The Three Pillars of Mental Health:

Hello and Happy New Year! I hope that you had a wonderful festive period and that you are all set to have a positive and productive 2021.

The Covid-19 pandemic is still with us, of course, and it has certainly had a detrimental impact on mental health, with anxiety levels continuing to escalate. Many of you may well be suffering with anxiety, depression, stress and worry as a result of the pandemic (things I wrote about a lot last year if you scroll through my blog pages).

There are many things you can proactively do to support your mental health and to reduce symptoms of anxiety, stress and depression. It certainly is possible to deal with those unwanted thoughts and feelings so that you feel better and happier. The research evidence I've mentioned below certainly l suggests that our mental health has been impacted.

In this article, I'm talking about the three pillars of mental health that were published in a research paper at the end of last year.

Sadly, one of the actions for improving your mental health doesn't include chatting with kangaroos! You may have missed the news at the end of last year that animals that have never been domesticated, such as kangaroos, can intentionally communicate with humans (McElligott, O'Keeffe, & Green, 2020). I think that is pretty incredible stuff (almost out of the Scooby-do cartoons that my daughter keeps watching). I think talking with kangaroos would certainly boost my sense of well-being, although personally I'd rather have a penguin as a pal (and keep in mind that there is scientific evidence for the mental health benefits of pets, as I've covered before).  

I like the idea of communicating with animals, although that's got nothing to do with this article about the impact of the pandemic and the three pillars of good mental health.

happy new year anxiety hypnotherapy in ely


Anxiety in the Covid-19 Pandemic

It is beyond doubt that the Covid-19 pandemic has had an impact on mental health.

During the second lockdown in England last November, I wrote about how data from the Office for National Statistics found that more than found that more than three quarters of adults were very or somewhat worried about the effect of coronavirus (Covid-19) on their life. Levels of worry had been increasing over the months as the pandemic endured and anxiety levels had remained at their highest since the start of April.

More and more evidence demonstrates that this Covid-19 pandemic is impacting on mental health for many of you. As well as fears about contracting the virus, there are worries about the future, impacts on meeting and interacting with others, difficulties planning, impacts on work and education and many other factors that lead to these high levels of Covid-19 anxiety and stress.

Whilst the vaccine might have started to roll out, we are all still going to be living with Covid-19, restrictions and everything else the pandemic entails for some time yet. We've been living with all this for approaching a year now, and I know many of you have had way more than enough of the pandemic, and there are of those of you who are just tired and fatigued with it all.  

I wrote more about mental health and the pandemic, its impacts and things you can do to support your mental health in this article: Protecting Your Mental Health During The Second Lockdown

We also have more recent evidence for the impact of the Covid-19 pandemic on anxiety levels. Santabárbara et al (Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. 2020) conducted a systematic review and meta-analysis to determine the prevalence of anxiety in the general population during the Covid-19 pandemic and found that anxiety in the general population has increased 3-fold during the Covid-19 outbreak. 

"As the overall global prevalence of anxiety disorders is estimated to be 7.3% normally, our results suggest that rates of anxiety in the general population could be more than 3 times higher during the COVID-19 pandemic. These findings suggest a substantial impact on mental health..."

Further evidence of the impact of the Covid-19 pandemic on mental health comes from Pan et al (The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. 2020), who found that people with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the pandemic.

Here in England there is perhaps a little positive news during this pandemic, with a study by Fancourt, Steptoe & Bu (Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. 2020) suggesting that the highest levels of depression and anxiety occurred in the early stages of the first lockdown and then declined fairly rapidly, possibly because individuals adapted to circumstances. However, they also highlight that groups of people already at risk for poor mental health (such as women and younger adults) before the pandemic remained at risk throughout lockdown and its aftermath.

Their study found that being female or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depressive symptoms at the start of lockdown and that these inequalities in experiences were still evident many weeks later.

If you are struggling with anxiety, or your mental health is being affected, it's more important than ever to take positive action to help you feel better. There are plenty of straightforward suggestions of things you can do for your mental health in the article I linked to earlier. And if you want to improve your mental health, or even if you want to maintain good mental health, there are three areas of life that it is worth paying more attention to.

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The Three Pillars of Good Mental Health

Whenever I am working with someone I always ask about their levels of exercise and the quality of their sleep. Whether it's related to anxiety, stress, depression, weight loss or anything else, I want to know about these areas of their life (amongst others) because we know exercise is good for your mental health, and sleep deprivation is not.

