Conversations in Health

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Mind & Body

Insomnia – a Non-Medicated Approach to Getting Better Sleep

Girl sleeping in late on weekend tired from long work week resting on plush white comforter

Insomnia and lack of sleep plague our modern society – over a third of Americans suffer from some form of sleep disturbance,  over 10 million use prescription sleep aids, and women are twice as likely as men to suffer from insomnia.  Often, prolonged sleep latency (difficulty falling sleep), or inability to sustain restful sleep can be signs of underlying anxiety, stress or depression.  The health implications of sleep deprivation are profound, including increased risk of heart disease and hypertension, cognitive impairment, a weakened immune response, and increased risk of weight gain, among others problems.  Approximately 60 percent of Americans have admitted to driving while sleep deprived, a significant risk for motor vehicle accidents.  According to research, being awake for 18 hrs leads to impairment equivalent to a blood alcohol level of 0.05, and after 24 hrs, of 0.10.   A blood alcohol level of 0.08 is commonly considered intoxication.

Over the counter sleep aids like melatonin, prescription drugs like zolpidem (Ambien) and others – while quick fixes – often lead to further masking of underlying sleep problems and some degree of daytime drowsiness.  While beneficial for short term needs, many Americans suffer from chronic sleep problems related to stress.  What are some alternative, healthy practices to restore restful sleep?  Here are a few healthy sleep habits:

  1. Maintain the same bedtime each day – a routine sleep schedule is key to healthy sleep, even on weekends.  Approximately 7-9 hrs of sleep is recommended for adults, and 10 hrs for school age children.  Often children who oversleep on holidays run into a cycle of inability to sleep at night, followed by daytime sleepiness.
  2. Turn off all electronic and other stimuli prior to sleep –  a good habit is to turn off the TV, tablets and phones about an hour before sleep.  Giving your body a chance to wind down, dimming the lights and transitioning to less mentally stimulating activities before sleep is key – both for adults and children.  The light emitted from most mobile devices also interferes with the natural rise in the body’s melatonin levels, making it harder to fall asleep.  Place your phone across the room if you are tempted to keep checking it at night.
  3. Visualization – there are many mindful visualization techniques that have been proven to reduce anxiety levels and relax the mind and body.  It can be as simple as visualizing a favorite, relaxing place, such as a beach, for five minutes.  Close your eyes and try to use all five senses to mentally place yourself in that location -visualize the ocean water, think of the sounds of the waves, the scent of salt in the air, and the feeling of  sand and sun on your skin.  For five minutes immerse yourself in that experience, and your body will began to relax while your mind refocuses.
  4. Writing – journaling, or simply writing down a to-do list on paper for 15 mins and then putting it away, can help off-load thoughts in your mind onto paper before sleep.
  5. Meditation & Mindfulness – one of the biggest challenges to falling asleep is often when we have too much on our mind – thinking about what we have to do the next day, worries about problems, etc.  Meditation and mindfulness is the process of being aware of one’s thoughts, and taking control of these thoughts in a healthy way.  Passively allowing our thoughts to take over our mind leads to increased anxiety and stress.  But similar to the visualization technique above, you can start with simple mindfulness exercises that redirect your thoughts to being present and aware of your body, breathing and surroundings.  Many studies have shown the cognitive benefits of meditation on the brain’s physiology and in reducing anxiety and depression.  It has a similar role in helping with insomnia.  Not sure how to practice mindful meditation?  Try this mobile app, Head Space , which offers 10 minute practical meditation exercises which you can incorporate into everyday life, including relaxation technique prior to sleep.
  6.  Cooling off – some studies have shown the benefit of cooler temperatures for falling asleep.  Try reducing your thermostat settings to 65-68 degrees at night.
  7. Cut the Caffeine – of course, limiting caffeinated beverages prior to sleep is a known element of good sleep hygiene.  If you are suffering from insomnia, try to eliminate any late afternoon coffee or soda runs as well.

