The Mental Health First-Aid That You’ll Hopefully Never Need

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Take Your Mental Health As Seriously As General Health!

Sometimes, health and productivity means excelling—sometimes, it means avoiding illness and unproductivity. Both are essential, and today we’re going to tackle some ground-up stuff. If you don’t need it right now, great; we suggest to read it for when and if you do. But how likely is it that you will?

  • One in four of us are affected by serious mental health issues in any given year.
  • One in five of us have suicidal thoughts at some point in our lifetime.
  • One in six of us are affected to at least some extent by the most commonly-reported mental health issues, anxiety and depression, in any given week.

…and that’s just what’s reported, of course. These stats are from a UK-based source but can be considered indicative generally. Jokes aside, the UK is not a special case and is not measurably worse for people’s mental health than, say, the US or Canada.

While this is not an inherently cheery topic, we think it’s an important one.

Depression, which we’re going to focus on today, is very very much a killer to both health and productivity, after all.

One of the most commonly-used measures of depression is known by the snappy name of “PHQ9”. It stands for “Patient Health Questionnaire Nine”, and you can take it anonymously online for free (without signing up for anything; it’s right there on the page already):

Take The PHQ9 Test Here! (under 2 minutes, immediate results)

There’s a chance you took that test and your score was, well, depressing. There’s also a chance you’re doing just peachy, or maybe somewhere in between. PHQ9 scores can fluctuate over time (because they focus on the past two weeks, and also rely on self-reports in the moment), so you might want to bookmark it to test again periodically. It can be interesting to track over time.

In the event that you’re struggling (or: in case one day you find yourself struggling, or want to be able to support a loved one who is struggling), some top tips that are useful:

Accept that it’s a medical condition like any other

Which means some important things:

  • You/they are not lazy or otherwise being a bad person by being depressed
  • You/they will probably get better at some point, especially if help is available
  • You/they cannot, however, “just snap out of it”; illness doesn’t work that way
  • Medication might help (it also might not)

Do what you can, how you can, when you can

Everyone knows the advice to exercise as a remedy for depression, and indeed, exercise helps many. Unfortunately, it’s not always that easy.

Did you ever see the 80s kids’ movie “The Neverending Story”? There’s a scene in which the young hero Atreyu must traverse the “Swamp of Sadness”, and while he has a magical talisman that protects him, his beloved horse Artax is not so lucky; he slows down, and eventually stops still, sinking slowly into the swamp. Atreyu pulls at him and begs him to keep going, but—despite being many times bigger and stronger than Atreyu, the horse just sinks into the swamp, literally drowning in despair.

See the scene: The Neverending Story movie clip – Artax and the Swamp of Sadness (1984)

Wow, they really don’t make kids’ movies like they used to, do they?

But, depression is very much like that, and advice “exercise to feel less depressed!” falls short of actually being helpful, when one is too depressed to do it.

If you’re in the position of supporting someone who’s depressed, the best tool in your toolbox will be not “here’s why you should do this” (they don’t care; not because they’re an uncaring person by nature, but because they are physiologically impeded from caring about themself at this time), but rather:

“please do this with me”

The reason this has a better chance of working is because the depressed person will in all likelihood be unable to care enough to raise and/or maintain an objection, and while they can’t remember why they should care about themself, they’re more likely to remember that they should care about you, and so will go with your want/need more easily than with their own. It’s not a magic bullet, but it’s worth a shot.

What if I’m the depressed person, though?

Honestly, the same, if there’s someone around you that you do care about; do what you can to look after you, for them, if that means you can find some extra motivation.

But I’m all alone… what now?

Firstly, you don’t have to be alone. There are free services that you can access, for example:

…which varyingly offer advice, free phone services, webchats, and the like.

