In this lesson we're going to be talking about Chapter 10, "Understanding Mental Health and Coping With Stress". After this lesson you should be able to define mental and emotional health, understand the relationship between physical activity and mental health. You should also be able to describe the role that physical activity can play in both the prevention and the treatment of anxiety and depression, define stress and the stress response, and also comprehend the relationship between physical activity and stress.
To begin, let's define mental health, and we'll use the definition from the US Department of the Health and Human Services. They define mental health as—I'm going to start this slide over again. To begin, let's define mental health, and here we'll use the definition from the US Department of Health and Human Services, where they define mental health as a state of successful performance of mental function resulting in productive activities—productive activities you could think of as work, going to school—fulfilling relationships with other people, and the ability to adapt and change and to cope with adversity, and adversity here could be many different things; we all encounter some form of adversity in our daily lives, and so that could really apply to many different aspects within our daily routines and lives.
Now a similar concept is emotional health, and we talked about this in Chapter 1. Our emotions, such as joy, fear, guilt, love, etc. occur in response to events and are intimately connected to our mental health, so we're going to use these terms interchangeably throughout this chapter, both mental and emotional health.
We've talked many times throughout this semester about the importance of physical activity for our physical health, but in this chapter we're going to explore the relationship between physical activity and psychological or mental health. And so the three main functions of physical activity in relation to mental health are, first, that physical activity is able to enhance positive mental health outcomes such as self-esteem. So for example, persons who are more active have higher self-esteem. Those people also have more positive body image and better cognitive functioning. Second, physical activity can help protect us against mental health disturbances such as anxiety and depression, and we'll talk about each of those later in this chapter. And finally, physical activity can be used as a treatment for symptoms of anxiety and depression, and often it's used as an adjunct or additional treatment, in addition to maybe cognitive behavioral therapy, or medication as well.
And the underlying assumption of the relationship between physical activity and mental health is really that we cannot separate the mind from the body, that the mind and body have a very intimate relationship and they don't operate as independent units; in fact, they're very closely integrated. And so, interestingly, this is not a new idea. The Greeks subscribed to the saying of mens sana in corpore sana, "in a sound mind is a sound body," and so for a long time, people have been thinking about the connection between mind and body, and in ancient Greek, regular physical activity was encouraged for both mental and physical health.
Now when we use the term "mental illness," we're talking about all diagnosable mental disorders, and these come from the Diagnostic and Statistical Manual for Mental Disorders, or the DSM. We're currently on the fourth edition, and the fifth edition is being revised and worked on right now, and this book includes hundreds of mental illnesses. So I want you to understand that mental illness goes well beyond anxiety, depression, that we're going to talk about in this chapter, but those are some of the most common, so that's why we'll talk about them here, but you should understand that a mental illness just reflects changes in your thinking, mood or behavior that lead to some sort of impaired function. So in a very general sense, that's the definition of mental illness, and we'll cover, like I said, the common examples—anxiety, depression—and we'll also cover stress, because it can play a role in development of these other mental illnesses such as anxiety and depression.
Anxiety disorders affected about 18% of the population the year before this survey was conducted, as you can see in the figure on the left-hand side, and nearly 30% of those surveyed at some point in their lifetime. So it's a very common problem in the US, and you can also see that, in the figure on the right, that anxiety disorders are more prevalent in women compared to men, and they tend to peak between the ages of 30 and 44 and then decline as we age.
Depression is another common mental illness in the US, with about 6.7% of the US population experiencing a major depressive disorder in the year prior to this survey, as you can see on the left-hand side of the figure, again, and about 16.5% experience this major depressive episode at some point during their lifetime up through the survey. And so, similar to anxiety, women are also more likely than men to experience depression, and people over 60 years old are much less likely to experience depression compared to any other groups.
