Mental Health and Wellbeing the Importance of Emotional
Mental Health and Wellbeing & the Importance of Emotional Resilience: A Whole School Approach Dr Harry Barry MB, BAO, BCH, DO, MRCGP (London), MICGP, MA CBT
The Mental Health Student Tsunami Most principals, teachers, boards of management and guidance counsellors work are acutely aware of and are trying to cope with an avalanche of mental health challenges in their students. This storm is occurring in Ireland, UK and USA. This talk is going to explore the routine causes of mental distress in our students; what lies behind this tsunami; the importance of emotional resilience; and how schools need to develop a ‘whole school approach’ to managing the current ‘epidemic’.
What did our 6 th Years actually want to know? How to deal with: l Anxiety in relation to exams l Panic attacks l Pressure they felt from their parents to do well in exams l Disappointment in relation to exam results l Failure in life l Body-image problems l Fear of the future and the unknown
What did your 6 th Years actually want to know? And how to cope with: l Feelings of depression and low self-esteem. l Stress, and concerns about how to achieve happiness in life. l Relationship difficulties with the opposite sex l Stress in terms of ‘coming out’. l Making the right choices in college and in life. An interesting list!!!
Mental Health is defined as: ‘A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (WHO).
Mental Health Spectrum All of us at a particular moment in time will be: 1. Mentally healthy 2. Mentally/Emotionally distressed. 3. Mentally ill. In real life, these 3 states intermingle and overlap. Schools are like any other domain in our lives, but are often where mental health difficulties present for the first time. At least 75% of mental health difficulties and illness appear before the age of 25 – especially between 13 and 25.
Mental/Emotional Distress The vast majority of mental health difficulties prevalent in our young people are not due to severe mental illness. They are due instead to a mixture of life crisis situations intermingled with common mental health conditions: 1. Toxic stress or ‘burnout’. 2. Anxiety. 3. Mild to moderate Depression. 4. Alcohol/Substance misuse/abuse. Self-Harm can be often triggered by any of the above conditions. Too big to cover in this talk.
Toxic Stress Many of you present and indeed many of the young people you deal with are at risk of developing or are already showing signs of toxic stress. Toxic Stress occurs when our stress system becomes overwhelmed from a mixture of work and non work based stressors. We begin to pump out persistently high levels of our stress hormone Glucocortisol. With significant physical and psychological consequences.
Are you stressed? If toxically stressed you may notice some of the following warning signs: l Constant fatigue, loss of interest, apathy. l Sleep difficulties, nightmares, teeth grinding/night guard. l Feeling down or flat, easily angered or frustrated, less efficient at school or work. l Fighting more with parents or peers or siblings or in your own cases with partners and work colleagues.
Are you stressed? Or l Persistent headaches, abdominal pain, and muscle pains. Increased incidence of cold sores, mouth ulcers and general viral and bacterial infections. l Poor concentration and decision making and reduction in short term memory. l Negative behaviours – stop exercising, poor diet, excessive use of alcohol/substances or late night surfing the web/obsessive usage of social media and technology.
The Stressors (Students) These can include amongst many: l Exam pressures/career choices/picking wrong courses/not academic so feeling ignored. l Social media pressure/shaming/bullying/sexual pressures from porn/FOMO/peer group isolation/constant self-rating -------- etc. l Relationship difficulties/parental pressures/fear of failure/lack of resilience/life skills/being overprotected -------------etc. l Gender and sexual identity issues -------etc l The hidden drug epidemic.
Anxiety There are 3 main types of Anxiety which may cause mental or emotional distress in students: 1. 2. 3. Acute Anxiety. General Anxiety. Social Anxiety.
Acute Anxiety There are 2 main types: 1. Panic Attacks – sudden burst of intense physical symptoms (heart pounding, fast shallow breathing, dry mouth, stomach in knots, throat closing in etc. ). Usually last 5 to 8 minutes but can last for an hour. 2. Phobias – where I develop all of the above if exposed to certain situations – going to school, crowds, lifts, buses, trains, planes etc.
