Mental Health and Running – anxiety, and inner peas.

Following Liz's inspiring story I thought I'd share a little of my own experience in managing my mental health. I developed anxiety in my mid-twenties, I'd always been a 'worrier' as a child but it took on a new level and gradually became a weight on my shoulders. There's a lyric in a Florence and the Machine song that goes,

It's hard to dance with the devil on your back, so shake him off”

Anxiety was the devil on my back, and try as I might I couldn't shake the bugger off! At it's worst I felt a constant tension and tightness across my chest, I simply couldn't relax and my mind was churning all the time. For me to unwind I needed total immersion in something, a computer game, good film or book but as soon as I stopped doing this my worry would kick in again.

My understanding, at the time, was that anxiety was due to chemical changes in the brain. That view, it turned out, was a little simplistic. My way of managing had 2 parts 1) to try and improve this chemical balance by running to boost the amount of happy chemicals (endorphins etc) and 2) to avoid alcohol, which can be a depressant and caffiene which is thought to be anxiogenic (anxiety provoking). On top of this I ate blueberries. Yep, she'd loads of them! I read somewhere that they were good for mood. At times this approach worked very well but by around 2010 I realised I was actually getting worse.

The low point was a panic attack at work. I hid in the toilets and just cried as quietly as I could so no one would hear. Even then my mind was working incredibly fast, examining my feelings and thinking about them. The thing about a low like this though is that it can be good – it prompted me to ask for help rather than just battling along eating blueberries! I saw a counsellor through work and with his guidance started to piece myself together again.

Through this I developed a new and very useful understanding of how my mind worked. It wasn't just a case of chemical changes but 3 broad areas that are hugely interlinked. Biology, Psychology and Social factors. What you may have heard of as a biopsychosocial model. I can see you thinking, oh no he's going all technical on us again! Bare with me…

Bio – means the biological changes associated with mental health and there are many. There is an established link between body and mind biologically – when people say it's all in your head it's wildly inaccurate. A body under stress heals slower, feels more pain and has higher levels of muscular tension. The brain shows different levels of activation in the areas that process emotion and the 'fight or flight' response. Typically anxiety is accompanied with bodily sensations, churning stomach, excessive sweating, dry mouth or constant need to use the toilet. Much of this comes from an activation of the fight or flight mechanism which prepares the body to escape from immediate danger and involves the release of adrenaline and other hormones.

Psycho – to me this means how we think, how we feel and how we behave. Closely linked with the biology, as, if your body is in the middle of a fight or flight response it's more likely you'll think and feel negatively and act to avoid what's causing the fear. This can lead to a pattern of fear and avoidance and thinking negatively can almost become a habit. Part of this is something called ANTs – Automatic Negative Thoughts. Our brains produce thousands of thoughts per day, it's likely a percentage of these will be negative. They are automatic, we dont choose them or have responsibility for them. Sometimes these come with an emotional response too so we might feel sad, guilty, angry or worried about the thought. It's easy to get wrapped up in these negative thoughts and sadly ANTs often hunt in packs. When you're busy dealing with one thought a host of others can come along and overwhelm you. I have a theory that they are a product of the fight or flight response. Let's say you're a caveman, you spot a tiger a few feet away, your fight or flight response is triggered. With it comes a host of negative thoughts, “that tiger will eat me!” “I will die!” “I'll never get the chance to finish that cave painting” “there is no way I could fight it off!” “the only solution is to run away” this happens automatically – you don't choose to think like this and it motivates you to evade and run away. I think a crucial part is the feeling that you cannot cope with the threat you must run. In the modern world we rarely have tigers roaming the street, but situations in life can lead you to conclude “I cannot cope with this, I must run and avoid this situation in future” the problem is though, we are regularly faced with situations that are stressful and can't be avoided, especially if our social situation is a difficult one..

Social factors – this is another complex area, feeling anxious and depressed often leads us to withdraw socially. It then becomes more challenging to return to socialising again and you feel more withdrawn. More than this though, this area involves work, family, relationships, leisure activities and friendships. It's about our support network and how well we utilise that support. It's about our roles – I like to be the helper and hate being the one asking for help. It's about how we communicate too and who, if anyone, we are emotionally close to.

As I started to piece all this together I was able to make sense of things and see why running on it's own wasn't the solution for me. While it undoubtedly helped with mood and probably helped my body release endorphins and improve the 'bio' part it didn't change how I thought, how I felt or how close I was to people. So what did?…

The first step was recognising I was in a severely stressed and anxious state and that that was having a huge influence on how I thought, felt and behaved. I then needed strategies to relax my body and mind.

