Picture this cartoon: a squirrel is lying on a psychoanalyst’s couch, a bearded bespectacled man with a notepad sitting next to it. The squirrel is saying “When I learned that you are what you eat, I realized I was nuts!” There is no doubt that what we eat affects our mood, energy, and cognitive function. The nutrients and/or chemicals in our food influence how well we sleep, how efficiently we burn calories, how well our cardiovascular system functions – in other words, our overall health and longevity. So it really is true that “you are what you eat.”
When we eat poorly, it can put us on a roller-coaster of mood and energy fluctuations, which sets us up for continued poor choices of “quick fix” foods and beverages. Over time, we become trapped in a vicious cycle of needing caffeine and sugar to start the day, craving fatty foods and sweets to keep us going throughout the day, and then needing alcohol or medications to calm down at day’s end. Sound familiar?
Is your SAD diet making you sad? As Leslie Korn writes in Nutrition Essentials for Mental Health, “the standard American diet, consisting of overly processed foods containing refined sugars, leads to chronic inflammatory states and neurotransmitter imbalances. Inflammation is now understood to underlie most mental illness, including depression. Chronic low-level inflammation contributes to depression and cognitive decline.”
The Gut Brain: There is increasing scientific evidence that many illnesses, from diabetes to depression, may in fact be the product of an unhealthy gut and digestive system. You may have had a “gut feeling” about this, as the gut is now being referred to as “the second brain.” Did you know that 95% of the body’s serotonin is produced in the gut?
Rebecca Carey, a pediatric GI doctor, wrote in a recent blog, “I have witnessed repeatedly across the age continuum that when intestinal health improves, other seemingly unrelated things such as behavior, development, and temperament also improve.”
Rest and digest: “Digestion occurs in a state of relaxation. Stress can slow down or stop the digestive process.” (Korn, 2016) Mindful eating, which involves pausing to give your full attention to what you are putting in your mouth, while tuning in with all of your senses to the experience of eating, will aid digestion. In fact, just taking a few slow, deep breaths prior to eating can help, because it stimulates the parasympathetic nervous system, which is known as the “rest and digest” system, as opposed to the sympathetic nervous system’s “fight or flight” functions.
Sugar is a drug: It acts on the same neurotransmitters in the brain as alcohol, cocaine, and heroin. Regular use leads to increased tolerance, cravings, and addiction; quitting causes withdrawal symptoms. And we know that refined sugars trigger inflammation. There is more than enough evidence, according to journalist Gary Taubes in The Case Against Sugar, that sugar is not only the root cause of today’s diabetes and obesity epidemics, but is a signficant contributing factor in heart disease, Alzheimer’s, and many other long-term, degenerative diseases. Healthy alternatives to sugar include stevia, agave syrup, and locally-sourced honey. Aspartame and other chemical sweeteners are NOT healthy alternatives, as they too have been implicated in obesity and diabetes.
The Great Gluten Debate: Twenty five years ago, when I was advised to reduce my gluten intake, it was a challenge to find edible alternatives to the breads, pastas, and cereals I was used to, not to mention becoming aware of all of the hidden sources of gluten, like soy sauce. However today most grocery stores have a section devoted to gluten-free products, many of which are quite tasty, and most restaurants, even fast-food establishments, offer gluten-free options.
But while gluten is definitely dangerous for the small percentage of people with Celiac disease, an autoimmune disorder, many others like myself have similar distressing digestive symptoms when they consume gluten, although they don’t have the biomarkers for the disease. Some doctors have mistakenly told these people their symptoms are imagined. Is gluten sensitivity real or imagined? Finally, research has proven that “non-celiac gluten sensitivity is not imagined”, because “although the NCWS group did not have the cytotoxic T cells found in those with celiac disease, they had markers of intestinal cellular damage related to a severe systemic immune activation.”
My patients who have reduced or eliminated gluten in their diet notice the same things I did: better mood, better sleep, more energy, as well as significantly improved digestion. So while you may not have to eliminate gluten, you might feel better if you do.
