MENTAL HEALTH. Its true meaning.

So before I start harping on, I have a few questions.

  • What is the first thing that enters your mind when you see or hear the words mental health?
  • Why are they so powerful?

When you come across those words I bet for the majority of people that if we played ‘word association’ we would be greeted with a whole range of negative words, negative perceptions, and for some, misconceptions about its meaning.

It is interesting that mental health – two words that affect every person on Earth have become so feared. Unnecessarily I might add!

  • If we were to play ‘word association’ with physical health, would your answers be any different? How about if we say social health?

I have been wanting to write about mental health and mental illness for a while because there are (in my eyes) big issues around the wording and terminology we have in our society. And not just with these, but with many other words associated to health and wellbeing every single day. Before I go on it is really important I point out the difference between mental health and mental illness.

Mental health ‘is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’ WHO. Mental health is something we all have, it can be both good and also not so good. And it moves, it changes, we may have ups and downs with mental health the same as we might with physical health.

Mental illness is ‘a condition that impacts a person’s thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis. Each person will have different experiences, even people with the same diagnosis.’ –NAMI.

So I thought I would do a poll, my own little social experiment of word association and the responses were albeit very honest, but a reflection of how culture and society has led to us having a big misconception and lack of understanding of the word.

Some responses included;

Stress, depression, illness, fear, weak, not enough support, unstable.

How does this happen?

Why are we so drawn to negatives when talking about these words? And for those who clearly saw the tweet and status but didn’t respond, why didn’t you? Was it through fear of being associated with it? Was it because you don’t think it matters to you? Was it worry over whether you said the right/wrong thing?

I am fascinated with how this has become such a misunderstood term.

Let’s talk physical health. Everyone has physical health, one might have an accident and chronic pain, that required treatment and management but is (for many conditions) treatable. One might have a cold or flu, a little bug and physically feel unwell, but then a few days later and a small intervention i.e. antibiotics etc and they get better. We accept this in society because it happens to everyone right? We have all felt a little poorly at times, probably all visited the doctor or gone home for some tlc, and that’s fine.

We also have a HUGE boom in culture around physical health and working to get active, improve physical health both from government and health agendas but also social media getting involved. Crossfit gyms, personal trainers, various walking and exercise groups, Instagram pinterst and other social media platforms getting involved and suddenly it is cool to look after and work on physical health. Because at the end of the day, a good active balanced lifestyle has an impact on long term physical health right?

So why the hell aren’t we doing this with mental health?

We understand that physically, certain foods, exercise and/or physical activity, sleep, limited alcohol etc are all protective factors, they look after our physical health and have been proven to prevent the onset of many health conditions.

So with our mental health what can we do? It is NO DIFFERENT!! I find it very frustrating both professionally and personally. I have always, since the day I set up my company, tried to encourage the proactive side to our work. Yes, there is a place for a reactive service. But there is an even bigger place for PREVENTION, being PROACTIVE, and actively looking after our mental health.

The protective factors link in with physical, social and financial health. They can be as simple as;

  • Getting enough sleep
  • Getting sufficient daylight
  • Having quality time with friends and family,
  • Making the time to do your hobbies and have some time for you.

It isn’t rocket science, but we don’t always encourage them and we certainly don’t prioritise them in our own lives.

I don’t think it is always a lack of education or awareness, because we all know ourselves more than anyone else could. Sometimes we may need the support of others to identify them and put these factors in place, but I think the real issue lies with society, our culture. The fact that we go around cringing whenever we hear those words, we try to avoid engaging in those conversations in case somehow we get tarnished, or draw attention to ourselves. When actually what we need to do is start talking more; not about mental illnesses, but our own mental health. We see so many posts and pictures on social media for completing a big walk, hike or run, why don’t we do it when we have done an hours meditation? Or had an hour to self reflect? Why don’t we talk about our own mental health more to actually promote this aspect of health.

We need to stop being scared of these words and realise them for their true potential. Our mental health is fundamental and an essential part to our overall wellbeing, so why don’t we start acting like it! We know we can promote and improve mental health, the same as we can physical health, so let’s make a conscious effort to break down those misconceptions and start putting us first. We do that, and slowly we’ll start to change that unhealthy culture and have an environment where mental health is being talked about and prioritised the same as a person’s physical health.

I am going to kick start this off by leaving my own statement about my mental health;

‘Today I am going to spend some time at my allotment. Because my brain needs a rest and the fresh air always makes me feel better. And for me this a really important part of maintaining my own mental health’

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An athlete’s story: Clean eating and intense training– where do we draw the line?

