Dr Caroline Bell Canterbury District Health Board Department of Psychological Medicine University of Otago, Christchurch

 Where are we now ?  What is Well being ?  Can we improve it ?

SECONDARY STRESSORS  Insurance, financial, delays ……  Family load disrupted routines, sleep, kids, elderly, friends leaving  Community load changes to city, roads, people left, landscape  Social load no CBD, fewer movies, restaurants, activities  Workplace load  Relocation, shared spaces  Organisational and physical uncertainty, financial  Its not business as usual but demands for business as usual

 CERA  All right campaign  CDHB  Wide spectrum of response

COMMON PERSISTING THEMES  Fatigue / exhaustion  Feeling despondent / overwhelmed  Loss of control  Feelings of anger and frustration – lowered tolerance  Poor concentration  Absenteeism / presenteeism  Interpersonal / relationship issues  Substance abuse

PTSD Perception death - marked hyperarousal Rescue workers - PTSD Previous PTSD Depression Anxiety disorders Substance abuse Relationship problems

 High exposure  Life stressors  Financial, homes, businesses, relocation  Limited social supports  Previous mental health difficulties  High risk professions  New group - any of us

NEED TO IDENTIFY PEOPLE NEED FURTHER HELP?  Persistent low mood, loss of hope, suicidal  Persistent rumination or memories  High levels anxiety/hyperarousal  High levels distress  Avoidance/withdrawal  Risk taking  Aggression/ relationship problems  Alcohol or drug abuse

WELLBEING  Not just happiness  Life satisfaction and +ve emotions  Flourishing  Positive emotions  Engagement – flow  Relationships  Meaning and purpose  Accomplishment

WHY IS WELLBEING IMPORTANT  Physical health  Mental health  Relationships  Workplace satisfaction  Community cohesiveness

NEUROBIOLOGY

 Increased activation of the amygdala  Focus threat  Prepares fight/flight  Less interest in non-essential activities  Reduced activation of frontal brain regions

NEUROBIOLOGICAL MODEL 14 Overactive amygdala Impaired vmPFC inhibition onto amygdala networks

 Increased activation of the amygdala  Increased vigilance  Less interest in non-essential activities  Reduced activation of frontal brain regions  Planning, complex thinking  Increased glucocorticoid  Earthquake brain, Bush fire brain, Flood brain

LIFE BECOMES NARROWER  Head down, blinkered approach  Focus on stress - trying to deal with things can’t control  Reduction innovative strategic thinking  Things add value dropped off

THIS WILL LEAD TO…  Reduced wellbeing  Health  Relationships  Social  Career

WHAT WILL HELP  Dealing with real practical problems – zoning, insurance, financial  Well being  Active not passive process

WELLBEING – CAN YOU CHANGE IT  Genes  Circumstances  Intentional activity

WELLBEING  Nurture social relationships  Increase flow activities / learning  Look at what is important to you  Optimism, positive emotions  Tolerance and gratitude  Avoid overthinking, flexible approach

What enhances well being  Exercise  Learning  Mindfulness  Yoga  Gratitude  Reduce amygdala activity  Increase frontal cortical activity

NEUROBIOLOGICAL MODEL 22 Increase vmPFC inhibition onto overactive amygdala networks

REALLY WHAT CAN WE DO  1. TAKE TIME  Fast not necessarily best  Often need to build new foundation life  Time  Space  Energy

REALLY WHAT CAN WE DO  2. ASSESS OUR ENERGY LEVELS  Focus on problems causing the stress  Keep on going  Stop listening to our needs (body, relationships, social)  Keep listening needs  Recharging – brief and often

REALLY WHAT CAN WE DO  3. FOCUS ON WHAT WE CAN CONTROL  Stress result circumstance and attitude  Circumstances  Lots out of our control  When stressed focus on most intensive problems  Attitude  What can do, have achieved, will do  Sleep, relationships, sport, music

REALLY WHAT CAN WE DO  4. WHAT AM I NOT DOING NOW  Stress demands constant focus  Drop out things feel not add value to this  But these are exactly things that add value to our lives  Time reflect  Doing things with friends  Doing things give you enjoyment  Can’t wait and put on hold til all over

REALLY WHAT CAN WE DO  5. BUILD BACK ROUTINES  Routines free us up, familiarity, security  Give us time  Dropped out of routines or things different  Put new routines back

WHAT’S IMPORTANT TO KNOW IS…  Can learn from this what is really important  Should celebrate what we have achieved  We can do something about how we are feeling and our wellbeing  But……….

WHAT’S IMPORTANT TO KNOW IS…  This is new and hard  We HAVE TO look after our wellbeing THIS IS IN OUR CONTROL AND ITS TOO IMPORTANT TO LOSE