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

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1081

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

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 www.viacharacter.org 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

How Do We Tackle Addiction and Substance Use Problems?

Ministry of Health Vanuatu

MOH logo

July 2019 Mental Health Newsletter

white and blue health pill and tablet letter cutout on yellow surface

Why do people use substances?

We are not entirely sure, but we do know that mind and mood-altering substances have been used for thousands of years and are present to some degree in every society throughout the world. Some researchers say that it comes from an inbuilt desire to escape the monotony of everyday life. Other substances are used for medicinal purposes, from alleviating pain to relieving fatigue to deliberately altering the way people think and feel about things.

What are the most common substances used in Vanuatu?

The primary substances used in Vanuatu, in order of prevalence, is kava, alcohol, and then cannabis or marijuana. There is less of an issue with other illicit substances in Vanuatu, such as cocaine, heroin, ecstasy and crystal methamphetamine. Let’s have a look at the main two substances in more detail: alcohol and kava.

four champagne flutes with assorted color liquids

Alcohol

Throughout history, people have viewed alcohol as a substance that nourishes and gives comfort. According to the Bible, one of the first things Noah did after the great flood was to plant a vineyard (Genesis 9:21). Many myths and religious beliefs reflect the importance of alcohol.

The religious practices of many societies saw alcohol as something to be consumed at special rituals: weddings, births, funerals and other special events. The overall emphasis of most religions and cultures was on temperance or drinking in only moderate amounts and at certain times. Drunkenness was generally condemned.

Alcohol consumption is one of the most significant risks to health. It causes more 3.8% of all deaths worldwide and 4.5% of the burden of injury worldwide from all the non-death related complications that it can also create. Transport-related injuries are closely linked to excessive alcohol use, as is domestic violence and other violent crime.

The ten best ways to tackle alcohol problems worldwide, according to research by the World Health Organisation (WHO), includes:

  1. Ensuring there is a minimum legal age to buy alcohol
  2. Having a government monopoly of retail sales of alcohol
  3. Restrictions on hours or days of sale of alcohol
  4. Restrictions on the density of alcohol sales outlets
  5. Taxes on alcohol by volume, not by type of alcoholic drink
  6. Sobriety checks
  7. Lowered limits for blood alcohol concentration
  8. Suspension of licences for driving a vehicle under the influence of alcohol
  9. Probationary licences for young and new drivers including a zero limit for blood alcohol concentration
  10. Brief (and potentially mandated) interventions for hazardous drinkers.

Prevention strategies such as education and persuasion, even though they are frequently used to try to tackle the issue, are not as effective at reducing hazardous alcohol consumption! Therefore more needs to be done at a Government level, and new alcohol legislation that incorporates the ten above strategies is currently being drafted in Vanuatu.

No level of alcohol consumption is considered “completely safe”. For women who are pregnant or breastfeeding, not drinking any alcohol is the safest option.

The maximum amount of alcohol recommended on any one occasion to reduce the risk of short-term alcohol related injury is four standard drinks. Short-term risks include accidents, falls, injuries and other risks associated with binge drinking.

The maximum amount of alcohol recommended to avoid long-term health risks is drinking no more than two standard drinks of alcohol each day. Long-term health risks of alcohol include potential brain damage, as well as cancer of the mouth, throat, oesophagus, liver, bowel, breast and prostate.

See the source image

Kava

Kava, also known as Piper Methysticum, is a small shrub native to the islands in the South Pacific. The root and stems are made into a non-alcoholic, psychoactive beverage. It has been used socially and ceremonially for hundreds of years in Hawaii, Fiji, Vanuatu and Tonga.

After drinking a shell or two, a feeling of heightened attention combined with relaxation begins to come on. Although it is soothing, it is unlike alcohol in that thoughts remain clear.

Kava has been marketed since the early 1990s as a herbal remedy for stress and anxiety and insomnia; its popularity has grown ever since. While there is some clinical evidence supporting its use, Kava contains compounds known as kavalactones, which are responsible for its psychoactive qualities. In the brain, they operate on non-opiate pathways to offer a natural and non-narcotic action against anxiety.

According to Duke University Medical Centre, kava is beneficial for anxiety and doesn’t produce dependency or negatively affect heart rate, blood pressure, or sexual function. In a six week study conducted by the University of Melbourne, kava was found to reduce anxiety and was generally well tolerated.

Menopausal women may also find kava to be an excellent option, as it helps their psychological status without affecting estrogen levels – this is especially important when osteoporosis and cardiovascular disease are a concern. In 2003, a clinical study reported that kava encouraged a healthier, pleasant mood among menopausal women.

There are concerns surrounding Kava and liver health

While some suggest it is toxic to the liver, the verdict from scientific research is unclear. One of the primary arguments is that liver damage from kava is unpredictable, dose-independent, and not reproducible. Thus, individual metabolic differences are more likely and excessive consumption of kava should be avoided if possible. The Vanuatu NCD booklet recommends consuming no more than two shells of kava per night.

One common side effect of long term use of Kava consumption is development of a scaly skin rash known as dermopathy. There are several hypotheses concerning its cause. Some speculate it may be the result of interference with cholesterol metabolism. Another idea is that certain metabolites bind to skin proteins and cause an immune response. Regardless, it is often only associated with heavy, prolonged use and is reversible when consumption stops.

Kava Shouldn’t Be Mixed with Prescription Drugs

This is not exclusive to kava; it applies to all herbal therapies. Your body is an ongoing chemistry experiment, and everything you consume can affect it. The metabolizing enzymes that process food and nutritional supplements are the same that metabolize prescription drugs and interactions can occur. If you are taking prescriptions, talk to your prescribing doctor before starting supplemental therapies, including kava.

What about driving after consuming kava?

Concerns have been raised over the effect of sedatives — prescription and herbal — on driving motorized vehicles. It is a valid concern. Safety is extremely important and kava does elicit a certain physically tranquilizing effect. To assess the situation, researchers at the University of Melbourne conducted a driving simulation experiment with 22 adults who were given a “small” serving of kava. The results were inconclusive as the traditional production and making of Kava is not exactly scientific compared to pharmaceutical products. The researchers suggested that additional research is required before an all-out safety rating can be assessed. The best advice is to play it safe, and do not drive after you have consumed kava!

dirty addiction cigarette unhealthy

The Nature of Addiction and Abuse

Many people do not understand why or how other people become addicted to drugs. They mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to.

Impact on the brain

Most drugs affect the brain’s “reward circuit” by flooding it with the chemical dopamine. Dopamine is part of our brain’s reward system, and it controls the body’s ability to feel pleasure and desire. It also motivates a person to repeat behaviors needed to thrive, such as eating, drinking and spending time with loved ones. The overstimulation of the reward circuit that drugs can create causes the intensely pleasurable “high” that can lead people wanting to take a drug repeatedly.

As a person continues to use drugs, the brain adjusts to the excess dopamine by making less of it and/or reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high. It can also cause them to get less pleasure from other things they once enjoyed. Learning, judgement, decision-making, stress management, memory and behaviour are all affected in people with an addiction. Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

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Why do some people become addicted and others do not?

People are often surprised to find how easy it is to become addicted to something. Some things people become addicted to include:

  • Not only drugs or alcohol but to coffee or sweets or certain foods that dominate their lives.
  • Some people become addicted to objects, art, cars, technology like phones and computers or games or other things they believe they cannot do without.
  • Some people are addicted to activities such as exercise, sport, watching TV, eating, sex or socialising.
  • Some people become fixated or addicted to certain types of people or a person and they feel that they cannot live without them.

When it comes to substances, addiction is complex and hard to predict.  It may be related to biology, gender, ethnicity, or personality.  The presence of other mental disorders may also influence the risk for drug use and addiction.

It may also be related to environment. A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.

A person’s stage of maturity and development, family values, education and culture may also add to the risk of developing an addiction to substances. These same factors may be protective.

men and women standing infront of dining table

Can Drug addiction can be managed, cured or prevented?

Addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk of relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with cognitive and behavioural therapy ensures the best chance of success for most patients.

Treatment approaches tailored to each patient’s drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

Perhaps the most powerful tool societies have to combat substance abuse is to develop an understanding of the complex issues and possible causes. Education of parents and children from a very early age can make a great deal of difference.

Simply ignoring or banning the discussion on substance use does not work. Children and young adults are very curious and are subjected to many forces outside their homes and communities. Providing information and guidance means that they will be better informed and will then make up their own mind when they are exposed to the temptation of trying a substance.

The American National Institute of Health suggests a number of strategies to combat substance abuse, including:

  • Prevention programs such as education and management of early risky behaviour such as school difficulties, deviant behaviours, management of aggression and treatment for abuse. Family education.
  • Drug and alcohol education through schools, media other mediums such as churches and community groups with appropriate laws to regulate availability of not only illegal substances but also of over the counter medications.
  • Targeted education programs particularly in secondary schools, colleges and universities.
  • Media campaigns that provide realistic and appropriate information to the public.
  • Training programs that address substance abuse in schools, industry and sports.
  • Funding for research in local areas to address emerging substance abuse issues.
  • The development of appropriate services both government and non-government to deal with substance abuse. This includes the provision of information and training and services to those seeking help. These services could also provide education and support for family members or others affected by drug abuse.

