Emotional Wellness

This is the Key Points handout from my Empowering Patients presentation on December 10th, 2020.

What is Emotional Wellness? 

A deep sense of meaning and purpose, an abiding sense of peace, the ability to manage the stress and transitions of life, awareness of your thoughts and feelings and the ability to manage them.

Why emotional health matters

1. Emotions influence our behaviour, our relationships and our thinking.
2. Anxiety holds us back from doing what we need to do, from moving forward, from reaching out, and from giving our best to the world.
3. Depression is a major cause of disability and absenteeism from work or school.

Anxiety Disorders

When your anxiety has a significant impact on your function at work, school or home or in your social life.

1. Generalized Anxiety: excessive worry about many things
2. Panic Disorder: recurrent panic attacks (symptoms may include chest pain, a racing heart, sweats, shortness of breath and dizziness)
3. Obsessive Compulsive Disorder: repetitive intrusive thoughts or recurrent compulsions to perform an act (e.g. checking, handwashing, rituals)
4. Social Anxiety: excessive anxiety in specific social situations e.g. large groups, interviews, shopping
5. Phobias: extreme specific fears e.g. spiders, heights, flying

Mood Disorders

The Symptoms of Depression: fatigue, change in sleep, change in appetite, impaired concentration, forgetfulness, thoughts of death or suicide, self-blame and guilt, feeling sad, hopelessness, lack of enjoyment or pleasure, loss of motivation.

Bipolar Disorder: episodes of depression and mania/hypomania (heightened mood and energy, overconfidence, decreased need for sleep, impaired judgment, decreased need for sleep, delusions of grandeur)

Psychotic Symptoms

 impaired reality testing, delusions (fixed false beliefs), hallucinations (seeing or hearing things that are not real), disorganized behaviour e.g. schizophrenia

KEY EMOTIONAL HEALTH SKILLS

1. A Meditative Practice

to calm your mind, centre your thoughts and reflect.

Recommended Reading on Mindfulness: Joseph Goldstein, Thich Nhat-Hahn, Jon Kabat-Zinn, Jack Kornfield. 

Podcasts/Websites: JackKornfield.com, TaraBrach.com

2. Cognitive Therapy

• Reflect on the thoughts that trigger your emotions. Is there another way to look at the situation? 
• Question the underlying beliefs behind unhealthy thinking.
•  Identify your cognitive distortions: 

Emotional Reasoning: Inappropriately reasoning from how you feel e.g. “I feel something bad will happen; therefore, it will.”

Fortune Telling: Assuming that you really know how things will turn out e.g. “I’ll always feel this way.”

Mind-Reading: Believing you really know what another person is thinking e.g. ”I know why my friend didn’t call me back.” “I know they think I’m a loser.”

Overgeneralizing: Making broad assumptions based on the facts on hand e.g “No one cares about me.” “All men/women are the same.”

Polarizing: All or nothing, black or white, good or bad thinking e.g. “She used to be an angel; now she’s evil.” “Either you’re with me or against me.”

Shoulding: Inappropriate judgment e.g. “Everyone should always treat me nicely!” “I have to be perfect.”

Personalizing: Taking things too personally e.g. “He did that just to hurt me.”

Catastrophizing: Believing the worse things will happen e.g. “I’m going to fail and I’ll never be a success.” “This is the end of the world.”

Recommended Reading: Mind Over Mood by Padesky and Greenberger; Authentic Happiness by Martin Seligman.

3. Visualizing Your Goals

• Turn your problems into goals. 
• Instead of replaying the past or ruminating on the negative, think about what you want. 
• When you are most relaxed, visualize yourself having achieved your goal. 
• How do you feel? What do you see? What do you hear? Make it real!

4. MANAGING STRESS

Burnout: when the demands of work or life exceed our ability to manage them.

Seizing the Locus of Control

• Identify your sources of stress.
• Are you reacting in proportion to the stress?
• Recognize what you can change or control.
• Accept what you cannot change; assume responsibility for what you can.
• Recognize your choices.

The 80/20 Rule: 20% of our reaction to a situation is related to the facts; 80% arises from what we bring from our past and how we conceptualize the present.

The Daily Management of Stress

Be a good parent to yourself:

1. Go out and play. Have an exercise routine.
2. Don’t skip meals. Schedule regular healthy meals.
3. Go to bed. Get enough sleep and take regular breaks.
4. Go to the doctor. See your own family doctor appropriately.