And while we know that sleep, physical activity, and diet are associated with mental health and well-being, we now also have research and evidence about which of them most strongly predicts mental health and well-being following the publication of a study by Wickham, Amarasekara, Bartonicek & Conner (The Big Three Health Behaviors and Mental Health and Well-being among Young Adults: A Cross-sectional Investigation of Sleep, Exercise, and Diet. 2020). Whilst this research looked specifically at young adults, I think there are valuable insights here for all of us, especially as we already know how important these three pillars of mental health are from other research.

As the authors note, healthy lifestyles are important contributors to both physical and mental health. Getting high-quality sleep, engaging in physical activity, and eating well not only have advantages to physical health, but also have advantages to mental health such as reduced risk of depression and anxiety and increased psychological well-being.

When comparing these three mental health pillars, they found that sleep quality is an important predictor of mental health and well-being, whereas physical activity and diet are secondary but still significant factors in mental health.

"This study highlighted the relative contribution of sleep, physical activity, and diet to the prediction of depressive symptoms and flourishing. Our findings suggest that future lifestyle interventions targeting sleep quality may be most beneficial at improving mental health and well-being. However, physical activity and diet should not be disregarded, particularly as they also uniquely predicted differences in depressive symptoms (physical activity) and well-being (physical activity and raw fruit and vegetable intake). Sleep, physical activity, and a healthy diet should be thought of as multiple tools for promoting optimal mental health and well-being."

The importance of prioritising your sleep is also borne out by some other research that provides robust evidence that sleep loss is affecting more people during the Covid-19 pandemic than previously, reflecting the fact that stress levels have risen due to anxieties about health, financial consequences, changes in social life and the daily routine (Falkingham et al (Sleepless in Lockdown: unpacking differences in sleep loss during the coronavirus pandemic in the UK. 2020)). There's more on this here: Coronavirus and Mental Health - Sleep Deprivation and Dreaming.

This research by Wickham, Amarasekara, Bartonicek & Conner adds to the evidence supporting how important it is that you get enough good quality, undisturbed sleep each night to support your mental health, as inadequate sleep is a risk factor for both anxiety and depression. Whilst those with insomnia or sleep disorders may benefit from individual therapy, for many of you it may mean giving more priority to good sleep hygiene and prioritising night time over getting more stuff done or being online. You can also make use of many of the same strategies and techniques that quieten thoughts and feelings from overthinking, worry and anxiety that I've covered before now.

It also makes sense to incorporate another of the mental health pillars, physical activity into your day. There is a mass (again as I've covered many times before) of evidence supporting how exercise supports your mental health and can reduce symptoms of anxiety and depression (and on the flip side, how too much sedentary time can have a negative impact on your physical and mental health).

If you want to support your mental health, you can also take a look at your diet and what you eat. Having a healthy diet is associated with reduced risk of depression and improved mood. Start tweaking your eating planning and choices, reduce sugar intake and eat more fruit and vegetables.

If you want to reduce anxiety and depression symptoms and have a better sense of well-being and mental health then it's worth paying attention to all three of these areas. This research suggests improvement around sleep quality should be your number one focus, but by adding a bit more physical activity and amending a few eating decisions to healthier things, you can begin to nudge all three areas forwards.

If you need any help with sleep issues, motivation, focus, healthier eating or anything else then do get in touch. And, to make 2021 a year of good mental health, be sure to take action in your life  on these three pillars of good mental health. 

Wishing you good mental health for 2021,

Dan Regan

Hypnotherapy in Ely & Newmarket


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Falkingham, J., Evandrou, M., Qin, M. and Vlachantoni, A., 2020. Sleepless in Lockdown: unpacking differences in sleep loss during the coronavirus pandemic in the UK. medRxiv.

Fancourt, D., Steptoe, A. and Bu, F., 2020. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. The Lancet Psychiatry.

McElligott, A.G., O'Keeffe, K.H. and Green, A.C., 2020. Kangaroos display gazing and gaze alternations during an unsolvable problem task. Biology Letters16(12), p.20200607.

Pan, K.Y., Kok, A.A., Eikelenboom, M., Horsfall, M., Jörg, F., Luteijn, R.A., Rhebergen, D., van Oppen, P., Giltay, E.J. and Penninx, B.W., 2020. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. The Lancet Psychiatry.

Santabárbara, J., Lasheras, I., Lipnicki, D.M., Bueno-Notivol, J., Moreno, M.P., López-Antón, R., De la Cámara, C., Lobo, A. and Gracia-García, P., 2020. Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Progress in Neuro-Psychopharmacology and Biological Psychiatry, p.110207.

Wickham, S.R., Amarasekara, N., Bartonicek, A. and Conner, T., 2020. The Big Three Health Behaviors and Mental Health and Well-being among Young Adults: A Cross-sectional Investigation of Sleep, Exercise, and Diet. Frontiers in Psychology11, p.3339.