Substance abuse can be managed and most persons affected will recover from drug addiction and lead productive lives in their community. Society attitudes need to reflect both understanding and support.

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For more information or advice, please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

 

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

 

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

 

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

 

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

 

Dr Damon Ashworth

Clinical Psychologist

Ministry of Health and Mind Care Clinic, Port Vila Central Hospital

Do This: Straightforward Advice for Life From a Successful CEO, and Where This Advice Goes Wrong!

Derek Sivers seems like a pretty cool guy. On his website, he calls himself a musician, producer, circus performer, entrepreneur, TED speaker, and book publisher. He started a company called CDBaby and made millions from this. He then gave the company to charity, resulting in millions of dollars subsequently being used to help up-and-coming musical artists who need some monetary support to try and realise their dreams.

Sivers also reads a lot of non-fiction books that are focused on psychology, self-help and self-improvement. He has little reviews of these books on his website and gives them a score out of 10, which is great if you are in need of a recommendation of what to read.

In 2016, Sivers tried to summarise all of the key points that he obtained from reading so many non-fiction books. These key points were put into “do this” directives for him as a personal guide to various aspects of life. The directives were first brought to the public’s attention in his episode of the hugely popular ‘Tim Ferriss Show’ podcast. Because of the demand for the remainder of these lists, they were shared on Derek’s website sivers.org. He also plans on doing more with these directives in the future, including potentially writing his own book.

Below are his directives, as well as my opinion of them. Directives that I completely agree with will be in green. Directives that I disagree with or that go against scientific research will be in red.

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How to be useful to others:

Get famous

  • Do everything in public and for the public.
  • The more people you reach, the more useful you are.
  • The opposite is hiding, which is of no use to everyone.

Get rich

  • Money is neutral proof you’re adding value to people’s lives.
  • So, by getting rich, you’re being useful as a side effect.
  • Once rich, spend the money in ways that are even more useful to others.
  • Then, getting rich is double useful.

Share strong opinions

  • Strong opinions are very useful to others.
  • Those who were undecided or ambivalent can just adopt your stance.
  • But those who disagree can solidify their stance by arguing against yours.

Be expensive

  • People given a placebo pill were twice as likely to have their pain disappear when told the pill was expensive.
  • People who paid more for tickets were more likely to attend the performance.
  • People who spend more for a product or service value it more, and get more use out of it.

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WHAT I THINK: While there are a lot of famous and rich people who are useful to other people, there are many others who are not. What is true is that if you are famous and rich, you have the potential to have more influence on others and do more positive things, such as Bill and Melinda Gates. You also have the potential to negatively influence more people too, such as Donald Trump. What you do with that power and exposure is up to you.

You can also make a difference to others without being rich or famous. Don’t underestimate the difference you can make as a teacher or coach or parent or volunteer or community member or any other role where you interact with others on a regular basis. If you charge more, people will value your services more, you will earn more money and then have a greater chance to be useful to others.

Do try to be informed before sharing your opinions publicly. Look at all the damage Jenny McCarthy did by sharing her opinions on vaccines and autism.

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How to get rich:

Live where luck strikes

  • Live where everything is happening.
  • Live where the money is flowing.
  • Live where careers are being made.
  • Live where your role models live.
  • Once there, be as in the game as anyone can be.
  • Be right in the middle of everything.

Say yes to everything

  • Meet everyone.
  • Pursue every opportunity.
  • Nothing is too small. Do it all.
  • Like lottery tickets, you never know which one will win. So the more, the better.
  • Follow-up and keep in touch with everyone.

Learn the multiplying skills

  • Speaking, writing, psychology, design, conversation, 2nd language, persuasion, programming, meditation/focus.
  • Not pursued on their own, they’re skills that multiply the success of your main pursuit (e.g., A pilot who’s also a great writer and public speaker; A chef with a mastery of psychology, persuasion and design).
  • These skills multiply the results of your efforts, and give you an edge over others in your field.

Pursue market value, not personal value

  • Do what pays well.
  • Do not be the starving artist, working on things that have great personal value to you, but little market value.
  • Follow the money. It tells you where you’re most valuable.
  • Don’t try to make a career out of everything you love. For example, sex.

Shamelessly imitate success

  • Imitate the best strategies of your competitors.
  • The market doesn’t care about your personal need to be unique.
  • It’s selfless and humble to use the best ideas regardless of source, to create the best service or product for your clients.
  • Get great at executing other people’s ideas as well as your own.

Be the owner, not just the inventor

  • It’s tempting to try to be the ideas person, having someone else do the dirty work of making those ideas happen.
  • Ideas don’t make you rich. Great execution of ideas does.
  • A rule of capitalism: whoever takes the most financial risk gets the rewards.
  • The biggest rewards will always go to those that fund it and own it.
  • To get rich, be the owner. Own as close to 100% as possible.

Benefit from human nature

  • Instead of complaining about the downside of human nature, find ways to benefit from it.
  • Instead of complaining about the rules, just learn the game, then play it.

 

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WHAT I THINK: To get rich, it is important to know how humans think and act, and to find ways to benefit from this instead of wishing for things to be different. It is useful to see what has worked for others, to learn how to do things in this way first, and then to adapt the best things so that what you are doing is authentically yours. It is important to try to own the product or service you are trying to sell. If you don’t do this, your earning potential will always be capped and will generally always be less than your bosses.

While it is true that people need to be willing to spend money in order to make money, it’s not just about taking financial risks. There are many broke people out there who have spent too much on bad ideas. Figure out how to test your ideas or products first to see how the market responds before investing too much in it, and don’t be afraid to make changes or start over again if a better opportunity presents itself. Ideally we aren’t just doing something for the money. If we love it, are good at it and it makes a lot, you will be much happier than doing something just because you know that it pays well.

While it is true that we don’t know which opportunities will necessarily work out, we also can’t make much progress if we are saying yes to everyone and everything. Meet and connect with the right people who are not just out for themselves until you find a great idea. Then pursue this project for a set period until you know if it is likely to make you rich or not. If not, jump ship as soon as you realise it and keep brainstorming and connecting and saying yes until you find your next great idea. Once you have this, learning how to prioritise and say no may be even more important than always saying yes. Same with being in the middle of everything. It’s good until you know which path you want to go down. Once you know, distance from others can be just as good until an idea has been executed.

The last bit of advice that isn’t here is don’t gamble or invest in get rich quick schemes. Use debit cards instead of credit cards. Don’t buy the most expensive insurance options. Do invest in index funds and other trustworthy stocks regularly and as early as you can and don’t change them around too much. Compounding interest will help you to gain a lot of money over time. But having heaps of money beyond what you need to meet your basic needs isn’t likely to make you a lot happier in the long run.

flight technology tools astronaut

How to thrive in an unknowable future:

Prepare for the worst

  • Since you have no idea what the future may bring, be open to the best and the worst.
  • But the best case scenario doesn’t need your preparation or your attention.
  • So mentally and financially prepare for the worst case, instead.
  • Like insurance, don’t obsess on it. Just prepare, then carry on appreciating the good times.

Expect disaster

  • Every biography of a successful person has that line, “And then, things took a turn for the worse.”
  • Fully expect that disaster to come to you at any time.
  • Completely assume it’s going to happen, and make your plans accordingly.
  • Not just money, but health, family, freedom. Expect it all to disappear.
  • Besides, you appreciate things more when you know this may be your last time seeing them.

Own as little as possible

  • Depend on even less.
  • The less you own, the less you’re affected by disaster.

Choose opportunity, not loyalty

  • Have no loyalty to location, corporation, or your past public statements.
  • Be an absolute opportunist, doing whatever is best for the future in the current situation, unbound by the past.
  • Have loyalty for only your most important human relationships.

Choose the plan with the most options

  • The best plan is the one that lets you change your plans.
  • Example: renting a house is buying the option to move at any time without losing money in a changing market.

Avoid planning

  • For maximum options, don’t plan at all.
  • Since you have no idea how the situation or your mood may change in the future, wait until the last moment to make each decision.

aerial view of city with lights during night

WHAT I THINK: It’s good to be creative, flexible, adaptable and open to change. These characteristics will become even more important in the future, because change is likely to continue to happen at an even faster and faster pace. People back in the 14th century kind of knew what to expect by the 15th century, but most people living now have no idea what life is likely to look like in the 22nd century. This doesn’t mean that we shouldn’t plan, and it definitely doesn’t mean that we should only plan for the worst. Life has continued to get better and better in so many ways, and it is likely to continue to get better in many ways too. It doesn’t mean it can’t get worse, but we shouldn’t all become doomsday preppers or not buy anything in case disaster strikes. Try to only buy the things you need that will help add value to your life.