Vitamins and supplements: There has always been debate among healthcare professionals on whether or not we get enough of the essential vitamins and nutrients in our diet. I believe most Americans do not, and I include myself, even though I have a healthy diet. So I take a high-potency multi-vitamin, as well other supplements including Omega-3 fish oil and vitamin D. There is extensive research demonstrating the benefits of Omega-3 fish oil supplementation on mood, as well as metabolism and cardiovascular health; vitamin D has also been shown to relieve low mood and low energy. These are the two supplements that I recommend most often to my patients.
Healthy eating: It doesn’t have to cost a lot of money or take a lot of time – but it isn’t as cheap or quick as unhealthy eating. Think of it as an investment in your well-being. Decades of research have proven that the Mediterranean diet, and other diets rich in Omega-3 fatty acids and antioxidant-laden fruits and vegetables, while low in sugar and processed food, are highly correlated with good mental health, as well as good health and longevity.
I love Michael Pollan’s rubric, from his 2008 book In Defense of Food: An Eater’s Manifesto, which is Eat food, mostly plants, not too much. “Eat food” means eat things that are actually identifiable as animal or vegetable, rather than the highly processed stuff that comes in packages, with a long list of unpronounceable chemicals in the ingredients. Another way to think about this is to shop the perimeter of the grocery store, where the produce, meat, and dairy sections are, limiting what you buy in the middle aisles. “Mostly plants” emphasizes the importance of having the bulk of our diet consist of fruits, vegetables, nuts, and legumes. If you eat meat, poultry, fish, and/or dairy, consume them in smaller quantities. And finally, “not too much” is a reminder to pay attention to portion size. The American diet has been “supersized” to the point that many people consume as many calories in one meal as they actually need for the entire day (where do those extra calories go? Not away!)
Add first, then subtract: Although eliminating sugar and gluten in your diet will likely lead to the greatest overall improvement in your health and mental health, it’s not easy to give up the foods you crave and enjoy the most. So make that a long-term goal, and start with adding more healthy items: 1) probiotics to help re-balance your gut bacteria (found in good-quality yogurt, or available in capsules); 2) green, leafy vegetables like kale and spinach to add key nutrients; 3) foods high in anti-oxidants like blueberries and beets; 4) healthy fats like olive oil and avocados; and 5) lean sources of protein like fish and chicken, which contain amino acids, the building blocks of serotonin and other neurotransmitters. It may take a few weeks before you notice improvement in mood and energy, but if you are patient and persist in a commitment to healthy eating, you WILL feel better!Learn More
It is common knowledge that exercise is good for your health, but did you know that exercise is just as important for your mental health? The human body was simply not designed to do as much sitting as most of us now do, between our jobs, commute, and time spent in front of TV/computer screens at home. This increasingly sedentary lifestyle has led to increased rates of diabetes and obesity, but also more anxiety, depression, and insomnia than in previous generations.
Exercise is an effective treatment for depression
“A growing body of evidence shows that exercise is an effective treatment for mild to moderate depression. Exercise strengthens our biochemical resilience to stress, encourages the growth of new brain cells, bolsters self-esteem and may even counterbalance an underlying genetic risk for mental illness. Moreover, the inverse is true: physical inactivity increases the risk for depression.” (Scientific American MIND, Jan-Feb 2017 vol 28(1) 27-31)
According to this article, “exercise also seems to mimic some of the chemical effects of antidepressant medication.” Hey, think about that sentence for a moment: isn’t it more accurate to say the opposite, that antidepressants mimic the chemical effects of exercise? Which came first?
The most common complaints about antidepressants are that they cause weight gain, loss of libido, and seem to lose their effectiveness after a few years of regular use. Exercise has the opposite effect: it is more likely to lead to weight loss and increased libido; and the longer you do it, the more effective it is. Furthermore, it doesn’t require a prescription, and the cost can be minimal (a good pair of walking or running shoes is all you need to start).
Exercise for anxiety
The research on exercise as a treatment for anxiety is less conclusive, in part due to fewer studies, and because different forms of exercise are indicated for different types of anxiety – e.g., people with social anxiety benefit from exercise via structured group activities, whereas someone with panic disorder may need to work out solo in a medically supervised setting. However, no studies have shown that exercise makes anxiety worse, and since anxiety often co-exists with depression, and responds to antidepressant meds, it is logical to try exercise for anxiety relief.
