Introduction to Relaxation Techniques
Benefits of Relaxation
Progressive Muscle Relaxation Techniques
Isometric Muscle Relaxation

Introduction to Relaxation Techniques

“An anxious mind cannot exist in a relaxed body”

Says Dr. Edmund Jacobson, the person who developed Progressive Muscle Relaxation in the 1930′s.

There are many relaxation techniques. Two of them are progressive muscle relaxation techniques1&2 and isometric muscle relaxation3. Both are equally applicable in the prophylaxis and management of stress and anxieties, but only the latter has practical relevance in a situation currently provoking social anxiety.

Benefits

Relaxation techniques are effective for

• the promotion of good health
  • mental
  • physical
  • social
• the management of psychological conditions like
  • stress,
  • tension headache,
  • migraine,
  • backaches,
  • generalized anxiety,
  • panics,
  • social phobia, and other specific phobias
• the management of physical conditions like
  • hypertension,
  • ulcerative colits etc,

Progressive Muscle Relaxation

Progressive muscle relaxation is a systematic technique for achieving a deep state of relaxation. It involves tensing and relaxing, in succession, a number of different muscle groups of the body. The method was originally developed by Harvard physiologist Edmund Jacobson in the 1930s, to include a series of 200 different muscle relaxation exercises. Recently the system has been abbreviated to 15–20 basic exercises

Before you begin

• Set aside 20 minutes per session, and preferably two sessions every day.
• Practice at regular times: on awakening, before retiring, or before meals are generally the best times.
• Find a quiet location to practice where you won’t be distracted.
• Practice on an empty stomach: Do not attempt progressive relaxation within an hour after eating a full meal
• Assume a comfortable position: Lying down on your back or in a sitting position. If sitting, sit in a comfortable chair with your back straight, shoulders back, ankles comfortably together and hands on your knees. Otherwise, lie on your back with your body straight, arms at your sides and feet together.
• Loosen any tight clothing and take off shoes, watch, glasses, contact lenses, jewelry, and so on.
• Give yourself permission to put aside the concerns of the day.
• Assume a passive, detached attitude. This is probably the most important element. You want to adopt a “let it happen” attitude and be free of any worry about how well you are performing the technique.
• Let go: Do not try to relax. Do not try to control your body. Do not judge your performance. Just let go.

During session

• The muscle groups are taken in succession in predetermined order. After you have practiced for some time you can alter the order as it suits you.
• Each group is tensed hard (not so hard that you strain, however) for about 7–10 seconds, and then relaxed suddenly, NOT slowly.
• Concentrate on what is happening. Feel the buildup of tension in each particular muscle group. It is often helpful to visualize the particular muscle group being tensed.
• You then give yourself 15–20 seconds to relax, noticing how the muscle group feels when relaxed in contrast to how it felt when tensed, before going on to the next group of muscles.
• You might also say to yourself “I am relaxing”, “Letting go”, “Let the tension flow away”, or any other relaxing phrase during each relaxation period between successive muscle groups.
• Throughout the exercise, maintain your focus on your muscles. When your attention wanders, bring it back to the particular muscle group you’re working on.
• Allow all the other muscles in your body to remain relaxed, as far as possible, while working on a particular muscle group.
• Tense and relax each muscle group once. But if a particular area feels especially fight, you can tense and relax it two or three times, waiting about 20 seconds between each cycle.