Especially if you have kids, stability is good, so don’t be afraid to set up roots. Buy a house, start a business where you live, and develop friendships with other people in your neighbourhood. Some people may leave, businesses may collapse, marriages may crumble, but research still indicates that people have more satisfied relationships if they get married than if they live together but don’t get married. Married men are also both happier and healthier than single men. Divorce negatively impacts kids, especially if there is a lot of conflict, and learning how to overcome difficulties is better than always avoiding things or running away as soon as things get tough or another seemingly desirable option presents itself. We always think the grass is greener on the other side, but when we get there it’s often not as shiny or as different as we first thought (or better than we’ve previously had).

Essentially, having plans and making commitments is better than having none, as long as you are also open to making tweaks and even big changes if things really aren’t working out. Research indicates that having too many options makes it too hard to choose and not making a decision can be really stressful and both physically and emotionally draining. Research also indicates that we tend to become happier with our choices over time once we have made them, as long as we commit to our choices and don’t keep trying to doubt ourselves or leave all the other doors open too.

four women standing on mountain

How to like people:

Assume it’s their last day

  • Everyone talks about living like it’s your last day on earth.
  • Instead, to appreciate someone, live like it’s their last day on earth.
  • Treat them accordingly. Try to fulfill their dreams for the day.
  • Really listen to them. Learn from them.

Be who’d you’d be when alone

  • You could live in a crowd, pleasing only others.
  • You could live in solitude, pleasing only yourself.
  • But ideally, when in a crowd, be the same person you’d be when alone.

Assume men and women are the same

  • Men think women are so different from them.
  • Women think men are so different from them.
  • But the differences among men and differences among women are far greater than the differences between men and women.
  • So, counteract your tendency to exaggerate the differences.

Always make new friends

  • As you grow old and change, old friends and family will be unintentionally invested in maintaining you as you were before.
  • Let go of people that don’t welcome and encourage your change.

Avoid harming the relationship

  • For long-term relationship success, it’s more effective than seeking the positive.
  • A friendship that may take years to develop can be ruined by a single action.

Act calm and kind

  • Regardless of how you feel

Don’t try to change them

  • unless they asked you to.
  • Don’t teach a lesson.
  • Stop trying to change people who don’t think they have a problem.

Find wisdom in your opponents

  • Really engage with those who think opposite of you.
  • You already know the ideas common on your own side.

Purge the vampires

  • Get rid of people that drain you, that don’t make you feel good about yourself.
  • They make you hate all people.

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WHAT I THINK: It is great to really try to appreciate others, and understanding that some people may die soon is a helpful way to ensure that we don’t take others for granted. The Tail End by Tim Urban is an awesome blog post that nicely highlights how little time we actually have left with the important people in our lives. We should try to make the most of our time with them while we still have it so we don’t regret it later.

We can learn a lot from others if we ask them about their life and experiences and beliefs and really listen, even if they have different ways of looking at things to us. But we shouldn’t try to give advice or teach lessons to others unless someone has asked or agreed to it first (or they’re reading your blog post!).

While it is good to minimise how much time we spend with people that drain us or make us feel bad or don’t accept us for who we are, it is also important to try and maintain our old friendships too. Having both old friends and family to keep us grounded and new friends to help us learn and grow is having the best of both worlds.

Men and women are different in some ways, and it is important to understand how and why. Of course we should still see each other as individuals and not just a gender, but this is the same with people who come from a different culture, ethnicity, nationality, religion and any other group that is different to yours. If we can understand group norms, it can help us to understand others a little bit better, but we should also be willing to change our perceptions of others based on what they say and do, rather than hold onto rigid, unhelpful or even discriminatory stereotypes.

While it’s not possible to always be 100% ourselves around others, the more authentic we can be the more we will feel energised around others and connected with them. Similarly, we shouldn’t always act calm if we really are upset or angry or worried and need to express our feelings or what we need. What we can do is express this in a way that is still kind and considerate so that you don’t unnecessarily burn any bridges.

Thanks for reading! For more advice on a good life, feel free to check out some of my other articles, especially: Can We Develop Our Own Guide to Better Living?; 10 Bits of Advice I’d Give My 10-Year-Old Self; Ten Traits of Highly Successful People; 25 Ideas That Could Change Your Life.

Dr Damon Ashworth

Clinical Psychologist

 

Is it Better to be Completely Honest, a Strategic Truth-Teller or an Occasional Liar?

I used to lie a lot growing up. Not quite as bad as Holden Caulfield in ‘The Catcher in the Rye’:
I’m the most terrific liar you ever saw in your life. It’s awful. If I’m on my way to the store to buy a magazine, even, and somebody asks me where I’m going, I’m liable to say I’m going to the opera. It’s terrible.
J.D. Salinger, The Catcher in the Rye
But still pretty bad.
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I remember lying to my mum about cleaning my room so that I could go outside to play (instead pushing all the mess under the bed or throwing it in the wardrobe).
I remember lying about doing my homework so that I didn’t have to do it and could play video games, then lying about being sick the next day so that I could finish the assignment that I was meant to do the night before.
I remember lying about how many points I scored in basketball to friends, or about how many alcoholic drinks I had to my parents whenever they picked me up from a high school party.
I even remember lying to my brother’s friend about my surfing skills (I didn’t have any), and to a classmate about how many languages I spoke (I can say maybe 30 words in Indonesian, Spanish, and Italian, but not much more).
I think back to these moments, and I’m not proud of saying these things, but I can also understand why I did it.
I wish that I could have been a less lazy, more confident and self-assured kid who was always honest with his friends and strangers and did the right thing by his parents and teachers. But how realistic is that scenario, and is it even ideal?
The truth is always an insult or a joke. Lies are generally tastier. We love them. The nature of lies is to please. Truth has no concern for anyone’s comfort.
Katherine Dunn, Geek Love

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Why Do People Lie?

We lie to:

  • fit in and pretend we are like others
  • stand out and pretend we are different to or better than others
  • seek approval from others
  • be seen as more loveable/desirable/acceptable
  • feel better about ourselves
  • avoid getting into trouble
  • protect other people’s feelings or avoid hurting them
  • be polite
  • avoid feeling hurt, sad, disappointed, guilty or ashamed
  • keep a secret
  • maintain confidentiality
  • be consistent with societal norms

I’m not upset that you lied to me, I’m upset that from now on I can’t believe you.
― Friedrich Nietzsche

What Happens if We Are 100% Honest?

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In the 1997 comedy ‘Liar Liar’, the main character is played by Jim Carrey. He’s a high flying lawyer who keeps disappointing his son Max by making promises to him that he can’t keep by always putting work as his first priority. After his dad doesn’t turn up to his birthday celebration, Max wishes for his dad to not be able to tell a lie, and the magic of movies makes this wish comes true.
What results is some hilarious situations in which Jim Carrey’s character gets himself into trouble for saying the whole truth when it would definitely be more polite to lie. This includes telling his secretary why he didn’t give her a pay rise, telling his boss that he has had better than her, and confessing to everyone in a crowded elevator that he was the one who did the smelly fart.
The moral of the story was two-fold:
  1. Sometimes it is necessary to lie, or at least not always be brutally honest and say everything that comes to your mind, and
  2. By trying to be as honest as possible whilst also being tactful, you may actually become a better person that upsets people less and has better quality and more authentic relationships.
One lie has the power to tarnish a thousand truths.
Al David

Radical Honesty

In 2007, A.J. Jacobs wrote an article for Esquire magazine about a month long experiment that he did on a small movement called Radical Honesty. It was titled ‘I Think You’re Fat‘ and is definitely worth a read. Much more than the 1995 book called ‘Radical Honesty’ by Brad Blanton that initially inspired the article:

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Blanton had worked as a psychotherapist for 35 years in Washington D.C. and ran 8-day workshops on Radical Honesty that retailed for $2,800 back in 2007. Blanton says his method works, although he may distort some of the positive benefits for personal and financial gain. He’s been married five times, and claims to have slept with more than 500 women and six men, including a “whole bunch of threesomes.” He also admits to lying sometimes.

She looks honestly upset, but then, I’ve learned that I can’t read her. The problem with a really excellent liar is that you have to just assume they’re always lying.
Holly Black, Black Heart

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I Think You’re Fat

In Jacobs article, he wasn’t overly positive about Blanton’s version of Radical Honesty either. If we didn’t have a filter between what we say and what we notice in the world, in our body and in our thoughts like Blanton advocates, the results would probably be less funny and more consequential than what happened to Jim Carrey in ‘Liar Liar’. Jacobs declares:

Without lies, marriages would crumble, workers would be fired, egos would be shattered, governments would collapse.” – A.J. Jacobs

Jacobs found it impossible to not tell a lie during his month long experiment, but did cut down his lying by at least 40%. He also scared a five year-old girl, offended numerous people, and spoke about sex and attraction to the point where he felt creepy.

