Mindfulness Meditation for Anxiety Group

The Rowan Center for Behavioral Medicine is offering a 12-week group to teach mindfulness skills to individuals struggling with anxiety. The group will focus on experiential exercises designed to teach mindfulness meditation, breathing retraining, and present-moment focus. Mindfulness has been shown to help people successfully cope with stress and difficult emotions and increase vitality in daily life. 

Day and Time:
Mondays: 6:30 pm  – 7:30 pm

Led by:
Puja Chhabra, LCSW RYT LCS24159

Location:
The Rowan Center for Behavioral Medicine
500 East Olive Avenue, Suite 540
Burbank, CA 91501

Cost:
$50 per session
Some insurance benefits may apply. Please inquire further.

Contact:
Please call our Intake Coordinator at (818) 446-2522 or email info@rowancenterla.com to schedule your free half hour screening. 

Puja Chhabra is a licensed clinical social worker, specializing in psychodynamic, trauma informed and holistic approaches in working with individuals. She is a dedicated yoga teacher, committed to learning about the deep connections between the mind and the body. Puja believes that the combination of psychotherapy and yoga compliments one another and alleviates symptoms related to depression, anxiety and trauma. She specializes in supporting individuals in connecting to their sense of hope, in the midst of life’s stressors, transitions, and challenges. Puja’s unique therapeutic approach is based on reflecting on the past, understanding barriers to living in the present moment, and moving towards self compassion and acceptance.  Puja is committed to sharing simple yet effective tools of mindfulness, body movement and meditative practices to enhance clinical work. 

Please feel free to call the Rowan Center for Behavioral Medicine for further information 818-446-2522 or email info@rowancenterla.com 

 

Feelings Part 2: Identifying Feelings

As mentioned in my previous post on feeling, many people go through much of their lives ignoring or suppressing their feelings. This can be for a multitude of reasons including fear of falling apart through experiencing strong emotions and messages from childhood that labeled certain feelings as bad or unacceptable. Because suppressing feelings becomes so automatic for many, many report that they don’t even know what they are feeling. By learning to recognize the characteristics of suppressed feelings and tuning into your body, you can become much more adept at identifying what you are feeling. 

Even though feelings are suppressed, they typically don’t just go away. They often manifest in a number of bodily and psychological symptoms.

Free-floating anxiety: Anxiety is a very normal and common reaction to any multitude of situations. However, if you are feeling anxious and uneasy for no identifiable reason, it may be due to unexpressed feelings. If this is a state you are familiar with, try to observe if this free-floating anxiety arises the next time you hold in your anger toward someone. 

Depression: Depression can arise when we hold in grief or feelings of sadness over a loss. Indeed, a grief reaction that is not fully expressed can evolve into a depressive episode. Getting in touch with our grief, crying and fully mourning often allows us to feel better and begin the healing process. If you have not experienced a recent loss, your depression may be anger directed towards yourself. This is particularly true if your find yourself attacking and criticizing yourself. 

Psychosomatic symptoms: Frequent headaches, gastrointestinal symptoms, high blood pressure and asthma often occur as a result of chronically withheld feelings. Holding in feelings over the course of many years is a form of stress that takes a toll on bodily systems. Often people find that when they learn to identify and express strong feelings, their physical symptoms abate.

Muscle Tension: Tense muscles are a particularly effective cue that feelings are being chronically withheld. We tend to hold tension in different body groups depending on what feeling we are suppressing. Anger tends to lead to the tightening of the neck and shoulders, while grief and sadness often results in tightening muscles in the chest and around the eyes. Fear typically reveals itself through the tightening in the stomach and diaphragm. While these are typical patterns of muscle tightening, these are not absolute. That’s why it is important to get to know your own particular physical experience of various feelings.

Tune Into Your Body

Thinking about your worries and concerns keeps your primarily in your head. It is necessary to shift focus from your mind to your body. The following steps have been adapted from Eugene Gendlin’s work on experiential focusing can be quite helpful in getting in touch with your physical experience of feelings.

  1. Physically relax. Spend five to ten minutes using a relaxation technique such as progressive muscle relaxation or meditation to slow down the mind and relax the muscles of the body.

