The secret of the care of the patient is in caring for the patient. - Francis Peabody
So it was the second session of the group yesterday. I blogged about the first session last week. Sadly a couple of people couldn't get to this second meeting - due to a pre-planned holiday and to an unexpected crisis. It's quite common for participants to miss one or two evenings across a twelve session course like this, but I want to be careful when people miss such an early meeting. It's important that they don't lose their way and get left behind. They will get copies of the handouts and the Autogenic CD, but I also make a note to contact them myself.
As I've highlighted already, this course is broad. We're going to be looking at health behaviours (exercise, diet, smoking, alcohol), relaxation/meditation skills (applied relaxation, mindfulness, visualisation, compassion), relationships (emotional intelligence, social networks), and wellbeing (positive emotions, self-determination, happiness). Over the first four sessions, our focus is primarily on exercise, diet, and relaxation/mindfulness.
We started the session with the Autogenic Training practice they had working at over the previous few days. Everyone had kept a practice record for the last week. I collected these records and we then went round giving everyone in turn a chance to say a bit about how their Autogenic practice had been going - and to troubleshoot any emerging difficulties. As each person reported in, I had their weekly practice record in front of me. This helps a lot in being able to respond helpfully. Additionally they had kept a note of any physical exercise they had done during the week and had estimated how many "moderate activity" minutes of exercise had been involved. See the basic 2 page "Be active your way: a fact sheet for adults" US guideline handout I gave them last week for more details on this.
I then went on to project the first half dozen Powerpoint slides for this week's session. Participants also receive miniatures of these slides as one of their handout sheets. I introduced them to the research behind my blog post "Would you like to be 14 years younger - it's largely a matter of choice!". I highlighted that this research on mortality - showing a quartering of the death rate over 11 year follow-up in those with healthy rather than unhealthy lifestyles - is paralleled by similar research on psychological state. So the post "New research shows diet's importance for preventing depression" links with a couple of papers published at the end of 2009, while more recently still Jacka et al have shown a diet-anxiety link too. The associated, freely-viewable American Journal of Psychiatry editorial "Nutrition and psychiatry" discusses all these findings. Exciting times! And great that the health behaviour advice we should be following to optimise our physical health & mortality risk, is increasingly being shown to be the same advice we should be following for our psychological health as well.
A caution in running this "Life skills" course is not wanting to overwhelm people with too many behavioural change demands at once. However some course participants will already be following most or all the health advice on exercise and diet - and I don't want these group members to get bored because they're not being asked to make any changes! There's a challenge for me here as course facilitator.
Anyway, my compromise at the moment is to simply begin dietary change by starting to get us all to chart our daily fruit & vegetable intake this coming week. Research suggests this is one of the more important areas of food-mood connection. I handed out the British Dietetic Association's leaflet "Fruit & vegetables - enjoy 5 a day!". Although I know a fair amount about healthy eating - and my own diet is good - I would be pushed to say just how much cucumber or cabbage or blackberries I would need to eat to qualify as having consumed a "portion". It will be interesting to chart this. And there are many helpful internet resources too; see for example a variety of websites that I have recommended.
I also took a further step forward with our focus on exercise. They had been simply charting "moderate activity" exercise minutes last week. This week I'm asking them to begin setting themselves exercise targets. At minimum, I would hope for everyone to be getting 150 "moderate activity" minutes over the week - pushing up towards 300 minutes. Some participants are already easily achieving this, while others struggle to reach this level. I talked about the value of making exercise flexible, accessible and enjoyable. I warned against being totally committed to just one form of exercise e.g. just running, or just cycling, etc. My concern is that it may make participants too vulnerable to injury. Having a choice of more than one form of exercise means that even if, for example I can't run due to a strain, I may still be able to use a bicycle or swim.
For those who got a good deal of their weekly exercise through walking, I introduced the idea of walking intensity and pointed out that - to qualify for their overall weekly exercise total - they needed to walk in chunks of at least 10 minutes, at least at intensity 2 to 3 on the UK scale I handed out. I also encouraged them to consider using pedometers. See an earlier post on this site - "Exercise 4: pedometers can help us walk more". I gave them details of this post in the handout on pedometers and, for those who wanted, lent them a pedometer to try out over the next week.
I now asked them to reflect on the course so far and consider what they would like their priorities to be over the coming week. I gave them a form to fill in about all this - a "Reflection & intentions" sheet. They then paired up to share what had emerged for them, and to explain their next week's intentions to their partner. I explained that I would get them to get back in the same pairs next week to check in on how their intentions had gone. I would very much like to encourage this kind of group support to become very helpful for them over these coming weeks.
Finally we looked at the next Autogenic Training exercise they would be moving to this week - see the second half dozen slides I showed them. I talked about "Dealing with mental chatter". Fuller details of what this involves, with handouts and downloadable recordings, are available on this site at "Autogenic Training, session two".
Good. This session felt less potentially over-full of information than last week's to me. Having this broad focus on three areas - relaxation/meditation, exercise, and diet - seems to be working OK.
See "Lifeskills ... session 3" for what we cover next week.