What is Social Inhibition?


Social inhibition is a conscious or subconscious avoidance of a situation or social interaction.

With a high level of social inhibition, situations are avoided because of the possibility of others disapproving of their feelings or expressions. Social inhibition is related to behaviour, appearance, social interactions, or a subject matter for discussion. Related processes that deal with social inhibition are social evaluation concerns, anxiety in social interaction, social avoidance, and withdrawal.

Also related are components such as cognitive brain patterns, anxious apprehension during social interactions, and internalising problems. It also describes those who suppress anger, restrict social behaviour, withdraw in the face of novelty, and have a long latency to interact with strangers. Individuals can also have a low level of social inhibition, but certain situations may generally cause people to be more or less inhibited. Social inhibition can sometimes be reduced by the short-term use of drugs including alcohol or benzodiazepines.

Major signs of social inhibition in children are cessation of play, long latencies to approaching the unfamiliar person, signs of fear and negative affect, and security seeking. Also in high level cases of social inhibition, other social disorders can emerge through development, such as social anxiety disorder and social phobia.


Social inhibition can range from normal reactions to social situations to a pathological level, associated with psychological disorders like social anxiety or social phobia. Life events are important and are related to our well-being and inhibition levels. In a lab study conducted by Buck and colleagues, social inhibition in everyday life was reviewed. Researchers observed how individuals interacted and communicated about different stimuli. In this study, there were female participants called “senders” who viewed twelve emotionally loaded stimuli. There were also participants in the study called “received” who had to guess which stimuli was viewed by the senders. The senders were either alone, with a friend, or with a stranger while viewing the slides. The results of the study revealed that being with a stranger had inhibitory effects on communication, whereas being with a friend had facilitative effects with some stimuli and inhibitory effects with others. The results show how anyone can be inhibited in daily life, with strangers or even friends. Inhibition can also be determined by one’s sensitivity levels to different social cues throughout the day. Gable and colleagues conducted a study in which they examined different events participants would record at the end of their day. Participants were also measured on the behavioural activation system and the behavioural inhibition system. The results revealed that individuals with more sensitivity on the behavioural inhibition system reported having more negative effects from daily events.

Expression can also be inhibited or suppressed because of anxiety to social situations or simple display rules. Yarczower and Daruns’ study about social inhibition of expression defined inhibition of expression as a suppression of one’s facial behaviour in the presences of someone or a perceived anxious situation. They addressed the display rules we all learn as children; we are told what expressions are suitable for what situations. Then as age increases we are socialised into not expressing strong facial emotions. However, leaving the face with a reduced expression hinders communication. In turn this makes the face a less reliable social cue during social interactions. Friedmen and Miller-Herringer bring these nonverbal expressions to the next level by studying individuals that have a greater level of emotional suppression. They state that without proper emotional expression social interactions can be much more difficult because others may not understand another individual’s emotional state.

This being said, there are also four commonly seen irrational cognitive patterns involved in social inhibition. The first pattern centres on self-esteem and perfectionism. In these cases, an individual would inhibit themselves through self-criticism; they want to do everything the “right” way. The second pattern deals with unrealistic approval needs; here individuals want to gain the approval of others and will fear rejection if they express too much. In the third pattern, unrealistic labelling of aggressive and assertive behaviour depicts how many individuals that inhibit themselves may feel as though aggression or assertiveness is bad. They believe if they express these behaviours they will receive a negative label. The last pattern discusses criticism of others, this pattern is a spin-off from the first. They will be highly critical of others much like they are to themselves. Shyness is another factor that is a part of social inhibition. Shyness is associated with low emotional regulations and high negative emotions. In many cases shy individuals have a greater change of social inhibition.

Although social inhibition is a common part of life, individuals can also have high levels of inhibition. Social Inhibition on higher levels can sometimes be a precursor to disorders such as Social Anxiety Disorder. Essex and colleagues found that some early risk factors may play a role in having chronically high inhibition. In this study, mothers, teachers, and the child reported on the child’s behavioural inhibition. The factors that were found to be contributors to social inhibition were female gender, exposure to maternal stress during infancy and the preschool period, and early manifestation of behavioural inhibition. In severe cases, clinical treatment, such as therapy, may be necessary to help with social inhibition or the manifesting social disorder.

Over the Lifespan

Social inhibition can develop over a lifespan. Children can be withdrawn, adolescents can have anxiety to social situations, and adults may have a hard time adjusting to social situations which they have to initiate on their own. To be inhibited can change and be different for many. In many cases, inhibition can lead to other social disorders and phobias.

Infants and Children

In infants and children, social inhibition is characterised by a temperament style that will have children responding negatively and withdrawing from unfamiliar people, situations and objects. In addition to cessation of play, inhibited children may display long latencies to approaching an unfamiliar person, signs of fear and negative affect, and security seeking. Avoiding behaviour can be seen at a very young age. In one study, Fox and colleagues found that even at four months of age some infants had negative responses to unfamiliar visual and audio stimuli. The study was longitudinal; therefore, follow ups revealed that half the infants who had high negative responses continued to show behavioural inhibition through the age of two. Fox’s longitudinal study reported that the expression of behavioural inhibition showed a small degree of continuity. Over time, the toddlers who were quiet and restrained continued the trend into childhood by being cautious, quiet, and socially withdrawn. The uninhibited control group of the same ages continued to interact easily with unfamiliar people and situations. There has also been a link between inhibition at childhood age with social disorders in adolescents and adulthood. Schwartz and Kagan found that in a longitudinal study from ages two to thirteen, sixty-one percent of teens who had inhibitor traits as toddlers reported social anxiety symptoms as adolescents, compared to twenty-seven percent of adolescents who were uninhibited in earlier life. However, not every child that has some withdrawn or inhibited behaviour will be inhibited as an adolescent or manifest a social disorder.

The caregiver alone is not solely responsible for inhibition in children; however, in some cases it can be a factor. Caregivers can affect the inhibition levels of their child by exposing the child to maternal stress during infancy and the preschool period. In addition, in some situations the child may simply have early manifestation of behavioural inhibition. There seems to be no parenting style that researchers agree on to be the best to combat social inhibition. Park and Crinic say that a sensitive, accepting, overprotective parenting is best to reduce the negative behaviours because it will allow the child to be themselves without judgement. However, Kagan hypothesized that firm parenting styles are better suited for socially inhibited children. Researchers supporting sensitive parenting believe that too firm of a parenting style will send a message to children that says they need to change.


Social inhibition has been widely studied in children; however, research on how it develops through adolescence and adulthood is not as prevalent, although anxiety-related social problems are most commonly seen in adolescents. Many of the behavioural traits are the same in adolescence as they are in childhood: withdrawing from unfamiliar people, situations and objects. However, it has been tested that adolescents are more aware of their social situations and are more likely to be inhibited in public settings. Researchers found younger individuals to be more likely to differentiate between public and private settings when inquiring about potentially embarrassing issues. It is also thought that inhibition is in many ways addressed in childhood and adolescence simply because schools facilitate interactions with others. As an adult, the same facilitating circumstance may not occur unless the individual prompts them on their own. Gest states that adults do not have as many casual peer interactions and friendship opportunities that guide and support relationships unless they facilitate them on their own. Adolescent research has also shown that social inhibition is associated with a more negative emotional state in young men than women.

This is in contrast to a study that measured inhibition levels through self reports from the adolescent and their parents. West and Newman found that young American Indian women and their parents reported higher levels of inhibition than young American Indian men; in addition, the parental reports also predicted social anxiety in young American Indian women over young American Indian men. In this same study, relationship development with peers was investigated over time. West and Newman stated that low levels of behavioural inhibition had an association with early social and school situations and that were related to greater levels of socially mediated anxiety, especially negative evaluation of fear by peers. This study then speculates about the possibility that adolescents and children who have a generally positive social experience will be more aware of the status of these positive relationships, therefore more anxious about failure in their social domain. Other studies also discussed how in many cases, early behavioural inhibition is a risk factor for the development of chronic high school-age inhibition and possible social anxiety disorder. Although social inhibition can be a predictor of other social disorders there is not an extremely large portion of adolescents who have developed an anxiety disorder and also had a history of inhibition in childhood.

Besic and Kerr believes that appearance can be a factor for social inhibition. In their study they hypothesized that a way to handle difficult situations with behavioural inhibition was to present an off-putting appearance. They examined “radical” crowds, such as those labelled as goths and punks and if their appearances fulfilled a functions for their inhibition. They state that a radical style could be used to draw away the social boundaries and relieve them of pressures or expectations to interact in unfamiliar situations with unfamiliar peers. Another possibility is that an individual may be self-handicapping to ensure that they will not have to interact with unfamiliar peers. The results revealed that radicals were significantly more inhibited than other groups. However, there are other inhibited individuals in other social classifications. The highest inhibited radical was no more inhibited than the highest inhibited individual in other groups.