Express your emotions with those close to you with a group of confidantes. Form or join a support group.

Live in accord with your values.

Attend to Your Relationships

1. Foster emotional intimacy. Agree on a habit of checking in with one another each day. How are you feeling? How was your day?
2. Show your affection. Express your positive feelings. Remember the 5 languages of love and the human brain’s Negativity Bias: You need to see and say 5 positives for every negative.
3. Schedule regular dates, family time and time with good friends. Commit your time to who matters most. Don’t wait ‘til there’s time; make time!
4. Communicate in a healthy way. Take a breath and let anger cool before you react. Acknowledge the other’s feelings and point of view. Express how you feel without blame.

Right Speech: Is it true? Is it helpful? Is it kind?

Where to Find Help

Canadian Mental Health Association 

cmha.bc.ca

Courses, resources, cognitive therapy and support.

Burnaby Mental Health 

fraserhealth.ca (604) 453-1900

Assessment, treatment, counselling and crisis intervention.

Cameray Child & Family Services

203 – 5623 Imperial Street, Burnaby (604) 436-9449 cameray.ca

Counselling for children and families.

AnxietyBC 

anxietybc.com

Education, cognitive therapy courses.

BounceBackbc.ca a free online skill-building program for adults and youth over 15 years of age

Mood Disorders Association of BC

mdabc.net

Support groups, cognitive therapy and wellness programs.

SAFER  (604) 675-3985

Education, support and counselling for those who have suicidal thoughts, have attempted suicide. 

Support for family members.

Burnabycoronavirus.com for COVID information, social supports and Doc Talks

The Four Foundations of Self-Care

• What you eat (what you put into your body). 

• What you do (physical activity and rest). 

• How you feel (emotional wellbeing). 

• How you connect (healthy relationships).

Please share this information with your family, friends and anyone else who may find it helpful.

Together we’ll create a healthier community and a healthier future.

An Introduction to Mindfulness

by Davidicus Wong, M.D.

This is a handout I share with my patients to introduce them to the practice of mindfulness and principles of cognitive behavioural therapy. I consider these to be two fundamental emotional wellness skills that every adult and child should learn.

Like any other skills we wish to master, practice – particularly daily practice – is essential. Through the power of the human brain’s capacity for neuroplasticity (to change itself), we learn new skills – including new ways of thinking and feeling – through repeated practice. In the words of the pioneering Canadian neuropsychologist, Donald Hebb, “Neurons that fire together wire together.”

MINDFULNESS MEDITATION helps us to centre our minds, increase our awareness and calm the nervous system that modulates how we experience pain and other sensations. The practice of mindfulness teaches us a less reactive approach to the rest of our lives. We become open to accept and experience every aspect of our lives, our selves and our sensations, without clinging, aversion or judgment.

We begin meditation by spending 15 or 20 minutes each day just sitting in a quiet place in a comfortable position. We turn our attention to the natural flow and sensations of the breath without trying to control it in any way. This becomes a safe and calming anchor that we can return to at any time.

We can then turn our attention to sounds as they arise in our immediate environment, just attending to the arising and disappearance of different sounds as they come and go from our awareness. We don’t have to label or identify each sound. We simply remain aware of them as they arise.

We can centre our awareness on different physical sensations in the body, perhaps the pressure at points of contact, warmth, coolness, vibrations, pulsations, tingling and even pain. We can move awareness to different areas of the body, and if a sensation such as pain in one part of the body is difficult to manage, we can shift our attention elsewhere, to the part of the body that is most comfortable or back to the anchor of the breath.

With practice, we are able to maintain awareness and attention to every sensation without reacting to it, without aversion, clinging, judgment or identification. With time, we recognize that everything within our awareness is ever changing; nothing is constant – no sensation (not even pain), no mood, no emotion and no thought.

We are able to attend to each thought as it arises without getting carried away in a train of thoughts or a story in the remembered past or imagined future. We can note thoughts as they arise, without judgment or identification and let them go. We can do the same with the transient feelings and emotions that arise without getting caught up and carried away with them. We experience moods, feelings and emotions but we are not our moods, feelings or emotions. We can see them as transient, temporary conditions like a mist, a fog or a shower. They pass through us or we pass through them.

