Mar 292020
 

The coronavirus outbreak arose in late 2019 in China and spread in 2020. Spreading faster than the virus has been anxiety, panic, and fear-based responses. Consequently, every day sees a new rule or change in policy, even when such an immediate reaction is not warranted. Fear is an evolved emotional response occurring when threat or danger is perceived, motivating adaptive responses. Human intelligence has intensified threat and danger related thoughts, amplifying the emotional responses. Worsening the situation is contagion, and I am not referring to biological spread of the virus. If we see another person reacting with fear it triggers a feeling of fear: there must be a threat because that person is reacting with fear. Our social evolution has left us vulnerable to contagion.

To this point in time, fear and its amplification—anxiety—appears to have taken a greater toll on people overall than has the virus. As a psychiatrist, I have noted intense anxiety not only in patients but those I know and observe outside of my practice. Many people fully retreat avoiding walking in areas largely devoid of people, further enhancing the perception of threat and danger. Undoubtedly, lower mood and even depression is on the rise related to the extreme isolation and anxiety. Hence, the mental health impact due to the spread of fear and anxiety has outstripped the impact of the virus! Now some might respond that the virus is killing people. Yes, but what the early peer-reviewed evidence indicates is that most of these people are elderly with significant medical illness, a segment of the population that is highly vulnerable to severe outcomes from upper respiratory tract infections. My mother contracted such an illness while in a nursing home and passed away from it, although the underlying medical illnesses were really what took her. These unfortunate individuals are always vulnerable to upper respiratory illnesses such as from viruses and bacteria.

A horrible consequence of this excessive anxiety and even panic response, whipped up by traditional and social media, is that rational thought processes, planning, and responses are sacrificed. In crisis circumstances, it is prudent to take a look at the relevant pluses and minuses, and act accordingly. Covid 19 to date primarily takes the elderly and ill; it is not equivalent to the swine flu of 1918 that was killing young and healthy individuals, nor is it turning people into zombies. Given this apparent reality, a logical reasoned course would have been to protect those vulnerable from the outset, such as screening anyone who has contact with a physically vulnerable person, and ensuring that only screened individuals interact with them. Instead the response has generally been irrational and fear-based, such as focusing on extensive isolation of those not that vulnerable to serious outcomes, with day-to-day changes in policies and rules as opposed to a few days to a week to adapt. This reactionary process only serves to ramp up fear, and lacks sense. For example, blanket one size fits all approaches such as treating flights from all destinations, even those with no reported cases, as a major threat while ignoring train and bus travel. Also, discouraging people to get out and walk in areas that are not congested, although few areas are crowded nowadays. Walking and maintaining a reasonable distance from others has an extremely low chance of spreading the virus, and the vast majority of those able to walk are not that vulnerable to serious consequences. With the mental health benefits of walking, being active, and seeing others enjoying this experience anxiety is countered. In other words, the minuses are low and the pluses high.

My suggestion as a psychiatrist, and also someone who has engaged in adventure activities such as backcountry skiing and scuba diving, is to resist the temptation to react with anxiety and panic. Counter the negative threat and danger perceptions, and weigh in the pluses and minuses of different courses of action. Also, appreciate the contagion impact, and realize that just because someone is reacting with fear and/or panic it does not mean there is a threat. Maybe in our ancestral hunting-gathering group history a fear response indicated a predator, but not now. Applying humor which is a mature defense consisting of placing a lighter spin on things can be a major asset in these heavy times. A humorous anecdote comes from a person I know who works in a newsroom, where a sign indicates, “Report every story as if it’s World War III.” The newsroom staff are getting so sick and tired of having to report the WWIII coronavirus narrative that they are hoping for a murder, stabbing, or cat stuck in a tree, just for a break from the repetition! An additional and easy way to counter the escalating fear and even panic, is to absorb yourself in a positive focus as the absorption helps negativity recede. Who knows, when online video watching is exhausted maybe picking up a book and reading. Also, resist media exposure as it is designed to ramp up fear responses!

Feb 152020
 

Mental illness accounts for approximately half of all illnesses, but receives a fraction of the funding that physical illness does. In addition, treatment options are limited in their effectiveness and mental health in the general population is not ideal. Hence, there is a great need for beneficial and cost-effective interventions, with the situation dire in third world countries and even first world countries with unevenly spread mental health resources. But what might qualify as an option?

