Maintaining the balance

• Kay Wilhelm

• Consultant Psychiatrist, St Vincent’s Hospital, and Black Dog Institute

• Associate Professor, UNSW

and Chair, Doctors’ Health Program, NSW Medical Board

Early lifestyle decisions count

• The Nuns’ Study

• Autobiographical essays written by novices over 60 years ago

• ‘Idea density’ dementia at 75

• Optimistic style good health

– Ageing with Grace, Snowdon

The good news

• Adults continue some regeneration of neurons cells through adult life

• Daily memory checks aid memory

• Regular physical (aerobics)

and mental exercise

(neurobics)

Factors that retard ageing

Optimistic attitude

Maintaining close friends, and an intimate relationship

Enjoyable leisure

Regular exercise

Job satisfaction

Having successes acknowledged

Financial security,living within means

Balanced lifestyle: domains

• Body

• Mind

• Spirit

• Network

What constitutes a healthy lifestyle?• Study of healthy old age in Okinawa

• Age is celebrated: A child until 55

• After 97, a ritual symbolises a return to childhood

– The Okinawa Way, Wilcox et al, 1995, Penguin

Lifestyle

• Vegetables 7 serves a day

• Fish 3 times a week

• Water 6 glasses a day

• Green tea

• Meditation

– The Okinawa Way, Wilcox et al, 1995, Penguin

Exercise prescription

• Strength training aids walking speed

• Tai chi helps balance

• Weights training aids depression and osteoporosis

• Major effect is to enhance memory, improve network

– Feder et al, 2000, BMJ, 321, 1007-1011

Psychological Life Skills

• Cause and effect thinking (foresight, extrapolation)

• Focus on the salient

• Reality testing (what evidence?)

• Problem solving (direct, timely)

• Coping skills (humour, diversion)– Michael Yapko

Psychological Life Skills

• Self management (sleep, diet)

• Time management (procrastination, delegation)

• Stress management

• Assertiveness (limit setting)

• Eliciting support» Michael Yapko

Concept of Mindfulness

• Time spent ‘not doing’

• Being aware of what is happening in the present on a moment to moment basis

• Leads to greater control» Elliston (2001) Mindfulness in medicine and

everyday life BMJ Career focus 17th Nov

One minute exercise

• Sit in front of clock or watch

• Your task is to focus your entire attention on your breathing, and nothing else, for one minute

• Don’t put it off until later, do it now» Elliston (2001) Mindfulness in medicine and

everyday life BMJ Career focus 17th Nov

Emotional expression

• Lifelong emotional suppression: adverse effects on health

• Positive emotion in writing reflects readiness to resolve negative arousal

• The importance of narrative: writing 10 minutes a day for 3-4 days

• Influence on behaviour, physiology» Pennebaker, Opening Up, 1994 Guildford

Importance of staying connected• Positive benefit of confiding

relationship• Buffering effect of social network• Improves health outcomes

(postoperative, post AMI)• Confounds the effect of other

interventions• Share positives as well as negatives

The importance of network

• Loss of parent in childhood

• Cohort studies: Girls growing up in orphanages, Harvard men

• Gender differences : Fixed and nurturant roles

Roles for older family members• Women in charge in religion

• Oldest family members ensure good relationships between ancestors and surviving family members

• Preside over annual ceremony at family tomb

» The Okinawa Way, Wilcox et al, 1995, Penguin

Resilience in the face of adversity• Important factor in a land of migrants

• Constitutional optimism

• Maintaining hope for self and others

• Being able to distance one’s self

• Prioritising» Frankl, Man’s Search for Meaning, 1959, Pocket

Providing balance

• Practice demands, family responsibilities, personal lifestyle needs

• Positive psychology: more self care, peer support groups, challenge own self critical thoughts, foster optimism, influence work environment

– Yarney and Wilkes, BMJ, 322, 252-3

Reflection: listening to yourself• Time taken to stand back and

observe the processes, patterns, connections and possibilities in one’s life.

• A level of awareness of one’s own attitudes and reactions and implies

• Object is to stand back and reflect when distressed rather than react

Listening to yourself

• Questioning one’s own feelings and motives

• Helped by journal keeping, provocative reading, writing a personal mission statement

• Recognising ‘blind spots’

• Use of retreat, peer group

Self care

• Walk 30 minutes/day most days• Avoid large blood sugar swings,

excess caffeine and other stimulants • Practice brief relaxation and

mindfulness techniques• Use cognitive techniques (reframing)• Learn motivational interviewing:

practice on self!

Self care at work

• Pleasant environment

• Good people skills

• Awareness of how you deal with stress - and what constitutes a stressor

• Diversional rituals to clear the head and relax the mind

Habits of highly effective people• Be proactive - power to choose• Begin with the end in mind• Win/win situations• Learning from experience• Emotional regulation• Recreation - physical, expressive,

creative» Covey, 7 Habits of Highly Effective People

Survival measures

• Make sure you do things other than work

• Create your dream work schedule• Learn to say ‘no’ without feeling guilty• If you need help, ask for it• Seek peer support

– Kersley (2001) Striking the balance BMJ, 8th Dec

Womens’ issues

• Problem of doing a good job: how to limit what is asked of you

• Self esteem and letting go: doing too much yourself

• Shared care strategies

Balance at work and home

• What would you do if you had time?

• What do you want to change?

• How would you like it to be?

• What’s stopping you?

• Where can you start?

• What are the barriers?

• How can you reward yourself?

Motivational interviewing: Stages of change• Precontemplation: none considered

• Contemplation: thinking about it

• Action: ready to make a change

• Maintenance: consolidation

• Relapse or incorporation

Task: Investment prioirities

• Body (diet, exercise, rest, GP)

• Mind (new ideas, creativity, journal)

• Spirit (meaning to life, rituals)

• Family and friends (network nurture, human capital)

• Community (social capital)

• Work (place, peers, keeping up)

What are the barriers?

• Body

• Mind

• Spirit

• Family and friends

• Community

• Work

Assos Prof Kay Wilhelm kwilhelm@stvincents.com.au

Self Care

• Maintain confiding relationships to facilitate emotional expression, sharing ideas and experience

• Get your own GP

• Make one decision in each domain (for next week and the next year)

• Booklist available