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Mental Health Promotion: A Practical Approach Nimi Singh, MD, MPH Division of Adolescent Health and Medicine Department of Pediatrics University of Minnesota,

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Presentation on theme: "Mental Health Promotion: A Practical Approach Nimi Singh, MD, MPH Division of Adolescent Health and Medicine Department of Pediatrics University of Minnesota,"— Presentation transcript:

1 Mental Health Promotion: A Practical Approach Nimi Singh, MD, MPH Division of Adolescent Health and Medicine Department of Pediatrics University of Minnesota, Minneapolis

2 Overview n Current standard of care n Role of stress physiology –Effects of stress on cognition and mood –Alternative definition of mood disorders n Homeostasis (psychological resilience) n Shutting of the stress response –Sleep, nutrition, physical activity, recreation –Stress reduction strategies

3 Epidemiology of mental health needs in children and adolescents n Mild to moderate depression –Prevalence: one in five –age of onset is decreasing –Estimated that about 80% of adolescents with “depression” really have what can better be termed an “adjustment disorder” –Current Treatment: medication plus/ minus psychotherapy n Untreated major depressive disorder in adolescents –Lasts 7-9 months –Recurrence: 40% within 2 yrs, 70% within 5 yrs (Beasley et al., Adol. Med., 1998:18)

4 Treatment: Pharmacotherapy vs. Psychotherapy? n JAMA Aug. 18, 2004- Vol. 292, No. 7 (807-820): –Treatment for Adolescents with Depression Study (TADS): n Randomized placebo-controlled 12-week trial n N= 436 (Major Depressive Disorder) n CBT + Fluoxetine vs. Fluoxetine vs. CBT vs. placebo n Response: 71% vs. 60.6% vs. 43.2% vs. 34.8% n 1.6% attempted suicide (no completed suicides) n CBT was the most protective against this (not statistically significant, possibly due to small number of subjects)

5 Treatment: Pharmacotherapy n NEJM Jan. 17, 2008- Vol. 358, No. 3 (252-260): –Selection bias in RTC’s of SSRI’s: n Meta-analysis, 74 RTC’s, 12 antidepressants n 12,500 patients (1987- 2004) n Of 38 positive studies, all but one was published n Of 36 the FDA considered negative or equivocal –22 were not published –11 were published with positive conclusions THEREFORE: n 48/ 51 appeared to be positive, but…. only 38/ 74 actually produced positive results n Need effective non-pharmacological approaches to optimizing mental health and supporting recovery

6 Psychological Stress 101: n Evolutionarily advantageous: –Example of caveperson and saber-tooth tiger –Blood get shunted to organs critical for survival (heart, lungs, muscles, brainstem) – Blood gets shunted away from organs NOT critical for survival (GI track, reproductive track, immune system, prefrontal cortex) –Allows for “fight, flight or freeze” response n Gets triggered equally by EXTERNAL as well as INTERNAL events (i.e. negative thoughts) n Not all events are true threats to survival (but our body doesn’t know this!)

7 Psychological Stress Response: (continued) n Increased arousal, alertness, vigilance –Over-interpretation of stimuli as potential threat to survival –Maximizes ability to stay alive in life-threatening circumstances –Chronic: cycle of negative emotions and distorted perception n Inhibition of higher (cortical) mental activity – Mind goes “blank” (thinking is reflexive, not reflective) –Unable to take in and process new information as easily (car keys) n Chronic repetitive negative thoughts can become: –Anxiety disorders (worries about the future) –Depressive disorders (anger, sadness, regrets about the past) –PTSD n Harmful/ addictive behaviors: an attempt to “quiet the mind” –Drug and alcohol use –Cutting behavior

8 Definitions of psychological functioning: n Mental/ psychological distress: –Temporary loss of the ability to self-right psychologically –the “stress” response keeps getting triggered –Produces distorted thinking (moods, behavior): everything is perceived as a potential threat to survival –Distorted thinking, in turn, re-triggers the stress response n Mental health: –The ability of the mind to self-right (innate) –A state of psychological well-being and security –Ability to access common sense, wisdom, creative problem-solving, etc.. –related to being in a state of “non-stress” or “alert but relaxed” –Ability to let go of negative thought and return to “present moment” thinking

9 HOMEOSTASIS The ability of the body (and mind) to balance and heal itself

10 Psychological Homeostasis n The mind’s ability to SELF-RIGHT (innate) n Allows access to higher cognitive functioning (pre-frontal cortex) n During a stress response, blood is shunted from this region to the brainstem in order to facilitate the “fight, flight or freeze” response n Most of the time, we’re able to return to non-stress-based thinking, but sometimes we get stuck n In order to facilitate the mind’s ability to self-right, therefore… …we needs to support our body’s ability to shut off the STRESS response …we needs to support our body’s ability to shut off the STRESS response

11 Optimizing Homeostasis n Stress Management techniques –CRITICAL first steps: n Good sleep hygiene n Optimal nutrition n Physical activity n Recreational activities –Self-regulatory techniques ( biofeedback, self-hypnosis) –Body movement therapies (Yoga, Tai chi, Qi gong) n Cognitive/ Behavioral: –Traditional cognitive behavioral therapies – Mindfulness-based Stress Reduction (Jon Kabat-Zinn, Ph.D) –Health Realization (focus on innate capacity to self-right)

