The Professional Athlete’s Checklist for Optimal Mental Performance: Part One

My last sports psychology article covered 21 strategies that you can apply to improve your sporting performance. If you struggle to cope with adversity, remain free from worry, tend not to peak under pressure, get offended by what your coaches say to you, or struggle to focus as much as you would like to, I highly recommend checking that article out first.

One question that I had when I shared these skills with the Vanuatu Women’s Beach Volleyball Squad was “What skills do I try to learn first?‘ Another question was “When exactly do I try to apply them?” These are both great questions, as I don’t want anyone to overthink what they are doing too much, especially during a significant competition.

This article and the next one will try to answer both of those questions. Firstly, if you already cope well with adversity or peak under pressure every time, don’t even bother trying to learn new skills. Just keep doing what you are already doing, because it is working. If you have poor concentration and goal setting skills, however, then do focus on learning the strategies that I have recommended and see if they work for you.

Now onto when to apply these skills. Below is a checklist that I have created to see if you are already doing everything that you need to do for optimal performance. This article goes into training for an upcoming event and before the competition. The next blog post will cover what is helpful to know how to do both during competition and afterwards.

woman holding two ropes in gym

Training for an Upcoming Event

1. Are you training/ practising enough to improve as quickly as you would like to? [_]

If you notice that you are not growing as much as you hoped, it is important to look both at the frequency (how often you practice), duration (how long you practice for) and the intensity (how hard you practice when you do) to know if one or all of these variables need to change. You can assess this yourself or figure it out with your coach or trainer.

2. Is your practice deliberate enough? [_]

You must have specific objectives for each training session and each week. It is also essential that you have particular skills that you are trying to improve with each activity you do that aims to help you to meet these objectives.

3. Do you have baseline measurements of all the key things you want to improve and are you tracking your progress with these measures? [_]

If you have not conducted a baseline assessment of your skills or the things you want to improve, it will be tough to know how much progress you have made. Baseline measurements could include your weight, vertical jump, flexibility, 40m dash, reaction time. Whatever aspects you and your coach want to improve, figure out a way to assess them and keep track of your progress concerning these things as you train and prepare for a competition. Then you will know if you are on the right track with your training or will need to switch things up.

4. Are you over-training and not giving your body enough time to recover between practice sessions? [_]

Load management is all the rage in the NBA these days. Wilt Chamberlain used to play 48 minutes a night for a whole season at his prime, never subbing out. Now some of the stars will sit out the second night of a back-to-back set, as teams have realised that playing two nights in a row increases their risk of injury. Signs of over-training may include mental exhaustion, muscle fatigue, impaired motivation and concentration and reduced performance. If you are experiencing these things or are concerned that you are overdoing it, talk to your coach, reduce your workload for a bit, and see what happens. If your symptoms go away and your performance improves again, you will know that you are on the right track.

5. Are you eating healthily and enough for your training objectives? [_]

Fresh vegetables and fruit and good sources of protein (fish and lean meats) and fats (eggs, nuts, avocado, some oils) and whole-grains are generally considered healthy. Anything processed or deep-fried or too sugary or salty is not considered very healthy, and having too much caffeine and sugary drinks isn’t recommended either, but there are sport-specific recommendations that nutritionists can provide also. If you are burning an extra 3,000 calories of energy a day in your workouts, you will need to eat more and may require more carbs than an athlete who is only burning an extra 200-500 calories a day.

6. Are you getting enough sleep and rest? [_]

The average adult needs 7-9 hours of sleep, with more sleep than usual needed after strenuous and extended training sessions. In between training sessions, try not to always be on the go either. Give yourself enough downtime for leisure, fun, socialising, relaxation and recovery.

7. Are you practising mindfulness meditation daily? [_]

Even 10 minutes a day can significantly improve concentration abilities during practice and competitions. Some people prefer doing it first thing in the morning. Others prefer last thing at night. Whenever you think you could consistently do it, set a reminder on your phone, have a meditation app (e.g. headspace, smiling mind, calm, buddhify etc.) that can guide you through a meditation, and then do it at the same time every day for at least three weeks. Once it becomes a habit, you won’t regret that you have started to do it and built it into your daily routine.

8. Are you aware of unrealistic and unhelpful thoughts, and do you practice challenging them or letting them go? [_]

There are two ways that we can successfully manage unhelpful thoughts. Firstly, we can try to challenge and change them, which is a CBT (cognitive behavioural therapy) strategy. To do this, notice what you are thinking. Ask if it is a realistic or a helpful thought? If it not practical or desirable, ask yourself what ideas might be more useful to have. Then every time you have the initial thought, try to remind yourself of the more suitable replacement thought instead. Secondly, sometimes it is not the thought that we have that is problematic, but how much we get caught up in the idea or fuse with it.  Each time you notice you are too fused with a thought, aim to create some distance or let it go using defusion skills, which is an ACT (acceptance and commitment therapy) strategy. Imagine the belief in a different colour or font, or said in a funny voice, or put it on a cloud and let it float away. Both thoughts challenging and defusion can be helpful for people, so see which strategy you like best, and then apply it whenever your thoughts are impairing your performance during training sessions.

9. Are you practising in ways that simulate the conditions and pressure you will experience during the event? [_]

Andre Drummond was an awful free throw shooter in basketball games in his first few NBA seasons, making much less than half his shots. Yet, in training, he could make 9 or 10 out of 10 regularly. If this is similar to you with a skill that you do well in training but poorly during events, experiment with the stakes during practice to make it more game-like or have more on the line. Every missed free-throw at training might equal two laps of running around the court or 20 pushups.  It would mean that the athlete may tense up a bit more, meaning better preparation and more practice for tense in-game situations.

10. Are you also allowing yourself to have fun, experiment with skills and play games? [_]

Extreme athletes like skateboarders and freestyle skiers don’t always practice deliberately, especially not the athletes who started the field. They improved their skills by doing what they loved, playing around with their friends, and challenging each other to push their boundaries and see what is possible. So even though deliberate practice is the best way to improve specific skills, getting into a flow state and not thinking about things too much is the best way to improve performance. Don’t forget to have fun, play around, push yourself just outside your comfort zone, and see what happens.

healthy person woman sport

Before a Competition

1. Do you have a consistent pre-competition ritual? [_]

Before games, I try to have a low-GI carb-heavy meal the night before, get 8 hours of sleep if possible, get up at my usual wake time, eat protein shortly after waking, and not have too heavy a meal too close to competition. I pack my bag with all the things I need, arrive at the stadium about an hour before the game. I then warm up a little bit by myself. After this I stretch and listen to music that helps me to get pumped up and focused. I then discuss the game plan with my team and coach. We then all go out as a team and warm up together before the introductions and the game begins.

2. Does it help you to perform at your best regularly or allow you to get into the zone quickly? [_]

If your pre-game ritual doesn’t help you to perform at your best, see what you can do to shake it up. Maybe get there earlier than you usually do. Find a quiet spot. Bring headphones and do a 10-minute meditation. Practice a few easy skills to fire up your muscle memory and boost your confidence. Listen to music and focus on your objectives for the day. Visualise yourself doing the moves you want to do and being successful doing this. Add something in that you don’t usually do, or take something out that you don’t think is helping, and see what the result is. Over time, you’ll know what helps and what doesn’t, and what to do more before a competition.

3. Do you know what type of environment is most helpful for you to prepare yourself before the competition? [_]

Some people are more extroverted and like to be around people, socialising and connecting and laughing and having fun. Others are more introverted and like space from others and quiet. Experiment with this before competitions, and soon you’ll know what environment is best for the significant events.

4. If the ideal environment is not available, do you have a back-up plan of what you can do? [_]

Let’s say you prefer space and quiet, but there are no change rooms around, and you need to remain by the side of the court. You may need noise-cancelling headphones or other things that can still take you away from where you are a bit so that you can focus and do your pre-game ritual and get into the zone for when the competition begins,

5. Are you aware of your arousal level before a game? [_]

Think of this as a scale from 0 to 10, where ten is overwhelmed, anxious and panicky, and zero is as relaxed as you can be. Check in to your physical symptoms and give yourself a score from 0 to 10.

6. Do you know what arousal level is ideal for you at the start of the competition? [_]

If you compete in a sport where precision is critical, you may want to be at three or a four. If you need to be aggressive and reactive, like in boxing or American football, it may be better to be at eight or nine. Once you know what number you are at, determine if you need to increase it or decrease it for it to be ideal for the event.

7. Do you know how to pump yourself up if you are feeling apathetic, lazy or tired? [_]

Let’s say that your arousal level is at a one or two and you need it to be at a six, what can you do to pump yourself up? Do you need some caffeine or sugar or an energy drink? Do you need to jump around to get your lymphatic system flowing? Do you need to watch motivational videos or listen to a pump-up music soundtrack? Do you need to remember your values or goals, or why you put in all the hard work at training or why you love the sport? Whatever you decide to try, give it a go, and if it works, repeat it next time. If not, move onto something else.

8. Do you know how to relax if you are feeling too overwhelmed, worried, stressed or anxious? [_]

Let’s say you are at nine or ten and want to be at five or six. There are thousands of spectators ready to watch you. You start to worry that you are feeling too anxious and tense and won’t perform well as a result. Try to re-frame this anxiety as excitement. Remind yourself that being pumped up means more oxygen to the limbs, which can help you to run faster, jump higher, put in more effort. Then if your arousal level is still too high or you are worrying too much, ground yourself. Look at what you can see, hear, touch, taste and smell. Remind yourself that you are safe and there is no danger. Take some slow deep breaths and put your focus on one thing at eye level in the distance. Tense your muscles, breathe in, then release the tension as you breathe out. Stretch nice and slowly. Remember the objectives that you want to focus on that are within your control and think back to times when you have successfully done this. Remind yourself that you can do this, exhale all the air, and then go out there and give it all. People don’t tend to regret losing as much when they know they have given it their best!

Stay tuned for part 2…


Dr Damon Ashworth

Clinical Psychologist

20 Fascinating Paradoxes About Life

What is a Paradox?

According to the Oxford dictionary, a paradox is a noun that has two meanings:

1. A seemingly absurd or contradictory statement or proposition which when investigated may prove to be well founded or true.

2. A person or thing that combines contradictory features or qualities.

I love paradoxes because they are sometimes funny and usually also quite insightful. Listening to the audiobook version of the Tao Te Ching by Lao Tzu was like listening to one paradox after another. This was especially surprising to me, because it is an ancient book of wisdom. So a great paradox is much more than just a cliche, even though it can appear like that over time.