Adult cases of social inhibition are hard to come by simply because many see it as something that happens through development. Although research is lacking, developmental considerations suggest there may be a stronger association between behavioral inhibition and peer relations in adulthood. One researcher says this lack of information may be because adults are not put in as many socially interactive situations that would guide them through the situation. It would seem that adults have an increased responsibility to initiate or structure their own social peer relationships; this is where social inhibition could have a more problematic role in adulthood than in childhood. One study that did contribute to adult research used questionnaires to study both clinical and nonclinical adults. Like in adolescence, behavioral inhibition was also found to be associated with anxiety disorders in adulthood. In addition the study found that childhood inhibition was specifically a factor in a lifetime diagnosis of social phobia. Gest also measured adult peer relations, and to what degree they had a positive and active social life. For example, researchers wanted to know if they participated in any recreational activities with others, how often they met with others, and if they had any close confiding relationships. The participants were rated on a 5-point scale on each peer relationship they disclosed. The results revealed that social inhibition had nothing to do with popularity, however it was correlated with peer relations in both genders and emotional stress in only men.

A similar study found that some shy men had a low occupational status at age forty because they entered their career later in life. However, another researcher has commented on this giving this example, perhaps remaining at home longer allows young adults to accumulate educational and financial resources, before moving out and becoming more independent. Additionally it was found that young adults who were inhibited as children were less likely to move away from their families. There is also some discussion of the inhibition through generations and children mirroring their parents. Results indicated that children whose birth mothers met criteria for the diagnosis of social phobia showed elevated levels of observed behavioural inhibition. Social inhibition can decrease with age due to cognitive deficits that can occur in old age. Age-related deficits have an effect on older adults’ ability to differentiate between public and private settings when discussing potentially embarrassing issues, leading them to discuss personal issues in inappropriately public situations. This suggests that deficits in inhibitory ability that lead to inappropriateness are out of the individual’s control.

In Different Contexts

In Schools

Schools can be a place for children to facilitate different social interactions; however, it can also uncover social and school adjustment problems. Coplan claims that Western children with inhibition problems may be at a higher risk of developmental problems in school. Although social inhibition may be a predictor of social and school adjustment problems in children, Chen argues that the effect of social inhibition on school adjustment differs between Western cultures and Chinese culture. Chen found that in Chinese children, behavioural inhibition was associated with greater peer liking, social interaction, positive school attitudes, and school competence and fewer later learning problems, which is also different from western cultures. In other studies, researchers such as Oysterman found there to be difficulties in adjustment in children that were experiencing inhibition. In Western cultures, these difficulties are seen more because of the emphasis on social assertiveness and self-expression as traits that are valued in development. In other cultures children are sometimes expected to be inhibited. This does not contrast with other cultures in which children are socialised and assert themselves. Despite these differences there are also similarities between gender. Boys were more antagonistic in peer interaction and seemed to have more learning problems in school. Girls were more cooperative in peer interaction and had a more positive outlook on school. They formed more affiliations with peers, and performed more completely in school.

Other researchers like Geng have looked to understand social inhibition, effortful control, and attention in school. In Geng’s study, gender came in to play with high socially inhibited girls being extremely aware of their surroundings, possibly paying too much attention to potentially anxious situations. It is well known in a large number of research studies social inhibition had been linked to other anxiety disorders. However Degnan and colleagues believe that being able to regulate your effortful control may serve to reduce the anxiety the comes from inhibition. Nesdale and Dalton investigated inhibition of social group norms in school children between the ages of seven and nine. In schools there becomes an increase in social in-groups and out-groups as children increase in age. This study created different in-groups or exclusive groups and out-groups or inclusive groups. The results showed that students in the inclusive group liked all students more, while students in the exclusive group like their group over other groups. This study could help in the future to facilitate school peer groups more efficiently.

In the Workplace

Social inhibition can manifest in all social situations and relationships. One place that we can see the effects of social inhibition is in the workplace. Research has shown that social inhibition can actually affect the way that one completes a given amount of work. In one experiment, participants completed a task in a laboratory setting, varying whether or not another individual was present in the room with the participants while they attempted to complete the task. The results showed that when another individual was present in the room the person focused on completing the experimental task decreased their body movements, hand movements, and vocalisation, even though the other person did not speak to or even look at the participant. This suggests that just the mere presence of another person in a social situation can inhibit an individual. However, although the individual in charge of completing the experimental task was socially inhibited by the presence of another person in the laboratory, there were no significant links between their social inhibition when completing the task and improved performance on said task. These findings suggest that an individual may socially inhibit themselves in the work place if another person is also in the room, however, such inhibition does not suggest that the inhibited individual is actually performing the duties assigned to them with more accuracy or focus.

In Psychological Disorders


Links between social inhibition and depression can be found in individuals who experienced social inhibited behaviours during childhood. Researchers from the UK conducted a study in an attempt to explain possible links between social inhibition in infancy and later signs of depression. The researchers based their study on previous information from literature acknowledging that there are social and non-social forms of inhibition, and that social inhibition is significantly related to early social fears. The researchers hypothesized that social inhibition in childhood would be linked to higher levels of depression in later years. Participants completed a number of questionnaires about their experiences of social inhibition in childhood and their current levels of depression. Results showed a significant relationship between depression and recalled social fears, or, social inhibitions during childhood. Furthermore, the researchers related their findings to another study conducted by Muris et al., in 2001 which found that there is an association between social inhibition and depression in adolescents. The study compared adolescents who were not inhibited to those who are, and found that:

“adolescents experiencing high levels of behavioral inhibition were more depressed than their counterparts who experienced intermediate or low levels of behavioral inhibition”.

Another study set out to examine the link between social inhibition and depression, with the basis for their study being that social inhibition (which they explain as a part of type D personality, or distressed personality) is related to emotional distress. The researchers explain that a major factor related to social inhibition is the inhibited individual not expressing their emotions and feelings, a factor that the researchers cite in relation to the link between social inhibition and depression. Overall, the results of the study show that social inhibition (as a factor of type D personality) predicts depression, regardless of the baseline depression level of the individual. Significantly, this study was conducted with young, healthy adults, as opposed to working with those in self-help groups or with individuals who have a pre-existing medical or psychological condition.


Social inhibition can be affected by fear responses that one has in the early “toddler years” of their life. In 2011, researchers Elizabeth J. Kiel and Kristin A. Buss examined “how attention toward an angry-looking gorilla mask in a room with alternative opportunities for play in 24-month-old toddlers predicted social inhibition when children entered kindergarten”. In the study, the researchers specifically looked at the toddlers’ attention to threat and their fear of novelty in other situations. The researchers paid special attention to these two factors due to previous research suggesting that “sustained attention to putatively threatening novelty relates to anxious behavior in the first 2 years of life”. Also, it has been found in earlier research conducted by Buss and colleagues that no matter the differences, individual responses to novelty during early childhood can be related to later social inhibition. These results already link fear responses, particularly in children, to social inhibition, mainly such inhibition that manifests later on in the individual’s life. Overall, the researchers based their experiment on the notion that the more time a toddler spends being attentive towards a novel potential threat the greater the chance that they will experience issues with the regulation of distress, which can predict anxious behaviour such as social inhibition.

Through a study intended to further connect and understand links between fear and late social inhibitions, the researchers conducted a study where they worked with 24-month-old toddlers. They placed the toddlers in a room called the “risk room” which is set up with a number of play areas for the toddlers to interact with, with one of those areas being a potentially threatening stimulus, in this case, an angry looking gorilla mask. The children are left alone, with only their primary caregiver sitting in the corner of the room, to explore the play areas for three minutes, and then the experimenter returns and instructs the toddler to interact with each of the play areas. The purpose of this was to allow for other experimenters to code the reactions of the toddler to the stimuli around him or her, paying special attention to their attention to threat, their proximity to the threat, and their fear of novelty.

The results of this study indicate that attention to threat (attention given, by the toddler to the feared stimuli) predicts social inhibition in kindergarten. Further, if the child approaches the feared stimuli, the relation to later social inhibition is not significant. When a child’s behaviour is to keep more than two feet away from the threatening stimulus, their behaviour can be seen as linked to later social inhibition. Another important factor that the researchers found when looking at the prediction of social inhibition is the child paying a significant amount of attention to a feared or threatening stimuli in the presence of other, enjoyable activities. Mainly, if the child’s duration of attention to the threatening stimuli is significant even when there are other enjoyable activities available for them to interact with, the link to later social inhibition is stronger due to the fact that “toddler-aged children have increased motoric skill and independence in exploring their environments; so they are capable of using more sophisticated distraction techniques, such as involvement with other activities”.

In another study looking at social inhibition and fear, the researchers made the distinction between different forms of inhibition. Mainly looking at behavioural inhibition the researchers separated the category into two subcategories, social behavioural inhibition and non-social behavioural inhibition. The researchers cite an experiment conducted by Majdandzic and Van den Boom where they used a laboratory setting to attempt to elicit fear in the children. They did this by using both social and non-social stimuli. What Majdandizic and Van der Boom found was a variability in the way that fear was elicited in the children when using either the social or non-social stimuli. Essentially, this study realised that there is a correlation between social stimuli producing fear expressions in children, whereas non-social stimuli is not correlated to fear. This can be evidence of social inhibition due to the social stimuli that result in fear expressions in children.

