Collective Wisdom for Positive Health: Exploring Positive Psychiatry and

Fountain Of Health Initiative

Presenters:

Dr. Popuri M. KrishnaMBBS, DPM, MD, DABPN, FRCPC, FAPAAssociate Professor of Psychiatry,Northern Ontario School of MedicineConsultant General and Geriatric PsychiatryHealth Sciences North – Sudbury – Ontario

Dr Lisa Van Bussel, MD FRCPCGeriatric Psychiatrist, St Joseph’s Health Care London, ONAssociate Professor, Department of Psychiatry, Western University.

Monica Bretzlaff, BA,TRSManager Behavioural Supports Ontario (Provincial & North East), NBRHCRegional Aboriginal Mental Health ServicesSenior’s Mental Health- Regional Consultation Service

DisclosuresDr. Popuri M. Krishna

I have been on the Drug Advisory Board in the past for Janssen Pharmaceuticals.

I do not have any mitigating reason to have any conflict of interest with this presentation

Dr Lisa Van Bussel, MD FRCPC

I do not have any mitigating reason to have any conflict of interest with this presentation

Monica Bretzlaff, BA TRS

I do not have any mitigating reason to have any conflict of interest with this presentation

Learning Objectives:

• Understand the core concepts of positive emotions and wellness.

• Identify the components of positive psychiatry that promotes well-being and resilience.

• Examine behavioral health change tools, such as the Fountain of Health Initiative, to promote brain health and resilience.

• Translate knowledge into: 1) self-reflective and 2) academic practices.

Good Morning

Overall Rank

Country/Region Score GDP per capita

Social support

Healthy life expectancy

Freedom to make life choices

Generosity Perceptions of corruption

1 Finland 7.632 1.305 1.592 0.874 0.681 0.192 0.393

2 Norway 7.594 1.456 1.582 0.861 0.686 0.286 0.340

3 Denmark 7.555 1.351 1.590 0.868 0.683 0.284 0.408

4 Iceland 7.495 1.343 1.644 0.914 0.677 0.353 0.138

5 Switzerland 7.487 1.420 1.549 0.927 0.660 0.256 0.357

6 Netherlands 7.441 1.361 1.488 0.878 0.638 0.333 0.295

7 Canada 7.328 1.330 1.532 0.896 0.653 0.321 0.291

8 New Zealand 7.324 1.268 1.601 0.876 0.669 0.365 0.389

9 Sweden 7.314 1.355 1.501 0.913 0.659 0.285 0.383

10 Australia 7.272 1.340 1.573 0.910 0.647 0.361 0.302

Happiest Countries in the World

The 2018 report features the happiness score averaged over the years 2015-2017. As per the 2018 Happiness Index, Finland is the happiest country in the world. Norway, Denmark, Iceland and Switzerland hold the next top positions. The report was published on 14 March 2018 by UN. The full report can be read at 2018 Report.

What is Positive Psychiatry?

It is the science and practice in understanding and promotion of well-being through assessments and interventions aimed at positive psycho social factors among people who are at high risk for developing mental or physical illness.

-Dilip Jeste

Positive Psychiatry a Clinical Hand Book

Positive Psychiatry Promotes…

• Wellness and resilience, as it integrates the collective wisdom of bio-psycho-social and spiritual thoughts related to positive emotions.

• Ideas related to happiness and well-being along with enhancing cognitive behavioural health.

• Positive behavioural health changes that inspire brain health and resilience in practice.

Positive Psychiatry Multi Modal View

Positive Psychiatry

• Positive Psychiatry is intended to complement and enrich “psychiatry as visual” expanding its primary focus from pathology to health and enhancing wellbeing.

• The focus is on identifying and enhancing protective factors and neuroplasticity. Thus it has a role in increasing resilience and primary prevention.

Assessment in Positive Psychiatry

• Measurement of positive mental health is lacking in DSM-5

• Psychological General Well Being Index

• PGWB - Dupuy 1984

• WHO – 5 Well Being Index (Bech et al 2013)

• Both are disease independent scales.

