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How quickly this past year has gone by. It seems like such a short time ago that I wrote my June, 2022 column and noted that as has been my practice since I began to write my monthly articles in 1999, this would be my last column until September. As has also been my custom, I want to express appreciation to my readers for the comments, questions, and insights you have offered in response to the topics I have addressed. Receiving such feedback always adds meaning to my work and writings.
I regularly post links on my social media platforms (Twitter; LinkedIn; Facebook) to articles I believe will be of interest to those who follow my work. In considering the main subjects about which I posted and/or described in my monthly articles during the past couple of years, I recognized that many highlighted the importance of engaging in realistic behaviors that strengthened our physical and emotional well-being. Some pieces extolled the benefits of regular exercise. Others examined the positive impact of acts of kindness and gratitude, not only on the recipients of these actions but also on those who initiated such behaviors.
My use of the word realistic is in line with a concept I have emphasized in previous writings, namely, “personal control” as a basic component of resilience. Personal control, which many view as similar to the message housed in the serenity prayer, involves focusing our time and energy on modifying those situations over which we have some influence, rather than on factors over which we have little, if any, control. Realistic behaviors are those that are within our personal control and our current skill set.
The Impact of Physical Exercise
Given my longstanding and ongoing interest in therapeutic lifestyle changes that can improve our well-being and resilience, I was drawn to two recently published articles. One was titled “What Type of Exercise Is Best for Mental Health” authored by Kira Newman, the other “How Small Acts of Kindness Can Help with Anxiety” written by Jill Suttie.
Newman reported the findings of a comprehensive study involving 128,000 participants that examined the impact of exercise in dealing with anxiety and depression. The study, headed by research fellow Ben Singh at the University of South Australia, examined a variety of activities from tai chi and yoga to aerobics and dance to strength training. The results demonstrated that exercise led to a reduction in depression and anxiety.
Singh believes that physical activity is beneficial in several ways: “By releasing endorphins and boosting our mood, improving sleep, reducing stress, supporting self-esteem and confidence, and making us feel accomplished and purposeful.” The kind of exercise that proved most beneficial for mental health were those of “higher intensity.”
The study also examined what might be an optimum amount of exercise each week and found that “less than 2.5 hours per week was actually better than more.” Four to five sessions per week of physical activities appeared to offer the best results. In addition, each session didn’t have to be very lengthy with no differences found between 30-minute and hourlong workouts. Newman wrote, “The researchers suggest that this moderate amount of exercise may feel more manageable, so it doesn’t become a burden in people’s lives.”
Newman raised the question, “If exercise is so helpful for feelings of depression and anxiety, why aren’t doctors prescribing it more?” One reason offered by the researchers is that in the United States, exercise, adequate sleep, and changes in diet are often viewed as “complementary alternative treatments,” to be introduced when therapy and medication are not effective. Singh asserted, “Physical activity is a safe and effective way to improve mental health, and it is a treatment that should be considered alongside other treatments.”
Strategies to Address Obstacles to Healthier Behaviors
In my clinical practice, I have often witnessed that when patients become more anxious and/or depressed and feel increasingly depleted, regular exercise and a healthy diet are the first casualties. One patient said, “I know I should get back to a daily brisk walk, but I feel too tired to do so.” Another noted, “My mind immediately goes to cookies and ice cream when I’m feeling stressed. It becomes a vicious cycle. As I eat more junk foods, I gain weight and then I get more depressed and less likely to exercise and eat healthier foods. And then I begin to feel helpless and hopeless.”
Recognizing the challenges of adopting and maintaining a healthy lifestyle, Singh suggested strategies for doing so. The following are several of his recommendations:
Start small and set realistic goals. For example, if you haven’t previously walked or jogged, start with 10-15 minutes of this activity. While this may seem obvious, I have observed numerous examples of people who set unrealistic goals for themselves, only to feel like failures when they were not able to meet these goals. One of my most memorable experiences was with a man who told me he knew he should begin to exercise and planned to start by jogging five miles a day. He set this goal although he had rarely, if ever, engaged in aerobic exercises! Part of the therapy was to establish more realistic initial goals, namely, walking for about 8 minutes followed by a couple of minutes of jogging and then a couple of minutes for walking. During several months he worked his way up to longer times for exercise.
Find an activity you like. I recall that one of the first exercise machines I ever bought was a “rowing machine.” A friend had recommended it, and I know many people like using it. However, I didn’t enjoy this type of exercise and soon I was using the machine less and less as more and more dust gathered on it. I then bought a treadmill and have continued to use it regularly, especially during less than ideal weather for walking/jogging.