The researchers of the current study took the results from the Majdandizic and Van der Boom study and expanded on their work by looking at variability in fear expressions in both socially inhibited children and non-socially inhibited children. What they found was that mainly socially inhibited children have effects such as shyness and inhibition with peers, adults, and in performance situations, as well as social phobia and separation anxiety. The stronger link with fear reactions comes mainly from those children who were non-socially behaviourally inhibited. While these results go against previous findings, what the researchers were eager to stipulate was that “the normative development of fear in children have indicated that many specific fears (e.g. fear of animals) decline with age, whereas social fears increase as children get older”.

Social Phobia

Social inhibition is linked to social phobia, in so much as social inhibition during childhood can be seen as a contributing factor to developing social phobia later on in life. While social inhibition is also linked to social anxiety, it is important to point out the difference between social anxiety and social phobia. Social anxiety is marked by a tendency to have high anxiety before a social interaction, but not experience the avoidance of the social activity that is associated with social phobia. Social phobia and social inhibition are linked in a few different ways, one being physiologically. When one is experiencing extreme levels of inhibition they can suffer from symptoms such as accelerated heart rate, increased morning salivary cortisol levels, and muscle tension in their vocal cords. These symptoms are also reported by those with social phobia, which indicates that both social inhibition and social phobia interact with the sympathetic nervous system when the individual encounters a stressful situation.

Further, it is suggested throughout literature that social inhibition during childhood is linked to later social phobia. Beyond that research has indicated that continuity in inhibition plays an important role in the later development of social phobia. Continuity of social inhibition means someone experiencing social inhibition for a number of year continuously. The research explains work done with young teenagers, which found that the teenagers who had been classified as inhibited 12 years earlier were significantly more likely to develop social phobia than young teenagers who were not classified as inhibited. This research pertains to the link between social inhibition and generalised social phobia, rather than specific phobias. When looking at continuity in social inhibition some research offers reasoning as to why the social inhibition may continue long enough to be a predictor of social phobia. Researchers have suggested that if the early childhood relationships are not satisfactory they can influence the child to respond to situations in certain inhibitory ways. When this happens it is often then associated with poor self-evaluation for the child, which can lead to increased social inhibition and social phobia. Also, if a child is neglected or rejected by their peers, rather than by their caregiver, they often develop a sense of social failure, which often extends into social inhibition, and later social phobia. The link between social inhibition and social phobia is somewhat exclusive, when testing for a possible link between non-social inhibition and social phobia no predictive elements were found. It is particularly social inhibition that is linked to social phobia.

The research also suggests that social inhibitions can be divided between different kinds of social fears, or different patterns of inhibition can be seen in individuals. The researchers suggest that certain patterns, or certain social fears, can be better predictors of social phobia than others. Mainly, the researchers suggest that there can be different patterns of social inhibition in relation to an unfamiliar object or encounter. These specific patterns should be looked at in conjunction with motivation and the psychophysiological reaction to the object or encounter to determine the specific patterns that are the better predictors of social phobia.

Another study aimed to examine the link between social inhibition and social phobia also found that social phobia is linked to the social phobic being able to recall their own encounters with social inhibition during childhood. The social phobic participants were able to recall social and school fears from their childhood, but they also were able to recall sensory-processing sensitivity which indicates that the social phobic participants in the study were able to recall having increased sensitivity to the situations and behaviours around them.

Another study explains that social phobia itself has a few different ways it can manifest. The study aims at understanding the link between social inhibition and social phobia, as well as depression in social phobia. What the study found was an important link connecting the severity of social inhibition during childhood to the severity of social phobia and factors of social phobia in later years. Severe social inhibition during childhood can be related to lifetime social phobia. Further, the researchers point out that inhibition during childhood is significantly linked to avoidant personality disorder in social phobia as well as childhood inhibition linked with major depressive disorder in social phobia that spans across the individual’s lifetime. A major suggestion related to the results of the study suggested that while inhibition can be a general predictor of risk factors related to social phobia, it may not be a specific predictor of social phobia alone

Social Anxiety Disorder

Social anxiety disorder is characterised by a fear of scrutiny or disapproval from others. Individuals believe this negative reaction will bring about rejections. Individuals with social anxiety disorder have stronger anxious feeling over a long period of time and are more anxious more often. In many cases, researchers have found that social inhibition can be a factor in developing other disorders such as social anxiety disorder. Being inhibited does not mean that an individual will develop another disorder; however, Clauss and colleagues conducted a study to measure the association between behavioural inhibition and social anxiety disorder. The results of the study discovered that 15% of all children have behavioural inhibition and about half of those children will eventually develop social anxiety disorder. This is why behavioural inhibition is seen as a larger risk factor.

That being said, Lim and colleagues researched the differences between early and late onset of social anxiety disorder and its relation to social inhibition. Through the duration of their study, they found those diagnosed as early onset had complaints other than ones about social anxiety symptoms. Early onset individuals would frequently have more severe symptoms and higher levels of behavioural inhibition. Additional behavioural inhibition was more severe especially in social and school situations with only the early onset cases. Lorian and Grisham researched the relationship between behavioural inhibition, risk-avoidance, and social anxiety symptoms. They found that all three factors correlated with each other and risk avoidance is potentially a mechanism linked to an anxiety pathology.


Alcohol Consumption

Social inhibition can be lowered by a few different factors, one of them being alcohol. Alcohol consumption can be seen to lower inhibitions in both men and women. Social inhibitions generally act to control or affect the way that one conducts themselves in a social setting. By lowering inhibitions alcohol can work to increase social behaviours either negatively or positively. Importantly, one must remember that the higher the dosage of alcohol, the greater the damage it will cause to inhibitory control.

By lowering inhibitions, alcohol can cause social behaviours such as aggression, self disclosure, and violent acts. Researchers have suggested that situational cues used to inhibit social behaviours are not perceived the same way after someone consumes enough alcohol to qualify them as drunk:

“interacting parties who are impaired by alcohol are less likely to see justifications for the other’s behavior, are thus more likely to interpret the behavior as arbitrary and provocative, and then, having less access to inhibiting cues and behavioral standards, are more likely to react extremely.”

This idea of increased extreme social behaviours is believed to come as a result of lowered inhibitions after consuming alcohol. Alcohol can lower inhibitions for a number of reasons, it can reduce one’s self-awareness, impair perceptual and cognitive functioning, allows for instigator pressures to have more influence over an individual, and can reduce one’s ability to read inhibitory social cues and standards of conduct.

When attempting to examine the effects that alcohol consumption has on social inhibition researchers found that after being provoked sober individuals used inhibiting cues, such as the innocence of the instigator and the severity of the retaliation to control their response to the aggressive provocation. However, the researchers found that an intoxicated individual did not have these same inhibitions and, as a result, exhibited more extreme behaviours of retaliated aggression to the provocation without processing information they would normally consider about the situation. On average, drunken individuals exhibited more aggression, self-disclosure, risk taking behaviours, and laughter than sober individuals. Extreme behaviours are not as common in sober individuals because they are able to read inhibitory cues and social conduct norms that drunken individuals are not as inclined to consider. These negative social behaviours, then, are a result of lowered social inhibitions.

Alcohol consumption also has the ability to lower inhibitions in a positive way. Research has been conducted looking at the way an intoxicated person is more inclined to be helpful. Researchers were of the same opinion that alcohol lowers inhibitions and allows for more extreme behaviours, however, they tested to see if this would be true for more socially acceptable situations, such as helping another person. The researchers acknowledged that, generally, an impulse to help another is initiated but then inhibitions will cause the potential helper to consider all factors going into their decision to help or not to help such as, lost time, boredom, fatigue, monetary costs, and possibility of personal harm. The researchers suggest that while one may be inhibited and therefore less likely to offer help when completely sober, after consuming alcohol enough damage will be done to their inhibitory functioning to actually increase helping. While this suggestion differs from socially negative behaviours that are seen after social inhibitions have been lowered, it is consistent with the idea that alcohol consumption can lower inhibitions and, as a result, produce more socially extreme behaviours when compared to a sober counterpart.

Alcohol consumption can lower social inhibitions in both men and women, producing social behaviours not typical in the individuals’ day-to-day sober lives. For example, in social settings women will tend to be uncomfortable with sexual acts and provocations as well as feeling uncomfortable in social settings that are generally male dominated such as strip clubs or bars. However, consumption of alcohol has been seen to lower these inhibitions, making women feel freer and more ready to participate socially in events and behaviours that they would normally feel inhibited from participating in if they were sober. As an example, women participating in bachelorette parties generally consume copious amounts of alcohol for the event. As a result, the females feel less inhibited and are more likely to then engage in behaviour that they would normally view as deviant or inappropriate. In an examination of bachelorette parties it was found that when those attending the party consumed only a couple of drinks behaviour minimally reflected any alcohol consumption, assuming that the party guests were still socially inhibited and less inclined to perform deviant behaviours. Similarly, “levels of intoxication were correlated with the atmosphere of the party, such that parties with little or no alcohol were perceived as less ‘wild’ than parties a lot of alcohol consumption.” Conceivably, the bachelorette parties show tendencies of “wild” behaviour after excessive alcohol consumption, which consequently lowers the inhibitions of the consumers.

