WEEK 8

Question 1

Cold showers – do they work?

Answer 1

reduction of self-reported sick leave (total number of days sick) from work but not illness days (# of days felt ill)

• No differences in duration spent in cold (30s vs 60s vs 90s)
  => appears intensity rather than duration of symptoms is modulated by intervention
• No substantial difference on other measures of anxiety, quality of life
• Limitations: self-report/no blinding

Question 2

Cold water immersion

Answer 2

• Poor quality studies with suspect data
• One comparison (not randomized – based on choice) of 20 min cold-water
  immersion for 3 days in row (in 13.6C sea water) versus staying on campus showed benefits in mood and vigour in 64 uni students
  => but extremely poor study with lots of mistakes

Question 3

Heat therapy
(Sweat lodges, Turkish baths, Russian Banya, hot pools)

Answer 3

Suggested benefits:
* Heat can promote neurogenesis
* Heat releases endorphins
* Heat reduces inflammation
* Heat reduces amyloid accumulation
* May reduce significantly risk for dementia and improve depression

• Trials suggest 20 minutes in sauna at 800C is effective dose
• Or 30 minutes in a bath 1-2/week
• Caution: saunas not for everyone – e.g. not good for pregnancy, children, those with high BP or heart disease, some meds

Question 4

Song / Music

Answer 4

• Music evokes emotions
• Music associated with reduced stress and anxiety, enhanced mood and purpose in adults
• Also improves quality of life and coping for people with health conditions
• Enhance morale in adults
• Some small RCTs show it can lead to reduction in anxiety
• not a lot of research in the field

Question 5

Art

Answer 5

• Research suggests visits to art museum can improve well-being and quality of life, reduce stress
• Greater engagement with arts and humanities associated with living longer and lower mortality risks, lower levels of loneliness, higher subjective health
• Has become a prescription in some countries
  => One initiative in UK of “Arts on Prescription” associated with a 37% decrease in primary care doctor visits, 27% reduction in hospital admissions

Art is a harmonious experience in which people feel a range of positive states, such as flow, feeling moved, or getting chills, and view experience as enjoyable

A transformative experience in which people deeply engage with art and reflect on their pre-existing schemas and update them based upon their art engagement, typically encountering a range of positive and negative states throughout this process

Question 6

A conceptual model as to how art may contribute to flourishing

Answer 6

1. REFLECTION:
   - refers to engaging cognitive and emotional processes during arts and humanities activities that influence habits, values, or worldview
2. ACQUISITION:
   - refers to social and cognitive processes of arts and humanities engagement (e.g. mastery experiences) that lead to development of adaptive and enduring perspectives, habits, and skills (e.g. self-efficacy)
3. IMMERSION:
   - refers to being absorbed in experience and devoting attention to cognitive and emotional experiences during art engagement
4. SOCIALIZATION:
   - refers to how people develop new identities or reaffirm identities relevant to arts and humanities and influences how people interact with one another
5. EXPRESSION:
   - refers to process of externalizing thoughts and emotions, such as through discussion or via creation of art

Question 7

Pet therapy

Answer 7

• Pets constitute connection to nature, function in recreational and work activities, and provide companionship in homes
• Importance of pets founded on human–animal bond concept:
  => “mutually beneficial and dynamic relationship that exists between people and other animals that is influenced by behaviours that are essential to health and wellbeing of both”
• However, review showed variable effects and not wholly supportive of benefit of pets on mental health:
• While 17 of 54 studies had clear association of pet ownership & positive mental health, remaining 37 articles show mixed association, no association, or negative association
  => Lots of problems with methodology of research, huge variability, varied measures being used, hard to compare
• Other studies suggest dog ownership has positive effect on mental
  wellbeing in teens compared to no dog ownership; however, cat ownership
  had a negative effect compared to no cat ownership
• Psychological outcomes might be influenced by level of attachment with pet
• Other issues:
• Anthropomorphism of pets might have negative impact on animal’s welfare
• Untreated stress of people who turn to pets instead of human social supports and health professionals may cause pets to be more stressed

