17
EXERCISE AND SOCIAL INTERACTION SELF-STUDY
The Effects of Consistent Exercise and Social Interaction on Depression: A Self Study
In Partial Requirements of the Masters of Arts in Clinical Psychology
Abstract
As a student who has struggled with depression due to stress related events, and currently is completing a Master’s of Arts degree while working full-time with three young children, the potential for increases in depression is very high. A trial was conducted over a two week period introducing two variables upon depression: regular aerobic exercise and consistent non-work social interaction in the work place. The proposed hypothesis was the reduction of depression due to these two interventions. The results are measured and revealed to support this proposed hypothesis and discussion is offered relating to safe and effective use of self and the impact of this self-study for future students.
Key words: exercise, social interaction, depression, psychological well-being
Introduction
Everyone experiences sadness at various points in their lives. It is a normal, healthy part of life and beneficial in aiding individuals to grieve significant losses. Experiencing a “low mood” in response to a significant loss can keep an individual from making impulsive decisions. Everyone experiences depressive moments.
However, as Pinel points outs, some people experience a disproportionate intensity of depression that can become debilitating (Pinel, 2017). It can affect every area of an individual’s life. When depression becomes intense (lasting longer than a couple of weeks, or frequently reoccurs), individuals are suffering from clinical depression (Pinel, 2017). Researchers are reporting the rise in clinical depression or major depressive disorders resulting in the global recognition of its prevalence in the population (Ferrari et al., 2013). The World Health Organization declared depression to be the leading cause of health concerns and disabilities worldwide (Depression, WHO, 2017).
I have journeyed with depression my whole life. The biospsychosocial impact of my depression reflected common symptoms: irritability, negativity, lack of motivation, sleep disturbances, increased isolation and a consistently “low mood” (Clark et al., 1999). The symptoms “spiked” and became overwhelming several years ago with the combined factors of the birth of my third son and the unexpected death of my mother-in-law.
I decided to seek help and treated my depression from a biopsychosocial perspective (at the time I was unaware of Melchert’s approach to psychotherapy; Melchert, 2011). My doctor identified biological factors, my psychologist identified the psychological component, and I took a stress leave from work and self-disclosed to my family and close friends. I treated my depression with pharmacological methods and therapy, with the help of my social supports. These are important factors in my self-study since I believe that my previous (and continual) treatment plan for my depression influenced my results. At least, they were a necessary foundation for the proposed interventions to build upon.
I proposed two interventions to test their impact upon my level of depression: regular physical exercise and consistent social interaction. Both have been proven through evidence based studies to have positive effects on individuals who struggle with depression.
Exercise
The World Health Organization recommends that adults between the age of 18 and 64 should engage in 150 minutes each week of moderate aerobic activity (Physical Activity, WHO, 2017). The WHO recommends that an individual participates in multiple aerobic activities, spread out throughout the week, which should last in duration of more than ten minutes. Following these criteria will result in multiple health benefits.
The benefits of exercise on a person’s physical health have been well documented. Primarily focused on the preventative measures of exercise on diseases such as coronary heart disease, obesity, diabetes and even some cancers; health promoters often present the need for regular exercise as a deterrent to morbidity and pre-mature mortality. However, with the rising costs on national health care systems relating to mental health concerns, more research is being directed to the impact of regular exercise on an individual’s mental health and well-being.
Dr. Kenneth Fox (1999) surveyed evidence, from a variety of epidemiological studies, which reported the noticeable impact of regular exercise on clinical depression. He concluded that individuals who regularly exercised were less likely to suffer from clinical depression (Fox, 1999). Noting the limitations, yet considering the growing research, Fox argued that exercise should be used to help treat depression.
Peluso & Geurra de Andrade (2005) performed a literature review of articles using human based trials that contained the key words of “sports”, “exercise”, “mood” and “depression”. The results were then screened to only include studies that investigated the relationship between exercise and mood. They summarized that consistent aerobic exercise positively impacts the psychological health of individuals suffering with depression (Peluso & Geurra de Andrade, 2005).
However, the means and method of improvement are not clear. Depression may be directly impacted by exercise due the release of endorphins or increases in synaptic transmission of monoamines (Peluso & Geurra de Andrade, 2005). Or, depression may be reduced due to the increase in self-efficacy of the individual (Peluso & Geurra de Andrade, 2005). Whether exercise directly reduces depression; or, the resulting increases in self-esteem, vitality, and improved self-image correlate in a reduction of depression – either method results in a positive influence on an individual’s level of depression.
Social Interaction
Human beings are innate social creatures. We require consistent relationships that foster positive well-being (Baumeister & Leary, 1995). The debilitating effects of social isolation are clearly seen in the degrading psychological and physical health of prisoner isolation and war captives (Umberson and Montez, 2010). Social isolation can be torturous and is detrimental to our holistic health.