  2. Ask yourself, “What am I feeling right now?”

  3. Tune into the place in your body where you usually experience emotional sensations such as anger, fear and sadness. Often observing the area of your hear or gut will reveal some sensations, but this may be different for you. Try to identify your particular place where feelings arise in your body.

  4. Observe what you sense when you tune into your body. Don’t try to analyze, figure out, or judge what arises. Just allow your self to wait and observe any feelings that are surfacing.

  5. Many find that they get stuck in steps 3 and 4 and are inundated with racing thoughts. If this occurs for you, simply begin at step 1 as this may mean that you need some more time to relax. You might try a few minutes of slow deep breathing.

  6. Once you have come into contact with a sense of what you are feeling, ask yourself:

    • Where in my body is the feeling?

    • What is the shape and size of this feeling?

    • If the feeling had color what would it be?

Hopefully, this exercise will help you begin to get in greater contact with your physical experience of various feelings. If you are still having a hard time identifying what you are feeling, you might find the feeling list below helpful. 

Positive Feelings                Negative Feelings

Affectionate        Great                                                            Afraid            Hostile

Alive                   Happy                                                             Angry            Humiliated

Amused             Hopeful                                                         Anxious        Hurt    

Accepted        Joyful                                                               Apprehensive        Ignored        

Beautiful        Lovable                                                            Ashamed        Impatient

Brave            Loved                                                                  Awkward        Inadequate

Calm            Loving                                                                  Bitter            Incompetent

Capable        Loyal                                                                  Bored            Indecisive

Caring            Passionate                                                      Confused        Inferior

Cheerful        Peaceful                                                           Contemptuous        Inhibited

Cherished        Playful                                                           Defeated        Insecure    

Comfortable        Pleased                                                   Dejected        Irritated

Competent        Proud                                                        Dependent        Isolated

Concerned        Quiet                                                          Depressed        Jealous

Confident        Relaxed                                                       Despairing        Lonely

Content        Relieved                                                         Desperate        Melancholy

Courageous        Respected                                            Devastated        Miserable

Curious        Safe                                                                 Disappointed        Misunderstood

Delighted        Satisfied                                                    Discouraged        Muddled    

Desirable        Secure                                                        Disgusted        Needy

Eager            Self-reliant                                                   Distrustful        Outraged

Energized        Sexy                                                           Embarrassed        Overwhelmed

Excited        Silly                                                                 Exacerbated        Panicky

Forgiving        Special                                                       Fearful            Tired

Friendly        Strong                                                          Foolish            Touchy

Fulfilled        Supportive                                                 Frantic            Trapped

Generous        Sympathetic                                          Frustrated        Troubled

Glad            Tender                                                          Furious        Unappreciated

Good                                                                                  Guilty            Unattractive

Grateful                                                                             Hateful            Uncertain

                                                                                            Helpless        Uncomfortable

                                                                                            Hopeless        Uneasy

                                                                                            Horrified        Unfulfilled

In my next post, I will be providing some suggestions for expressing and communicating your feelings, so they no longer have to remain suppressed. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Feelings Part 1: Defining Feelings

Many people who come into therapy report that they are disconnected from their feelings. A notable symptom of many psychological conditions including depression and anxiety is disconnection with one’s own feelings. It makes sense that people who are experiencing emotional pain and trauma often suppress their emotions. This coping strategy is often very effective in reducing distress in the short-term but the long-term ramifications can be painful and far-reaching. One negative effect of pushing down negative emotions is that positive emotions are also muted. Another consequence of emotional repression is that after a period of many years people sometimes cannot identify what they are feeling. Others may be able to identify their feelings but cannot express them. Many people find themselves feeling chronically depleted and unfulfilled. 

What exactly are feelings? Feelings are a total body response that involves the limbic system and autonomic nervous system. When you feel emotionally excited you may notice increased heart rate, increased respiration, sweating and even trembling or shaking. Extreme feeling states such as those experienced during panic attacks are characterized by our bodies’ fight of flight response, which mobilizes our ability to respond in the face of danger or threat.

Feelings do not just occur out of nowhere but are influenced by your thoughts and perceptions. The way we view the external world as well as internal events such as self-talk, imagery or memories affects the feelings we experience in response to stimuli. For example, shortness of breath and a racing heartbeat can be attributed to fear when in the presence of something we perceive as dangerous such as a growling dog. The same physiological sensations could also be interpreted as excitement if we’ve just seen our favorite sports team score a point. 