Now by relax I don't mean a glass of wine or a long hot bath I mean a formal relaxation technique. This is when I discovered the Mental Health Foundation website and their wonderful free podcasts. They have 10 or so all together and I went through and tried each of them until I found a couple that helped. Everyday I came in from work, the kettle went on and I relaxed for 15-20 minutes. At first I found my mind wandering off and negative thoughts popping up, “this is pointless” “this isn't working” etc etc. In fact in the early days I sometimes felt more stressed after relaxation than before, but I stuck with it. It taught me something hugely valuable – to let thoughts come and go and gently draw my focus back to the relaxation. After a few weeks I really looked forward to my relaxation sessions. Some of them were even quite funny – my counsellor had a very strong Nigerian accent and he would say, “imagine you are filling with inner peace” and I would hear “imagine you are filling with inner peas” all I could picture was my body gradually filling with thousands of little green peas!

The thing with relaxation is that you aren't trying to empty your mind or stop thinking, that's nearly impossible, instead you're trying to focus on something else and see when you become distracted by thoughts and gently, kindly bring yourself back to that focus. It's challenging initially but if you keep practicing it starts to pay off. There are lots of different types, like mental imagery and progressive muscle relaxation.

After a few weeks of relaxing every day the sensation of fear started to lessen, sometimes for a few hours, sometimes a few days. It wasn't far away and could quickly come back but I could see I was improving. I could also see how differently I thought and felt when not in an anxious state. I could be objective and rational, things no longer had that panic associated with them.

The next step was the Cognitive Behavioural Therapy (CBT) approach. Its basis is how you think affects how you feel and how you behave. Therefore if you challenge negative thinking you feel better and behave differently. I had tried this when in an anxious state and it had actually made things a lot worse. I got so wrapped up in my thoughts and challenging them that I was constantly ruminating, thinking things over and over in an exhausting battle in my head. This, I feel, is the downside of CBT – there is a danger of ruminating and over thinking and by challenging your thoughts it can feel like you are constantly challenging yourself. My counsellor helped me see that for CBT to work I needed to work on 1 thought at a time and to notice if I was getting sucked in to a pattern of over thinking. There is a free online CBT programme called Living Life to the Full it includes online assessment of your mood using a questionnaire, then makes recommendations based on this. For CBT based counselling or any other mental health concerns consult your GP.

Once I'd relaxed a bit my thinking was less negative and less extreme and I was able to challenge some thoughts and see where I'd been very negative. I developed a few techniques that seemed to work for me. One I call the 100% rule. It asks you to be objective.

Out of 100% how true is this thought?

Is it true 100% of the time? Can you think of an example when it wasn't true?

Can you change it?

If you can't change it, can you accept it, could you cope with it?

I also found it helps to deal with the first negative thought not the ones that result from it. So let's look at an example from just before my marathon.

Negative thought 2 days before my marathon;

My GPS watch might break and stop working during my marathon

Secondary to that

I might not be able to pace myself and get a rubbish time

Maybe I'll go out too fast and not finish

What happens to the charity money if I don't finish?

It'll be really embarrassing if I have to pay everyone back….

And so on!

So the first thought, out of 100% how true is it that the GPS won't work?

0.5% maybe, if less. It works fine at the mo.

It's not true 100% of the time in fact it's never failed to record a run, I'm just worried because it took a while to boot up the other day.

Can I change it? Yes I can update the software and make sure it's fully charged.

Can I cope with it if it doesn't work? Yes, just stick close to a pacer.

If I don't get involved in the secondary thoughts, just deal with the primary it's easier. The final trick I found was “move on and wait”. Sometimes you don't feel immediately relieved with this method. Part of you still worries, it's then tempting to think about it more and more. For me I found it's best to draw a line under it and move on. Usually, given half an hour or so, you feel better and can see the situation for what it really is. By the way, the GPS worked just fine.

The problem I found though is that some negative thoughts carry such an emotional charge that you can't help but be drawn into them. Before you know it, with the help of a few other negative thoughts thrown in, you're feeling stressed and anxious. CBT was a big help for me, but I needed something else…that something came in the form of Mindfulness.

Mindfulness is an amazing concept. It's fair to say it changed my life. It's quite hard to describe it, without it sounding a bit new age (which it probably is). Mindfulness is present moment awareness. It's being in each moment, observing non-judgementally. For me the key thing is the awareness. This is an area of us that sort of sits above thought and feeling and is usually kinder and wiser. To use the example above with the GPS, the awareness would help me observe how I was thinking, to see I was thinking negatively and then do nothing about it. Yep, nothing. Zilch. Zip. Nada. Nil. Mindfulness helps you see thoughts as just thoughts. To observe your mind like a river with you observing from the riverbank. Occasionally a negative thought floats by, you can jump into the river and get caught up in it or just observe it and let it float by.