In addition to the health burdens that mental illnesses place on the individual who has them, and their families, we also spend a great deal of money on treating mental illnesses in the United States. So you can see on the left that in 2006, $57.5 billion were spent on treating mental illnesses, and this amount has increased since 1996 and is comparable to the amount that we spend on cancer and asthma, and just slightly less—as you can see in the figure on the right—than the $78 billion that we spent on heart conditions in 2006. So the take-home point here is not just that it costs us a lot of money, but that prevention and treatment of mental illnesses, in particular with behavioral changes such as being more physically active, is important not only for the health and wellbeing of our population, but also to reduce the economic burden of these diseases.
In the next few slides we'll describe both anxiety and depression, and we'll talk briefly about what we know about the relationship between physical activity and these diseases, and we'll start with anxiety. Anxiety is a normal feeling from time to time when we're faced with either real or imagined situations in our environment that cause us fear, but anxiety disorders are not normal, and these really come from a heightened arousal or fear over a sustained period of time. And it's really important to note that there are many different types of anxiety disorders, so it's not just that you have anxiety. There are different types; anxiety is kind of an umbrella term, and there are different types of anxiety disorders underneath that umbrella term of anxiety, and some of the most common are listed here on the slide—social anxiety, panic disorder, generalized anxiety disorder, etc. -and they're also described very well in your textbook. So we're not going to spend a ton of time here on this PowerPoint describing each one of these, but you should know that these disorders can have different symptoms, and they occur under different situations. So, for example, social anxiety disorder is a chronic fear of being watched or judged by others, and may result in, among other things, trembling or nausea when presented with certain social situations. So, for example, someone might have situations at work or school that give them these symptoms. Another anxiety disorder in comparison, post-traumatic stress disorder, involves frightening memories of a previous traumatic experience. We're hearing about this a lot now with veterans that have come back from the war that have those frightening memories still on their mind as they come home. And this disorder may cause a person to have trouble sleeping or be easily startled. And so you can see these two disorders are very different, although they're both categorized under anxiety disorders, and so I'd encourage you to read about all of these disorders and their symptoms in your textbook.
On this slide you can see many of the common symptoms of anxiety disorders, and again, not all anxiety disorders will have all these, but these are very common symptoms. And so you can see that some of them are psychological, so feeling apprehensive or powerless, but some of them are physiological—having increased heart rate, sweating, breathing rapidly. So the anxiety can manifest itself in many different ways in your body.
So now let's move on to depression. Depression is just one type of mood disorder, and it can vary in both severity—how intense the feelings of depression are—and also in duration, or the length of time that we experience these feelings. And so from time to time we all experience depressive reactions, and these are short in duration, and the severity lessens over time. So, for example, let's say you get a job or school rejection letter. Initially you might feel sad or feel worthless, but that doesn't last very long and that feeling gets better with time. Dysthymia is similar to depressive reactions but much longer in duration, so instead of those feelings going away, they just persist. It's described as a chronic form of depression that lasts a longer period of time. And finally, major depression is a serious condition that leads to the person's inability to function, and potentially suicide if the person isn't treated, and it's defined as having one or more major depressive episodes over a two-week period. So these are very serious feelings that go well beyond our normal depressive reactions that we all experience from time to time.
Here you can see some of the common symptoms of depression. Again, there are many different symptoms, and people don't need to experience all of these symptoms to be classified as depressed. And notice that they can be psychological, as indicated by one star on this slide; behavioral, two stars; or physical, three stars. And so you should also note that some of the symptoms can manifest in very different ways depending on the individual, so if you look at sleep, someone could have insomnia and not be able to sleep; on the very other end of the spectrum, someone might be sleeping excessively. The same thing goes for appetite; someone might have weight loss or weight gain based on increased or decreased appetite. And so for even more—again, this is not a complete list—and for even more symptoms of depression, check out your textbook.