Feelings exist in two groups- basic and complex. Basic emotions include anger, grief, sadness, fear, love, excitement and joy. Complex feelings may be a combination of more basic emotions and are often mediated by our thoughts. Examples include eagerness, relief, disappointment and impatience. Often, we find the complex feelings last a longer time and are more tied in with thinking, while basic feelings are better characterized by their short duration and the prominence of physiological symptoms. Many times, we experience a mixture of many feelings. When having interpersonal difficulties with a loved one, we can experience a multitude of emotions including anger, sadness, guilt and love. 

Feelings give you energy and getting in touch with and expressing your feelings can make you feel energetic and vibrant. People who are out of touch with their feelings often report being lethargic, numb or depressed. Furthermore, blocked or withheld feelings often result in stress and anxiety.

Feelings are not right or wrong – they simply exist. Experiencing fear, joy, guilt, sadness or anger is not wrong or invalid. Typically, recognizing and expressing your feelings in appropriate ways is more healthy than denying them. It is important not to judge yourself or anyone else for the feelings they have. 

We often suppress our feelings by actively controlling them or holding them in. This may occur because the context is not appropriate for expressing our feelings. For example, when you are at work and feel annoyed with your supervisor’s request. In this scenario, immediately expressing your feelings would not be effective. Other times, we may experience unpleasant feelings and immediately busy ourselves by trying to ignore our feelings. This unconscious avoidance or evasion of feelings is what is referred to as repression. When we get in the habit of suppressing feelings, we often find that we have a hard time expressing feelings appropriately or even accurately identifying them. This can lead to chronic feelings of emptiness or numbness and a lack of contact with your core sense of self. 

When feelings are suppressed over a long period of time, individuals may sense that they have surrendered or can experience a partial loss of control when experiencing emotions. Chronically suppressed feelings become large and overwhelming and people sometimes feel that they are going to lose control or go crazy if they give full voice to long-suppressed emotions. However, by accepting and experiencing your feelings fully, they become less scary and help us develop greater awareness of ourselves and our relations to others. 

In my next post about feelings, I will be exploring ways to identify, express and communicate feelings in healthy ways. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

The Power of Forgiveness

Ancient wisdom and recent research from the field of positive psychology suggests that learning to forgive may just be one pathway to greater emotional freedom, peace, better relationships and improved health. 

Forgiveness is defined as a deliberate decision to release feelings of anger, resentment and vengeance towards someone who has harmed you, regardless of whether or not they deserve it. It does not mean forgetting or condoning the offenses that were done to you, nor does it necessarily mean that you reconcile with the offender.

Our willingness to engage in forgiveness is typically contingent upon the value or closeness of the relationship to the wrongdoer and the probability that the wrongdoer will harm us in the future. In close relationships, the person who was wronged becomes less motivated to retaliate or remain estranged from the offender and more focused on goodwill towards the offender, despite their past hurtful actions. In more distant relationships, where we forgive a person with whom we do not want a continuing connection, forgiveness is defined as reducing resentment and motivation toward revenge.

In contrast to forgiveness, unforgiveness is a negative emotional state in which the person who was wronged maintains feelings of hostility, anger and hatred towards the person who committed the offense. Holding a grudge has been linked to increased physiological stress, including increased heart rate and higher blood pressure (Witvliet, 2011). Lack of forgiveness can wreak havoc on relationships, shifting partner’s goals to competition rather than cooperation (Fincham & Beach, 2014). 

The key benefit of forgiveness is that it frees the person who has been wronged from corrosive anger. Practicing forgiveness allows the person who has been wronged to heal and move from being defined by the pain that they have suffered. Learning how to forgive can lead to increased self-esteem, better moods, less anger and anxiety, decreased stress and happier relationships. 

Fred Luskin, Ph.D., a pioneer in the study of forgiveness, has developed the “Nine Steps to Forgiveness” that has been used worldwide to help people give up grudges. He states that forgiveness is a process that occurs along the continuum of mourning. He identified three steps that are essential for forgiveness. The first step involves fully acknowledging the harm done, to take in the fact that you’ve lost something and its painful. The second step on the path to forgiveness is to experience all of the feelings normally associated with the difficult experience. If someone has been suppressing their reactions to the event, they will need to experience the range of emotions such as fear, sadness and anger that the harmful event evokes. The third step in the process is sharing your grief with one or more trusted others, as the human connection is central to healing.

