Emotional Wellness

Emotional wellness is the ability to recognise what you are feeling. It is the ability to manage those feelings without harm to yourself or the people around you, and to say what you need in a way others can hear. It is better understood as a set of capacities that can be practised and improved than as a fixed trait a person either has or lacks.

It is not permanent happiness. Sadness, anger and fear are ordinary parts of emotional life, and a person can be emotionally well while feeling all three in a hard week. It is not a diagnosis, and no clinician assesses or treats it as one. It is also not another word for mental health, although the two are closely related, and the difference between them is the most useful thing on this page.

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What emotional wellness is made of

Researchers who wanted to measure wellbeing ran into the same problem the word creates for everyone else: it is vague. One way round it was to work backwards from illness. Huppert and So identified ten features of psychological well-being by defining the opposite of the common symptoms of anxiety and depression.¹ The ten they arrived at are:

• competence
• emotional stability
• engagement
• meaning
• optimism
• positive emotion
• positive relationships
• resilience
• self-esteem
• vitality

The list is more informative for what it leaves out than for what it contains. There is no item for feeling good most of the time, and no item for having few problems. Competence, engagement, meaning and vitality all describe what a person is able to do and able to care about. That is why emotional wellness can grow during a difficult year rather than only during an easy one, and why a comfortable life is no guarantee of it.

Emotional wellness and mental illness are not opposite ends of one line

Most wellness writing treats emotional health as a single scale, with unwell at one end and well at the other. The research does not support that picture. Positive psychologists argue that doing well and doing poorly are not simple opposites, but two distinguishable dimensions, so complete mental health means high psychological well-being together with the absence of a disorder.²

Wellbeing researchers reach the same place from a different direction. Wellbeing and illbeing are not necessarily polar opposites, and the relationship between them differs across conditions such as depression, anxiety, drug abuse and eating disorders.³ The two are distinct dimensions that relate to each other at many points.

This has a practical consequence for readers on either side of it. A person living with a diagnosed condition can still build meaning, engagement and steady relationships, and that work is not put on hold until the symptoms clear. A person with no diagnosis at all can be flat, disconnected, and going through the motions of a life that looks fine from outside. Mental well-being may be associated with onset, recovery and recurrence of episodes of mental illness, although the detail of those associations is complex.⁴

What it looks like in an ordinary week

In a consulting room, emotional wellness is rarely described in the abstract. It shows up in small, specific things. It might mean saying "I am angry with you" to a partner instead of going quiet for two days. It might mean noticing tightness in the chest before a meeting and recognising it as fear rather than a heart problem. It might mean being upset by a rejection on Monday and still able to work by Wednesday.

Honesty in close relationships is part of it, not an optional extra. Authenticity in relationships, meaning openness and honesty with the people close to you, has been found to predict relational health, including more secure romantic attachment and interpersonal trust.⁵ The reverse is also familiar in clinical work: people who perform a steady version of themselves for everyone tend to end up lonely inside relationships that look good on paper.

These questions are more useful than a checklist of tips, because the answers are specific to one life rather than to the topic. If you want a reading of your own situation, work through them for the week just past:

• When something upset you, could you name the feeling more precisely than "bad" or "stressed"?
• Who did you tell, and how long did you wait before telling them?
• What did you do with the feeling: sit with it, act on it, or push it out of sight?
• Is there someone you are consistently not honest with about how you are doing?
• When last did you do something because it interested you rather than because it was required?
• If this week repeated for three months, what would have to change?

What helps, and what it does not do

Two habits of emotion regulation have been studied more closely than any others, and they are usually measured together. The Emotion Regulation Questionnaire distinguishes expressive suppression, controlling your emotions by not expressing them, from cognitive reappraisal, thinking about a stressful situation in a way that helps you stay calm.⁶

Suppression is what most people reach for under pressure, because it works in the moment and costs nothing socially. Reappraisal is slower and harder, and it is the one that changes what the situation means rather than only what shows on your face. Neither is a technique to install and forget. Researchers have compared how different patterns of using acceptance and cognitive restructuring relate to measures of psychological well-being, and whether people who use both fare better than people who use only one.⁷ The question of which combination suits which person is still open.