The order of the muscle groups and how to tense them

• Dominant (right if you are right–handed, left if you are left–handed) hand, wrist and lower arm:Make a tight fist; Hold for 7–10 seconds; and then release for 15–20 seconds. As should be every case, try not to disturb other muscle groups.
• Upper arm on the dominant side:You can tense these muscles by pressing your arm against your chest, the floor, your bed, or some other suitable surface.
• Nondominant (left if you are right–handed, right if you are left–handed) hand, wrist and lower arm :As in the other side
• Upper arm on the non–dominant side:As in the other side
• Face and jaw muscles:Tighten your jaw so that your teeth are together, but do not press down with great force. Wrinkle your nose and forehead and stretch back the corners of your mouth as far as you can. You should hold this position for only about five seconds; though it’s generally easier to feel the resulting relaxation from this group than some of the others, if repeated too quickly or too long, it can result in a headache.
• Muscles of your neck:Stretch your neck so that your chin almost touches your chest. At the same time, exert pressure so that your chin does not quite reach the chest – this is called counterposing your muscles, and if done correctly, it will result in some trembling in your neck. This is another position that should only be held for about five seconds. However, it can safely be repeated with a short break in between, if you find that your neck is one of your high–tension areas.
• Alternatively, Tighten the muscles in the back of your neck by pulling your head way back, as if you were going to touch your head to your back (be gentle with this muscle group to avoid injury). Focus only on tensing the muscles in your neck. Hold … and then relax. Since this area is often especially tight, it’s good to do the tense–relax cycle twice.
• Shoulders, chest and upper back:To tense these, sit up straight and push your shoulder blades back as though you are trying to touch them. This group can be difficult to release abruptly, but practice will make perfect in this regard. Note that it is not important whether or not your shoulder blades actually do touch. Ten seconds.
• Abdominal muscles:Tighten your abdominal muscles by sucking in your abdomen.
• Buttocks:Tighten your buttocks by pulling them together. Hold…and then relax. Imagine the muscles in your hips going loose and limp.
• Upper dominant legs (thighs):Squeeze the muscles in your thighs all the way down to your knees.You will probably have to tighten your hips along with your thighs, since the thigh muscles attach at the pelvis.
• Lower dominant leg:Tighten your calf muscles by–pulling your dominant foot toward you (flex carefully to avoid cramps).
• Dominant foot:Point your toes downward. Because the feet are relatively fragile compared to the larger muscle groups of the torso and limbs, do not hold this position for more than about three seconds, and do not repeat it more than twice, at most, in a session. If held too long or too strongly, this position can cause a cramp.
• Upper non–dominant legs (thighs): As in the other side
• Lower non–dominant leg: As in the other side
• Nondominant foot: As in the other side

Isometric muscle relaxation

Isometric muscle relaxation techniques involve tensing and relaxation of muscles without overt movement. They provide rapid relaxation that can be applied in a variety of situations. Because they do not involve any obvious change in posture or movement, they can be done unnoticed even when in company of people.

During session

• Take a small breath and hold it for up to seven seconds
• At the same time, gradually tense a chosen muscle group. Do not tense to the point of discomfort.
• After about seven seconds, breath out and slowly say the word “relax” to yourself
• Gradually let all the tension go from your muscle. Slow and gentle is the rule.
• If convenient or if desired, close your eyes
• For the next minute, each time you breath out say the word “relax” to yourself and let all the tension flow out of your muscle.
• Repeat if necessary with the same or other muscle groups until you feel relaxed.
• The exercise can be adapted for problematic situations such as waiting in line.

Examples of Isometric Relaxation

• While sitting, slowly tense leg muscles by crossing your feet at the ankles and press down with the upper leg while trying to lift the lower leg or trying to pull the legs in opposite direction
• Place hands, palm against palm, and press down with the top hand while trying to lift the lower hand.
• Place hands under the sides of a chair and pull into the air.
• Place hand behind the head and interlock the fingers. Try to pull hand apart while pushing head backward into the hands.
• Tightly grip an immovable rail or bar and let the tension flow up the arms.
• While standing, lock legs stiffly straight, then release
• Facial muscle can be tensed in a variety of ways, often by exaggerating different expressions such as smiling, frowning, surprise

Resources

www.rci.rutgers.edu/~rccc/Relax.htm
www.hypnos.co.uk/hypnomag/jacobson.htm
management of anxiety disorders..library

International Classification of sleep disorders (ICSD) defines inadequate sleep hygiene as “a sleep disorder due to performance of daily living activities that are inconsistent with maintenance of good quality sleep and full daytime alertness”.

Sleep hygiene consists of non-specific measures to induce sleep¹. They are:

• Arise at the same time daily.
• Limit daily in-bed time to the usual amount present before the sleep disturbance.
• Discontinue CNS-activating drug (like caffeine, nicotine, amphetamine) and alcohol.
• Avoid daytime naps (except when sleep charts shows that they induce better night sleep)
• Establish physical fitness by means of graded program of vigorous exercises early in the day.
• Avoid evening stimulation: substitute television with radio or relaxed reading.
• Try very hot, 20-minute body-temperature-raising bath soaks near bed time.
• Eat at regular times daily; avoid large meals near bed time.
• Practice evening relaxation routines, such as progressive muscle relaxation.
• Maintain comfortable sleep conditions: the bed, the light

What coping is?
Classifications of coping skills
Adaptive coping
Eight lines of coping skills

What Coping Is

Coping is a conglomerate of emotional, cognitive, and behavioural attempts to ameliorate our stress reactions when faced with situation that is unpredictable, unexpected, a threat, a challenge to our capability, or a catastrophy. Such a situation is called stressor.