Below are the nine steps that Dr. Luskin recommends to work towards forgiveness in your own life.

  1. Clearly define what happened and why it hurt you. Tell a trusted confidante.

  2. Commit to forgiveness in order to release pain for yourself, not for someone else.

  3. Be clear that forgiveness is not condoning the action or necessarily reconciling with the offender. It is something you do for yourself in order to cultivate peace and understanding. It is about changing the grievance story and taking the “life experience less personally.”

  4. Gain some perspective. Your distress is likely coming from the hurt feelings, thoughts and physical sensations you are experiencing now rather than from the offense that happened in the past.

  5. When you feel upset about the offense or the offender, practice a stress management technique.

  6. Alter your expectations. Recognize the “unenforceable rules” that you have for how others should behave. Give up seeking things from other people that they do not choose to give you. You have the choice to work towards your own health, love, peace and prosperity.

  7. Focus your energy on finding positive ways to meet your goals rather than mentally replaying your hurt.

  8. Shift your focus from your wounded feelings and look for love, beauty and kindness in your life.

  9. Remind yourself of your own heroic choice to forgive.

 For more on forgiveness, consider these books:

Emotional Freedom: Liberate Yourself From Negative Emotions and Transform Your Life (2010). by Judith Orloff, M.D.

or

Forgive for Good: A Proven Prescription for Health and Happiness (2001). by Fred Luskin, Ph.D.

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

REFERENCES

Fincham, F. D. & Beach, S. R. H. (2014). I say a little prayer for you: Praying for partner increases commitment in romantic relationships.  Journal of Family Psychology, 28, 587-593.

Witvliet, C.V.O., DeYoung, N.J., Hofelich, A.J., and DeYoung, P.A. (2011). Compassionate reappraisal and emotion suppression as alternatives to offense-focused rumination: Implications for forgiveness and psychophysiological well-being. The Journal of Positive Psychology, 6,286-299. 

Mindfulness and Cancer 2: Working with Scanxiety

Scanxiety (scan anxiety) – the peek in anxiety that happens as patients with cancer prepare for a scan such as an MRI, PET. bone scan or CAT etc.

Often the anxiety begins to build in the week(s) before the next scan. It can lead to difficulty concentrating, problems with sleep, fatigue, and a general sense of being on edge. While fear and worry associated with an upcoming scan is normal, it important to manage these feelings so that they do not interfere with your day-to-day life.

Some patients experience symptoms of post-traumatic stress as a result of previous traumas or particularly difficult courses of treatment. For these patients, the fear associated with scans interferes with daily life and leads to sleeplessness, nightmares, changes in mood and avoidance including repeated rescheduling or missing tests.

Mindfulness to Deal with Difficult Thoughts and Emotions

As you prepare for an impending scan, you may find that you experience an increase in feelings of anxiety and thoughts about possible poor outcomes. By observing how your emotions are experienced in the mind and body you can begin to use your mind in a new way to manage those feelings more effectively. Here are two helpful mindfulness meditation exercises that can be used when working with difficult emotions such as anxiety about an impending scan:

http://marc.ucla.edu/mpeg/04_Meditation_for_Working_with_Difficulties.mp3

http://mindfulwaythroughanxietybook.com/wp-content/uploads/mp3/Emotions_and_pSensations.mp3

Another exercise that can be helpful in addressing anxiety is to simply observe your thoughts and emotions as they come. Rather than allowing anxiety-filled thoughts to take over your thinking in the days before a scan, you can use mindfulness exercises to disengage from these thoughts. Here is a helpful exercise for observing your thoughts and feelings:

http://mindfulwaythroughanxietybook.com/wp-content/uploads/mp3/Clouds_and_Sky.mp3

While the days and weeks leading up to scans are often anxiety provoking, having tools to help you manage those emotions can make a big difference in whether you are able to keep your appointment and how emotionally prepared you feel for the day. You may also find it useful to practice some of the breathing exercises found below to help during your test. If you find that you are continuing to have difficulty managing your anxiety post-treatment, it may be helpful to seek out the help of a therapist who can work with you on additional techniques to address your worries.

