JMIR Publications

ABSTRACT

Background:

Anxiety and depressive disorders are common and burdensome, yet many people prefer to self-manage and do not access treatment or fail to achieve meaningful improvement. Prior research indicates that the frequency of performing simple, everyday actions, namely “The Big 5” (i.e., healthy thinking, meaningful activities, having goals and plans, healthy routines, and social connection) is strongly associated with support mental health and wellbeing. This research has been primarily quantitative in nature and so less is known about how people perceive and interpret changes in their mental health when engaging in or limiting these actions.

Objective:

To explore participants’ perceptions of mental health changes, and associated insights into what most impacts their mental health, during a randomised controlled trial (RCT) involving the systematic restriction and followed by resumption of the Big 5 actions.

Methods:

This longitudinal qualitative sub-study analysed weekly free-text comments from 70 asymptomatic Australian adults (Intervention Group [IG] n=36; Control Group [CG] n=34). IG participants completed an 8-week RCT comprising three phases: a 2-week baseline phase (Phase A), a 2-week behaviour restriction phase during which they reduced the frequency of The Big 5 actions (Phase B), and a 4-week recovery/resumption phase during which they increased the frequency of The Big 5 actions back to usual levels (Phase C). CG participants were instructed to maintain usual habits and activities. The weekly free-text comments related to what participants had noticed and learned about their mental health. These were thematically analysed using framework methods to identify patterns in perceived changes, considering trial phase, group allocation, and participant characteristics.

Results:

Analyses identified five interrelated themes around what participants reportedly learned and what most impacted their mental health: (1) Rhythms of daily life and routine, (2) Harnessing internal psychological resources, (3) Social support and interpersonal stressors, (4) Staying active and enjoying yourself, and (5) Environmental and external influences. In the IG, participants reported that behavioural restriction led to subjective disruptions across all five themes, precipitating declines in mood, energy, and stability; resumption fostered recovery, along with increased insights into oneself and mental health, coping strategies, and a sense agency. Compared to the IG, the CG more often emphasised environmental and external influences.

Conclusions:

Findings reinforce the centrality of specific daily actions, namely the Big 5, to people’s subjective wellbeing and suggest an additional “macro-level” comprising environmental and external influences. Exposure to behavioural restriction and resumption/recovery served to highlight the importance of certain factors for mental health and appeared to improve people’s sense of agency and locus of control regarding their mental health. Clinical Trial: N/A