Author: Rebecca Stanwyck

THERAPIST HEAL THYSELF

I’m a silver lining person, usually able to see the positive in any situation, no matter how glum or dire, but I confess that it has been increasingly difficult for me to maintain my optimism in light of what’s been happening in our world over the past year.
 

Each natural disaster, each horrific mass shooting, each bizarre pronouncement from the tweeter-in-chief is worse than the last. It has felt like we are witnessing the complete destruction of the planet and unraveling of the social order. As a result, I found myself falling into a deeper-than-usual seasonal depression this winter. I had to use the tools I have learned, and have taught others for years, to get out of it – and I’m here to tell you that they work!
 

Before talking about what worked, I should mention that there were things I did which didn’t help, in fact, they probably made my depression worse, and kept it going longer than necessary. I engaged in some unhelpful behaviors that were attempts to distract myself from how I was feeling, or control the people and things in my immediate environment. These included retail therapy (buying things I didn’t need), fantasizing about the future (more than usual), and trying to plan “perfect” family gatherings (which of course didn’t happen, setting me up for more depression). I don’t usually engage in these behaviors when I’m feeling good, but they’re old habits, and at the time it didn’t register that they were unhealthy coping mechanisms.
 

Despite my professional training and experience, I was in denial. I didn’t want to see that I was beginning to get depressed, though there were obvious signs and symptoms: sleep problems, from difficulty falling asleep to waking in the night and not being able to get back to sleep, which led to low energy, both physical and mental, and increased worry about all of the things that I have no control over, including climate change, politics, natural disasters, and death.
 

After a few weeks, I admitted to myself that I was depressed, but I didn’t tell anyone else, because I was aware of feeling shame. (This shouldn’t happen to me, I’m a mental health professional, I help other people who are depressed, but not me, I know better, etc.) By now I noticed other symptoms: ruminating about what had triggered the depression and how to get rid of it; social withdrawal – I had to push myself to connect, but it was increasingly difficult to do, and my efforts often seemed to backfire, resulting in a lot of negative self-talk (I’m terrible at networking, I miss social cues, etc.). Conversation became a chore. And I still wasn’t sleeping well, so I was consuming more caffeine and chocolate, as well as high-sugar, high-fat holiday treats, which also fed the depression. My body was lethargic, my mind was sluggish, and I just felt completely stuck.
 

Finally I accepted that the depression wasn’t going to just go away. I remembered what I teach:  MOTIVATION WORKS BACKWARDS IN DEPRESSION. So I pushed myself to do things that would give me a sense of mastery (simple tasks like cleaning the kitchen) or pleasure (driving myself to Half Moon Bay so I could soak up some sunshine and ocean air, and be around other people who were enjoying life, even if I couldn’t yet). Once I’d done those things, I was able to build on that little bit of momentum to plan more physical activity as well as initiate social connection.
 

I focused on the basics, forcing myself to get back into my regular exercise and healthy eating routines. I scheduled lunch dates with friends, and made a point of telling them I’d been depressed, rather than pretend I was fine. Taking walks in nature, whether or not the sun was shining, helped a lot, as did reaching out to my network of friends and colleagues, many of whom have experienced depression themselves, for some F2F connection. Knowing that I’m not alone, other people have felt this way too, was super helpful. I’m sure the fact that the days were getting longer helped, too. By late February, I was back to my normal good mood and energy.
 

A word about mindfulness meditation and the role it can play in relieving depression: my own experience echoed what the research has shown, which is that when you’re in the middle of a depressive episode, it’s actually pretty difficult to do formal sitting meditation. This is also true if you’re in the middle of a panic attack or highly anxious. Even if you’ve been practicing meditation regularly for many years, as I have, it becomes difficult to access the benefits of practice during these times. So I didn’t force myself to sit on the cushion every day.
 

But I did practice mindfulness in other ways:

• I acknowledged what I was thinking and feeling, rather than ignoring it.
• I recognized that my thoughts and perceptions were negatively skewed, so I tried to not take them too seriously.
• I practiced grounding myself in the present moment by focusing on my breath and body throughout the day.
• I practiced mindfulness of daily routine activities, using my five senses.
• I remembered to do lovingkindness practice, and offered myself some self-compassion.
• And I sought out opportunities to do sitting meditation with others at meditation centers and yoga studios.

And finally, a disclaimer: my intention in sharing my experience is to help reduce the stigma that is still so common in our society around mental health issues. By no means do I intend this as medical advice for you, the reader, or anyone else. This is my story, and these are the things I did that helped me get better. Depression comes in many different flavors, with different causes as well, which is why it is so important that anyone who is suffering from it should talk to a medical doctor as well as a mental health professional about what might be the most effective treatments for them. The important thing is to reach out and get the help you need! If you don’t know where to start, take a look at my Resources page, or read some of the Articles I’ve written about help for depression.

