Life is an opportunity to experience joy, love and create. We’re also liable to suffer along the way, and the global pandemic has presented many challenges to emotional and mental health. Here’s what the latest research shows you can do to overcome depression, anxiety and other psychological problems.

When 5472 Danish citizens were asked to rank the severity of their own health problems, they rated depression and breathing problems the most unendurable.

Unfortunately, depression and anxiety are an increasing global issue. In Australia one in five of us were suffering a mental or behavioural health issue in the National Health Survey of 2017–18, compared to 17.5 per cent in 2014-15. Those struggling with both anxiety and depression rose 5 per cent in the same period. And, tragically, suicide claims the lives of more Australians between the ages of 15 and 44 than any other cause. The societal and economic dislocations associated with COVID-19 have only exacerbated the challenges.

Hearteningly, many also transcend and heal from afflictions of the mind, heart and soul. Todd Kashdan, a professor of psychology at George Mason University, Virginia, says this ability for many to thrive after mental health problems remains a blind spot in psychiatry. “Depression is sometimes far from being an inevitable death sentence. It can be a way station. In a surprisingly large number of cases, people move from the ashes of despair to flourishing,” he wrote in Psychology Today.

What is psychological and emotional wellbeing?

Leading American psychiatrist Dr Mark Goulston, author of Get Out Of Your Own Way and Just Listen, defines psychological wellbeing as being able to handle any upset, disappointment or adversity that the world throws at you without doing something destructive to yourself or the world. The most psychologically healthy tolerate exceptional levels of frustration, upset and disappointment, Goulston explains, because of an ability to look at a situation from another person’s point of view. But our psychological wellbeing is in a constant state of flux.

Goulston prefers the terms “stress management” or “psychological wellbeing” to “mental” health. The latter has become an alienating label, creating barriers to understanding and healing. “The word mental scares people,” he says. “Because of the stigma, it triggers avoidance, and as a result it [our health] doesn’t get addressed.”

What’s ailing us?

An article in Nature in May 2020 asserts that the framework for understanding our psychological problems is essentially flawed. People’s problems don’t fit into neat, prescribed, carefully partitioned categories. Instead, our issues overlap and shade into each other. Research in 2018 by psychiatrist Oleguer Plana-Ripoll found having any single psychological problem predisposes us to others, including those with completely different symptoms. It’s now hypothesised that the various manifestations of our problems might stem from the same root causes.

Most social scientists ascribe our emotional health to a melting pot of social, psychological and biological factors. What gets ignored too often are the social factors, Goulston says.

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Johann Hari, author of Lost Connections, travelled the world interviewing top researchers on the topic, and believes most depression and anxiety stem from our lost connection to meaningful work and values, status and respect, relationships, nature and a hopeful future. “Just as we have physical needs, human beings have natural psychological needs,” Hari says. “The culture we built is good at lots of things, but there’s good evidence we’ve been getting less and less good at meeting these. What the best evidence shows is: your depression is not a glitch. If you’re depressed or anxious, you’re not weak; you’re not crazy; you’re not a machine with missing parts. You’re a human being with unmet needs. And what you need is love and practical support to get those deeper needs met. Your pain makes sense. It’s a normal response to an abnormal situation, is how Viktor Frankl [author of Man’s Search For Meaning] put it. Because we’re living in an abnormal situation, it’s becoming increasingly normal.”

Hari views distress as a warning. “Distress is necessary. It’s the signal that something is wrong. We should be listening to the signal and respecting and honouring it, because it’s telling us something we need to hear.”

The sum of your whole body

Your emotional and psychological health exists deeply entwined with your physical wellbeing and should be taken just as seriously. Depression and anxiety can, research proves, weaken your immune system, constrict blood vessels, impair memory, cause inflammation, headaches, weight fluctuations, breathlessness, gastrointestinal upsets and more. Emotional pain is linked to a greater risk of disease — from the flu to heart problems and dementia.

The reverse happens. People with chronic health problems often experience depression and anxiety as a side effect, a consequence of living with a serious health problem and/or because it alters body chemistry.

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While your genes and biology can make you more prone to psychological afflictions, Hari found they don’t write your destiny. “Genes interact with the environment. There are real changes that happen in your brain where you become depressed and anxious that can make it harder to get out, and that’s why you need more love and support when you’re depressed and anxious, not less.”