Conversely, meaningful and positive social interaction can dramatically increase an individual’s sense of satisfaction (Umberson and Montez, 2010). Whether in one-to-one interactions or within a group context, positive social engagement is proven to reduce depression (Umberson and Montez, 2010). Social interactions can be divided into three categories: interaction with people (friends, family, colleagues), interaction for people (volunteering for charities or activities for work), and personally supportive relationships (Eurostat, 2013). Interactions for people has been proven to cause the most stress or anxiety of the three options.
Also, an individual’s personality temperament will affect a person’s perception and sense satisfaction with each social encounter (Littauer & Sweet, 2011). Various personalities approach and engage socially from vastly different perspectives. Understanding each personality temperament will help inform an individual’s perception of their social interactions.
Hypothesis
Regular aerobic exercise and increased social interaction at work will decrease my sense of depression.
I hypothesized that walking outdoors, three times each day, for at least 15 minutes each time, would reduce my depression. I also hypothesized that increased non-work social interactions at work would reduce my depression.
Method
Participant
One participant, who is a 43 year old male. I am married with three children, have full-time employment and I am enrolled in the MACP at Yorkville. I have a history of struggling with depression and was diagnosed with moderate depression in 2014. I have been through psychotherapy and currently practice a daily relaxation exercise and often utilize mindfulness exercises.
My current work environment does not mandate “coffee breaks” in the morning and afternoon. Also, I currently work alone in a building surrounded by farmer’s fields with occasional social interaction when people “drop-in” or I visit them. However, these interactions are work related and not considered social in nature.
Design and Procedure
This assignment involved a quasi-experiment investigating the impact of two interventions on depression and academic satisfaction over a 14 day trial period. I established a baseline reading of my current depression utilizing Beck’s Depression Inventory (BDI; Appendix B) two days before the trial period commenced. BDI is recognized globally as an effective tool to measure depression (Wang & Gorenstein, 2013).
Wang & Gorenstein (2013) examined the wealth of material related to usage of BDI as a measurement for depression. They approved it’s utilization as a method of indicating depression, but recognized its short-comings in diagnosing depression (Wang & Gorenstein, 2013). Realizing the limitations of BDI, I utilized it as a tool to measure my indication of depression on each day of the study.
I completed Littauer’s personality profile to determine my perspective on social interaction. According to Littauer, each personality has emotional needs that are looking to be met in unique ways through social interactions (Littauer & Sweet, 2011). To assess my satisfaction with each social interaction, I utilized a modification of the assessment tool employed by Williams, K. D., Cheung, C. K., & Choi, W (2000) to access the Basic social needs satisfaction (BSS; Appendix C).
After establishing a baseline score via BDI of 29, I introduced two variables: I began fast walking 60 to 70 minutes every day (10 to 15 minutes during my morning break, 30 to 40 during my lunch break, and 10 to 15 minutes during my afternoon break). I would walk along the boardwalk beside Lake Temiskaming and enjoy the natural beauty while exercising.
I also moved my work location to the local library where they allowed me to use a computer station in the middle of the room. This enabled me to interact consistently with the librarian who worked close by and any who came in to use the library. Harvey Reis (2001) presented the difference in emotional impact between social interactions between groups and one-on-one engagements. I engaged in only one-on-one interactions allowing for uniform research results. Each break, I would purposely interact with the librarian for at least 5 minutes. At the end of the day, I evaluated my satisfaction with the encounters throughout the day using the BSS.
Data Analysis
Each intervention was measured according to its own scale as well as their impact on my depression. These results were placed in an Excel graph (Appendix A).
Results
My physical activity remained constant, even within horrible Northern weather (hail, sleet, snow). Each day, I fast walked at least 60 minutes.
The number of daily interactions are self-explanatory and are included in the graph analysis due to their impact upon the results. The single librarian was absent one day and his replacement was not friendly; in fact, she was very stand-offish. This impacted the number of social interactions on that day and my overall sense of satisfaction and psychological well-being. When I returned to my original work environment, my BDI increased.
My overall satisfaction with each day’s social interaction could range from 0 to 35. The first few days reflect my enjoyment and satisfaction compared to the limited social interaction with my previous work location. As the librarian and I become more familiar with each other, my enjoyment and satisfaction increased, which was predicted by Reis (Reis, 2001). The drop in number of social encounters, and subsequent drop in satisfaction, reflects the change in the library staff and reflects my return to my original work environment.
According to Littauer, I am a Choleric-Sanguine personality meaning that I am an extrovert and enjoy social interaction (Littauer & Sweet, 2011). Apparently, it is an emotional need as well. When subjected to social isolation (or only experience social interaction that is a requirement for work), I experience psychological distress (Umberson and Montez, 2010). This was reflected in my research.
The BDI measurement ranges from 0 to 63. My baseline began at a measurement of 29. Each day, my BDI score lowered until by the end of the trail period, my score was 20 which was a decrease of 31%! When I returned to my original work environment, my depression score spiked.
My Academic satisfaction was already high, and this assignment maintained my level of satisfaction.
Discussion
I predicted that regular physical exercise and consistent, non-work related social interaction would have a positive effect on my psychological well-being resulting in a reduction of my depression. The results support this hypothesis. My scoring, using BDI, decreased as my satisfaction with my social interactions increased.