On this slide we'll very briefly cover the relationship between physical activity and mental health, and more specifically physical activity and anxiety and depression. And for more detail—this is just a summary of conclusions from an article that you can see listed here at the bottom of the slide—that article's been provided in your list of readings for this week, so this is just a brief overview of that. We know that physical activity may play a role in reducing the symptoms of both anxiety and depression, and interestingly, it might be more important to focus on being physically active rather than focusing on improving someone's cardiovascular functioning or fitness, and so there might be something about just being active, just get out there and walking or biking or swimming; there might be something about doing those activities, regardless of changes in fitness, that is good for mental health, and specifically anxiety and depression. And finally, research has shown that physical activity seems to be as effective as medicine for treating mild to moderate depression. And so these are, again, just a few things that we already know from previous research, and for a full summary, or more complete summary, read the article that's listed in this week's readings.
In the second half of this lecture we're going to talk about stress, and stress is something that's present in everyone's daily life, and each person requires a different amount of stress for their optimal functioning or health. Stress often has a negative connotation in our society. We talk about how stressed out we are at work or at school or at home; we imagine stressful life events, such as a big exam or losing a job; but the reality is that stress is not always bad, and so when stressors in our environment lead to positive outcomes, we call them eustress, or good or helpful types of stress. And then distress is when life stressors lead to negative outcomes such as, at the extreme ends, anxiety disorders or depression.
And so when we talk about stressors, we're just talking about a demand that's placed on the body that disturbs the body's homeostasis, or stable state. That demand could be a particular event like speaking in public; it could be a situation like being in big groups of people; it could be anything, literally anything in your life that disturbs your body's homeostasis. And it's important to note that it's our reaction to that stressor, not the stressor itself, that determines the stress response that we'll talk about later in this chapter. And so some examples of potential stressors, again, having to speak in public, deadlines, crowds, having a baby, getting married, searching for a job. What I want you to notice in this list is that they're not all negative events. Even events that we would consider to be very positive—so, for example, getting married—can be also very stressful for people, depending on how you react to those events. And so physical activity and exercise is also considered a stressor because it disturbs the homeostasis of your body, and clearly we believe that physical activity and exercise are positive things. So we'll talk some more about stressors and how they affect your body, and how your reaction affects your body, here in the next few slides.
So as I just talked about when introducing the concept of stress, I mentioned that some stress is needed for optimal performance, and this is theorized by the Yerkes-Dodson Law, as you can see in the illustration on the right. In this figure on the illustration on the right, the X-axis represents levels of stress, with too little stress on the left, too much stress on the right and optimal levels of stress right in the middle, and the Y-axis indicates performance or health ranging from low to high. So when you have very little stimulation or stress in your life, also called hypostress, that can lead to feelings of boredom, fatigue; you might lack motivation to participate in new challenges or new opportunities. But alternatively, when you have too much stimulation or too much stress, that can also lead to poor health or performance, so you see both ends of the spectrum there along the X-axis. On the far left and the far right you have low performance or low health and both of those conditions. But to achieve high performance or good health, you need to have an optimal level of stress that results in creativity, your motivation to make changes, and many other positive outcomes.
You can see in this figure the flow of stressors and coping that can lead to harmful behaviors and psychological and physiological symptoms if the stressor is not appropriately managed, if you don't appropriately deal with the stressors in your lives. And the signs of hyperstress, or chronic stress, that are listed here on the slide, including turning to drugs or alcohol, anxiety, headaches, ulcer, etc.—there are many more—occur if someone has a strong reaction to a stressor (or in this case listed on the slide as an activator) and then they have unsuccessful coping, or they're unable to deal with this stressor. And it's important to note, again, that we're talking about our response to the stressor, not the actual stressor that determines this reaction, which is both physiological and psychological. In other words, what I consider to be a stressor may or may not be a stressor for you or someone else, and so what we perceive as stressful may also change as we age or as we have more life experiences.
Regardless of the type of stressor that we're experiencing, our body responds in a very similar way physiologically, so although our psychological response may differ from one stressor to another, the physiological response follows these three phases of the general adaptation syndrome: alarm, resistance and exhaustion. And you can see those on the slide, but we'll talk about each one of these physiological stages in the next few slides, but first, if you need a primer on the parts of the nervous system and how they work together, watch this about 5-minute video that's included on the bottom of the slide. It should help you to understand these physiological changes in your body with stress.