Social Support – After the disasters

This fall it seemed every week brought a new calamitous disaster: hurricanes, massive flooding, earthquakes, firestorms, and the worst mass shooting in US history. Because the topic of social support was on my mind, I was particularly tuned in to how people support one another during and after a disaster. Here are some of my observations:
 
During the disaster

In the face of immediate, life-threatening danger, people act instinctively – to run, hide, save themselves and their loved ones, including pets. This is the fight-or-flight response in action. Yet a few people “freeze” instead, becoming paralyzed, unable to act to save themselves. Why? According to Stephen Porges’ Polyvagal Theory, if the threat is perceived as being too big, causing the person to feel overwhelmed and powerless, the nervous system will short-circuit the normal fight-or-flight response and cause a state of “feigned death” as a last-ditch effort to save one’s life.
 
We see this freeze response in victims of child abuse or other trauma, and it may persist into adulthood if the trauma has not been treated. According to Attachment Theory, people who received adequate caring, love, and nurturing in their families of origin have a more positive outlook and expectation that others will help them; whereas those who experienced abuse, neglect, or trauma as children may not be able to trust others to help.
 
In a disaster, some people act heroically, risking their own safety in order to help or save others’ lives. Those who have military training and first responders do what is counter-intuitive: they run toward the danger, whether from fire or an active shooter. They leave their home to burn in order to help others save theirs. How do they do it? Their training overrides instinct. My heartfelt thanks to all of the first responders, law enforcement officers, firefighters, and healthcare professionals who risk their lives and safety to save others!
 
Reading the accounts of what people chose to take with them when they evacuated from the fires, I noted that some grabbed laptops and important documents, while others took a load of clothes from the laundry. I wondered: if I had only a minute or two to evacuate my home, what would I take? It’s a worthwhile exercise to think about what’s important and where is it located, perhaps even to rehearse a “grab and go” drill. Of course, disasters are an exercise in accepting the impermanence of all things.
 
After the disaster

Following a disaster, those whose lives were threatened may be in a state of shock. How long this state lasts – from hours to weeks – is partly a function of the magnitude of the person’s loss, but more importantly, a function of their inner resourcefulness, coping skills, and resilience. This is the time when social connection/social support is most critical.
 
How the community responds is also a function of the magnitude of the loss as well as the community’s resourcefulness. If a few people have lost their homes, neighbors will readily take them in. If an entire neighborhood has been obliterated, there is more confusion about where to go for help. Resources may be plentiful, as with the Texas hurricane/floods and the Northern California fires; or they may be scarce, as with the devastastion of Puerto Rico and the Virgin Islands.
 
People are often at their best following a disaster – we are generous, we are kind, we go out of our way to help. We reach out to share our own food, clothing, money, and shelter, as well as offering it in bulk donations to community organizations. Human beings are most inclined to help, and are most generous with, those who they see as like themselves. We could see this phenomenon in its ugliest form in Trump, who treated Texans magnanimously and Puerto Ricans like untouchables, but most people are inclined this way. We feel the strongest social bonds with people we are related to or know personally, so it’s easier to offer support. However, if an entire community needs support, and especially if we’re connected with them only through social media, we may feel social overload and even disaster fatigue.
 
The downside of social support

Humans are tribal in nature, for eons we have organized ourselves in tribes, groups, families, and mutual aid societies, to support one another. This can be a wonderful, positive phenomenon, but it has a dark side, too: where resources appear scarce, we fight other tribes and groups to get or keep what we deem as ours, and we rationalize why we shouldn’t provide support to “foreigners,” forgetting that all of the perceived differences amount to less than 1% of our total human DNA.
 
Social relationships can be sources of stress and strain rather than benefit. While in general, being married conveys health benefits, singles fare better than unhappily married people, and having poor quality relationships is worse for your health than being alone and socially isolated.
 
The importance of emotional support

A need that often goes unrecognized in those who survive a life-threatening experience or lose their home is emotional support. Survivors may need to talk about their loss, their fear and trauma – or they may not be able to talk about it, yet still need someone who can understand their emotional pain and offer support, whether through physical comfort or simply a kind presence.
 
It is easier to give than receive. Most people find it much easier to offer help, than to be the one asking for help. Research on the health benefits of social support shows that while giving support is correlated with health and living longer, receiving support conveys no longevity benefit. Perhaps this is because it’s stressful to ask for help, or because those who receive support are already suffering more ill-effects of stress.
 
Having more Facebook friends seems to convey health and mental health benefits, because people perceive plenty of social support being available. However, during a disaster, social media users may feel overwhelmed with the volume of support requests, and at the same time obligated to provide support, even while they may be in need of support themselves.
 