General Anxiety This is an often lifelong battle with the following symptoms: 1. Psychological – catastrophising, worrying, procrastination, indecisiveness and constant sense of foreboding. May be perfectionist. Constant self – rating. 2. Physical – persistent bouts of fatigue, poor cognition, sleep difficulties, nightmares, teeth grinding, tired but wired.
Social Anxiety This is an often unseen but extremely distressing condition, which can impact on all aspects of the person’s life, including school (and staff rooms!). There are 2 common types: 1. Social Interactional Anxiety – where people of any age become anxious ++ when exposed to normal human interactions – e. g. the party or pub or staff room. 2. Social Performance Anxiety – where people become anxious ++ when performing – e. g. giving presentations at work.
Management of Anxiety 1. 2. 3. Panic attacks and Phobias – can be banished for life using simple Flooding and Exposure exercises (see Anxiety and Panic/videos). May need CBT therapist to assist (2 to 3 visits). General Anxiety – lifestyle changes as described. CBT - how to banish control, rating and catastrophising. May need CBT therapist. Social Anxiety – can be also rapidly banished for life using simple CBT techniques (see Anxiety and Panic and ER). May occasionally need CBT therapist (2 to 3 visits).
Depression is: 1. A clinical condition which occurs in bouts. 2. Each bout will normally last from 6 to 12 months. Often triggered by stress. 3. 80% will only have between 1 and 4 episodes in their lives. The other 20% may suffer from more regular relapses. In between are well. 4. 50% will present for first time between 15 – 25. 5. Twice as common in girls.
Presenting Symptoms of Depression During bouts the person may complain of: 1. Persistent low mood/emotional pain for over 2/52 – usually present for help long after this. 2. Fatigue ++, sleep difficulties (early waking), anhedonia, loss of drive, loss of appetite, loss of interest in life. 3. Negative thinking about themselves and the world (I am worthless). 4. Significant cold cognitive difficulties – key for schools/colleges to know. 5. Suicide thoughts and plans. Always ask.
Management of Depression 1. 2. 3. 4. 5. Ideally should be assessed by professional (GP or specialist). Is it mild/moderate/severe. If mild – lifestyle changes and talk therapy (CBT or counselling) If moderate – may need to consider adding drug therapy to above. If severe – will normally require drug therapy plus above. In severe cases ++ may need hospitalization – this is the exception. Attendance at school/work should depend on above assessment and cognitive capacity.
Cognition Cold Cognition is perhaps the most hidden and least discussed symptom in mental health. It relates to the brain’s capacity for memory, attention and concentration, decision making, executive function and psychomotor speed. Cognition can be reduced in Toxic Stress, General Anxiety and significantly reduced in Depression. In Depression it makes the person increasingly believe that they are useless and a failure, dropping their mood further.
Cognition 95% of students/adults during a bout of Depression will experience moderate to severe cognitive dysfunction. The majority will improve greatly following treatment but a % will have some residual difficulties. N. B. – watch out for cognitive difficulties in students at school/college!!!!
Skills adolescents need 1. 2. 3. 4. 5. 6. 7. Physical health (exercise, nutrition etc. ). Meaning (the importance of altruism). Mental health (how I feel about myself, others and life? ). Activities of living - how to use washing. machine; what is an iron; what is cooking? The importance of education - points or life. Mindfulness. Problem solving and resilience.
Prevention What can we do to reduce the risks of mental/emotional distress and recurrence of bouts of mental illness in students? The answer is that we cannot prevent all of the above but can significantly reduce the incidence and impact of both. This requires a suite of measures involving lifestyle changes and developing critical emotional resilience skills.