We use a variety of coping methods: some more often than others; some more adaptive than others. If there is a predominent coping skill in an individual, this is called his coping style

Classifications of coping skill

The target of any coping method is to reduce emotions, solve problems, or avoid reality1. Based on this, a coping method can be:

• Emotion-Focused
• Solution-Focused
• Avoidance

Solution-Focused Coping involves a person’s efforts to resolve the problem or situation that causes him/her to feel stressed. Examples of solution-focused coping involve:

• Learning more about a situation
• Learning how to relax
• Exercise
• Time management
• Developing organizational skills
• Recognizing what can be changed (e.g., situation, exposure, interpretation)
• Eating and sleeping well, striving for balance

Emotion-Focused Coping refers to a person’s efforts to decrease the emotional impact of a stressful situation and/or to increase a sense of emotional well-being. Examples of emotion-focused coping include:

• Talking to a friend or relative
• Seeking support or professional help
• Looking for ways to relax
• Rethinking the meaning of a situation or event
• Identifying distorted thinking or beliefs

Avoidance Coping takes place when an individual attempts to ignore or minimize a problem or stressful situation, and/or looks for ways to escape its impact. Examples include:

• Using alcohol or drugs
• Isolating oneself
• Procrastinating
• Keeping things to oneself
• Suicidal thoughts
• Oversleeping

The overall outcome of a coping method can be adaptive, that is, to the good of the individual or maladaptive, that is, to the detriment of the user. Based on this, a coping method can be:

• Adaptive
• Maladaptive

Adaptive coping

In the Workbook for Coping Skills Workshop, Hope and Cope Wellness Centre calls adaptive coping “good coping” and defines it as “as active problem solving that is optimistic, resourceful, practical and flexible”.

It furthers says that “Good coping implies personal control that lets you achieve what is important to you. Good coping also means recognizing your own strengths, and giving yourself a pat on the back”1.

Eight lines of coping skills

In the Workbook, line of coping skills are highlighted:

• Mindfulness
• Ways of Thinking
• Relaxation
• Goal Setting
• Problem Solving
• Communication
• Social Support
• A Healthy Lifestyle

Mindfulness

Mindfulness is simply the state of being attentive to and aware of what is taking place in the present moment, putting your mind to what you are doing, but not reacting to it, a kind of meditation in daily life, a way of celebrating in small ways the passage through the day.

Thinking Ways of Coping

Any fact creates a thought within us, spontaneously and seemingly without any effort on our part. From that thought comes a feeling; for example

FACT: A friend passes by you on the street and doesn’t speak to you.
THOUGHT: She/he is upset at me for something.
FEELING: Anger or Frustration.

Note that the feeling came directly from the thought and not from the fact. We have little or no control over most of the facts in our lives but we have total control over the thoughts. The more you feel you have control in a situation, the less stress and anxiety you feel. It is usually our feelings that drive our actions. You always can have some impact and some degree of choice.

Practice identifying the facts, thoughts, and feelings in your mind from time to time. Sort out one from the other. By simply identifying and labelling the facts, thoughts and feelings you can begin to change the thoughts which will change your feelings.

Questions to ask yourself are:

• Is this a fact? Can it be changed? Do I have control over it? What thought results from this fact in my mind?
• Is this a thought? If so, is it a helpful or unhelpful one to me? Can I change it? Changing thoughts is also called “reframing”.
• Is this a feeling? If so, from what thought did it come? Is this a pleasant or unpleasant feeling? Do I want to change it?

Thus, a sense of personal control over our emotions comes from the monitoring and control of our thoughts our. This is a simple statement and it is extraordinarily powerful. It says that we have control over what and how we choose to think. The notion of choice is clear. For many of us from time to time, it is easier and less painful to believe that we have no control over our thoughts than to admit that we can take responsibility for them.

So the next step is to see if we can change our thoughts, even though we frequently do not believe that it is possible!We do this by first understanding and accepting that although the brain is an intelligent organ, it also is very naive. It responds to whatever messages we give it whether they are true or not!