Below is a list of some of my favourites, starting with one from the Tao Te Ching:

  1. New beginnings are often disguised as painful endings” – Lao Tzu

young game match kids

2. “Who you are speaks so loudly I can’t hear what you’re saying.” – Ralph Waldo Emerson

man wearing brown suit jacket mocking on white telephone

3. “I’d rather be hated for who I am, than be loved for who I am not” – Kurt Cobain

hi haters scrabble tiles on white surface

4. “I refuse to join any club that would have me for a member.” – Groucho Marx

black steel welcome hanging signage

5. “You know what the issue is with this world? Everyone wants a magical solution to their problem, and everyone refuses to believe in magic.” – Alice in Wonderland

woman holding teacup

6. “I am the wisest man alive, for I know one thing, and that is that I know nothing.” – Plato

man wearing brown jacket and using grey laptop

7. “Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.” – Rumi

adventure cliff lookout people

8. “We judge ourselves by our intentions and others by their behaviours.” – Stephen Covey

man in blue crew neck shirt staring at woman trying to lift barbell

9. “If you don’t risk anything you risk everything.” – Mark Zuckerberg

action adventure challenge climb

10. “The more we do, the more we can do; the more busy we are, the more leisure we have.” – William Hazlitt

man and woman holding hands walking on seashore during sunrise

11. “Only you can take responsibility for your happiness…but you can’t do it alone. It’s the great paradox of being human.” – Simon Sinek

group hand fist bump

12. “If you try to fail and succeed, which have you done?” – George Carlin

man person street shoes

13. “Seek freedom and become captive of your desires. Seek discipline and find your liberty.” – Frank Herbert

red and blue hot air balloon floating on air on body of water during night time

14. “Nowadays most people die of a sort of creeping common sense, and discover when it is too late that the only things one never regrets are one’s mistakes.” – Oscar Wilde

active activity adventure backpack

15. “Whatever you do will be insignificant, but it is very important that you do it.” ―Mahatma Gandhi

man person mountain hiker

16. “He who fears he shall suffer, already suffers what he fears.”― Michel de Montaigne

close up photo of jack o lantern

17. “A lot of people never use their initiative because no-one told them to.” – Banksy

microphotography of orange and blue house miniature on brown snail s back

18. “If someone doesn’t value evidence, what evidence are you going to provide to prove that they should value it? If someone doesn’t value logic, what logical argument could you provide to show the importance of logic?” ― Sam Harris

battle black blur board game

19. “Let go of certainty. The opposite isn’t uncertainty. It’s openness, curiosity and a willingness to embrace paradox, rather than choose up sides. The ultimate challenge is to accept ourselves exactly as we are, but never stop trying to learn and grow.” Tony Schwartz

two men assisting woman riding on swing

20. “If you don’t get what you want, you suffer; if you get what you don’t want, you suffer; even when you get exactly what you want, you still suffer because you can’t hold onto it forever. Your mind is your predicament. It wants to be free of change. Free of pain, free of the obligations of life and death. But change is law and no amount of pretending will alter that reality.” – Socrates

bench cold dawn environment


Dr Damon Ashworth

Clinical Psychologist

What Psychological Strategies Can Improve Your Sporting Performance the Most?

I’ve played a lot of sport in my lifetime. My first basketball game was on the Diamond Valley mini-courts in Victoria, Australia when I was six years old. My most recent game was this week at Wan Smol Bag in Port Vila, Vanuatu. That means I’ve been playing organised sport for over 27 years now.

Both of my parents were Physical Education teachers and excellent sports coaches, and they consistently encouraged my two siblings and me to play sports and be active. I’m not sure if my siblings felt this too, but there was a sense that we should take sport seriously, and it was essential to try your best and be an unselfish team player and a fair opponent.

For example, this Larry Bird Converse poster hung on the wall in our house when I was younger:

It makes me sick when I see a guy just watching it go out of bounds.” – Larry Bird

I was a super competitive kid, with the majority of my childhood consisting of competing against whoever I could find, but especially my brother and friends. I also tried to compete in anything I could, including board games, computer games, card games and multiple sports.

I’ve managed to have some success in several sports. I finished in the top 10 in the state in swimming in Primary (Elementary) School, the top 20 in discus throwing, and the top 30 in alpine skiing. In High School I made the State team in volleyball for three years in a row and the Victorian Institute of Sport and the Australian Youth Squad for volleyball. I then moved to the USA at 16 to play Varsity volleyball, basketball and tennis in California and Virginia. Later on, I won a State Championship in the top division in the Victorian Volleyball League at 25 and won a championship playing Semi-professional basketball when I was 27 in Australia.

Despite this modicum of success, I don’t think that I reached my potential.

I was a bit like Allen Iverson in his famous “practice” speech:


I loved to play, but I hated to practice. I was not overly goal-focused outside of turning up on game day, giving my all, and doing whatever I could to help my team win. When I was younger, I also had what is known as a ‘fixed mindset’, and thought that I could not change my athletic capabilities with deliberate effort.

It wasn’t until I started to learn psychology at university that I began to realise that I could mentally change how I approached the games that I played. I began to apply the psychological skills that I had learnt and developed a growth mindset rather than a fixed one. I became less afraid of losing, more able to learn from setbacks and mistakes, and more able to step up when the game was on the line. I also discovered how to bounce back after making a few mistakes, keep pushing and trying when we were losing, and perform at my best on a much more consistent basis.

I wish I could have had these skills earlier in my life, and I would like to be able to share them with you so that you can hopefully take your game to the next level too.

action adult american american football

How Strong is the Mental Side of Your Game?

The Athletic Coping Skills Inventory (ACSI) looks at seven sub-scales related to how you mentally approach sport and helps to highlight areas in which you might struggle:

Sub-scale #1: Coping with adversity – assesses if you remain positive and enthusiastic even when things are going badly. Also determines if you stay calm and controlled, and can quickly bounce back from mistakes and setbacks. 

  • Do you remain positive and enthusiastic during a competition, no matter how bad things are going?
  • When things are going badly, do you tell yourself to keep calm and does this work for you?
  • When you feel yourself getting too tense, can you quickly relax your body and calm yourself?
  • Can you maintain emotional control regardless of how things are going for you?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, you currently are not coping as well as you could with adversity.

man wearing black tank top and brown shorts climbing rock


  • If things are going bad during a competition, try cognitive restructuring. Tune in to what thoughts are going through your mind. Then ask yourself if they are realistic thoughts and if they are helpful thoughts to be having right now? If you are thinking about anything that is not what you are meant to be doing in the present, they are probably not helpful. If it’s the mistake you just made, let it go and move on. If it is worrying that you might keep making mistakes and lose, let it go and move on. Tell yourself “this isn’t helpful!” or ask yourself “what is a more helpful way to be thinking right now?” It might be “keep calm”, or it could be another mantra that you find helpful. Then stop focusing on your thoughts and focus on whatever is in your control in the present that will help you to get back on track. Then do it. 
  • If you are feeling overwhelmed or out of control during a competition, try deep breathing.  Tune into your breathing. Chances are, your breath is probably rapid and shallow if you feel overwhelmed, tense or out of control. Then, exhale and breathe out all of the air in your lungs. Slowly breathe deeply into your stomach, pause for a second or two, and then exhale all of the air out again. Keep breathing slowly and deeply and exhaling all your air until you feel a bit calmer and more in control. Then stop focusing on your breath and put your focus back to the main objective that you have that is in your power in the present.
  • If you feel too physically tense during a competition, try progressive muscle relaxation. Tune in to where you feel most tense, then pick one area to target first. Squeeze it as hard as possible, take a deep breath in, pause, breathe out and relax. Then repeat if needed or move onto another tense muscle area. If you can’t tense it because of the sport you are doing, try to breathe in and around the tight area and then see if you can relax it with the out-breath. Repeat as often as needed. Once you feel less tense, stop focusing on your body tenseness and put your focus back to whatever is in your control in the present that will help you to achieve your objectives.

Sub-scale #2: Coachability – assesses if you learn from coaches instructions and are open to accepting constructive criticism or advice without taking it personally or becoming upset:

  • Do you manage not to take it personally or feel upset when a coach tells you how to correct a mistake you’ve made?
  • When a coach criticises you, do you feel helped rather than upset?
  • If a coach criticises or yells at you, do you correct the mistake without getting upset about it?
  • Do you improve your skills by listening carefully to feedback and instructions from your coaches?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, you currently are not very coachable. My dad said that I was uncoachable growing up, but it did improve by applying a few strategies.

athlete athletic baseball boy


  • When a coach criticises or yells at you, try not to take it personally. If it is a competition, the coach is likely to be on an emotional rollercoaster, just like you. They may care just as much or even more than you about winning, but they cannot control your behaviour on the field. They can merely make suggestions or sub you out, which may make them feel even more stressed or anxious than if they were out there performing. See if there is any merit in what they are saying to you regardless of how they have said it. If it is useful advice, take it on board. If it is not helpful, try to tune it out and re-focus on whatever it is that is within your control that will help you to achieve your objectives.
  • Develop a growth mindset and let go of your ego. When you make a mistake in practice, try to listen to feedback from coaches about what led to the error and how you can improve it. If they don’t give you any feedback, ask for it when it is appropriate. It is generally a lot easier for someone else to see what you are doing wrong and how you can improve it than it will be for you to view it. Asking someone in your coaching staff to film what you are doing can also help because then you can view what they see and can have a discussion with them about how to improve it. 
  • Listen carefully to the advice and instructions that your coaches have, especially during practice and before and after a game. The coach’s job is to help you perform at your best, so try to take on board what they suggest and give it a go before rejecting it as not helpful. Having a growth mindset sees mistakes and losses and failures as opportunities to reflect on what went wrong and how you can improve it. A coach can help with this, especially after a game and in practice. Asking questions to clarify what they said if you don’t understand can also help to ensure you are following or trying what they suggest. During a game, don’t overthink things too much, and get back to your game plan that you and your coach have established before the event.

Sub-scale #3: Concentration – reflects whether you become easily distracted and whether you can focus on the task at hand in both practice and game situations, even when adverse or unexpected conditions occur:

  • When you are playing sports, can you focus your attention and block out distractions?
  • Is it easy to keep distracting thoughts from interfering with something you are watching or listening?
  • Do you handle unexpected situations in your sport very well?
  • Is it easy to direct your attention and focus on a single object or person?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, your ability to concentrate is not as good as it could be.



  • Meditate regularly. It doesn’t matter which type of meditation you do, but practice it for at least 10 minutes a day. Developing a daily meditation routine will help you to improve your concentration levels on a game day more than anything else. I prefer mindfulness meditation the most, and the apps I would recommend the most to download if you want to have a guided meditation session daily are:
    • Smiling Mind
    • Insight Timer
    • Headspace
    • Calm
    • Waking Up
    • Ten Percent Happier
    • Buddhify
    • Balance
  • Avoid multitasking. Whatever you are doing throughout the day, try to focus on one thing at a time rather than attempting to do two or three things at once. It will be less tiring for you, and will also train your concentration. Just ask yourself, no matter what you are doing “What is most important right now?” and try to put all of your attention and focus on that one task. If your mind tries to distract you or get you to do something else, thank your mind and bring your attention back to whatever is most important at that moment.
  • Practice informal mindfulness. Formal mindfulness involves sitting down and doing mindfulness meditation for a set period. You can also approach any other task that you are doing mindfully, which is called informal mindfulness. To do this, no matter what you are doing, try to see if you can approach the task as if you have never done it before in an open, accepting, non-judgmental way without wishing for it to be any other way. Jon Kabat-Zinn calls these the attitudes of mindfulness, and when applied to sports, you are likely to have a sense of relaxed concentration that is the key to getting into the zone or a state of flow more regularly.

Sub-scale #4: Confidence and Achievement Motivation – measures whether you are confident and positively motivated. Also assesses if you consistently give 100% during practices and games, and work hard to improve your skills:

  • Do you get the most out of your talent and expertise?
  • Do you feel confident that you will play well?
  • Do you give 100% during practices and competition, and don’t have to be pushed to practice or play hard?
  • Do you try even harder when you fail to reach your goals?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, you do not have high levels of confidence and achievement motivation.