Neuroplasticity, though, means psychological problems aren’t hardwired. “Your brain is constantly changing,” he says. “Just because it changes in one direction doesn’t mean it can’t change in the other.”

Address hidden organic causes

In a 2011 book, Unmasking Psychological Symptoms, Harvard psychiatrist Barbara Schildkrout suggests physical medical complaints may be the true cause of up to 25 per cent of mental health issues. These include sleep apnoea, thyroid problems, Cushing’s disease, chronic infections, side effects of medications, Alzheimer’s, blood sugar disorders and overexposure to pesticides, chemicals or heavy metals. A routine physical medical examination can help rule out any organic, physical causes.

Connect positively with yourself

Sadly, our competitive society is good at making you feel inadequate, out of touch with your unique self and what matters to you.
At a minimum, you should aim for self-acceptance, Goulston says. It’s making peace with the fact you’re not perfect; accepting parts of yourself you feel ashamed of. If you’re having difficulty with self-love, he suggests Jungian “shadow work”, which involves accepting those dark traits of personality we all have.

Sometimes the negative self-talk comes from within, such as when we’re too perfectionist. All too often it’s a result of abuse. The Adverse Childhood Experiences Study shows traumatic experiences in childhood highly predict the risk of depression, anxiety, physical health problems and suicide in adulthood.

Hari says survivors commonly internalise the voice of the abuser. “If you’re given opportunity to reduce the shame around your abuse that has a huge antidepressant effect.”

Social connection

“There’s a huge amount of evidence that loneliness is connected to depression,” Hari says. “Humans evolved to live in a tribe. We are the first humans ever to disband our tribes and imagine we can do it alone, and it makes us feel terrible. We are the loneliest human society in human history.” More than one in five Australians in a 2018 survey claimed they rarely or never have anyone to talk to or turn to.

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Dan Schawbel, author of Back to Human, believes that over-reliance on technology to communicate plays a huge role in the rise of loneliness and emotional problems in the young. “While people get these dopamine hits every time they connect with people virtually, that is no substitute for a true human interaction you would get in person,” Schawbel says. He suggests maximising every aspect of your day to be social, and views the loneliness crisis as a mutual social obligation: “It really takes all of us to support each other through this.”

A 2018 study shows the happiest folk are those with the highest social capital and social support. Joining one social group reduced the risk of depression relapse by 24 per cent (by 63 per cent for three groups) in a University of Queensland study.

Support

According to Goulston, there’s a neuroscience behind why having someone listen to our problems is healing. “When we are under stress our cortisol goes up, and activates part of our emotional middle brain called the amygdala. When over-activated, it hijacks us away from being able to think through reality, into a primitive fight or flight mode.”

The antidote to cortisol is oxytocin, Goulston says. It’s the “love” hormone triggered by positive warm interactions and skin-to-skin touch, and related to feelings of wellbeing, anxiety reduction, bonding and closeness.

Goulston suggests writing down the qualities of people we look forward to seeing on the left side of a sheet of paper. On the right side, write down the qualities of people who take energy away from you and those you may be putting up with. “Keep these top of mind, so when you meet people, and you get a sense that they have the qualities on the left side of the sheet, commit yourself to developing a relationship with this person.”

Counselling offers another means to get the support and guidance we need.

Zen acceptance

In The Subtle Art of Not Giving a F*ck, Mark Manson promotes a Zen-like acceptance of life’s downs and our own imperfections. He blames the information explosion for bombarding us with unrealistic expectations and desires that create discontent and comparison that’s bad for your emotional wellbeing. “Our society today, through the wonders of consumer culture and hey-look-my-life-is-cooler-than-yours social media, has bred a whole generation of people who believe that having these negative experiences — anxiety, fear, guilt, etc — is totally not okay,” he writes.

The thought process he suggests is detachment from the myth we have to be awesome all the time. Manson is scathing of the self-improvement and positive thinking movement, which he says emphasises our perceived shortcomings.

Meaningful values

“Everyone needs a scripture to guide to them through life,” Hari says. “And ours has trained us to look for happiness in all the wrong places. We’ve been given a system of meaning that doesn’t make us feel good and at some level we know that. Just like junk food has taken over our lives and made us physically sick, junk values have taken over our minds and made us mentally sick.”