Relaxation

Quick Relaxation Techniques(1)

• The clenched fist:Clench your fist tightly for a count of ten. Release and let your whole body go completely limp.
• The deep breath:Take a full deep breath and hold it for a count of ten. When you exhale let it all out at once, letting your body go completely loose and limp. This is related to the first technique in that it too involves an initial tightening (holding the breath for a count of ten followed by a sudden and complete release as you let your breath out all at once.) In addition, it takes advantage of another basic principle — the fact that the body is most relaxed when exhaling.
• The breathing countdown:Breathing normally, let go more and more as you release each breath, while counting slowly from 10 to 0, one number per breath. By focussing on the “letting go” feeling as you let out each breath let go even more to produce a cumulative effect. Counting backwards (one number sper breath) helps create the effect of descending (as if you were in an elevator going down another floor with each breath)—becoming more relaxed with each breath.
• The warm hands:Imagine yourself basking in the warm sun on a beach or soaking in a hot tub until you can actually feel warmth come into your hands. This technique uses the principle that the power of thought directly affects the body. An example of this principle in action is what happens when you’re hungry and begin anticipating your favourite meal. Your mouth automatically starts watering – a physiological response (salivation) caused by a thought. In the same way, the thought of warmth can have a direct effect on circulation. And since we know that the blood flowing out to the extremities is directly linked with relaxation, thoughts of warmth – especially warm hands – will cause an automatic relaxation response.

Goal Setting

Goal setting is important because it has been found to:

• Help re-establish a normal, daily routine.
• Help set priorities when there are many demands on your time and energy.
• Help accomplish tasks that are important in the here and now.
• Help experience a sense of being while working on goals.

Problem Solving

Steps in Problem Solving:

• Define the problem.
• Recognize how you feel about the problem. Accept your feelings.
• Relax and try not to think about solutions for a while.
• Consider all possible solutions.
• Try to imagine how other people might solve the problem or how to obtain the information needed to solve the problem.
• Evaluate the pros and cons of each solution.
• Arrange the solutions into a list starting with the least practical or least desirable one, all the way to the best.
• Make a choice.
• Briefly consider some favourable or positive aspects of the original problem. Can you think about it differently? Undesirable events often produce spectacular strengths.

Communication

Did you know that Communication is:

• 7 percent Verbal
• 35 percent Facial Expression
• 35 percent Body Language
• 23 percent Tone Of Voice

Communication is simply the sending and receiving of messages, intentional and unintentional, verbal and nonverbal. Being able to communicate well is a skill that most of us have not learned about and yet it is an essential part of good coping. It affects our feelings and our health.

There is need to learn the difference between assertive and aggressive communication and use the former, which is expressing yourself – your needs, your feelings, perspectives – in a manner which is clear, direct and neither threatening nor attacking.

Social Support

People need people. Although that statement seems obvious it is only in the last few years that we have come to learn just how important others are for our well being. For example, we know that people who have a close confidant(s), friend, or spouse live longer and are healthier than those who do not!

Social support includes giving and receiving encouragement, practical help, positive feed-back and rewards, understanding and caring, and role modelling.

Another aspect of social support is knowing where to go to obtain the right type of social support. People’s social support network usually extends to friends, family, health care workers and co-workers. It is not the number of people you know but the quality of care and support those people provide that matters.

Healthy lifestyle

What makes a healthy lifestyle?

• Exercise
• Nutrition
• Laughter
• Handling Fatigue
• Hope
• Spirituality
• Forgiveness
• Self Trust
• Sexuality

What anxiety is
Different forms of anxiety
What might trigger anxiety
How is anxiety treated

What anxiety is?

An anxiety problem does not mean that you are weak, that you are losing your mind, or that you have a personality problem. Severe anxiety is a problem that can be overcome with treatment. Effective treatments are available.

The word ‘anxiety’ is used to describe the mental and physical response to feared and threatening situations. This reaction can include trembling, choking, increased heart rate, sweating, feelings of unreality and so on. Anxiety is a normal response experienced by everyone at times. Nearly being hit by a car, sitting for an exam or giving a public talk are all examples of situations in which most people would experience some anxiety.

You are likely to be suffering from an anxiety disorder if you experience any of the following:

• The anxiety reaction occurs frequently.
• Your fears are out of proportion to the situation.
• You start to avoid places or situations where you experience anxiety.
• It interferes with your working, social or family life.

