Mental Health Awareness Month: Fitness #4Mind4Body

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

Let’s Talk About Anxiety

by Annabelle Parr

Anxiety is a hot topic these days. It’s all over the news, and apparently it is on the rise. In the age of information and technology, we are constantly bombarded with doom and gloom news alerts, including reminders that on top of everything else, we are plagued with increasing anxiety. Eventually, these reminders can get exhausting and may even contribute to the anxiety that is apparently so prevalent in the first place.

Image source: https://www.theodysseyonline.com/poems-read-anxiety

Of course, there are benefits to all this conversation around anxiety: we have a better understanding of what anxiety is and as a result we may be able to understand and empathize with those who are struggling better. But it’s important to be careful that we don’t pathologize all anxiety, and that we don’t lose sight of the strength that exists in those who truly do have anxiety disorders.

Anxiety: Natural Response to Stress or Disorder?

The way we talk about anxiety today, it is easy to believe that all anxiety is inherently bad and forget that it’s our natural response to threat or danger. We actually need anxiety to survive; it prepares our body to respond appropriately in the face of danger. However, our physiological experience of anxiety developed back when the regular dangers humans faced included running from large, sharp toothed predators. So when we are experiencing the fight-or-flight response before a big exam or presentation, it may not feel particularly adaptive. But despite the discomfort that comes with anxiety, it is natural when it is experienced as the result of a particular situation or problem, when it is proportional to the stressor, and when it only lasts until the situation is resolved (ULifeline, 2016). Anxiety, though often painful, is an important and adaptive part of the human experience.

Image source: aconsciouslifenow.com

Though originally an adaptive response, anxiety does have the potential to be harmful when it manifests as “constant, chronic and unsubstantiated worry that causes significant distress, disturbs your social life and interferes with classes and work” (Active Minds, 2016). In other words, anxiety is no longer helpful when it begins to appear when there is no actual threat present. When a person experiences anxiety but has no threat to respond to, what happens? They begin avoiding situations that are actually safe. Their mind and body are telling them that safe situations are threatening, which can have a debilitating effect. When anxiety becomes disordered, it arises unexpectedly, is overwhelming, and, rather than catalyzing adaptive behavior in the face of a threat, often fosters avoidance of everyday situations (Here to Help, 2016).

Image source: http://www.huffingtonpost.com/2015/05/18/anxiety-photos-katie-crawford_n_7292548.html

So what is the takeaway? Anxiety is uncomfortable, but it helps us respond to threat, uncertainty, trouble, or feelings of unpreparedness (Active Minds, 2016). Anxiety becomes a problem (and possibly a disorder) when it comes seemingly out of nowhere and in the absence of a stressor proportional to the response, and it interferes with functioning in some way.

Recognizing Strengths as well as Struggles

There is no denying that feeling anxious is not pleasant. It can range from uncomfortable to unbearable. For those with anxiety disorders, anxiety is unpleasant on a whole new level; it can be completely overwhelming and paralyzing. It is hard to describe how out of control one can feel in the middle of a panic attack, or how draining it is to go through the day (week, month, or year) flooded with anxiety.

But in the midst of this struggle, it’s important to remember that anxiety doesn’t own you. It may be a part of you, and it may influence your life in various and profound ways. But anxiety does not determine who you are. A diagnosis does not define you. You are not a disorder. You are not weak, powerless, or alone.

Image source: http://quotesgram.com/from-brene-brown-quotes/

Acknowledging the pain anxiety can bring is so important, but it can also be helpful to recognize that struggling with anxiety may also foster certain strengths. According to Dr. Tracy Foose (2013), trait anxiety is associated with being “highly conscientious, honest, detail oriented, performance driven, socially responsible, [and] self-controlled.” Furthermore, learning to cope with anxiety can push us towards an increased self-awareness and knowledge of ourselves. Because it is so uncomfortable, it can motivate us to grow and change parts of ourselves or our lives that may not be serving us. And once we learn that we can move through the discomfort of anxiety, we often feel stronger and more confident in ourselves knowing that we have the fortitude to move through something so profoundly difficult (Sutherland, 2011).