I’m writing this blog today not as a professional in mental health, not somebody who offers emotional support nor as a therapist but for the rare occasion, as myself in the role of athlete. This is a topic close to my heart because I have seen the effects of over training and food restriction take hold of those around me but I have also experienced areas of this myself across my teenage years and even to this day …

Elite sport is a very unique culture, performance is key and in order to achieve that level of excellence people’s standards of wanting perfection in everything from physical attributes, conditioning, aesthetics through to our personality types are extremely high! So, in a world where this is the norm how do we know what is healthy? How do we know when we are within a healthy zone of training, eating and performance culture without crossing that line in to routine, obsession and unhappiness? And beyond that in to eating disorders and further mental health issues?

I guess the real answer is that for most, we probably don’t! Not least until we are caught in that cycle and experiencing these things for real! You will find much research in sport discussing the importance of good nutrition, there is of course evidential backing for clean eating, fuelling your body efficiently and ensuring our ‘machine’ – our only vessel to execute greatness in sporting domain is appropriately fuelled! Likewise, with the training in order to achieve the very best standards in sport (regardless of the sport) you will find hours of practice, dedication, rehearsal and conditioning are essential to meet the mark – rest and recovery of course being just as important in that!

Now with the amount of sport science involved in sport these days athletes are very well looked after in these respects, we can trust in the team around us to provide us with the information, programmes and support to achieve these high standards. However, to follow such routine takes a certain type of person…

Somebody said to me once when I was a young athlete ‘in order to make it in sport, you have to have an element of craziness about you’, now at the time I didn’t understand what this meant. But years on, through many or the usual ups and downs of sport, more understanding of the sporting culture and greater self awareness in knowing my own habits I realise they were fairly accurate! That’s not to say I’m crazy or those around me are crazy, but I realise that there is certainly an element of obsession, addiction, routine and perfectionism that comes with the territory of making it in performance sport.

What can start as a routine and merely ‘following the programme’ quickly becomes your world, your whole world starts to revolve around the sport, the eating and the training you do … but that’s normal isn’t it? Because you have targets to meet? Goals to achieve? And this is only way to get there?!?!

In some respects those goals keep you going, they motivate you and inspire you to keep going, keep pushing and striving for perfection. One of my favourite quotes was given to me by my father (an ex international rugby player himself) and that was ‘by aiming for perfection we can reach excellence’. This has almost become my own motto – but in my training for big competitions where I stuck to training religiously and clean eating, no drinking, no going out, routine and discipline in everything I did, it quickly started to turn to something else….

Although training brilliantly in the gym and feeling great physically, there came a point where I noticed starting to feel unhappy about following the plan for myself. I envied those around me indulging in what they wanted, I couldn’t allow myself to have that treat or cheat meal in fear of the guilt that would follow, I never wanted to break the routine because id set myself a target and if I didn’t follow it through till after competition that would meant I failed, I would have lost, I would have done myself an injustice.

Now my reasons for this structure was certainly not weight based!!! And in reality I was very rational in that I knew I was never going to suddenly put on lots of weight or my performance suddenly dip – it was purely the target and expectation I had set myself. But that wasn’t the driving force for me…

Wanting to go in to big competitions knowing I had done everything I possibly could to be the best I can be, that was my motivator – that has always been my number 1 motivation in everything I do. ‘TO BE THE BEST ME’ not to look back and think I could have done any more.

So how do we break the cycle? I guess for me, as somebody who experienced over training as a teenager I know my signs and indicators a lot better. I can recognise that there is a difference between what is needed and what I want, I know my body a lot better. I know when I can push it but also when I need to rest. I can recognise when that need for excellence is starting to become more of an obsession than a lifestyle.

For me, a healthy mind is a healthy body – I have always been a strong advocate of this message not only because of the research available but because I feel it myself! I follow a healthy lifestyle, I sleep well, I don’t drink very often, I eat well and make good food choices and I also work hard in the gym. As much as I love to feel great inside and out from this choice of lifestyle I can also now see that times where I am really craving rest, something different, spontaneity of eating whatever I fancy, having a drink with a meal etc it is probably because I need it. And that’s ok!

I have learnt that actually I feel much happier by following that lifestyle but allowing myself to enjoy things around me and the things I crave. I always think that being rational, having perspective and also just enjoying life, and allowing yourself to be happy helps with making these choices…

There is so much pressure on athletes to look and be a certain way, so much media attention around lifestyle, fitness and clean eating that images and advice surround us everywhere we turn. But there are two rules people all need to follow when taking on any of these lifestyle changes;

  1. Each person is different, you have to learn what works for you, what you want, what your body needs and also your mind needs, emotionally where do you sit with all of this?
  2. You have to be happy! If you aren’t happy then is it working for you?