Additional Resources

For additional mindfulness exercises visit:

The Mindful Way Through Anxiety

http://mindfulwaythroughanxietybook.com/exercises/

UCLA Mindful Awareness Research Center

http://marc.ucla.edu/body.cfm?id=22

I sincerely hope that you have found this post helpful. Please look for more upcoming blogs in this series on mindfulness and cancer both on our website and on our Facebook page at www.facebook.com/rowancenterla.

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

Multiple Sclerosis and Anxiety

Multiple sclerosis (MS) is a common neurologic disease that affects approximately 2.3 million individuals around the world. Emotional disorders, such as anxiety, are more common in people diagnosed with MS than in the general population. In fact, approximately 40% of people with MS will experience impactful anxiety in their lifetime. 

What Ways Do People With MS Experience Anxiety?
Anxiety is an umbrella term. There are many different ways people can feel or experience anxiety. Some examples include: generalized anxiety, social anxiety, panic attacks, phobia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Panic attacks, specific phobia (an intense fear of a particular thing, such as injections or spiders), and obsessive-compulsive disorder (OCD) are more common in MS than in the general population. However, the most common form of anxiety in MS is generalized anxiety, which is characterized by chronic daily worry. If chronic daily worry reaches a certain threshold of intensity or frequency, and it interferes with your ability to function day-by-day it can be diagnosed as an anxiety disorder. This is called generalized anxiety disorder (GAD). 

A Little More About Generalized Anxiety
Generalized anxiety disorder can be difficult to diagnose and treat because many of the symptoms overlap with common symptoms of MS.  Let’s look at the diagnostic criteria for GAD in more detail:

A diagnosis of GAD is made when an individual experiences excessive, uncontrollable worry and 3 or more of the following symptoms on most days for at least 6 months:
•      Restlessness, feeling “keyed up” or “on edge”
•      *Fatigue
•      *Difficulty concentrating or feeling like your mind goes blank
•      Irritability
•      *Muscle tension
•      *Sleep disturbance: difficulty falling asleep, staying asleep, restless sleep, or unsatisfying sleep

At least 4 of 6 of the GAD symptoms can ALSO be symptoms of MS (*starred above). Thus it can sometimes be difficult to distinguish between what is MS, what is anxiety, and what is both!

So Why Is Anxiety More Common In MS?
Overlap of Symptoms. As we noticed above, a partial explanation is the overlap of symptoms. Because anxiety shares some similar symptoms with MS it is “easier” for someone to meet a diagnostic threshold, or meet the criteria for an anxiety disorder.  However that is not the whole story!

An Emotional Response. Living with a chronic progressive condition, like MS, can be very stressful; there is inherent uncertainty. One might be led down a rabbit hole of worries. You might worry about the disease itself (e.g., Will my disease progress? How fast will it progress? What symptoms might I have in the future? When will I have my next exacerbation?). These thoughts might lead to worries about how MS could impact daily life, work, and family. Anxiety is most common when there is uncertainty about your health condition, especially when newly diagnosed or during relapses.

A Symptom of the Disease. More research is needed to understand the physiological factors that contribute to anxiety in MS. However, there is some evidence that the Fight or Flight Response is disrupted in people with MS who experience anxiety. The Fight or Flights Response is a function of the hypothalamic-pituitary-adrenal axis – a complex system that controls our reaction to stress. Finally, certain medications commonly used in MS have been linked to increased anxiety.

How Do I Know If I’m Anxious?
A questionnaire called the GAD-7 (https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf) can help to screen for anxiety. A score of 10 or more on the scale means that anxiety is interfering with your daily life and should be discussed with your medical provider.

Since there are overlapping symptoms between MS and anxiety, it’s best to consult with your health care provider. Your provider will help determine if what you are experiencing is, in fact, anxiety. They can also help you decide the best treatment.

Why Should Anxiety Be Treated?
It is important to treat anxiety. If left untreated, anxiety can interfere with your ability to successfully function in day-to-day life. Anxiety is also associated with: increased pain, poor sleep, more fatigue, MS exacerbations, and pseudo-exacerbations. Anxiety can almost always be treated with counseling (psychotherapy) and/or medications.

