Mental Health KPI’s
Guest Blog by Katrina Dennehy CBT from Smaointe CBT Mental Healthcare
“Mental health” is a phrase that’s thrown around a lot these days. What does it mean? How does it actually work? And what types of things impact it?
These are the questions that actually got me into the profession of psychotherapy in the first place. If I have learned anything in my 11 years of practice, it’s that the term is not a “one size fits all”. It is as individual a concept as how you think, how you feel or what makes you different to the next person.
One aspect I do like to make reference to is the idea of KPI’s, or Key Performance Indicators. KPI’s are the external factors involved in determining the state of our mental health. Obviously how we feel and think is internal, but what impacts how we think and feel? What are the precursors to our mental health state?
Before taking a look at our feeling and thinking, it is important to firstly address 4 areas in particular, these are:
- Social Interaction
What is your sleep like? Do you get to sleep easily? Do you stay asleep once you are asleep? Do you wake up frequently? And if so, how long would you stay awake for? Do you dream? Do you feel rested when you wake up?
All of these questions are relevant in defining what ones sleep pattern is. If there is a problem in any area here, where the problem is usually gives a good indication as to what is happening with the person cognitively, and subsequently what we can do to resolve it.
A lack of good quality sleep can lead to a myriad of problems. There are 2 types of sleep: Non Rapid Eye Movement sleep (Non-REM) and Rapid Eye Movement sleep (REM). Non REM sleep involves deep sleep which allows a toxic protein called Beta Amyloid to essentially be cleaned out of the brain. This protein is associated with diseases such as Alzheimers. The impact that sleep deprivation has on the person is that it reduces the performance of systems such as the reproductive system, memory consolidation and the immune system. Once we go past 19 hours waking time, we are as deficient as someone that is legally drunk!
REM sleep is comparatively as essential to mental health, in that it provides a type of emotional first aid to the brain to repair the damage done by waking life. This is the time when brain wave activity picks up speed, and the brain processes ‘files’ it has collected during its’ waking time. When we do not have a full nights sleep the emotional centre piece of the brain, the Amygdala, generates very strong emotional reactions and becomes hyper-reactive. In fact it is 60% more responsive in a sleep deprived brain than what it would be in a brain that has sufficient sleep. The connection between the prefrontal cortex (The CEO of the brain- controls high level functioning such as rational reasoning, short term memory and executive functioning) and the amygdala is near on severed in a sleep deprived brain. Therefor it is just as important to have REM, dream sleep, as it is to have deep sleep. This strengthens the communication between the areas in the brain that control thinking and feeling. We find solutions to problems that previously would have seemed impenetrable. Hence the adage, sleep on a problem, It just looks different in the morning.
When, what, how often and where we eat have a big impact on us. If we do not fuel the body then secondary functions, like conscious thinking takes a back seat. Essentially, rational reasoning becomes an unnecessary function within the brain so that primary functioning, eg. Walking, talking, breathing, living, can sustain us. What this means for the brain is that we temporarily lose the ability to rationally think ourselves through simple situations and thus can lead to emotional distress.
For example, I may deal fine with someone screaming down the phone at me over something, however, if I have not eaten for a while, my brain has shifted gear and only allows primary functions to work. My temporal lobe (the part that operates rational reasoning and conscious thought) cannot operate as efficiently as it normally would and the limbic system (the part that operates emotion) floods, causing an ‘irrational’ reaction, resulting in me crying uncontrollably about the person shouting at me and me telling myself that I am having the WORST day ever.
The rational mind would have quite easily been able to say “Well that person that shouted at me was not being very nice, and maybe she/he is not having a very good day that they felt the need to offload on me”.
What we eat, very obviously has an impact on how we feel/think. Did you know that, for example, if you have coffee on an empty stomach (first thing in the morning) it increases cortisol levels, our stress hormone, at a time when our levels are already biologically higher. As caffeine is a psycho-active stimulant, this means that up to 50% of the caffeine is released into the system up to 5-6 hours after having that morning coffee, and 25% is released 10-12 hours AFTER. This increases our susceptibility to stress/anxiety before we ever face any outside triggers.