Finally, if you do feel like anxiety is controlling your life, you don’t have to stay stuck in this space. Not only can anxiety teach you to embrace vulnerability and reach out for support from loved ones, but therapy offers very effective treatment. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can teach valuable coping skills, and can help to change your relationship to anxiety. Nothing will ever take anxiety away completely, but we wouldn’t want that because without anxiety, we wouldn’t survive. But therapy can help us learn that even in the worst throws of anxiety, we will survive, and even thrive.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Active Minds. (2016). NSOD: Difference between normal anxiety and an anxiety disorder.  Retrieved from: http://www.activeminds.org/component/content/article/512-nsod-difference-between-normal-anxiety-and-an-anxiety-disorder

Foose, T. (2013, Feb. 19). Positive traits seen in anxiety disorders. SF Gate. Retrieved from: http://www.sfgate.com/health/article/Positive-traits-seen-in-anxiety-disorders-4291474.php

Here to Help. (2016). What’s the difference between anxiety and an anxiety disorder?  Retrieved from: http://www.heretohelp.bc.ca/ask-us/whats-the-difference-between-anxiety-and-an-anxiety-disorder

Sutherland, M. (2011). The Benefits of Anxiety. Retrieved from: https://willowtreecounselling.ca/articles/the-benefits-of-anxiety/

ULifeline. (2016). Anxiety vs. anxiety disorders. Retrieved from: http://www.ulifeline.org/articles/439-anxiety-vs-anxiety-disorders

How Anxiety Affects Couples

by Jan E. Estrellado, Ph.D.

Most of CSAM’s blogs focus on the experience of having a mental health condition, such as anxiety, depression, or PTSD.  This blog is a little different because it focuses on the impact of a mental health condition, anxiety, on couples.  What is it like to care for, live with, and support someone with anxiety?  What kind of strain might this cause in a relationship and what can couples do to sustain each other and their relationship?

Loving Someone with Anxiety

Partners or spouses of individuals with anxiety might experience feelings of helplessness.  When anxious loved ones feel intense fear (i.e., scared of having a panic attack or becoming severely preoccupied with worried thoughts) or avoid certain situations (i.e., not wanting to drive on the freeway or refusing to leave the home), partners may not feel there is much they can do to help reassure or calm them down.  When a partner does attempt to help ease his or her loved one’s suffering, those attempts (i.e., reassuring, problem-solving) may be rejected by the anxious individual.  This can be extremely hurtful and can lead to other intense feelings described below.  In addition, partners may try to help by offering to drive for the anxious partner, agreeing to skip a social event, or allowing the anxious partner to engage in compulsions so that he or she gets relief.  While these efforts are meant to be helpful, the avoidance partners are enabling actually contributes to and maintains the anxiety-related problems.   

Image source:  http://www.recovering-couples.org/

The emotions that partners of anxious individuals can experience range and vary greatly.  They may feel anger and frustration that the anxiety inhibits their lives, and because their partner’s anxiety is outside of their control.  It is difficult to accept that a loved one may continue to feel anxious, regardless of the actions of the partner.  If a partner’s anger remains unresolved over a long period of time, this can turn into resentment, minimization, or blame.  Partners may feel overlooked or overshadowed by their loved one’s anxiety, perhaps feeling like their needs can’t be met when calming their partner down feels the most urgent.

Being the Anxious Partner in the Relationship

Image source:  http://www.dralexandrasolomon.com/common-fights/

The partner who experiences extreme worry can easily feel guilt, shame, and embarrassment at their lack of ability to manage anxious feelings.  They may also feel misunderstood and alone.  These negative feelings, if not addressed or acknowledged effectively, might actually contribute to further anxiety.  If an anxious person feels his or her partner is getting frustrated, that person might shut down, withdraw from the relationship, or engage in unhelpful coping behaviors, such as smoking cigarettes or shopping excessively. When worry and stress take up a lot of space in a relationship, the anxious individual often feels responsible for his or her partner’s feelings of frustration, hurt, or helplessness.  These feelings of guilt or embarrassment compound the individual’s pre-existing feelings of worry, increasing the suffering of that person. 

It may be difficult for the anxious partner to know what he or she needs.  Perhaps he or she is too ashamed to ask for support when so much help has already been requested of the partner.  When a person experiences intense fear in the moment, it can be challenging to know what is helpful and perhaps even more challenging to communicate those needs effectively.  Intense fear, by nature, prevents a person from thinking logically or rationally and it can be tough to know how to reign one’s self in during those moments.