• They cover a basic life perception of the dynamic state of well being

Positive Psychosocial Factors

• Optimism

• Wisdom

• Personal Mastery

• Self – efficacy

• Coping

• Creativity

• Conscientiousness

• Spirituality/Religiosity

Wisdom

Aadi Sankara 16th century

Knowledge + Experience

+ = Wisdom

Bhakti (Reverance)

Dr. Deepak Chopra from Chopra Foundation 2019

• True wisdom leads to such things as insight, intuition, depth of experience, self awareness and humility before mysteries that will never be full comprehended

• Wisdom is totally a different way of looking at reality

• It is the only way to fulfill the infinite potential that human beings possess and on global scale, it is the only way we will reach desperately needed solutions

Biological Factors

Biological Factors

Hypothalamus

Oxytocin Vassopressin

Nucleus Accumbens

Sympathetic SystemParasympthetic System

SleepSLEEP DEPRIVATIONS : Reduce metabolism

Weaken immune system

Impairs memory

Impairs concentration

May foster weight gain

• Develop sleep as a habit

• Develop pre sleep routine? Stretches, brushing teeth

• Do boring things like washing the dishes

• Have a set time

• Absolute darkness

• Slightly colder temperature

• Use socks if needed

• ? White noise

• Physical activity and exercise in the daytime/evening

Self Regulation of Sleep(Caldwell et all 2001, Kahn – Green et all 2007)

Sleep disruption leads to

↑Tension

↑Irritation

↑Depression

Decreased feelings of positive affects

↓Energy

↓Joviality

↓Enthusiasm

• This can lead to reduced emotional regulation.

• Sleep deprivation leads to disruption in functional connectivity between the Amygdala and Frontal Cortex –(Killgore 2013)

Diet

Exercise

FOR SENIORS > 65

• 2.5 hours of moderate aerobic exercise such as a brisk walk each week

OR

• 1 hour and 15 minutes of vigorous exercise such as jogging each week

FOR ADULTS < 65

• 2.5 hours of high intensity exercise such as running each week

Ecological Factors

• No smoking

• Green spaces in communities

• Reduction of pollution

Emotions

James – Lang Theory of Emotions 1884 – Centers in the Brain

Cannon-Bard Theory of Emotion 19th Century Interaction of Brain - Body

• Positive Fantasies emerge from a persons aroused needs.

• Needs Influence the content of peoples thoughts or images

• Physiological Needs – Hunger, Thirst, Sex

• Psychogenic Needs – Achievement, Affiliation, Power

• Based on Maslow’s Hierarchy of Needs (1943)

What is a Positive Emotion?

• Depending on ones goals.

• Individually a person can have atypical emotions

• Cultural differences also influence a positive emotion

• Positive emotions have the ability to broaden thought – action and build resources.

• The value of positive emotion is in eliciting a positive behavior. Sometimes not all anger should be avoided. Not all fears should be treated the same.

Positive Emotions

• They feel pleasant

• The events that precede the emotion are goal –congruent

• The affective state produces desirable consequence

Positive Emotions

• Have an undoing effect on the person (Fredrickson et al 1998)

• These emotions lead to broaden and build thought –action tendencies

• They have unique ability to speed physiological recovery from lingering negative emotional states

• They decrease sympathetic arousal and increase parasympathetic nervous system activity

• This leads to stress reduction and cognitively improves coping with the stress

Positive Emotions• Gratitude

• Love/Affection

• Pride

• Joy

• Compassion

• Happiness

• Interest

• Challenge

• Awe

• Tranquility

Interest, Challenge and Determination

• These are opportunity – related emotions

• Interest motivates attention

Let me see what is this? (curiosity)

• This leads to learning and knowledge

• Interest is stronger when the target is novel or complex but within ones’ ability to understand

Challenge/Determination

• When you appraise a situation is effortful but optimistic

• “Things are not currently as desired but with effort they could be” with good motivation and perseverance leads to promoter mastery and growth (opposite is boredom)

Benefit – Related Emotions

• Each of them arises under conditions associated with success or benefit

Happiness

Pride

Gratitude

• Happiness can be a response to positive circumstances This includes both intrapersonal and interpersonal events. Happiness can increase creative, out-of-the-box thinking (Fredrickson et al 2005)

Pride

• Pride arises in response to a success

• It is evoked by appraisal that personally relevant and goal conducive

Example : Proud parent, proud to win a race

Two types a) Authentic Pride

b) Hubristic Pride (with narcissist traits)

Gratitude

• Is a positive emotion that arises when a person appraises the situation in which a need or desire is fulfilled often there is an external influence.