Sugar also has a direct impact on our feeling. As sugar causes a stark peak and subsequently a stark drop in insulin levels, it causes our dopamine receptors to become compromised and therefor has a vastly negative affect on how we feel. It is actually more addictive than cocaine!
How we feel has a direct link with how we think. Imagine it was a pair of sunglasses; once we put them on everything we look at looks darker; this is negative thinking. We feel bad, so everything we look at looks bad.
If we allow our body to go into ‘starvation’ mode, the same is similar as above. The brain will instinctively pick and choose which primary functions are most important and rational reasoning along with emotion will take an immediate hit. We are all familiar with the term ‘hangry’, this is a legitimate phenomenon! It may not be isolated to just anger, it simply implies that if the body is starved (has not eaten in more than 4-5 hours) it simply will not possess the ability to rationalise it’s way out of otherwise easily managed situations. Eating a little more often quite simply keeps the brain stable enough to maintain cognitive and emotional functioning at its’ optimum level, or at least gives it a fighting chance.
I could go on forever about this one! We have all seen the studies related to the impact that exercise has on our mental health, how it increases endorphins and heightens serotonin levels (happy hormones). Still, exercise is ‘marketed’ for its physical advantages and promoted to get physically fit in order to reduce risk of medical illness. I absolutely sing to this tune, but as one who is personally allergic to exercise, it took more than just the physical need to either lose weight, or get physically healthier to move my backside! Learning about what it does for the brain and subsequently how it motivates one for life is ultimately what worked for me.
A single workout has an immediate effect on your brain. It increases neurotransmitters like dopamine, serotonin and noradrenaline. A single workout can improve your ability to shift and focus attention and that focus improvement will last for at least 2 hours. The most transformative effects of exercise are its protective effects on your brain. Think of the brain like a muscle, the more you work it, the bigger and stronger it gets. This is what happens to the prefrontal cortex and the hippocampus. Why is that important? Because these 2 areas are the ones that are most susceptible to degenerative diseases and normal cognitive decline in ageing. 3-4 times a week doing 30 mins exercise will help to delay these effects. Exercise literally helps to protect your brain from incurable diseases and it will change the trajectory of your life for the better.
Something we have all learned over the last 12 months is how important social interaction is to our mental health. We are a social species and thrive on interaction and engagement. Even someone who is socially anxious needs to interact to realise their influence on their relationships and assimilate their sociological value. This is exactly why we need interaction. Within groups, we deindividuate, that is, we can share responsibility with others. It’s less the loss of the sense of self, and more the interaction gives us a purpose or place within a larger system.
Systems are ultimately what shape who we are. When we are born, we become part of the family system, then we’re introduced through parents into the larger system, let it be family friends, creche, school etc. We grow through systems and institutions (school, college, work, communities, organisations) and all of these external influences provide us with the opportunity to create a larger frame of reference for life, outside of our own existence. It’s an extension of the normal developmental process called ‘perspective taking’ that babies experience at around 6 months, where they learn that Mammy and Daddy actually see things differently to how I see them. We are not all looking at the same thing. This perspective taking needs to exist in order for society to work and not dissolve, but also needs to happen for the individual so that they do not become consumed with purely their own perspectives/thoughts and learn that outside their head exists a very different reality. Often when someone is anxious or depressed this is what is stuck.
So, in conclusion, these 4 areas together will not provide a ‘magic wand’ effect once identified and examined within your own context. They will however, give a good starting point as to what you can immediately do to instantly impact your thinking and your mood. Put quite simply, if you get 6-8 hours of sleep, eat well, exercise a little 4 times a week and maintain a level of social interaction, this will put you well on the road to “controlling your controllables”.
Cognitive Behavioural Psychotherapist
Katrina is PhD Candidate, Psychology UL
MA Cognitive Behavioural Psychotherapy