The Challenge of Promoting Wellbeing

A study in Nature Human Behaviour published this week shows promise for mindfulness and positive psychology to improve mental states of wellbeing. (https://www.nature.com/articles/s41562-021-01093-w).

I was invited to discuss the findings on the Morning Show today with TV3 in New Zealand. We asked viewers if they practiced mindfulness. While 30% answered YES, 50% NO, another 20% answered “what the heck is mindfulness?”

Thus, 70% disengaged.

The host, Duncan Gardner, dismissed the interview with “See you next year.” Viewers really learned nothing about this important, yet flawed study. The interview is available at 46 minutes into episode on 20 April 2020.

In a nutshell, a systematic review and meta-analysis of 419 randomised and controlled studies involving 53,288 people showed low to moderate impact. Mindfulness-based and multi-component positive psychological interventions showed some efficacy in clinical and non-clinical populations.

Singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based and reminiscence interventions were impactful.

Read those last two paragraphs again. Do they make sense to you?

The Promise

The suffering caused by physical, emotional and mental distress in our modern time is enormous and increasing. Thus far, the impact of psychology, psychiatry, medicine and pharmacology has been limited and confusing. The incidence of common conditions such as depression, anxiety, attention disorders and Autism continue to increase alarmingly.

As humans confront the changing environments we have created, we are failing to adapt. Despite massive investments, preventable physical, emotion and mental conditions continue to accelerate. We are not solving the challenge of wellbeing.

We desperately need effective interventions. All work done to define and test solutions must be celebrated. This is certainly the case in this meta-anaylsis but, in my opinion, we have a long way to go.

The Problems

Reading through the abstract of this paper is agonising. The vague terms used, and lack of clear definitions leave the average person confused or disengaged. Wellbeing – physical, emotional, mental, social and spiritual – are not defined.

How does the average person engage with ‘Mindfulness-based and multi-component positive psychological intervention’? No wonder, people prefer a pill or a glamorously promoted supplement such as the vitamin C promoted in the commercial preceding the interview.

Good science must define and simplify the terms so that they can be tested and, if proven successful, effectively promoted in practical ways.  For example: slow, diaphragmatic breathing through the nose at six breaths per minute reduces anxiety symptoms by xx%.

Psychologists have a long road to travel to bring clear, effective solutions to solve for wellbeing. Their claim: ‘researchers drill down to the core of wellbeing worldwide’, is false.

Solutions

Define the Goal

To live a good life inspired by love and guided by knowledge was Bertrand Russell’s recommendation. It is hard to beat. ‘To live’ is action based and physical. ‘Inspired by love’ is the domain of emotional and social intelligence. Guided by knowledge is mental awareness, agility and meaning.

If we are to use the term wellbeing, let’s agree that it includes physical vitality, mastery of emotion, agility of thought, social connection and meaning (spiritual).

When we use the term resilience, we mean the learned set of skills to:

• Bounce forward in adversity
• Grow physical, emotional and mental resources
• Connect with self, others and nature
• Discover flow in your life and work

We must define the terms clearly, embracing the integration of different components and expressing it in a way people can understand.

Define the Components

The most challenging component of an effective wellbeing and resilience strategy will be to define the human factors that we want to impact.

For example, a clinical diagnosis of depression is description of a prolonged state of sadness. It has physical aspects in fatigue and sleep disturbance. The emotion of sadness is persistent and overwhelming. The mind becomes confused, pessimistic and indecisive. A range of solutions exist. 

Physical activity, sunshine, sleep and good nutrition can reduce the symptoms. Emotion regulation including impulse control, gratitude, appreciation and kindness help. Mental skills such as CBT and ACT can work. All of these can work better than antidepressants if applied consistently.

The challenge of a therapist, coach, trainer or digital tool is to identify the right intervention for the person and secure consistent, disciplined application. Anyone can learn how to improve mental agility (CBT). Consistent application is a huge challenge.

Human factors describe the physical, emotional, social and mental attitudes and behaviours that can be learned and mastered. Annually, we search our assessments for the key factors that determine a good life. In 2020, these were the key factors that drive integral wellbeing and resilience:

Note that the lead strength factor is Presence which we discussed on TV today. Presence, for some, is more tangible and less threatening than mindfulness. You are in the moment and fully focused. Focus requires attention control. You are non-judgemental meaning that you are not self-critical and drop your worry and rumination.

To be present also means being fully alert, physically well, refreshed, nourished, calm and positive. One can be fully present in any moment of choice - breathing, enjoying, connecting, problem-solving or simply resting.

Interactions and High Leverage, Practical Interventions

In our experience, this is a huge opportunity to turn the tide of suffering. Taking depression and anxiety, the two most common mental illnesses, we throw billions at therapy, medications and vague techniques. What if we were to simply secure a good night of sleep? Then, perhaps a slow diaphragmatic breathing practice?

If we sleep and breathe well, we have a profound preventive and curative solution for mental illness and physical illness. In addition, we would be stronger, better connected and much more functional in daily tasks.

By tracking the development of these human factors, we are able to identify the ones that respond to assessment, training and support. In a sample of 1,788 people during 2020 we were able to show the following changes:

By integrating these factors in categories of wellbeing and resilience, we can show how each category changes through a six-month training intervention:

This group of entrepreneurs (n = 115) achieved significant positive change in every category measured. For example, the depression category includes the factor related to a diagnosis of depression (sadness, confusion, insomnia, self-critical, self-doubt). We see a 44% reduction in this category and a 54% reduction in distress symptoms. In addition, they are better able to master stress, be physical well, emotionally intelligent, mentally agile and connected with greater meaning (purpose, integrity, fulfilment, altruism, trust and flow)

Match the Actions to the Person

Finally, while some will respond positively to mindfulness, others may respond better to worry control, fitness, sleep or positivity. In a globally integrated world, we need to offer a range of clear, well defined skills that can be effectively interpreted by people in different circumstances.