• “If the only prayer you said was Thank you, That would be enough” (Eckhart Tolle, Spiritual Teacher)

Gratitude

• It is a relationship strengthening emotion

• A person who practices gratitude can cope more effectively with stress. On the receiving side it improves our self esteem when we internalize feeling valued and respected. The more we convey our specific gratitude, the more deepening of intimacy and increases the joy in our life.

Surprise

• It is an emotion involving a sense of uncertainty

• Generally it is positive and uplifting like a surprise visit or party!

Hope

• HOPE is an emotion associated with expectation of pleasure in the future

In Contrast

• FEAR is the emotional opposite of Hope

• Hope and Fear both have a combination of cognition (thinking) and emotional components

• Appraisal of the situation – cognitive optimism –emotion

Love/Affection

• Romantic Love

• Parental Love

• Platonic Love

• Are different shades of this emotion

• The spiritual teachings of the bible are mostly based on this positive emotion

Love

• The focus is on other person

• A strong emotional bond of yourself and the other (object)

• Love leads to attachment with the object

• According to Buddhist philosophy this is the cause of suffering!

Compassion

• A related positive emotion to love

• We become interested in another person

• This emotion is the very definition of our humanity

• Offspring of compassionate care givers are more likely to survive (Goetz et al 2010)

• Compassion appears to be important for our survival and we admire it in others!

• Compassionate people are more likely to find supportive social networks

• Someone who is sensitive to the needs of others is likely to be more compassionate

• It is certainly a socially desirable emotion

Compassion

Compassion is categorized as positive emotion

BUT

It may feel unpleasant in some instances

It is associated with low arousal but feels pleasant

Love

Friendliness

Gratitude

All involve perception of other person as the cause of the pleasant event

WHERE AS

Tranquility, challenge, interest, relief all involve yourself as an agent for the emotion

Grand Canyon

Awe

• Is a common response to artisitc works, a great music concert, National Wonders or Religious experiences

• The things that elicit awe are unusual, conceptually or perceptually complex and rich in information

• The things are always external to the self

• In Awe there seems to be a perception that the self is small in comparison to the object

• A belief that something is greater than yourself!

• This leads to a sense of connection with the world (Planet Earth, by David Attenborough)

Tranquility

Absence of Arousal is as much an emotional state as a high level of arousal

Nothing needs to be done Right Now!

Tranquility

• The state is pleasant and involves a sense that all is well with the world

• This gives the person the opportunity to recuperate from the stresses and strains of life

• Embracing Tranquility as an emotion helps to open the doors to appreciate positive emotions

Up Regulation of Positive Emotions(Livingstone and Srivastava 2012)

Engagement Strategies

• Social affiliation

• Clubbing

• Partying

• Interacting positively with others with the present moment, through savoring and social interaction

Betterment Strategies

• Focus on self improvement

• Spiritual Fulfillment

Indulgence Strategies

• Pursuit of momentary pleasure

• Eating out, Shopping, Relaxing, Spa

Balance is the Key! Over indulgence leads to imbalance!

Down Regulation of Positive Emotions

Sometimes it may be necessary to evaluate the life situation and the progress in life; if too much positivity has a toll on your self, then Down Regulation may be needed:

• Mindfulness

• Meditation

• Yoga

These techniques can be used for both enhancing and controlling positive emotions.

Functional MRI – Yoga Meditation

Telles, S., Singh, N., Naveen, K. V., Deepeshwar, S., Pailoor, S., Manjunath, N. K., ... & Balkrishna, A. (2015). A fMRI

study of stages of yoga meditation described in traditional texts. Journal of Psychology & Psychotherapy, 5(3), 1.

