Further recreational activities include art and other aesthetic pleasures, which have long been employed for self-healing. For example, the great 19th-century philosopher John Stuart Mill— one of history’s outstanding intellectual prodigies—spent his childhood force-feeding himself with facts. However, when at 20 he fell into a severe depression, he turned to the arts—music, painting, and especially poetry—for self-therapy, and these, his biographer reported, were what “saved him” . Many studies suggest that enjoyable recreational activities, and the positive emotions that ensue, foster multiple psychological and physical benefits . However, some studies of recreation include and conflate additional healthy lifestyle factors such as exercise, relaxation, and time in nature, and there are few clinical guidelines. Mental health professionals will therefore need to use their clinical skills to assess and support individual patients’ interests. “The bottom line message is that we should work to cultivate positive emotions in ourselves and in those around us not just as end states in themselves, but also as a means of achieving psychological growth and improved psychological and physical health over time” .Chronic stressors can exact a major toll across multiple organ systems and levels. This toll extends from psychological to physiological to chemical to genomic expression . Even though stress is universal,vertical growing racks few people are trained in managing it. In addition, humans now face an array of novel stressors for which there are no evolutionary or historical precedents.
Many people therefore respond unskillfully or even self-destruc-tively, aided and abetted by pervasive unhealthy influences such as advertising, media role models, and novel psychoactive drugs . Yet many skillful strategies for stress management are now available, ranging from lifestyle changes to psychotherapy to self-management skills. Beneficial TLCs include almost all those discussed in this article— especially exercise, recreation, relationships, and religious or spiritual involvement—and specific self-management skills can both complement and foster these TLCs.Specific stress management skills include somatic, psychological, and contemplative approaches. Somatic skills span both ancient Oriental and contemporary Western techniques. The Chinese mindful movement practices of tai chi and qui gong are increasingly popular in the West, and research studies suggest they are associated with both physical and psychological benefits . A review of 15 randomized controlled trials of tai chi’s effects on psychosocial well-being found significant benefits for the treatment of anxiety and depression but also noted the mixed quality of the trials . Western self-management skills include mental approaches such as self-hypnosis and guided imagery as well as somatic approaches, especially muscle relaxation therapies that center on systematically tightening and relaxing major muscle groups. By doing this, patients learn to identify and release muscle tension and eventually to self-regulate both muscle and psychological tensions. Muscle relaxation skills are widely used for the treatment of anxiety disorders, including panic and generalized anxiety disorders, and meta-analyses reveal medium to large effect sizes . Contemplative skills such as meditation and yoga are now practiced by millions of people in the United States and by hundreds of millions worldwide . Concomitantly, an explosion of meditation research has demonstrated a wider array of effects—psychological, therapeutic, neural, physiological, biochemical, and chromosomal—than are associated with any other psychotherapy . Considerable research suggests that meditation can ameliorate a wide array of psychological and psychosomatic disorders in both adults and children .
Multiple studies, including meta-analyses, show that meditation can reduce stress measures in both clinical and normal populations . Partially responsive psychosomatic disorders include, for example, cardiovascular hypertension and hypercholesterolemia, hormonal disorders such as primary dysmenorrhea and Type 2 diabetes, asthma, and chronic pain . Responsive psychological difficulties include, among others, insomnia, anxiety, depressive, eating, and borderline personality disorders . Meditation can also be beneficial when combined with other therapies. The best known combinations are dialectical behavior therapy , mindfulness-based stress reduction, and mindfulness-based cognitive therapy. A meta-analysis of mindfulness-based therapies found large effect sizes for anxiety and depressive symptoms of 0.95 and 0.97, respectively, and therapeutic gains were maintained at follow-up . It is now clear that meditation, either alone or in combination with other therapies, can be beneficial for both normal and multiple clinical populations. However, it is less clear how different meditation practices compare or how meditation compares with other therapies and self-regulation strategies such as relaxation, feedback, and self-hypnosis . Yoga may also be helpful for stress and mood disorders. However, studies on yoga are fewer, and reviews have drawn cautious conclusions . In addition to its benefits for relaxation and stress management, meditation may also enhance measures of psychological capacities, health, and maturity in both patients and nonpatients . Particularly important to health care professionals are findings that meditation can enhance valued caregiver qualities such as empathy, sensitivity, emotional stability, and psychological maturity while reducing distress and burnout . On the cognitive side, studies suggest that meditation can enhance some measures of cognition and may reduce age-related cognitive losses and corresponding brain shrinkage.