Psychotherapy
Cognitive-Behavioral Therapy (CBT) is very effective in treating anxiety disorders. This type of therapy helps you identify and alter maladaptive thinking patterns (cognitions) that reinforce worry and anxiety (e.g., “If I have another exacerbation, I’ll lose my job!”). This therapy also helps you identify and modify actions (behavior) that trigger or reinforce worry and anxiety (for example: avoiding feared situations or objects like injections, doctor appointments, or MRIs).

Acceptance and Commitment Therapy (ACT) is another effective treatment, especially for GAD. The primary goal of ACT is to find ways to pursue your chosen values, despite difficult and potentially unchanging life circumstances (e.g., a diagnosis of MS). 

Medications
Medication does not cure anxiety, but can keep symptoms under control while you learn coping strategies, or until life stressors decrease.  Medications most commonly used for anxiety include: •       Antidepressants: SSRIs, Tricyclics, or MAOIs
•       Anti-Anxiety Medications: benzodiazepines, buspirone
•       Beta-Blockers (prevent the physical symptoms that accompany certain anxiety disorders such as  increased heart rate)

Other strategies for reducing anxiety
•       Mindfulness based stress reduction (MBSR) – Free guided podcasts can be found on the UCLA Mindful Awareness Research Center website (http://marc.ucla.edu/body.cfm?id=22)
•       Deep breathing
•       Regular exercise

How Do I Find Treatment?

If anxiety seems to be a problem for you, talk to your health care provider. He or she can refer you to a mental health professional.  If you are diagnosed with MS, or are the family member/care provider of a person diagnosed with MS, the National MS Society can help. Check out their website (www.natioanlmssociety.org) or call the MS Navigator Program at 1-800-344-4867. Additional resources are listed below.

Resources

National MS Society: Emotional Changes in MS. http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/emotional-changes/index.aspx

National MS Society: Stress

http://www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/stress/index.aspx

National MS Society: Exercise is Medicine

http://www.nationalmssociety.org/chapters/was/programs–services/exercise-is-medicine/index.aspx

NIMH: Treatment of Anxiety Disorders

http://www.nimh.nih.gov/health/publications/anxiety-disorders/treatment-of-anxiety-disorders.shtml

 Shadday, A. (2007). MS and your feelings: handling the ups and downs of multiple sclerosis. Alameda CA: Hunter House.

Meghan Beier, PhD is a Rehabilitation Psychologist and Clinical Researcher at the University of Washington Medicine Multiple Sclerosis Center. Dr. Beier obtained her Ph.D. from Yeshiva University, and completed a 2-year Multiple Sclerosis rehabilitation research fellowship in the Department of Rehabilitation Medicine at the University of Washington School of Medicine, which was funded by the National Multiple Sclerosis Society. Her research and clinical focus is the cognitive and emotional symptoms common to multiple sclerosis. 


REFERENCES

1.         Haussleiter IS, Brune M, Juckel G. Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment. Ther Adv Neurol Disord. 2009;2(1):13-29.

2.         S D, Burke T, Bramham J, O’Brien MC, Whelan R, Reilly R, et al. Symptom overlap in anxiety and multiple sclerosis. Mult Scler. 2013.

3.         Eifert G. Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol. 2009;16(4):368–85.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Fuel Your Mind

Did you know that your brain uses 20% of your body’s oxygen calories despite being only 2% of your body’s weight? (1) Whether you are awake or asleep, your brain is constantly demanding nutrients and energy to function. And where do we get these nutrients you say? Yes, from food!

Researchers have known for a very long time that what you eat has the potential to affect your mood, cognition, awareness, and overall mental health, yet it is rarely mentioned when mental health conditions, such as depression and anxiety, arise. This may be because nutrient depletion is difficult to recognize. Scientists have proposed that an individual in good health may be depleted of nutrients for a substantial amount of time, months to years, before signs and symptoms begin to occur (2), however, long term depletion can lead to permanent damage. So how do we support our mental health and fuel our brains long term? Through wellness!

These simple steps can get you started on the road towards a healthy mind:

1.     Sleep. Sleep. Sleep. Despite contradicting evidence, it is recommended that adults get 7-8 hours of sleep each night (3). Your body is working all day and your brain never stops. Your brain needs sleep!