Brain and Connections

Spirituality

• “A human capacity for relationship with that which transcends sense phenomena” (Holmes 1982)

• “ A person perceives it as a heightened or expanded consciousness that is independent of ones’ efforts and that deepens ones’ awareness of self, others and the world”

• The term spiritual wellbeing indicates wholeness in contrast to fragmentation and isolation

• A sense of universal belonging

• Spirituality and Religious Participation are highly correlated with positive successful aging

• Just as much as diet, exercise, mental stimulation, self efficacy and social connectedness

-MacArthur Foundation Research Network on Successful Aging

• It is the responsibility of physicians to understand what “being spiritual” means to an individual in order to provide complete “holistic” care of that persons psychological and spiritual needs

• Spirituality is a life long developmental task until death (Moberg 2001)

• Fanatical religious beliefs can affect physical and mental health adversely (Mueller et al 2001)

Spirituality cont.

Obtaining Spiritual History• Spirit

Spiritual beliefs

Personal beliefs

Integration with spiritual community

Rituals

Implication for care

Terminal care

• HOPE Sources of hope

Organized religion

Personal Spirituality

Effect on medical care and end of life issues

Assessment of Spirituality

Four Simple Questions

1. Is faith (religion, spirituality) important to you in this illness?

2. Has faith been important to you at other times in your life?

3. Do you have someone to talk about religious/spiritual matters?

4. Would you like to discuss religious matters with someone?

Overcoming Problems with Positive Thinking

How can positive thoughts or feelings be put into positive action?

This can happen by Self Regulatory Power

Self Regulation

• Approach and Avoidance systems affect positive feelings = ↑Approach ↓Avoidance

• Expectancy occurs by beliefs which are based on past or present experience

• Fantasy is a future mental time travel

• Both can occur with positive emotions and thoughts depending on the values we place for ourselves.

• Human behavior can be understood possibly by three factors

• The field of Cognitive behavior therapy is based on this. By altering 2 of the 3 components we can possibly bring change in the 3rd.

Mental Contrasting

• Implicate Brain Areas Associated with

- Working and episodic memory

- Intention, maintenance and action preparation

- Vivid visualization

• This process enables people to recognize feasibility based on experiences in the past when committing to goals.

When mental contrasting is combined with implementation intention

• When someone wants to develop better eating habits she may develop a “If______then plan”

• “If I open my refrigerator, then I will grab a piece of fruit”

People can develop their self control by Mental Contrasting combined with Implementation Intention

Effective Goal Attainment

This is a Meta Cognitive Strategy (Dan Kirk, Psychologist from New York – 2013)

Mental Contrasting

Resilience Promotion Interventions

• Pharmacological if needed interventions

• Various cognitive behavioural techniques

• BMAC – Broad-Minded Affective Coping –(Panagioti et al 2012)

• Learned Optimism Training – (Seligman 1999)

• Well Being Therapy – (Fava et al 1999)

• Hardiness Training – (Florian 1995)

• Fountain of Health – (Keri-Leigh Cassidy 2010)

References1. Barrett, L. F. (2009). The future of psychology: Connecting mind to

brain. Perspectives on psychological science, 4(4), 326-339.

2. Barrett, L. F., & Satpute, A. B. (2013). Large-scale brain networks in affective and social neuroscience: towards an integrative functional architecture of the brain. Current opinion in neurobiology, 23(3), 361-372.

3. Pasupathi, M., McLean, K. C., & Weeks, T. (2009). To tell or not to tell: Disclosure and the narrative self. Journal of Personality, 77(1), 89-124.

4. DeNeve, K. M., & Cooper, H. (1998). The happy personality: A meta-analysis of 137 personality traits and subjective well-being. Psychological bulletin, 124(2), 197.

5. Pals, J. L. (2006). Narrative identity processing of difficult life experiences: Pathways of personality development and positive self‐transformation in adulthood. Journal of personality, 74(4), 1079-1110.

6. Atchley, R. C. (2009). Spirituality and aging. JHU Press.

7. Brugman, G. M. (2006). Wisdom and aging. In Handbook of the psychology of aging (pp. 445-476). Academic Press.

8. Seligman, M.E. & Csikszentmihalyi, M. (2000). Positive Psychology: An Introduction. Am Psychol, 55(1), 5-14.

References9. McEwen, B. S. (2004). Protection and damage from acute and chronic stress: allostasis

and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032(1), 1-7.