But also, there are ways you can look after yourself a little bit; do the things you’d advise someone else to do, even if you’re sure they won’t work:

  • Take a little walk around the block
  • Put the lights on when you’re not sleeping
  • For that matter, get out of bed when you’re not sleeping. Literally lie on the floor if necessary, but change your location.
  • Change your bedding, or at least your clothes
  • If changing the bedding is too much, change just the pillowcase
  • If changing your clothes is too much, change just one item of clothing
  • Drink some water; it won’t magically cure you, but you’ll be in slightly better order
  • On the topic of water, splash some on your face, if showering/bathing is too much right now
  • Do something creative (that’s not self-harm). You may scoff at the notion of “art therapy” helping, but this is a way to get at least some of the lights on in areas of your brain that are a little dark right now. Worst case scenario is it’ll be a distraction from your problems, so give it a try.
  • Find a connection to community—whatever that means to you—even if you don’t feel you can join it right now. Discover that there are people out there who would welcome you if you were able to go join them. Maybe one day you will!
  • Hiding from the world? That’s probably not healthy, but while you’re hiding, take the time to read those books (write those books, if you’re so inclined), learn that new language, take up chess, take up baking, whatever. If you can find something that means anything to you, go with that for now, ride that wave. Motivation’s hard to come by during depression and you might let many things slide; you might as well get something out of this period if you can.

If you’re not depressed right now but you know you’re predisposed to such / can slip that way?

Write yourself instructions now. Copy the above list if you like.

Most of all: have a “things to do when I don’t feel like doing anything” list.

If you only take one piece of advice from today’s newsletter, let that one be it!

Don’t Forget…

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  • What is pathological demand avoidance – and how is it different to ‘acting out’?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    “Charlie” is an eight-year-old child with autism. Her parents are worried because she often responds to requests with insults, aggression and refusal. Simple demands, such as being asked to get dressed, can trigger an intense need to control the situation, fights and meltdowns.

    Charlie’s parents find themselves in a constant cycle of conflict, trying to manage her and their own reactions, often unsuccessfully. Their attempts to provide structure and consequences are met with more resistance.

    What’s going on? What makes Charlie’s behaviour – that some are calling “pathological demand avoidance” – different to the defiance most children show their parents or carers from time-to-time?

    What is pathological demand avoidance?

    British developmental psychologist Elizabeth Newson coined the term “pathological demand avoidance” (commonly shortened to PDA) in the 1980s after studying groups of children in her practice.

    A 2021 systematic review noted features of PDA include resistance to everyday requests and strong emotional and behavioural reactions.

    Children with PDA might show obsessive behaviour, struggle with persistence, and seek to control situations. They may struggle with attention and impulsivity, alongside motor and coordination difficulties, language delay and a tendency to retreat into role play or fantasy worlds.

    PDA is also known as “extreme demand avoidance” and is often described as a subtype of autism. Some people prefer the term persistent drive for autonomy or pervasive drive for autonomy.

    What does the evidence say?

    Every clinician working with children and families recognises the behavioural profile described by PDA. The challenging question is why these behaviours emerge.

    PDA is not currently listed in the two diagnostic manuals used in psychiatry and psychology to diagnose mental health and developmental conditions, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Health Organization’s International Classification of Diseases (ICD-11).

    Researchers have reported concerns about the science behind PDA. There are no clear theories or explanations of why or how the profile of symptoms develop, and little inclusion of children or adults with lived experience of PDA symptoms in the studies. Environmental, family or other contextual factors that may contribute to behaviour have not been systematically studied.

    A major limitation of existing PDA research and case studies is a lack of consideration of overlapping symptoms with other conditions, such as autism, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, selective mutism and other developmental disorders. Diagnostic labels can have positive and negative consequences and so need to be thoroughly investigated before they are used in practice.

    Classifying a “new” condition requires consistency across seven clinical and research aspects: epidemiological data, long-term patient follow-up, family inheritance, laboratory findings, exclusion from other conditions, response to treatment, and distinct predictors of outcome. At this stage, these domains have not been established for PDA. It is not clear whether PDA is different from other formal diagnoses or developmental differences.

    girl sits on couch with arms crossed, mother or carer is nearby looking concerned
    When a child is stressed, demands or requests might tip them into fight, flight or freeze mode. Shutterstock

    Finding the why

    Debates over classification don’t relieve distress for a child or those close to them. If a child is “intentionally” engaged in antisocial behaviour, the question is then “why?”

    Beneath the behaviour is almost always developmental difference, genuine distress and difficulty coping. A broad and deep understanding of developmental processes is required.

