Ecotherapy is a way to improve mental health, by being active outdoors and in a green environment.

According to research published last month by Mind, ecotherapy should become a recognized treatment option for people with mental health problems. Their report, “Ecotherapy: the green agenda for mental health”, is the first study commissioned to look at the benefits of “green exercise” on depression. (Mind is the National Association for Mental Health, the leading charity in England and Wales devoted to mental health.)

Its results are very interesting, although not completely surprising. Researchers from the University of Essex compared the effects of a 30 minute walk in a country park with the same amount of time in an indoor shopping centre.

• 71 per cent reported decreased feelings of depression after the walk in the park. 22 per cent reported an increase after walking in the shopping centre and only 45 per cent experienced a decrease.
• 71 per cent felt less tense after walking in the park, while 50 per cent felt more tense after walking in the shopping centre.
• 90 per cent claimed increased self esteem after the walk in the park; 44 per cent experienced lower self esteem after the shopping centre walk.
• 88 per cent reported an improved mood after the walk in the park. This compares with 44.5 per cent for the shopping centre, while another 44.5% per cent experienced lower mood.

Clearly walking in a park has health benefits, while there is a good chance that going shopping will worsen your state of mind.

There goes my article on retail therapy!

A second study conducted by the University surveyed 108 people with mental illnesses about their experience of ecotherapy. 94% said green activities had helped with their depression, and 90% said the combination of nature and exercise had the greatest effect. That’s an enormous positive response!

According to the report there are four main reasons why green exercise is beneficial:

• Natural and social connections: watching wildlife, evoking good memories, spiritual feelings
• Sensory stimulation: colors and sounds, fresh air, enjoyment, escape from pollution, contrasts with urban life, being exposed to the weather
• Activity: using manual skills, physically challenging activities such as digging or cycling
• Escape from modern life: time to think and reflect, clear the head, get away from pressures and stress.

Mind’s Chief Executive Paul Farmer said:

“Mind sees ecotherapy as an important part of the future for mental health. It’s a credible, clinically-valid treatment option and needs to be prescribed by GPs, especially when for many people access to treatments other than antidepressants is extremely limited. We’re not saying that ecotherapy can replace drugs but that the debate needs to be broadened.”

What do you think?

My Woes

Firstly, I’ll give you a bit of background.

When my life caved in some years ago, a concerned friend told my wife that I probably had depression. Not long after that, my friend’s diagnosis was confirmed by our family doctor. While admitting that he was lacking in experience, he prescribed one of the older SSRIs, because he “hadn’t tried that one in a while”. He was an excellent, wonderful, gentle, nice doctor, but mental health was a weakness.

Over the next 2 years while under his care I tried a succession of anti-depressants, but with little success. It became apparent that I was “treatment resistant” and the anti-depressants were “pooping out”. I held out little hope for an effective treatment.

Around this time I read a journal article written by a well-known and respected Australian psychiatrist. I was impressed by the article, and there were snippets of information that seemed relevant to my illness. Not backward in being forward, my wife promptly made an appointment to see him, for a treatment review.

Being diagnosed as having bipolar was somewhat of a relief. He told me that I wasn’t treatment resistant, and that he doesn’t believe in “poop out” at all. My treatment just wasn’t suitable for my condition in the first place. (As an aside he noted that the anti-depressant I was taking was prescribed at way below “a therapeutic level”.)

Receiving the correct diagnosis is not a cure-all for getting well, but it certainly is a start. It took me another 2 years of trial and error to find a treatment that was “satisfactory”, I guess. I’d say it’s about 80% to 90% right (so non-medical stay-well strategies play an important part).

Enough about me…but keep in mind that my experience is fairly common.

Should you seek a second opinion?

Seeking a second opinion, or a specialist opinion, for a proposed treatment is very common. It is not an insult to your doctor, and they are very unlikely to receive it in that way. It is normal so don’t feel uneasy.

It makes sense to have a second opinion if you’ve been receiving treatment and you don’t think you’re getting any better. Just be sure to consider whether it’s because the treatment plan is not effective or because you’re not following the treatment plan designed for you.

Another reason to seek a second opinion is if you aren’t comfortable or are dissatisfied with your current health provider.

What do I stand to gain from seeking another opinion?

Here are some clear benefits:

Any cons?

