (physiological), Cold, Shortness of breath, Sweating, Trembling/ Muscle tightness, Rapid heart rate. Effects on your mind (psychological), Tense/nervous, Difficulty concentrating, Irritability, Sleep disturbances

• Surprised: Effects on your body (physiological), Tingling skin, Rigid muscles, Heavy stomach, Grasping items/people for comfort. Effects on your mind (psychological), Dependent on whether the trigger is positive or negative, General sense of attentiveness, Intense feeling of happiness or anger/fear, Disorientation

• Contempt: Effects on your body (physiological), Upright posture so to ‘look down’ on others, Eye rolls. Effects on your mind (psychological), Negative comparison, Sarcasm / mockery, Dismissive, Lack of respect, Emotional disconnect

Rejection and failure 

• Rejection is an uncontrollable emotion (to be dismissed as inadequate/faulty). Example: not getting a leadership position or being chosen for something, losing a competition, being excluded from a friendship. Impact: Stress & anxiety for the future, self doubt, low self-esteem and self-worth, self-isolation, sadness & depression, anger, reliance on addictive substances. 

• Failure is a controllable feeling (lack of success) example causes: lack of supportive relationships, comparing self to others, low self esteem, shame, unrealistic expectations, negative self took, poor self concept. Impact: Some people will dismiss the value of the task, criticise the people involved or question the fairness of the situation faced. Others may flee the failure by disengaging our attention. 

To combat this you can use the ABCDE model

• A- activating event. The event that triggers unwanted responses. B-beliefs. The beliefs/thoughts about A. C-consequences. Internal/external behaviours that result from B. D-dispute. Challenge belief from step B:is it rational? E-exchange. Swap old beliefs for new balanced ones.

Consequences of suppressing emotions:

• Reasons for suppressing emotions: To conform, because they were told too, to avoid not socially acceptable feelings, replace uncomfortable feeling with comfortable one, past experiences too difficult to process

• Effects: Physiological: tightening of muscles, physical pain, nausea, digestive problems, chronic illness. Psychological: anxiety, depression, moodiness/irritability  

• Consequences: May feel more socially accepted but at the cost of physical pain/ physiological effects and psychological effects of anxiety and depression. So don't suppress emotions.

Growth and fixed Mindset:

• Growth mindset: Belief that intelligence, talents, and personality can grow through effort, challenge and feedback. Have a desire for learning and trying new things, embrace challenge and risk to improve skills and knowledge, seek and embrace constructive feedback to pave next steps, acknowledge and reflect upon mistakes as a tool for improvement, explore new subjects and interests with openness and curiosity, understand the value of effort and using strategies to overcome challenges

• Fixed mindset: Belief that intelligence, talents, and personality are fixed traits that cannot grow. Have a desire for approval and achieving success, avoid challenge and the risk of failure or mistakes, resist seeking and embracing constructive feedback , view mistakes as an indicator of talent and intellect, stick to tasks and activities in which they can be successful , view effort as a reflection of lower ability and avoid embracing challenge

Comparison: Fixed mindset people view and avoid mistakes, stick to and avoid challenges, resist and avoid feedback, avoid and resist risk, resist. Growth mindset people reflect and acknowledge mistakes, seek and acknowledge feedback, acknowledge and embrace challenge, seek and embrace effort, explore and seek risk. 

KEY TERMS FOR EACH: view, avoid, stick to, resist vs reflect, acknowledge, seek, embrace, explore

The more you use these thinking patterns and behaviours, the stronger the neural pathways become and thus increasing your likelihood of using those pathways. (how mindset influences behavior, etc)

Common thinking errors

• Magnification or Minimisation, emotional reasoning, overgeneralization, disqualifying the positive, magical thinking, should statements,  all- or nothing thinking, personalization, jumping to conclusions

• Magnification and minimization: exaggerate/minimise importance of achievements e.g Believing your own achievements are unimportant, believing your mistakes are excessively important, you get a stain on your new shoes and think they’re ruined and can’t be worn anymore.

• Overgeneralization. Broad interpretations from single/few events e.g “I felt awkward during my job interview. I am always so awkward” or “A person becoming upset when a bird poops on their car “Birds are always pooping on my car!”

• Magical thinking: belief that thoughts and actions influence unrelated situations. E.g “If I hadn’t hoped something bad would happen to him, he wouldn’t have gotten into an accident”.

• Personalization: Belief you are responsible for events totally out of your control. E.g When your basketball team loses a game, you think it’s entirely your fault. Or “My mom is always upset. She would be fine if I did more to help her”.