    Interestingly, while girls are “under-represented” in autism research, they are equally represented in studies characterising PDA. But if a child’s behaviour is only understood through a “pathologising” or diagnostic lens, there is a risk their agency may be reduced. Underlying experiences of distress, sensory overload, social confusion and feelings of isolation may be missed.

    So, what can be done to help?

    There are no empirical studies to date regarding PDA treatment strategies or their effectiveness. Clinical advice and case studies suggest strategies that may help include:

    • reducing demands
    • giving multiple options
    • minimising expectations to avoid triggering avoidance
    • engaging with interests to support regulation.

    Early intervention in the preschool and primary years benefits children with complex developmental differences. Clinical care that involves a range of medical and allied health clinicians and considers the whole person is needed to ensure children and families get the support they need.

    It is important to recognise these children often feel as frustrated and helpless as their caregivers. Both find themselves stuck in a repetitive cycle of distress, frustration and lack of progress. A personalised approach can take into account the child’s unique social, sensory and cognitive sensitivities.

    In the preschool and early primary years, children have limited ability to manage their impulses or learn techniques for managing their emotions, relationships or environments. Careful watching for potential triggers and then working on timetables and routines, sleep, environments, tasks, and relationships can help.

    As children move into later primary school and adolescence, they are more likely to want to influence others and be able to have more self control. As their autonomy and ability to collaborate increases, the problematic behaviours tend to reduce.

    Strategies that build self-determination are crucial. They include opportunities for developing confidence, communication and more options to choose from when facing challenges. This therapeutic work with children and families takes time and needs to be revisited at different developmental stages. Support to engage in school and community activities is also needed. Each small step brings more capacity and more effective ways for a child to understand and manage themselves and their worlds.

    What about Charlie?

    The current scope to explain and manage PDA is limited. Future research must include the voices and views of children and adults with PDA symptoms.

    Such emotional and behavioural difficulties are distressing and difficult for children and families. They need compassion and practical help.

    For a child like Charlie, this could look like a series of sessions where she and her parents meet with clinicians to explore Charlie’s perspective, experiences and triggers. The family might come to understand that, in addition to autism, Charlie has complex developmental strengths and challenges, anxiety, and some difficulties with adjustment related to stress at home and school. This means Charlie experiences a fight, flight, freeze response that looks like aggression, avoidance or shutting down.

    With carefully planned supports at home and school, Charlie’s options can broaden and her distress and avoidance can soften. Outside the clinic room, Charlie and her family can be supported to join an inclusive local community sporting or creative activity. Gradually she can spend more time engaged at home, school and in the community.

    Nicole Rinehart, Professor, Child and Adolescent Psychology, Director, Krongold Clinic (Research), Monash University; David Moseley, Senior Research Fellow, Deputy Director (Clinical), Monash Krongold Clinic, Monash University, and Michael Gordon, Associate Professor, Psychiatry, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Black Bean Hummus Panini

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    A recipe for a sandwich? Try it once, and you’ll see why. Welcome to your new favorite!

    You will need

    Method

    (we suggest you read everything at least once before doing anything)

    1) Grill the eggplant slices until soft.

    2) Spread hummus generously on one side of both slices of bread.

    2) Add the black beans on top of one slice (the hummus will help them stay in place), followed by the sun-dried tomatoes and then the eggplant. Top with the other slice of bread, hummus-side down.

    3) Coat (carefully, please) the inside of the panini press (both interior sides) with olive oil. If you don’t have sprayable oil, using a sheet of kitchen roll to apply the oil is a good way to do it without making a mess.

    4) Grill the assembled sandwich, until the bread starts to brown and the insides are warm; this should take about 4 minutes.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Why You’re Probably Not Getting Enough Fiber (And How To Fix It)

    First things first… How much fiber should we be eating?

    *This one is also a great read to understand more about the “why” of fiber

    Meanwhile, the average American gets 16g of fiber per day.

    So, how to get more fiber, without piling on too many carbs?