When surveyed a number of women who had attended a bachelorette party, or had one in their honour, in the past year reported that their behaviour when under the influence of alcohol was different from their behaviour when sober. One party guest reported:

“People drink … to lose inhibitions and stuff that is done… I would never do sober. It lowers inhibitions – that is the main point of it.”

These reports suggest that “alcohol was used to lower inhibitions about being too sexual, about the risk of being perceived as promiscuous, or about being sexual in public. Women commented that they felt freer to talk about sex while under the influence of alcohol, to flirt with male strangers, or to dance with a male stripper.” The research collected surrounding women and their alcohol consumption in these settings provide examples of the reduction of social inhibitions in relation to excess alcohol consumption


Social inhibitions can also be reduced by means unrelated to an actual substance. Another way that social inhibition can be decreased is by the attainment of power. Research has examined the way that having either elevated or reduced power affects social interactions and well-being in social situations. Such research has shown a relationship between elevated power and decreased social inhibitions. This relationship of those with elevated power and those with reduced power can be seen in all forms of social interactions, and is marked by elevated power individuals often having access to resources that the reduced power individuals do not have. Decreased social inhibition is seen in those with elevated power for two main reasons, one being that they have more access to resources, providing them with comforts and stability. The second reason is that their status as a high power individual often provides the powerful individual a sense of being above social consequences, allowing them to act in ways that a reduced power individual may not.

The elevated power individuals will experience reduced social inhibition in various ways, one being that they are more likely to approach, rather than avoid, another person. Also, with the reduced inhibition associated with high power individuals, they are more likely to initiate physical contact with another person, enter into their personal space, and they are more likely to indicate interest in intimacy. High power people tend to be socially disinhibited when it comes to sexual behaviour and sexual concepts. Consistent with this expectation, a study working with male and female participants found that when the male and female felt equally powerful they tended to interact socially with one another in a disinhibited manner.

Further, the research suggests that as a result of their reduced social inhibition, powerful individuals will be guided to behave in a way that fits with their personality traits in a social situation in which they feel powerful. Similarly, in a laboratory study it was found that when one person in a group feels powerful their reduced social inhibition can result in decreased manners. The study found that, when offered food, the powerful individual is more likely to take more than the other individuals in the room. This can be seen as the powerful individual exhibiting reduced social inhibitions, as they reduce their attention to common social niceties such as manners and sharing.



Certain factors can increase social inhibition in individuals. Increased inhibitions can occur in different situations and for different reasons. One major factor that contributes to the increase of social inhibition is power. Reduced power is linked to an array of negative affect, one of which being increased social inhibitions. Power, in this instance, can be defined as a fundamental factor in social relationships that is central to interactions, influencing behaviour and emotional display. Further, power is such an essential factor in social relationships because power determines who is the giver and who is the receiver in the exchange of rewards and resources. Power is present in all social relationships, not just typical hierarchical establishments such as in employment or school settings. Power, then, is related to increased social inhibitions when an individual feels that they are in a powerless or diminished power position. Those who are deemed to be high in power are generally richer in resources and freedom, as well as decreased levels of social inhibition, whereas those who are deemed to be low in power are generally low in resources, constrained, and prone to experiencing increased social inhibition.

Research shows that individuals who are considered to be low in power experience more social threats and punishments, and generally have less access to social resources. As a result of this these individuals are prone to developing more sensitivity to criticism from others, and are more susceptible to accepting when someone constrains them. These factors contribute to increasing social inhibition in those individuals. Similarly, studies have shown that the absence of power can heighten the processes associated with social inhibition. Experiments on the interaction between power and inhibition have shown that when participants are in a situation where they perceive more punishments and threats their cognition and behaviour will show more signs of social inhibition related affect. Environments which distinguish the differences between the powerful and the powerless can lead to the social inhibition of the power reduced individuals as a response to their social interactions with the heightened power individuals.

Some of the social inhibited behaviours that a low-power individual will experience in these social situations will be embarrassment and fear and they may even go on to feel guilt, sadness, and shame. Further, low power individuals can be seen socially inhibiting themselves in ways that can, in the end, favour the high-power individuals. These can include inhibiting themselves from providing input on ideas, hesitating in normal speech, and even increasing their facial muscle actions in order to keep themselves from displaying emotions. When the low-power individuals are in a social situation with a high-power individual they will also commonly exhibit social inhibition by inhibiting their postural constriction and reducing their gestures. Researchers have generalised these suggestions of interaction between a high-power individual and low-power individuals to say that these expressions of social inhibition are expected to carry over into all areas of social interaction for the low-power individual. That is to say that low-power individuals will not only exhibit social inhibition when in the presence of a high-power individual. They will continue to be socially inhibited in all social aspects of their lives as a result of their low-power status. Further, low-power individuals tend to devote increased attention to the actions and behaviours of others.

Biological Factors

Another possible explanation for increased social inhibition has to do with biological factors. A study of brain activity in those who rate high on the scale for social inhibition showed a number of brain areas that are related to the heightened inhibitions. In their study the researchers aimed to find the link between socially inhibited individuals and an over activation of the cortical social brain network. The researchers did this by examining the brain activity of individuals who rate high in social inhibition as they respond to video clips of facial and bodily expressions that were potentially threatening. What the researchers found was that those who rate high in social inhibition show an overactive orbitofrontal cortex, left temporo-parietal junction, and right extrastriate body area. When the threat -related activity was being presented to the participants, these areas of the brain showed increased activity in comparison to those who do not rate high for social inhibition. What the researchers speculate is that, in this instance, hyperactivity in these brain structures does not mean better functioning. Further, “the orbitofrontal cortex is connected with areas that underlie emotional function and empathy”. This relates to one’s ability to stimulate how another person feels in their own facial displays. The over activity and decreased function of these brain structures can affect individuals by increasing social inhibition and behaviours related to social inhibition.

Personality Traits

Further, there is speculation that social inhibition can also be increased by the type of personality an individual has and behaviours that those individuals inherently display. Namely, those who are dependent and reassurance seeking are more commonly likely to display increased social inhibition.

Clinical Levels

Although social inhibition can occur as part of ordinary social situations, a chronically high level of social inhibition may lead some individuals to develop other social or anxiety disorders that would also need to be handled clinically. Through childhood, adolescence, and adulthood, clinical levels of social inhibition can be measured. Social inhibition can be a precursors for other social disorders that can develop in adolescence or adulthood


There are many implications for the diagnoses of social inhibition, however there are many cost-efficient ways to measure and treat this social disorder. One measure that has reliably assessed the traits of social inhibition is the seven-item inhibition scale of the Type D Scale-14. Another measure is the Behavioural Inhibition Observation System (BIOS). In clinical trials this measure is to be used for children completed by parents, teachers, and clinicians. Other scales are the:

  • Behavioural Inhibition Questionnaire (BIQ);
  • Behavioural Inhibition Instrument (BII);
  • Behavioural Inhibition Scale (BIS);
  • Preschool Behavioural Inhibition Scale (P-BIS); and
  • Behavioural Inhibition Scale for children ages 3-6.

There are also many versions of these scales that are specifically for parents, teachers, or even the child or possibly an inhibited individual to take. There are also times when these measures are grouped together; in many cases the Behavioural Inhibition System scale and Behavioural Activation System scale are used together. These two measure are the most widely used and together they consist of behavioural inhibition and behavioural activation scales that deal with reward response and fun seeking. The Behavioural Paradigm System is an observation system that allows measurements of behavioural inhibition in systematic natural environments. With this system researchers will observe cessation of play and vocalisation, long latencies to approaching the unfamiliar person, signs of fear and negative affect, and security seeking in environments such as classrooms, playgrounds, and in home settings. This paradigm was followed by many adaptations, one specifically was the adaptation of the Observational Paradigm. In an additional study by Ballespi and colleagues the paradigm was changed to be more suitable for a school environment. The adapted paradigm met three important criteria, the tests were suitable for a school environment, there had to be materials for the test that could be transported easily, and the observation of behavioural inhibition signs had to have the potential to be seen in a short period of time.

Ballespi and colleagues discussed one of the most recent measurement systems in the Behavioural Inhibition Observation System. This new system will allow clinicians to provide a quick measure for behavioural inhibition. This system is used during the first meeting with the child. In this first meeting, the child will be exposed to a strange, unfamiliar situation. The scale will then be completed after the therapist has time to observe the child in an interview setting. Researchers want to find a way to have an actual measure for inhibition, however this is difficult. There is a difference in observations, a parent or teachers is going to observe the child over long periods of time in several natural situations. The parents do not actually observe the child but instead rate the behaviour inhibition on the ideas they have formed about the child. The clinician will not have all this information and will base his or her first measure on observation alone; they measure state while parents and teachers measure traits. This is where the differences come up in measure however after several visits the measures of the clinicians, teachers, and parents become more similar.