  • Know your personality: Take the IPIP-NEO personality assessment to get a good sense of your personality and what is likely to motivate you. If you are an extrovert, you probably need to train with other people and need excitement and fun. You may not need as much rest, either. If you are an introvert, you may need some individual sessions to remain focused and motivated and plenty of time to reflect and recover between practices and competitions. If you are agreeable, you will enjoy co-operating with the plans of your coaches or other athletes and helping out others. If you are disagreeable, you will probably need to do things your way a bit more to stay motivated and confident.  If you are highly conscientious, you could have a consistent training schedule and pre-game routine, and you will be able to follow it and benefit from it. If you are low on conscientiousness, you will need a bit more flexibility and variety in your training and preparation and goals to stay on track. If you are highly neurotic, you will have more times that you feel down, anxious, angry, self-conscious, but developing skills to assist you with these emotions will help. If you are low on neuroticism, you are unlikely to be bothered by intense emotions or self-doubt and won’t need additional strategies. Lastly, if you are very open to experiences, you are likely to remain confident and motivated even if things don’t go according to plan and accept whatever is happening and make room for whatever feelings arise. If you are low on openness, you will probably need more contingency plans so that you will know what to do and feel less overwhelmed when things don’t go according to plan. 
  • Clarify your essential values: The values exercise that I have previously written about is a great way to identify and remember why you are playing sport and what you are hoping to get out of it — knowing our why can help us to be much more motivated to push through pain and challenges when things get hard. By figuring out which values are essential, quite important and not relevant to you, you can see if you have been living in line with your fundamental values or applying them in your sport. If you haven’t, setting some goals that are consistent with these values will increase your motivation and hopefully improve your confidence too.
  • Apply your character strengths to your sport: The VIA character strengths survey is a similar principle to values clarification, with the VIA standing for values in action. Take the survey, identify your top 5 key strengths and apply them more to your practice and competition. It could help your confidence and motivation a lot.

Sub-scale #5: Goal setting and mental preparation – assesses whether you set and work toward specific performance goals. It also determines if you plan and mentally prepare for competition, and if you have a “game plan” for performing well:

  • Do you set concrete goals to guide what you do in your sport on a daily or weekly basis?
  • Do you tend to do a lot of planning about how you will reach your goals?
  • Do you set your own performance goals for each practice?
  • Do you have your game plan worked out in your head long before the game begins?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, you are currently not setting enough goals for yourself in your sport or preparing yourself mentally as much as you could be.

man holding clipboard inside room


  • Get on the same page as your coach (and teammates if you have them) about your objectives in your sport and the steps that you will all need to take to achieve these objectives. By doing this, including having contingency plans for if things are not going well, your coach should be to help you stick to your plan and encourage you to switch to a contingency plan if things are not working as well as you both hoped. You can apply this for your training sessions, your weeks in the lead up to competition, before a game, during competition, and afterwards. If your coach changes the rules and goes off course, it is vital to be able to raise this and remind them of your overall objectives so that you can remain on track and make progress towards your long-term goals. 
  • Make sure the goals that you set are SMART goals. SMART means that your goals should be specific, measurable, achievable, relevant and time-framed. You will then know if you have achieved them or not in the time that you have set and can make adjustments as needed.
  • Have a consistent pre-game ritual to mentally and physically prepare yourself for the game. Maybe eat the same meal the night before a competition (carbo-loading), do things to wind down and switch off to ensure you don’t get to bed too late and obtain a good quality sleep. Wake up at a similar time in the morning if possible, and have the breakfast that your nutritionist has suggested is most helpful. Stay well hydrated. Have a game plan figured out with your coach well in advance before the competition and keep that fresh in your mind on game day. Get to the event place early enough to not have any unnecessary stress. Choose the location that allows you to get into the state you want to be when competition starts. If you can’t choose the room, bring noise-cancelling headphones or other things that can still help you to feel settled wherever you are. Then listen to music or motivational material as needed, warm up your body as required, visualise doing well or think back to times you have performed well in the past, and centre yourself before competition. Then go out there and enjoy it.

Sub-scale #6: Peaking under pressure – measures whether you are challenged rather than threatened by pressure situations and if you perform well under pressure — if you are a clutch performer:

  • Do you tend to play better under pressure because you think more clearly?
  • Do you enjoy the game more when there is more pressure during it?
  • Are pressure situations challenges that you welcome?
  • Do you make fewer mistakes when the pressure is on because you concentrate better?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, you are currently not peaking under pressure or getting into the zone as much as you potentially could.

man on red watercraft


  • Try the seven steps of centering:
    1. Select a comfortable focal point in the distance that is below eye level.
    2. Form a clear intention in your mind of what you aim to do.
    3. Breathe slowly and deeply in a mindful way and breathe all the air out with each breath.
    4. Release your muscle tension by observing where you are most tense in your body, then release this tightness by first tensing it further and then letting go, or just trying to release it with each out-breath.
    5. Find your centre of gravity or “chi” and use that to help ground you where you are and with what you are doing.
    6. Repeat your process cue, or imagine what it sounds, feels and looks like to achieve what you are aiming to do in step 2. If there is a word that describes this, you can use it as your cue. Golfer Sam Snead would use the word “oily” to describe the smooth and effortless swing that he wanted.
    7. Channel your remaining energy into a dynamic and inspired performance. Trust that all the hard work that you have put in during training will pay off and help you to achieve your aim, and see if you can enjoy the competition and the peak performances that can come with this.
  • Develop your inner game. Timothy Gallwey wrote one of the best sports psychology books of all time with ‘The Inner Game of Tennis.’ The first step of the inner game is to observe what is happening in a non-judgmental way. The second step is to picture the desired outcome. The third step is to trust your body to be able to reach your desired outcome and don’t try to overthink it. The last step is to nonjudgmentally observe the change in your performance and results by doing this.
  • Get into a flow state. To increase your chances of getting into a flow state, you first need to try to remove or zone out from all potential distractions. It is also important that the task that you are aiming for strikes a good balance between your current skill level and the challenge you are facing. If the challenge is slightly greater than you perceive your current skills to be, flow is most likely to happen. If it is not challenging enough, you are likely to be bored. If it is too challenging you are likely to be anxious. Psychologist Mihaly Csikszentmihalyi says that there are eight main characteristics of flow:
    1. you need to put all of your concentration on the task at hand.
    2. you need to be clear about your goals and be able to get immediate feedback about if you are on the right track.
    3. flow transforms time, and things feel like they are either speeding up or slowing down in a flow state.
    4. the experience must be intrinsically rewarding, or enjoyable in and of itself and not just a means to another end.
    5. your performance should feel effortless and easy in a flow state.
    6. there needs to be a good balance between challenge and skills, ideally the thing you are doing is both challenging and requires a lot of skill.
    7. your actions and awareness are merged, and you are no longer in your head thinking about what you are doing or worrying about your performance.
    8. you feel fully in control of what you are attempting to do in pursuit of your objectives.

Sub-scale # 7: Freedom from worry – assesses whether you put pressure on yourself by worrying about performing poorly or making mistakes. It also determines if you worry about what others will think if you perform poorly:

  • Do you worry quite a bit about what others think of your performance?
  • Do you put a lot of pressure on yourself by worrying about how you will perform?
  • While competing, do you worry about making mistakes or failing to come through?
  • Do you think about and imagine what will happen if you fail or screw up?

How often do you do these things – rarely, sometimes, often or almost always?

If you have said rarely or sometimes to most or all of these items, your worries are probably impairing your performance.

man in gray sleeveless shirt carrying white and brown spalding basketball


  • Try constructive worry. I don’t recommend this strategy during competition, but it is excellent to do before or after a game or when you are training for an upcoming event and are feeling worried. Create a table with three columns, and say what is worrying you in column one, what you can do to address the worry in column two, and when you can solve it in column three. It shouldn’t take much more than 5 minutes, and might look like this:


What Can I do to address this?

When can I address this?

What if I lose?

Train hard, prepare well, try my best

Now and at the competition

What if I make mistakes or fail?

Mistakes help me to learn and improve. Remember the Michael Jordan quote about failure leading to success

Anytime I have a setback, try to have a growth rather than a fixed mindset and see what I can learn from it to get better

What if others judge me?

Try to care less about this and focus on what is in my control, which is training hard, preparing well and trying my best. Also, don’t forget to have fun. If others judge me for trying my best, that is more about them than it is about me

Now. I can put my energy into things that are within my control, which is my intention and my actions, and let go of everything else

  • Practice grounding yourself in the present. Ask yourself: “What are five things I can see right now?” “What are four things I can touch or feel right now?” “What are three things I can hear right now?” “What are two things I can smell right now?” “What is one thing I can taste right now?“. These questions help you to become fully grounded in the present, instead of worrying about things going wrong in the future or ruminating about a mistake you made in the past. Finally, ask yourself: “Am I safe?“. If there is no imminent physical danger, you do not need to be in ‘fight-or-flight’ mode, and your brain can relax while you take a few deep breaths and re-focus on what you need to do next to achieve your objective.
  • Defuse from unhelpful thoughts. Sometimes it is helpful to challenge our worries if we know they are unhelpful. If you instead think of something more useful to believe, it might eliminate your fears. If it does not, try to defuse from your worry instead and aim not to get too caught up in it. Thinking “I’m going to miss this shot” won’t help, so if it crosses your mind, imagine putting this worry on a leaf on a river and let it float downstream, or put it on a cloud and watch it float away, or put it in a box on a conveyor belt and let it speed away into the distance. There are many different defusion strategies to help you let go of worrying thoughts. Look them up, try them out when you are not competing, see which ones are most effective for you, and then apply the most effective ones during your next competition. The less you worry, and the more you focus on what you can do that is in your control, the better your performance is likely to be.

To answer the title question, the best psychological strategies to improve your sporting performance are the ones that work best for you. See which sub-scales you score the lowest on, try some of these strategies that I have recommended, and then let me know what worked and how much your performance improved. I look forward to hearing about your improvement and growth!

Dr Damon Ashworth

Clinical Psychologist

Dealing With Work Stress and Burnout


MOH logo


Not all stress is bad for you. Sometimes stress is exciting, like planning a holiday or a family function, starting a new job or moving into your new home. In these circumstances, your feelings can be a combination of excitement and anticipation mixed with some concerns or fear. You hope things will go well, but at the same time, you worry about something not working out. This is normal, and the stress you feel, as long as it is not too much, can help you to plan better and anticipate problems.

A moderate level of stress can lead to you feeling increased energy levels, sharper in your senses, and better able to focus and concentrate on what is happening and what you need to do.

What is Stress?

A simple explanation of distress is the feeling you get when you no longer feel in control of a situation. This means is that the situation itself is less important to how stressed you feel than your perception of how in control of the situation you are.

Our brain is like a problem-solving machine, and is always trying to figure out if we have the resources available to meet, the demands of the task that we need to do:

  • If we feel that we have sufficient resources to do what we need to do successfully, we are not likely to feel too stressed.
  • If we are not sure if we have sufficient resources, we may feel overwhelmed or stressed out until we have more information that suggests that we can manage the situation successfully.
  • If we feel that we do not have sufficient resources, we are likely to become overwhelmed and stressed out, and sometimes even despondent or hopeless, two warning signs for burnout.

Too many situations where we feel out of control leads to a build-up of distress and many negative consequences over time. The trouble is that modern life is so full of frustrations, deadlines, and demands that many of us don’t even realise how stressed we are. Whatever your job, by recognising the symptoms and causes of stress, you can take the first steps to reduce its harmful effects and improve your quality of life.

The Physiology of Stress

Stress is your body’s way of responding to any demand or threat. When you feel threatened, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, which prepare the body for emergency action. This is known as the “fight or flight” response and it is an inbuilt survival mechanism that is your body’s way of protecting you from danger.

The body’s nervous system often does a poor job of distinguishing between daily stressors and life-threatening events. If you are stressed over an argument with a friend, a traffic jam or too many bills, your body can still react as if you are facing a life-or-death situation. Most workplace and everyday stressors these days are not likely to kill us, so it is important to be able to successfully manage these stressors before they build up too much and exceed what is healthy for you.