We can be mindful when walking, attending to the sensations of each step, the sounds and pressures on the feet and the movement of the legs. This becomes a mindful anchor from which what we hear, see, feel and think arises in our open and accepting awareness. 

Mindfulness can be practiced while eating, attending to the taste and texture of each bite of food; swimming, attending to the sensations of buoyancy, flowing water on the surface of the skin and rich sounds of moving water and air; and even driving. Mindfulness only begins with meditation. When you apply the healthy attitudes of non-reactive acceptance, gratitude and compassion to everything in your life throughout each day, you will discover a deeper level of peace, happiness and meaning. 

Mindfulness when diligently practiced can bring serenity to your mind and body throughout each day – an open, accepting and nonreactive approach to your life. It can foster in you greater compassion for others and yourself.

COGNITIVE BEHAVIOURAL THERAPY trains us to uncover our underlying beliefs and assumptions, choose our conscious thoughts, reframe our situation and shape our emotions. We can discover that we can improve our moods, thoughts and function in life through healthy self-care – eating regular healthy meals, ensuring adequate rest, daily appropriate physical activity and spending quality time with supportive friends and those loved ones who naturally lift our spirits. Mindfulness meditation can help us identify unskillful thoughts (those that increase suffering) and help us choose skillful ones.

MORE RESOURCES (I’ve put my favourites in bold)

MINDFULNESS MEDITATION

The Miracle of Mindfulness: An Introduction to the Practice of Mindfulness (Thich Nhat Hanh)

Insight Meditation: The Practice of Freedom (Joseph Goldstein)

Mindfulness: A Practical Guide to Awakening (Joseph Goldstein)

Radical Acceptance (Tara Brach)

True Refuge: Finding Peace and Freedom in Your Own Awakened Heart (Tara Brach)

JackKornfield.com, TaraBrach.com Jack Kornfield and Tara Brach’s videos, guided meditations and lectures are available for free on these websites. By listening to these teachers, you will quickly see how the attitude of mindfulness can be applied to your everyday life.

Local mindfulness retreats: Westcoast Dharma Society http://www.westcoastdharma.org

MicrodosingMindfulness.com will show you how to fit in routine mindfulness breaks in just a few minutes a day

THE PRACTICAL SCIENCE OF NEUROPLASTICITY

Hardwiring Happiness (Rick Hanson)

Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom (Rick Hanson)

COGNITIVE BEHAVIOURAL THERAPY

Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment(Martin E. P. Seligman)

Feeling Good: The New Mood Therapy (David D. Burns)

Mind Over Mood: Change How You Feel by Changing the Way You Think (Dennis Greenberger, Christine Padesky)

Anxietybc.ca has many useful resource including the Mindshift app for smart phones

Checkingin is a free mindfulness app for your smart phones

DIALECTICAL BEHAVIOURAL THERAPY (a synthesis of mindfulness and cognitive therapy)

            The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free From Worry, Panic, PTSD, & Other Anxiety Symptoms (Alexander L. Chapman)

For an effective technique for establishing healthy new habits, check out TINYHABITS.COM

Understanding and Embracing Emotional Health – Challenging Common Mental Health Myths

Understanding and Embracing Emotional Health – Challenging Common Mental Health Myths

Davidicus Wong, December 6^th, 2020

It’s been called the parallel pandemic. The social isolation, uncertainties and financial impact of COVID-19 has stressed us all, but those most vulnerable – including the elderly, the homeless and those struggling with addictions – have been hit hardest.  

Most people don’t realize that up to 30% of the daily work of a family physician involves emotional health – helping patients manage difficult emotions, relationship challenges, anxiety and stress. 

But I know that this is just the tip of the iceberg because many people are reluctant to bring up emotional issues and may never seek support. 

There remains a stigma attached to emotional or mental health challenges. In recent years, pubic health agencies have tried to remove the stigma by getting people to talk about it. 

But for many, just raising the awareness that you can and should talk about it to those who can help hasn’t erased the prejudice, embarrassment and myths associated with emotional health.

An unfortunate legacy of the 17^th century philosopher, Rene Descartes is mind-body dualism, the incorrect separation of mind and body as completely distinct and independent. 

The reality is that there is no such separation. The brain is obviously an inseparable part of the body. In fact, you can recognize many emotions by how you experience them physically. 