Sustaining the Relationship

What can a partner of an anxious individual do to help make the relationship work?  One crucial element is for the partner to make sure that he or she is able to maintain his or her own health and wellness.  A partner can feel guilty for taking care of himself or herself, especially knowing that his or her loved one may be suffering.  However, if both partners are suffering, especially over a long period of time, the relationship is no longer sustainable.  A partner might need to seek this support outside of the relationship.  Examples of support outside the relationship include trusted friends, family members, health providers, faith leaders, co-workers, and therapists.

Image source:  http://claudialistens.me/couples/

In addition, a person may want to communicate his or her needs to the anxious partner, even if it is difficult.  If only one person’s needs are being met or paid attention to consistently, the relationship feels one-sided—another predictor of an unsustainable situation.  Asking for one’s needs to be met can also include discussing feelings and reactions to the partner’s anxiety.   While communicating feelings in an authentic, yet caring way, can be challenging, both partners might experience some relief and a greater connection, and the likelihood of resentment decreases.

An anxious individual may not want to wait until he or she experiences intense fear to know what help the partner can provide.  Rather, identify wants and needs during more calm or grounded moments.  When an anxious person knows what works, it is easier to engage his or her partner in a collaborative manner.  Having a “game plan” can ease some of the intensity of fear in the moment. 

Finally, as we say in Acceptance and Commitment Therapy, anxiety can have a place in the relationship, but it shouldn’t be “driving the bus.”  When anxiety appears to be controlling the direction of the relationship despite the couple’s best efforts, it’s time for one or both individuals in the relationship to seek outside support.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Trauma and the Brain

by Jan E. Estrellado, Ph.D.

image source: 

http://www.forbes.com/sites/toddessig/2015/12/02/post-traumatic-stress-disorder-ptsd-is-more-than-a-bad-story/#31ac76b313ad

Responses to trauma can be found in both the mind and the body.  In the mind, people can experience unwanted, intrusive thoughts that remind them of the traumatic event.  They may feel misunderstood, isolated, and irritated with others around them.  Their beliefs about the world might change from a sense of safety and stability to one of unpredictability and danger.

In the body, people can feel “on edge,” like something bad is about to happen.  They may feel more anxious than usual, with symptoms of an increased heart rate, sweatiness, hyperventilating, difficulty focusing, or even a panic attack.  This is more likely to be true when they are exposed to an internal or external cue reminding them of the traumatic event, but for others, it can feel like it comes out of nowhere.

Trauma Response in the Brain

For an individual with PTSD, much of the response to trauma can be found by understanding what is happening in the brain. 

When something might be dangerous or threatening, it first goes to the thalamus, which is responsible for receiving sensory input (what you see, smell, taste, touch, and hear).  From the thalamus, it can go in one of two directions.  In the first direction, the “more sensible” direction, the sensory cortex accurately appraises the event as non-threatening and the hippocampus (responsible for memories), confirms or modifies this response.  This direction, while slower than the second direction, is often more capable of accurately assessing true threat.

Image source: 

http://www.helpguide.org/articles/ptsd-trauma/ptsd-in-the-family.htm

In the second, “less sensible” direction, the thalamus sends signals to the amygdala (the emotion and fear center of the brain), which then goes to the hypothalamus, where action is taken to get relief.  This direction is often seen as tapping into the “fight or flight” response to fear.  While this direction is quicker and engages our survival mechanisms, it can also get us into trouble if our response is bigger than the situation calls for.

For individuals with PTSD, their brains often go in the second direction.  Their amygdala is on “over-drive” and cannot help them evaluate what is a true threat and what is not. 

Re-Training Your Brain

If your brain is trained to fire its amygdala at will, what can you do about it?  Enter the pre-frontal cortex.  This part of the brain is responsible for planning, strategizing, executing, reasoning, and decision-making.  At CSAM, we often encourage our patients with PTSD to engage their pre-frontal cortex in various ways: deep breathing, mindfulness practice, even coloring!  Any grounding activity that helps you stay in the present moment will help you engage your pre-frontal cortex.  These are effective short-term strategies for helping to manage an individual’s immediate PTSD-related anxiety.