When stress is within your comfort zone, it can help you. In emergencies, stress can save your life by giving you extra strength to defend yourself. Stress can also help you rise to meet challenges. Stress is what keeps you on your toes during a presentation at work, sharpens your concentration or drives you to study for an exam when you would rather be doing something else. However, when you start to lose control stress stops being helpful and can start causing significant damage to your mind and body.


The Effects of Chronic Stress

When you repeatedly experience too much stress, there is a disruption to nearly every system in your body. It can shut down your immune system, upset your digestive and reproductive systems, raise blood pressure, increase the risk of heart attack and stroke, speed up the aging process and leave you vulnerable to many mental and physical health problems.

Potential health problems caused by chronic stress include:
1. Depression and anxiety
2. Weight problems
3. Autoimmune diseases
4. Skin conditions, such as eczema
5. Reproductive issues
6. Pain of any kind
7. Heart disease
8. Digestive problems
9. Sleep problems
10. Cognitive and memory issues

Causes of Stress

Common external causes of stress:
1. Major life changes
2. Work or school
3. Relationship difficulties
4. Financial problems
5. Being too busy
6. Children and family

Common internal causes of stress:
1. Chronic worry
2. Pessimism
3. Rigid thinking, lack of flexibility
4. Negative self-talk
5. Unrealistic expectations/Perfectionism
6. All-or-nothing attitude


Signs and Symptoms of Burnout

The following table lists some of the common warning signs and symptoms of burnout, which is likely to occur when we have been too stressed for too long. The more signs and symptoms you notice in yourself, the closer you may be to stress overload or burnout.

Cognitive symptoms:
* Memory problems
* Inability to concentrate
* Poor judgment
* Seeing only the negative
* Anxious or racing thoughts
* Constant worrying

Emotional Symptoms:
* Depression or general unhappiness
* Anxiety and agitation
* Moodiness, irritability, or anger
* Feeling overwhelmed
* Loneliness and isolation
* Other mental or emotional health problems

Physical symptoms:
* Aches and pains
* Diarrhoea or constipation
* Nausea, dizziness
* Chest pain, rapid heart rate
* Loss of sex drive
* Frequent colds or flu

Behavioural symptoms:
* Eating more or less
* Sleeping too much or too little
* Withdrawing from others
* Procrastinating or neglecting responsibilities
* Using alcohol, cigarettes, or drugs to relax
* Nervous habits (e.g. nail biting, pacing)

Managing Stress in the Workplace

What can you do to better manage stress?

  • Learn to distinguish between normal stress and stress that is overloading you.
  • Learn to recognise the signs of a build-up of chronic stress.
  • Discover the factors that may influence your tolerance for stress.
  • Learn about your body and how you react to stress.
  • Try to not let things build up. Do not waste time if possible. Deal with things as soon as you can to minimise overload.
  • If you can, make changes in your life to protect you from stress.
  • Where possible deal with matters and people to solve problems.
  • Learn more about the things that stress you out and use this knowledge to protect yourself from these stressors. This is known as increasing your resilience.
  • Unless it is not possible, avoid certain situations or people that you know cause you a lot of stress. Anticipate and better prepare yourself in these circumstances so that you can control the situation.
  • If you have a failure or setback take a moment to reflect on what actually happened. Do not immediately blame yourself, as it may not have been your fault. It may have been outside your control regardless of what you tried to do.
  • Increase your level of physical activity when you can, exercise helps your body to recover more quickly and improves your immune system which is often compromised by stress.
  • Don’t avoid people who can help you. Work colleagues, friends and family are your psychosocial supports. When you share your concerns, others may see solutions that you cannot see or they may be able to help you in other ways.
  • Examine your diet particularly when you are experiencing stress. Certain foods, alcohol or other drugs may actually increase your stress levels even though you might feel that they help you in the short-term.
  • Learn relaxation strategies and or practice meditation to help you calm down when you are feeling too stressed, panicky or overwhelmed.
  • Deep and slow breathing into your stomach and then exhaling all of the air with each breath can really help after even 1-5 minutes.
  • Progressive muscle relaxation where you tense and release various muscle groups in your body while you breathe in and out slowly and deeply also helps.
  • Imagining yourself in a nice, calm and peaceful place or out in nature can provide a brief escape and reduce stress.
  • Mindfulness mediation is a very effective way to manage stress, reduce pain and improve your focus. Mobile phone apps such as headspace or calm or smiling mind can teach you these skills in about 10 minutes each day
  • If you cannot manage your stress, seek professional advice.

people having meeting inside conference room

What Can Organizations Do to Manage Stress and Burnout?

Organizations and employers can do any of the following:

  • Seek information about stress and how to successfully manage it.
  • Develop policies and procedures to deal with discrimination and to help support people who are too stressed or suffering from burnout.
  • Give mental health the same importance as general health and safety and provide education and training.
  • Improve HR processes and become more aware of what is happening in the workplace to ensure that situations or high levels of stress during certain times are monitored and those involved receive support. E.g., precisely in high-risk areas such as police, correctional or accident and emergency and military services some situations will impact on many people and these incidences should be monitored and processes put into place to protect and support those involved.
  • They can also ensure that staff are aware that their organisation has a positive attitude towards stress and mental health and takes these matters seriously.
  • A larger organization may also be able to staff a specialist confidential counselling position or train some staff to provide psychosocial education and support to people affected by stress.

Colleagues can also play a vital role. You do not have to be a psychiatrist or mental health worker to know when a workmate mate is under stress or is not coping. You can provide necessary support by asking the person affected if they are okay or is there anything you can do. Having a friendly ear is sometimes exactly what is needed to start a healing conversation. This can lead to a referral to a more appropriate service.

One vital skill that a friend or colleague needs to learn is to not to give advice or judge a person when they are trying to explain their situation. It is better to allow the person to talk through their issue and offer support. If you are able to do it, you could help by finding an appropriate place for the person to seek professional help, e.g. a mental health clinic or women’s support group or perhaps a pastor or community leader if appropriate.

Stress, Burnout and Mental illness are often misunderstood, and education and awareness of what these issues are and how they affect people are vitally important in all organisational settings.

For more information or advice, please contact:

Mind Care Clinic

Psychiatry Department



VOIP: 1081


Namalinuan Clinic




Mental Health Clinic




Mental Health Clinic




Mental Health Clinic




What Separates a Good Athlete From a Truly Great One?

Could You Be Like Mike?

Michael Jordan is potentially the greatest basketball player of all time. He is also thought to be the king of staying laser focused and composed under pressure, and consistently performing at his best. He holds the record of 866 straight games in the NBA scoring at least 10 points, and he scored over 20 points in all of his last 47 playoff games.

Jordan holds ten scoring titles for the most points scored in a season, as well as the highest career regular season scoring average (30.12 points per game) and career playoff average (33.45 ppg). He went to the NBA finals 6 times, and won 6 championships with the Chicago Bulls, alongside 6 NBA most valuable player (MVP) awards. Jordan also won the defensive player of the year award once, played in 14 all-star games, made ten all-NBA first teams and won five MVP awards. He was inducted into the basketball hall of fame in 2009, and was named ESPN’s greatest North American athlete of the 20th century. Not too bad a career.


How did Jordan perform to such a high level so regularly, especially when the stakes were the highest? The stadiums were packed with media and screaming and jeering fans, and millions more watched on TV around the world, and yet he managed to consistently step up, night after night.

Maybe it was just was genes or natural talent. However, if this was the case, Jordan’s children should have also been great, and Jordan wouldn’t have been cut from his high school basketball team as a sophomore.

Maybe it was his physical conditioning. Again, this might be true, but there have been plenty of fit and athletic players in the NBA, and not all of them go on to become superstars.

There’s also the infamous ‘flu game’ in game 5 of the 1997 NBA finals against the Utah Jazz, where the commentator Marv Albert said this:

“The big story here tonight — the story concerning Michael Jordan’s physical condition. He is suffering from flu-like symptoms.”


Because the series was tied at 2 all, Jordan didn’t want to let his physical state prevent him from playing. Jordan started slow, and later admitted that he felt weak, had really low energy and couldn’t breath properly. In spite of almost passing out and having to slump over with his hands on his knees whenever the game stopped, Jordan helped the Bulls fight back from a 16-point first quarter deficit to win 90-88 and then go onto win the series in 6 games. In the process, he scored 38 points, 7 rebounds, 5 assists, 3 steals, 1 block and the three-pointer that sealed the game with less than a minute to play.

What separated Michael Jordan from the rest and helped him to become one of the greatest athletes of all time was his mental fortitude and mindset. He never gave up, truly believed that great things were possible as long as he put in the work and tried his best, and he never backed down from a challenge.

Here are two of his most famous quotes that perfectly exemplify this:

Jordan didn’t care about making mistakes or failing in the eyes of others. What he really cared about was trying his absolute best, and not letting fear of failure hold him back from doing everything he could to help his team win. It could be that Michael Jordan is an anomaly here, but I don’t think he is.

If you look at all the greats, their mindset and mental strength played a huge role in their overall level of success. Let’s look at Simone Biles in gymnastics, who has now won 25 medals at the World Gymnastic Championships in her career, including 19 gold.

Here’s how she approaches training and competitions:

Biles believed in working harder than anyone else in practice to be the best, but also prioritized being confident in herself and her abilities, and knew that in order to do this, she needed to also ensure that she looked after her mental and emotional health.  

What about Michael Phelps, who is the most decorated Olympian of all-time with 28 Olympic medals in swimming, including 23 gold:

Phelps, like Biles, tried to train harder than anyone else to be the best. He also focused on building belief and confidence in himself and not listening to any doubters who tried to tell him that something couldn’t be done. Like Jordan, he did not view it as failure to try as hard as he could to achieve his goals, even if he fell short.

All three amazing athletes had incredible success when it mattered most. Their mental attitude towards themselves, setbacks, practice and competition was no doubt a huge factor in the results that they achieved.

man climbing on rope

The Equation for Success

Some people may still try to put their success down to talent, but hopefully all of you know that this is wrong. Psychologist Angela Duckworth, in her book ‘Grit: The Power of Passion and Perseverance’ developed an equation for success based on her research into the area:

talent + effort = skill

skill + effort = achievement

This means that the amount of hard work and effort you put into your training and preparation is twice as important for success than your initial level of talent.

Duckworth doesn’t exactly say this in her book, but once the effort has been put in at training, I truly believe that the next most important predictor of success is your mindset and mental strength on the day of the competition.

silhouette of a boy playing ball during sunset

Finding Flow

Most professional athletes know what it is like to be “in the zone” or in a “peak experience” as Psychologist Abraham Maslow called it. It has also been commonly referred to as a “flow state”, which was initially coined by psychologist Mihaly Csikszentmihalyi and examined in detail in his book ‘Flow: The Psychology of Optimal Experience’.

Flow can be defined as:

“being so involved in an activity that nothing else seems to matter. The ego falls away. Your perception of time changes. Every action, movement and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you are using your skills to the utmost, and those skills are significantly magnified. Physical skills, mental skills, psychological skills, social skills, creative skills, decision-making skills. Flow breaks boundaries. You are flow. It is you. There is no thought. You are fully immersed in your body and the moment. You experience profound mental clarity and a sense of oneness. Everything just works.”

I’ve never been to an Olympics before, but I can tell you that when I am confident and in the zone playing basketball or volleyball, I feel like no one can stop me, the game is so easy, things seem to move in slow motion and my level of performance astounds me. I am not exactly the best shooter in basketball, but I have had some games where making a basket was as easy as throwing a stone into the ocean from the edge of a pier.