As Umberson and Montez (2010) noted, social interaction improves mental health. As Peluso & Geurra de Andrade (2005) summarized, my physical exercise improved my psychological well-being. Overall, my depression scoring dropped by 31% when using the BDI has a measuring tool. When I returned to work at my original location, my depression scoring reflected a closer number to its original base line.
Safe and Effective Use of Self
In light of this new information, I am forced to make changes to my current work environment in order to promote a healthy use of self. The results cannot be ignored. Regular exercise is possible to maintain regardless of my work location. I require the self-discipline to follow through (which I have been able to continue).
The social interactions that I require at work will be a greater challenge to meet. However, I will be meeting with my board of directors to discuss the possibility of working half the day at the library and the other of the day in my current work location. If the common goal is work longevity (which my mental health is a key factor), I believe we will be able to reach a suitable accommodation.
Future Students
For future students, the evidence based articles, coupled with this quasi-experiment, prove the need for consistent, regular exercise as a treatment for and prevention of depression (Peluso & Geurra de Andrade, 2005). For personalities similar to mine, consistent non-work social interaction will aid in our psychological well-being. Social isolation will probably increase depression (Littauer & Sweet, 2011).
References
Depression, Let’s Talk (2017). WHO. Retrieved on March 15 from
http://www.who.int/mediacentre/news/releases/2017/world-health-day/en/
Ferrari A.J., Charlson F.J., Norman R.E., Patten S.B., Freedman G., Murray C.J. (2013) Burden
of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Med 10(11): e1001547. https://doi.org/10.1371/journal.pmed.1001547
Fox, K. (1999). The influence of physical activity on mental well-being. Public Health Nutrition,
2(3a), 411-418. doi:10.1017/S1368980099000567
Littauer, F. & Sweet, R. (2011). Personality Plus at Work: How to Work Successfully with
Anyone. Grand Rapids, MI: Baker Publishing.
Melchert, T. (2011). Foundations of Professional Psychology: The End of Theoretical
Orientations and the Emergence of the Biopsychosocial Approach. Amsterdam: Elsevier.
Peluso, Marco Aurélio Monteiro, & Andrade, Laura Helena Silveira Guerra de. (2005). Physical
activity and mental health: the association between exercise and mood. Clinics, 60(1), 61-
70. https://dx.doi.org/10.1590/S1807-59322005000100012
Physical Activity and Adults (2017). WHO Retrieved on March 14, 2018 from
http://www.who.int/dietphysicalactivity/factsheet_adults/en/
Pinel, J. & Barnes, S. (2017). Biopsychology. Pearson: University of British Columbia.
Eurostat (2013). Quality of life indicators – leisure and social interactions. Retrieved on March
15, 2018 from http://ec.europa.eu/eurostat/statistics-explained/index.php/Quality_of_life_indicators_-_leisure_and_social_interactions
Reis, H. T. (2001). Relationship experiences and emotional well-being. In C. D. Ryff & B. H.
Singer (Eds.) Emotion, Social Relationships and Health (pp. 57-85). Oxford: Oxford University.
Umberson, D., & Montez, J. K. (2010). Social relationships and health: A Flashpoint for health
policy. Journal of Health and Social Behavior, 51(Suppl), S54–S66. http://doi.org/10.1177/0022146510383501
Wang, Yuan-Pang, & Gorenstein, Clarice. (2013). Psychometric properties of the Beck
Depression Inventory-II: a comprehensive review. Revista Brasileira de Psiquiatria,
35(4), 416-431. Epub December, 2013.https://dx.doi.org/10.1590/1516-4446-2012-1048
Williams, K. D., Cheung, C. K., & Choi, W. (2000). Cyberostracism: effects of being ignored
over the internet. Journal of Personality and Social Psychology, 79, 748-752.
Appendix A
Legend:
Blue – number of non-work social interactions
Orange – overall satisfaction based upon BASS and divided by 2 to fit scale
Grey – depression score based upon BDI and divided by 2 to fit scale
Gold - Time in minutes of aerobic activity, divided by 10 to fit scale
Appendix B
Beck's Depression Inventory
This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6.
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.
11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.
14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look unattractive
3 I believe that I look ugly.
15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.
INTERPRETING THE BECK DEPRESSION INVENTORY
Now that you have completed the questionnaire, add up the score for each of the twenty-one questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circles zero on each question. You can evaluate your depression according to the Table below.
Total Score____________________Levels of Depression
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression
Appendix C
Basic Needs Questionnaire
(Williams, Cheung, & Choi, 2000)
For each question, please select the response that best represents how you felt during the interaction you just engaged in with the other participant. Please use the following scale when making your responses.
1=NOT AT ALL
2
3
4
5
6
7=EXTREMELY
Belong : I felt a bond with the other person.
Self-esteem : I felt liked.
Control : I felt I had the ability to significantly alter events during the interaction.
Meaningful existence : I felt useful.
Positive mood : I felt good.