Make exercise a habit. Singh strongly advocated that we make exercise a regular part of our daily routine. The regularity might involve going for a walk before or after work or using weights when we arise in the morning. We don’t have to be obsessively rigid about when we exercise, but I do believe that some regularity can increase the probability that we will engage in that exercise.
Don’t give up. This is often easier said than done. Singh recognized that there will be times when we don’t feel like exercising but advised that it’s important that we not back away from achieving our goals. I know that at the beginning of an exercise session such as going for a jog, I often asked myself, “Why are you doing this?” Typically, after five or so minutes, especially when I felt warmed up, the question of “why?” was replaced by thoughts about the benefits of aerobic exercise and the activity became more pleasurable. Singh added that people struggling with depression often required additional support to maintain an exercise regimen. Support might come from having an exercise buddy or buddies (a helpful strategy used by many people) or speaking with a therapist to overcome obstacles.
Singh also observed, “Exercise can be a helpful part of treatment, but it’s not a cure. It’s not a replacement for current treatments such as medications and counseling.” I agree with this perspective. Having different lifestyle and therapeutic techniques available allows us to call upon the most effective strategies at various times in our lives.
Acts of Kindness and Mental Health
Physical exercise and acts of kindness may seem to reside in different spheres of our lives. However, both have been found to contribute to a lessening of depression and anxiety. I have consistently asserted that a sense of connectedness with others is a basic foundation of resilience. Thus, I was intrigued by the following sentence at the beginning of Jill Suttie’s article: “While cognitive behavioral therapy (CBT) helps many people have less anxiety and depression, it may not have much effect on their sense of social connection—a central part of a happy, healthy life.”
Suttie summarized research conducted by psychologists David Cregg and Jennifer Cheavens, both on the faculty of The Ohio State University. Participants in the study displayed “medium levels of depressive or anxiety symptoms.” They were randomly assigned to three groups to engage in one of three activities for five weeks. One group was asked to perform three random acts of kindness on two days of the week. They could be “big or small acts that benefit others or make them happy, typically at some cost to yourself in terms of time or resources.” The individuals in this group recorded doing acts of kindness for both people they knew and those who were strangers. Examples were buying coffee for a stranger in line at Starbucks or baking cookies for friends or shoveling a neighbor’s driveway.
The second group was requested to plan and organize a social activity on two days of the week, described as “big or small activities for the purpose of enjoyment.” The third group was asked to engage in the CBT technique “cognitive appraisals.” The latter involved completing a “thoughts record” for at least two days a week. These records included the use of a workbook “to identify distressing or distorted thoughts and learn how to challenge those thoughts to make them less problematic.”
Prior to the beginning of the study, then every week during the study, and five weeks after it ended, the participants reported on “their depression, anxiety, and stress; their sense of social support; their positive and negative feelings; and their satisfaction with life.”
What, if any, different outcomes would you predict for the three groups? Cheavens, one of the authors of the research, noted in some ways she was surprised by the findings. All three groups reported being “less depressed and anxious, had lower negative feelings, and felt more satisfied with life.” However, the group that engaged in random acts of kindness displayed the greatest reductions in depression and anxiety together with a higher satisfaction with life. In addition, and very importantly, while acts of kindness and organizing social activities both increased a sense of social support, practicing kindness improved it even more, with benefits still evident after five weeks.
Reflecting on these findings, Cheavens remarked, “We did think that, if there was going to be an advantage of one group over another, it might be the thoughts record group, since that’s such a tried-and-true way of addressing depressive and anxiety symptoms. But the kindness group did as well or better, and that group also had increases in social connection that didn’t happen in the other two groups.”
These findings resonate with my view that displaying kindness towards others (e.g., what I have labeled “contributory” or “charitable” activities) nurtures compassion and resilience in our lives while also enriching the lives of those who are the recipients of our actions. Cheavens observed that while she wondered if it would be difficult for participants struggling with anxiety and depression and feeling overwhelmed to focus on helping others, she found that “it was not a particularly hard sell.”
Cheavens cautioned (just as Singh had about exercise) she was not suggesting that prescribing acts of kindness for people who suffered from depression and anxiety was in place of medication and/or established CBT techniques but rather could serve as one more strategy to use in helping people with their mental health. For those experiencing a less severe form of anxiety or depression, being kind to others “can help your mood and make you feel closer and more connected to people—something we could use more of in society, in general.”
Cheavens added, “The Surgeon General has been talking about the importance of belonging and socially connecting to other people. . . . I know that when I’m feeling a little cranky or burned out, doing things for other people is often a go-to strategy for me.”
Although I will not be sending out another column until September, I will continue to post links to articles on my social media platforms.
Also, I hope that during the next couple of months you devote time to engage in realistic lifestyle changes such as exercise and acts of kindness that will enrich your physical and emotional well-being.