The answer is activity, particularly appealing given how natural and positive it is! In the realm of physical health physical activity is well established, but the notion of activity for mental health is still lacking. Interestingly, activity plays a much greater role in mental health than physical health, due to how for the latter it is really all about physical activity, while for mental health diverse types of activity play a role. As a psychiatrist treating a wide-range of conditions, I have seen first-hand the benefit of activity and routinely apply it to clients. Furthermore, I practice behavioral activation treatment (BAT), an intervention that is at least as effective as medication for severe depression. Furthermore, in my own life I have been highly active noting the benefits for mental health. This background and experience led me to research the spectrum of activity to reveal the evidence and uncover the reasons for why activity is so beneficial.

The resulting book, Activity For Mental Health(Academic Press) explores activity in general, and specific forms of activity—physical, social, nature, cognitive, art/hobby, and music. Two key reasons for why activity in general characterizes mental health are requirements derived from human evolution and the value of absorption in positivity. In contrast to our tree-dwelling higher primate relatives, humans had to be active walking about in search of food, water, safe resting sites, and other valuable resources. Consider our two-legged (bipedal) form of motion and how difficult this would be for chimpanzees, orangutans, and gorillas. These primates actually do quite fine in limited spaces, without the physical and mental costs that humans incur. In other words, we evolved to be active and this is expressed in the requirements for health. Regarding a positive focus, negative distractions are ever present and weigh us down psychologically. Absorbing oneself in a positive focus, such as that inherent in activity, removes a person from negativity fostering positive mental health. Absorption in positive foci represents a form of adaptive dissociation.

Beyond activity in general benefiting mental health, physical, social, nature, cognitive, art/hobby, and music activity each have an impact. In this day and age of “evidence-based” interventions, it is important to establish whether or not and to what extent the various forms of activity both treat mental illness and advance mental health in the general population. On a 1-5 scale with 1 the highest level, the evidence does not fall below 3 and is typically in the 1-2 range. The impact and reasons for why each form of activity is beneficial for mental health in brief consists of:

PHYSICAL HEALTH:

Various forms of research conclusively demonstrate that physical activity advances mental health. Improved physical self-perspectives and associated changes in self-concept appear to play a significant role in the psychological benefit. At a biological level, physical activity does appear to increase blood flow to the brain and neurogenesis meaning the growth and survival of neurons.

SOCIAL ACTIVITY:

Humans evolved in hunting-gathering groups instilling a social brain, in contrast to tigers for instance that are quite fine on their own. We require social contact and in a world that is becoming more and more socially fragmented, isolation and loneliness contribute to mental illness. It turns out that the impact is greater for loneliness than isolation per se. With social and emotional support, mental health is advanced.

NATURE ACTIVITY:

Given the beauty and serenity of natural settings it “naturally” follows that nature is beneficial for mental health, but certain safety related issues actually influence this outcome. The evidence is strong that nature activity can enhance mental health, even though the role of physical and social activity in nature has to be teased out. Regarding why nature activity seems to work, it induces relaxation responses thereby reducing stress responses. Several very interesting features of natural settings seem to align with how the brain is structured to achieve this outcome.

COGNITIVE ACTIVITY:

Although it would seem that mental activity enhances mental health in terms of mood and the like, very little research focuses on this, with the vast majority addressing the impact of cognitive activity on cognitive functioning, such as with dementia. The intriguing role of so-called negative symptoms is explored revealing the powerful impact on mental health and illness. One outcome that appears clear is cognitive activity predicting cognitive health and not the reverse. Pertaining to mental illness such as dementia the benefit is greatest in the early phases.

ART/HOBBY ACTIVITY:

I note that few people have a real hobby while many can benefit from acquiring one. Research backs up this perspective demonstrating how such activity both treats mental illness and advances mental health in the general population. This outcome arises from diverse studies conducted in many regions of the world. Several psychological benefits including empowerment and motivation flow from art/hobby activity.

MUSIC ACTIVITY:

This form of activity might seem to fit into the art/hobby category, but it is very distinct. The history of music and mental health is entertaining with the good, bad, and ugly all well represented. Ultimately, it appears all good based on how music activity resonates with emotions due to amazing similarities. In addition, music appears to activate and stimulate many brain regions. The evidence for music activity enhancing mental health is very strong, and it appears to have a profoundly positive impact on elderly people.

Consistent with my clinical work, I cover how behavioral activation treatment works to reveal the power of behavioral activation. However, the focus is on informal activity to treat mental illness and improve mental health in the general population. Activity including the specific forms of physical, social, nature, cognitive, art/hobby, and music, represents a robust, cost-effective, and easily accessible mental health intervention. Treat yourself to activity therapy in the ways discussed, and expand the degree of involvement and diversity of options to the benefit of your mental health.

See the Books section of this website for more information and links to sellers.