Exercise for insomnia
Here the research gets even more complicated. While it is clear that exercise nearly always leads to better sleep in people who don’t have sleep problems, among those who do, the immediate effect of exercise may make their insomnia worse. However, this effect disappears over time, after a few months of regular exercise. In other words, one day of exercise might rev you up instead of calm you down, but if you stick with it, exercise will improve both the quality and quantity of your sleep.
What if you hate exercise? Perhaps you just haven’t yet found the right activity for you, or perhaps you’re thinking of exercise as work instead of play. Here are some playful ideas to consider:
1. Buy a jump rope or hula hoop;
2. Volunteer to walk dogs at the local animal shelter (East Bay SPCA);
3. Sign up for the annual Trails Challenge through the East Bay Regional Parks District;
4. Take an introductory class in yoga, Tai Chi, or anything that involves moving your body at your local community college or rec center;
5. Try one of these: SoulCycle, Zumba, Nia, or Five Rhythms dance.
If you love exercise but “have no time,” then you may need to get creative to find a way to fit it into your busy schedule. Perhaps you may also need to give up on the idea of doing it perfectly, or the way you used to. One of my clients, a working mother with two young children and no time for the exercise classes she used to enjoy, was inspired to try family “dance parties” in her living room a few afternoons a week. Her kids loved it, and she not only worked up a sweat, but felt happier afterward. Exercising with other people is often more fun, can help with motivation, and increases production of “feel-good” chemicals in the brain.
If you have a disability or chronic illness that limits your energy or ability to participate in group or outdoor activities, you can still find a way to exercise. When I was young and could count on two hands the number of TV channels, there was a “Sunrise Yoga” program on my local PBS station. In today’s “500-channel universe,” there are undoubtedly multiple options for yoga and exercise programs available to you through your TV, tablet, laptop or smart phone. See what you can find!
Remember, the research shows that it takes 60 – 90 days of regular practice to install a new habit, whether you’re trying to learn to meditate, play an instrument, or eat less and exercise more. So just get moving – and tomorrow and the next day, do it again.Learn More
I don’t like Daylight Saving Time. This is not just a personal opinion, but also my professional one, because I know how disruptive even minor changes to the sleep-wake cycle can be – to mood and emotion regulation, memory and cognitive function, as well as overall health. Sleep is foundational to good mental and physical health, and most of us aren’t getting enough of it, which contributes to increased rates of vehicle accidents, as well as diabetes, obesity, addiction, anxiety, and depression.
“Spring ahead” is worse than “fall back.”
Most people find it harder to get up one hour earlier, as we did last week, than one hour later, as we do in the fall. It’s also more challenging to make yourself feel sleepy one hour earlier in the evening, versus staying awake longer. The alarm clock may force you awake in the morning (if you don’t just sleep through it) but there’s no corresponding device to force you to fall asleep. As a result it can take a couple of weeks to fully adjust to the time change and catch up on sleep. You can read more about the origins of Daylight Savings Time here, but now I’d like to focus on sleep – why we need it, what keeps us from getting it, and how we can improve our sleep habits.
Why do we need sleep, anyway? To understand why it’s so important, let’s look at what happens while we sleep. Over the course of a typical night’s sleep, we will cycle through 4 different stages, from light sleep to deep, including a phase called REM, for rapid eye movement, which is when we dream. Here’s a graph of a normal adult’s night of sleep, showing the cycles:
Notice that most deep sleep (stages 3 and 4) occurs in the first half of the night, while REM and light sleep alternate in the second half. It’s easier to awaken from a light sleep stage than a deep one. As we age, we spend more time in light sleep and less in deep (children spend most of their time in deep sleep).