Treatments used for social inhibition are primarily assertive trainings introduced by therapies. These treatments are about teaching the inhibited individual to express and assert their feeling instead of inhibiting them. Assertiveness training is an important operation for behavioural therapist because it can help with behavioural issues, as well as interpersonal inadequacies, and anxiety in adults. In some cases this training can go by a different name because assertiveness is sometimes categorised by aggression therefore it can also be called appropriate expression training.

In one study discussing assertive training Ludwig and Lazarus found irrational cognitive patterns that inhibited individuals have to deal with and how to overcome them. The four patterns are self-criticism/Perfectionism, unrealistic approval needs, unrealistic labelling of aggression/assertive behaviour, and criticism of others. There are three different phases that work to combat the irrational cognitive patterns and inhibitory actions during social situations. These phases are meant to be actively practiced. The individual will receive homework assignments, and have to do role-playing exercises to overcome their inhibitions. The first phase discussed was about talking more. Ludwig states that there cannot just be an increase in talking but also an increase in expressing and talking about how one feels. The point of this phase is to get an individual talking no matter how ridiculous or trivial it may seem. Phase two is about dealing with the responses that come from talking more. When an inhibited individual starts talking more they may become embarrassed. However, with positive reactions from others they will learn that being embarrassed about some of the comments made is not devastating, and in turn the individual may talk and act more freely. In addition to the positive feedback the individual will review particularly embarrassing moment to assess why they were embarrassed to help combat those thoughts. If the inhibited person can understand the irrational thoughts they will eventually feel less embarrassed and act more freely. Role playing is also a way to help the individual understand different social behaviours. Mirroring is a way some therapist will show the client their own behaviour. The last phase deals with additional strategies that can help through social situation such as expressing disagreement, dealing with interruptions, initiating more conversations topics, and more self-disclosure. Ludwig and colleagues also make sure to explain that no one should compulsively apply these behavioural techniques in all situations. An individual should not go over board using them; additionally there are times when initiating some conversation topics and talking more are inappropriate.

Group therapies are also used in the treatment using assertiveness. Hedquist and Weinhold investigated two group counselling strategies with socially anxious and unassertive college students. The first strategy is a behavioural rehearsal group, which aims to assist members to learn more efficient responses in social situations. This was to be accomplished by rehearsing several difficult social situations. The second strategy was a social learning group that was about honesty about everything; any withholding behaviours were seen as being dishonest. Another rule was every individual had to take responsibility for everything that said. The results of this study showed that both strategies helped significantly in treating the anxiety and unassertiveness.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_inhibition >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Self-Objectification?


Self-objectification is when people view themselves as objects for use instead of as human beings.

Self-objectification is a result of objectification, and is commonly discussed in the topic of sex and gender. Both men and women struggle with self-objectification, but it is most commonly seen among women. According to Calogero, self-objectification explains the psychological process by which women internalise people’s objectification of their bodies, resulting in them constantly criticising their own bodies.

Relationship to Objectification

Objectification and self-objectification are two different topics, but are closely intertwined. Objectification looks at how society views people (in this case, women) as bodies for someone else’s pleasure. This occurs in advertisements where the body but not the face of a woman is shown. These messages put an unrealistic standard on women’s bodies, dehumanising them to an object of visual pleasure, and self-objectification occurs in response. Women start to internalise the message that they are not individual human beings, but objects of beauty, pleasure, and play for men or women, and they start to look at themselves and their bodies as such.

The perpetuation of self-objectification can be described as a cycle. Objectification causes self-objectification which perpetuates objectification, and the cycle goes on. Both media and social interaction factor into that cycle as well. Media is everywhere, plastering seemingly perfect women across billboards, in music videos, and on covers of magazines. These ideals cause people to put on an unrealistic lens, thinking that they should look and act like the women in the media are portrayed, perpetuating the cycle of self-objectification. Social interactions affect this cycle as well, as the way people communicate with each other subconsciously furthers objectification as well. This type of talk is known as appearance related communication. Two types of appearance-related communication that have had an effect on the existence of self-objectification are fat talk and old talk.

Appearance-Related Communication

Fat talk, a term coined by Mimi Nichter, refers to women making comments about their own weight, dieting, or justifications of one’s eating or exercising habits. It includes comments such as, “I’m out of shape”, or “I’m just eating everything today”. Women who engage in fat talk are more likely to struggle with body dissatisfaction, self-objectification, depression, anorexia, bulimia, and other eating disorders.

Old talk refers to negative statements about wrinkles, skin tone, yellowing teeth, and other physical aspects of the natural aging process. Women who engage in old talk are more likely to be dissatisfied with their bodies, engage in self-objectification, suffer from depression and anxiety, and it may even decrease their quality of life and actual lifespan. Both fat and old talk result in higher self-objectification, as women measure themselves against and attempt to reach an unrealistic standard.

In Different Generations

One period of time in a woman’s life where self-objectification happens excessively is during pregnancy. Magazines offer pictures of pregnant celebrities with golden skin, toned legs, and a perfectly rounded, “cute” pregnant belly. The photo-editing makes it seem real, and people start to think that is how they ought to look when they are pregnant. Looking at these perfect pictures results in pregnant women feeling worse about themselves and being incredibly self-conscious about their weight even though their weight gain is normal and necessary. They see themselves as not good enough, again, objectifying their identity to a body that needs to be perfect. Studies have also been done on adolescent girls, and what heightens self-objectification at an early age. With the amount of over-sexualised media that children are exposed to, young girls start to identify themselves as a “prize” to be used and given away at an early age. This objectification is fuelled heavily by media and the fact that it is highly sexualised. The more a young girl is exposed to media that sexually objectifies women, the more they will internalise those beliefs and ideals and objectify themselves.

An Overview of Mental Health in China


Mental health in China is a growing issue. Experts have estimated that about 173 million people living in China are suffering from a mental disorder.

The desire to seek treatment is largely hindered by China’s strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony. While the Chinese government is committed to expanding mental health care services and legislation, the country struggles with a lack of mental health professionals and access to specialists in rural areas.

Brief History

China’s first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.

In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.

In a meeting jointly held by Chinese ministries and the World Health Organisation (WHO) in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China’s priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.

In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.

Since 2006, the government’s 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses. These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.

In 2011, the legal institution of China’s State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalised against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients’ rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment. However, Human Rights Watch has criticised the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.

Since 1993, WHO has been collaborating with China in the development of a national mental health information system.

Current Situation

Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.

Prevalence of Mental Disorders

Researchers estimate that roughly 173 million people in China have a mental disorder. Over 90 percent of people with a mental disorder have never been treated.

A lack of government data on mental disorders makes it difficult to estimate the prevalence of specific mental disorders, as China has not conducted a national psychiatric survey since 1993.

Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6% of people with major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China’s National Centre for Mental Health, Liu Jin, estimated that approximately 50% of outpatient admissions were due to depression.

There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.

The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999. Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62% of incidences.

It is estimated that 18% of the Chinese population, about 244 million people believe in Buddhism. Another 22% of the population, roughly 294 million people believe in folk religions which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behaviour as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honouring one’s family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.

Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family’s reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family’s overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalise their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.

In addition, many of these philosophies teach followers to accept one’s fate. Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracised.

Lack of Qualified Staff

China has 17,000 certified psychiatrists, which is 10% of that of other developed countries per capita. China averages one psychologist for every 83,000 people, and some of these psychologists are not board-licensed or certified to diagnose illnesses. Individuals without any academic background in mental health can obtain a license to counsel, following several months of training through the National Exam for Psychological Counsellors. Many psychiatrists or psychologists study psychology for personal use and do not intend to pursue a career in counselling. Patients are likely to leave clinics with false diagnoses, and often do not return for follow-up treatments, which is detrimental to the degenerative nature of many psychiatric disorders.

The disparity between psychiatric services available between rural and urban areas partially contributes to this statistic, as rural areas have traditionally relied on barefoot doctors since the 1970s for medical advice. These doctors are one of the few modes of healthcare able to reach isolated parts of rural China, and are unable to obtain modern medical equipment, and therefore, unable to reliably diagnose psychiatric illnesses. Furthermore, the nearest psychiatric clinic may be hundreds of kilometres away, and families may be unable to afford professional psychiatric treatment for the afflicted.

Physical Symptoms

Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms. For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression. However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.


According to various scholars, China’s psychiatric facilities have been manipulated by government officials in order to silence political dissidents. In addition to misuse by the state psychiatric facilities in China are also misused by powerful private individuals who use the system to advance their personal or business ends. China’s legal system lacks an effective means of challenging involuntary detentions in psychiatric facilities.

Chinese Military Mental Health


Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent (25%) of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression. Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.


Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers’ experiences in the plateaus. The change of emphasis from physical to mental health can be seen in China’s four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops’ ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.

Mental health issue can impact active military members’ effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation. It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.