Slowing the breath is the most commonly recommended practice for a body already in alarm, and there is measured support for it. A study of breathing and attention reports work by Zeidan and colleagues in which brief mental training improved sustained attention and reduced fatigue and anxiety.⁸ That is a modest finding, not evidence that breathing treats an anxiety disorder. Ten slow breaths will not resolve anything, but settling the body's alarm response makes clearer thinking possible.

Relaxation practice has an honest limit that wellness pages seldom print. A 2017 systematic review found that relaxation techniques and cognitive behavioural therapy both helped improve mental health in adults with irritable bowel syndrome, but that only the therapy improved daily functioning.⁹ Feeling calmer and functioning better are not the same outcome, and a practice can deliver the first without touching the second. Supportive practices support wellbeing; they do not treat a mental health condition, and a page that suggests otherwise is misleading its readers.

When self-directed work is not enough

No list of practices can tell a person whether what they are carrying is ordinary strain or something that needs a clinician. Four things settle that question better than the topic of the distress does, and a therapist assessing a new patient asks about all four in the first session.

If several of these point the same way, and particularly if impact and direction do, it is time to consider therapy. A conversation with a therapist is then a more reasonable next move than a fifth self-help practice. Nothing about that judgement depends on how serious the original event was. People come through severe losses with their functioning intact, and people are brought down for months by something they consider trivial and are ashamed to mention.

What therapy adds to self-directed work is another person in the room, and that is not a soft extra. Gilbert holds that compassion from another person helps to settle threat and self-protective strategies,¹⁰ and that it builds the inner conditions in which growth, change, healing and well-being become possible. The relationship itself carries part of the work: in one psychotherapy study, participants reported improving wellbeing over time, and that improvement correlated positively with the therapeutic alliance they had with their therapists.¹¹

Your therapist will usually spend the first sessions working out with you what you are hoping will be different, and will say plainly if what you are describing needs a medical assessment as well. No honest clinician promises an outcome or a timeframe. A good working relationship is also not automatic, and if it has not developed after several sessions it is reasonable to say so, and reasonable to see someone else.

Finding a therapist in your own country

Who may call themselves a therapist, and what they are permitted to do, is decided country by country, and sometimes region by region inside one country. In the United States, the scope of practice for each provider type is set at state level by statute, regulation or guidance.¹² What a counsellor, a psychologist and a social worker may each do differs between states. A qualification that means one thing where the page was written can mean something different where the reader lives.

Two checks handle this wherever you are. Ask which body holds the practitioner's registration, and then confirm the registration with that body directly, since almost every regulator publishes a searchable register. If a title is unfamiliar, ask what training sits behind it and what the person is registered to do.

TherapyRoute is run by clinicians and lists registered therapists in countries around the world. If you would like help deciding what to look for and what to ask in a first call, read our guide on how to find the right therapist.

Related reading

• Mental health: the wider context this page sits inside.
• Stress management: for pressure at work or in study that has not yet become distress.

Team TherapyRoute

References

1. [1] Source hosted at hqlo.biomedcentral.com. hqlo.biomedcentral.com/articles/10.1186/s12955-020-01423-y.
2. [2] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2): Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2), 33.13: Positive Psychology (pt 2) (pp 7265-7272).
3. [3] Diener, Oishi & Tay - Handbook of Well-Being (2018, DEF): Diener, Oishi & Tay - Handbook of Well-Being (2018, DEF), Environmental (pt 22) (pp 295-302).
4. [4] Source hosted at www.cambridge.org. cambridge.org/core/journals/the-british-journal-of-psychi....
5. [5] PubMed Central. pmc.ncbi.nlm.nih.gov/articles/PMC6676168.
6. [6] PubMed Central. pmc.ncbi.nlm.nih.gov/articles/PMC9764238.
7. [7] PubMed Central. pmc.ncbi.nlm.nih.gov/articles/PMC5323484.
8. [8] DOI record. doi.org/10.3389/fpsyg.2017.00874.
9. [9] Source hosted at www.nccih.nih.gov. nccih.nih.gov/health/relaxation-techniques-what-you-need-....
10. [10] Gilbert & Leahy (eds) - The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies (2007): Gilbert & Leahy (eds) - The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies (2007), Chapter 6 Evolved minds and compassion in the therapeutic relationship (pt 1) (pp 123-130).
11. [11] PubMed Central. pmc.ncbi.nlm.nih.gov/articles/PMC11700981.
12. [12] Congressional Research Service (Congress.gov). congress.gov/crs_external_products/R/HTML/R43255.web.html.