For those who have other contributing medical factors affecting sleep, such as restless leg syndrome, snoring/sleep apnea, back pains, consult with your medical provider for further evaluation.  We hope you will try to implement some of these healthy sleep habits in your nightly routine.

Meditation – the Scientific Benefits

Spa concept. Three candles on green background.

The Mental Health Benefits Of Meditation: It’ll Alter Your Brain’s Grey Matter, And Improve Memory, Sense Of Self

By Lecia Bushak

It appears that scientific evidence of meditation’s powers continues to add up. Meditation, in a way, is like exercise for our brains: it’s been shown to assist in mental health maintenance, improve our memory, empathy, and sense of self — similar to how exercise boosts our resilience, muscle strength, cardiovascular health, and blood pressure/cholesterol.

Perhaps one of the most fascinating studies published on meditation is one from several years ago — but one that is good to keep in mind if you’re interested in mental health and brain plasticity. The study, led by Harvard researchers at Massachusetts General Hospital (MGH), found that meditating for only 8 weeks actually significantly changed the brain’s grey matter — a major part of the central nervous system that is associated with processing information, as well as providing nutrients and energy to neurons. This is why, the authors believe, that meditation has shown evidence in improving memory, empathy, sense of self, and stress relief.

“Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day,” Dr. Sara Lazar, a Harvard Medical School instructor in psychology, said in the news release. “This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing.”
The idea that mindfulness and meditation can bring you compassion, focus, and joy is thousands of years old, but it’s only recently that science has begun to back it.

In the study, 16 participants took a Mindfulness-Based Stress Reduction program for 8 weeks. Before and after the program, the researchers took MRIs of their brains. After spending an average of about 27 minutes per day practicing mindfulness exercise, the participants showed an increased amount of grey matter in the hippocampus, which helps with self-awareness, compassion, and introspection. In addition, participants with lower stress levels showed decreased grey matter density in the amygdala, which helps manage anxiety and stress.

“It is fascinating to see the brain’s plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life,” Dr. Britta Holzel, an author of the study, said in the press release.

Another recent study examining the health benefits of positive thinking found that mindfulness exercises like meditation or yoga actually changed the length of telomeres in breast cancer patients — which works to prevent chromosomes from declining. And in the past, researchers have found that people who practiced meditation actually had different brain structures than people who didn’t.

Indeed, the notion that meditation can foster improved sense of self, compassion, happiness, and focus is thousands of years old, but it’s only now that science has begun backing it.

http://www.medicaldaily.com/mental-health-benefits-meditation-itll-alter-your-brains-grey-matter-and-improve-319298

 

Finding Support for Families Living with Mental Illness

Team

 

Looking for support and resources to help care for a loved one with mental health concerns?  A great first step is contacting your local NAMI chapter — the National Alliance on Mental Illness (NAMI) is a supportive and strong network with chapters all over the country.  They have been where you are, and can help you start getting the support  and resources you need – for yourself, and your loved one.

Education Classes

NAMI Basics
NAMI Basics is a class for parents and other family caregivers of children and adolescents who have either been diagnosed with a mental health condition or who are experiencing symptoms but have not yet been diagnosed. This course is also available in Spanish, Bases y Fundamentos de NAMI.

NAMI Family-To-Family
NAMI Family-to-Family is a class for families, partners and friends of individuals with mental illness. The course is designed to facilitate a better understanding of mental illness, increase coping skills and empower participants to become advocates for their family members. This program was designated as an evidence-based program by SAMHSA. The course is also available in Spanish, De Familia a Familia de NAMI.

NAMI Homefront
NAMI Homefront is a class for families, partners and friends of military service members and veterans experiencing a mental health challenge. The course is designed specifically to help these families understand those challenges and improve the ability of participants to support their service member or veteran.

NAMI Peer-To-Peer
NAMI Peer-to-Peer is a recovery education course open to anyone experiencing a mental health challenge. The course is designed to encourage growth, healing and recovery among participants. This program is also available in Spanish, De Persona a Persona de NAMI.

NAMI Provider Education
NAMI Provider Education is a class for line staff at facilities providing mental health treatment services. The NAMI Provider Education class is designed to expand the participants’ compassion for the individuals and their families and to promote a collaborative model of care.