Comparatively, assessing the mental health status of the People’s Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments. With such diverse military roles over an area of 8.4 million square kilometres (3.25 million square miles), it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems.

Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops; other researchers found that depressive symptoms can worsen. These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.

Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training, or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves. Researchers also suggest to improve the mental health of the military members, programmes should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.


In 2006, the People’s Republic Minister for National Defence began mental health vetting at the beginning of the military recruitment process. A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviours, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits. Similar research has been conducted into the external factors that impact a person’s mental fortitude, including single-child status, urban or rural environment, and education level. Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Centre for Human Rights of a small portion of the People’s Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should:

“…close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.”

In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People’s Republic of China, it stated, “The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.”

Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People’s Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood. This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China. In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government. As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, Xi Jinping, General Secretary of the Communist Party of China, promised to enact laws that protect the welfare of veterans.

What is Positive Affectivity?


Positive affectivity (PA) is a human characteristic that describes how much people experience positive affects (sensations, emotions, sentiments); and as a consequence how they interact with others and with their surroundings.

People with high positive affectivity are typically enthusiastic, energetic, confident, active, and alert. Research has linked positive affectivity with an increase in longevity, better sleep, and a decrease in stress hormones. People with a high positive affectivity have healthier coping styles, more positive self-qualities, and are more goal oriented. Positive affectivity also promotes an open-minded attitude, sociability, and helpfulness.

Those having low levels of positive affectivity (and high levels of negative affectivity) are characterised by sadness, lethargy, distress, and un-pleasurable engagement (see negative affectivity). Low levels of positive affect are correlated with social anxiety and depression, due to decreased levels of dopamine.

Research and Findings

Studies are finding there is a relationship between dopamine release and positive affect in cognitive abilities. For instance, when dopamine levels are low, positive affect can stimulate the release of more dopamine, temporarily increasing cognitive, motor, and emotional processing. Stimulating dopamine release influences several cognitive functions. First, an increase in dopamine in the nigrostriatal system can temporarily relieve motor or cognitive dysfunction, due to Parkinson’s.

An increase in dopamine release also influences the mesocorticolimbic system, via ventral tegmental area (VTA) cells, increasing mood and open mindedness in older adults. Positive affect also stimulates dopamine production in the prefrontal cortex and the anterior cingulate facilities, which help with processing working memory and executive attention. Lastly, PA indirectly improves memory consolidation in the hippocampus, by increasing acetylcholine release from an increase in dopamine.

Overall, positive affect results in a more positive outlook, increases problem solving skills, increases social skills, increases activity and projects, and can play a role in motor function.

Relationship with Negative Affectivity

Refer to Negative Affectivity.

Positive affectivity (PA) and negative affectivity (NA) are nearly independent of each other; it is possible for a person to be high in both PA and NA, high in one and low in the other, or low in both. Affectivity has been found to be moderately stable over time and across situations (such as working versus relaxing). Positive affectivity may influence an individual’s choices in general, particularly their responses to questionnaires.

Relationship with Happiness, Self-Esteem and Extraversion

Happiness, a feeling of well-being, and high levels of self-esteem are often associated with high levels of positive affectivity, but they are each influenced by negative affectivity as well. Trait PA roughly corresponds to the dominant personality factors of extraversion; however, this construct is also influenced by interpersonal components.


Because there is not a hard-and-fast rule for defining certain levels of positive affectivity, different self-reported assessments use different scales of measure. Several prominent tests are listed below; in each of these, the respondent determines the degree to which a given adjective or phrase accurately characterizes him or her.

  • Differential Emotions Scale (DES): A PA scale that assesses enjoyment (happy or joyful feelings) and interest (excitement, alertness, curiosity).
  • Multiple Affect Adjective Checklist – Revised (MAACL-R): Measures PA according to the DES scale and to an additional scale assessing thrill-seeking behaviour (i.e. how daring or adventurous the person is).
  • Profile of Mood States (POMS): Uses vigour scale to assess the domain of PA.
  • Expanded Form of the Positives and Negative Affect Schedule (PANAS-X): This test uses three main scales:
    • Joviality (how cheerful, happy, or lively);
    • Self-assurance (how confident and strong); and
    • Attentiveness (alertness and concentration).
  • International Positive and Negative Affect Schedule Short-Form (I-PANAS-SF): This is a brief, 10-item version of the PANAS that has been developed and extensively validated for use in English with both native and non-native English speakers.
    • Internal consistency reliability for the 5-item PA scale is reported to range between .72 and .78.

In Business Management

Positive affectivity is a managerial and organisational behaviour tool used to create positive environments in the workplace. Through the use of PA, the manager can induce a positive employee experience and culture. “Since affectivity is related to the employee experiences, we expect the employees with high PA to feel considerable organizational support. Their optimism and confidence also helps them discuss their views in a manner characterised by constructive controversy with their supervisor, so that problems are solved and their positive feelings confirmed”. Positive Affectivity allows creative problem solving to flourish in an environment where employees are not intimidated to approach managers, therefore employees believe they are playing a key role in the organisation in coming forward with solutions. The goal is to maximise PA and minimise any negative affectivity circulating in the business. Negative emotions, such as fear, anger, stress, hostility, sadness, and guilt, increase the predictability of workplace deviance, and therefore reduce the productivity of the business.


Positive affectivity is an integral part of everyday life. PA helps individuals to process emotional information accurately and efficiently, to solve problems, to make plans, and to earn achievements. The broaden-and-build theory of PA suggests that PA broadens people’s momentary thought-action repertoires and builds their enduring personal resources.

Research shows that PA relates to different classes of variables, such as social activity and the frequency of pleasant events. PA also strongly relates to life satisfaction. The high energy and engagement, optimism, and social interest characteristic of high-PA individuals suggest that they are more likely to be satisfied with their lives. In fact, the content similarities between these affective traits and life satisfaction have led some researchers to view both PA, NA, and life satisfaction as specific indicators of the broader construct of subjective well-being.

PA may influence the relationships between variables in organizational research. PA increases attentional focus and behavioural repertoire, and these enhanced personal resources can help to overcome or deal with distressing situations. These resources are physical (e.g. better health), social (e.g. social support networks), and intellectual and psychological (e.g. resilience, optimism, and creativity).

PA provides a psychological break or respite from stress, supporting continued efforts to replenish resources depleted by stress. Its buffering functions provide a useful antidote to the problems associated with negative emotions and ill health due to stress, as PA reduces allostatic load. Likewise, happy people are better at coping. McCrae and Costa concluded that PA was associated with more mature coping efforts.

Mental Health in Japan: The Rise of Recluses

Did you know that the pressures from work and society are causing more people in Japan to shun the outside world.

In the attached article by The Economist we can read about “Mika Shibata’s youngest son”, aged 26, who has not emerged from his bedroom for a year! (The Economist, 2019, p.49).

In an article by Andrew McKirdy, for the JapanTimes.co.jp, he states that a Government survey suggested that 613,000 people, between the ages of 40 and 64, are believed to be hikikomori.

This is up from the estimated 541,000 people aged between 15 and 39 that a 2015 Cabinet Office survey found to be hikikomori.


McKirdy, A. (2019) The prison inside: Japan’s hikikomori lack relationships, not physical spaces. Available from World Wide Web: https://www.japantimes.co.jp/life/2019/06/01/lifestyle/prison-inside-japans-hikikomori-lack-relationships-not-physical-spaces/#.Xil8ymieSUk. [Accessed: 23 January, 2020].

The Economist. (2019) Mental Health in Japan: The Rise of Recluses. The Economist. 30 November 2019.

Exercise for Mental Health

1.0 Introduction

“Lifestyle modifications can assume especially great importance in individuals with serious mental illness. Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease. An essential component of lifestyle modification is exercise. The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike. Evidence has suggested that exercise may be an often-neglected intervention in mental health care.” (Sharma, Madaaan & Petty, 2006).

This article provides an overview of exercise for mental health.

It is now a well-known ‘secret’ that exercise (and, let us not forget, physical activity) has an important part to play in both our physical health and mental health.

I think we can safely state that you (the reader) almost certainly already know that an inactive lifestyle contributes to chronic miseries such as obesity, diabetes, heart disease, cancer, osteoporosis, and an earlier death. You may also be one of the third of people who have resolved to exercise more (well, maybe get Christmas out the way first!).

However, how often do people consider the contribution of physical exercise to their mental health? And, with an expected rise in the number of people with mental health issues, it is more important than ever to extol the benefits of exercise.

“It is estimated there will be nearly 8 million more adults in the UK by 2030. If prevalence rates for mental disorders stay the same (at around one in four), that is some 2 million more adults with mental health problems than today. It is also estimated that there will be one million more children and young people in the UK by 2030. Again, if prevalence rates for mental disorders stay the same (at around one in ten), that is some 100,000 more children and young people with mental health problems than today.” (Mental Health Foundation, 2013, p.2).

Exercising releases natural chemicals, such as serotonin, dopamine and endorphins into the body, which help to boost mood. High levels of serotonin are linked to elevated mood while low levels are associated with depression. Exercise can also help reduce the amount of harmful chemicals in the body that are produced when an individual is stressed.