Lifestyle changes These include advice on: 1. Exercise. 2. Improve work/life balance. 3. Technology detox. 4. Sleep. 5. Alcohol moderation. 6. Introducing Yoga/Mindfulness.
Lifestyle changes Exercise – 30 minutes a day. Diet – eat less, reduce sugar, more fruit and veg, reduce coffee, more fish, less red meat etc. Try and reduce incidence of obesity!!! Alcohol/Substances - the ‘elephant in the room’! Technology detox – the ‘monster’ in our midst! Sleep – the most important of them all! Let’s explore the areas of technology and sleep in greater detail.
Lifestyle changes – What can schools do? Some suggestions: 1. Encourage a whole school programme involving sport or exercise of any type. Our students are often unfit and resistant to PE. 2. Also a whole school approach to nutrition – so many students are overweight or obese. In an ideal world ‘domestic science’ would be compulsory. 3. Constantly discuss the dangers of misuse of substances such as hash and other drugs and alcohol
Technology The most common cause of difficulty ‘detaching’ for all of us is to fall into the habit of checking constantly, day and night, our phone for emails and social media inputs. This is a message for adults especially. We fail to understand that our brain can become addicted to such behaviour – craving positive intermittent feedback – giving us a dopamine high. We can also become ‘anxious’ due to fear of missing out (FOMO) on some critical email or message.
Technology This leads to a constant barrage of information pouring into our already overloaded brains – TMI. This in turn leads to us becoming fatigued and cognitively sluggish but also wired. But it is our inability to keep the smartphone and other devices out of our bedrooms that causes the greatest damage to our mental health. It interferes with sleep – blue light, emails coming in at all hours, early morning checking, trouble getting back to sleep and the devastating consequences of this on our health.
Technology and Students Although useful there are some pitfalls: 1. Some students spending between 4 -6 hours a day on some form of technology. 2. Many are obsessed with social media; others with gaming. 3. Greatly increases risks of anxiety, low mood, self and other rating, self-harm, eating disorders etc. 4. Can reduce social skills and prevent the formation of emotional resilience.
Technology and Students Is Social Media/Smartphone addiction lying at the heart of much of the stress/anxiety/emotional distress being experienced by many students. From Porn to shaming to sexting to cyberbullying to self and other rating to lack of sleep, exercise to lack of one to one empathy experiences to selfharm sites ----- the list is endless. Many schools have bravely challenged head on the monster, banning its use during the day. But a lot of buy in from parents is also necessary to challenge the monster.
Technology Protocol 1. 2. 3. 4. 5. No devices of any form (including Kindle) in bedrooms. Having definite ‘phone/devices free intervals’ where the phone is turned off or placed on silent. All meals should be phone free for example. All technology switched off in every household by 10. 30 pm – that includes everybody!! If exercising or reading or involved in any hobby – phone free applies. No phone based work activity at home!!!!!
Technology Protocol In relation to school and students: 1. Many schools are now moving to ban usage of phones during the day. 2. Some are using clear locker attachments to assist with this. 3. Regular conversations about ‘why’ constant over usage can be damaging to our physical and mental health. 4. Especially discuss the importance of how it can lead to sleep deprivation or damage other students mental health.
The Importance of Sleep All adults (us) need 8 hours sleep!!!!!!! Adolescents need 9 ½ hours sleep!!!! If they lack this they can struggle emotionally, physically and cognitively with serious physical consequences. Sleep is divided into alternating blocks of NREM and REM sleep cycles. The first 4 hours of sleep is mainly NREM and this is where the brain consolidates memory, removes toxic waste from the brain, and prunes the developing adolescent brain.
The Importance of Sleep If students lack NREM sleep they are going to struggle cognitively and find their normal pruning disturbed. The last 4 hours of sleep is mainly REM sleep. This is where we detach emotions from memories, creatively solve problems, integrate memories with past ones and clear memories of previous day. If students lack REM sleep they will become more anxious, depressed, irritable, impulsive, prone to self-harm and poorer at problem solving and cognitive functioning.