2.     Increase fruit and vegetable intake. Fresh foods are packed with antioxidants and other vitamins and minerals that help your body prevent damage to your brain caused by stress. They also help your brain make chemicals needed to feel joy and euphoria, like norepinephrine and serotonin.  

3.     Get your daily dose of healthy fats. The cells in your brain are all surrounded by layers of fat, also known as lipids. In fact, 10-12% of your brain is made of lipids. (4) Eating foods high in omega-3 fatty acids can support brain health. (5), (6) Avocados, walnuts, olive oil, and wild fish are some of the best sources of healthy fats and fat soluble vitamins that are also important in keeping the brain healthy.

4.     Spend time in the sunlight. Fifteen minutes a day can go a long way as it will help your body make vitamin D. (7) Although not fully understood, vitamin D acts on areas of the brain that are linked to mental health conditions, like depression and Alzheimer’s Disease. (7) This is one vitamin that is not naturally in many foods, so if you are a person that should avoid exposure to sunlight (or live in northern parts of the world (8)), you should consider supplementation and look for foods fortified with vitamin D, like milk, yogurt and juices.

5.     Increase physical activity. It helps get your blood pumping and brings necessary oxygen to your brain. The more you do, the more efficient your body is at using oxygen.

6.     Drink water! Your brain is 77-78% water. (4) Hydration is key to keeping your neurons firing quickly and efficiently throughout the day.

7.     Eat foods rich in vitamin B12 and iron. Vitamin B12 helps build strong neurons and promotes your ability to reason and problem solve (9) and iron is needed to bring oxygen to all your living cells. (10) Animal proteins, such as chicken and beef, are great sources of these nutrients. Other good sources include eggs, spinach, tofu, and beans.

8.     Limit alcohol and caffeine. Research has shown that alcohol can contribute to depression, memory loss and anxiety. (11) Caffeine can worsen anxiety, agitation and sleep disorders. (12) Many people crave these things, but the body does not need them! 

Stay tuned for more on nutrition and your health!

Jonae Perez, MPH, RD
Registered Dietitian

Jonae Perez is currently a clinical dietitian at Professional Child Development Associates providing nutrition counseling for children with special health care needs. She completed her Master of Public Health and nutrition training at the University of Washington, Seattle. She has a background in exercise science and is passionate about adult and pediatric wellness. 

REFERENCES

1.     Clark DD & Sokoloff L (1999). Basic Neurochemistry: Molecular, Cellular and Medical Aspects, eds. Siegel GJ, Agranoff BW, Albers RW, Fisher SK & Uhler MD. Lippincott, Philadelphia, pp. 637–670.

2.     Leyse-Wallace R (2013). Nutrition and Mental Health. Boca Raton, FL: CRC Press.

3.     National Heart, Lung, and Blood Institute, Department of Health and Human Services (2012, Feb 22). How much sleep is enough? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch

4.     McIlwain H & Bachelard HS (1985). Biochemistry and the Central Nervous System, Edinburgh: Churchill Livingston.

5.     McNamara RK & Strawn JR (2013). Role of long chain omega 3 fatty acids in psychiatric practice. PharmaNutrition; 1(2): 41-49.

6.     Freeman MP, et al. (2006). Omega 3 fatty acids: evidence basis for treatment and future of research psychiatry. Clin Psychiatry; 67(12): 1954-1967.

7.     Vitamin D Council (2013). Does vitamin D play a role in your health condition? Retrieved from http://www.vitamindcouncil.org/health-conditions/

8.     Huotari A & Herzig KH (2008). Vitamin D and living in northern latitudes – an endemic risk area for vitamin D deficiency. Int J of Circumpolar Health; 67(2-3): 164-178.

9.     Louwman MWJ, van Dusseldorp M, Fons JR, et al. (2000). Signs of impaired function on adolescents with marginal cobalmin status. Amer J Clin Nutr; 72(3): 762-769.

10.  Linus Pauling Institute (2015). Iron. Retrieved from http://lpi.oregonstate.edu/infocenter/minerals/iron/

11.  American Psychological Association (2015). Understanding alcohol use disorders & their treatment. Retrieved from http://www.apa.org/helpcenter/alcohol-disorders.aspx

12.  Winston AP, Hardwick E & Jaberi N (2005). Neuropsychiatric effects of caffeine. Advances in Psychiatric Treatment; 11(6): 432-439.

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