10. Richardson, G. E. (2002). The metatheory of resilience and resiliency. Journal of clinical psychology, 58(3), 307-321.

11. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of personality and social psychology, 57(6), 1069-81.

12. Vaillant, G. E. (2008). Aging well: Surprising guideposts to a happier life from the landmark study of adult development. Little, Brown.

13. Yehuda, R., Golier, J. A., Tischler, L., Harvey, P. D., Newmark, R., Yang, R. K., & Buchsbaum, M. S. (2007). Hippocampal volume in aging combat veterans with and without post-traumatic stress disorder: relation to risk and resilience factors. Journal of psychiatric research, 41(5), 435-445.

14. Fredrickson, B. L. (2000). Cultivating positive emotions to optimize health and well-being. Prevention & Treatment, 3. Retrieved from www.unc.edu/peplab/publications/Fredrickson_2000_Prev&Treat.pdf.

15. Carstensen, L. L., & Mikels, J. A. (2005). At the intersection of emotion and cognition: Aging and the positivity effect. Current directions in psychological science, 14(3), 117-121.

16. Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. New York: Piakus

References17. Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice. American

family physician, 63(1), 81-88.

18. Anderson, R.S. (1998). On being human: The spiritual saga of a creaturely soul. In W.S. Brown, N. Murphy, and H.N. Molonly (Eds.), What eve happened to the soul? Scientific and theological portraits of human nature (pp.175-94). Minneapolis, MN: Fortress.

19. Belcher, A. E., Dettmore, D., & Holzemer, S. P. (1989). Spirituality and sense of well-being in persons with AIDS. Holistic Nursing Practice, 3(4), 16-25.

20. Blazer, D., & Palmore, E. (1976). Religion and aging in a longitudinal panel. The Gerontologist, 16(1 Part1), 82-85.

21. Boehnlein, J.K. (2000). Psychiatry and religion: The convergence of mind and spirit. Washington, DC: American Psychiatric Press.

22. Finnegan, D.G., & McNally, E.B. (1995). Defining God or a higher power: The spiritual center of recovery. In R.J. Kus (Ed.), Spirituality and chemical dependency(pp. 39-48). Binghamton, NY: Haworrth.

23. Koenig H.G. (2001). Religion, spirituality and medicine: How are they related and what does it mean? May Clin Proc, 76(12), 1189-91.

24. Koenig, H.G., McCullough, M.E., & Larson, D.B. (2001). Handbook of religion and health. New York: Oxford University Press.

References25. Moberg, D. O. (2005). Research in spirituality, religion, and aging. Journal of

Gerontological Social Work, 45(1-2), 11-40.

26. Musick, M. A., Traphagan, J. W., Koeing, H. G., & Larson, D. B. (2000). Spirituality in physical health and aging. Journal of Adult Development, 7(2), 73-86.

27. Paloutzian, R.F., & Ellison, C.W. (1982). Loneliness, spiritual well-being, and the quality of life. In L.A. Peplau & D.E. Perlman (Eds.). Lonliness: A sourcebook of current theory, research, and therapy. (pp.224-237. New York: Wiley Interscience.

28. Schenck, D. P., & Roscoe, L. A. (2009). In search of a good death. Journal of Medical Humanities, 30(1), 61.

29. Thibault, J.M. (1993). A deepening love affair: The gift of God in later life. Nashville: Upper Room.

30. Tornstam, L. (1996). Gerotranscendence—a theory about maturing into old age. Journal of Aging and Identity,1,37-50.

31. Young, J. D. E., & Taylor, E. (1998). Meditation as a voluntary hypometabolic state of biological estivation. Physiology, 13(3), 149-153.

32. Telles, S., Singh, N., Naveen, K. V., Deepeshwar, S., Pailoor, S., Manjunath, N. K., ... & Balkrishna, A. (2015). A fMRI study of stages of yoga meditation described in traditional texts. Journal of Psychology & Psychotherapy, 5(3), 1.