If you don’t know what I mean, check out Klay Thompson’s shooting performance in only one quarter of basketball, smashing the previously held record:

Notice how it didn’t seem to matter where he was or who was defending him; he was in the zone, and he was going to shoot the ball as soon as he caught it, and those shots were going to go down.

The book ‘The Rise of Superman’ by Steven Kotler suggests that extreme and adventure sport athletes are the best at getting into flow states consistently and remaining there while competing. Because of the real risk of death and serious injury with mistakes, flow is not just a desired state to aim for but a necessity in these sports. Consequently, only the athletes that can consistently do it survive, both in the sport and in their lives.

Kotler tries to go beyond flow to explain unbelievable performances, such as pro-skater Danny Way jumping the great wall of China with a broken ankle:

Kotler says that every athlete has the capacity to get in the zone. Unbelievable performances are about experimenting with the impossible once you are in a flow state, pushing your limits, and seeing what you are truly capable of. 

man wearing black long sleeved shirt standing on mountain

The opposite is also true. When I am not in a good headspace or my confidence is low, even the most basic moves feel difficult and scoring points can feel almost impossible. I’m going to guess that most of you have had similar experiences in your own sports too. When things just aren’t clicking. Where you start to doubt yourself. Where no matter what you try you just can’t get out of your head and you tense up. You start to miss free throws like Shaq:

What if you could be like Michael Jordan or Danny Way, and consistently perform at your best and reach your potential when it matters most? How would that feel, and how much would you pay to figure that out?

Fortunately, I won’t be charging you anything, but I do hope to help you unlock your own secrets to consistently great performance. In my next article, I’m going to teach you the mental skills and strategies to bounce back from adversity, take on helpful feedback from your coaches, and remain focused and composed even in highly stressful and distracting situations. I’m also going to help you to become more consistently confident and motivated, have clear objectives and be well prepared, perform at your best under pressure and not let your worries interfere with your game or prevent you from getting into a consistent state of flow. Stay tuned. 


Dr Damon Ashworth

Clinical Psychologist

Understanding Anxiety

Ministry of Health Vanuatu

October 2019 Mental Health Newsletter

Understanding Anxiety

Is Anxiety the same thing as Stress?

Sometimes people use the terms stress and anxiety to explain the same feeling. However, to a mental health expert, the difference is essential, because the management of each condition are different.

Negative stress or distress is the feeling you get when you “lose control of a situation” and do not believe that you have the necessary resources to handle the situation successfully.

Stress is your body’s way of responding to any demand or threat. When you feel threatened, your nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, which rouse the body for emergency action. Your heart pounds, you feel tense and alarmed and experience many sensations as well as thoughts.

Anxiety can produce feelings of distress too, but it is the excessive worrying about the future and the things you are afraid of coming true.

If someone has a big exam coming up, they may feel the physical symptoms of stress because they want to do well, and this can help them to study. However, if they are too anxious about failing the exam, they will want to avoid studying because it feels too scary for them.

When does Anxiety become a problem?

Everyone gets nervous or anxious from time to time. If we have to make a speech, attend an interview, or deal with a problematic upcoming event, we can all experience stress, fear and worry. However, for some people, anxiety becomes so frequent, or so forceful, that it begins to take over their lives.

Anxiety also comes in many different forms including generalised anxiety, panic attacks, phobias, social anxiety, obsessive-compulsive disorder, hoarding and post-traumatic stress disorder. The distinction between an official diagnosis of anxiety and “normal” levels of worry isn’t always clear. Anxiety can be a complex disorder to diagnose and treat, and a person’s background and personality may also be a significant factor.

The best way to know if anxiety is becoming a problem for you is if you find yourself always worrying about something that may or may not happen in the future. If this worrying is causing you a lot of distress and making it difficult for you to focus on what you need to do in the present moment or enjoy life, then it is becoming an issue.

Anxiety is usually “future” oriented. Even if you are worrying about something that happened in the past, the anxiety is focused on what the consequences will be from this in the future. The most common question a person with anxiety asks themselves is “What if?’ The answer to what if questions for someone with problematic anxiety tends to be the worst case scenario. This is called catastrophizing, and only leads to more stress and worry over time.

What are the Different Anxiety Disorders?

The following are the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) definitions for each anxiety disorder. Please not that these symptoms need to cause significant distress or impairment to daily activities for them to be significant enough to warrant a diagnosis.

Generalised Anxiety Disorder (GAD)

  1. Excessive anxiety and worry about a wide variety of topics, events or activities.
  2. Worry occurs more often than not for at least 6 months and is clearly excessive.
  3. The worry is difficult to control, and may easily shift from one topic to another.
  4. The anxiety and worry is accompanied by at least one of the following symptoms in children, and at least three in adults:
    1. Restlessness or edginess
    2. Tires or fatigues easily
    3. Impaired concentration or mind going blank
    4. Irritability which may or may not be observable by others
    5. Increased muscle aches and soreness
    6. Difficulty sleeping, including falling to sleep or staying asleep or poor sleep quality
    7. Sweating
    8. Nausea
    9. Constipation/diarrhea

Specific Phobia

Specific phobias are an intense and irrational fear of specific natural events, mutilation, animals or situations. A specific phobia diagnosis needs to have:

  • Unreasonable, excessive fear
  • An immediate anxiety response
  • Avoidance or extreme distress
  • Presence of symptoms regularly for at least six months

The top ten most common specific phobias are:

  1. Arachnophobia – fear of spiders
  2. Ophidiophobia – fear of snakes
  3. Acrophobia – fear of heights
  4. Agoraphobia – fear of crowds or open spaces
  5. Cynophobia – fear of dogs
  6. Astraphobia – fear of thunder and lightning
  7. Claustrophobia – fear of small spaces
  8. Mysophobia – fear of germs
  9. Aerophobia – fear of flying
  10. Trypophobia – fear of holes

Panic Attacks

A panic attack needs to have four or more of the following symptoms:

  • Palpitations or increased heart rate
  • Sweating
  • Shaking or trembling
  • Shortness of breath or a feeling of not being able to breathe
  • A feeling of choking
  • Pain or discomfort in the chest
  • Nausea or upset stomach
  • Feeling dizzy, lightheaded, faint or unsteady
  • Feelings of unreality or being detached from oneself
  • Fear of losing control or “going crazy”
  • Fear of dying
  • Numbness or tingling in different parts of the body
  • Sudden chills or hot flushes

Panic disorder occurs when after someone has a panic attack, they then begin to worry about having more panic attacks and avoiding situations or places that they worry will trigger another one.

Post-traumatic Stress Disorder (PTSD)

  1. For a diagnosis of PTSD, the person needs to have been exposed to a situation that involved:
  • Death
  • Actual or threatened serious injury
  • Actual or threatened sexual violence

This could be exposure via direct experience, witnessing it happening to someone else, or hearing about it happening to a relative or close friend.

  1. Presence of at least one persistent intrusive or re-experiencing symptom:
    • Nightmares about what happened
    • Flashbacks about what happened
    • Unwanted upsetting memories
    • Emotional distress after exposure to reminders of the traumatic event
    • Physical reactivity after exposure to reminders
  2. Presence of avoidance in at least one way:
    • Avoidance of having trauma-related thoughts or feelings
    • Avoidance of external places or things that act as reminders of the traumatic event
  3. Presence of at least two negative changes to beliefs and mood:
    • Overly negative thoughts about self, others or the world
    • Strong negative feelings, including sadness, anger and guilt
    • Exaggerated blame of self or others for the traumatic event
    • Decreased interest in engaging in activities that one used to enjoy
    • Feeling isolated and cut off from others
    • Feeling emotionally numb or unable to experience positive emotions
  4. Presence of at least two symptoms of hyper-arousal:
    • Irritability and aggression
    • Risky or destructive behaviour
    • Hypervigilance or being “on guard”
    • Exaggerated startle response
    • Difficulty concentrating
    • Difficulty sleeping
  5. These symptoms must have occurred for at least one month, or it is an acute stress reaction.

Obsessions and Compulsions (OCD)

Obsessions consist of two important elements:

  1. Recurrent and persistent thoughts, urges, or impulses that are experienced as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
  2. The individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions have two core features also:

  1. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

For a diagnosis of OCD, the obsessions and compulsions must be time-consuming and take more than one hour per day or cause significant distress or impairment. Some people with OCD have good insight into their behaviours and why they do it, but struggle to change, and other people may not have any insight into why they do what they do or how they can change it.

Hoarding Disorder

Hoarding disorder is characterized by the following symptoms:

  1. Persistent difficulty in parting with or discarding possessions, regardless of their actual value.
  2. This difficulty is due to a perceived need to save the items and wanting to avoid the distress associated with discarding them.
  3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (eg. Family members, cleaners, authorities).
  4. The hoarding makes it difficult to maintain a safe environment for self and others

The person with the hoarding behaviour may have good insight and realise their excessive acquisition of things is a problem, or they may have poor insight and not recognise that their behaviour is unhealthy.

Treatment of Anxiety

There is a variety of treatments available for anxiety. Most psychological treatments of anxiety disorders are supported by research as being effective treatments that can significantly improve functioning and reduce distress.

If you or someone close with you is experiencing one of the above anxiety disorders, it would be wise to discuss this with your health professional and in some cases obtain a referral to a mental health unit.

For more information, support or advice, please contact:

Mind Care Clinic

Psychiatry Department



VOIP: 1972

Namalinuan Clinic



Mental Health Clinic



Mental Health Clinic



Mental Health Clinic



Self-harm and Suicide Prevention

Ministry of Health Vanuatu

MOH logo

September 2019 Newsletter

The 10th September 2019 is World Suicide Prevention Day.


According to the World Health Organisation, a person dies from suicide somewhere in the world every 40 seconds. This means that nearly 800,000 people die from suicide across the world every year.

Guyana has the highest suicide rate of any country in the world, with 44.2 per 100,000, but South Korea (28.9 per 100,000), Sri Lanka (28.8 per 100,000), Lithuania (28.2 per 100,000) and many other countries are also way too high.

76% of those who died by suicide were male, a ratio of more than 3:1. This ratio stays pretty steady for nearly all age groups, with men always dying from suicide at a higher rate than women.

The most alarming thing about these findings is that our suicide rate is increasing, an extra 2.1 per 100,000 in only five years. The percentage of suicide has also grown in the US by 24% from 1999 to 2014, after consistently declining the 14 years before that, according to data from the Centers for Disease Control and Prevention (Aboujaoude, 2016).

In the US it’s meant to be increasing due to the increasing use of antidepressants and their link to suicidality, to inadequate health insurance coverage, to the global financial crisis, increased divorce rates, higher opiate drug use, and the internet (Aboujaoude, 2016).

While it is good that many of these factors do not apply in Vanuatu, there are still over 11% of suicide-related search results on the internet that are pro-suicide (Recupero, Harms & Noble 2008). This means that we need to provide as much material as possible that shows people that suicide is neither the best option or the only option.

Warning signs of suicide:

After a completed suicide you will hear everyone in the family and community ask the same questions – Why? Why did this happen? What could I have done differently so that they would still be alive right now? These are natural questions that we all go through so that we can try to make sense of something that doesn’t make any sense. It is part of the grieving process, and these questions do become less frequent and less intrusive over time.