On the positive, being radically honest did save Jacobs time, resulting in him having to talk less to the people he didn’t want to talk to and do less of the things he didn’t want to do. It saved him mental energy by not having to choose how much he would lie or massage the truth. It also meant that people were usually more honest with him in return, and he found out that his relationships could withstand more truth telling than he expected. So, similar to the ‘Liar Liar’ take-away message, Jacobs concluded:

  1. Being radically honest all the time and never having a filter is likely to be inappropriate in many settings and lead to more confrontations with others, and
  2. We could probably benefit by being more authentic, honest and truthful with others, especially in intimate relationships, as secrets tend to weigh us down.

There is beauty in truth, even if it’s painful. Those who lie, twist life so that it looks tasty to the lazy, brilliant to the ignorant, and powerful to the weak. But lies only strengthen our defects. They don’t teach anything, help anything, fix anything or cure anything. Nor do they develop one’s character, one’s mind, one’s heart or one’s soul.
José N. Harris

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What is a Lie?

In his interesting small book ‘Lying’, Sam Harris defines a lie as:

anything that is done to intentionally mislead others when they expect honest communication.” – Sam Harris

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Omission vs Commission

In ‘Lying’, Sam Harris distinguishes between lies of commission, where the person is active in their intent to deceive, and the more passive act of omission, where the person fails to do something or say something that they probably should. Both commission and omission are deceptive, in that they are both misleading to the audience or person who is the target of the action or lack of action.

Harris believes that lies of commission are a more serious violation of ethics and likely to be more harmful, just like pushing someone in front of a train is a more serious ethical violation than not saving someone who was hit by a train when you had a chance to do so.

Harris argues for people to stop all forms of commission, and says that we can enhance our world, build trust and improve relationships by always being honest in our communication. While he believes that omission is also lying, he does not believe that we can or should eliminate all forms of omission. He says that “skillful truth-telling” is sometimes required, so that we can be both honest and tactful in our words and avoid causing unnecessary harm.

Lets have a look at the following three examples to see the difference between radical honesty, lying and skillful truth-telling.

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SCENARIO ONE: Your husband asks if he looks fat in an outfit that you honestly believe it isn’t flattering for him. You could say:

A) “Yeah. You do look fat. I’d say about 10 pounds overweight. Maybe you should skip dessert for a while.”

B) “Not at all sweety. You look amazing!”

C) “You look nice, but I think I prefer the black jumper and blue jeans I bought you a few weeks ago. Want to try that on and see which one you feel better in?”

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SCENARIO TWO: Your sister and her family are in town for the week and decide to stay at your place for the whole time because they want to save money. You don’t dislike them, but also don’t feel like you have heaps in common, and you’d really prefer to be catching up on your work that you are behind on. On night four she notices that you are a little tense and asks if you mind them staying there. You could say:

A) “I kind of do. I wish you weren’t so tight and could have paid for a hotel if you were going to stay more than 3 nights. A week is really pushing it and I’d prefer you left.”

B) “Mind? Are you kidding? I love it. The more the merrier I always say! Stay for as long as you’d like.”

C) “It’s a busy week for me in terms of work, so it wasn’t ideal timing for me. If I seem a bit tense, I’m sorry. I do want to be able to help you guys out because family means a lot to me.”

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SCENARIO THREE: You’ve been unemployed for six months and get a job interview to wait tables at a restaurant in town. You’d ideally prefer an acting job. The boss of the restaurant asks what your career plans are, as they really want to hire someone who is going to stick around. You could say:

A) “Well, acting has always been my passion, so this is really just a stop-gap job to pay the bills and put food on the table. I couldn’t care less about the job or your restaurant. I just want a regular paycheck so that I can pay my rent and bills until I get a real job.”

B) “I’d love to become a professional waiter. I’ve always thought that to provide great service to people is my calling in life, and I plan on sticking around for at least five years and show everyone just how amazing your restaurant is. I’m in it for the long-haul.”

C) “I’m not too sure about what will happen with my career, but at this stage I’d really like to be able to work here. I am available seven days a week and will put in 100% effort whenever when I am on shift. I am also willing to learn whatever skills are required, and I can promise that I will give you as much notice as possible if my plans ever do change in the future.”

In each of these scenarios, A is the radically honest response, B is the active lying or commission response and C is the skillful truth-telling response. While no actual lies are being said in the C answers, not everything is being said, which is technically omission.

Many people still believe that omissions are a big no no:

When truth is replaced by silence, the silence is a lie.
Yevgeny Yevtushenko

A lie that is half-truth is the darkest of all lies.
Alfred Tennyson

At times to be silent is to lie. You will win because you have enough brute force. But you will not convince. For to convince you need to persuade. And in order to persuade you would need what you lack: Reason and Right.
Miguel de Unamuno

People think that a liar gains a victory over his victim. What I’ve learned is that a lie is an act of self-abdication, because one surrenders one’s reality to the person to whom one lies, making that person one’s master, condemning oneself from then on to faking the sort of reality that person’s view requires to be faked…The man who lies to the world, is the world’s slave from then on…There are no white lies, there is only the blackest of destruction, and a white lie is the blackest of all.
Ayn Rand, Atlas Shrugged

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Is it Ever Helpful to Lie to Ourselves?

The short answer is yes. It has been found that it is psychologically healthier to be slightly optimistic than to be completely realistic. Research indicates that people with depression are often more realistic in their appraisals of situations and other people’s judgments of them than people without depression. Most “healthy people” believe that, in comparison to the average person, they are better drivers, more intelligent, better workers, better parents and better lovers.

The main reasons people lie to themselves is they like to feel that they are important and maybe a little bit more unique or special than they really are. To prove this point, how would you feel if someone told you that you were just “average”? People also like to see themselves as a good person who behaves in particular ways for good reasons. Even people that consistently cause harm to themselves or others.

Anyone with an unhealthy addiction becomes an expert at lying to both themselves and others. This secrecy and dishonesty only further fuels the sense of depression, shame and guilt that people with an addiction would feel, as long as they are actually in touch with the whole truth of the situation and the consequences of their actions. Most addicts are not however, thanks to in-built defense mechanisms.

Defense mechanisms are mostly subconscious or unconscious methods that we engage in to protect our ego or positive sense of self. Some of the more famous ones are denial, humour, repression, suppression, rationalisation, intellectualisation, projection, displacement, regression, and my personal favourite, reaction formation (click here for a full description of these defense mechanisms and how to identify yours). Most people will deny engaging in defense mechanisms if you ask them directly about it, but they’ll also be able to easily tell you that other people do. The reality is we all lie to ourselves at times, and maybe we need to in order to maintain a “healthy” outlook on ourselves, others, the world and our future.

The visionary lies to himself, the liar only to others.
Friedrich Nietzsche

I lie to myself all the time. But I never believe me.
S.E. Hinton, The Outsiders

The best lies about me are the ones I told.
Patrick Rothfuss, The Name of the Wind

Anybody who says they are a good liar obviously is not, because any legitimately savvy liar would always insist they’re honest about everything.
Chuck Klosterman

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So What Can We Do?

The most accurate recommendations that I could find on lying were also some of the simplest:

If you don’t want to slip up tomorrow, speak the truth today.
Bruce Lee
If you tell the truth, you don’t have to remember anything.
Mark Twain

I tend to agree with Sam Harris that it is a worthwhile aim to try to never be actively dishonest. This approach is also consistent with one of Jordan Peterson’s better rules from his ’12 Rules for Life’ book – Rule #8: “Tell the truth – or, at least, don’t lie“.

The philosopher Robin Devenport wouldn’t agree with either Harris or Peterson. He states:

“it is impossible for anyone to be truly honest about many things, as long as he (or she) carries biased perspectives, hidden resentments, unresolved longings, unacknowledged insecurities, or a skewed view of self, to name just some inner human conditions… if absolute honesty is impossible, then we are all liars by nature, at least to a degree.”

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Dan Ariely also concludes in his excellent book ‘The Honest Truth about Dishonesty’ that we all tend to lie to everyone, especially ourselves. We lie only as much as we know we can get away with, but not so much that it becomes hard to keep seeing ourselves as a good person.

Devenport continues:

“Perhaps the best we can do, then, is only to lie in ways that are intended to promote another’s well-being or spare her unnecessary pain, and so further our integrity. The ‘noble liar’ is someone who tries to live by good intentions, even if that means intentionally lying to another person, if doing so is the lesser of two evils…Before we cast too harsh a judgment on the liar, let’s first understand what his motives are.” – Robin Devenport

We all need to try to be as honest as we can, especially with those that we love, and make sure that when we do lie, it is for a good reason. We also need to realise that it will never be possible to be 100% honest about everything to anyone, including ourselves, and that is okay. Other people won’t be 100% honest with you or themselves either, and that doesn’t make them bad people. It’s what we lie about and why that really matters. 
Dr Damon Ashworth
Clinical Psychologist

Our Environment Makes More of a Difference to Our Health and Mental State Than We Realise

It’s been over 9 months now since I moved to Vanuatu to volunteer as a Clinical Psychologist with the Port Vila Central Hospital and the Vanuatu Government’s Ministry of Health. That means that I am over a third of the way through my volunteer experience.