While our conscious awareness is turned off during sleep, and some systems slow down – like those that regulate movement – other body systems become more active. These include the immune system, so lack of sleep lowers your resistance to cold or flu viruses, and leads to being sick longer. Other restorative benefits of sleep include hormonal balancing, removing toxins, and regulating your metabolism. And although scientists still don’t know exactly why this is true, if people or animals are totally deprived of sleep, especially REM sleep, they die within weeks.
Even short periods of sleep deprivation have negative consequences for health and mental health. In one study, healthy young men who were allowed only 4 hours’ sleep a night for 2 nights reported a 23% increase in hunger; similar studies have revealed that restricted sleep ramps up production of hormones that stimulate appetite, and increases the risk of developing type 2 diabetes. Other studies have demonstrated that even brief sleep restriction leads to an increase in negative thinking patterns as well as low mood.
As Professor Robert Stickgold from Harvard Medical School explains in this video, sleep helps us to remember and consolidate what we learned during the day, organizing and making meaning from our experiences, as well as improving our ability to problem-solve: Why We Sleep video
If sleep is so essential, why is it so elusive? According to the National Sleep Foundation, adults ages 18 to 65 need an average of 7 to 9 hours of sleep per night. However, in surveys conducted by the National Institutes of Health every few years, about 35% of adults report getting less than 7 hours a night. Alarmingly, 38% report nodding off during the day at least once in the previous month, and 5% report they’ve nodded off while driving!
Reported rates of insomnia and other sleep problems have steadily increased over the last hundred years or so, which scientists attribute to a combination of factors (people have migrated from rural to more densly populated urban areas, lead busier, more complicated lives, and work longer hours in brightly lit buildings) but clearly, exposure to artificial light is a key factor.
What can you do to improve sleep without drugs?
The rate of prescription sleep medication use has nearly doubled in the last decade, with higher use among women, older adults, and those who seek mental health treatment. (There is an insightful analysis about these trends in this Huffington Post blog, Who Is Taking Sleeping Pills?) These medications are intended for short-term use, can have unpleasant side effects, and disrupt normal sleep phases, especially REM sleep. What works best is to establish healthy habits that promote sleep.
The one habit that will give you the most benefit: Establish, and stick to, a regular sleep-wake cycle. The practice of skimping on sleep during the school or work week, and then hoping to catch up on the weekend, is an unhealthy one. When you keep changing the time you go to bed or get up, it interferes with your body’s natural ability to self-regulate, to wake itself, and to fall asleep easily. Ideally, you should awaken and go to bed at roughly the same time every day, or at least most days. This helps to set the body’s internal clocks that regulate things like metabolism and mood.
The second most beneficial habit: Turn off all screens (television, computer, tablet, phone) at least an hour, preferably two, before bedtime. The blue light that emanates from our devices interferes signficantly with our natural Circadian rhythm. Scientists have recently discovered that our internal “master clock” is much more sensitive to light on the blue end of the spectrum. So if you must use your devices at night, at least block the blue light with a special filter or amber-lens glasses. To read more about this, see my article Clock genes, manic mice, blue light, amber lenses.
Create a restful sleep environment. We sleep best in a room that is dark, quiet, and comfortably cool (60 to 65 degrees F). Because the body’s temperature naturally drops in the evening just before bedtime, you may be tempted to bump up the thermostat, but it’s better to just dive under the covers and relax into the coolness of the sheets. Electric blankets can be used to warm the bed, but shouldn’t be kept on all night. Down comforters work best to hold in body heat at night. It’s important to have a mattress that supports the spine in its natural curve, and pillows that can be adjusted as you shift positions during the night. Everyone has different preferences, but personally, I don’t think memory foam or the number system beds are worth the extra money.
Avoid these things in the hours before bedtime: Stimulants, including coffee, black or green tea, colas, chocolate, energy bars, spicy food, and some cold/allergy medications. Alcohol in all forms. The traditional “nightcap” may make you drowsy quicker, but once the alcohol is metabolized, in 3-4 hours, you’ll pop back awake again and find it harder to get back to sleep. You should also avoid intense, aerobic exercise, TV news, and arguments with family members within 3 hours of bedtime.