Presentations

NAMI Ending The Silence
NAMI Ending the Silence is an in-school presentation designed to teach middle and high school students about the signs and symptoms of mental illness, how to recognize the early warning signs and the importance of acknowledging those warning signs.

NAMI In Our Own Voice
NAMI In Our Own Voice is a presentation for the general public to promote awareness of mental illness and the possibility of recovery. This program is also available in Spanish, En Nuestra Propia Voz de NAMI.

NAMI Parents & Teachers As Allies
NAMI Parents & Teachers as Allies is a presentation for teachers and other school personnel to raise their awareness about mental illness and help them recognize the early warning signs and the importance of early intervention.

NAMI Compartiendo Esperanza
NAMI Compartiendo Esperanza is a bilingual presentation for Latino communities designed to promote mental health awareness, explore signs and symptoms of mental health conditions and highlight how and where to find help.

NAMI Sharing Hope
NAMI Sharing Hope is a presentation for African American communities designed to promote mental health awareness, explore signs and symptoms of mental health conditions and highlight how and where to find help.

Support Groups

NAMI Connection
NAMI Connection is a weekly or monthly support group for people living with a mental health condition. This program is also available in Spanish, NAMI Conexión.

NAMI Family Support Group
NAMI Family Support Group is a weekly or monthly support group for family members, partners and friends of individuals living with a mental illness.

http://www.nami.org/Find-Support/NAMI-Programs

 

‘Mindful’ Eating – Promoting Healthy Habits in Kids

An apple and a paper bag with lunch. Vintage Style.

How schools are using ‘mindful eating’ to help prevent eating disorders

By Juli Fraga
At Waddell Language Academy, a K-8 School in North Carolina, Monica Mitchell-Giraudo, a French immersion middle school teacher, instructs 19 sixth-graders to gather into a circle.

“Okay, everyone, let’s take a few mindful breaths, and think about our gratitude for Amy, who brought us apples for snack today,” says Mitchell-Giraudo. “As you take these breaths, try to tune into your body. What sensations do you notice?”

“I notice my stomach is already growling,” chuckles Ben.

“My mouth is watering,” exclaims David.

Another student follows David and then another until each child has had their turn. After each of her student’s observations, Mitchell-Giraudo rings her Tibetan meditation bell. Each time the children remain still, despite the loud chimes.

[The problem with recess in the United States: We get 27 minutes. Finnish kids get 75, Japanese kids even more.]

Next, she instructs her students to hold and examine the apples. First, they pick up the fruit and roll it between their fingertips. Then, on her suggestion, they bring the apples to their noses, using their sense of smell to savor the flowery scent of their snack before taking the first succulent bites.

“Excellent, class,” says Mitchell-Giraudo. “Also, as a gentle reminder, before you eat the apple, ask yourself whether or not you’re hungry.” The students nod in recognition. “Remember, you don’t have to eat if your body isn’t giving you a hunger signal,” she says.

These students are learning a practice called “Mindful Eating,” that focuses on cultivating “present moment awareness” during meal times. Mindful eating invites participants to “pay attention” to the food in front of them and engage their five senses (sight, smell, hearing, taste and touch) before consuming a single morsel. This mindfulness practice builds the children’s awareness of important physical cues like hunger and satiety.

While mindful eating is scientifically proven to help prevent overeating and obesity, a new psychological study suggests that it may also forestall eating disorders, such as anorexia and bulimia, which affect 30 million people each year and are the deadliest of psychiatric illnesses. Surprisingly, anorexia nervosa is deadlier than major depression, schizophrenia or bipolar disorder. In fact, individuals who suffer from this severe illness are at higher risk of suicide, as well as prone to major health complications, such as cardiac arrest.

The National Eating Disorders Association states: “For young women, 15-24 years-of-age, Anorexia is twelve times more fatal than all other causes of death among this age group. Only 1 in 10 eating disorders sufferers will receive treatment for that illness, which makes prevention programs even more valuable.”