Students and Sleep 1. 2. 3. 4. Sleep is possibly the most hidden yet least understood and discussed threat to the mental health and wellbeing of our student population. The sleep cycle of average 13 – 19 year old is one to two hours later than adult cycle (so we cannot get them to go to bed at night and get them to rise in morning). Weekend sleep cycle disruption can be like flying to USA!! The risks to sleep from technology cannot be overstated.
The Importance of Sleep To avoid suffering sleep deprivation at both ends of the night. Some tips include: 1. Bed by 11 to 11. 30 if possible. 2. Rise at the same time every day. 3. 9 ½ hours sleep for adolescents is essential and the great healer. 4. No phones or devices in bedrooms. 5. Blackout blinds and well aired rooms. 6. Avoid coffee after midday (us).
Can schools be ‘leaders’ in improving focus on sleep? 1. 2. 3. 4. 5. Ideally schools would actually kick in later (after 10) but this is seen as impractical. Have constant discussions with students at every stage – especially exam classes – as to ‘why’ they should focus more on sleep. Encourage good sleep hygiene with parents and students. Ask parents/students to ban technology from rooms and switch off by 10. 30 pm at latest. Begin any discussions on mental health by focusing first on sleep!!!
Emotional Resilience This relates to our capacity to adapt emotionally to the challenges of life. In the past it was felt to be a fixed entity. This is no longer the case. All of us can learn key personal, social and life resilience skills. These skills reduce both stress and anxiety and also our risk of developing depression. It also make us better social networkers. .
Emotional Resilience There are 20 key skills: Social Skills – how to develop empathy, read non – verbal cues, the art of conversation, how to banish social anxiety and how to deal with performance anxiety such as presentations. Personal Skills – deal with flooding; perfectionism, catastrophising, failure, problem solve, procrastination, mindfulness, LFT and others. Life Skills – how to deal with conflict, deal with the unfairness of life, develop pragmatism and learn how to cope with stress and work/life balance.
Emotional Resilience and Students 1. 2. I believe that a combination of significant changes in the lifestyle patterns of many of our students as already discussed, combined with developing some ER skills would transform their mental health and wellbeing. Just as no student should leave school without a good grounding in the ‘activities of living’ I believe that no student should leave without many of these resilience skills.
Emotional Resilience Skills It would not be possible in this presentation to explore the 20 skills I feel are necessary to develop Emotional Resilience. Today therefore we are going to look at a ‘taster menu’ of useful and important ER skills for life. This is going to be a mainly interactive session. For this session – I am going to focus on the adults present – as if we do not learn how to apply these skills in our own lives – we have no chance of teaching them to students.
Empathy, involves learning how to sense where others are at from an emotional point of view. It is often called a ‘soft skill’. This is the skill which most allows us to smoothly navigate the social landscape of life. Increasingly we are realizing the importance of this and other soft skills. Let’s now see how empathy would work in practice by doing the following exercise.
Empathy Exercise For 1 minute turn to the person beside you and tell them how ‘you are really struggling to cope with the increasing demands of the workplace’. The person who are sharing the story with, has the task of appearing completely disinterested, even dismissive and quite cold during the conversation.
Empathy Exercise For the second minute I want you relay the same story. The person listening now has to play the role of being completely absorbed in your story, trying to see themselves in the distressing scenario that is being shared. They should also, through their non verbal cues and tone of voice, make you feel as if you are the most important person in the world!
Why is Empathy so important? Empathy is the door to the soul of another human being. Many assume that we either have it or lack it. In reality it is a skill we can all learn and practice it till it becomes automatic. Those who have developed the skill will be more at peace in their lives and much more effective at coping with life’s challenges. They will also find their social and personal relationships blossoming. .