• Jumping to conclusions: Interpret the meaning of a situation with little or no evidence. e.g “I bet no-one will come to my birthday party”. Or “I’m really going to blow it. What if I flunk?’.

• Emotional reasoning: The assumption that emotions reflect the way things really are. E.g “I feel like a bad friend, therefore I must be a bad friend”. Or “I don’t feel like doing this, so I’ll put it off”.

• Disqualifying the positive: Recognising only negative aspects of a situation and ignoring positives. E.g You might receive many compliments, but only focus on the single piece of negative feedback.

• Should statements: belief that things should be a certain way. E.g “I should always be perfect”

• All or nothing statements: thinking in absolutes “always” “never” “every”. Looking at things in black and white categories. E.g “I never do a good enough job on anything”.

• Common thinking error impact: irrational beliefs that can make you experience negative emotions and makes you mean to yourself 
  

Flight/fight/freeze: 

• Involuntary response/ survival mechanism, triggered by threat/stressful or fearful situation, the response depends on proximity and situation. Fight- confronting and fighting off the threat. Flight- escaping by running away to safety. Freeze- keeping absolutely still and silent to avoid detection. 

• Parts of brain: amygdala (see below) and prefrontal cortex- responsible for decision making, reasoning, personality expression, complex cognitive behaviours, maintaining social appropriateness

• Brain's response: the amygdala (processes aggression, anxiety,fear) tells you to panic after seeing something frightening/ period of intense stress (physical or psychological). Feelings and emotions then bypass the prefrontal cortex (higher order association center). Therefore we react instinctively/ are less in control of our feelings. To remain in control of emotions, we require a safe processing environment.

• Nervous system: the part linked with this response is the PNS (peripheral nervous system, the autonomic nervous system within this) The autonomic system can be divided further into sympathetic and parasympathetic nervous systems. Sympathetic- carries signals related to fight/flight response, Increases heart rate, blood pressure, breathing rate and pupil size.  Parasympathetic- could do with freeze reaction, relaxes body after periods of danger/stress, Decreases heart rate, blood pressure, pupil size and increases digestive juices. 

• Combined response: Amygdala tells you to panic, sends signals to hypothalamus which stimulates autonomic nervous system. The sympathetic system is activated unless a freeze response occurs then parasympathetic.

• Impact on emotional response/thoughts: Thinking patterns would be impacted due to prefrontal cortex being skipped in the process so decisions wouldn't be well formed, and emotional responses may be out if line e.g not appropriate according to societal expectations

Window of Tolerance 

Window of tolerance: concept describes optimal zone of arousal for a person to function in everyday life. Within this window we can effectively manage/cope with emotions

• Dysregulation: Is an inability to control or regulate one's emotional responses, which can lead to significant mood swings and significant changes in mood. When dysregulated a person may be operating outside of the window and cannot effectively manage or cope with their emotions

• Hyperarousal: fight/flight. Heightened energy happens when the nervous system is in high alert (even if no danger). Symptoms: Angry outbursts, fear, anxiety, emotional overwhelm, hypervigilance, “deer in the headlights” freeze

• Hypoarousal: freeze response, result of an overloaded parasympathetic nervous system, it can be triggered by feeling threatened, recounting traumatic memories, or feeling emotions associated with past trauma. Symptoms: Numbness, emptiness, blank stare, inability to speak, dissociation. Also known as “shutdown” or “collapse” response. Can impact a person’s sleep and eating habits, leaving them feeling emotionally numb, socially withdrawn, and finding it difficult to express themselves.

Interrelationship: the fight/flight/freeze responses happen when someone is outside their window of tolerance and experiencing hyperarousal. This is because in hyperarousal the subject may be facing intense stress or other triggers. The freeze response can also occur due to hypoarousal.  In hypoarousal the parasympathetic nervous system being overloaded is because that is the system that recuperates after fight/flight/freeze response

Language skills:

You can help someone who is dysregulated by using emotion coaching and doing things like validating them and having empathy/being there for them emotionally but also things like giving them grounding strategies - such as deep breathing for example. 

Grounding strategies 

• Support individuals to focus on what’s going on around them instead of their thoughts. Allows a person to slow breathing, lower heart rate, and allow the brain to process information. When distressed, the fight/flight response is activated, making it very difficult to think clearly. 

