Mindsets, Resilience &Mental Capital:

Utilising experimental and applied clinical psychology to

enhance wellbeingProfessor Ed WatkinsProfessor Ed Watkins

Mental capitalMental capitalThis encompasses a person’s cognitive and emotional resources. It includes their cognitive ability, how flexible and efficient they are at learning, and their “emotional intelligence”, such as their social skills and resilience in the face of stress. It therefore conditions how well an individual is able to contribute effectively to society, and also to experience a high personal quality of life. The idea of “capital” naturally sparks association with ideas of financial capital and it is both challenging and natural to think of the mind in this way.

Mental wellbeingMental wellbeingThis is a dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society.

From Foresight Mental Capital & Wellbeing Project (2008), Government Office for Science, Watkins expert reviewer

Mood Disorders: a public health research challenge

•Highly prevalent, recurrent, & disabling

•The vast majority of depression goes unrecognised and untreated

•Treatment of choice is anti-depressant medication BUT cost effective evidence based psychological approaches are available •for earlier and longer term benefits

Depression & Anxiety very common• c. 1 in 10 people suffer at any point in time, 16% over lifetime• High impact in workplace (at syndromal and subsyndromal levels):

– 420k employees in Britain in 2006 reported depression, anxiety, stress at work at levels that were making them ill (Health & Safety Executive, 2007)

– 22.3% people in paid employment mental health problem (Singleton et al., 2001)

– Lost productivity from absenteeism & presenteeism, early retirement, sickness leave

– In UK, depression & anxiety estimated to cost £17bn in lost output and direct health care costs p.a., with £9bn lost through benefit payments & lost tax receipts.(Centre for Economic Performance, 2006)

© MDC 2012

Depression and disability pension awardN

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Severity of symptoms

N=141

HR=10.6

95% CI8.3-15.5

PAF=0.01

N=668

HR=3.8

95% CI2.8 – 5.0

PAF=0.03

N=1827

HR=2.3

95% CI1.8 – 2.9

PAF=0.07

N=4380

HR=1.3

95% CI1.1 – 1.7

PAF=0.07

”Sub-clinical”

Mild Moderate

Severe

Knudsen et al. J Psychosomatic Research 2010

A clinical psychology approach• Hypothesis: knowledge, technology & methods developed

in experimental and applied clinical psychology have relevance to determining means to leverage such a shift, both by reducing languishing/mental disorder and increasing flourishing.

• Ideally, use to understand causal mechanisms and then identify interventions to simultaneously: – reduce vulnerability/symptoms– promote mental capital & wellbeing

A clinical psychology approach• Experimental psychopathology (Translation I)→ identify

and manipulate putative mechanisms underpinning pathology to determine causality (e.g., cognitive bias modification)

• Intervention process-outcome research (e.g., randomized controlled trials) → develop & evaluate efficacy of interventions to reduce symptoms

• Health Services Research (Translation II) → develop & evaluate means to disseminate and deliver effective, cost-effective, widely available interventions (into the NHS)

A clinical psychology approach• Experimental psycho-eudaemon-ology (Translation I)→ identify

and manipulate putative mechanisms underpinning happiness and wellbeing to determine causality (e.g., cognitive bias modification)

• Intervention process-outcome research (e.g., randomized controlled trials) → develop & evaluate efficacy of interventions to improve mental capital and well-being

• Health Services Research (Translation II) → develop & evaluate means to disseminate and deliver effective, cost-effective, widely available well-being promotions (? Into culture, workplace, schools, media?)

Shifting Mind-set• Improved identification, prevention, treatment of anxiety &

depression critical to enable normal function & enhance performance• Enhancing more helpful mind-sets = means to reduce this

vulnerability, strengthen resilience, promote well-being & productivity

• Approach: Identifying helpful versus unhelpful mind-sets & training helpful mind-sets

• Powerful, innovative, acceptable (non-stigmatising) means to enhance mental & emotional resilience & improve performance (“learning good mental habits”)

© ERW 2012

Worry & Rumination – core mechanism

• Tendency to repetitively dwell on:• meanings and implications of feelings,

past mistakes, difficulties, and perceived inadequacies (“Why me?”)

• or about what could go wrong in the future (“What if?”).

• Thinking style characteristic of individuals prone to anxiety & depression that contributes to onset and maintenance of problems

© MDC 2012

Why do I feel so bad?

Why did this happen to me?

Why can’t I handle things better?