Empathy Exercises 1. 2. Empathy Awareness Exercise – here we learn to become more aware of positive and negative empathy interactions between ourselves and others over a 4 – 6 week period. Empathy in Practice Exercise – here we learn to apply what we have learnt above to all social interactions over the next 4 – 6 weeks or so till it becomes automatic.
Flooding This is a skill that allows us to manage and banish the acute physical symptoms so prevalent in Panic Attacks and Phobias. It should be taught to all young people in late primary and secondary school but all of us should be aware of it. All of these symptoms are created by a simple burst of Adrenaline, triggered by our amygdala(aka Gunslinger). The Leopard! These symptoms are therefore ‘uncomfortable but not dangerous’!
Flooding This is a simple technique where we allow the uncomfortable physical symptoms of acute anxiety to flow over us. We embrace the symptoms which in the case of a Panic attack will last 5 to 8 minutes, without trying to stop them by any other behaviour such as leaving the area, breathing exercises, going to A/E, tranquillizers etc.
Flooding The secret here is that the Gunslinger senses you no longer assigning a danger to the physical symptoms but are going with them and turns down or off. But also at that moment resets its memory banks so fires less on next occasion. And with repeated Flooding applications switches off for good. You have tamed your Gunslinger!!
Uncertainty One of the commonest causes of stress and anxiety in highly driven work teams is learning how to deal with the uncertainty of life. This is because we are demanding that we have absolute control of all aspects of life – especially at work. This leads us to demand 100% certainty in relation to both our everyday lives and at work. If we cannot achieve this demand, we rate ourselves as failures and become anxious and stressed.
The Coin Exercise To teach us to deal with uncertainty try the following coin exercise for 4 weeks: 1. I want you to list off all the activities you like to do during an average day and week. 2. Good examples might be TV or Netflix, Walking, Reading, Cooking, Shopping, Going out for Meals with Partner, Yoga, Social Media – you must honestly write down what would work for you. 3. You have 1 minute to put them down!
The Coin Exercise Now for the wicked part! 1. You have to acquire a coin. 2. For the next 4 weeks, every time you want to watch every episode of a series, or any sport event or anything on TV/Netflix you want to see, you have to toss the coin. Heads you can watch it. Tails and you miss it and cannot watch it on repeat. 3. Every time you want to walk – heads you can walk at a normal pace, tails at a snails pace.
The Coin Exercise 1. 2. 3. 4. Every time you want to go out with your partner for a meal – you both get ready. Then toss the coin. Heads you can go. Tails and you miss it. The key is ‘how did you adapt’. Every time you want to take a glass of wine or beer with a meal. Heads you can. Tails and it is water. With shopping and you find something you fancy. Heads you can take it. Tails and you miss it. And so on with the list you created!!
The Coin Exercise What this exercise teaches us is that life is a little like the toss of a coin. There is always going to a % chance that it will go your way. Equally there is a % chance that it will go against you. The secret is learning how to adapt! If you haven’t got the message after 4 weeks – I suggest a second 4 weeks should do the trick!!!
Priority List Exercise I am going to list off some different aspects of your lives and I want you enumerate them in order of priority in your life at this moment. One being the most important and six the least. You have 1 minute. social media/hobbies work children wider family relationship self
A Typical ‘Unhealthy List’ An unhealthy list would look like this: 1. 2. 3. 4. 5. 6. Work. Children. Extended family – parents and siblings. Relationship. The Rest (social media, hobbies) Self!!!
A healthy priority list should look like this: 1. 2. 3. 4. 5. 6. Self. Relationship. Children. Wider family. Work. The rest (hobbies, social media etc).
The importance of self and relationship The most important priority is to look after your personal physical and mental health. Many consider this to be a selfish concept but in real life it is quite the opposite. We are of little use to ourselves or others if we do not get these basic priorities correct!!! Following this we must protect and nourish our personal relationships if relevant. These form the foundations of a healthy W/L balance.