Try adding these sleep promoters: Herbal tea, especially containing valerian or chamomile. I use a valerian-peppermint blend, with a little honey. If you must snack before bed, eat lightly, of foods that contain tryptophan – milk, bananas, turkey. Some people like a mug of warm milk, with a dash of cinnamon. Other things that help to promote sleep: a warm – but not hot – bath, dim lights, soft music, gentle touch or massage. And some form of prayer or meditation. Some people find that taking melatonin, which is naturally produced by the body, helps, but it should be taken in the smallest possible dose (I use a 1 milligram sublingual tablet).
Sleep On It! Robert Stickgold in Scientific American, October 2015.
The Clocks Within Us. Keith C. Summa and Fred W. Turek in Scientific American, February 2015.Learn More
Today, the shortest day of the year (in the northern hemisphere) is a good day to talk about seasonal depression. At my latitude, there are fewer than ten hours between sunrise and sunset. That’s bad news for people like me, who have a hard time getting up before daylight, and if it’s cold outside too, fight the urge to stay in bed, or at least in PJs, all day. In the winter months I’m more sluggish, prone to irritability and sadness, and more likely to take a negative view of things. I’m not clinically depressed, however, I’m just very affected by sunlight, and the absence of it.
While many people are similarly affected, some do experience a true clinical depression during the winter, whether caused or simply made worse by the absence of sunlight. Here are some tips for coping with seasonal depression, or SAD (Seasonal Affective Disorder, as it’s known in the clinical literature), gathered from both my experience as well as scientific research.
I’ve learned that giving in to those urges to hide under the covers, sleep all day, isolate from people, or use alcohol, food, or other substances to numb your emotional sensitivity just doesn’t work. These things actually feed the depression, and keep it going longer. What works better instead:
1) Move your body! Even though it might feel like slogging through molasses, and your stiff joints may complain loudly, get up and do physical exercise, or some kind of movement. Exercise has been well documented to be one of the most effective treatments for depression – more effective than medication, and without any negative side effects.
When we get depressed, stressed, anxious or fearful, there’s an unconscious tightening of muscles, and a holding in of emotion, that produces a tension throughout the body. We have many expressions for this, including “putting the armor on,” “hardening our shell,” or “holding it together.” This takes effort, and expends physical energy, so if we’re doing it for a long time, we’ll get tired, even to the point of exhaustion. Have you ever felt so exhausted you couldn’t relax or sleep? When that happens, what actually helps the most is to start moving your body.
Don’t overdo it at first, just take a walk, do some gentle yoga or stretching, or any easy movement that will allow those tense muscles to loosen, and will also release neurotransmitters that can improve mood. There’s an excellent article on the benefits of exercise in the latest issue of Scientific American Mind: The Exercise Cure – Why it may be the best fix for depression
2) Stop feeding your depression. When mood and energy are low, we’re much more likely to crave sugary foods and drinks, as well as caffeine, to get us going. While anything with sugar will often give a brief burst of energy, it’s the wrong kind of energy, leaving you more depleted after the quick high wears off. And although the temptation to imbibe may be strong, especially around the holidays, keep in mind that alcohol is actually a central nervous system depressant. Both alcohol and sweets will feed depression far more than relieve it. To find out why we crave sugar, especially when we’re depressed, read this excellent blog post by the “Mindfulness MD.”