2.0 Benefits of Exercise

In simple terms, exercise provides a variety of short- and long-term, and obvious and less obvious, benefits.

  • Exercising benefits nearly all aspects of a person’s health (CDC, 2019) – In addition to aiding control weight, it can improve the chances of living longer, maintaining/improving the strength of bones and muscles, and an individual’s mental health.
  • When an individual does not get enough exercise, they are at increased risk for health problems – these include cardiovascular disease, high blood pressure (hypertension), type 2 diabetes, some cancers, and metabolic syndrome (CDC, 2019).
  • Exercise also increases a variety of substances that play an important role in brain function (Section 4.0).
  • Exercise can help prevent (certain) mental illnesses and is an important part of treatment.

Exercise is well-known to stimulate the body to produce our natural feel-good hormones which can make problems seem more manageable.

The simple act of focusing on exercise can give an individual a break from current concerns and damaging self-talk. Further, depending on the activity, individuals may benefit from calming exercises, be energised, and get outside or interact with others, all of which are known to improve mood and general health.

With this in mind, the health benefits from regular exercise that should be emphasised and reinforced by every professional (e.g. mental health, medical, nursing, physiotherapist, fitness/exercise) to individuals include:

  • Improved sleep;
  • Increased interest in sex;
  • Better endurance;
  • Stress relief;
  • Improvement in mood;
  • Increased energy and stamina;
  • Reduced tiredness that can increase mental alertness;
  • Weight reduction;
  • Reduced cholesterol; and
  • Improved cardiovascular fitness.

2.1 What is the Importance of Exercise for those with Mental Health Problems?

Having a mental health problem can put an individual at a higher risk of developing a serious physical health problem. For example, individuals with mental health problems are:

  • Twice as likely to die from heart disease (Harris & Barraclough, 1998).
  • Four times as likely to die from respiratory disease (Phelan et al., 2001).
  • On average, likely to die between 10 and 17 years earlier than the general population, if they have schizophrenia or bipolar disorder.
    • This may be due to a number of factors including poor diet, exercise and social conditions. People may also be slower to seek help, and doctors can sometimes fail to spot physical health problems in people with severe mental health problems.

3.0 Linking Physical Health and Mental Health

It is still very common for physical health and mental health, aka mind and body, to be treated separately (both medically and in general), although attitudes are slowly changing.

There is an increasing pool of evidence that suggests that exercise is not only necessary for the maintenance of good mental health, but it can be used to treat even chronic mental illness.

For example, it is now clear that exercise reduces the likelihood of depression and also maintains mental health as people age. On the treatment side, exercise appears to be as good as existing pharmacological interventions across a range of conditions, such as mild to moderate depression, dementia, and anxiety, and even reduces cognitive issues in schizophrenia.

The question you might now be asking is, how?

3.1 Exercise directly affects the Brain

Aerobic exercises (such as jogging, swimming, cycling, walking, gardening, and dancing) have been proved to reduce anxiety and depression (Guzszkowska, 2004). These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitaryadrenal (HPA) axis and, thus, on the physiologic reactivity to stress (Guszkowska, 2004). It has been suggested that this physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including:

  • The limbic system, which controls motivation and mood;
  • The amygdala, which generates fear in response to stress; and
  • The hippocampus, which plays an important part in memory formation as well as in mood and motivation.

However, it is important to note that other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health which include (Peluso & Andrade, 2005):

  • Distraction;
  • Self-efficacy; and
  • Social interaction.

In 2017, Firth and colleagues suggested that regular exercise increases the volume of certain brain regions – in part through:

  1. Better blood supply that improves neuronal health by improving the delivery of oxygen and nutrients; and
  2. An increase in neurotrophic factors and neurohormones that support neuron signaling, growth, and connections.

They also stated that of critical importance for mental health is the hippocampus (an area of the brain involved in memory, emotion regulation, and learning). Studies in other animals show convincingly that exercise leads to the creation of new hippocampal neurons (neurogenesis), with preliminary evidence suggesting this is also true in humans.

“Aerobic exercise interventions may be useful for preventing age-related hippocampal deterioration and maintaining neuronal health.” (Firth et al., 2017, p.230).

There is an accumulating evidence base that various mental health conditions are associated with reduced neurogenesis in the hippocampus.

The evidence is particularly strong for depression and, interestingly, many anti-depressants – that were once thought to work through their effects on the serotonin system – are now known to increase neurogenesis (Anacker et al., 2011) in the hippocampus.

Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. It has a popular image as a contributor to feelings of well-being and happiness, though its actual biological function is complex and multifaceted, modulating cognition, reward, learning, memory, and numerous physiological processes. It sends signals between nerve cells. Serotonin is found mostly in the digestive system, although it is also in blood platelets and throughout the central nervous system. Serotonin is made from the essential amino acid tryptophan.

3.2 What does this Mean in Theory?

Theories suggest that newborn hippocampal neurons are likely to be particularly important for storing new memories and keeping old and new memories separate and distinct – Meaning neurogenesis allows a healthy level of flexibility in the use of existing memories, and in the flexible processing of new information.

Frequently, mental ill health is characterised by a cognitive inflexibility that:

  • Keeps the individual repeating unhelpful behaviours;
  • Restricts their ability to process or even acknowledge new information; and
  • Reduces their ability to use what they already know to see new solutions or to change.

Consequently, this suggests that it is plausible that exercise leads to better mental health, in general, through its effects on systems that increase the capacity for mental flexibility.

4.0 Substances that Play an Important Role in Brain Function

  • BDNF (brain derived neurotrophic factor) is a protein that creates and protects neurons (nerve cells) in the brain helps these cells to transmit messages more efficiently, and regulates depression-like behaviours (Vithlani et al., 2013; Sleiman et al., 2016).
  • Endorphins are a type of chemical messenger (neurotransmitter) that is released when we experience stress or pain to reduce their negative effects and increase pleasure throughout the body (Bortz, Angwin & Mefford, 1981).
    • Endorphins are also responsible for the euphoric feeling known as a “runner’s high” that happens after long periods of intense exercise.
  • Serotonin is another neurotransmitter that increases during exercise. It plays a role in sending messages about appetite, sleep, and mood (Young, 2007).
    • It is the target of medications known as SSRIs or SNRIs, which are used to treat anxiety and depression.
  • Dopamine is involved in controlling movement and the body’s reward response system. Due to its role in how the body perceives rewards, it is heavily involved with addictions.
    • When amounts of this chemical messenger are low, it is linked to mental health conditions including depression, schizophrenia, and psychosis (Grace, 2016).
  • Glutamate and GABA (gamma-amino butyric acid) both act to regulate the activity of nerve cells in the parts of the brain that process visual information, determine heart rate, and affect emotions and the ability to think clearly (Maddock et al., 2016).
    • Low levels of GABA have been linked to depression, anxiety, PTSD, and mood disorders (Streeter et al., 2012).

5.0 Exercise as Treatment in Mental Health

  • Just one hour of exercise a week is related to lower levels of mood, anxiety, and substance use disorders (de Graaf & Monshouwer, 2011).
  • Among people in the US, those who make regular physical activity a part of their routines are less likely to have depression, panic disorder, and phobias (extreme fears) (Goodwin, 2003).
  • One study found that for people with anxiety, exercise had similar effects to cognitive behavioural therapy in reducing symptoms (Wipfli, Rethorst & Landers, 2008).
  • For people with schizophrenia, yoga is the most effective form of exercise for reducing positive and negative symptoms associated with the disorder (Vancampfort et al., 2012).
  • While structured group programmes can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients (Richardson et al., 2005).
  • Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population (Sharma et al., 2006).
  • Exercise is especially important in patients with schizophrenia since these patients are already vulnerable to obesity and also because of the additional risk of weight gain associated with antipsychotic treatment, especially with the atypical antipsychotics.
  • GP surgeries, across the UK, are starting to routinely prescribe exercise as a treatment for a variety of conditions, including depression.
  • The National Institute for Health and Care Excellence (NICE) recommends that if an individual has mild to moderate depression, taking part in three exercises sessions a week can help.