The Priority List Exercise For the next 3 months I suggest that you and your partner on a weekly basis review your priority list. If it is unhealthy, then decide what changes you need to introduce into your life for the following week. You will notice how less stressed you begin to feel when your list is healthy. And how stressed you become if it becomes persistently unhealthy. One road leads to mental distress, the other to mental health. You choose!!
Unconditional Self - Acceptance The most important emotional resilience skill in life especially in the workplace and the one that best counteracts stress, anxiety and even depression is to develop unconditional self – acceptance. This brings us to explore the world of self – rating. Let’s firstly perform the following exercises.
The Rating Scale! 1. 2. 3. Mark down on this scale where you rate yourself as a person between 1 and 100 (1 = awful and 100 = amazing)! Then mark down where other people rate you as a person! I am then going to ask you to visualize that you are informed that you have made a major mistake at work or have lost a valuable customer. Or informed that you are a poor parent! Or diagnosed with Depression and put on medication! Now re - mark on your scale how you would rate yourself and how others would rate you if any of the above happened in real life!
The Rating Scale! Now consider: How many changed their rating depending on the question asked? On what grounds did you rate yourself as a person? On what grounds did you allow others to rate you? Can you rate a human being at all? No! What is the measuring tool? None!
Unconditional Self Acceptance The most effective technique to become ‘comfortable in our own skins’ is to develop Unconditional Self-Acceptance. This is where we: Learn to accept ourselves, without conditions, for the special unique human beings that we are, but feel free to rate or measure our behaviour, which includes our skills and talents. Unconditional Self-Acceptance was created by the father of CBT Albert Ellis.
Unconditional Self Acceptance What this means in practice is: 1. 2. 3. I am not allowed to rate, or judge myself as a person. I am not allowed to accept other people’s rating, or judgement of me as a person. I am allowed to rate or judge my behaviour and skills but not myself as a human being.
Our PC The enemy of unconditional self – acceptance is the ‘pathological critic’ which is embedded in our emotional mind. When negative as in anxiety and depression, our PC (who is vague, a bully and talks rubbish) can be nasty – convincing us as individuals what it says is true. It suggests we are useless, weak, a failure, boring, worthless or simply abnormal!!!! All of which are a form of rating!!
How to develop Unconditional Self - Acceptance Over a 3 month period carry a notebook. If you find yourself rating or struggling with failure/perfectionism, write down the trigger and the rating. Then challenge on paper your PC. ‘Am I a weak person’ or ‘am I weak at a particular skill or behaviour’? ‘Am I a useless person’ or ‘just useless at a skill or behaviour’ which I can then work on to improve?
The 3 Minute Mindfulness Exercise We are going to finish with the following simple 3 Minute Mindfulness Exercise. I want you to fully relax in your chair. Then close your eyes and I am going to ask you to focus your mind for a minute each on your thoughts, breath and limbs as I instruct you to.
The 3 Minute Mindfulness Exercise Minute One – focus your mind on the thoughts going on in your head. Do not try and change them – just observe them. Minute Two – focus your mind on the simple physical sensation of your breathing. Again do not try and control it. Minute Three – focus your mind for 15 seconds on becoming aware of each of your 4 limbs – right arm, right leg, left arm and left leg.
Emotional Resilience Skills These are just a sample of the skills we all need to survive in life. The coin exercise deals with anxiety. The unconditional self-acceptance exercise assists with depression, anxiety, coping with failure, deal with perfectionism etc. Flooding assists young people how to deal with the physical symptoms of panic and anxiety. This allows them to deal with panic attacks and phobias.
Emotional Resilience Skills We will be doing a Q/A following this presentation. If anyone wishes to ask questions about any of these skills - ask away. Schools might find it useful to download the audiobook of ER skills and discuss some of these skills in small student groups. I would recommend using my website drharrybarry. com for videos and books to assist in this process.
Coming Soon EMOTIONAL HEALING April 23 rd 2020
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