Passion, Hobby, & Activity (PHA)
Over two years into the Covid-19 pandemic, there is now a real fearthat the deleterious mental health effects may linger for many years tocome.Ettman et al.1 showed that depression has increased during the pandemic for a variety of factors. We propose that hobbies, when aligned with one’s passion and embedded in daily activities, is a potential solution for mental health prevention and treatment during these difficult times.
The World Health Organization (WHO) has made many recommendations2 on how individuals can take care of their mental health, including maintaining regular sleeping and eating patterns, as well regular exercise. Having a hobby is a less commonly discussed solution, even though it has been widely cited as lowering levels of depression or even preventing it from occurring in the first place.3
Dr. Mukarram Zaidi, a family physician in Calgary and one of the authors of this blog, has been seeing an increasingnumber of people who lost interest and joy in their lives. This is one of the commonest features of depression, known as anhedonia. In addition, the use of medications has its limitations.4As a solution, Dr. Zaidi has encouraged his patients to explore the concept of aligning their Passion, Hobby & Activities, or PHA. PHA is a term Dr. Zaidi has coined, which posits that individuals should find something they are extremely passionate about (e.g., photography, hockey or skiing) and try to make it into a constant hobby or activity. In this way, the three components are aligned.
An interest or hobby is usually regarded as an activity done for fun or pleasure during spare time. It can provide satisfaction, but only for a short while. A passion, on the other hand, is an activity that involves a strong enthusiasm and excitement. It is something that one cannot live without. People often feel compelled to make time for their passions, no matter how busy life gets. Aligning one’s hobby with one’s passion is the key.
Individuals are encouraged to explore new hobbies, which can turn into regular activities, such as painting, sewing, knitting, gardening, or carpentry. New behaviours can positively impact mental health by providing novel experience and cognitive stimulation. Learning new skills also helps to take focus away from anxiety. This is replaced with creativity and playfulness. When these activities are done in group settings, people can find social support and a sense of purpose.
Studies including individuals with depression have reported that the brain needs constant stimulation or ‘exercising’ of the neural circuits that mediate positive emotions via sustained and deliberate activity to counter the onset of anhedonia.5 The therapeutic focus and concept of PHA is similar to other translational treatments such as Positive Affect Stimulation and Sustainment (PASS) and Positive Affect Treatment (PAT).6
PASS focuses on planned events, and enhancing positive emotions related to them, as well as savouring the moments by recalling and writing about the event. PAT is similar in that individuals schedule events and deliberately associate positive emotions with them. However, PHA has more of a preventative element to it, as the concept promotes regular (e.g., daily or weekly) participation in a specific passion.
Cognitive Behavioral Therapy (CBT) is a structured approach used to treat a variety of mental health disorders by exploring the links between thoughts, emotions, and behavior.8 CBT helps patients understand their current ways of thinking and behaving, while simultaneously providing them with the necessary tools to change their maladaptive cognitive and behavioral patterns.8 When focusing on one’s personal passion and aligning it as a hobby, one can also help overcome procrastination, removing the need for repeated decision making. In this way, PHA naturally dovetails with existing CBT behavioral techniques to enhance functioning and increase pleasure or productive experiences.
PHA’s interventional approach is consistent with the well-known theory of behavioral activation. Originally developed as part of CBT, behavioural activation emphasizes increasing adaptive, pleasurable activities that would reinforce a positive emotional state and promote behavior change. Behavioural activation aims to provide more adaptive alternatives that diminish patterns of negative reinforcement and withdrawn or avoidant behavior (characteristics underlying depression).7 PHA parallels behavioural activation by increasing positive reinforcement and diminishing negative reinforcement, but PHA also has the possibility to enhance therapeutic effects by specifying the way in which one should structure / align their activity. If the hobby is something that the person is truly passionate about, it becomes sustainable and easier to maintain.
Studies have shown that low assets / income is associated with poor mental health, especially for racialized communities, who are often disproportionately affected.9-11 Individuals who cannot afford to take time off work or see a specialized therapist can greatly benefit from PHA as it is a low-cost intervention.
By encouraging people to look within themselves and consider their passions and align them with their regular hobbies, PHA could reduce depressive symptoms.
One question remains: What is your PHA?
Abul Rehman Syed is a BAO Candidate, Class of 2024 at University College, Dublin.
Umar Syed Zaidi is in the Bio Science Program, Class of 2025 at the University of Calgary.
Dr. Mukarram Ali Zaidi is a Clinical Assistant Professor in the Department of Family Medicine, Cumming School of Medicine at the University of Calgary.
References
1. Ettman CK, Cohen GH, Abdalla SM, et al. Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults. Lancet Reg Health - Am. 2022;5:100091. doi:10.1016/j.lana.2021.100091
2. #HealthyAtHome. Accessed February 5, 2022. https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health
3. Fancourt D, Opher S, de Oliveira C. Fixed-Effects Analyses of Time-Varying Associations between Hobbies and Depression in a Longitudinal Cohort Study: Support for Social Prescribing? Psychother Psychosom. 2020;89(2):111-113. doi:10.1159/000503571
4. Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53. doi:10.1001/jama.2009.1943
5. Heller AS, Johnstone T, Shackman AJ, et al. Reduced capacity to sustain positive emotion in major depression reflects diminished maintenance of fronto-striatal brain activation. Proc Natl Acad Sci. 2009;106(52):22445-22450.
6. Winer ES, Jordan DG, Collins AC. Conceptualizing anhedonias and implications for depression treatments. Psychol Res Behav Manag. 2019;12:325-335. doi:10.2147/PRBM.S159260
7. Soucy Chartier I, Provencher MD. Behavioural activation for depression: Efficacy, effectiveness and dissemination. J Affect Disord. 2013;145(3):292-299. doi:10.1016/j.jad.2012.07.023
8. Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT. 2013;6(9):579-585. doi:10.1177/1755738012471029
9. Ettman CK, Cohen GH, Abdalla SM, Galea S. Do assets explain the relation between race/ethnicity and probable depression in U.S. adults? PLOS ONE. 2020;15(10):e0239618. doi:10.1371/journal.pone.0239618
10. Ettman CK, Cohen GH, Galea S. Is wealth associated with depressive symptoms in the United States? Ann Epidemiol. 2020;43:25-31.e1. doi:10.1016/j.annepidem.2020.02.001
11. Hou WK, Lee TMC, Liang L, et al. Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong. Soc Psychiatry Psychiatr Epidemiol. Published online February 16, 2021:1- 10. doi:10.1007/s00127-021-02037-5