6.0 Examples of How Exercise can Support Mood, Well-being, and Mental Health

  • General:
    • Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function (Callaghan, 2004).
    • Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal (Peluso & Andrade, 2005).
  • Depression:
    • According to findings from the Royal College of Psychiatrists (2019), if an individual keeps active they are less likely to experience symptoms of depression.
    • The reason for this is because exercise has a certain effect on chemicals in our brains, such as dopamine and serotonin, which affect both your mood and thinking.
    • Just by adding a bit more physical activity into their daily life, an individual can create new activity patterns in the brain which can boost their mood.
    • However, the individual should take it at their own pace, and not attempt difficult new exercises straight away.
  • Anxiety:
    • Frequent exercise can help people with anxiety to be less likely to panic when they experience ‘fight-or-flight’ sensations.
    • This is because the human body produces many of the same physical reactions, including heavy perspiration (sweating) and increased heart rate, in response to exercise.
    • A study by the American Psychological Association in 2011 demonstrated that over a two-week exercise programme, a test group of 60 people who took part in exercises showed significant improvements in anxiety sensitivity compared to a control group (Weir, 2011).
  • Stress:
    • Stress does not just affect an individual’s brain, with its many nerve connections, it also has an impact on the way they feel physically.
    • This can manifest as muscle tension, especially in the face, neck and shoulders.
    • However, research by the Anxiety and Depression Association of America (2018) shows that physical activity is helpful when stress has depleted an individual’s energy – because exercise produces endorphins that act as a natural painkiller.
    • And, these endorphins help relieve tension in the body and relax muscles, which can alleviate stress.
  • Attention Deficit Hyperactivity Disorder (ADHD):
    • Although the exact cause of ADHD is unknown, research suggests that exercise can have a similar effect on the brain as medication for ADHD does.
    • This is because exercise releases chemicals in the brain such as norepinephrine, serotonin and dopamine, which help to improve focus and attention.
    • And, physical activity can help to improve mood, concentration and motivation – all of which help to reduce symptoms of ADHD.
  • Post-Traumatic Stress Disorder (PTSD) and Trauma:
    • Activities such as sailing, hiking, and mountain biking, and rock climbing have particularly been shown to alleviate the effects of PTSD and trauma.
    • By focusing on their body and how it feels when exercising, an individual can help their nervous system become ‘unstuck’, so that it moves out of the immobilisation stress response that can create PTSD or trauma.
  • Memory:
    • As well as improving our concentration, physical activity can also help age-related memory problems.
    • A study in 2012 (Sifferlin, 2012) found that people in their 70s who participated in more physical exercise, such as walking several times a week, experienced fewer signs of ageing in the brain than those who were less physically active.

7.0 How much Exercise should an Individual Be Doing?

In the UK, the NHS (2019) suggests that adults (19 to 64) should:

  • Do some form of physical activity every day – with any activity being better than none.
  • Do strengthening activities that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week.
  • Do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week.
    • Moderate activity includes: brisk walking, water aerobics, riding a bike, dancing, tennis, pushing a lawn mower, hiking, and roller blading.
    • Vigorous activity includes: Jogging or running, swimming fast, riding a bike fast or on hills, walking up the stairs, sports (e.g. football, rugby, netball, and hockey), skipping rope, aerobics, gymnastics, and martial arts.
  • Reduce time spent sitting or lying down, and break up long periods of not moving with some activity.

Do not be disheartened, as exercise does not have to be done for hours on end. For example, ten minutes of moderate or vigorous activity at a time, fifteen times a week will see the individual achieve the recommended amount.

Muscle strengthening activities should be incorporated into an individual’s exercise routine twice a week. This includes yoga, lifting weights, resistance band exercises, and things like press/push-ups, and sit-ups. An individual’s muscles should be tired by the time they are finished with their exercises, but the individual should make sure they are not trying to lift too much too soon, or they could injure themselves.

In 2013, Rethorst and Trivedi, psychiatrists, demonstrated that three or more sessions per week of aerobic exercise or resistance training, for 45 to 60 minutes per session, can help treat even chronic depression. In terms of intensity, for aerobic exercise, Rethorst and Trivedi (2013) recommend achieving a heart rate that is 50-85% of the individual’s maximum heart rate (HRmax).  For resistance training, they recommend a variety of upper and lower body exercises – three sets of eight repetitions at 80% of 1-repetition maximum (RM, that is, 80% of the maximum weight that the individual can lift one time). They suggest that effects tend to be noticed after about four weeks (which incidentally is how long neurogenesis takes, refer to Section 3.1), and training should be continued for 10-12 weeks for the greatest anti-depressant effect.

With contemporary trends for exercise ‘quick fixes’, this may seem like a lot of exercise, but no worthwhile mental health fix comes for free. Remember, even exercise levels below these recommended amounts are still beneficial and, of course, the side effects (e.g. weight loss, increased energy, better skin, improved physical health, etc.) are very acceptable.

8.0 Mental Health and the Fitness Industry

“Physical health is one thing, but mental health, despite being something which can dramatically impact and affect someone’s life, is an often overlooked component of a person’s wellbeing.” (Waterman, 2018).

Traditionally, determining whether an individual was ‘healthy’ or ‘unhealthy’ ultimately come down to how the individual looked, their fitness levels, their diet, and whether they suffered from any specific physical health conditions.

The fitness industry is geared towards physical health improvements, and health questionnaires (also known as Physical Activity Readiness – Questionnaires, PAR-Q, or Exercise Readiness Questionnaire, ERQ) are largely focussed on physical health conditions.

Catch all questions that are typically asked include:

  • Do you have any other medical conditions?
  • Do you have, or have you had any illnesses recently?
  • Do you know of any other reason why you should not do physical activity?
  • Is stress from daily living an issue in your life?
  • Are you on medication?
  • Do you take any medications, either prescription or non-prescription, on a regular basis?
    • What is the medication for?
    • How does this medication affect your ability to exercise or achieve your fitness goals?

Questionnaires can vary from basic information collection (1 page) to fairly data intensive (6-8 pages), but questions asked and information collected vary vastly between fitness providers.

“In fitness, we get so caught up talking about bodyfat levels, bodyweight, aerobic fitness abilities, and food choices, that we neglect to address hugely important factors which affect our mental health.” (Waterman, 2018).

9.0 Summary

An individual does not have to have a gym membership to make exercise a part of their life! Picking physical activities that are easy to incorporate into the things/activities they already do and having a strong social support system are important in incorporating exercise into an individual’s routine.

Exercise also may help to meet the need for cost-effective and accessible alternative therapies for depressive disorders – particularly for the substantial number of individuals who do not recover with currently available treatments.

It is important to note that even small improvements in exercise levels or diet create a positive upward spiral that increases the sensitivity of the dopamine receptors that signal reward, so that exercise will eventually become rewarding, even if that seems unimaginable at the outset!

10.0 Useful Publications

11.0 References

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Anxiety and Depression Association of America. (2018) Exercise for Stress and Anxiety. Available from World Wide Web: https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety. [Accessed: 27 November, 2019].

Bortz, W.M., Angwin, P., Mefford, I.N. (1981) Catecholamines, Dopamine, and Endorphin Levels during Extreme Exercise. New England Journal of Medicine. 305, pp.466-467.

Callaghan, P. (2004) Exercise: A Neglected Intervention in Mental Health Care? Journal of Psychiatric Mental Health Nursing. 11, pp.476-483.

CDC (Centres for Disease Control and Prevention). (2019) Physical Activity Basics. Available from World Wide Web: https://www.cdc.gov/physicalactivity/basics/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fphysicalactivity%2Fbasics%2Fpa-health%2Findex.htm. [Accessed: 26 November, 2019].

Firth, J., Stubbs, B., Vancampfort, D., Schuch, F., Lagopoulos, J., Rosenbaum, S. & Ward, P.B. (2017) Effect of aerobic exercise on hippocampal volume in humans: A systematic review and meta-analysis. NeuroImage. 166, pp.230-238.

Goodwin, R.D. (2003) Association between physical activity and mental disorders among adults in the United States. Preventative Medicine. 36(6), pp.698–703. https://doi.org/10.1016/S0091-7435(03)00042-2.

Grace, AA. (2016). Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. Nature Reviews. Neuroscience. 17(8), 524-532. http://doi.org/10.1038/nrn.2016.57.

Guszkowska, M. (2004) Effects of Exercise on Anxiety, Depression and Mood [in Polish]. Psychiatria Polska. 38(4), pp.611-620.

Harris, E.C. & Barraclough, B. (1998) Excess Mortality of Mental Disorder. British Journal of Psychiatry. 173, pp.11-53.

Maddock, R.J., Casazza, G.A., Fernandez, D.H. & Maddock, M.I. (2016) Acute Modulation of Cortical Glutamate and GABA Content by Physical Activity. Journal of Neuroscience. 36(8), pp.2449. DOI:10.1523/JNEUROSCI.3455-15.2016.

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Phelan, M., Stradins, L. & Morrison, S. (2001) Physical Health of People with Severe Mental Illness. BMJ. 322(7284), pp.443-444.

Rethorst, C.D. & Trivedi, M.H. (2013) Evidence-based recommendations for the prescription of exercise for major depressive disorder. Journal of Psychiatric Practice. 19(3), pp.204-212. https://doi.org/10.1097/01.pra.0000430504.16952.3e.

Richardson, C.R., Faulkner, G., McDevitt, J., Skrinar, G.S., Hutchinson, D.S. & Piette, J.D. (2005) Integrating Physical Activity into Mental Health Services for Persons with Serious Mental Illness. Psychiatric Services. 56(3), pp.324-331.

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Sifferlin, A. (2012) Exercise Trumps Brain Games in Keeping our Minds Intact. Available from World Wide Web: http://healthland.time.com/2012/10/23/exercise-trumps-brain-games-in-keeping-our-minds-intact/. [Accessed: 27 November, 2019].

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