Longer-term strategies include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT).  These interventions have strong support in the scientific literature showing their effectiveness to manage PTSD.  In CPT and PE, patients “re-train their brains” to reduce their reactivity to distressing cues, often related to the traumatic event.  They continually re-write or re-tell the story of their traumatic event until they make new meaning of the trauma, learn that the trauma memories are not dangerous and discover that they can handle the upsetting responses that come with remembering the traumatic event.  In Acceptance and Commitment Therapy, patients practice mindfulness in order to understand what distressing thoughts they have when they recall the traumatic event.  They develop a willingness to engage with the memories and feelings of the traumatic event, so that they are “freed up” to live a life based on their values and what’s important to them.

CSAM is here to help

If you or someone you love might benefit from CPT, PE, or ACT following a traumatic experience, or if you would like more information about our other therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

U.S. Department of Veteran Affairs (2015).  How common is PTSD?.  Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp

Pursuing Values over Resolutions in the New Year

by Jan E. Estrellado, Ph.D.

2016 has arrived!  As we say good-bye to 2015, it’s time to look forward to setting intentions for the new year.  Knowing that resolutions don’t always work out, what if we tried basing those intentions on our values rather than on our goals?

Image source: http://allisonpataki.com/set-new-years-resolutions-january/

The Problem with Resolutions

It seems that while many people make resolutions every year, only a few are able to maintain those changes.  According to the Statistic Brain Research Institute (2015), 45% of people in the U.S. make resolutions, but only 8% of people successfully achieve them.  In 2015, the top three resolutions for the new year were losing weight, getting organized, and spending less/saving more.

Why might it be so hard for us to accomplish the resolutions we set so hopefully at the beginning of each year?  And perhaps more importantly, how do we deal with and recover from the guilt, anxiety, stress, and embarrassment that often come when we fail to meet these goals?

For some helpful answers, we might look to Acceptance and Commitment Therapy (ACT), an evidence-based intervention that, in the words of Happiness Trap author Russ Harris (2008), “helps people create a rich and meaningful life, while effectively handling the pain and stress that life inevitably brings.” 

According to ACT (pronounced as one word), it is the struggle with “what’s wrong” in our lives that causes much of our suffering.  We’ve all been there: the slice of chocolate cake we couldn’t resist, the day we chose to stay home instead of going to the gym, or spending more than we wanted to eating out.  It is normal to feel ashamed, guilty, or frustrated with ourselves, often accompanied by thoughts of self-judgment and doubt (i.e., I have no self-control, I was doomed to fail from the start, etc.).  It is so easy to spend time and energy beating ourselves up for what we should have done, that we end up in a worse place than when we started.  How many of us have eaten that second slice of chocolate cake to soothe our guilt about eating the first one? 

Values-Based Living

Image source: http://www.sanitygurus.com/relaxation/

In contrast to resolutions, values are never finished.  Think of values as the direction you are headed in (“westward”) versus a destination west of you (“Hawai’i”).  One can continue on in that direction indefinitely and it will never be done.  It is a series of choices we make over and over again to carve out a path in the direction of that value. 

What might values-based living look like as an alternative to New Year’s resolutions?  Let’s take the #1 resolution of 2015: losing weight.  Why might losing weight be important to you? Do you want to feel good in your body, to invest in your physical health, to live longer for your family or to model healthy behaviors to your children?  Clarifying why we choose a goal might be more important than the goal itself.  For example, if I want to live long enough to see my kids grow up, my choices might focus more on being active with my kids and less on counting calories.  I may or may not lose weight, but keeping my choices and behaviors aligned with my greater value moves me toward the person I would like to be.

Acting in service of our values does not mean that the path will be easy or comfortable.  In fact, choosing our values means that we also choose the pain that will inevitably come.  Living from our values means we accept that painful and unwanted outcomes sometimes happen. Staying the values-based course as the painful stuff happens is what gives us meaning and purpose.

Are you willing to give values a try this year?

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Statistics Brain Research Institute (2015).  New years resolution statistics.  Retrieved from http://www.statisticbrain.com/new-years-resolution-statistics/

Harris, R. (2008).  What is acceptance and commitment therapy?  Retrieved from   http://www.thehappinesstrap.com/about_act