The first 1-2 months were challenging and a little overwhelming with so many new things to learn and new people to meet. I was also feeling a bit guilty about the people that I had left behind to have this experience. Especially my old jobs in private practice and the patients that I had there.

Once I settled in however, the following 7 months have been some of the best times of my life. I’m not pushing myself too hard anymore, am experiencing a great variety of opportunities with my volunteering work, helping people where I can, and developing some excellent friendships too.

About two months ago, I returned from a two-week trip to Australia to attend my sister’s wedding. It was my first time going back to Melbourne since moving to Port Vila, and I was really excited to go back, but also curious to see if things felt any different after not being there for the prior 8 months.

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Before I left Melbourne in August 2018, I was burning out. I had been highly productive and efficient with my work and was cramming a lot in to every day and every week, but I was also stressed out and exhausted, and my elevated blood pressure and constant fatigue were pretty solid indicators that the lifestyle that I had was not going to be sustainable forever. I was also beginning to feel more isolated and disconnected from others, and wondered if this was just a sign of the times, my age, or my environment.

Moving to Vanuatu for 2 years was the perfect way to find out. Port Vila is a really social place if you want it to be, as people are always willing to stop for a chat or a drink at one of the 400+ nakamals in town. Vanuatu is also said to run on “island time”, which means that Port Vila operates at a much more leisurely pace then Melbourne. This isn’t so great if you want your 3-on-3 basketball tournament to start on time, but pretty great for reducing stress as long as you don’t worry too much about things that are out of your control.

The first thing that highlighted to me how much more relaxed I am in Vila is that when it came time to wrap up work to fly to Australia for my sister’s wedding, I felt so refreshed already that I didn’t even feel like I needed to have the holiday. That had never happened to me before.

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The moment I arrived back in Melbourne however, I felt stressed again, and shortly after that, tired. I don’t know if it was staying in the city, but a lot of people were rushing and agitated both on the road and walking around. Everyone seemed to be on a personal mission to get from point A to point B as fast as they could because they had important things to do and important people to see. Even I began to get caught up in this way of thinking within a day or two, and it was hard to unwind and relax.

People in Melbourne also seemed to be off in their own world of headphones and smartphones, with very little interaction with anyone on the street. The few strangers that I did smile at or say hello to looked at me like I was weird, and I was like “oh, yeah…we don’t acknowledge other people here!”

Reverse cultural shock is a real thing. Sometimes it does take a while to adjust back, even longer than it takes to adjust to a new culture in a new place. People from Melbourne often expect Asia or South America or Africa to feel different when they first travel there. It is a much weirder experience for things to feel unusual in a place that you have previously always called ‘home’.

My sister’s wedding was beautiful and heartwarming, and I couldn’t be happier for her and her new husband. It was amazing to see a lot of my friends and family again, and I do hope to stay in touch with all of the important people in my life from Melbourne.

I just don’t know if I still call Australia home.

 

Dr Damon Ashworth

Clinical Psychologist

Can We Develop Our Own Guide to Better Living?

The Making of a Genius?

In 1726, at the young age of 20, Benjamin Franklin came up with a list of thirteen virtues that he wanted to live his life by. He then carried around a small booklet so that he could track his daily and weekly progress against these virtues.

An example of this tracking system as well as a description of these virtues was included in ‘The Autobiography of Benjamin Franklin’:

 

T = Temperance: Eat not to dullness; drink not to elevation.

S = Silence: Speak not but what benefits others or yourself. Avoid trifling conversation.

O = Order: Let all your things have their places; let each part of your business have it’s time.

R = Resolution: Resolve to perform what you ought; perform without fail what you resolve.

F = Frugality: Make no expense but to do good to others or yourself; i.e., waste nothing.

I = Industry: Lose no time; be always employed in something useful; cut off all unnecessary actions.

S = Sincerity: Use no hurtful deceit; think innocently and justly, and if you speak, speak accordingly.

J = Justice: Wrong none by doing injuries, or omitting the benefits that are your duty.

M = Moderation: Avoid extremes; forbear resenting injuries so much as you think they deserve.

C = Cleanliness: Tolerate no uncleanliness in body, clothes or habitation.

T = Tranquility: Be not disturbed at trifles, or at accidents common or unavoidable.

C = Chastity: Never use venery but for health or offspring, never to dullness, weakness or the injury of your own or another’s peace or reputation

H = Humility: Imitate Jesus and Socrates.

That’s a pretty intense list to try and follow, and Franklin never seemed to achieve them all on any day if you look at his chart above. Maybe he still improved more from striving towards living by these virtues than if he hadn’t, even if he didn’t achieve them? It’s hard to know.

What we do know is that Benjamin Franklin managed to do a lot in his lifetime, and he excelled at nearly everything that he put his mind to. Most people still know who Franklin is nearly 300 years later and his face remains on the US $100 bill, so he must have done a few things right.

12 Rules for Life?

By now, a lot of you have probably heard of Jordan B Peterson and his immensely popular self-help book ’12 Rules for Life: An Antidote to Chaos’.

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Here are his 12 rules, which make up the chapters of the book:

  1. Stand up straight with your shoulders back
  2. Treat yourself like someone you are responsible for helping
  3. Make friends with people who want the best for you
  4. Compare yourself to who you were yesterday, not to who someone else is today
  5. Do not let your children do anything that makes you dislike them
  6. Set your house in perfect order before you criticize the world
  7. Pursue what is meaningful (not what is expedient)
  8. Tell the truth – or, at least, don’t lie
  9. Assume that the person you are listening to might know something you don’t
  10. Be precise in your speech
  11. Do not bother children when they are skateboarding
  12. Pet a cat when you encounter one on the street

I notice some overlap between Peterson’s rules and Franklin’s virtues. # 8 and 10 from Peterson is very similar to Sincerity and Silence from Franklin. # 2 and 7 from Peterson is similar to Industry and Resolution from Franklin. # 6 is similar to Order and Tranquility from Franklin. Franklin’s list is more personal and focused on self-discipline and resisting excess, whereas Peterson’s list mentions children and animals.

Looking at the two lists, I’d take Franklin’s virtues over Peterson’s rules any day if I had to choose between the two as my guiding principles for life.

People seem to love Peterson at the moment not because his rules are what we should all live by, but because he is well read, intelligent, articulate and confident. He is very sure of himself and not afraid to say things exactly how he sees it, which makes him a strong thought leader in a time of confusion and minimal external input into what a positive and meaningful life actually consists of.

But what if rather than trying to adopt Franklin’s or Peterson’s rules to our own lives, we could actually learn how to come up with our own principles and virtues for better living?

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How Do We Develop Our Own Guiding Principles in Life?

It is possible to develop your own guide to a better life in only three steps…

STEP ONE: Who am I?

In order to know what we want, we first need to figure out who we are (or more accurately, what we see ourselves to be).

STEP TWO: What do I care about?

Once we know who we are, we must then figure out what is important or meaningful to us (and what isn’t).

STEP THREE: How do I show that I care about these things?

We then need to figure out what actions we need to take and what systems or habits we can develop that will help us to live consistently by these values.

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STEP ONE

Our identity, or who we see ourselves to be, often consists of many factual things. It may include our name, our family, our nationality, our ethnicity or racial background, our culture, our class, our friends, our relationship status, our sexuality, our gender, our religious beliefs, where we live, where we work, what we do for work, what our interests and hobbies are, and what we like to do for fun or to relax. Most people can answer these questions fairly easily.

Different factors can shape the overall identity of one person much more than they do for others. A cisgender straight white male may not consider that his gender, race, sexuality or culture play a big role in his identity, but these factors could be huge for someone who is non-gender conforming or sexually fluid or from a minority cultural or religious group in the country that they live in and have suffered stigma or discrimination as a result.

1a. Take a personality test to help answer the question “Who am I?”

No matter what is important to you, it is important for everyone to construct a cohesive narrative or story about who they are. If you are getting stuck in describing what your personality is, there are a number of tests out there that can help you. Peterson and I both agree that the five-factor personality model is probably the best personality test for the average person who is trying to understand themselves better. It can be completed for free at this website.

An individual’s scores on Extroversion, Agreeableness, Conscientiousness, Neuroticism and Openness to Experience are fairly consistent across their lives, so knowing where you sit on the spectrum of each one of these facets is a helpful way to get to know yourself better. It can also help you to work with who you are rather than against yourself when designing your own principles for better living.

