Where are we now and what can we do

1. Where are we now and what can we do Dr Caroline Bell Canterbury District Health Board Department of Psychological Medicine University of Otago, Christchurch

2. OVERVIEW • Where are we now ? • What is Well being ? • Can we improve it ?

4. SECONDARY STRESSORS • Insurance, financial, delays …… • Family load disrupted routines, sleep, kids, elderly, friends leaving • Community load changes to city, roads, people left, landscape • Social load no CBD, fewer movies, restaurants, activities • Workplace load • Relocation, shared spaces • Organisational and physical uncertainty, financial • Its not business as usual but demands for business as usual

5. WHAT DO SURVEYS TELL US • CERA • All right campaign • CDHB • Wide spectrum of response

6. COMMON PERSISTING THEMES Fatigue / exhaustion Feeling despondent / overwhelmed Loss of control Feelings of anger and frustration – lowered tolerance Poor concentration Absenteeism / presenteeism Interpersonal / relationship issues Substance abuse

7. DEVELOPING MENTAL HEALTH PROBLEMS • PTSD • Perception death - marked hyperarousal • Rescue workers - PTSD • Previous PTSD • Depression • Anxiety disorders • Substance abuse • Relationship problems

8. WHO ARE THE PEOPLE AT RISK • High exposure • Life stressors • Financial, homes, businesses, relocation • Limited social supports • Previous mental health difficulties • High risk professions • New group - any of us

9. NEED TO IDENTIFY PEOPLE NEED FURTHER HELP? • Persistent low mood, loss of hope, suicidal • Persistent rumination or memories • High levels anxiety/hyperarousal • High levels distress • Avoidance/withdrawal • Risk taking • Aggression/ relationship problems • Alcohol or drug abuse

10. WELLBEING • Not just happiness • Life satisfaction and +ve emotions • Flourishing • Positive emotions • Engagement – flow • Relationships • Meaning and purpose • Accomplishment

11. WHY IS WELLBEING IMPORTANT • Physical health • Mental health • Relationships • Workplace satisfaction • Community cohesiveness

12. NEUROBIOLOGY

13. ACUTE HEALTHY STRESS RESPONSE • Increased activation of the amygdala • Focus threat • Prepares fight/flight • Less interest in non-essential activities • Reduced activation of frontal brain regions

14. Neurobiological Model Overactive amygdala Impaired vmPFC inhibition onto amygdala networks 14

15. PERSISTENT STRESS • Increased activation of the amygdala • Increased vigilance • Less interest in non-essential activities • Reduced activation of frontal brain regions • Planning, complex thinking • Increased glucocorticoid • Earthquake brain, Bush fire brain, Flood brain

16. LIFE BECOMES NARROWER • Head down, blinkered approach • Focus on stress - trying to deal with things can’t control • Reduction innovative strategic thinking • Things add value dropped off

17. THIS WILL LEAD TO… • Reduced wellbeing • Health • Relationships • Social • Career

18. WHAT WILL HELP • Dealing with real practical problems – zoning, insurance, financial • Well being • Active not passive process

19. WELLBEING – CAN YOU CHANGE IT • Genes • Circumstances • Intentional activity

20. WELLBEING • Nurture social relationships • Increase flow activities / learning • Look at what is important to you • Optimism, positive emotions • Tolerance and gratitude • Avoid overthinking, flexible approach

21. UK FORESIGHT PROJECT What enhances well being • Exercise • Learning • Mindfulness • Yoga • Gratitude • Reduce amygdala activity • Increase frontal cortical activity

22. Neurobiological Model Increase vmPFC inhibition onto overactive amygdala networks 22

25. REALLY WHAT CAN WE DO • 1. TAKE TIME • Fast not necessarily best • Often need to build new foundation life • Time • Space • Energy

26. REALLY WHAT CAN WE DO • 2. ASSESS OUR ENERGY LEVELS • Focus on problems causing the stress • Keep on going • Stop listening to our needs (body, relationships, social) • Keep listening needs • Recharging – brief and often

27. REALLY WHAT CAN WE DO • 3. FOCUS ON WHAT WE CAN CONTROL • Stress result circumstance and attitude • Circumstances • Lots out of our control • When stressed focus on most intensive problems • Attitude • What can do, have achieved, will do • Sleep, relationships, sport, music

28. REALLY WHAT CAN WE DO • 4. WHAT AM I NOT DOING NOW • Stress demands constant focus • Drop out things feel not add value to this • But these are exactly things that add value to our lives • Time reflect • Doing things with friends • Doing things give you enjoyment • Can’t wait and put on hold til all over

29. REALLY WHAT CAN WE DO • 5. BUILD BACK ROUTINES • Routines free us up, familiarity, security • Give us time • Dropped out of routines or things different • Put new routines back

30. WHAT’S IMPORTANT TO KNOW IS… • Can learn from this what is really important • Should celebrate what we have achieved • We can do something about how we are feeling and our wellbeing • But……….

31. WHAT’S IMPORTANT TO KNOW IS… • This is new and hard • We HAVE TO look after our wellbeing THIS IS IN OUR CONTROL AND ITS TOO IMPORTANT TO LOSE