    Foods that contain fiber generally contain carbs (there’s a limit to how much celery most people want to eat), so there are two key ideas here:

    • Getting a good carb:fiber ratio
    • Making substitutions that boost fiber without overdoing (or in some case, even changing) carbs

    Meat → Lentils

    Well-seasoned lentils can be used to replaced ground beef or similar. A cup of boiled lentils contains 18g of fiber, so you’re already outdoing the average American’s daily total.

    Meat → Beans

    Black beans are a top-tier option here (15g per cup, cooked weight), but many kinds of beans are great.

    Chicken/Fish → Chickpeas

    Yes, chicken/fish is already meat, but we’re making a case for chickpeas here. Cooked and seasoned appropriately, they do the job, and pack in 12g of fiber per cup. Also… Hummus!

    Bonus: Hummus, eaten with celery sticks.

    White pasta/bread → Wholewheat pasta/bread

    This is one where “moderation is key”, but if you’re going to eat pasta/bread, then wholewheat is the way to go. Fiber amounts vary, so read labels, but it will always have far more than white.

    Processed salty snacks → Almonds and other nuts

    Nuts in general are great, but almonds are top-tier for fiber, amongst other things. A 40g handful of almonds contains about 10g of fiber.

    Starchy vegetables → Non-starchy vegetables

    Potatoes, parsnips, and their friends have their place. But they cannot compete with broccoli, peas, cabbage, and other non-starchy vegetables for fiber content.

    Bonus: if you’re going to have starchy vegetables though, leave the skins on!

    Fruit juice → Fruit

    Fruit juice has had most, if not all, of its fiber removed. Eat an actual juicy fruit, instead. Apples and bananas are great options; berries such as blackberries and raspberries are even better (at around 8g per cup, compared to the 5g or so depending on the size of an apple/banana)

    Processed cereals → Oats

    5g fiber per cup. Enough said.

    Summary

    Far from being a Herculean task, getting >30g of fiber per day can be easily accomplished by a lentil ragù with wholewheat pasta.

    If your breakfast is overnight oats with fruit and some chopped almonds, you can make it to >20g already by the time you’ve finished your first meal of the day.

    Enjoy!

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  • Carrot vs Sweet Potato – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing carrot to sweet potato, we picked the sweet potato.

    Why?

    Both are great! But there’s a winner in the end:

    Looking at the macros first, sweet potato has more protein carbs, and fiber, and is thus the “more food per food” item. If they are both cooked the same, then the glycemic index is comparable, despite the carrot’s carbs having more sucrose and the sweet potato’s carbs having more starch. We’ll call this category a tie.

    In terms of vitamins, carrots have more of vitamins B9 and K, while sweet potatoes have more of vitamins B1, B2, B3, B5, B6. B7, C, E, and choline. Both are equally high in vitamin A. Thus, the vitamins category is an overwhelming win for sweet potato.

    When it comes to minerals, carrots are not higher in any minerals (unless we count that they are slightly higher in sodium, but that is not generally considered a plus for most people in most places most of the time), while sweet potato is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Another easy win for sweet potato.

    Adding up the sections makes for a clear win for the sweet potato as the more nutritionally dense option, but as ever, enjoy either or both!

    Want to learn more?

    You might like to read:

    What’s Your Plant Diversity Score?

    Take care!

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  • Procrastination, and how to pay off the to-do list debt

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Procrastination, and how pay off the to-do list debt

    Sometimes we procrastinate because we feel overwhelmed by the mountain of things we are supposed to be doing. If you look at your to-do list and it shows 60 overdue items, it’s little wonder if you want to bury your head in the sand!

    “What difference does it make if I do one of these things now; I will still have 59 which feels as bad as having 60”

    So, treat it like you might a financial debt, and make a repayment plan. Now, instead of 60 overdue items today, you have 1/day for the next 60 days, or 2/day for the next 30 days, or 3/day for the next 20 days, etc. Obviously, you may need to work out whether some are greater temporal priorities and if so, bump those to the top of the list. But don’t sweat the minutiae; your list doesn’t have to be perfectly ordered, just broadly have more urgent things to the top and less urgent things to the bottom.

    Note: this repayment plan means having set repayment dates.

    Up front, sit down and assign each item a specific calendar date on which you will do that thing.