Looking at my last IPIP-NEO results, here are my percentile scores on each of the five factors, ranked from highest to lowest:

  • Openness to Experience: 95th percentile
  • Agreeableness: 90th percentile
  • Extroversion: 74th percentile
  • Conscientiousness: 74th percentile
  • Neuroticism: 13th percentile

Here are all facets that I am in the top 11% in comparison to other males of my age from Australia:

  • Cooperation…… 99th percentile
  • Liberalism………… 97th percentile
  • Adventurousness…… 95th percentile
  • Emotionality……… 90th percentile
  • Altruism………… 90th percentile
  • Trust……………… 90th percentile
  • Activity Level………… 90th percentile
  • Intellect…………… 89th percentile

WHO AM I?

DESCRIPTIVE INFORMATION: I’m Damon Ashworth. I’m the middle child in my family, with an older brother and a younger sister. My parents are still happily married and we all get along fairly well. I am a dual citizen of Australia and the United States of America, but have spent the majority of my life in Melbourne, Australia. I am of Caucasian descent. My parents were both teachers, so that makes me from the middle class I guess. My friends are predominantly from Melbourne, but I’ve made some friends when I lived in the US for two years and some good friends since moving to Vanuatu too. I am currently volunteering in Vanuatu for two years as a Clinical Psychologist with the Ministry of Health and at the Vila Central Hospital. I identify as straight male and I am currently in a happy monogamous relationship with my girlfriend. I have been baptized as a Christian, but do not attend any religious services. I love reading non-fiction books, listening to podcasts, playing basketball, volleyball and tennis, being creative through my writing and making music and movies. I love hip hop and some mainstream music, horror and comedy movies, and stand up comedy. I also love to be active, get outside and visit new places on holidays, and travel and snow ski when I can afford it.

PERSONALITY PROFILE: I am extremely high in openness to a variety of experience, including cultural, intellectual, emotional, and physical. I am very high in agreeableness and tend to do whatever it takes to have positive relationships with other people. I will always try to co-operate with others if I can. I like to challenge convention and try to help bring about progressive change. I prefer a lot of variety in my life and like to go on adventures. I am highly attuned to my emotions and the emotions of others around me, and try to remain open to whatever it is that I am feeling. I enjoy helping others when they need it. I trust others easily, and strongly believe that most people are generally good and not out to harm others. I have lived a pretty fast paced life, and care about being both efficient and effective. I love to have in-depth discussions with others, and enjoy playing with ideas and reflecting on important aspects of life through meditative practices and my writing.

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STEP TWO

Finding out what you care about is through the process of clarifying your values. Values are guiding principles in life that we cannot achieve like a goal, but make a choice to live by each day. Someone who values honesty is not living in a way that is consistent with what matters to them the moment they tell a lie, but is being consistent as soon as they go back to telling the truth. By clarifying which values are most important to us, we can then know when we have gone off track, and what we need to do to get back on.

2a. Engage in thought experiments to elucidate what is most important to you

An interesting experiential method to help patient’s identify their top values if they aren’t sure what they are is to write their obituary. For this, they would write what they hope would be said about them if they were to die after a long and good life. Every time I think of writing my epitaph, all I come up with is “Here lies Damon. He tried his best.” This tells me that one of my core values is applying myself to be the best that I can be.

If writing your obituary seems too dark or morbid, try to imagine your birthday party at least 20 years from now (I choose my 70th birthday). All of your closest friends and family are there. The most important person in your life gets up and makes a speech about the type of person that you have been from today until then (over the past 20+ years). What do you want to hear them say? It can be a powerful exercise that often brings tears to people’s eyes, and helps them to realize the type of person that they most want to be going forward, both to themselves and to others.

2b. Take a strengths survey to identify your key strengths or top virtues

If neither of the above exercises interest you or help to highlight your core values, the Values In Action (VIA) Character Strengths Survey can. It ranks your strengths from 24th to 1st, and is quite useful in elucidating what you may want your guiding principles in life to be. It can be found at this website.

My Top Strengths

Based on my 2018 findings, my top nine strengths are as follows:

  • 9: Honesty, Authenticity and Genuineness 
  • 8: Forgiveness and Mercy
  • 7: Fairness, Equity and Justice
  • 6: Creativity, Ingenuity and Originality
  • 5: Judgment, Critical Thinking and Open-Mindedness
  • 4: Humour and Playfulness
  • 3: Kindness and Generosity 
  • 2: Curiosity and Interest in the World
  • 1: Love of Learning

My Top Virtues

Based on my 2018 findings, my top virtues are as follows:

  • Wisdom – Average score = 6.2
  • Humanity – Average score = 8.33
  • Justice – Average score = 13.33
  • Transcendence – Average score = 13.4

WHAT DO I CARE ABOUT?

I care about being an honest person. I care about living my life in an authentic and genuine way and being a “real” person with everyone that I interact with. I care about forgiveness and being compassionate to those who have wronged me. I care about trying to be fair to others, and not let my decisions or actions be biased by my feelings. I try to give everyone at least one chance, and sometimes more unless it is obvious that the other person does not want things to be equal or fair too. I care about challenging convention and thinking of new and more efficient or effective ways to do things. I care about not jumping to conclusions and looking at the evidence and things from multiple perspectives before deciding what the best thing is to do. I care about being able to say that I am sorry and that I was wrong or being open to changing my mind if evidence to the contrary is presented. I care about not always being serious, and being playful and having fun and laughing or smiling with others. I care about being generous and kind with others, and giving them my time and help and undivided attention if it is possible to do so. I care about learning new things and continuing to develop my knowledge and skills in a variety of subjects and topics. I care about maintaining my curiosity and awe, growing as a person and gaining wisdom, and using what I have learned to help out humanity where possible. This may be individually, or on a larger scale.

silhouette of man touching woman against sunset sky

STEP THREE

Finally, we need to assess how much we have been living consistently with our core values or key strengths. In other words, how much are you currently being the person you want to be, and what changes can you make to move more in the right direction going forward?

3a. Do the Bullseye Exercise to assess where you are currently at

The Bullseye exercise, first created by Swedish ACT Therapist Tobias Lundgren, is the best way to determine if you are living consistently with your values in four key areas of your life: 1. school or work, 2. leisure or recreation, 3. personal growth or health, and 4. relationships (including with friends and family).

Keep your core values or key strengths in mind and say whether you have been fully consistent with these values in this area of your life (a bullseye) or if you have lost touch with your values (all the way at the outer circle), or anywhere in between. A full worksheet can be downloaded here, or you can imagine placing an X somewhere in each quadrant in the picture below:

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3b. Set up some sustainable systems and/or goals that would make it so you are living more consistent with your core values and strengths in each key area of your life.

Once you have identified where you stand on each quadrant of the bullseye, ask yourself what you can do over the next 1-2 weeks (short-term), next 1-3 months (medium-term) or next 6-18 months (long-term) that would help you to feel like you are living more consistently with your core values or key strengths. This could be designing a new system of working, eating, sleeping, or it could be goals and targets.

If you do set goals, make sure that are SMART:

SMART-Goals

HOW DO I SHOW THAT I CARE?

Work is going really well for me, although it would help to set weekly goals for myself, and assess my progress against these goals to determine my efficiency and productivity. I will do this each Monday morning at 8am. For leisure, we have been visiting beaches more frequently recently, and I want to get to the beach at least once each weekend if possible with other people so that we can enjoy our time together. I want to see new beaches at least once a month if possible too so that I explore different parts of Vanuatu. For relationships, I want to schedule in time in my calendar each month that is just dedicated to keeping in touch with all my family and friends back in Australia. Lastly, for personal growth and health, I have not been as active as I would like to be, and my lower back has been sore as a result. I want to get back into swimming at least once a week, and stretch every time I go to the gym or play basketball too.

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As you take action towards achieving your goals or putting your systems into place, you are showing yourself and others that you know who you are and what is important to you. You will begin to feel that you are heading in the right direction towards a more personally meaningful and satisfying life. You will have created your own guide to better living!

Dr Damon Ashworth

Clinical Psychologist

The Importance of Sleep for Good Mental Health

Ministry of Health Vanuatu

MOH logo

May 2019 Mental Health Newsletter

The Importance of Sleep for Good Mental Health

Sleep difficulties are a feature of nearly every mental health difficulty, including depression, anxiety, trauma, substance use issues, bipolar disorder and psychosis or schizophrenia. Take Depression for example. Up to 90% of individuals with Depression have sleep difficulties, and two out of every three have significant enough sleep problems to also have a diagnosis of Insomnia.

alarm clock analogue bed bedroom

Worse still, Insomnia does not tend to go away on its own without appropriate treatment. This is because once people start to sleep poorly, they tend to develop ways of thinking and behaving around sleep that make their problems worse over the long run.

Fortunately, there is a treatment out there that can improve your sleep. It’s called Cognitive Behavioural Therapy for Insomnia (CBT-I), which directly targets these unhelpful thoughts and behaviours around sleep.

CBT-I is an effective treatment for insomnia, with many studies showing it to be similar to sleeping pills at improving sleep in the short-term, and much more effective than sleeping pills at improving sleep in the long-term.