Different forms of anxiety

• Panic disorder
• Agoraphobia
• Social phobia
• Generalized anxiety

Panic disorder

People who suffer from ‘panic disorder’ are likely to experience attacks of sudden and intense anxiety. These panics cannot be associated with events occurring around the person. The person is generally free from anxiety in between panics.

Social phobia

The main feature of ‘social phobia’ is the fear of being the focus of attention or subject of criticism. People with this disorder may worry that they will do something silly or embarrassing in front of others. Often social phobia is experienced in many different social situations. This leads to the avoidance of these situations.

Agoraphobia

People who have agoraphobia experience psychological and physical anxiety and often panics, in particular places or situations, in which:

• there is a sense of being trapped or being unable to leave or escape
• it would not be easy to get help should the need arise
• the environment is different and unfamiliar
• they have had a panic before.

This leads to the avoidance of many situations and can severely affect day-to-day life. In extreme cases, people who suffer from agoraphobia find it difficult to leave the house.

Examples of commonly feared or avoided situations are leaving home, travelling alone, crowds, public places.

Generalized anxiety disorder

Generalized anxiety is different from the other anxiety disorders. The experience of anxiety is not linked to specific situations or to a fear of having panic attacks. It is ongoing general anxiety, tension and excessive worrying about normal events and the future. You may feel worried most of the time about things that might go wrong or find that you are tense without knowing exactly what you are worried about. However, you are less likely to have all the feelings that are listed under `panic’ and `phobias’, such as fear of dying or fear of going crazy.

What might trigger anxiety?

There are many possible triggers for anxiety. It often starts during periods of psychological or physical stress.

Examples of psychological and physical stress include the following:

• relationship break-ups
• severe arguments
• the environment is different and unfamiliar
• loss of someone close
• loss of a job
• lack of sleep
• work pressure
• financial problems
• physical and sexual abuse
• physical illness
• excessive use of alcohol
• abuse of other drugs
• domestic violence
• trauma

How anxiety is treated

Feeling anxious does not necessarily mean you have a problem. Anxiety is a normal response that everyone has to certain situations; however, anxiety is not always useful; sometimes it reaches disabling proportions.

The aim is not to get rid of all anxiety but rather to reduce it to manageable proportions.

The best way to manage anxiety is through psychological help (counselling) and social support. With different psychological methods, it is possible to:

• control and stop panic attacks
• confront feared situations previously avoided
• change negative and unrealistic thinking and reduce worry.
• Talk to your doctor

Resources

extracts from Jerkins,R. ed.(2004) WHO Guide to Mental and Neurological Health in Primary care. Royal Society of Medicine Press (CDROM).

What is depression
Characteristics of depression
What might trigger depression
How depression is treated
How to avoid a recurrence of depression

What is depression?

Depression is an illness — it is common and treatable. Depression does not mean that you are weak or lazy. It is a common illness, like hypertension, diabetes or arthritis, and it can occur at any age. The good news is that there are treatments that work well.

Many people use the word ‘depression’ to describe feelings of sadness and loss. These feelings often pass within a few hours or a few days. During this time, people are able to carry on much as usual. The illness that your doctor calls depression is different from this. You feel sad much more intensely and for longer. It is common to lose interest in things that you used to enjoy. Depression commonly interferes with your work, social and family life.

Characteristics of depression

Depression can also affect people in many ways. Common symptoms are:

• low mood
• reduced or loss of interest
• lack of energy or motivation
• disturbed sleep: reduced or excessive
• changes to appetite: reduced or excessive
• physical aches and pain
• irritability and intolerance
• feelings of guilt
• loss of concentration.

What might trigger depression?

We know that there are changes in the level of certain chemicals in the brains of people who are depressed. There is also evidence that if your close blood relatives suffer from depression, you are at a greater risk of having depression.

For many people, depression is triggered by stressful events, alcohol or drug use. In others, a physical illness or medication causes symptoms of depression. In some people, however, there is no obvious trigger. Think about your situation — was your depression associated with one of the triggers listed below? If so, put a check beside it in the list of possible triggers below. If not, and you are aware of some other trigger, write it in the space provided. It would help to discuss this with your doctor, your family and friends.