While some suicides may occur without any warning signs, most people who are suicidal do give warnings, such as:

  • Increasing their alcohol and/or other drug use
  • Taking unnecessary risks and impulsivity, e.g. suddenly overtaking in a dangerous situation
  • Threatening suicide and/or expressing a strong wish to die
  • Exhibiting rage and/or anger often in helpless situation
  • Talking about wanting to die or to kill oneself
  • Being preoccupied with the topic of death
  • Researching ways to die
  • Buying equipment such as guns, weights, ropes or sharp instrument
  • Talking about feeling hopeless or having no reason to live
  • Talking about being a burden to others
  • Acting anxious or agitated often; behaving recklessly
  • Isolating or withdrawing oneself
  • Displaying mood swings frequently
  • Telling loved one’s goodbye
  • Setting one’s affairs in order
  • Giving things away, such as prized possessions
  • Referring to death via poetry, writings and drawings
  • Exhibiting dramatic changes in personality or appearance
  • Big changes in eating or sleeping patterns
  • Noticeable decline in performance at school, work or other important activities

Why do people attempt suicide?

There are many reasons why people die from suicide but untreated Depression is probably the main reason.

Here are some other reasons why people attempt suicide:

  • Untreated mental illness
  • The death of someone close
  • Loss of a child or custody of children
  • Divorce or major relationship issue
  • A serious illness
  • Chronic pain
  • Intense emotional pain
  • Bullying, both adults and children
  • Trauma from and an accident, rape, assault or loss from a disaster
  • Feeling trapped in a stressful situation
  • Inability to deal with humiliation
  • A serious business or financial loss
  • A terminal illness
  • Inability to deal with failure
  • Alcohol or drug abuse and confusion or false perceptions
  • Inability to accept growing old
  • Need to protect someone else
  • Not be a burden on someone
  • Not feeling connected or a sense of belonging with others
  • To punish someone or make a point
  • Uncontrollable impulses
  • Major legal problem/embarrassment or financial burden
  • Loss of hope
  • Copycat suicides where someone has died by suicide and someone else follows the example. This usually happens where people have looked up to the person who died and/or identified strongly with them.

If you are noticing some warning signs of suicide in someone who has also had some big changes or significant events happen to them recently, it is important to check in with them, ask how they are doing, and get additional support if they are having suicidal thoughts and are considering different ways that they could end their life. Treatment with a mental health professional can make a big difference and reduce the risk of someone dying from suicide.

What is Self-Harm and How Can We Manage It?

The terms self-harm and suicide often get grouped together but actually mean two different things. Both are infliction of pain and sometimes people who begin with selfharm may later commit suicide. Generally, people who selfharm do not wish to kill themselves; whereas suicide is a way of ending life.

Self-harm is the intentional and deliberate hurting of oneself

Most common methods of self-harm include:

  • Cutting
  • Burning
  • Picking at the skin
  • Pulling hair
  • Biting
  • Deliberately hitting one’s body so that they feel pain or break something, e.g. punching a wall
  • Placing oneself in some danger where they won’t die but are likely to sustain an injury
  • and other less common ways

Indicators of self-harm

If you are worried that someone you care about is self-harming, there are signs that you should look out for:

  • Many cuts/burns on the wrists, arms, legs, back, hips, or stomach
  • Wearing baggy or loose clothes (e.g., wearing hoodies or long sleeves during hot days to conceal the wounds)
  • Always making excuses for having cuts, marks or wounds on the body
  • Finding razors, scissors, lighters or knives in strange places e.g. in a bag or under the bed
  • Spending long periods locked in a bedroom or bathroom
  • Isolation and avoiding social situations more frequently than they used to

Why do people self-harm?

  • To escape their feelings
  • To cope with life stressors
  • To express their pain
  • To punish themselves for some perceived guilt
  • Some people lack self-esteem and feel that they deserve what they are doing to themselves because of something they did wrong or something someone said to them that proves to them that they are “bad” or “no good”
  • To feel “high”. When we get hurt, endorphins are often released into the blood stream, resulting in a mild feeling of euphoria. Self-harming behaviours can become addictive and habit forming.
  • To feel more in control. Some people have said that “when they hurt themselves” they reconnect with their body or are able to focus on the pain they feel from the harm they have caused rather than feeling disconnected or overwhelmed from all the other issues in their lives.

So in a strange kind of way, many people who self-harm are doing this as a means to try and cope with their distress rather than commit suicide. Self-harm is a response to painful emotions and experiences. Unfortunately, self-harm is dangerous, and can lead to people accidentally killing themselves. It may also become a habitual way of coping with any stress, and is therefore considered a maladaptive or unhelpful coping strategy. Consuming too much alcohol, or junk food, or even social media are other maladaptive coping strategies.

Adaptive or helpful coping strategies for dealing with distress include:

  • Socialising with friends
  • Problem solving
  • Journalling about the issue and writing about how you feel and what you could do
  • Talking to someone that you trust and that can help you to solve your problem
  • Being proactive about addressing the issue if there is something that you can do to fix it
  • Any form of exercise or movement, including walking, running, dancing, yoga, sports
  • Getting outside into nature and connecting with the world around you
  • Listening to music
  • Eating healthy foods including lots of fruit and vegetables
  • Learning relaxation techniques including deep breathing, progressive muscle relaxation, imagery or visualisation exercises and meditation
  • Pray or go to church or discuss how you are feeling with a spiritual or community leader
  • Seek professional help from the mental health team in your province.

What Else Can You Do?

Self-harm and suicide are complex matters and sometimes difficult to talk about. Some people believe that if you raise your concerns with someone you may increase the risk that they will attempt suicide. This is not the case.

If you become aware that someone is self-harming be gentle and ask them what is leading to them self-harming and if there is anything else is wrong in their life at the moment? Don’t criticise or judge them as they may not be willing to talk to you about the topic again. Be patient and ask how you can help. Suggest a referral or a meeting with other people that the person accepts.

If you think that someone is suicidal ask them what they are planning to do. Sometimes it’s just a passing idea so stay connected and talk gently and suggest seeking help. If they are just talking about suicide it means they have some ideas but may not act.

But if they begin to become specific and say how they will hurt themselves or they have bought a rope or poison or have other means (a definite plan) then they are very vulnerable so its best that they seek professional help from a doctor, paramedic, mental health nurse or psychologist.

Remove the means if you can and be honest with them about seeking help. Try not leave them completely alone if they are not able to say to you that they they feel safe and want to live.  It is very difficult to watch someone all the time and people who are feeling suicidal can be impulsive.

Suicidal thoughts and feelings do change and can get better. It is mostly about trying to keep people feeling safe and as calm as possible until the thoughts and feelings pass and they begin to feel different.

If you are struggling with the fear of death, the following book can help:
  • “Staring at the Sun: Overcoming the Terror of Death” by Irvin D. Yalom.
If you are struggling with lack of meaning and purpose in life, the following books can help:
  • “Finding Flow: The Psychology of Engagement with Everyday Life” by Mihaly Csikszentmihalyi
  • “Finding Your Element: How to Discover Your Talents and Passions and Transform Your Life” by Ken Robinson and Lou Aronica
  • “Man’s Search for Meaning” by Viktor Frankl.
If you are being held back by fear and self-doubt, the following books can help:
  • “The Confidence Gap” by Russ Harris and Steven Hayes
  • “Feel the Fear, And Do It Anyway” by Susan Jeffers
  • “Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead” by Brené Brown
If you are struggling with grief, the following books can help:
  • “Why Bad Things Happen to Good People” by Harold S. Kushner
  • “On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss” by Elisabeth Kübler-Ross and David Kessler

DISCLAIMER: If the content of this newsletter upsets you or you are struggling with suicidal thoughts or self-harm and would like more information, advice or support, please contact:

Mind Care Clinic

Psychiatry Department



VOIP: 1081

Namalinuan Clinic



Mental Health Clinic



Mental Health Clinic



Mental Health Clinic



What Values Do You Try to Live Your Life By?

Values are guiding principles for our lives that are endless pursuits. We cannot achieve a value in the same way we can accomplish a goal. However, at any point in time, you can connect with them, act in accordance to them, and receive the vitality, energy, improved self-worth, greater emotional well-being and happiness that are often the result of living consistently with our values.

To figure out your most important values, first write if each value in the list below is very important to you (V), quite important to you (Q), or not important to you (N).

It is essential that we choose the values that feel right to us, rather than pick the values that we think our parents or society might want us to follow.

people girl design happy

Then, for only your very important values, score from (0-10) how much you have been living according to this value over the past month, with:

0 = not following this value over the past month,

1 – 3 = following this value occasionally,

4 – 6 = following this value sometimes,

7 – 9 = following this value often, and

10 = always living by this value.


  1. Connecting with Nature: Importance of value to you (V, Q, N?) = ________, Consistency with value if it is very important to you (0-10?) = _________
  2. Gaining wisdom: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  3. Creating beauty (in any domain, including arts, dancing, gardening): Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  4. Promoting justice and caring for the weak: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  5. Being loyal to friends, family and/or my group: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  6. Being Honest: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  7. Helping others: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  8. Being sexually desirable: Importance (V, Q, N?) = _____, Consistency (0-10?) = ________
  9. Having genuine and close friends: Importance (V, Q, N?) = ____, Consistency (0-10?) = _____
  10. Having relationships involving love and affection: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  11. Being ambitious and hard working: Importance (V, Q, N?) = ____, Consistency (0-10?) = ____
  12. Being competent and effective: Importance (V, Q, N?) = _____, Consistency (0-10?) = ______
  13. Having a sense of accomplishment and making a lasting contribution: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  14. Having an exciting life: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  15. Having a life filled with adventure: Importance (V, Q, N?) = ____, Consistency (0-10?) = ______
  16. Having a life filled with novelty and change: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  17. Being physically fit: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  18. Eating healthy food: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  19. Engaging in sporting activities: Importance (V, Q, N?) = ____, Consistency (0-10?) = ______
  20. Acting consistently with my religious faith and beliefs: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  21. Being at one with God: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  22. Showing respect for tradition: Importance (V, Q, N?) = ____, Consistency (0-10?) = _____
  23. Being self-disciplined and resisting temptation: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  24. Showing respect to parents and elders: Importance (V, Q, N?) = ____, Consistency (0-10?) =____
  25. Meeting my obligations: Importance (V, Q, N?) = ______, Consistency (0-10?) = _________
  26. Maintaining the safety and security of my loved ones: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  27. Making sure to repay favours and not be indebted to people: Importance (V, Q, N?) = ______, Consistency (0-10?) = _________
  28. Being safe from danger: Importance (V, Q, N?) = ______, Consistency (0-10?) = _______
  29. Being wealthy: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  30. Having authority, being in charge: Importance (V, Q, N?) = ____, Consistency (0-10?) = ____
  31. Having influence over other people: Importance (V, Q, N?) = ____, Consistency (0-10?) = ____
  32. Having an enjoyable, leisurely life: Importance (V, Q, N?) = ____, Consistency (0-10?) = ____
  33. Enjoying food and drink: Importance (V, Q, N?) = ______, Consistency (0-10?) = _________
  34. Being sexually active: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  35. Being creative: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  36. Being self-sufficient: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  37. Being curious, discovering new things: Importance (V, Q, N?) = ______, Consistency (0-10?) = ______
  38. Figuring things out, solving problems: Importance (V, Q, N?) = ______, Consistency (0-10?) =______
  39. Striving to be a better person: Importance (V, Q, N?) = _____, Consistency (0-10?) = ______
  40. Experiencing positive mood states: Importance (V, Q, N?) = ____, Consistency (0-10?) = ______
  41. Feeling good about myself: Importance (V, Q, N?) = _______, Consistency (0-10?) = ______
  42. Leading a stress-free life: Importance (V, Q, N?) = _______, Consistency (0-10?) = _______
  43. Enjoying music, art or drama: Importance (V, Q, N?) = _____, Consistency (0-10?) = ______
  44. Designing things: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  45. Teaching others: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  46. Resolving disputes: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  47. Building and repairing things: Importance (V, Q, N?) = _____, Consistency (0-10?) = ______
  48. Working with my hands: Importance (V, Q, N?) = ________, Consistency (0-10?) = ______
  49. Organising things: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  50. Engaging in clearly defined work: Importance (V, Q, N?) = _____, Consistency (0-10?) =_____
  51. Researching things: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  52. Competing with others: Importance (V, Q, N?) = ________, Consistency (0-10?) = _______
  53. Being admired by many people: Importance (V, Q, N?) = _____, Consistency (0-10?) = _____
  54. Acting with courage: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  55. Caring for others: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  56. Accepting others as they are: Importance (V, Q, N?) = ____, Consistency (0-10?) = _______
  57. Working on practical tasks: Importance (V, Q, N?) = _____, Consistency (0-10?) = ________
  58. Seeking pleasure: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  59. Avoiding distress: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________
  60. Avoiding self-doubt: Importance (V, Q, N?) = ________, Consistency (0-10?) = _________

It will be difficult/impossible to always live by all of our very important values, because some values will come into conflict with each other. However, if you are have scored it a 5 or below in your consistency rating, then try to set a goal for the next month of how you can live more consistently with this value.