Research shows that CBT-I consistently reduces the time taken to get to sleep, decreases the amount of time spent awake during the night, and improves sleep quality and efficiency, with improvements persisting after treatment finishes. This is unlike sleeping pills, which typically lead to sleep difficulties coming back once people with insomnia stop taking them.

Sleeping pills are also not recommended for use beyond 2-4 weeks at a time, because they stop working after a while and people need to take bigger doses over time to get the same effects. Sometimes doctors prescribe them more because they think they will work faster for patients, but even one session of CBT-I has been shown to make a significant difference to one’s sleep at night!

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CBT for Insomnia consists of four main components:

  1. Psychoeducation: This provides people with helpful information around sleep, including homeostatic pressure, circadian rhythms, hyper-arousal and sleep hygiene recommendations. Sleep hygiene means having a comfortable bedroom environment, minimising light exposure before bed, exercising during the day, minimising caffeine and alcohol and doing things to wind down or manage worries before bed.
  1. Sleep scheduling: This provides people with helpful information on when they should be going to bed at night, the time they should be arising from bed in the morning, and the ideal amount of time that they should be in bed for each night. Stimulus control and sleep restriction are the two main interventions included in sleep scheduling, and both are scientifically supported for improving sleep quality and sleep efficiency if done properly.
  1. Relaxation techniques: Because hyper-arousal plays a huge role in Insomnia, it is important to help people develop strategies to quieten the mind and calm the body, during the day, before bed and in bed. Relaxation techniques can include imagery training, meditation, biofeedback training, deep and slow breathing and progressive muscle relaxation.
  1. Cognitive Therapy: This provides people with the skills to challenge their unhelpful or unrealistic beliefs about sleep. A lot of individuals with Insomnia attribute all of their tiredness, mood difficulties or poor performance at work to their sleep difficulties, and this puts too much pressure on them to get a good night’s sleep. It is therefore important to get them to see the other factors that may contribute to how they feel during the day, present them with data that challenges their fears, and help them to develop realistic expectations about their sleep.

In Vanuatu, there is currently only one psychologist located at the Mind Care Unit in Port Vila who is trained in CBT-I. Please come down to receive this effective treatment if you or a family member is struggling with poor sleep. Until then, there are other sleep strategies that you can try:

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BEST SLEEP INTERVENTIONS OVERALL

In 2017, Dr Damon Ashworth, Clinical Psychologist and Sleep Researcher, ran 26 two-week experiments on his sleep to determine which interventions were most helpful for him.

He gave each intervention a score out of 100, based on how effective he found the strategy (25 points), how easy it was to apply and use the strategy (25 points), and how much scientific evidence there was that showed that this strategy could improve sleep (50 points).

Here are all of the sleep interventions he tested, ranked from best to worst based on their overall score out of 100:

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High Distinction

  1. Stimulus control = 85/100
  2. Winding down before sleep = 85/100
  3. Sleep restriction = 81/100
  4. Relaxation strategies pre-sleep = 81/100

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Distinction

  1. Meditation = 77/100
  2. No alcohol = 75/100
  3. Wearing blue-light blocking glasses before sleep = 75/100
  4. Listening to music in the evening = 73/100
  5. Yoga/Pilates = 72/100
  6. Constructive worry or writing down plans = 71/100

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Credit

  1. Avoiding TV before bed = 69/100
  2. Melatonin = 68/100
  3. Aromatherapy = 68/100
  4. Sauna or hot bath in the evening = 68/100
  5. Morning sunlight = 65/100
  6. Reading or listening to audiobooks pre-sleep = 63/100
  7. Exercise during the day = 61/100

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Pass

  1. No caffeine = 58/100
  2. Food that helps sleep = 57/100
  3. Controlling temperature = 57/100
  4. Massage in the afternoon = 57/100
  5. Comfort of sleep surface = 56/100
  6. Sleeping alone = 53/100
  7. Creativity in the evening = 52/100

Sleep Recommendations

(Stepanski & Wyatt, 2003)
  1. Decrease time in bed – Sleep efficiency is a better predictor of satisfaction with sleep and daytime mood than total sleep time. So if you only get 7 hours of sleep per night, spend 7.5 hours of time in bed. This will allow for better sleep over time.
  2. Regular bedtime and arising time – Reducing variability in your sleep can make a huge difference in how long it takes you to get to sleep, how restful a sleep you have, and how refreshed you feel in the morning. Have a set bedtime, and whenever you feel sleepy around this time, go to bed. Then set an alarm so that you can wake up at the same time each day. If you want to sleep in on weekends, allow yourself no more than one hour later than you usually wake up. Following this regardless of how much sleep you get helps to strengthen your circadian rhythms and build up your homeostatic pressure to ensure better sleep over time.
  3. Exercise – Vigorous exercise prior to bedtime is actually unhelpful for sleep, but expending more energy during the day is likely to lead to better quality sleep at night. The earlier in the day it is done, the greater the effect it will have.
  4. Less caffeine and alcohol – Minimise these substances where possible, especially within 4 hours of bedtime as they both have significant effects on sleep quality. Alcohol can reduce worries and result in getting to sleep quicker, but results in poorer sleep quality in the second half of the night. Alcohol can also can lead to more snoring due to the loosening of the throat muscles. Caffeine boosts cortisol levels, a.k.a. stress, and results in less deep sleep and more awakenings.
  5. Do not try to sleep – It is something that has to come on naturally. The harder you try to get to sleep, the less likely you will be able to, as trying activates the autonomic nervous system, which also increase how stressed you feel. The more you allow yourself to relax, the more likely sleep is.
  6. Do not keep looking at your phone or alarm clock during the night – If your alarm is set, then there is no need to know the time in bed. This will only increase performance anxiety if you look and see that you have not slept for very long. Put it in a draw, cover it with a shirt, or face it the other way.
  7. Keep naps short – Napping during the day reduces your pressure for sleep by the time you get into bed at night. If you have to nap, keep it less than 30 minutes so that you don’t go into a deep sleep, and do it before 4pm so that sleep pressure can build up again by the time you go to bed that night.
  8. Engage in relaxing activities before bed – Just like waking up, going to sleep is a transitional process. Don’t expect that your mind will shut off immediately as soon as you get into bed. Whatever it is, do something relaxing as a pre-bed routine. Watch some T.V., read a book, listen to some music, have a hot bath, practice yoga, mindfulness or relaxation techniques. Then maintain that relaxed state in bed and allow sleep to come.
  9. Use the bedroom only for sleep and sex – This means no reading, eating, internet surfing, game playing, phones, T.V., planning, worrying etc. in bed. Want bed = sleep.
  10. Make worry list before bed – To prevent your mind from racing in bed, reflect on the day about 2 hours before you want to sleep, write down any worries, concerns or problems you may have, create a to-do-list, or plan for the day ahead. Then if thoughts come up in bed, remind yourself that you have already sorted them out or that they can wait until tomorrow.
  11. Leave the bed if awake – Sometimes no matter what we try, you may find yourself awake in bed. If you do not fall to sleep within what feels like 20 minutes, get up, go to another room, and do something relaxing until you are sleepy before returning to bed. Over time, this will recondition the bed with sleepiness rather than frustration and allow you to fall asleep quickly. If you are worried that you may never sleep if this was the case, give it a try for a week. It may be the most difficult recommendation to follow initially, but it produces long-lasting results quickly.

For more details on these interventions and strategies, go to www.deliberatelybetter.com.au.

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

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

 

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

 

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

 

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

 

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

 

Dr Damon Ashworth

Clinical Psychologist

10 Bits of Advice I’d Give My 10-Year-Old Self

When I was ten, I was in grade four at primary school. I was one of the tallest kids in the class, and fairly skinny and uncoordinated.

I loved sport and computer games. I enjoyed living where I did in the north-east suburbs of Melbourne and had some good friends that I spent a lot of time with.

I hated school, talking on the phone, doing chores around the house, and my little sister. I also tried to take sick days from school fairly regularly with a sore tummy that I only realised years later was actually anxiety. I’d had a horrible teacher the year before who really didn’t seem to like me, and had no idea how to cope.

Here are the first ten thoughts that come to mind that I would say to myself if I could go back in time and have a chat with my ten-year-old self:

calm daylight evening grass

1. Before you do anything else, breathe

I know you worry a lot and stress yourself out by overthinking, but you don’t have to have all the answers yet, or maybe ever. Before you do something you may regret, stop, take ten slow, deep breaths into and out of your belly, and try to breathe out all the air with each breath. Then see how you feel and what you can do.

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2. Focus on one thing at a time

I know that you feel that you have too many things to do and not enough time. But multi-tasking is a myth and will just stress you out more. Determine whatever it is that is most important to you in any given moment, and then try to put all of your intention and effort into that until it is complete, or you need to take a break or have a rest or something more important comes along.

