Five basic habits may be key to good mental health

Professor Nick Titoff’s professional goal is to make himself unnecessary. As a professor of psychology at Macquarie University and director of the university’s digital mental health service, MindSpot, he wants to help more people with mild to moderate anxiety and depression understand what they can do every day to look after their mental health.

As part of this mission, Professor Titov and his team developed “The Big 5,” an evidence-based program that encourages five broad types of activities that, when undertaken regularly, are strongly associated with good mental health.

While the Big Five activities vary from person to person, a large cohort study conducted in Australia and Canada found that people who have healthy thinking patterns, plan for the future, engage in meaningful activities, have healthy habits, and socialize with friends and family at least four times a week are mentally healthier than those who don’t.

Healthy thinking is one of the biggest predictors of good mental health. Healthy thinking includes thinking realistically about yourself, the world, and the future, and treating yourself with respect, especially in difficult situations.

Healthy habits include cooking and eating healthy meals, having a regular bedtime, exercising regularly, etc. Meaningful activities give us a sense of accomplishment, satisfaction, and joy.

The results now include data from over 20,000 people and show a consistent pattern: doing more of the Big Five makes you feel better, and doing less of them makes you feel worse.

To learn more about the benefits of the Big Five, Professor Titov designed a study in which he asked participants to systematically reduce and then resume these activities under supervision, allowing him and his team to observe the effects on symptoms of depression and anxiety. The findings were published in the journal Neuropsychiatry. Behavioral Research and Therapy.

Why ask people to stop?

With physical illnesses, researchers often understand the triggers of illness or the trajectory of deterioration, gaining insight into how treatments work, but this is not the case in psychology.

“Despite billions of dollars being spent on mental health interventions around the world, psychology has not built strong models that predict not only recovery but also deterioration,” says Prof Titov.

“To prevent mental illness, we need to know its causes and mechanisms. One way to do this is to ask mentally healthy people to stop or limit the frequency of things we know are good for their mental health — in this case, the ‘Big Five’.”

“We believe this is the first study in the world that aims to link mental health status with measurable behavior.

“This represents a new paradigm and potential avenues for improving our understanding of mental health and mental illness.

“The design of this scheme required careful consideration of ethics and safety. As mental health professionals, asking people to stop activities that we know are good for them is not something we take lightly.”

For this reason, the decision was made to carefully screen volunteers and keep the group very small so that all participants could be closely monitored.

Initially, Professor Titov aimed to recruit 26 mentally healthy people and ask them to systematically restrict their Big Five activities over a four-week period.

To monitor their wellbeing, volunteers have regular calls with him or his colleague, Victoria Barrett, a chartered psychologist, and also complete weekly self-assessments to measure symptoms of depression and anxiety, and how many times a week they perform their usual Big Five activities.

However, the results were so striking that a decision was made to reduce the sample size to 12 and the duration to two weeks.

“We found that people who restricted their Big Five activities by 25% or more had significantly worse mental health,” says Prof Titov. “No one used the word ‘depressed,’ but they all said they were ‘suffering.'”

“We expected a small drop in happiness, but we didn’t expect it to fall so sharply, or for some people to take so long to recover.”

To take part in the program, participants had to have no significant symptoms of depression or anxiety and not be taking medication for any mental health problems. All participants completed assessments to establish baseline levels of depression and anxiety, which were measured over a two-week period.

Eleven had depression symptoms in the healthy/minimal range and one was classified as mild.

Disintegrated everyday life

After just one week of restriction, one participant’s condition significantly worsened and he quickly moved into the recovery phase.

At the two-week mark, only four participants remained in the healthy/minimal range of depression, five had progressed to mild, and three to moderate, the latter range indicating an increased risk of a clinical diagnosis of depression.

During the recovery phase, participants were instructed to return to their usual Big 5 activities with the support of regular SMS prompts from the study team.

Improvements began to appear immediately, but for some people it took time for them to return to their normal state.

After five weeks, 11 participants had their depression symptoms return to the healthy/minimal range, and one had returned to the mild range. The pattern of anxiety symptoms was similar to that of depression, but the changes were less pronounced.

Prof Titoff said some participants were more vulnerable to the loss of the Big Five than others, and those who restricted their activities the most were most affected.

“One person told me they felt like their whole routine had been upended,” he says.

“He realized he was tired in the afternoon and took a nap, which meant he didn’t sleep well at night. As a result, he overslept the next morning and didn’t have time to shower.”

“Also, the more I restricted myself from the big five, the longer it took me to recover.

“People report that recovery has been much harder than they expected. Some said they felt like they had lost their mental health and had to talk themselves into returning to their usual routines, habits and lifestyle.

“All participants said they learned valuable life lessons, but there is no doubt that if they had continued, some would have been at risk of experiencing full-blown depression.”

Next steps

Professor Titoff is planning a series of additional, larger-scale studies on the Big 5. Although his research focuses on anxiety and depression, he believes the same model could be usefully applied to other high-prevalence conditions, such as eating disorders, body dysmorphic disorder and even social and generalized anxiety disorders.

In parallel with the planned study, and based on the strong results, the MindSpot team is developing a free SMS prompting service that people who feel they are struggling mentally can sign up to.

A simple Big Five based intervention programme is currently being developed for use by Mindspot therapists and has shown interest from clinics in Australia and overseas.

“I think one of the really important insights that this study provides is that there are parallels between mental health and physical health,” Prof Titoff says.

“Both of these take time to build up strength, and if for some reason you don’t continue doing a particular activity you lose strength and it takes longer to recover than you’d expect.”