Question 8

Sleep architecture (phases)

Answer 8

1. Light sleep: stages 1 and 2
2. Deep sleep: stages 3 and 4 – slow wave sleep
   => Important for memory consolidation
   => Synapses are augmented
   => information learned moves from ST to LT storage
3. REM – when dreaming takes place, reduced activity of amygdala
   => Good for processing emotional memories

Question 9

Sleep and Mental Health
- Insomnia and depression

Answer 9

• People with Insomnia are:
• 9.82 times more likely to have depression than people without insomnia
• 17.35 times more likely to have anxiety than people not having insomnia
• Increased number of awakenings related to increased depression
• Non-depressed people with insomnia 2X risk to develop depression, compared to people with no sleep difficulties
  => i.e. insomnia predicted depression

Question 10

Sleep and Mental Health
- Improving sleep leads to… (according to research)

Answer 10

• Improving sleep led to:
• significant medium-sized effect for decreasing: composite mental health, depression, anxiety, and rumination
• significant small-to-medium sized effects on decrease in stress
• small significant effects on positive psychosis symptoms (symptoms reduce)
• Dose response relationship: greater improvements in sleep quality led to greater improvements in mental health

Question 11

Sleep and wellbeing
* Which is most important? Sleep, diet or exercise?

Answer 11

• SLEEP QUALITY IS THE STRONGEST PREDICTOR depressive symptoms and wellbeing,
  => followed by sleep quantity and physical activity
• Raw fruit and vegetable consumption predicted greater wellbeing (although effect
  lost after 8 servings) but not for depressive symptoms when controlling for covariates

Question 12

Non-drug options to manage sleep disturbance and insomnia?

Answer 12

• CBT
• Progressive relaxation therapy
• Sleep environment
  => Dark, cool, quiet
• Reset circadian rhythm
  => Exposure to morning light
  => Use red lenses 1-2 hours before sleep
• Ensure alarm clock out of sight
• Exercise
  => 50 minutes/day moderate intensity
  => Include strength training
• Warm bath
  => Aromatherapy oils: Lavender
• Stimulus control therapy
  => Keep a fixed wake time
  => Avoid napping
  => Sleep only when sleepy

Question 13

Improving your Sleep
- R-E-S-T (what does it stand for?)

Answer 13

1. Routine
2. Environment – comfortable, cool (200C), blackout blinds, no noise, no work in bedroom, get rid of cell phone
3. Stimulation Control: avoid caffeine, alcohol, no light-emitting devices
4. Thinking – use a worry book

• Tips: Aim for 7-9 hours
• More regular – better impact on your grades
• Put phone away at night

Question 14

Sleep and chronotype?

Answer 14

• We all differ in our chronotype – i.e. night owl or morning lark
  => Might be genetically determined
• Also, we have shorter ultradian cycles throughout day
• Rest-activity-cycle (BRAC) – about 90 minutes long (varies 8-120 minutes) – oscillate between alertness and sleepiness (comes in waves - look at image)
  => At peak – good time to tackle something demanding, at trough – take a break
  => Can find dips based on yawning – track it over a day
  => Can also use this to decide when to go to bed - go to bed when at a trough, not a peak

Question 15

Green spaces

Answer 15

• Being close to nature is associated with lower stress
• Green spaces associated with more physical activity and longevity as well as lower depression and anxiety scores
• Green prescriptions given to 456 NZ sedentary patients (regular walk in park) increased physical activity and wellbeing
• According to Harvard Grant Study, men who were “generative” (taking perspective beyond one’s own life) and engaged in physical activities (like gardening) in their 50s, more likely to be thriving in their 80s
• Gardening associated with reductions in depression, anxiety as well as increases in life satisfaction, quality of life, and sense of community
• Access to a private garden associated with better evaluative wellbeing

Question 16

History of nature being therapeutic

Answer 16

• 1812, physician Benjamin Rush observed patients did better if working in gardens (USA)
• Gardens and growing fruit and veg was norm until 1950s
• However, in recent times green spaces associated with houses is being neglected and we’re beginning to realise once again the importance of green space for out health
• Starting to realise outsourcing food to others hasn’t been great for our mental health

Question 17

Therapeutic horticulture (Study using NNBT vs CBT)
=> * RCT (84 participants with stress): 10 wks CBT versus 10 wks gardening programme (Nacadia®nature-based therapy (NNBT))

• What were the findings?