The first phase of the general adaptation syndrome is alarm reaction, and here we're talking about a biological reaction that occurs in immediate response to a stressor to prepare the body for intense physical activity, and the simple goal here is protecting oneself against danger, and we call this the "fight or flight" response because it affects nearly every part of our body, and it's preparing our body for intense physical activity such as fighting or fleeing, hence the "fight or flight" response. And this response involves the autonomic nervous system, and specifically it uses the sympathetic part of that nervous system that you just learned about in the video, and this part of the nervous system controls our bodily functions that occur without conscious thought. This response also initiates changes in our hormonal system called the neuroendocrine system, and you can see in the figure on the right-hand side of this slide the many parts of the nervous system and the body that are involved in creating this fight or flight response. In the grey boxes you can see the response results in increased alertness, increased heart rate, increased conversion of sugar to glucose to provide the muscles with the extra energy they need for that intense physical activity, and all this occurs as an immediate response to a stressor that's created by the sympathetic nervous system. Alternatively, once that stressor has been removed or the person successfully deals with that stressor, the body tries to return itself to homeostasis, so the parasympathetic nervous system is activated and is responsible for the relaxation response.
The next stage occurs after the alarm stage if the stressor is not completely removed, so if you don't completely deal with that stressor, then initiated the alarm stage, then we move into this stage of resistance, but this stage of resistance can also occur in response to non-life-threatening stressors, and these are the stressors that we face most often, such as exams, job interviews, not having enough money, etc. And prolonged time in this stage of chronic stress can negatively impact our health. Now this response is mainly driven by the endocrine system and the activation of the hypothalamic-pituitary-adrenocortical pathway, or the HPAC pathway, and as you can see in the figure on the right, the beginning of this pathway is a stressful thought; for example, thinking about how you can't pay the rent this month. That stressful thought causes a series of events that eventually leads to the release of cortisol from the adrenal glands, and if the stress is acute, cortisol can help us. So if the stress is a short period of time, cortisol can help us prepare the body to deal with that stressor, but under chronic conditions, cortisol has negative effects on the body such as lowering immunity to disease, raising our blood pressure, increasing abdominal fat, and many other things you can read about in your text. And so, although you're not responsible in this class for knowing the intricate details of the HPAC pathway, you do need to know that keeping this pathway activated for chronic, long periods of time negatively impacts our health, and it's just one reason that we should try to minimize chronic stress in our daily lives.
The final stage of the general adaptation syndrome is the stage of exhaustion, and here this is where the body's resources are depleted. They can no longer keep up with that stress and try and manage or mitigate that stress, and so the body becomes fatigued, and this happens from prolonged exposures to a stressor that is not dealt with or not dealt with appropriately, and it can lead to increased susceptibility to illness. So this is a stage that you don't want to get to, and another great reason why we want to manage our stress.
The figure on this slide shows the negative impacts that stress can have within our bodies. Look at this list and then watch the video that explains some of the other negative implications of stress and the ways that we can manage the stressors in our own life to promote optimal health.
Because we know that stress can play such a big role in the health and wellness of our being, we want to be able to use different approaches to manage the stress in our daily lives, and so we're going to talk about three here that are included in your textbook. And these are kind of general approaches to stress management, but it's important to note that the goal of all three of these is to keep yourself at a healthy level of stimulation or stress, and so we want to have some stress—we're not trying to eliminate stress from our lives altogether—but the first of these approaches is called environmental engineering. Here we're really talking about controlling your stressors by avoiding them or, stating another way, changing your environment in ways that eliminate that stressor. So, for example, if you're stressed about your monthly finances and you feel that you're overspending, you could create a budget and give yourself a spending allowance each month to control that overspending, and ultimately to avoid the stress of not knowing whether you're overspending or not. So that's one example of changing your environment in order to avoid or eliminate that stressor.