• Grounding strategies: Box breathing, describe an activity, finger tapping, 5-4-3-2-1, categories, mental exercises, imagine yourself somewhere safe,  body awareness, reorienting yourself, mindful observation, finding your feet, 

• Effects on the nervous system: your heart rate lowers, slow breathing rate, releases muscle tension, and the brain can process information better. Can go from sympathetic nervous system high alert to parasympathetic nervous system to take control and allow you to rest. Impact on fight/flight/freeze response is that it can turn it off and as mentioned shift control to a strengthened parasympathetic nervous system for you to rest, plus it can expand your window of tolerance so your fight/flight/freeze response does not happen as often. 

Emotion Coaching

• The steps: be aware, connect, listen with empathy and validate, label emotions, find good solutions.

• Be aware: Noticing changes in facial expressions, behaviour, posture, tone, body language and be attuned to their feelings. Example phrase: ‘Is everything ok? Tell me what’s going through your head’.

• Connect: Use it as a chance to connect, don't be dismissive, encourage them to talk to you. Example phrase:‘Let’s sit here for a moment, I’ll stay with you. It’s okay to feel _______.’

• Listen with empathy/validate: listen carefully and seek to understand- feel their pain, don't judge or offer unwanted advice. Example phrase: ‘I’m so sorry you’re going through this’.

• Label emotions: Use an emotion wheel starting at the centre, go outwards, help identify emotions by asking them- don't tell them what they are feeling. ‘Tell me what you’re feeling’.

• Find good solutions: Don't expect it to be fixed right away, do it together but don’t do it for them. ‘What could your next steps be and how can I help?’

• EXTENSION: apply emotion coaching framework and critique 

Empathy vs Sympathy

• Empathy: The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another

• Examples: I understand your pain and I’m so sorry you are going through this. It must be really difficult. Instead of “I feel so bad for you- at least things can't get worse?

• Empathy vs Sympathy: Empathy is feeling how another feels, sympathy is feeling sorry for their misfortune without facing the uncomfortable emotions of experiencing it with the person. 

Values and beliefs:

• Values: one's judgement of what is important in life. Beliefs are an acceptance that something exists/ is true usually without proof.

• Beliefs help us form our values, which can determine our attitudes which can determine our behaviour. In summary beliefs and values determine your treatment of others (attitude) and how you approach different situations (behaviour). Being more aware of thinking patterns can lead to more informed decisions. 

• Examples: Belief: Education can unlock a person's potential and provide them with the tools to succeed in life, regardless of their background. Value: Lifelong learning. Attitude: Approaching education with a growth mindset. Challenges and mistakes are opportunities for learning and improvement. Behaviour: Actively seek out new learning opportunities, participate in discussions, and consistently strive to improve my understanding.

• Own values and beliefs: Belief: Being seen as equal is important regardless of factors such as race, gender, sexuality, ability, age and will make the world better if we don’t treat each other with hatred because of things we can't change. Value: equality. Attitude: Treat others with respect and compassion regardless of their background. Behaviour: Actively seek ways to foster inclusion and bring upon equality every way I can, and consistently strive to learn others perspectives and address whatever biases I may have. 

• Navigating Conflict Circumstances: identify values: once you know why there is conflict you can start finding a resolution. Get talking: Talk and actively listen- makes you more likely to understand/accept another's viewpoint. Be mindful that there is no right or wrong and don’t judge even if you believe their argument is illogical or mean. 

Find common ground: Identify values that overlap and negotiate a win-win situation. 

COMMAND SKILLS

List: Dot points, do number specified not more or less

Identify: Recognise/name/state key points, characteristics, terms or features

Define: State/explain meaning of term. Don’t use the term in response

Outline: Brief summary, sentence format. Use examples

Describe: General description to show in depth understanding of concepts/terms in sentence form

Explain: Higher level of detail, help reader understand how/why

Compare: Identify similarities and differences and unpack them

Distinguish: Make clear differences between two or more concepts/topics/examples

Justify: Explain why option you chose was best option, provide evidence/data to support

Discuss: Go into detail about characteristics of a concept use examples 

Evaluate: Address positives/strengths and negatives/weaknesses then form judgement

Emotion Coaching:

1. Be aware of emotions

• tune into the person's emotions and your own

• Observe, learn and listen to the person closely

• Understand that emotions are a valuable and important part of life

2. Connect with person

• Respect the person’s feelings by actually listening to them

• Show them that you understand

• Do not try give unsolicited advice

• Avoid judging and criticising the person

3. Listen with empathy and validate

• Identify what they are feeling instead of telling them what they should feel

• Help person identify and name emotions

4. Label emotion  

5. Find good solutions