Answer 17

• Found that the NNBT (nature therapy) was to equivalent CBT for:
  => improvement in wellbeing
  => reduction of stress/burnout

This is good as CBT is known to work

Question 18

What is Nacadia® NBT?

Answer 18

• NNBT is a 10-week programme, participants meet 3 days/weekk for 3 hrs
• Consists of five components:
  1. Therapeutic conversations:
• individual conversations based on CBT and psychoeducation based on MBSR (mindfulness based stress reduction)

2. Awareness exercises:
   * individual and group physical and mental awareness exercises in accordance with MBSR and related to nature experiences, such as mindful walking in garden
3. Nature-based activities:
   * individual gardening activities, dependent on season: choice of activity is guided by what is comprehensible, manageable and meaningful for individual
   * Mindful awareness is integrated into activities: participants trained to notice non beneficial behavioural patterns that could lead to stress
4. Reflection and relaxation time:
   * individual time for reflection and relaxation in garden
5. Homework:
   * individual homework to practice different techniques and methods

Question 19

Green prison programmes
- findings?

Answer 19

• GreenHouse Program on Rikers Island:
• Reoffending rates (1 yr) from Rikers: 65%
• Reoffending after completing Horticulture Programme (gardening): 10-15%

Question 20

Recovery in hospitals with horticulture

Answer 20

• Majority of hospitals built 1950s onwards prioritized functionalism, infection control, and technology
  => Lacked daylight, greenery and fresh air
• Receiving flowers in hospital more likely to have a Duchenne smile relative to other comparable gifts
• Sunny rooms expedite recovery in hospital and lower infection rates
• Views of nature associated with speedier recovery, lower levels of stress, more positive mood, less pain meds used, discharged on average one day earlier
• Plants in rooms speed recovery from abdominal surgery
• Abstract art LESS calming than pictures of natural world

=> Flowering plants are an inexpensive and effective medicine for patients recovering from surgery

Question 21

Plants in offices

Answer 21

• Green plants and green walls have positive effects on stress reduction, positive emotions, attention restoration, increases in comfort through improved air quality, humidity, reduced sound levels, and attractiveness
• Flowers in offices induce more relaxing feelings compared with controls not exposed to flowers

Question 22

Bringing Nature to the City

Answer 22

• By 2050, 70% will live in cities, spend 93% of our time in an indoor environment or sitting in an enclosed vehicle
• Busy streets require us to process a lot of sensory and visual information and disrupt ability to focus and drain energy
• Depression is 40% higher and anxiety 20% higher in urban areas relative to rural areas
• Just 20 minutes in nature restores mental energy and strengthens brain’s ability to focus
• Proximity to green space reduces aggression and anxiety, improves mood and reduces mental fatigue
• Introducing green spaces around buildings could reduce offending by 7% and help residents feel more hopeful and less helpless
• Having 10 more trees in a city block, on average, improves health perception in ways comparable to increase in annual income of $10,000 and moving to neighbourhood with $10,000 higher median income or being 7 yrs younger

Question 23

Theories on why/how we benefit from nature:

Answer 23

• Biophilia hypothesis suggests human ancestors depended on connecting with nature to survive
  => evolutionary pressures led to human preference for a connection with nature
• Stress-reduction theory: proposes past exposures to unthreatening natural environments contributed to survival via stress-reducing physiological responses
• Other perspectives consider roles of natural environment in addressing existential anxieties, such as meaning in life, isolation, freedom, and death
• Eco-existential positive psychology: describes how restorative experiences with nature might contribute to sense of identity, multiple forms of happiness, meaning, social connectedness, freedom, and awareness of one’s mortality
• Bacteria in soil, such as M. vaccae, may boost serotonin in brain

