There are significant links between mental health and poor physical health and/or a diagnosis of a physical ailment (Mental health Foundation, 2016). NHS England (2013) reported that 27% percent of people with Diabetes, 29% of people with Hypertension, 31% of people who suffered a Stroke, 33% of Cancer sufferers and 44% of people diagnosed with HIV/AIDS, also have depression. In addition, they report figures for service users and those with mental health issues are a larger portion accessing A&E, arriving more often by ambulance, being considered of more significant concern (an emergency) and also staying in hospital longer than patients without mental health issues. There is only an association and little understanding of causation. Having mental health issues is associated with more risky behaviours (smoking, drug and/or alcohol abuse, physical inactivity, etc.), and less self-care practises (e.g., brushing teeth and/or showering, eating regularly and healthily, exercising, etc.), which can lead to poor physical health outcomes.
Scientist may have uncovered some of the explanation between poor mental health and poor physical health. McEwen (2008) says “The brain is the central organ of the stress response and determines what is stressful, as well as the behavioral and physiological responses to potential and actual stressors.”, In addition, he explains “Glucocorticoids play a role in these changes … Although glucocorticoids and catecholamines are the two defining hormones of the “fight or flight” stress response”. Cortisol is one of these Glucocorticoids, which helps the body recover from stress, although higher levels of this stress hormone is associated with poor mental and physical health outcomes. The Telegraph reported that stress can increase the probability of death by five-fold. Additionally, Kamali et al (2012) found that people with Bipolar Disorder with suicidal tendencies had higher levels of cortisol than non-suicidal people with the disorder. People with depression have higher levels of Cortisol (Verywellbeing, 2020; Burke et al, 2005). Conversely lower levels of cortisol are associated with more life satisfaction, good self-esteem and good social support networks (Steptoe et al, 2009).
McEwen asks “If being “stressed out” has such pervasive long-term effects on the brain as well as the body, what are the ways to reduce the negative consequences?”. Acceptance and Commitment Thearpy (ACT) may hold the key. Learn more about ACT. ACT focuses on the hexaflex which comprises of 6 main principles that lead to Psychological Flexibility. Psychological Flexibility relates to developing Positive affect towards life. When you are fused with negative thought process and unhelpful stories is an area to work on through Cognitive Defusion. When you are fused with theses stories and thought processes you are going to see more potential stressors and triggers in your environment. This could lead to a higher release of cortisol.
Similarly, being in the present moment means you are not entangled in these stories and thought processes and not spending lots of time ruminating. When you engage in ruminating to a high degree you can be considering past events that provided stress, or anticipating and imaging impending stress. Fight or flight responses have been essential for survival and evolution, although the modern day stressors are related to financial security, having a home, having a family, etc.. This exert from the first chapter of the ‘Happiness Trap’ by Russ Harris explains this perfectly:
With each generation the human mind became increasingly
skilled at predicting and avoiding danger. And now, after a hundred
thousand years of evolution, the modern mind is still constantly on
the lookout for trouble. It assesses and judges almost everything we
encounter: Is this good or bad? Safe or dangerous? Harmful or
helpful? These days, though, it’s not sabre-toothed cats or 200-
kilogram wolves that our mind warns us about. Instead it’s losing
our job, being rejected, getting a speeding ticket, not being able to
pay the bills, embarrassing ourselves in public, upsetting our loved
ones, getting cancer, or any of a million and one other common
worries. As a result we spend a lot of time worrying about things
that, more often than not, never happen.
When you consider how our brain is always in this mode of ‘fight or flight’ against this modern-day stressors, and how our brain is actually indirectly causing physical damage through it’s coping response, the extent of the health crisis is not surprising. Also, not surprising to read that Heart disease is the biggest killer in the UK (BBC, 2013) and that higher levels of Cortisol increases your risk of Heart Disease (University of Rochester). ACT has been shown to support people suffering from Depression, and you can learn more about this in the December 2015 edition or by looking at the research (Bohlmeijer et al, 2011; Clarke, 2014; Hayes et al, 1999; Hayes & Wilson, 1994).