This is especially true with your top 5 values, so identify your top five values from this list if you can, and try to live according to these core values on a regular basis. If you manage this, you are much more likely to feel that you are on the right track and heading in the right direction in your life.

backlit beach clouds dawn

Dr Damon Ashworth

Clinical Psychologist

PLEASE NOTE: These value descriptions were taken from a values cards exercise that I did during my doctoral degree. I am not sure who developed it, but will happily give credit to them if anyone can let me know who did.


Youth Mental Health & Managing Exam Stress

Ministry of Health Vanuatu

August 2019 Mental Health Newsletter

The 12th August 2019 is International Youth Day.

In October 2018, Vanuatu’s Mental Health Team travelled to Epi to visit patients and discuss mental health treatment with the nurses at Vaemali Health Centre. They also had the opportunity to talk to some of the high school students at Epi High School about Adolescent Mental Health.

Following this talk, a number of the students said that they were feeling very stressed about their exams coming up. They wanted to know how to best prepare for their exams and cope with the stress that they were feeling.

Top tips to best prepare for exams, as determined by the Hunimed Web Team:

  1. Give yourself enough time to study
  2. Make a realistic study schedule
  3. Try not to leave anything for the last minute
  4. Make sure your study space is organized
  5. Have a comfortable chair and with enough space and light to study in
  6. Remove all other distractions apart from the task you are working on when studying
  7. Use flow charts, diagrams, and other visual aids to make it easier to revise the material you have learnt
  8. Practice on old exams if they are available
  9. Explain what you know to others, and why you have answered a question on a certain way
  10. Organise study sessions with friends who are learning the same things
  11. Take regular breaks. The pomodoro technique recommends 25 minutes of concentrated study followed by a five-minute break. 50 minutes of study followed by a 10-minute break can work well too
  12. Do not try to study for more than 8 hours a day, including class time. Any more than this and new information won’t be learned as well
  13. Still spend time socialising with friends and family or exercising when you are not studying to give your mind a rest and look after your mental health
  14. Snack on healthy food that your brain benefits from, including natural, fresh, and vitamin rich foods. Fruits, vegetables, and nuts and seeds are especially helpful. Avoid consuming too much sugar, processed foods and caffeine
  15. Plan the day of your exam, including the time you want to wake up so that you can get enough sleep the night before, bathe, eat a nutritious breakfast and get to the exam without rushing and increasing your stress
  16. Drink plenty of water while studying and have a bottle with you during the exam too if that is allowed.

Here are the top 10 tips for looking after your mental health, according to The Mental Health Foundation:

  1. Talk about your feelings (with people who are likely to listen and not judge)
  2. Exercise regularly (30 mins a day, 5 days a week)
  3. Eat well (lots of vegetables and minimal processed food or foods high in sugar, salt and saturated fats)
  4. Drink sensibly (lots of water is best, but a little bit of coconut water and vegetable juice is good too)
  5. Keep in touch with loved ones
  6. Ask for help when you need it or could use it
  7. Take a break (rest and play and socializing and getting outside into nature is great)
  8. Do something you’re good at (accomplishment and achievements or mastery over something helps us to feel good)
  9. Accept who you are (especially the things you cannot change about yourself)
  10. Care for others (help at home, in the community, with strangers. Essentially, try to be kind to others and appreciative of nice things they do for you)

Adolescence has always been a time full of change:

  • Puberty,
  • Hormonal and bodily changes,
  • New schools or universities,
  • New friendship groups,
  • Starting a new job,
  • Beginning to date, or
  • Maybe even moving out of the family home.

The rapid rate of technological growth is complicating this process for most adolescents by accelerating the amount of change and new experiences that they are exposed to.

With this new technology, we now have more ways to stay in touch, but this is not always a good thing:

  • Bullying and social exclusion can be perpetuated 24 hours a day, resulting in a sense of no escape for those being targeted.
  • Due to the lack of regulation and adolescents being more technologically knowledgeable than their parents, most adolescents have access to much adult-only information at the swipe of a finger and click of a button.
  • A lot of the data collected on the internet is stored forever, meaning that “a little bit of fun” or one small mistake can have severe consequences for the future of that individual.

Critical facts about adolescent mental health from the World Health Organisation:

  • One-in-six people in the world are between 10 and 19 years of age.
  • Mental health conditions account for 16% of the global burden of disease in people aged 10-19 years.
  • Half of all mental illness begins by the age of 14.
  • Most cases of mental illness go undetected and untreated.
  • Depression is the third leading cause of illness and disability among adolescents. At its worst, depression can lead to suicide.
  • Suicide is the second leading cause of death among 15 to 29-year-olds worldwide, following only road accidents.
  • Risky behaviours, including substance abuse, unhealthy eating or sleeping patterns, interpersonal violence, dangerous driving and unsafe sex often begin during adolescence.
  • Exposure to poverty, disaster, abuse or violence can make adolescents more vulnerable to mental health problems.

As seen above, suicide is the 3rd leading cause of death for adolescents and 2nd leading cause of death among 15-29-year-olds. The important takeaway message is that many of these deaths can be prevented, through better awareness, community support, and specialist services to assist those in need.

Prevention of mental health difficulties begins with a better understanding of what the main issues are and what you can do about them.

By prioritising adolescent mental health, it will not only help the individuals being supported, but it will also help the economy and community at large, both now and into the future.

It t is important for adolescents to know that confidential help is available, and that things can get better if they are struggling with too much stress or other mental health problems such as Depression, Anxiety, Insomnia, Substance Abuse, or Relationship difficulties at home or at school.

If you are in Vanuatu and would like more information, advice or support, please contact:

Mind Care Clinic

Psychiatry Department



VOIP: 1081

Namalinuan Clinic



Mental Health Clinic



Mental Health Clinic



Mental Health Clinic



D.A. MoH Port Vila, January 2019

How do we change our stress levels if they are not helping us to function well during the day or sleep well at night?

Stress levels that are both too low and too high can cause problems at different times of the day and in different situations.

It is important to first figure out if your stress level is too low, too high or just right for the situation that you are in.

The best way to figure out your stress level is to think of a scale from 0-10, where 0 is as relaxed and calm as you could possibly be, and 10 is as overwhelmed as you can be:

  • If your stress level is between 0 and 2, you will probably not want to do much except for sit or lie there because you are so relaxed. It is great to have low arousal levels if you are in bed at night, as you are likely to feel sleepy and fall asleep quickly. You may also feel really calm and peaceful if you are lying around by the pool on holiday and don’t have anything that you have to do. However, it is less ideal if you are at work or home and need to get things done. You might feel apathetic, unmotivated, bored, flat or even a little sad or depressed if you want to achieve a goal during the day but your arousal level is too low.
  • If your stress level is between 4 and 6, you are at the optimal level for feeling alert and focused and functioning well during the day. However, if they remain at a 6 once you go to bed, your brain may want to keep ticking over and thinking about things, and your body may not be as relaxed as it needs to be to feel comfortable, fall asleep quickly and remain asleep throughout the night.
  • If your stress level is between 8 and a 10, you are in the danger zone, and it can be difficult to calm yourself down quickly or to think about anything except for the perceived threat or threats to your safety in your environment. At 10 you are probably having a panic attack and thinking that you are going crazy or that you are going to die. It is very hard to fall asleep if your brain thinks that you are in imminent danger, as we are at our most vulnerable to attack when we are asleep.

You then need to rate your stress level at the moment, between 0 and 10, based on the above scale.


If you are unable to put a number on your stress level immediately, ask yourself further questions, such as:

  • How active is my brain right now?
    • Are my thoughts calm (low stress), appearing at a comfortable pace (moderate), or racing (high stress)?
    • Am I on the lookout for danger and focused on potential threats in my environment (high stress), able to concentrate on what I am doing (moderate) or daydreaming about nothing specific (low)?
  • How tense is my body right now?
    • Do I feel relaxed physically (low stress), comfortable (moderate) or tense (high stress)?
  • Do I notice any other strong physical sensations right now?
    • Is my chest pounding, heart racing, am I feeling hot or sweaty, feeling restless or irritable or needing to move around a lot, experiencing shortness of breath or rapid breathing (all signs of high stress)?
    • Do I feel physically tired, flat, and have no energy or no motivation (all signs of low stress)?
  • What do I feel emotionally?
    • Do I feel calm, peaceful, bored, apathethic, sad or depressed (all signs of low stress)?
    • Do I feel content, satisfied, or happy (moderate)?
    • Do I feel excited, anxious, stressed, angry, frustrated, overwhelmed or panicky (all signs of high stress)?

Once you know your current stress level, you then need to determine what the optimal level of stress is for the current situation that you are in:

  • If you are in a war zone, 7 or 8 is probably optimal,
  • if you are at work, 5 or 6 is probably optimal,
  • if you are wanting to chill and relax, either by yourself or with friends, 3 or 4 is probably optimal, and
  • if you are in bed and wanting to sleep, 1 or 2 is probably optimal.

Now that you have your current stress level and your optimal level for the situation that you are in, you will know if you need to do something to increase or decrease it.

As you will see in the following section, there are many different lifestyles, personality factors and strategies that can increase or decrease our stress levels during the day and at night and when we are in bed.

What to do if your stress levels are too high and you want to reduce them

1. Do less during the day

Always being on the go and trying to be productive all the time increases our stress levels over time, which increases our cortisol levels, which increases our stress further.

Try to see if you can do less, by delegating more tasks to others, hiring others to do things you don’t like, asking for more help from your partner or children, or putting less important tasks off until later.

2. Lower your standards

The Pareto principle states that we can obtain 80% of the results we want with only 20% of the effort. This means that the last 20% takes 80% of the effort.

What would happen if you became okay with things being ‘good enough’ (80%) rather than ‘perfect’ (100%)? You could take the 80% effort that you normally put into trying to be perfect, and apply 20% to four other areas of your life. The result would be you achieve 80% of the results you want in five areas of your life in comparison to 100% of the results in one area of your life and 0% in the other four.

By choosing to drop your standards a little bit, you can get more done with less effort, which could also mean less stress, lower cortisol, and better sleep at night.

3. Take more breaks during the day

The Pomodoro technique has been found to be one of the most productive ways to study. It involves setting a timer for 25 minutes, then taking a five-minute break, and then repeating the process.