Life is far too short not to be happy and I know for me my performance is crucial, clean eating is important as is my training but ultimately if I do all of those things and aren’t happy along the way then that’s the failure. The failure and injustice isn’t in skipping a session to rest, having that lie in, or eating something bad, the failure is depriving my body and mind of things I want, the things I need and I now realise that by actually by doing that from time to time it helps me keep a good equilibrium. I am able to sustain an all-round healthy lifestyle, one that is disciplined, positive and performance based – not robot like!! Most importantly one which fits me!!!!

Gender Roles, Sport and Wellbeing … the link!

When you look at traditional, old-fashioned gender roles in UK society you might think of women as the house wives, the carers, nurturers, the stay at home and care for the young types….wear their heart on their sleeves. For men, you might think of the bread keeper, the ‘man of the house’, protector and provider of the home. Turns out that despite us now being in a very modern 21st century world these stereotypes in gender roles may not have moved on that far!
Turning our attention to sport, how do gender roles play a part? Do they exist?
Recent studies suggest that they do exist and are very powerful in both stigmas, conformity and individual wellbeing! Within sport there are clear gender norms of what is socially appropriate for males and females, these are known to add pressure on the athlete socially and emotionally. The male athletes’ ‘social norm’ might suggest that they are expected to take part in risky behaviours such as binge drinking, sexual promiscuity and aggressive behaviour (Liu and Iwamoto, 2007). Now, we understand that the modern man may not want to behave that way; more that they may want to take time to be with their family, actually show their emotions to others and be the ‘model athlete’ – clean eating, no substance misuse and a very hard and focused work ethic with their training. So what happens if you’re a male elite athlete and you suddenly find yourself in a team where these older masculine gender roles exist? First, let’s have a look at how females are affected by gender roles in sport!
The issue found with female sport is existence of the older stereotypical ‘femininity’ norms (Mahalik et al, 2005). But the difficulty for females lies not necessarily with these normal themselves but within the contradictions that exist between that and the reality of elite level sport. For example to be successful in sport a female athlete would need to show what are typically masculine traits such as competitiveness, aggressiveness and toughness (Beal, 1996) whilst also maintaining their femininity by displaying attractiveness, heterosexuality and maintaining relationships with others. These conflicting themes are not only confusing for the athlete to understand but they are difficult to achieve and cause further issues with self-esteem, physical health, interpersonal relationships and the onset of further mental health problems. Evidence from studies such as this found that females trying to conform to these norms either showed symptoms of, or had current eating disorders and deep issues around their body image (Green et al, 2008).
….So coming back to my earlier question – what happens if you are the athlete in an environment where these gender norms exist? Do you ignore those norms and live your life as you wish risking your social inclusion and acceptance of the team? Or do you conform to the group and the gender roles in place knowing that it will make you unhappy and may even affect your relationships with those you love and your own health?
Sadly although we understand that these gender norms are old-fashioned, out of date and a detriment to the athlete they do still exist and they are very powerful. Especially in the experience and fear of social stigma for those who wish to deviate and actually live their life as they please embracing their own norm as opposed to societies.
But how does that really impact on health and wellbeing longer term? Previous blogs by us describes the prevalence of mental health issues in sport generally, but also emerging from this literature is the relationship between gender roles and wellbeing. Good and Wood (1995) found that male athletes who felt the need to conform to gender roles appeared to hold negative attitudes towards support services because ‘real men’ have control over their emotions, are powerful and have a better self-reliance therefore there is no need to access support. This was also supported by the findings of Addis and Malik (2003) who found similar differences in attitudes and a underutilisation of services within the male athletic population. Alongside these perceived gender roles, the athlete’s level of openness also has an impact on attitude formation and uptake of services. Generally speaking individuals who are more aware of their emotions and more open to the idea of counselling are more likely to access the support (Vogel et al 2007) but gender differences have also been found within levels of openness within the population. Women are found to have more favourable attitudes towards accessing mental health support than men (Fischer and Turner, 1970; Leaf, Bruce, Tischler, and Holzer, 1987). This is supported by Komiya, Good and Sherrod (2000) who also found that female athletes have a higher level of emotional openness, a more positive attitude towards mental health support therefore experience less self stigma and are more likely to access such support. Population because of perceived gender roles, claiming that ideologies and masculinity were the main causes.
Norms in society will take some time to change, but so long as media and the individuals in those sports teams continue to reinforce them they will never change and catch up with the real world! Female athletes can be both competitive and aggressive but remain beautiful and great nurturers at the same time; male athletes can be strong and successful without taking part in risky behaviours or being promiscuous.
The more these conflicts exist, the more we risk the wellbeing, health and performance of our athletes so let’s open our eyes to the changes in sport, society and the 21st century. Let’s embrace each athlete for who they are and rather than drag them in to the grey of the majority let’s push them and their individuality in to the limelight to celebrate their differences.

