Physical & Mental Health

Health and Wellbeing program – grounded in a self-efficacy:

Michael Pudaloff – 27th May 2018

Background

“By 2020-21, there will be increased access to psychological therapies, so that at least 25% of people (or 1.5 million) with common mental health conditions access services each year”….. The increase in access to psychological therapies will be targeted. Two-thirds of the additional people receiving services will have co-morbid; physical and mental health conditions or persistent medically unexplained symptoms.” NHS Five Year Forward View for  Mental Health – March 2017 and 30% of the UK population accounts for 70% of the total spend of the NHS (Royal College of General Practitioners, 2013)

Self-efficacy:  The underlying premise of this presentation is; a significant number of the 30% of the population who account for 70% of the total spend of the NHS could, by engaging in an extended program of supported self-efficacy, take greater ownership of their health. In doing so, they could increase their sense of personal well-being and likely enjoy enhanced life chances. In addition to a potential reduction in demand for NHS services.

Bandura’s (1977) theory of self-efficacy focused upon the interplay between two types of expectancies. He proposed self-efficacy involves being confident that one can perform the requisite behaviour (efficacy expectation) and that action will produce the desired outcome (outcome expectation).

Helplessness

Self-efficacy requires having the self-confidence to believe one can perform the requisite behaviour (efficacy expectation) and that action will produce the desired outcome (outcome expectation). However, self-confidence among those living for extended periods with co-morbid physical and mental health conditions or persistent medically unexplained symptoms is likely to be generally low, an in some instances bordering upon a sense of helplessness.

Martin E.P. Seligman, the US psychologist’s theory of learned helplessness has become a basic principle of behavioural theory, that seeks to explain why individuals may accept and remain passive in negative situations despite their clear ability to change them. In his book Helplessness (1975), Seligman argued that, as a result of negative expectations, other consequences may accompany; the inability or unwillingness to act, including low self-esteem, chronic failure, sadness, and physical illness.

Learned Optimism and Positive Psychology

Ten years into his work on learned helplessness, Seligman changed his mind about what was going on in his team’s experiments:

“Not all the rats and dogs after inescapable shock became helpless, nor do all people after being presented with unsolvable problems or inescapable noise. One out of three never gives up, no matter what we do. Moreover, one out of eight is helpless to begin with” Seligman – Authentic Happiness (2017).

Observations that became the foundation of Seligman’s later work, in particular, the conceptualisation and development of Learned Optimism and Positive Psychology in co-operation with his colleague Proof Mike Csikszentmihalyi. Martin Seligman wrote in 2008:

“I propose that the field of positive health has direct parallels to the field of positive psychology, parallels that suggest that a focus on health rather than illness will be cost saving and life saving. Finally, I suggest a different mode of science, the Copenhagen-Medici model, used to found positive psychology, as an appropriate way of beginning the flagship explorations for positive health.” Martin Seligman (2008), Positive Health, International Association of Applied Psychology.

Positive Health Psychology

Positive psychology is evidence-based and concerned with wellbeing. As Martin Seligman remarked: “ In practice, subjective well-being is a more scientific-sounding term for what people usually mean by happiness.” Seligman considers the five elements of the acronym PERMA contribute to supporting wellbeing:

• Positive Emotions         P
• Engagement                   E
• Relationships                 R
• Meaning                         M
• Accomplishments         A

Positive emotions:

Positive emotions can be about the past, present or future. Positive emotions about the future include optimism, hope, faith and trust. Those about the present include joy, ecstasy, calm, zest, ebullience, pleasure and (most importantly) flow: these emotions are what most people usually mean when they casually – but narrowly – talk about “happiness,” The positive emotions of the past include satisfaction, contentment, fulfilment, pride and serenity.” Seligman (2017).

Engagement:

Is important to our wellbeing and happiness. Engagement in this context relates to activities that give us ‘gratification’, a sense of fulfilment and enjoyment. Activities so absorbing we forget the passing of time. Diverse activities that might include; restoring a car, reading a good book, art making or running a half marathon, activities, that engage our social and emotional intelligence. Activities requiring our perseverance and stimulate our need to be creative.