12 Health Realization n Healthy psychological functioning –What it looks like –What gets in the way n What you can do about it –Notice poor psychological functioning in others and in self –Shift to a higher state of functioning

13 Health Realization n WE are the creators of our own thought n The quality of our thinking (positive vs. negative) creates our perception of reality in the moment n Negative thoughts distorts our perceptions, and yield unreliable/ inaccurate information n We can notice and disengage from negative thought n Result: Shuts of stress response, clears the mind n What bubbles up in its place is ALWAYS of a higher quality ( “wisdom”, “common sense”, “higher cognitive functioning”) ( “wisdom”, “common sense”, “higher cognitive functioning”)

14 HEALTH REALIZATION n How does this work in day-to-day life?!!! n CONCEPTS: –Thoughts –Moods –Separate realities –Levels of Understanding

15 THOUGHTS n Come and go n Can’t control which thoughts come in n Can choose which thoughts one chooses to give life to, and which to let go of n Quieting/ slowing down one’s thoughts allows us to access our INNATE WISDOM –Everyone has it ( …psychological homeostasis!) –It is never damaged by life experiences –Gets clouded over by negative thinking n Recognize yourself as the “thinker” of your thoughts and that thoughts aren’t facts (movie analogy)

16 Two modes of thought (adapted from Glenwood-Lyndale Health Realization Training Center 1999, Cindi Claypatch, (612) 823-823-5973 ) n Conditioned (left brain) Type: “Computer mode”: Accesses stored info. ComparisonComputation Good for finite variables State of mind: BusyMechanical n Original/Open (right brain) Type: “Receiver” mode: Accesses one’s own wisdom/common sense Creativity/Insight Good for relationships State of mind: Calm Peaceful

17 Two modes of thought (cont.) n We get into trouble when we use “conditioned” thought when we should be using “open” thought: –Human-human interactions: n Trying to break an old “habit” of interaction with someone n Trying to understand a new/ different point of view (we keep reverting back to “what we already know” which becomes a block to understanding) –Trying to solve a problem under new circumstances

18 MOODS n Come and go n Are neutral (high/low vs. good/bad) n Can affect quality of thinking n Are internal n May be created by the quality of one’s thoughts (internal) n May also be affected external factors: –Tiredness –Illness –Weather –Stressful life-event –Food –Chemicals

19 Thoughts and Moods (adapted from Glenwood-Lyndale Health Realization Training Center 1999, Cindi Claypatch, (612) 823-823-5973 ) THOUGHTS : → HIGH perspective SecureLight-hearted In the moment EffortlessExploratory LOW perspective InsecureSerious/personalForeverHardFear-based EMOTIONS: HIGH mood Flexible Involved Responsive Positive outlook Creates sense of security in others LOW mood Controlling/rigid Distorted Reactive False sense of urgency

20 GUIDELINES around MOODS n When in a low mood: –Develop a way to recognize this in yourself –Suspend major decisions –Don’t always trust your own thinking –Be careful about taking yourself/others seriously –Be cautious of verbal/ behavioral interactions –Don’t commiserate (moods can be infectious!) –Let others know what you need –Slow down your thinking (drop, distract, dismiss, ignore) –Pamper yourself –Give yourself a “time-out”

21 GUIDELINES around MOODS (cont.) n Assess mood level of self and others n Recognize role of thought n Remember: YOU create/ sustain moods (inside-out process) n Be easy on yourself and others n “SEE THE INNOCENCE”

22 SEPARATE REALITIES Every individual has a separate view of life given : –their moment-to-moment ability to create thought –the quality of their state of mind in the given moment

23 Separate Realities (cont): n Thoughts, along with our past experience, shape our sense of “reality” n Moment to moment, our view of reality changes, depending on our emotional state n The “lower” our mood, the more attached we are to our view of reality n The “higher” our mood, the more comfort and tolerance we experience with respect to different realities

24 Separate Realities (cont): n People are INNOCENTLY creating their reality all the time (unaware how mood is affecting thinking) n Whatever thoughts are in our minds IS what creates our experience/ view of reality n If we’re not in present-moment thinking, our perception is distorted

25 Health Realization in Action (when interacting with others) “Parenting from the Heart” Jack Pransky, Ph.D n See your [children] as having health, wisdom and common sense within them n “Problem behavior”: a result of insecure thinking

26 Communication Skills (cont.): n Notice your own mood (insecure vs. secure) n Quiet your own thinking and observe n Listen for understanding

27 Communication Skills (cont.): n Feeling of warmth/safety→ Helps the other feel more secure→ Raises the quality of their thinking n Postpone acting/decision-making when not coming from a place of calm/security

28 Resources n Internet search terms: –Health Realization –Psychology of Mind n Books: –“Parenting from the Heart” Jack Pransky, Ph.D –“ You can be happy no matter what” Richard Carlson, Ph.D –“Slowing down to the speed of life” Joe Bailey, Ph.D –“Mental health naturally” Kathi Kemper, MD –Henry Emmons, MD n “Chemistry of Joy/ Chemistry of Joy workbook” n “Chemistry of Calm”

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