Athlete Wellbeing

We hear the word ‘wellbeing’ being used more and more, but do we really understand what it is? How this relates to our athletes? I would hope that this blog provides a brief insight in to wellbeing and begin to broaden our perspective on the factors affecting athlete wellbeing at elite level.

  Wellbeing is a term more commonly used within discussions around general health and happiness. Bouchard and Shepherd (1994) describe it as ‘positive physical and emotional wellbeing with a high capacity of enjoying life and challenges, and possessing adequate coping strategies in the face of difficulties.’ Robertson and Cooper (2011) state that the term wellbeing is a combination of a good level of physical, social and psychological wellbeing’.

  On the most part wellbeing in sport seems more focused on psychological wellbeing however; there should be an acknowledgment of other factors that may impact over all wellbeing such as physical and social factors. In a diagram designed for the ‘Wellbeing’ Book by Robertson and Cooper called the ‘The Three Components of Wellbeing’ they attempt to demonstrate how these factors interlink. For example, ‘psychological wellbeing in the workplace’, in this instance professional sport we would expect a positive attitude, ability to handle stresses and feel a sense of purpose. The physical wellbeing at work would involve sleep and relaxation patterns, energy levels/fitness, smoking and alcohol reliance. Finally the social wellbeing aspect is having a positive and supportive network around the individual. They would argue that having these three positive avenues of wellbeing in place, individuals will have an overall positive wellbeing and be successful in their work places.

  Personality is an aspect of wellbeing which isn’t always acknowledged but some believe to be partly responsible for an individual’s level of happiness. The ‘Big Five’ personality factors are widely acknowledged as being 5 crucial aspects of personality; these include openness, conscientiousness, extraversion, agreeableness and neuroticism. Personality factors are only partly inherited, but in studies conducted by Weiss et al (2008) they found how crucial genetic factors were for levels of personality and the impact personality factors had to individual wellbeing, i.e. low levels of neuroticism/emotional stability has a positive effect on wellbeing. Although predetermined by genetics, it is not necessarily defined for life as an individual’s behaviours, learning experiences and surrounding also have an impact on personality and wellbeing factors and so always room to improve wellbeing.

  Biddle et al (2002) also comment on the impact of exercise to wellbeing and how regular exercise can actually reduce the symptoms of stress, anxiety and improve physical health. The Department of Health White Paper (DOH, 1999) targets mental health as an area of health to be improved – exercise being one of the key factors to help improve psychological wellbeing. Caspersen et al (1985) define exercise as ‘body movement produced by skeletal muscles and planned structured and repetitive bodily movements’. And whilst nationwide initiatives attempt to promote active lifestyles to improve wellbeing in the population many people associate exercise with being unpleasant and hard work, therefore are reluctant to engage. During much of the research surrounding wellbeing benefits from exercise it is worth noting that many studies involve and discuss exercise as low intensity, enjoyment based exercise as opposed to the intensity level and commitment required for elite sports people. Bouchard and Shepherd (1994) also acknowledge that exercise within competitive sport is not covered within the context of psychological wellbeing but more just the wider benefits of physical health in the community.  This is an interesting thought as it opens opportunity for studies to focus more on elite level sport and the impact this intensity of exercise has on athlete wellbeing.

 

  In summary, wellbeing is better known as being an umbrella term to cover social, physical and psychological health – with these three aspects closely linked to one another. Therefore, it is important for professionals involved with elite sport to understand that physical health (ie. Injuries/illness) may affect psychological health, social factors i.e. contract negotiations, moving clubs, or relationship difficulties can have a physical and psychological impact on the athlete and so on; as professionals we must open our minds to all facets of wellbeing in order to reach an appropriate diagnosis and to provide the best possible care for the athlete.

 

 

Perfectionism and its role in Athlete Wellbeing and Help Seeking

Perfectionism and its impact on wellbeing

Many believe that personality contributes to the way people perceive stigmas and their level of openness towards seeking psychological help (Miller, 2008).  Perfectionism is a facet of personality which may have both positive and negative consequences however; most research only focuses on its negative effects (Saunder, 2009). A broad definition of perfectionism is an ‘individual who displays a very high ambition for exceedingly high standards but also experiences harsh self-criticism’ (Frost, Marten, Lahart, & Rosenblate, 1990).