The research of Professor Kasser (one of Hari’s interview subjects) showed that the more one derives meaning from money and status the more likely one is to become depressed and anxious.

The psychological literature suggests that “belongingness” is associated with a greater sense of meaning. Those who believe their lives have a purpose cope best with loss, stress or trauma.

Contribution

It seems you are wired to contribute to something beyond yourself. Goulston, one of the world’s foremost experts on suicide prevention, says despair and disconnection underpin why people take their own lives. “If you break the word down, it means feeling unpaired — so unpaired with the future is hopeless; unpaired with the ability to help yourself is helpless, powerless, meaningless, useless, worthless. And, finally, you pair with pointless. When you feel unpaired with all the reasons to live, at the same time you pair with death to take the pain away.”

Goulston has a remedy for that. It involves small, achievable ways even the most burdened can gain a sense of contribution — anything from asking strangers about their day to leaving messages of encouragement for others. He sometimes gives clients expressing worthlessness snacks to give to homeless people. After a week of doing this, nearly all of them report feeling better.

Gratitude and forgiveness

Regular gratitude and forgiveness practices support your psychological wellbeing, Goulston says: “You can’t be grateful and disappointed at the same time.” Forgiveness helps you let go of pain, anger and grudges, he says.

He prefers gratitude to positive thinking, which doesn’t work for everyone and can be used at others’ expense as a kind of “thought control”. Faking it can also make you feel alienated from yourself and others.

High hopes, zero expectations

Hope is an underestimated and powerful cognitive process, attitude, belief and emotion. Research backs it, showing hope is highly related to emotional wellbeing and positive outcomes.

However, “false hope” (unrealistic expectations based on fantasies) can be counterproductive. The attitude you want to cultivate is one of high hopes for everything but zero expectations, Goulston says. “As soon as I have an expectation I start to count on it. And if I’m counting on it, that sets me up for when it doesn’t happen to suddenly fall apart.”

Leading hope theorist Rick Snyder defines hope as the perceived capability to find and use pathways to desired goals. Snyder’s research found hopeful people have a clearer vision of their goals and a mental map of how to get there. When blocked, they look for an alternative route to their goal.

Faith and a spiritual champion

Research consistently proves those with an active spiritual practice tend to be happier and better able to cope with adversity than those without. The emphasis here is on the word “active”. In a global study, 45 per cent of actively religious Australians claimed they were “very happy”, compared with 32 per cent of the inactively religious and 33 per cent of the unaffiliated. Researchers attribute this difference to the rewards of social capital.

Whether it’s God, Krishna, a guardian angel or your dead mother, Goulston says imagining someone who cares deeply about you triggers a surge of oxytocin. Further benefits of a faith, include positive emotions like hope, a sense of worth, control and meaning over life, and behaviours like altruism, suggests a research review in the journal ISRN Psychiatry.

Movement

Regular exercise has been found to be as effective as antidepressant medication. It’s suggested you do at least 30 minutes of moderate exercise most days of the week.

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According to Beyond Blue, exercise helps boost your mood through the release of endorphins, hormones that activate opioid-like receptors in your body, producing euphoria, and serotonin, a neurotransmitter associated with happiness, alertness and calmness. Exercise also increases circulation to the brain and your sense of control and self-esteem, improves sleep and energy and offers distraction and potentially companionship if you’re exercising with others. According to scientists involved with the “Why Travel” project, human brains are wired, in an evolutionary sense, for movement and sunlight.

Nature connection

So, if you can get your exercise outdoors, even better. A growing body of evidence shows stimuli from the natural world — whether it’s paintings or views of nature, to the forces of fire, weather and nature’s associated sounds and scents — does wonders for your emotional wellbeing. Eco-psychologists attribute this to the fact we evolved in the natural world.

In various studies, green spaces have been shown to reduce symptoms of a range of problems including attention deficit and hyperactivity problems, depression and anxiety.

The sun

Among the most convincing evidence of a relationship between mood and sunlight comes from the work of Dr Normal Rosenthal, who discovered seasonal affective disorder (SAD). According to Rosenthal, SAD, which causes a depressed mood, can occur in any condition where susceptible individuals don’t get enough light, including working indoors.