So what do you do know if you want to use ACT to improve your physical health. There are several wonderful books available on Amazon (view this wish list of great resources) and also some great resources on YouTube. To work on being present you can check out my previous blog about top tips for activities. In addition, learn some strategies about defusion to help you become unstuck with those unhelpful thoughts and stories. Consider your values, and work towards taking commited action towards those values to live a meaningful life. Russ Harris has some wonderful resources available that you can use. In addition you can reach out to family or friends to discuss any concerns about your physical or mental health. You may want to speak to a health care professional or your GP if you have serious concerns. Also you can contact any of the following charities who support people with mental health: Time to Change, Mind, Heads Together, CALM: Campaign Against Living Miserably, Mental Health Foundation.
If you want to understand more about Health and Wellness from the ACT model, watch this talk by Kelly G. Wilson, Ph.D.
Adam, E. K., Quinn, M. E., Travernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017). Diurnal Cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology, 83, 25-41, https://doi:10.1016/j.psyneuen.2017.05.018.
BBC, 2013 March 5, Unhealthy Britain: nation’s five biggest killers, Retrieved from: https://www.bbc.co.uk/news/health-21667065
Bohlmeijer, E. T., Fledderus, M., Rokx, T.A.J.J, Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology, Behaviour Research and Therapy, 49, 62-67.
Burke, H. M., Davis, M. C., Otte, C., & Mohr, D. C. (2005). Depression and Cortisol responses to psychological stress: A meta-analysis. Psychoneuroendocrinology, 30, 846-856.
Clarke, S., Kingston, J., James, K., Bolderston, H., Remington, B. (2014). Acceptance and Commitment Therapy group for treatment-resistant participants: A randomized controlled trial, Journal of Contextual Behavioral Science.
Gregg, J. A., Namekata, M. S., Louie, W. A., Chancellor-Freeland, C. (2014). Impact of values clarification on cortisol reactivity to an acute stressor. Journal of Contextual Behavioral Science, 299-304.
Harris, M. A. (2018). The relationship between physical inactivity and mental wellbeing: Findings from a gamification-based community-wide physical activity intervention. Health Psychology Open, 1-8. https://doi.org/10.1177/20551029177538
Harris, R. (2008). The happiness trap: How to stop struggling and start living. Trumpeter Books. First chapter Retrieved from: http://thehappinesstrap.com/wp-content/uploads/2017/06/The_Happiness_Trap_-_Introduction_and_Chapter_one.pdf
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.
Hayes, S. C., & Wilson, K. G. (1994). Acceptance and Commitment Therapy: Altering the Verbal Support for Experiential Avoidance, The Behavior Analyst, 17(2), 289-303.
Kamali, M., Saudners, E. F. H., Prossin, A. R., Brucksch, C. B., Harrington, G. J., Langenecker, S. A., & McInnis, M. G. (2012). Associations between sucide attempts and elevated bedtime salivary cortisol levels in bipolar disorder, Journal of Affective Disorders, 136(3), 350-358. https://doi:10.1016/j.jad.2011.11.027
McEwen, B. S. (2008). Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators, European Journal of Pharmacology, 583(2-3), 174-185.
Mental Health Foundation, 2016 February, Physical health and Mental Health, Retrieved from: https://www.mentalhealth.org.uk/a-to-z/p/physical-health-and-mental-health
NHS England – McShane, M., & Strathdee, G, 2013 November 25, Valuing mental and physical health together, retrieved from: https://www.england.nhs.uk/wp-content/uploads/2013/12/valuing-mental-health-cta.pdf
Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195, 42-49.
Steptoe, A., Dockray, S., & Wardle, J. (2009). Positive Affect and Psychobiological Processes relevant to health. Journal of Personality, 77(6), 1747-1776. https://doi.org/10.1111/j.1467-6494.2009.00599.x
Telegraph, Stress increases risk of death five-fold. Retrieved from: https://www.telegraph.co.uk/news/health/news/7991620/Stress-increases-risk-of-death-five-fold.html
University of Rochester, Stress can increase your risk for Heart Disease, Retrieved from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2171
Verywellbeing, 2020 March 25, The role of Cortisol in Depression, Retrieved from: https://www.verywellmind.com/cortisol-and-depression-1066764