One might argue that in sport being a perfectionist is positive because of their desire to achieve, high motivation levels and always looking to improve or better performances (Saunder, 2009) However, it is because of those high standards; sometimes maybe unachievable standards, that they experience a lot of self criticism and low self esteem when targets aren’t met. Therefore research has found high co morbidity with mental health issues; typically depression, anxiety and eating disorders (Egan et al, 2010).

The difficulty with perfectionism is that it carries many admired characteristics as well as negative, Hill et al (2010). For example, the pursuit of high standards would be a very positive trait to carry particularly in sport where the focus is often on self improvement. However, on the other hand perfectionists also tend to have a preoccupation with harsh self criticism which may impact on wellbeing and therefore is associated with psychological imbalance (Hill et al, 2010)

Within sport the term ‘burnout’ is often used; in performance terms it would be characterised by experiencing physical and emotion fatigue, a reduction in their feeling of accomplishment and feeling undervalued (Raedeke and Smith, 2001). Raedeke and Smith also recognise the interplay between burnout and psychological effects, i.e. wellbeing; explaining that individuals at burnout stage may also experience symptoms of anxiety and depression, with perfectionism being a key contributing factor. Jowett et al (2013) found that perfectionist athletes have a very high motivation and drive to succeed and avoidance style of coping. Therefore, seeking help or admitting they need support would lower self esteem and be an admission of weakness contributing to them trying even harder. In time, this potentially leading to burnout – or in this case, further mental health issues.

It is believed that certain personality traits are key contributing factors in the development of burnout and psychosocial distress experienced by athletes (Hill et al 2010). Hill goes on to explain that these personality factors can influence the athletes appraisal process and encourage a vulnerability to experience high levels of anxiety and pressure (Hall et al, 1998) Perfectionism for example can be associated with negative cognitions surrounding achievement and performance
therefore lead to further negative thoughts, increases in anxiety and decrease in wellbeing, what is interesting now is evidence suggesting that perfectionism may act as a predisposing factor to athletes developing burnout during their athletic career (Hill et al, 2008).

Perfectionism and its Role in Help Seeking

Alongside the role perfectionism appears to play in athlete wellbeing, it is also interesting to consider what role it may play in athletes then taking up additional support, or in this case, counselling.  Endler and Parker (1994) describe how there are two methods of coping, problem focused coping and avoidant coping. The two methods are set within the management of stress and attempt to explain the various ways individuals may perceive and effectively then manage their stress. Problem focused coping would be a more pragmatic and analytic approach where the cause of stress is identified followed by a series of steps of how to overcome, these are then practiced. So in effect this is an active coping approach.

Avoidant coping is exactly as it sounds, an individual who either acknowledges the stress exists and so is in denial, or loses interest or the motivation to combat it so they lower their efforts to overcome and simply allow the stress to take hold. Using these approaches to coping and it is interesting to link them back to perfectionism because how they interplay in an individual could be very different. On one hand there is the ‘problem focused’ person who may recognise they simply cannot manage alone and due to their perfectionist traits of self improvement and wanting to get better actively take up support. Or, the avoidant approach where although carrying the desire to improve the individual feels that the uptake of support is an admission of weakness therefore refuses to acknowledge the problem exists and may almost live in denial of the problem. What is interesting is that using the motivational factor of self improvement in perfectionist athletes we can see that there are still different approaches to how these individuals then choose to improve their situation and as with anything it is still up to that person whether or not they choose to engage in the help provided.

In terms of perfectionism and wellbeing, whilst for sport perfectionist traits are useful and desirable the constant striving for better and harsh self criticism when perfect performances aren’t obtained can have a real impact on physical health through over training and disordered eating and also psychological health of low self esteem and depression (Egan et al, 2006). As for the role of perfectionism and help seeking, what Endler and parker (1994) go on to explain is that is very much depends on the individual and the type of coping style they adopt. For some, perhaps those more open and self aware the use of an expert may be seen as a way of self improvement and reaching those goals, for another though it may be an admission of weakness and confirmation that they are struggling therefore an isolated and more self problem solving approach would be used (Endler and parker, 1994).

So, do you know your athletes? Are you able to identify which athletes have perfectionist traits? Do their perfectionist traits benefit or hinder them? Is support available and normalised so all athletes feel comfortable enough to access?