Mindfulness, like relaxation, is something you learn and cultivate. You do this through mindfulness meditation, which is a little different from relaxation although there is a lot of crossover. In mindfulness you are observing something, usually you start with your breathing. You focus on how the breath sounds, how it feels as the air moves in and out of your mouth and how your stomach rises and falls. All the while thoughts pop up and you observe them but keep bringing your attention back to this focus. It doesn't have to be breath, it can be a part or the whole of your body. It could be sounds you hear, tastes you experience, things you see. One of my favourite meditations was going to the beach and sitting on the pebbles. I'd listen to the sea and the crunch of people's feet on the stones as they wandered by. I'd feel the warmth of the wind stroking one side of my face and smell the BBQ's and occasional waft of cider breath from a nearby tramp! For more on Mindfulness the Mental Health Foundation has an online course but I don't think it's free. I can recommend the work of Jon Kabat-Zinn, especially Mindfulness for Beginners (available as a book or Audiobook). Below Jon Kabat-Zinn talks about the Mindfulness Based Stress Reduction programme (MBSR).


With time the meditation really, really helped. I had cultivated an awareness of how I was thinking. I could spot a negative thought and just not get drawn into it and I started to see how much these negative thoughts affected how I behaved. A breakthrough session came when I turned this mindfulness in on myself and started to really look at how I felt when I was anxious. I had this ball of tension in my chest and I decided to put it under a microscope and observe it – it looked a bit like this;

Seeing how you think and patterns in how you feel helps you to see when you're thinking and feeling anxiously. Because of that it often halts anxiety in it's tracks and worries no longer spiral out of control. A big help was spotting the 'urgency' the need to think about this now. When I was really anxious I'd use any spare minute to think something over in an attempt to find an answer. Now if I spot that sudden desire to engage and worry about something I see the signs of anxiety and move on to something else.

There is a whole lot more to Mindfulness than this. Research has shown that it changes the way the brain works. In one study subjects used Mindfulness meditation for 8 weeks and showed a change in activity in the area of the brain that processed emotion and the fight or flight response. In a older study by Jon Kabat Zinn they demonstrated up to a 50% reduction in pain in patients with chronic symptoms with an 8-10 week meditation programme. It's been shown to improve healing of skin conditions (psoriasis) and to improve relationship satisfaction. And it's even possible to run mindfully. Mindful running isn't easy and you'd probably need to practice other types of meditations first but if you're even just a bit more mindful when running it can enhance the experience. Mindful running means you hear every footfall, every birdsong, you smell the flowers you whizz by and see the sun glinting off the sea. It also means you're less likely to be drawn in to running along, focussing on how heavy your legs are, how tight your chest feels or worrying about something rather than enjoying the experience.

So how does this story end? With running to keep on top of the bio, mindfulness and CBT to take on the psycho and my growing confidence and better communication helping with the social part of this I gradually got better and better. In fact by April 2011 as I watched the Brighton Marathon I felt fine, even to the extent that now I rarely meditate or use relaxation techniques – I just don't feel the need to. But I do feel I'm more mindful, not just in 15 minute periods of meditation, but every day. I feel more human, more compassionate and infinitely more relaxed. The story didn't end there though, it took on a new chapter. Inspired by the marathon runners in 2011 I did Brighton Marathon in 2012 to raise money for the Mental Health Foundation as a thank you for helping me put myself back together. I've raised over £800 but the just giving page is still open (hint, hint!)… My slogan during the marathon was “26.2 miles is nothing compared with how far you've come….”

Well, it was until mile 21, then it became “oh my god, I'm totally broken! 26.2 miles is a ridiculously long way, what was I thinking!” Still, I finished it in a respectable 3:12:28.

My closing thoughts are this; I'm not a counsellor, nor am I trained in psychology. I'm not suggesting solutions here, just sharing my experience. What works for me may not be the answer for other people. What I've discovered is that running is a hugely valuable part of improving my mental health but for me I needed to look at how I felt and thought as well. Now I'm filled with inner peas and I did shake that devil off my back….

The worst part of this costume was the red body paint that I couldn't seem to shift even after a load of showers. 3 days later, on the morning I was due back to work I sent a friend a text which simply read, “oh my god. It won't come off!”