There are benefits with staying with your original health provider and not chopping and changing if you have a long relationship with them and they know your medical history well.

Once you have settled on a treatment make sure that the person treating you gives you a timeframe over which you can expect to see improvements so that you have realistic expectations.

I have an abundant life. I release the past. I express myself freely.

There. I’ve said it. Now if I repeat it many times over the next month, with emotion, and believing it to be true, then it will become my reality.

Or will it? I’m not sure. And can I really repeat it for the next month to find out?

…So, what is an affirmation?

You can basically think of it as “self-talk”; something that you say to yourself that directly affects your conscious and subconscious mind. It is a statement that you make internally which helps to maintain the emotional state that you’re in.

If I burn the dinner tonight (which is a reasonable presupposition) then a negative affirmation would be “I can’t seem to get anything right”. A positive affirmation would be “I am in control whenever I face a setback”. The first statement would reinforce a negative mindset; the second would reinforce a positive mindset.

By using positive affirmations in place of negative self-talk, it is possible to train your mind to overcome the kind of thinking that is so characteristic of depression.

Some examples of affirmations used for depression:

I am a worthwhile person
I attract joy into my life
I release all my negative emotions
I feel wonderful today
I have peace of mind

Does it all sound familiar?

In a similar way to affirmations, Cognitive Behavioral Therapy (CBT) uses positive self-talk to change negative patterns or habits in thinking, but in a more sophisticated, structured way.

What are the cons?

There is a whole internet industry offering a plethora of advice on how to construct effective affirmations. They typically fall into 3 traps:

1. Perfectionist thinking, where the standard required is extremely high
e.g. “every day, in every way, I am getting better.” Is this actually possible?

2. Globalization, where thinking is in absolutes
e.g. “I already have what I need within me”. Actually, people need outside resources and help.

3. Focus on self
e.g. “I am powerful. I am worthy. I am lovable. I am free.” I am being unrealistic.

Clearly, if you have depression and spend a lot of time meditating on affirmations like these you could be setting yourself up for a fall. At a time when you need to cut yourself some slack, you may be increasing the bar well above what is realistically achievable.

In the end, it seems the benefit that you receive from affirmations will depend on how you actually use them.

Further Reading:
The Pitfalls of Positive Thinking - Affirmations Versus Optimism
http://www.uncommon-knowledge.co.uk/positive_thinking.html

MoodGym
http://www.moodgym.anu.edu.au

What is it?
MoodGym was one of the first interactive websites to help with treating depression. It uses Cognitive Behavioral Therapy (CBT) to help you take more control of your thoughts, to help overcome anxiety or depression, and to develop skills to cope better with life. According to the latest studies, CBT is as effective as antidepressants in treating mild to moderate depression. CBT delivered via a website, anonymously, has also been shown to be effective.

How Does It Work?
MoodGym consists of interactive modules which are delivered to you in a specific order. The modules are: feelings, thoughts, unwarping, de-stressing, and relationships. At the end of each module you can apply the material to your own circumstances through a series of activities.

As you move through the program, you are presented with all kinds of information, animated demonstrations, quizzes and “homework” exercises. Your answers to the exercises are recorded in your own personal MoodGym Workbook, which keeps track of your progress. At the end there is opportunity for you to view this progress and your results. It could almost be called a dynamic self-help book!

Who Is It For?
Anyone can use it. It was designed for young people but almost anyone would find it helpful. It is especially good for those who are unwilling or unable to seek help (apparently 60% of people with depression). It is geared to those with mild to moderate depression, but not designed to replace traditional medical treatment or medicines.

What Does It Cost?
Nothing. The program is free and completely anonymous. And there are no ads!

My Opinion?
MoodGym is free and anonymous, which is worth repeating. They are great benefits. MoodGym offers an easy entry point for someone wanting a quick picture of their mental health, or to take the first, difficult step towards full treatment.

I have used MoodGym on and off for a few years now. If you have a username you can return whenever you like. I find it pitched at a younger audience, but I have still enjoyed benefits. Admittedly, I have a biological, “melancholic” kind of depression, so CBT is of limited use. But it has helped many thousands of others, so for anyone who struggles with negative self-talk then it is definitely worth a look.

Links:

Overview of MoodGym research
Summary of journal article