The second approach to stress management is called mind engineering, and just as it sounds, it involves the reinterpretation of stressors in your life in order to reduce the intensity of a response to those stressors, and remember that response is really what's important. So, for example, instead of being fearful of speaking in public, you might think about each speech that you need to give as an opportunity to practice a skill that will be useful in a future job, and so although the experience might still be slightly stressful for you, this new way of thinking might make the stress feel less intense or more manageable.
The third approach to managing stress—and again, this is just a general approach—is called physical engineering, or also termed stress-fit, and by this we mean that it's easier to deal with stress when our bodies are healthy from participating in regular physical activity, and this occurs for two primary reasons. First, when we experience the fight-or-flight reaction, the excess energy and biochemical byproducts are circulating in our body, and physical activity can help get rid of those, that excess energy or those byproducts. Second, remember that physical activity also stresses the body; it's a stressor. We get the same physiological response from physical activity as we do from stress, but it's a good type of stress that can help you deal with future responses to other stressors, and we call this physiological reactivity, when increased cardiorespiratory fitness buffers some of the effects of the stress response.
There are many possible explanations for why physical activity has positive effects on mental health, and in the last few slides of this lecture we'll look at five possible mechanisms for this relationship, and when I say mechanisms I simply mean reasons why there exists a relationship between physical activity and mental health. And the first of these is cognitive behavioral theory, and so this theory really poses that as someone engages in physical activity, they feel more confident in their ability to continue to engage in physical activity and that they're in control of their own behavior, and these feelings of control and competence are really not compatible with the feelings associated with anxiety or depression, and so people think that that might be one reason why physical activity or exercise help to improve mental health. The second possible explanation here is the social interaction theory, and this is really just that physical activity might provide opportunities for social support and interaction with others that we know improve mental health, and so, as you can see here in the picture, there are several older adults stretching together, most are smiling, they're interacting in a positive social environment, and so you can see how that might ward off some feelings of anxiety or depression.
The third possible explanation is that physical activity provides a distraction from our daily worries or our stressful society. It gives you, in a sense, a time out from the things that might be stressing you outside of that physical environment. And alternatively, the repetitive motions of some activities such as cycling, walking, or even just regular breathing while you're being physically active may also alter your state of consciousness that increases your calmness or maybe reduces tension. And so physical activity, one potential avenue to improve mental health, is that it just provides a distraction from our daily worries or stresses.
The fourth possible mechanism is called the endorphin hypothesis, and this is probably one of the most popular things that you hear in the media, and the endorphins are simply body chemicals that are responsible for enhancing euphoria and providing pain relief. We know that there is this neurochemical reaction that occurs that increases about 20 minutes after physical activity has been participated in, but there's not much support for this theory because no one has ever shown a change in mood with the increase in endorphins. So yes, the endorphins increase, but we don't know if those endorphins are actually improving mood, and in fact some research shows that when you block the endorphin receptors—so you don't allow those endorphins to work—people still feel better after exercise, so this is probably not the most plausible explanation. And the final explanation here for the relationship between physical activity and mental health is the thermogenic hypothesis, and this is really all about body temperature and muscle tension, or muscle tension relief or relaxation, and this is the idea that the warming effect on the body reduces muscle tension. So by being physically active we're warming up our muscles, we're reducing muscle tension, and hence that's where the relaxation comes from to improve mental health. And so these are just five possible explanations for the reason that we see the relationship between physical activity and mental health.
Now we've talked a lot about physical activity, but physical activity is certainly not the only way to relieve or reduce our stress, and so the four relaxation techniques here are also helpful, and you can find much more information about each of these four in the text—how to use them, how they work— and you should read that part of your text very carefully.
And so I'll finish this lecture by leaving you with a quote from Ralph Waldo Emerson that shows the connection between our physical and mental health, and he said "Physical fitness is not only one of the most important keys to a healthy body. It is the basis of dynamic and creative intellectual activity."