The relative effectiveness of social support depends not only on the kind of support provided, but also on the relationship of the receiver to the giver. “Signficant others,” i.e., partners, immediate family, and close friends, are better suited to provide emotional support as well as instrumental support (money, help with tasks); while “similar others,” i.e., members of larger neighborhood, religious, or social media networks, may be more effective at providing knowledge and information as well as validation and empathy, especially when they have shared similar experiences.
 
When it comes to emotional support from social relationships, quality matters more than quantity. And research indicates that small acts of care (e.g., a few words of encouragement, an enthusiastic response to good news, being physically present and attuned) can have a profound impact on personal and relationship well-being, helping people to thrive after a disaster, not simply survive.

Social Support – The Survey

 
I read a startling statistic recently: that over 25% of Americans said they had no one in whom they could confide or share a personal problem. While I haven’t yet tracked down the original source of this factoid, I did find out it was from a survey done in 2004, and that in a similar survey from 1985, the average number of trusted confidantes that respondents reported was three.

 
This raised a number of questions in my mind: first, what would a more current survey show? If this is a downward trend, it seems like an alarming one. Second, since the first survey was taken before the Internet era, and the second when Facebook was in its infancy, what role has social media played in either eroding or boosting social support? And in either of these surveys, did they ask those folks about their health or mental health?

 
There’s an enormous amount of scientific research, over decades, documenting what most of us know intuitively: social connection significantly affects health, as well as mental health. We humans are social animals, after all, who need to be in connection with others, to varying degrees. Even when social interactions may become a source of stress, on the whole, people need people.

 
So I decided to conduct my own survey, just for fun. I’m not a scientist, just a curious person who enjoys reading scientific journal articles, and I found among them a well-validated questionnaire designed to identify two aspects of social support: the number of perceived supports in a person’s life, and the degree to which they are personally satisfying. I based the first six questions in my survey on that questionnaire.

 
Since I also wanted to know about the role of social media, and the connection to mental health, I added my own questions on those topics, while still striving to keep the survey brief. Then I had to figure out how to conduct the survey. I’m actually one of the few remaining people on the planet who is not on Facebook, so I turned instead to my email newsletter mailing list.

 
The preliminary results from my survey (as of 9/1/17) are posted below. If you haven’t taken the survey and would like to, it will be available until 11/13/17.

I strongly recommend that you take the survey first, and then read the results below, so that you aren’t influenced by social opinion.

(TAKE SOCIAL SUPPORT SURVEY)

 
SOCIAL SUPPORT SURVEY RESULTS

• 32 people responded
• I was very relieved to see that everyone reported they have someone to support them!
• Over 50% reported they know 3 – 5 people who they can really count on to listen when they need to talk. Of the rest, 19% know 1 – 2 people, 25% know 6 – 9, and there were two respondents who have 10 or more people they can count on to listen.
• In a crisis situation, every respondent knows someone who will help, even if they have to go out of their way to do so: 16% of respondents know 1 – 2 people, 37% know 3 – 5, 34% know 6 – 9, and 16% know 10 or more.
• When consoling is needed due to a major upset, 31% of respondents know 1 – 2 people they can count on, 44% know 3 – 5 people, 22% know 6 – 9 people, and one lucky person knows more than 10.
• The degree of satisfaction for each type of social support was consistently ranked at or above “fairly satisfied.”
• As to how people usually connect with their social supports, phone or face-to-face conversation were neck-and-neck favorites, at 87% and 84%. Texting (62%) and email (53%) were also popular, with only 9% using video chat and 19% using social media.
• Over 80% of respondents chose “face to face conversation” as the most satisfying.
• As a group, respondents ranked themselves as “mostly healthy” and “mostly resilient.”
• The majority of respondents were Baby Boomers (53%), followed by Gen X’ers (37%).

 
One thing I would do differently if I were to do this survey over: allow respondents the option to rank their preferred means of contact, rather than limiting them to one response. I wish I had also put a box for comments in the survey itself, although a few people did contact me directly with their feedback, including this one:
Face to face is the most obvious but I have found it is contextual. I have consoled and supported and been supported by many friends/acquaintances for example on social media and it has been effective and satisfying. Typically face to face is impractical or not appropriate to the relationship.

 
So thank you, everyone who responded! Besides satisfying my curiosity, I hope that taking the survey stimulated your thinking about your social support network, whether it’s to appreciate how many people you do have that you can count on in times of need, or to acknowledge that your network may need some boosting. And now you can compare your results with others, which is one of one of the many ways that people use social interactions – to see how we rank, and to find out whether other people feel the same way. It’s good for our health to know we’re not alone.

 
In the next post I will write about some really interesting research findings on social support and its role in health and mental health, so please come back and read!

Nutrition and Mental Health

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!

Exercise for Your Mental Health

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.