Mental Health and Running – Liz’s story

This post is the first in a series of articles on RunningPhysio looking into mental health and running. It's a huge topic in the running community and many people run to help their mental well being, so we are very lucky to have Liz to share her story with us. Liz is a blogger in her own right and has a fantastic blog which I have to admit is one of my favourites, you can also follow her on Twitter – @4races4cities. It's a very personal story but one I'm very glad she felt she could share with us…

Twelve years ago, my Mum took her own life.

Initially, I wrote ‘my Mum killed herself’ at the end of that sentence, but I deleted it. ‘Took her own life’ sounds warmer somehow, doesn’t it? It’s less harsh, and those black words seem less stark against the white background of this blog post.

I’ve spent a lot of time writing about my Mum, mental illness, and the charity fundraising I do for Mind. You can read more about it all here.

I have spent less time, however, writing about my own personal struggle with mental illness. When Tom asked me to guest blog for him, I wasn’t sure what to write about. My own running blog is quite light-hearted and a bit silly, so when Tom suggested I write about the affects of exercise on depression and anxiety, I realised that it would be a good opportunity to share my experiences, in the hope that it might strike a chord with someone out there.

Anxiety has been part of my life for a very long time. The grief surrounding my Mum’s death was channelled, not through crying and pining, but through severe anxiety, culminating in terrifying panic attacks and OCD. I saw different types of therapists and was prescribed strong anti-anxiety medication, at one point I was very nearly sectioned under the Mental Health Act.

Nothing worked.

Years passed by, and I just learnt to live with my mental health problems, I became a shadow of the person I was and lived half a life – anxiety and OCD clung to me tightly, suffocating my every move, and I couldn’t shake them off.

You’re probably wondering why I’m sharing this on a physiotherapist’s blog, right?

Perhaps you came here to read a post about IT band pain, or curing your plantar fascitis, or find specific exercises to strengthen your leg muscles.

You’re probably a runner.

Well so am I.

I haven’t always been a runner. Running kind of crept up on me two years ago, in the midst of the heartbreaking end to my eight-year relationship. My anxiety levels at the time were sky-high and I was struggling to cope. I don’t know what provoked me to put on my trainers and go for a run.

I guess I didn’t really know what else to do.

So I just ran.

I didn’t go far, only up to the end of the street and back, but it was enough, enough to quell the panic that rose in my chest and quieten the racing thoughts that darted back and forth in my mind. My heart rate soared, and yet instead of culminating in a panic attack, the way it always did, I felt euphoric and alive.

The next day, I laced up my trainers and went out for another run, this time venturing a little further. I had taken part in a 5 and 10K race in the past, and knew that my legs were capable of covering a longer distance, so I just kept going. I think I ran about 5K in total, but it could well have been 26.2 miles. I felt strong, capable and empowered. Again, I returned home exhausted but elated. My anxiety levels seemed to lower and I felt like my head was clear for the first time in years. Running seemed to distract me from the cycle of worries that fed the anxiety – something really resonated deep within me, and unlike my past forays with running, this time it stuck.

I noticed a local half marathon advertised on a lamppost, which I saw when, yes you guessed it, I was out running. I impulsively signed up for it, knowing that I would have to train hard. I scoured the Internet for half-marathon training plans, and bought myself a pair of proper running trainers, clothes and a Garmin GPS watch. My days were arranged around my running schedule, and I constantly read books and magazine articles to garner tips and advice on becoming a better runner. Weeks went by and I started to feel so much better, I lost weight and began to pay better attention to the way I fuelled my body so that I could run faster and for longer. Most importantly, I slowly felt the powerful grip of anxiety releasing its hold on me.

My attitude towards the way I viewed myself also started to change. I had always thought that I wasn’t capable of doing things; I’d spent so many years hiding in the shadows, too afraid to step up and challenge myself, and yet here I was, training for a half marathon on a whim and pushing my body and mind to places I’d never been before.

There were days when I wanted to give up.

I’ve lost count of the amount of times that I would sit under a tree in the local park, part of my running route, head in hands, crying with frustration. Running challenged me in ways that I’d never experienced – it pushed and prodded and hurt and dared me to run further, faster, and harder. It would have been so easy to just bail, let myself be beaten, but I didn’t. I wouldn’t allow it.

I don’t quite know how running relieved me of the years of suffering with my personal demons; there’s been a lot of research over the last few years, and scientists aren’t quite sure either. All I know is that it worked for me. These days, I am free from anxiety and the panic attacks, and I can honestly say that I am the happiest I have ever been. My life is filled with enriching experiences, energy and laughter. And running.

It’s all about the running.