    This is not a deadline! It is your schedule. You’ll not try to do it sooner, and you won’t postpone it for later. You will just do that item on that date.

    A productivity app like ToDoist can help with this, but paper is fine too.

    What’s important here, psychologically, is that each day you’re looking not at 60 things and doing the top item; you’re just looking at today’s item (only!) and doing it.

    Debt Reduction/Cancellation

    Much like you might manage a financial debt, you can also look to see if any of your debts could be reduced or cancelled.

    We wrote previously about the “Getting Things Done” system. It’s a very good system if you want to do that; if not, no worries, but you might at least want to borrow this one idea….

    Sort your items into:

    Do / Defer / Delegate / Ditch

    • Do: if it can be done in under 2 minutes, do it now.
    • Defer: defer the item to a specific calendar date (per the repayment plan idea we just talked about)
    • Delegate: could this item be done by someone else? Get it off your plate if you reasonably can.
    • Ditch: sometimes, it’s ok to realize “you know what, this isn’t that important to me anymore” and scratch it from the list.

    As a last resort, consider declaring bankruptcy

    Towards the end of the dot-com boom, there was a fellow who unintentionally got his 5 minutes of viral fame for “declaring email bankruptcy”.

    Basically, he publicly declared that his email backlog had got so far out of hand that he would now not reply to emails from before the declaration.

    He pledged to keep on top of new emails only from that point onwards; a fresh start.

    We can’t comment on whether he then did, but if you need a fresh start, that can be one way to get it!

    In closing…

    Procrastination is not usually a matter of laziness, it’s usually a matter of overwhelm. Hopefully the above approach will help reframe things, and make things more manageable.

    Sometimes procrastination is a matter of perfectionism, and not starting on tasks because we worry we won’t do them well enough, and so we get stuck in a pseudo-preparation rut. If that’s the case, our previous main feature on perfectionism may help:

    Perfectionism, And How To Make Yours Work For You

    Don’t Forget…

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  • Infrared-Reflecting Patches For Health?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Hi! I’ve been reading about LifeWave patches, would you recommend them?❞

    For reference first, this is talking about these: LifeWave.com

    Short answer: no

    Longer answer: their main premise seems to be that the patches (subscription prices seem to start from about $100–$300 per month) reflect infrared energy back into your body, making you more energized and healthy.

    Fun fact: aluminum foil reflects infrared energy (which we feel as heat), by the way, and that is why space blankets (of the kind used in emergencies and by some athletes) are made shiny like that, often with aluminized mylar.

    We cannot comment too closely on the rest of the presented science of their products, as it seems quite unlike anything we’re accustomed to reading, and we were not able to make a lot of sense of it.

    They do cite research papers to back their claims, including research conducted by the company’s founder and published via an open journal.

    Many others are independent studies conducted by often the same researchers as each other, mostly experts in acupuncture and acupressure.

    For the papers we looked at, the sample sizes were very small, but the conclusions were very positive.

    They were published in a variety of journals, of which we cannot claim any prior knowledge (i.e:, they were not the peer-reviewed journals from which we cite most of our sources).

    Also, none were registered with ClinicalTrials.gov.

    To be on the safe side, their disclaimer does advise:

    ❝LifeWave products are only intended to maintain or encourage a general state of health or healthy activity and are not intended to diagnose, treat, cure, mitigate, or prevent any disease or medical condition of the body❞

    They do have a Frequently Asked Questions page, which tells about ancient Egyptian use of colored glass, as well as more modern considerations including joining, ordering, their commissions system, binary commissions and matching bonuses, and “how to rank up in LifeWave” as well as a lot of information about subscribing as a preferred customer or a brand partner, opting in to their multi-level marketing opportunities.

    Here’s what “Honest Brand Reviews” had to say:

    Honest Brand Reviews | LifeWave Review

    Our position:

    We cannot honestly claim to understand their science, and thus naturally won’t actively recommend what we can’t speak for.

    An expert’s position:

    Since we couldn’t understand how this would work, here’s what Dr. Paul Knoepfler has to say about their flagship product, the LifeWave X39 patch:

    LifeWave X39 stem cell patch story has holes

    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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