Mental Health

Intro

This module aims to provide you with the awareness and basic knowledge to manage your mental health and help you engage with your exercise programme.

To give you a good overview, you can watch the video below or you can watch the video here (via YouTube).

What is Mental Health?

"A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."

World Health Organisation

Typically, when living with and beyond cancer, the aspect of "coping with the normal stresses of life" is particularly important. In fact, those living with and beyond bowel cancer often suggest on the day of diagnosis, they feel like they begin to live a life with a 'new normal'.

Thinking about a more local context, the NHS states that mental health is:

"A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment. Levels of mental health are influenced by the conditions people are born into, grow up in, live and work in."

The NHS definition leans more toward a positive state of mind and body and highlights that mental health can be influenced in many ways. They both talk about safety, the ability to cope (with stress), connection and the environment. The World Health Organisation and NHS support that mental health is a key part of overall health. They even state, "There is no health without mental health".

It is time to get into what it really means for us, as individuals. Click onto the next slide to find out what affects your mental health.

Affects

So, what affects my mental health?

Mental health is not exactly simple to explain or break down. As you have already realised, there are a wide number of factors that will affect it. To explain mental health, it’s useful to think of physical health first. Take a moment and think about what “optimal” physical health is dependent on…

Regardless of your answer, you probably thought about something, including not having to take lots of medication, not having a cold, being able to move and do what you like, or similar. All of these are influenced by what you eat, your exercise, your genes and environment and more. There are some things that we can modify and take control of (like the first two) and some others that we can’t (like genes and, to a certain extent, environment, like where we leave or the air quality we breathe).

Mental health is the same. There is not only a single factor that will affect it. It depends on things like stress in life (both work and personal) and your capacity to deal with it, your social support circle and the meaningful relationships that you create within your community, a sense of accomplishment and a lot more. This means that, even though they might be similarities, what affects your mental health is unique to you. You might perceive things differently from other people or react in completely opposite ways. It is also not just good or bad. Instead, it works in more of a range, spectrum or continuum.

Some of the main points to keep track of when looking after your mental health are:

- Stress and anxiety – Where are they coming from, and how do you react to them?

- Your resilience levels – How much can you manage and still bounce back from adversity?

- Coping strategies – How do you deal with stress and how are you releasing it?

- Goal setting – Are your goals realistic and achievable? Are they setting you up for success?

- Self-talk – The way you speak to yourself.

- Sleep – Quantity and quality

- Connection – What are your support network, environment, and motivations?

Take a few seconds now to think about what affects your mental health. When thinking of something, ask yourself what effect that specific situation/event/factor has. How does it affect you? Refer to the list above if you need any hints thinking of the factors specifically affecting your own mental health (remember, they are not just good or bad).

Click onto the next slide to read about what strategies you can implement.

Emotionally aware

Being emotionally aware

Recognising and being aware of what you are feeling is important. It takes practice to do it (we don’t automatically recognise that we are angry as soon as we get angry). This is part of the healthy management of emotions. Recognise the signs of each emotion (thinking about how your body feels, how are you behaving), how are you speaking to yourself, and what is your point of view in the situation (is it a positive perception?). Your feelings (emotions) are a direct consequence of what you think. Likewise, your actions will be influenced by your feelings. Journaling and noting down how you feel is a great opportunity to have a look from a different perspective. For further information on emotional regulation, read this APA blog. You can also visit this Mindful Institute blog for a breakdown of the Relax, Reflex and Respond strategy (video and article).

Increasing your resilience

Resilience is your ability to bounce back from adversity. Throughout life, people will see up and downs, and it is normal in the case of bowel cancer survivors like you to experience cancer-related stressors and adversity. Resilience is fundamental to help you cope with those situations and successfully come out the other end of adversity. There are several ways to build your resilience, like journaling and meditating. To read more about resilience and how to develop it, visit this American Psychological Association blog. American Psychological Association blog.

Mind and body in sync

On your day off from the program, why not try a bit of meditation? Techniques like meditation, mindfulness and yoga are great ways to sync your mind and body, having a positive impact on your mental health. In a metanalysis, which studies in detail several individual research studies and combines their findings, Zainal et al. (2013) found a moderate to large positive effect of mindfulness stress reduction on breast cancer survivors. These interventions included several types of meditation and body awareness sessions. They were shown to lower participants’ perceived stress, anxiety and depression. To read more about meditation and mindfulness, visit this Mindfulness Institute blog. You can also find more resources in our library; take some time after the completion of this module to explore them.

