Dr Caroline Bell Canterbury District Health Board

Department of Psychological MedicineUniversity of Otago, Christchurch

Where are we now ?

What is Well being ?

Can we improve it ?

Insurance, financial, delays ……

Family load disrupted routines, sleep, kids, elderly, friends leaving

Community load changes to city, roads, people left, landscape

Social load no CBD, fewer movies, restaurants, activities

Workplace load

Relocation, shared spaces

Organisational and physical uncertainty, financial

Its not business as usual but demands for business as usual

CERA All right campaign CDHB

Wide spectrum of response

Fatigue / exhaustion

Feeling despondent / overwhelmed

Loss of control

Feelings of anger and frustration – lowered tolerance

Poor concentration

Absenteeism / presenteeism

Interpersonal / relationship issues

Substance abuse

PTSDPerception death - marked hyperarousalRescue workers - PTSD Previous PTSD

Depression

Anxiety disorders

Substance abuse

Relationship problems

High exposure Life stressors

Financial, homes, businesses, relocation

Limited social supports

Previous mental health difficulties

High risk professions

New group - any of us

Persistent low mood, loss of hope, suicidal Persistent rumination or memories High levels anxiety/hyperarousal High levels distress Avoidance/withdrawal

Risk taking Aggression/ relationship problems Alcohol or drug abuse

Not just happiness Life satisfaction and +ve emotions Flourishing

Positive emotions Engagement – flow Relationships Meaning and purpose Accomplishment

Physical health

Mental health

Relationships

Workplace satisfaction

Community cohesiveness

Increased activation of the amygdala Focus threat Prepares fight/flight Less interest in non-essential activities

Reduced activation of frontal brain regions

14

Amygdala

Regulatory / inhibitory Excitatory

mPFC Overactive amygdala

Impaired vmPFC inhibition onto amygdala networks

Increased activation of the amygdala Increased vigilance Less interest in non-essential activities

Reduced activation of frontal brain regions Planning, complex thinking

Increased glucocorticoid

Earthquake brain, Bush fire brain, Flood brain

Head down, blinkered approach

Focus on stress - trying to deal with things can’t control

Reduction innovative strategic thinking

Things add value dropped off

Reduced wellbeing

Health

Relationships

Social

Career

Dealing with real practical problems – zoning, insurance, financial

Well being Active not passive process

Genes

Circumstances

Intentional activity

Nurture social relationships

Increase flow activities / learning

Look at what is important to you

Optimism, positive emotions

Tolerance and gratitude

Avoid overthinking, flexible approach

What enhances well being

Exercise Learning Mindfulness Yoga Gratitude

Reduce amygdala activity Increase frontal cortical activity

22

Amygdala

Regulatory / inhibitory Excitatory

mPFC Increase vmPFC inhibition onto overactive amygdala networks

1. TAKE TIME

Fast not necessarily best Often need to build new foundation life

Time Space Energy

2. ASSESS OUR ENERGY LEVELS

Focus on problems causing the stress Keep on going

Stop listening to our needs (body, relationships, social)

Keep listening needs Recharging – brief and often

3. FOCUS ON WHAT WE CAN CONTROL

Stress result circumstance and attitude

Circumstances Lots out of our control When stressed focus on most intensive problems

Attitude What can do, have achieved, will do Sleep, relationships, sport, music

4. WHAT AM I NOT DOING NOW

Stress demands constant focus Drop out things feel not add value to this

But these are exactly things that add value to our lives Time reflect Doing things with friends Doing things give you enjoyment

Can’t wait and put on hold til all over

5. BUILD BACK ROUTINES

Routines free us up, familiarity, security Give us time

Dropped out of routines or things different

Put new routines back

Can learn from this what is really important

Should celebrate what we have achieved

We can do something about how we are feeling and our wellbeing

But……….

This is new and hard

We HAVE TO look after our wellbeing

THIS IS IN OUR CONTROL AND ITS TOO IMPORTANT TO LOSE