The universality of stress, as well as the multiple benefits of both lifestyle changes and self-regulation skills for managing stress, suggests that these TLCs and self-regulation skills deserve to be central components of health professionals’ training, personal and professional practice, and public outreach.Religious and spiritual concerns are vitally important to most people and most patients. Some 90% of the world’s population engages in religious or spiritual practices; these practices are a major means of coping with stress and illness; and most patients say that they would welcome their health professionals’ inquiring about religious issues . Yet few health professionals do. This lack of attention may be unfortunate given the prevalence and importance of religious and spiritual practices, their many influences on lifestyle and health, their impact on therapeutic relationships and effectiveness, and the deep existential issues they open . Considerable research suggests a complex but usually beneficial relationship between religious involvement and mental health. The most massive review to date found statistically significant positive associations in 476 of 724 quantitative studies . In general, religious or spiritual involvement is most likely to be beneficial when it centers on themes such as love and forgiveness and is likely to be less helpful or even harmful to mental health when themes of punishment and guilt predominate. Benefits span an array of health measures. Mental health benefits include enhanced psychological, relational, and marital well-being, as well as reduced rates of disorders such as anxiety, depression, substance abuse, and suicide. For physical health,vertical farming in shipping containers religious involvement seems beneficially related to both specific disorders such as hypertension and to nonspecific mortality rates . Strikingly, those who attend religious services at least weekly tend to live approximately seven years longer than those who do not, even when factors such as baseline health and health behaviors are statistically controlled . Important mediating and contributory factors likely include service to others and especially social support. Contemplative practices such as meditation offer further psychological, somatic, and spiritual benefits .It is important for mental health professionals to recognize that there are multiple levels of religious development. These levels range from preconventional to conventional to postconventionaland are associated with extremely different kinds of religious faith, practice, behavior, and institutions . For example, consider the developmental stages of religious faith. At the preconventional level, mythic-literal faith involves an unreflective, literal acceptance of culturally provided beliefs. At the synthetic-conventional level, people begin to create their own individual, but still largely unreflective, synthesis of diverse conventional beliefs.
At later post conventional stages, exemplified by conjunctive and universalizing faith, individuals critically reflect on conventional assumptions, open themselves to multiple perspectives, confront paradoxes, and extend their care and concern to all peoples . When developmental differences go unrecognized, problems ensue. For example, the views of one level are taken as normative, and those at this level tend to assume that people at other levels are mistaken, misguided, malevolent, or disturbed . Many contemporary religious and cultural conflicts appear to reflect these kinds of cross-level misunderstandings . For example, it makes clear that religions are not only culturally diverse but also developmentally diverse, and that mental health professionals need to be sensitive to both kinds of diversity. Religion can be an expression of immaturity, conventional maturity, and post conventional maturity, and of corresponding motives and concerns ranging from egocentric to ethnocentric to world centric . Interpretations that view religion as, for example, always regressive or always transcendental invariably overlook this developmental perspective. Examples of reductionistic interpretations that view religion as necessarily regressive or pathological include the writings of the so called “neoatheists,” such as the recent extremely popular books The God Delusion , The End of Faith , and God Is Not Great , all of which are ignorant of developmental research. Unfortunately, the widespread failure to recognize developmental differences—in faith, morality, values, ego, worldview, and more— and their far-reaching implications for religion and multiple other areas of life seems a significant factor underlying many contemporary cultural conflicts . Of course, religious behavior can sometimes be regressive or pathological. However, religious behavior can also both express and foster healthy, mature, and even exceptionally mature development. In fact, a classic goal of spiritual practices such as meditation is to foster post conventional development through, for example, bhavanain Buddhism and lien-hsinin Taoism . Contemporary research and meta-analysis are supportive, because meditators tend to score higher on measures of ego, moral, and cognitive development as well as self-actualization, coping skills and defenses, and states and stages of consciousness . Ideally, religious and spiritual traditions offer both legitimacyas well as authenticity. Given the significance of religious and spiritual involvement, it seems important for therapists to be familiar with developmental and other key issues and, where appropriate, to inquire about and support healthy involvement in this domain.From ancient times, service and contribution to others have been regarded as virtues that can benefit both giver and receiver . The world’s major spiritual traditions emphasize that, when viewed correctly, service is not necessarily a sacrifice but rather can foster qualities that serve the giver—such as happiness, mental health, and spiritual maturity. Altruism is said to reduce unhealthy mental qualities such as greed, jealousy, and egocentricity while enhancing healthy qualities such as love, joy, and generosity . The benefits of service are also said to extend to healing, such that healing oneself and others can be intimately linked. Multiple myths and healing traditions describe wounded healers, people who by virtue of their own illness learn to heal others and may thereby be healed themselves. In our own time, both theory and research point to correlations between altruism and measures of psychological and physical health. Multiple studies, including those that control for prior health factors, suggest that people who volunteer more are psychologically happier and healthier, are physically healthier, and may even live longer . The so-called “paradox of happiness” is that spending one’s time and resources on others can make one happier . Altruists of all ages may experience a “helpers’ high” . Even required community service for adolescents seems to effect long-term positive psychological changes, and even mandated monetary donations can make college students happier than spending the money on themselves . Erik Erikson famously suggested that “generativity” may be a hallmark of successful maturation. Moreover, altruism has a positive social contagion or multiplier effect. For example, cooperative behaviors cascade through social networks to induce further cooperation in others , and at the community level, service is a key contributor to social capital . In summary, considerable research shows positive relationships between altruistic behavior and multiple measures of psychological, physical, and social well-being. However, there are important qualifiers. Major exceptions include the caretaker burnout experienced by overwhelmed family members caring for a demented spouse or parent. Furthermore, the kind of motivation powering the prosocial behavior affects outcome. Whereas service motivated by pleasure in helping is associated with multiple positive measures , this association may not hold when service is driven by a sense of internal pressure, duty, and obligation . Psychotherapists repeatedly rediscover the healing potentials of altruistic behavior for both their patients and themselves. Alfred Adler emphasized the benefits of “social interest,” and helping other group members contributes to the effectiveness of group therapy and support groups such as Alcoholics Anonymous . Likewise, therapists often report that helping their patients can enhance their own well-being .