If you are a coffee or tea drinker, it may help to increase your consumption of caffeine a little during the dark days of winter. But leave the sugar out, and try stevia, or any kind of milk (almond, soy, or dairy) instead. If you simply must have a sweet treat, balance it with lean protein (e.g. low fat milk, cheese, or yogurt). Add more fruits and vegetables to your diet. If you’re not a big fan of vegetables, try putting them in a smoothie with some fruit, cook them in soup or stew, or stir fry them. My colleague Susan Blanc, nutritionist and cooking teacher, has some great classes and recipes to improve mood and brain health: Kitchen Table Remedies
3) Let the sunshine in. Seasonal depression is often a function of lack of sunlight, which helps our bodies produce Vitamin D, needed to help us regulate sleep, energy, and mood. Fortunately for those of us who live in California, we rarely have to wait very long for a sunny day. If the sun is shining right now as you’re reading this, stop! Use this time instead to get outside and go for a walk, or at the very least, find a sunny spot to sit and soak up some rays for 10 -15 minutes. If the sun hasn’t been out for awhile where you are, and/or you’re particularly sensitive to seasonal depression, you might want to look into getting a light box. Here’s a link to some solidly researched information on how light boxes help, and how to use them safely: Light therapies for depression
4) Do an enjoyable activity. Doing an activity that gives you pleasure or mastery, or both, is one of the most effective ways to get out of a low mood. When we’re down in the dumps, that self-critical inner voice is most active, telling us we shouldn’t do something fun or pleasurable until we get our work done. But if you’re not getting your work done because your mood and energy are low, then you need to reverse-engineer this, because motivation works backwards in depression. So give yourself permission to do a fun activity, something you enjoy and that just might put a smile on your face. Play an instrument, do a craft or hobby, watch a favorite TV show or funny movie – you get the idea. One caveat: do it for 30 minutes to a couple of hours; you don’t get to do this all day!
5) Clean or declutter your space.. If nothing sounds like it would be fun or give you pleasure, know that one of the hallmark symptoms of clinical depression is anhedonia, a loss of interest in things that normally are pleasurable. So if that’s where you’re at right now, then think of something you can do that will give you a sense of mastery or accomplishment. Pick a fairly simple task, one that will yield a visible result, like decluttering your desk or work space, organizing a drawer, or even washing dishes, and set a timer for 15 minutes so that you don’t get bogged down in it. When the timer goes off, take a break. Then you can choose whether to continue working on the task, or do something else. Clearing a space can help clear the mind.
6) Don’t be a hermit.. Depression can make contact with others challenging, so we isolate instead. But humans are social animals, and we are hard-wired for face-to-face connection to help regulate our moods and emotions. Among other benefits, it releases oxytocin, a chemical that promotes feelings of safety, security, and connectedness. So if you’ve been hiding out, relying on social media to feel connected, use your phone the old-fashioned way, and call a friend, or put the phone down and just go talk to someone. Don’t start the conversation with how depressed you are (and don’t talk about politics!) – instead, ask them about what they’ve been up to, or pick a more neutral topic, like the weather, sports, or the latest crop of movies. Make eye contact, and maybe even try a hug.
7) Listen to music. Music not only soothes the soul, but helps us feel connected with others. I recently attended a concert where the audience was asked, “in the midst of chaos, how do you find peace?” As I listened, I meditated on how music has helped people throughout history transcend their suffering. I thought about the origins of jazz and the blues, the protest songs of the 60’s, and my own personal soundtrack of favorite albums and artists that have helped me through troubled times (including the song with this line: “Everybody’s had the blues at some time, everyone has been abused.”) What are your favorite tunes? Can you sing or play one of them right now?
8) Get out in nature. I have found that one of the most effective ways to relieve my depression, stress, or anxiety, is to go for a walk in the hills near my home, or drive to a nearby regional park for a hike. Not only do I get the benefits of fresh air, maybe some sunshine, and moving my body, but it’s very powerful to ground myself in the natural world. Even if you don’t have access to a park, there are birds, trees, and wild creatures that exist in almost every environment. (The photo with the monarch butterflies was taken in Pacific Grove in February.)
Putting it all together: Reach out to a friend you haven’t seen in awhile, and make a commitment to do an activity together: have coffee or lunch, take a walk in the park, go to a musical performance or art exhibit. Or go for the Trifecta and do all three!
If this sounds overwhelming, remember that motivation works backwards in depression, so you’re going to have to challenge yourself. Consider also that face-to-face contact with people you care about, especially sharing a meal together, stimulates the production of oxytocin, the chemical in your brain that helps you feel safe and connected. Remember that moving your body will release the tension that comes from resisting reality, and may actually give you more energy as it helps produce mood-enhancing neurotransmitters. And finally, don’t forget that fresh air and sunshine replenish essential nutrients that improve mood; and that music (and art) soothe the soul and stimulate right-brain creativity and positivity.Learn More
Looking for ideas to help you deal with a drinking problem, or other problematic substance use? Have you stopped and are finding it’s a struggle to stay stopped? Are you seeking an alternative to AA? Or just searching for some additional tools? Let me tell you how mindfulness can help.
