Psychologists from Macquarie University’s mental health service, MindSpot say small things make a big difference

We all know that it is often the small things we do as part of our daily routine, like going for a walk or talking to a friend, that support maintain good mental health.

MindSpot Executive Director and Clinical Psychologist Professor Nick Titov says we all have certain habits and activities that serve as the foundation stones for our mental health.

“When we don’t do them, we become more prone to symptoms of depression and anxiety, and if we’re already feeling flat or down, we become vulnerable to feeling worse,” he says.

“Unfortunately, these are also the first things that slip when we are stressed or feeling overwhelmed.
There are simple things we can all do … and they appear consistent for people no matter their age, sex, marital status, or where they lived.

“It’s easy to forget about them or underestimate them, but they’re incredibly important to our general wellbeing.”
Titov and his team set out to identify which daily behaviours were the most important in keeping us mentally well.

Starting with a list of 500 things that evidence and anecdote have linked to good mental health, they developed the Things You Do Questionnaire, which asked people what they did to stay mentally well and how often they were doing those things on a weekly basis, then compared this to their responses on clinical measures of depression and anxiety.

They used the questionnaire in two studies, each with 3000 participants. Using data from the first study, they reduced the number of questions by a third for the second cohort.

“The results across the two cohorts were the same,” Titov says.

“They indicated that there are simple things we can all do each day to promote our own mental health, and they appear consistent for people no matter their age, sex, marital status, or where they lived.

“We have now tested these findings with more than 10,000 users at MindSpot and have confirmed the results. Our colleagues in Canada at the Online Therapy Unit have also used the questionnaire in a study of 1000 people, and their results were the same.

“More research is required to test this in other countries, but we believe that these five areas could be universal, and our colleagues overseas agree.”

The role of meaning, fun and healthy thinking
The results showed there were five key clusters of behaviours that acted as “psychological anchors”, with a clear order of importance.

The simple things: Doing something you find enjoyable, and spending time with positive people, are among the behaviours that contribute to good mental health.

Starting from most important, they are:
1. Meaningful activity: doing something satisfying, something you find enjoyable, or something you believe in.
2. Healthy thinking: treating yourself with respect, stopping yourself from thinking unhelpful or unrealistic thoughts, allowing yourself to be less than perfect, and recognising that things go wrong.

3. Having goals and making plans: setting realistic and achievable goals, doing something to help you achieve them, making a plan and sticking to it.

4. Healthy routines: going to bed and waking up at regular times, keeping a daily routine, preparing and eating a healthy meal, going for a walk every day or two.

5. Social connections: spending time with positive people, having a meaningful conversation, chatting about your day with a friend or family member, whether that’s in person, on the phone or online.

Titov says they seem so simple and obvious when you look at them.

“Most people recognise that these are the things they tend to do regularly when they are feeling mentally healthy, but they are also the things we tend to stop doing when we feel distressed,” he says.

“The two most important clusters are doing meaningful and fun activities and practising healthy thinking, and these are exactly the things that people often stop doing when they start to feel distressed.

“It can then become a downward spiral. The less satisfaction people have in their lives, the worse they tend to feel about themselves.

“When we see people at MindSpot, we ask them if they’re treating themselves the way they would treat others. When they’re feeling down, the answer is often no. People recognise that lack of self respect is a troubling sign, but changing it takes time and effort.”

The importance of goals
The third cluster, having goals, comes in play because many people who report feeling stressed, anxious or depressed are thinking about the past or their present worries.

“The more people think about the future by planning what they are going to do in coming days, weeks or months, the more likely they are to solve their current problems, or accept the things they can’t change, rather than dwell on them,” Titov says.

People who do something that brings them joy or satisfaction at least three times a week are likely to have better mental health than those who don’t.

“When we have a plan and we tick something off it, our brains release a range of chemicals that reinforce what we’ve just done and that makes us feel good. It provides a lift.

“When people are struggling, they’re not getting that positive reinforcement and they can find themselves in a downwards spiral.

“Like all of the behaviours we identified, you don’t have to have a big goal or a complex plan to get that reinforcement: just planning dinner can seem overwhelming if you’re feeling down, so if you can do that, you’re moving forward.”

Small steps
Surprisingly, the results of the two studies found there wasn’t a big gap between people who had quite severe symptoms of anxiety or depression and those with healthy mood levels.

“There’s a definite threshold with these behaviours, and when we fall below it, that contributes to feelings of depression,” Titov says.

“In some cases, people just need to do the things that make them feel better once or twice more a week and they can get past that tipping point.

“For example, people who do something that brings them joy or satisfaction at least three times a week are likely to have better mental health than those who don’t, and three or four social interactions a week is enough to support mental health for most of us.”

Study co-author and lead researcher on the Things You Do Project Madelyne Bisby, said many everyday actions were associated with good mental health.

“Many of us know the things we should be doing every day to support our physical health, like keeping active and brushing our teeth,” Bisby says. “But what about our mental health? There are also things we can be doing every day to keep mentally well.

“Sometimes it can be hard to know where to start, especially if you’re experiencing low mood. But we encourage people to start somewhere, no matter how small the steps are. The more we do, the easier it is to keep going.”
Sharing the results
MindSpot is currently developing a set of free resources that will be made available on its website later this year to share the learnings from the project more widely.

Habit reset: Professor Nick Titov (pictured) says making everyone feel just 10 to 15 per cent better “would be a great outcome”.

Along with the Things You Do questionnaire and a series of ‘life hacks’, they are planning an SMS prompt service to remind people to do the things that make them feel better.
“It’s about resetting people’s habits,” Titov says.

“Our aim is to help the community reach a point where we all know the things we can do every week to stay mentally healthy, just the same as we know we need to brush our teeth.

“This won’t ‘fix’ or cure mental health problems, but if it can just make everyone feel 10 to 15 per cent better, then that would be a great outcome.”

Nick Titov is a Professor of Psychology at Macquarie University and Executive Director of MindSpot
Dr Madelyne Bisby is a Postdoctoral Research Fellow and Clinical Psychologist at the eCentreClinic, in the School of Psychological Sciences.