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3. Don’t always believe what your thoughts tell you

I know that you personalise things a lot and catastrophise or imagine the worst. Some things are your fault, but many things are not. You are not “bad” or “evil”, but you can do some pretty mean things if you want to. You’re also probably not going to die about the homework assignment that you forgot to save on your computer. Start meditating 10 minutes a day before you go to bed, and you will be successfully understanding your thoughts and managing your emotions in no time.

notebook

4. Write things down

I know you feel that your mum and dad don’t always understand you, but you can learn to understand yourself through reflection. Write down 3 things that you are grateful for every day. Make a plan to address any concerns or worries that you have before they all build up and becoming overwhelming for you. If you spend 5-10 minutes every day writing in a journal, you won’t regret it.  Also, learn how to use a calendar or diary as soon as you can. Good organisational habits now will make life much easier for you later on.

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5. Don’t forget to have fun

I know that you are super competitive and hate to lose, but basketball, swimming, tennis, baseball or any other sport that you do is meant to be fun. Practice isn’t always fun as that’s focused on helping you to get better, but if you don’t enjoy competing or playing the games, find another sport that you think you will enjoy, and put more time into that. You are not going to be a professional athlete who gets paid, and that is okay. Sport is a very healthy hobby to have, and if you can enjoy it, it’s even better.

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6. It’s okay to make mistakes, get rejected or fail

I know that you struggle not being very good at something. Even though it doesn’t feel that good to be a novice or a beginner, the only way to become good at something is to first be okay at sucking at it. If you can persist through the sucking part, you will become a lot better over time, and not suck so much eventually, and probably even enjoy it. Keep playing and practicing guitar and trombone, keep drawing and being creative, and pay attention in Italian class. It’s pretty cool to be able to make art and speak multiple languages, and easier to learn when you are still young. Also, take French at high school, not Indonesian.

adult blur books close up

7. Keep reading and learning outside of school

I know you don’t like school much at the moment, but don’t just let your teachers dictate to you what you should learn. If something interests you, explore it further. If you have questions that you want to answer, see if you can find the answers in books. There are a lot of wise people that have clarified their thoughts and written it down for you. Their words will help you a lot as you get older, and fostering curiousity and love of learning at your age is awesome. If mum wants to teach you how to cook, bake, clean, iron, sew, listen to her, watch what she does, try it and get feedback until you know what you are doing. Same goes with dad trying to teach you about sport, cars, gardening and making things with tools. You won’t regret having these skills once you move out on your own.

men s white button up dress shirt

8. Make time for friends and family

I know that playing video games is fun, but technology shouldn’t replace face-to-face contact with other people. Be interested in people more than you are in things. You will learn a lot from them, and it will make you happier if you are yourself and they appreciate you for it. Your family won’t always be around as much as they are now, so try to enjoy the time you have with them even though they can all be annoying at times. And be nice to your sister. It’s not her fault that she is cuter and more extraverted than you. She’ll actually turn out to be a pretty cool person and a good friend to you one day.

finance sketch near laptop computer

9. Invest in index funds

I know that it is fun to spend money if you have it, but saving and investing doesn’t have to take much time and effort and is worth it. No matter how much money you earn or are given, put 10% aside and stick it into an index fund. The power of compounding interest means that you will be setting yourself up for your financial future, which will give you more freedom to do the things you want to do when you are older without having to worry about money. You probably won’t feel like you are sacrificing much, but the long-term benefit will be great.

biker holding mountain bike on top of mountain with green grass

10. Try to be the best you that you can be; everyone else is taken

I know that you often compare yourself to others and don’t feel like you are as good or as lovable as them. The truth is you will never be as good as your brother at being your brother, so don’t even try. Rather than comparing yourself to who others are today, try to compare yourself to who you were yesterday. As long as you are striving to be a better person each day, that is all you can do, so be proud of yourself for who you are and for the effort that you put in. Although it doesn’t feel like it sometimes, know that mum and dad are proud of you and love you too, even if they don’t always show it in the way that you want them to. Your life is going to be pretty cool in the future, and it doesn’t just get harder and harder, so try not to worry about the future too much. Focus on what is in your control each day, and the future will take care of itself!

 

Dr Damon Ashworth

Clinical Psychologist

 

What is Depression and How Can We Manage It?

Ministry of Health Vanuatu April 2019 Mental Health Newsletter

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What is Depression?

Approximately 1-in-5 people will experience Depression at some stage of their lives.

It is normal for people to experience short periods of sadness. Although some people may say that they are depressed if they feel sad at times, Depression, formally known as Major Depressive Disorder (MDD), is a psychological disorder of consistently lowered mood. Depression also comes with several physiological, cognitive and behavioural changes.

These changes include:

  • lack of interest or pleasure in most activities
  • fatigue
  • loss of energy
  • difficulties sleeping or sleeping too much
  • feeling restless or slowed down physically
  • increased or decreased appetite
  • substantial weight gain or loss without intending to do so
  • feelings of worthlessness
  • excessive or inappropriate guilt
  • indecisiveness
  • concentration difficulties, and
  • recurrent thoughts, plans or intentions towards death or suicide.

To meet criteria for Depression, an individual must have at least five of these symptoms most of the day, nearly every day for two consecutive weeks, and it must result in significant distress or functional impairment (American Psychiatric Association, 2013).

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Potential Treatments for Depression

1. Antidepressant Medications: 

Various antidepressant medications have been developed and prescribed over the years, including monoamine oxidase inhibitors (MAOIs), tricyclics antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and more recently norepinephrine (SNRIs) and dopamine reuptake inhibitors and melatonin-based antidepressants. The most commonly prescribed antidepressants worldwide are SSRIs, however, only TCAs are currently available in Vanuatu. This medication is not recommended for children, and is only recommended for adults with moderate to severe depression.

2. Psychological Treatments:

Cognitive Behavioural Therapy (CBT) for Depression is a non-drug treatment that focuses on improving what people think and believe (including their expectations) and behavioural factors associated with depression. CBT has many studies supporting it as an effective treatment for Depression, with research showing comparable or greater effectiveness than treatment by medication, especially with milder forms of Depression (Butler et al., 2006).

Furthermore, CBT and antidepressants together can have additional benefits over either CBT or medication alone for severe Depression (Thase et al., 1997). Thus, effective treatment for severe cases of Depression may benefit from both medication and psychological interventions like CBT.

3. Self-Help Strategies:

Currently, the number of Medical and Allied Health staff trained in Mental Health treatments in Vanuatu is limited, especially outside of Port Vila. There are also various instances where individuals are unable to access or do not want to use any of the traditional treatments for Depression. This is where self-help strategies for Depression can potentially assist.

In 2009, Morgan and Jorm asked several Depression experts which strategies (out of 282 possible options) they thought would be most likely to be useful for individuals with sub-threshold Depression.

They came up with a final list of 25 self-help strategies that can be frequently used by people with Depression.

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The 14 self-help strategies rated as most likely to be effective for Depression included:

  1. Make sure that you get out of the house for at least a short-time each day
  2. Eat a healthy, balanced diet
  3. Do something you enjoy
  4. Try to remain involved in purposeful activities for at least a small part of each day
  5. Engage in exercise or physical activity
  6. Make sure you get enough sleep at night and have a bedtime and rise time that varies little from day to day
  7. Engage in an activity that gives you a feeling of achievement
  8. Talk about problems or feelings with someone who is supportive and caring
  9. Let family and friends know how you are feeling, so they are aware of what you are going through
  10. Try methods to improve your sleep, such as not napping during the day, avoid caffeine and alcohol before bedtime, and make your bedroom as restful as possible
  11. Enlist a trusted friend or relative to help you get out and about or do activities
  12. Reward yourself for achieving a small goal
  13. Learn relaxation methods
  14. Make a list of strategies that have worked in the past for depression and use them

Seven strategies were rated by Depression experts to be less helpful but not likely to be harmful. These were:

  1. Take a nap
  2. Have a warm bath
  3. Take omega 3 fatty acids (fish oils)
  4. Get a massage
  5. Do yoga
  6. Take St John’s Wort
  7. Take antidepressants

Depression experts rated four self-help strategies as being potentially harmful for Depression. These were:

  1. Spend more time alone
  2. Drink alcohol
  3. Do something risky and exciting, such as driving a car too fast or under the influence of a substance
  4. Use illicit drugs, such as marijuana

A follow up study in 2012 by the same authors then compared what the Depression experts recommended to what individuals with Depression actually did.

By looking at their behaviour, individuals with Depression tend to isolate themselves way more than experts recommend, drink more alcohol than is valuable, and struggle to exercise, achieve things, talk to others, ask for help, and relax as much as they would like to.

What this means is that if you or a loved one has Depression, try out the first 14 self-help strategies listed above.

If they do not work or you are unable to do them, it may be important for you to seek extra help and support from someone that you trust or a qualified Mental Health professional such as a Mental Health Nurse or Psychologist. This is especially important if the Depression becomes severe and is affecting you or your loved one’s life at work, school or home

bench chair friends friendship

You do not have to suffer alone. For more information or advice, please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

 

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

 

Mind Care Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

 

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

 

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

Dr Damon Ashworth

Clinical Psychologist