Humans are not designed to concentrate on the one thing for hour after hour, yet work schedules are often set up where people work for 3.5 hours straight, eat lunch at their desk while they continue to work for an hour, then work for another 3.5 hours straight. People do this because they think they are too busy and cannot afford the time to stop, take a break, rest or relax. But what happens if these rest periods actually made us more productive?

When I worked night shift at the supermarket, we got two 15-minute breaks and one 30-minute break in an 8-hour shift, and we got paid to take all of these breaks. Maybe they were just being nice, but I think Woolworths realised that staff morale and productivity remained much higher with breaks happening at least every 2 hours.

Try it and see for yourself if you feel better after a week of taking more regular breaks and actually getting away from the desk or out of your office during this time.

4. Problem solve if something is worrying you or causing you stress

If you are feeling stressed about something, it helps to write down what is bothering you and a plan to address it if there is something that you can do.

People often fall into the trap of procrastinating or putting off doing something that would help them to feel a lot less stressed once it was done. If you are worried about your late tax return, playing video games might help distract you from thinking about the issue, but actually getting it done is going to feel much better. Fortunately, writing down a plan can provide us nearly the same amount of relief as actually doing the task, as long as we write down what we need to do, what the first action is that we need to take, and exactly when we are going to take it.

People also fall into the trap of worrying about or trying to change things that are out of their control. You cannot change other people or what has been done in the past, but you can accept these things, learn from what has happened, and choose what you want to do about it going forward. By writing this plan down, you will feel less stressed and have a much quieter mind than if you kept trying to change something that you have no control over.

5. Learn how to meditate

Mindfulness meditation is probably the most popular form of meditation at the moment. It involves paying attention to whatever is going on in the moment in an open, non-judgmental, non-striving, patient and accepting manner.

Apps like Smiling Mind, Calm and Headspace are great for teaching mindfulness mediation and giving you some techniques to observe what is happening in your body, in your mind, and in the environment around you without trying to change anything. There are other meditation apps that I have been told are good but I haven’t tried yet, including 10% Happier, Waking Up, Buddhify and Insight Timer.

There are others forms of meditation out there too, including transcendental meditation, Vippassana meditation and Metta meditation. Try a few different ones, see which one is the best fit for you and your lifestyle, and then try to incorporate it on a daily basis if you want to see what the long-term benefits may be for you.

Even 10 minutes of meditation a day, done either in the morning or at night, can make a big difference to people’s stress, anxiety, sleep, mood, concentration and pain, and help people to better regulate their emotional lives in general and not get caught up in as many unhelpful thoughts.

6. Learn relaxation strategies

This might be grounding, deep abdominal breathing, square breathing, 4-7-8 breathing, progressive muscle relaxation or imagery.

Find a relaxation strategy that helps you to regularly lower your stress levels, and then practice it regularly throughout the day whenever you realise your stress is higher than you would like it to be for the situation that you are in and the task that you want to do.

7. Learn cognitive restructuring skills

If you notice yourself worrying about something or feeling too stressed, try to identify what you are thinking, then ask yourself if these thoughts are realistic or helpful for you to be thinking about in that moment. If they are not realistic or helpful, ask yourself what is a more realistic or helpful way to think about the situation, and try to remind yourself of this if your initial thoughts occur again.

If the more helpful way of thinking doesn’t change how stressed you feel, ask yourself what is most important to you in the moment, and try to change your focus to this.

8. Engage in other tasks that you find relaxing and enjoyable during the day

This might be a massage, doing something creative, being out in nature, playing a game, engaging in sport, exercise or a hobby, doing some yoga or pilates, listening to music, having a spa, sauna, steam or hot bath, reading, listening to music, watching a movie or favourite TV show.

Doing things that give us a sense of meaning, pleasure, engagement, connection or achievement can improve our overall sense of well-being, which can increase our happiness and reduce our stress levels.

9. Spend time with friends, family or people that you feel calm around and accepted for who you are

Help someone out, volunteer, do a random act of kindness, or express gratitude to someone that is important to you.

Try not to take the important people in your life for granted, and really try to remain present and connect with whoever it is that you are talking to or spending time with.

Relationship warmth is the number one predictor of long-term health and happiness, and people do tend to feel less stressed when they have shared a concern with someone who actively listens and tries to understand what they are going through.

If you have no one in your life currently who can provide this for you, seeing a qualified therapist or psychologist can also help. It definitely did for me personally, as well as for many others.

10. Dedicate time for winding down before sleep each night

The last few hours before bed should not be for excessively demanding physical or cognitive tasks. If you have to finish off work, try to stop it at least an hour before bed, and focus on winding down and preparing your mind and body for sleep instead.

This winding down time is ideal for practicing the relaxation or meditation exercises that you have already learnt. You might also want to journal during this time, and reflect on 3 things that went well for you during the day or that you appreciated.

You can also listen to relaxing music, dim the lights, light some nice smelling and non-toxic candles, talk with friends or loved ones that you feel calm around, read a book or listen to a podcast or audiobook.

Anything that helps to lower your stress levels and doesn’t result in you using bright screens or being too physically active. Sex is one exception to this rule, and often helps people to feel more relaxed and sleepy afterwards, so don’t try to cut this out of your pre-sleep routine if it typically helps you.

11. Minimize your use of caffeine, alcohol or sleeping pills

Although these substances can sometimes help in the short-term, in the long-run they increase our stress levels and make it harder to function well during the day (caffeine) or sleep well at night (alcohol). They can also make us dependent on them (sleeping pills), where we feel that we can no longer sleep without them or need to keep taking bigger and bigger doses to get the same effect.

It is much better to learn other strategies to wind down apart from sleeping pills or alcohol, and other strategies to energize us apart from caffeine.

What to do if your stress levels are too low and you want to be more productive and function better:

1. Clarify your top five signature strengths and put these into action more

You can find out your strengths by going to and taking the free survey.

Once you have your top five signature strengths, set some goals to apply them more on a daily or a weekly basis, and see if it improves your energy and mood.

2. Make a to-do-list for the day and prioritise which tasks you need to do first

Making plans and ticking things off our to-do-list can reduce our stress levels if they are too high, but making to-do lists and focusing on our priorities can also increase our energy and focus if we are feeling unmotivated, bored or apathetic.

By achieving the first priority on our to-do-list, we then get a rush of dopamine, which encourages us to move onto the next task and achieve something else too.

3. Set some sub-goals or targets with whatever task you are trying to do

If you want to do something that seems like too much hard effort, make it a smaller goal, or just focus on the first step.

The five minute walk that you do is better than the 5km run that you don’t do, so break whatever goal you have down into a small and realistic task, especially if you are feeling flat or depressed.

Often getting started is the hardest part, and once we get started it is then easier to keep the momentum going towards achieving your overall goal.

You can also give yourself a target, such as I will write 200 words over the next hour. This will give you something to aim for or challenge yourself with, and can make it a bit more fun.  

4. Try activity bundling, pairing a less enjoyable task with a more enjoyable task

If there is something that you don’t like to do, pair it with something that you really enjoy to make it more bearable. This might be listening to energetic music while you are exercising or doing housework, or catching up with your extended family at your favourite restaurant.

I don’t like ironing, but I do enjoy binge-watching a good series on Netflix sometimes. If I spend a Sunday afternoon once a month ironing all my clothes that need ironing while binge watching a show that I want to catch up on, I can look forward to it instead of detest doing it. My ironing also gets done whenever I need to do it now, instead of being something that I continually put off.

5. Determine a reward for yourself if you complete what you need to do by a certain time, or create a negative consequence if you do not complete your task

You’ve already set yourself some goals or targets in the earlier steps. Now make yourself more likely to implement them or stick to them by increasing the stakes.

Let’s say you really want to see the new Marvel movie, and you know it is playing at 6pm. Tell yourself that as soon as you complete your to-do-list you can relax for the rest of the day and go to the movie that night (reward). If the to-do-list isn’t finished by 5:30pm, then you have to stay at work until it is done, and you can’t go to the movie that night (deterrent, or negative consequence).

Upping the stakes will increase your motivation and focus, especially as you get closer to the deadline. You just have to make sure that you follow through on the rewards and consequences for them to remain effective for you in similar situations going forward.

6. Drink coffee or eat simple carbohydrates with a high glycaemic index for a short-term energy boost

Need an instant hit of energy? Our brain runs on glucose, so anything that increases our blood sugar quickly will give you a quick boost if that is what you need to get started on something.

An energy drink or chocolate usually does the trick for me, but beware of the subsequent crash that will inevitably happen. It’s also not good for our long-term stress levels or overall health to rely too much on sugary products or caffeine for energy.

7. Eat protein, healthy fats or complex carbs with lots of fibre and a low glycaemic index for more sustained energy throughout the day

Tea is considered by a lot of people to be a healthier alternative to coffee, as it gives you less of a high and more sustained energy. Green tea is especially good, as long as you don’t have it with sugar.

Eggs, avocados, nuts, other fruits, and especially vegetables are great for sustained energy throughout the day, so eating these for your main meals or snacks will help.

If you are concerned that what you are eating is contributing to your low mood, low energy and reduced motivation during the day, make an appointment to see a nutritionist, and ask them to give you a meal plan to improve and sustain your energy throughout the day.

8. Drink enough water

Telling people to drink 8 cups of water a day is potentially more useless than telling people to get 8 hours of sleep every night. Your ideal water intake will differ massively depending on how hot it is where you live, how humid it is, how active you are, and how much you sweat. If it is hot and humid and you have been sweating a lot, you will need to drink a lot more water than if it is cold and you have been sedentary all day.

If your pee is clear, you are hydrated enough. If it is yellow or dark yellow, you are likely to be dehydrated. If your mouth is also dry or you are getting headaches or feeling tired or finding it difficult to concentrate, you are probably too dehydrated and should drink more water than you usually do over the next 24 hours. If these symptoms go away by tomorrow after you do this, your know that dehydration was the cause.

9. Take regular breaks

Taking a break can lower our stress levels further, so don’t do this if you have just begun a task or started doing something. It is only likely to increase your energy and motivation if you have already been working on the one task for too long.

Don’t keep working on the same task for anymore than two hours unless you are completely immersed in it and fully engaged still. As long as it has been at least 25 minutes, stop once you start to feel bored or tired or you are losing focus, and change your task or take a 10-15 minute break.  

You will know if time on task is the reason for your low energy as soon as you begin the new task or get back to what you were doing after the break.

10. Get out into nature (or at least look at it)

Too much time indoors or in unnatural environments such as a town or a city is not good for us. It can lead to you feeling both too stressed and uninspired.

If you have a park, nature reserve, lake or beach close by, go there if you’re feeling flat, and see if how you feel changes after 20-30 minutes. For most people they can feel a lot calmer, happier, more present and more creative after a short nature break.  

Patients in hospital with a nice scenic view have even been found to recover quicker than patients without a natural environment to look at, so even looking out a window if you have a nice view of greenery during your lunchtime or break from work is better than staring at your computer screen the whole time.

11. Remain physically active or do some exercise

In ‘Brain Rules’, the author John Medina said hunter-gatherers regularly walked 10-12 miles (16-20km) a day, and this is what is optimal for our brains and bodies.

If you are feeling apathetic or depressed, get out there and go for a walk or a swim, go dancing, go to the gym, take an aerobics class or play a sport.

Exercising for only 30 minutes five times a week has been found to be just as effective or more effective than antidepressants at improving mood, so start moving more, and see if this makes a difference for you.

I hope you find some of these strategies helpful. They are from an upcoming book that I am writing on sleep. I look forward to sharing it with you all once it is finished!

Dr Damon Ashworth

Clinical Psychologist