You can start now with a simple mindfulness exercise. Before we continue with more strategies, take a minute to close your eyes and notice the sensations in your body right now. Focus your thoughts on assessing what each part of your body feels like.

Click onto the next slide to continue.

Goal setting

We have already visited goal setting in a previous module. However, we want to reinforce the importance of effectively setting goals. Setting a goal that is unreachable will lower your motivation and self-esteem. This is why it is so important to set SMART goals. Remember, Specific, Measurable, Attainable, Realistic and Timely (or time-bound). Remember the goals that you are walking towards. How are you getting on with them? This could be walking for 10 min every day or doing 4 sessions in your weekly plan. Setting up small goals that lead you to the big one is fundamental. To revisit goal setting, go back to the Setting Goals module.

Positive self-talk

Self-talk has a big impact on how we feel and react to situations. The same scenario can either have a positive or negative effect on your emotions and mental health just based on what your perception is. Based on that, the basis of managing your self-talk is to be aware of what it looks like, when it happens and how you react to it. Positive self-talk is about changing those negative thoughts or statements into positive ones that make us feel hopeful, empowered, and optimistic. Visit this Healthline blog to learn more about it. Also, visit this CancerandWork.ca entry for information and a tool that will help you to rephrase unhelpful/negative thoughts into positive ones.

Fine-tuning your sleep

In a recent metanalysis, Scott et al. (2021) found that improving sleep positively impacts mental health factors like depression, anxiety, stress and even burnout measures. In addition, Tang et al. (2009) found that an exercise programme consisting of walking improves sleep quality in cancer patients. We know through the above and other research that exercise is a fantastic way to improve your sleep and, as a result, enhance your mental health. However, there is a need to acknowledge that cancer patients usually struggle to sleep through treatment or even after. So if you are struggling with sleep at this point, know that it is common. For more information on sleep and cancer, you can visit this entry from Sleep Foundation. We also have more resources in our library for you to explore on your own time. You can always speak to the clinical team for more specific ways how to manage your sleep.

We have now been through a number of strategies to work on your mental health. By exploring the resources provided, you will be able to gain a good knowledge of things that you can do in particular areas to stay on top of your mental health. There are a couple more important things that we would like to talk about. Click onto the next slide to continue.

Depression

Unfortunately, depression and anxiety are two of the most common impacts for those living with and beyond cancer. Often individuals also report developing an “out of body relationship” with themselves.

Recognising the signs of clinical depression

Depression can impact anyone, but it can particularly impact those living with and beyond breast cancer. It is important to have an awareness of some of the signs and common symptoms for you or your peers. These include:

Emotions

Emotions in cancer, and specifically bowel cancer cancer, can be challenging to discuss and can sometimes be overlooked.

Emotional side effects may occur after a diagnosis of cancer. This may bring new emotions you have not experienced before or previously experienced emotions to the forefront.

Some of the most commonly reported emotions brought up by those who have been diagnosed with bowel cancer cancer are:

- Stress
- Anxiety
- Depression
- Anger
- Fear of Side Effects
- Fear of the Unknown
- Worry and Uncertainty

In essence, the list could go on for many points! However, just like with physical activity and diet, with emotions and how each one of us processes them, there is not a 'one size fits all'. You may, at some point, experience all those emotions listed above; you may experience some, and you may experience none. It really is unique to you.

It can be very difficult or challenging for some of us to speak about or express our emotions, even to our loved ones. Some individuals find it helpful to speak to an oncology nurse or counsellor. However, if you are experiencing or have experienced any of the emotions listed above or even different ones, there are resources, support groups, and services out there that can offer some help and support. Go to our resource library to find them.

You will find links to the different support groups and resources in our resource library.

Summary

Summing up

In brief, mental health is just as important as your physical health. There are several strategies that you can implement to improve and take care of your mental health, including exercise.

This module provided you with an overall knowledge of mental health, the importance of exercise for it and strategies that you can implement to take care of it. If you haven’t done so yet, what Dr Mistry’s video on mental health and exercise.