Relationships:

“Numerous studies support the conclusion that social relationships are essential to wellbeing. In our study of very happy people, we found that every single respondent in our happiest group had excellent social relationships.” Diener & Seligman, (2002). Park, Peterson, and Seligman (2003) found that of 24 character strengths, those that best predict life satisfaction are the interpersonal ones.

Most importantly: Stable companionship within or outside of marriage appears to be central to wellbeing.

Meaning (Flow):

 A state of absorption experienced by an individual in a work or leisure activity and is characterised by a sense of intense concentration and a loss of self-awareness. A feeling of being perfectly challenged, neither bored or overwhelmed by the difficulty of the task and a sense that time is flying. The Flow is a fundamentally rewarding creative experience that improves life skills and wellbeing.

“Creating meaning involves bringing order to the contents of the mind by integrating one’s actions into a unified flow experience.” Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial.

Accomplishment (achievement):

The final element in the acronym and is principally a mark of self-recognition of achievement, mastery or competence that contributes to personal well-being. To be valued, accomplishment should not be easy for the individual to achieve (otherwise it would not really be an accomplishment).

The five elements of PERMA is not arranged hierarchically. Alternately they combine in various proportions to form a restorative that can lead to positive outcomes associated with wellbeing and happiness.

Overcoming Pessimism – Learned Optimism:

 Optimism is a mental and emotional state that can be trained and cultivated; according to Martin Seligman in his 1990 book Learned Optimism. He claimed; optimists enjoy better overall health and are less likely to suffer from depression in comparison with pessimists. Seligman invites pessimists to learn to be optimists by reviewing and monitoring their reactions to adversity in a new way.

Martin Seligman emphasised in his book Authentic Happiness (2017), the key to overcoming pessimistic thoughts; is to recognise them and to treat those thoughts as though; they were uttered by an imaginary rival whose mission in life is to make you miserable.

Learned Optimism and ABCD model: 

Martin Seligman emphasised in his book Authentic Happiness (2017), that once a pessimistic thought is recognised by an individual, they should argue against it using an ABCDE model. (A) stands for adversity, (B) for the belief(s) the individual automatically would have in respect to the specific adversity, (C) for the usual consequences of the belief(s), (D) for the individual’s disputation of their routine belief(s) and (E) for the energisation that occurs when the individual disputes the routine belief successfully. By effectively disputing beliefs that follow an adversity, the individual can change their reaction to adversity from dejection to good cheer.

Mindfulness: 

Mindfulness: There is synergy and overlap between positive psychology and mindfulness. Both claim to be evidence-based and dedicated to the promotion of wellbeing and happiness, the reduction of stress, anxiety and increased optimism. Mindfulness clinical interventions, cited by Siegel (2014),:

• Mindfulness-Based Cognitive Therapy (MBCT) – Segal, Teasdale, Williams
• Mindfulness-Based Cognitive Therapy (MBCT) – Segal, Teasdale, Williams
• Dialectic Behaviour Therapy (DBT) – Linehan
• Acceptance & Commitment Therapy (ACT) – Hayes, Stroshal, Wilson

Mindfulness in the present context incorporates elements of Buddhist philosophy and practices. A ‘scientised’ and secularised version stripped of the supernatural aspects of Buddhism, some might say to the detriment; – perhaps we all need something to believe in.

“Mindfulness—awareness of present experience with acceptance—is a deceptively simple way of relating to the contents of our minds that has been successfully practised to alleviate psychological suffering and enhance emotional well-being for over 2,500 years. Cutting-edge scientific research and rapidly accumulating clinical experience are now validating what ancient wisdom traditions have long taught: that mindfulness practice is an effective antidote to our hardwired propensity for psychological distress and is a reliable pathway to increased wisdom, compassion, and fulfilment.” Dr Ronald D. Siegel is now a part-time Assistant Clinical Professor of Psychology at Harvard Medical School/Cambridge Health.

Basic skills of Mindfulness: Focused Attention – Open monitoring – Acceptance and Loving Kindness

Focused Attention or what is traditionally called concentration, can help us to observe things clearly as an immediate experience, being in the present, rather than in the past or future. Concentration practices help to focus our attention, simply by paying attention to an object, such as our breath and every time the mind wanders to bring it back and refocus on our breath or other selected object. With practice, mundane events of everyday life, for example, bathing, eating, walking or driving to work can become rich and rewarding experiences in themselves, rather than tiresome chores to be checked off a daily ‘to do’ list.