<h3>Possible triggers</h3>

• Moving house
• Loss of job
• Divorce or separation
• Poverty
• Death of a loved one
• Unemployment
• Long term alcohol use
• Chronic drug use
• Certain medications
• Seasonal changes
• Dissatisfaction or conflict at work
• Loneliness
• Widowhood
• Marital problems
• Chronic physical illness
• Childbirth
• Being a victim of a crime or an accident
• Unsatisfactory relationships with family or friends
• Serious injury or illness in the patient or a loved one
• Unprepared social and cultural changes (immigration)
• Low self-esteem

How depression is treated

Because depression commonly involves stressful events and can also involve changes in body chemistry, depression is usually best treated with a combination of medical and psychological (or talking) treatments. Medical treatment includes antidepressant medication and psychological treatments include cognitive and behavioural therapy, and learning how to cope with stress.

If you are experiencing the symptoms of depression, it is advisable to talk to your doctor.

How to avoid a recurrence of depression

• It is very important that you follow your doctor’s advice
• Take your medication as directed without skipping any days
• Never reduce or stop taking medication without first talking to your doctor
• If you have stopped doing things you used to do, gradually increase what you do and include activities you enjoy
• Use the problem solving approach to deal with problems, stresses and worries
• Work on identifying your negative thoughts and changing them to positive ones.

Resources:

extracts from Jerkins,R. ed.(2004) WHO Guide to Mental and Neurological Health in Primary care. Royal Society of Medicine Press (CDROM).

What is mental health?
A scale to measure mental health
Mental health hygiene

What Mental Health is

According to the World health Organization (WHO), mental health has been defined variously by scholars from different cultures1. From a cross-cultural perspective, it is nearly impossible to define mental health comprehensively. Generally, however, the concept of mental health is multi-dimensional, involving

• subjective well-being
• perceived self-efficacy
• autonomy
• competence
• intergenerational dependence
• self-actualization of one’s intellectual and emotional potential¹

Characteristics of mental health

The study of the characteristics that make up mental health has been called “positive psychology”. Here are some of the ideas that have been put forward as characteristics of mental health:

• The ability to enjoy life: essential to good mental health.
• Resilience: The ability to bounce back from adversity has been referred to as “resilience”.
• Balance: between time spent socially and time spent alone; between work and play, between sleep and wakefulness, rest and exercise, and between time spent indoors and time spent outdoors and so on.
• Flexibility: of opinions, of expectations, emotions
• Self–actualization: ability to recognize our gifts and make our dreams come true.
• The ability to form healthy relationships with others.
• Good self–esteem
• Healthy sexuality.²

A Scale to measure mental health

A practical scale which is useful in understanding what mental health is the one designed by the American Psychiatric Association (APA) and is called Global Assessment of Functioning (GAF).3 It considers psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness, in a scale of 100 to 0, 100 being the ideal mental health status and 1 being the worst mental health status.

91 to 100%

Anyone with GAF score of between 91 to 100% has superior functioning in a wide range of activities.
life’s problems never seem to get out of hand.
He is sought out by others because of his or her many positive qualities.
He has no emotional problems like sadness, anxiety, excessive happiness, perplexity; no abnormal thoughts like like delusions, obsession, incoherence and so on; no cognition symptomes like problems of attention, concentration, memory, judgment, panning,calculation and so on; no perception probelms like hallucination of any sensory modality; and no behaviourioural probelms like aggression, restlessness, poor sleep.

In other words, a person with the score of 91 -100 doesn’t have any of these symptoms whatsoever: doesn’t have problems with sleep for whatever reason, is never sad in face of adversity, never anxious when preparing for exams or job interview, in total control of situations and circumstances. If you do not think your self rating gives you this GAF score, there is room for improvement.

81 to 90%

Absent or minimal symptoms (e.g. mild anxiety before an exam).
Good functioning in all areas.
Interested and involved in a wide range of activities.
Socially effective.
Generally satisfied with life.
No more than everyday problems or concerns (e.g., has occasional arguments with family members, but NO difficulty concentrating after family argumen.
No sad mood over loss of a loved one to cause even slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

71 to 80%

If symptoms are present, they are transient and expected reactions to psychosocial stressors (e.g., difficulty concentrating after family argument, sad mood over loss of a loved one).
no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

61 to 70%

Some mild symptoms (e.g., depressed mood, anxious mood, mild poor sleep, crawling sensation over the body, peperish sensation on the body, tension headache)
OR some difficulty in social,occupational, or school functioning (e.g., occasional truancy, or theft within the household)
But generally functioning pretty well
Has some meaningful interpersonal relationships.