When we are anxious or stressed, we breathe more rapidly, our hearts beat faster, our muscles tense, our stomachs turn and we sweat. 

When angered, not only do our thoughts race, but so do our heart and breathing rates. We feel a surge of agitated energy throughout the body. 

When depressed, we slow down physically as well as mentally, sleep is disturbed, energy dips and we may gain or lose weight from changes in appetite.

Our thoughts and emotions affect other “non-mental” aspects of our health and can contribute to high blood pressure, insomnia, irritable bowel syndrome, an overactive bladder, stomach ulcers, heartburn, chronic pain and fatigue. 

Compounding the false belief of mind-body separation are myths about emotional health. Because some conditions require medication, some incorrectly conclude that emotional problems are strictly chemical (i.e. neurotransmitter) imbalances. Others incorrectly assume that all emotional health problems are genetic. 

Another common misunderstanding among friends and family members of those suffering from severe clinical depression is that it is just the same as when we feel sad with a loss or other negative event. Depression can be so profound that it affects an individual’s outlook and ability to think clearly and solve problems. Those who have never experienced clinical depression may not understand why their loved one just can’t get over it or snap out of it. 

Your emotional wellbeing is an important aspect of your overall health. There is much we can do individually and collectively to support the wellbeing of everyone in our community. When your mood, stress or anxiety are affecting your function and enjoyment of life, don’t hesitate to seek help. 

Every community has organized supports for those struggling socially and emotionally. In Burnaby, we’re all working together through the Primary Care Network. Check the resources that are available at https://www.burnabycoronavirus.com/social-supports

On Thursday, December 10^th, I’ll be giving a free online talk on behalf of the Burnaby Division of Family Practice’s Empowering Patients program. The topic: Emotional Wellness. I’ll be sharing key emotional health skills that we all need to manage the effects of this pandemic and community resources for help. For more information: https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Maintaining Your Health During the Pandemic

In February, when celebrating her 100^th birthday with her family, my patient, Helen (not her real name) continued to thrive while managing her chronic health conditions. 

The pandemic changed all that.

She wasn’t infected with COVID-19. Her assisted living facility made every effort to protect its residents. However, this meant an end to all social activities . . . and visitors.

By June, I learned of Helen’s profound functional decline. She had lost weight, fell frequently and was no longer able to stand on her own. Her daughter, an experienced nurse recognized that she was in a potentially irreversible decline.

Once we were able to get approval for weekly visits from her daughter (in full PPE to protect Helen and others at the facility), Helen progressively regained her strength and quality of life.

The pandemic has affected every one of us, but in addition to those infected with COVID-19 and their families, those suffering from social isolation have been the most vulnerable.

We are at a crucial crossroads in this pandemic. With the daily rise in new infections, we each have to double down on our efforts to reduce the spread. We can’t wait for the majority of Canadians to be vaccinated. Many more will become sick and die in the coming months.

Continue to keep your distance, wear a mask when you can’t, keep your hands clean and ask yourself whenever you leave your home, if you really need to. Is it worth the risk to yourself and your family?

In the meantime, we must work together to maintain our physical, social and emotional wellbeing. We can’t do this alone. 

Your family physician’s clinic is still open – at least to calls. Don’t neglect chronic conditions and proactive healthcare. Labs and x-ray clinics are also still open. We’ve all made changes to provide the care you need while reducing your infection risks. 

If you haven’t had your flu shot yet and your local pharmacy or family practice clinic has run out, Burnaby residents can book an appointment with https://www.burnabyflu.com

Stay connected to your family and friends with frequent calls or video chats. Reach out to those who are living alone and ask what you could do to help. 

If you are feeling stressed, frustrated, anxious and even depressed, you are not alone. You are not alone in how you are feeling, and there is help in our community for you. 

Every community has organized supports for those struggling socially, emotionally and financially. In Burnaby, we’re all working together through the Primary Care Network. Check the resources that are available at https://www.burnabycoronavirus.com/social-supports

On Thursday, December 10^th, I’ll be giving a free online talk on behalf of the Burnaby Division of Family Practice’s Empowering Patients program. The topic: Emotional Wellness. I’ll be sharing key emotional health skills that we all need to manage the effects of this pandemic and community resources for help. For more information: https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Dr. Davidicus Wong is a family physician.