Mindfulness within the context of use in Western psychotherapy and neuroscience is actually a translation of the word SATI from Pali the language in which the teachings of the historical Buddha were written down. Sati denotes awareness and attention as we would use the words. Sati also implies remembering; not what was eaten at breakfast or an event from the past, alternatively remembering to being focused on paying attention throughout the course of a day.

Open monitoring reflects upon how the mind creates suffering for itself. As discussed in the previous slide, focused attention involves choosing an object and close focusing upon, like breathing in and out. Whereas open monitoring involves opening our awareness to whatever arises in consciousness. Focused attention and open monitoring together have the potential to develop an awareness of present experience. Focused attention can enable a practitioner to refine the attention of their mind to experience every moment as it occurs. When this level of proficiency has been achieved a practitioner can open their mind to whatever arises in awareness and review how the mind creates suffering for itself.

Who are we? People, unless trained in meditation practice, tend to be prisoners of a personal narrative corrupted by their desires and fears. An unforgiving narrative that is frequently unduly harsh in the judgement of others and themselves. Open monitoring has the potential for a practitioner to revisit their personal narrative as their ‘objective self’ and amend with acceptance and loving-kindness.

Acceptance and Loving Kindness to sooth and comfort. The skill of acceptance is vital for relationships and one way to develop acceptance is to use acceptance practices, one of those being lovingkindness practice. According to Harvard Medical School, Professor Ronald D Siegel, love and kindness practice has a tendency to move us away from finding faults in ourselves and others. Love and kindness practice also builds positive emotions, increase feelings of social connectedness and empathy towards others.

Professor Siegel in his audiobook of lectures, The Science of Mindfulness (2014) provides an example of love and kindness practice. He invites listeners to imagine and bring to mind a kind and loving person or even a loving pet and to send good wishes toward this loving being. Professor Siegel suggests using the following message of goodwill: “May you be happy. May you be peaceful. May you be free from suffering.” He adds the advice, that it often helps to place one hand one on top of the other and apply a little warmth and pressure to the heart area as you wish well for this naturally loving being. Adopting the placement of hands on heart, to also send the same good wishes to yourself and others, in an ever-widening circle.

Therapeutic Art-making:

 Earlier in the document, we referred to Meaning (Flow), a state of absorption experienced by an individual in a work or leisure activity that is characterised by a sense of intense concentration and a loss of self-awareness. For many people, art-making gives their lives’ meaning, a sense of being perfectly challenged.

The positive influence of the arts on health and healing is widely recognised. Art teacher Adrian Hill while in a hospital bed recovering from tuberculosis during 1938 spent most of his time drawing objects. According to Thompson (1989), Adrian Hill found the experience of art making during his hospitalisation to be self-therapeutic and Hill subsequently coined the term, ‘art therapy’.

Art making with the support of skilled facilitators offers participants safe therapeutic group environments. That complement Mindfulness and the promotion of self-efficacy and wellbeing. Art making has a concordance with (PERMA): Positive emotions, Engagement, Relationships, Meaning and Accomplishment.

Arts for Health & Wellbeing:

 The Department of Health and Arts Council England jointly published in 2007, “A Prospectus for Arts and Health.” The document was introduced with the declaration: “….the arts are, and should be clearly recognised as, integral to health and health services.”

Ten years on, the All-Party Parliamentary Group observed in their 2017 inquiry report: “The conundrum that we have found ourselves pondering is why, if there is so much evidence of the efficacy of the arts in health and social care, it is so little appreciated and acted upon.”

Lifestyle Choices for Health & Wellbeing:

It would be to ignore the elephant in the room, and a waste of an opportunity, to follow the described self-efficacy health and wellbeing programme without discontinuing the following negative lifestyle choices:

• smoking
• drinking too much
• eating an unhealthy diet
• not exercising enough
• having sexual health problems

 

Choose wellness – Very best wishes to you for the future