What does this mean about me?

What if it goes wrong?

Imagine catastrophicconsequences

Anxious, Depressed, Exhausted, Tearful, Poor Concentration, Burnout

But - Brief worry/rumination: a normal response to loss, threat, mistake

Can be helpful: problem-solving, learning, coming to terms (Watkins, 2008)•But unhelpful/pathological if •(1) it becomes a habit•(2) it involves ineffective mind-set

© ERW 2012

© ERW 2012

Why do I feel so bad?

Why did this happen to me?

Why can’t I handle things better?

What does this mean about me?

What if it goes wrong?

Imagine catastrophicconsequences

Exacerbates negative mood & cognition, impairs concentration, motivation, pleasure in experiments Predicts onset, duration,

severity of depression, anxiety, PTSD, substance abuse, eating disorders in prospective studies

Habitual Rumination and Worry (Watkins, 2008)

© ERW 2012

How can I fix this?

What can I learn from this?

What are the positive benefits of this?

What can I do next?

What is important to me now?

How did this happen?

Reduces negative mood & improves planning & problem-solving in experiments

Predicts recovery from upsetting and traumatic events and from depression in some prospective studies

Positive consequences of RT (Watkins, 2008)

Mind-sets in worry/rumination (Watkins, 2008)

© ERW 2012

• Unhelpful mind-set, characterised by an abstract focus on the meanings and implications of what happened/could happen (“Why?”; “What if”)

• Leading to greater negative emotional response, passivity, poor problem-solving.

• Helpful mind-set, characterised by a concrete approach focused on the specific details of the situation and the means by which to proceed (“How?”)

• Leading to a more action-oriented and resilient response to difficulties & better problem-solving

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Depression status

no questionwhy questionhow question

Watkins & Baracaia (2002): Style of processing influences problem-solving

Participants imagine 30 emotional scenarios in either abstract or concrete mindset as training before a stressful anagram test (Watkins, Moberly & Moulds, 2008, Emotion)

Abstract Mindset: I would like you to think about why it happened, and to analyse the causes, meanings and implications of this event.’

Concrete Mindset: I would like you to focus on how it happened, and to imagine in your mind as vividly and as concretely as possible a “movie” of how this event unfolded.’

© ERW 2012

Interventions for worry/ruminationBuilding on this work, we have developed and validated in clinical trials, two effective approaches to changing habits & mind-sets:•Cognitive Training - repeated practice at mental exercises (Watkins et al., 2009, 2012)

•Rumination-focused Cognitive Behaviour Therapy (CBT) (Watkins et al., 2007,2011).

Cognitive Training• Repeatedly applied to mildly negative events• Practice daily using CD; use as “First Aid exercise” to warning signs,

include absorption exercise• Designed to ground in the moment, keep in perspective• Most effective when practised until it becomes a habit• Key elements via direct instructions, guiding questions:

– (a) focusing on details in the moment (what you can see, hear, feel);

– (b) noticing what is specific and distinctive about the context of the event; – (c) noticing the process of how events and behaviors unfold – (d) generating detailed step-by-step plans of how to proceed from

here.

© ERW 2012

Watkins et al., 2011 Psych Med. Cognitive Training

121 Patients with major depression recruited GPsGuided self-help: 1 face-to-face session (90 mins), 3 x 30-min phone sessions over 6 weeks, CD exercisesRandom allocation to Concreteness Training (CT), Relaxation Training (RT) or Treatment-as-Usual (TAU).

severe

moderate

Shifting mind-set in RFCBT

• Coach experiential & visual imagery exercises• A) Focus on recreating experiences of being in a

concrete process-focused mind-set – absorbed, caught up in the task, “flow”, “in the zone”, peak experiences

• Often accompanies enhanced performance (“super-slow-motion effect”)

• B) Encouraging, supportive, non-judgemental mind-set to reduce self-criticism and negative evaluations (negative element of perfectionism)

© ERW 2012

© ERW 2012

Real-world Implementation• Greatest impact on well-being and reduction of

disability comes from:• Targeting subsyndromal levels of depression as biggest

effect on productivity (Knudsen et al; 2010) & easiest to treat (Judd et al., 1997)

• Outside the healthcare system – i.e., in everyday life – like the workplace (Marks et al., 2005)

• Potential for dissemination in workplace via engaging brief exercises for maximum impact

From Foresight Mental Capital & Wellbeing Project (2008), Government Office for Science