Question 24

Forest Bathing: Hang out in nature

Answer 24

Leads to reduction in stress, depression and anxiety and improved quality of life relative to other treatment

• Just conducting CBT in a forest seems to make a difference
  => 61% reduction in symptoms of depression versus 21% for CBT group conducted in hospital

Question 25

Green spaces and mortality

Answer 25

• Significant inverse relationship between increase in surrounding
  greenness [normalised difference vegetation index (NDVI)] and risk of all-cause mortality
• Inverse association between surrounding greenness and all-cause mortality
• Interventions to increase and manage green spaces should be considered as a strategic public health intervention

Question 26

Benefits of green environments not just about social class
* Study of inner Chicago where buildings differed whether surrounded by trees or concreted over – people randomly assigned to live in either

Answer 26

Tree and grass cover systematically linked to social ecosystem indicators:
* stronger ties among neighbours
* greater sense of safety and adjustment
* more supervision of children in outdoor spaces
* healthier patterns of children’s play
* more use of neighbourhood common spaces
* fewer incivilities
* fewer property crimes
* fewer violent crimes

• Barren, treeless spaces often become “no man’s lands:” discourage resident interaction and invite crime
• Presence of trees and well-maintained grass transform these no man’s lands into pleasant, welcoming, well-used spaces

Question 27

Blue Spaces (Natural spaces like oceans and rivers Artificial spaces, like ponds and fountains)

Answer 27

• Very little research
• Living close to or regularly visiting blue spaces associated with higher levels of physical activity and better mental health
• Those living near blue spaces more likely to exercise more than 300 minutes a week
• People who live within 5km of a coast report better mental health
• Children who spent more time at beach throughout year had fewer emotional problems and higher levels of prosocial behaviour
• But some studies show no effect

Question 28

Where should you go walking? Natural or urban?

Answer 28

• Mood improved in natural and urban environments
• Salivary cortisol reduced in natural and urban environments
• Restorative experience higher in natural environments
• Greater cognitive benefits of natural environments were seen 30 min after leaving the environment (natural better for longer term benefits)

Question 29

Architecture
- Promoting wellbeing in built environments

Answer 29

• Given humans spend 80% of time in built spaces, an architect has a key role in protecting health, perhaps more than other health professionals
• But very little research on this topic
• Key physical factors (e.g., light, temperature, sound, and air quality) of indoor environmental quality strongly influence occupant perception of built spaces as well as positive experiences of comfort
• variable temperatures reduced symptoms of drowsiness and difficulty in concentration
• importance of variable luminous environments on our circadian health
• Consider role of acoustic design in wellbeing in terms of reducing noise and improving social interactions
• Attending to all of these factors have higher productivity from workers and less sickness absence

Question 30

Change your environment (placement of food within our environment)

Answer 30

• Consumed 48% more candies when on desk compared with in drawer
• Consumed 25% fewer candies when in drawer
• Visibility and convenience both matter!

Question 31

Effect of distraction

Answer 31

• If we are focused on TV or our electronic devices when eating, we eat more
• If social engaged, our brains are more tuned in to satiety signals

Question 32

Healthy Location Index
- what is it?

Answer 32

An index that looks at the accessibility of locations to:
- Health-constraining features
- Health-promoting features

Question 33

Effects of deprived areas on health

Answer 33

• Most deprived areas of New Zealand often have most environmental ‘bads’ (fast food outlets) and less access to environmental ‘goods’ (green spaces, physical activity outlets etc)
• Mental health problems higher in health-constraining environments
• These represent upstream factors that contribute to wellbeing and are modifiable with good urban planning

Question 34

Does spending time in beautiful places boost happiness?

Answer 34

• Individuals happier in more scenic locations
• Relationship holds not only in natural environments, but in built-up areas too, even after controlling for presence of green space
• According to Attention Restoration Theory:
• scenes requiring less demand on attention allow us to become less fatigued, better
  able to concentrate, and thus perhaps even less irritable – can hold for urban settings too
• Aesthetics of environments policymakers choose to build or demolish may have consequences for our everyday wellbeing