The definition of mindfulness I use is: “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” It comes from Jon Kabat-Zinn, founder of the Mindfulness-based Stress Reduction programs that have been taught world-wide over the last 30-plus years.
Let’s examine this definition: “on purpose” means having the intention to step out of our usual autopilot mode, where we’re more likely to behave reactively. Then we bring our attention into “the present moment,” with an awareness of our breath and bodies – which always exist in the present – and working with our mind’s tendency to dwell in the past and worry about the future. Finally, we make this effort “non-judgmentally,” acknowledging the mind’s natural tendency to judge, as we try not to take ourselves, or our critical self-judgments, so seriously.
Can you begin to see how this approach might help? “Paying attention” leads to greater awareness – of both the things that can trigger addictive behaviors, as well as the impulses themselves – which interrupts automatic patterns of thinking and reacting. Being “in the present moment” means learning to accept what’s happening, whatever the experience may be, without using substances or behaviors to change it or escape from it. And doing so “non-judgmentally” helps to detach from the automatic thinking that often leads to a relapse after you’ve quit.
Mindfulness-based Relapse Prevention (MBRP) is an innovative approach that integrates evidence-based cognitive behavioral relapse prevention skills with mindfulness meditation practices. It is intended for adults in recovery from alcohol, drug, or other substance addiction – or who are simply concerned about problematic substance use. It offers an alternative to traditional aftercare and 12-Step programs, or an additional source of group support and tools to maintain sobriety. I’ve been using MBRP informally with my clients for a few years, and I’m now facilitating MBRP groups.
MBRP is similar to 12-Step groups and other relapse prevention programs in that it begins with an awareness that one’s substance use or other addictive behaviors are causing significant problems, and places responsibility for addressing these problems on the individual, while emphasizing the need for group support. It encourages developing “the wisdom to know the difference” between what we can and cannot control, as the Serenity Prayer says.
MBRP takes a slightly different approach to abstinence, treating it as a desired goal rather than a requirement for group participation, and de-pathologizes cravings, seeing them as based in normal human needs. MBRP group participants focus on their moment-by-moment experience, rather than processing their feelings or telling their stories. And they practice being mindful, using a series of guided meditation practices, each day of the week between group meetings.
One of the most valuable tools in MBRP is the SOBER Breathing Space. It’s a mini-meditation that can be done anywhere, any time you need to be able to pause, take a step back, and hit the reset button. You can try it for yourself, here:
Another really useful meditation practice we use is Urge Surfing. It’s based on the principle that any urge, craving, or strong emotion behaves like a wave in the ocean: it rises, crests, and then will eventually fade away. If we can learn to surf that wave, using our breath like a surfboard, we can ride the wave rather than succumbing to the urge and being wiped out by it.
A note of caution about this practice: some people find it to be an intense experience, so it isn’t advisable to try it when you’re already feeling triggered, or traumatized, or really stressed. But if you’re in a stable state, and have a way of managing any intensity that may arise – like going for a run, doing some meditative breathing, or calling a friend – then give it a try. One more word of caution: please don’t pick the most triggering situation for you when you first try this exercise, it’s best if you choose something that’s only a 2 or 3 on a scale of 1 -10.
The MBRP curriculum is designed to be presented in weekly 2-hour sessions over eight weeks. The initial sessions focus on learning and integrating basic mindfulness practices, then we move into how to apply these practices in daily life to deal with cravings, triggers, and stressful situations. The final sessions address self-care, support networks, and life balance.
Research studies have shown that MBRP leads to greater overall reduction in substance use, greater decreases in cravings, and greater self-acceptance than traditional treatment/aftercare approaches. My students have reported increased self-awareness – including better ability to identify automatic thoughts and recognize habitual thinking patterns that get them into trouble – as well as improved ability to deal with their feelings and strong emotional reactions, fewer cravings, improved overall mood, and better decision-making.