So far all the ranges we have considered have to do with people considered to be mentally healthy. But as you can see, some are more mentally health than others. It is important to note that someone who scores 71 to 80 today can score 61 to 70 tomorrow. We fluctuate along the continuum depending on the stressors at hand, our constitutional make ups, and prevailing environmental factors.

The next sets of scores are for those said to have poor mental health or, in other words, mental disorders. According to scientific research findings, one in four families is likely to have at least one member with a mental disorder; about one in ten of people all over the world has mental disorder at any point in time; and more than 25% of all people are expected to be at some points during their lives1.

51 to 60%

Moderate symptoms (e.g., emotionally cold and circumstantial speech, occasional panic-anxiety attacks)
OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).
Someone with a score in this range needs help, but himself may not know, or may not know what kind of help he needs due to ignorance. And people around him might think he is only proving difficult to relate or work with. No he needs help.

41 to 50%

Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting)
OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

People with score of 41 to 50% and 51 to 60% are said to have minor mental illness or non–psychotic mental illness

What of people with GAF score of below 41? These are people categorized as having major mental disorders, otherwise called psychotic disorders. These are the people you call mad because you don’t know what else to call them.

For the purpose of knowing who needs help, it is expedient to note that there are more than 400 types of mental disorders according to the WHO’s 10th edition of International Classification of Disease (ICD)4 and that less than ten of this are psychotic. For example poor sleep for at least three nights a week for at least two weeks in the absence of physical problem is a recognized mental disorder, needing therapy.

It is also expedient to note that the measure of mental health and mental illness is a continuum and that any body can slide down or up at anytime. So if you happen to know someone down the scale, it for you to offer all the help you can rather that mock, despise or run away from him.

31 to 41%

Some impairment in reality testing (delusion and hallucination) or communication (e.g., speech is at times illogical, obscure, or irrelevant)
OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood. (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

21 to 30%

Behavior is considerably influenced by delusions or hallucinations
OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation)
OR inability to function in almost all areas (e.g.,stays in bed all day; no job, home, or friends).

11 to 20%

Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement)
OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces)
OR gross impairment in communication (e.g., largely incoherent or mute).

1 to 10%

Persistent danger of severely hurting self or others (e.g., recurrent violence)
OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

0%

Inadequate information.

Can you place yourself at any point in this continuum between 0 and 100%? The lower you score yourself, the more the need to improve your mental health. As you can see from the scale, just as health is not the same thing as absence of disease, mental health is broader than a lack of mental disorders1.

Mental Health Hygiene

Mental health hygiene is the science of promoting mental health and preventing mental illness through the application of psychiatry and psychology5. Good “hygiene“ is anything that helps you to have a healthy life6. Here are some tips.

ACRONYM: A SQUARE, B SQUARE, C SQUARE, D SQUARE, R, S SQUARE

• Acquire adequate information on the nature and requirements of good mental health: books, internet, professional within reach
• Adaptive Coping skills/ Social skills acquisition
• Body Exercise
• Belt: car seat belt to limit injury from road traffick accidents; psychological belt to guard against both physical and psychological bruises
• Concerted efforts: clubs for promoting mental health; self-help groups
• Cry out for help: know when to seek professional help and do it on time.
• Drug free life: alcohol, cigarette, Indian hemp, cocaine, heroin, valium, amphetamine pentacozine, brenyln with codeine, pethidine
• Diet: adequate and safe
• Relaxation Techniques: progressive muscle relaxation, isometric muscle relaxation etc
• Stigmatize not the mentally ill: Do unto others what you’ll like them to do to you.
• Serenity prayer: “God grant me the fortitude to bear what I can not change, the courage to change what I can, and the wisdom to know the difference”

References

WHO (2001) The World health report : 2001 : Mental health : new understanding, new hope.
What is mental health? http://mentalhealth.about.com/cs/
stressmanagement
/a/whatismental.htm (Accessed: 15/09/07)
APA 1994. Diagnostic and statistical Manual of Mental Disorders 4th edition. APA washinton, DC
WHO. (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic guidelines. Oxford University Press. Oxford 5. www.encyclopedia.com/doc/1E1- metalhy.html
www.google.co.za/search?hl=en &q=sleep%2Bhygiene&
btnG=Google+Search&meta=Sleep hygeien