Studies show that sunlight exposure and light treatment can decrease symptoms of depression, bipolar, postnatal depression and premenstrual dysphoric disorder. Sunlight exposure boosts serotonin production and is key to a healthy sleep/wake cycle.

Sleep

Poor sleep makes you feel less equipped to cope mentally and physically with your day. So it’s unsurprising that, according to one study, insomniacs have a 40 to 46 per cent likelihood of suffering from a psychological problem compared to 16.4 per cent of sound sleepers. The relationship here is bidirectional: being depressed or anxious also produces a lousy sleep.

One of the biggest studies to address this chicken and egg issue, the OASIS trial, found helping university students sleep better reduced the severity of their mental health symptoms. It’s believed prolonged sleep disruption alters brain activity and chemistry.
The National Sleep Foundation recommends adults obtain seven to nine hours of sleep a night.

Meditation

Along with enhancing sleep, regular mindfulness meditation has been shown to reduce depression and anxiety problems including extreme panic.

Goulston says mindfulness works by taking your awareness off your pain. “It gives people something to focus on and a big part of this is your breathing,” he says. “Just doing that can be calming.”

Mindfulness meditation also changes our brain. Harvard Medical School research suggests the practice increases the density of many parts of the brain, including those associated with empathy, perspective taking and emotional regulation. Meditation also decreases the amygdala (which processes intense emotions like fear and stress and plays a role in the fight or flight response). Changes were found in participants after eight weeks of meditating 40 minutes daily.

Psychiatric nutrition

When you’re troubled, you’re more likely to eat poorly. However, a world-first trial by Deakin University suggests a good diet is as integral to your mind and mood as it is to the rest of your body. In 2017, Deakin’s Food & Mood Centre found a third of participants following a prescribed healthy Mediterranean diet for three months had remission of depression symptoms compared to 8 per cent of those in a social support group.

A number of studies have noted deficiencies in specific nutrients in people suffering psychological health issues. Commonly implicated deficiencies include omega-3, vitamins B and D, minerals including iron and amino acid precursors to neurotransmitters. Deficiencies and low-quality diets high in sugar, processed carbs and unhealthy fats are increasingly being seen as a significant element in bipolar disorder, depression, psychosis, anxiety disorders and ADD/ADHD.

Also related to diet is the observation by Dr Richard Mackarness (author of Not All in the Mind) that some people’s psychological health symptoms stem from food allergy, in particular coffee, white flour, milk and eggs.

Herbal medicine

Historically, herbs have been used to treat anxiety and depression and boost the nervous system. A literature review by the Cochrane Collaboration of the most well-known antidepressant herb, St John’s wort, found it comparable to antidepressant medication.

Balancing self-care

Ironically, “self-care” has become a burden and hard-won success symbol. In the Stress and Wellbeing in Australia survey in 2015, 40 per cent said trying to maintain a healthy lifestyle caused stress.

In its truest sense, self-care is paying attention to your daily needs as a human being. It’s getting enough sleep, eating properly, sharing your problems with others, doing whatever makes you happy and keeps you sane.

In reality, most of us struggle to find me time. People who’ve achieved balance suggest monitoring the thermometer of your emotions, making happiness and self-care non-negotiable and cutting the chaff from your life.

Life-changing habits

In Make Your Bed: Little Things That Can Change Your Life … And Maybe the World, Admiral William McRaven recounts how habits and attitudes he learned as a Navy SEAL prepared him for life. It’s the small stuff, repeated on a daily basis that creates the sum of your life. Many habitual patterns — like procrastination, eating on the run, inactivity or overusing social media — don’t serve you long term.

Knowing a behaviour isn’t good for you isn’t enough to make you change, Goulston says. “Because it becomes an addiction.” A better alternative is to replace it. “There’s an expression, we always guard our calendars. So, calendar it in.”

He recommends self-rating your happiness daily on a scale of one to 10. “Pick at least one thing that contributed to your happiness and one or more to your unhappiness. Calendar in going for a walk if that’s that one thing that made you happy.”

“Think of the times you have had mental or psychological wellbeing challenges and what worked for you before,” he suggests. There’s hope from knowing, “I’ll get through this, because I always have,” he says.