According to eating disorders researchers Michael Levine and Linda Smolak at Kenyon College, “By having children and adolescents participate in prevention programs, such as mindful eating, it can protect them from anorexia, bulimia and binge eating disorder.”

The positive life-affirming feedback from the children who participate in the program is the biggest testament to just how much these newly learned life skills are helping them.

“Mindful eating helps me respect the food that goes into my body,” asserts Jamie, a middle-school student in Mitchell-Giraudo’s class. “I can make better food choices,” she says, “because when I slow down to eat, I can tell which food is filled with fake ingredients and which foods are organic.”

“Mindful eating teaches children how to connect with their body signals, and learn how to eat intuitively,” says Kelsey Latimer, an eating disorders psychologist at the Center for Pediatric Eating Disorders and Children’s Health in Dallas. “This form of intuitive eating helps us distinguish between physical and emotional hunger and can help curtail overeating and binging.”

While Mindful Eating has been used in medical settings and eating disorder treatment centers, bringing the practice into the classroom as a preventative tool is a new concept.

“These programs buffer against eating disorder development,” suggests Latimer, “especially when administered during the late middle-school years. That’s a crucial period because it’s when students have been exposed to social the messages that “thin is in” but most have not yet manifested disordered eating habits to obtain a thinner physique.”

Mitchell-Giraudo, herself a graduate of the Mindful Schools program, echoes Latimer.

“It’s wonderful to see my students engage in 45 minutes of eating mindfully, especially since they used to scarf down their food in less than 10 minutes,” she says.

“By slowing down, my students have learned how to tell the difference between artificial and authentic flavors,” says Mitchell-Giraudo, “and this knowledge helps them make healthier food choices.”

Penelope says she is grateful that she’s learned these life skills. “Mindful eating is a great way to eat because it helps you feel good about yourself,” she says. “It’s helped me think about what I put into my body, which helps me grow stronger and do better in sports, too.”

While middle school is the ideal time to introduce eating disorders prevention programs, high school students can benefit just as much from the practice as those who are younger.

Aggie Giglio Kip, a nutritional counselor at Phillips Academy in Andover, Mass., incorporates mindful eating with her students in the dining hall.

The self-serve cafeteria bustles with activity as the students collect their food, flatware and beverages. Once they sit down to eat, Kip encourages them to unplug from other distractions, which means turning off their cellphones and powering down their computers. “Mealtimes are an opportunity to practice just eating,” she says.

Kip suggests that they “eat without judgment,” refrain from negative body talk and avoid measuring their self-esteem based on the foods they choose to eat. This is important since many of these teenagers struggle with the social and emotional changes of adolescence, including body image dissatisfaction.

For example, when Kip hears students say, “I ate the cookies — I was so bad,” a red-flag sign of negative body talk, she insists that they redefine the experience by using their senses to describe the flavors in the cookie. As an example, if a student feels guilty about eating oatmeal raisin cookies, Kip will ask her to focus and describe the scent and taste of the cinnamon, oatmeal and raisins.

Unfortunately, these kinds of courses are in short supply because many educators and school administrators believe that social and emotional programs are too expensive or time-consuming to implement. At many schools, teachers and school staff are often overwhelmed, overworked and underpaid. To save costs and reduce staffing issues, the schools bring prevention programs and/or leadership training into the schools like the Body Positive, founded by Connie Sobczak and Elizabeth Scott. The program trains educators and school staff in the principles of mindful and intuitive eating and teaches a series of self-exploration exercises that help them examine their feelings and attitudes about food and weight so that they can relay these messages to their students, too.

Kathy Laughlin, director of counseling at San Domenico High School in San Anselmo, Calif., is a fan of the Body Positive training. “The risk factors for eating disorders at my school are very high,” he says. “Since we began to incorporate this program, I have not seen as many girls with issues related to body hatred.”As the evidence demonstrates, implementing a mindful eating practice is one of the best ways to help students develop a healthy mind and body connection — one which will bolster them for years to come.

https://www.washingtonpost.com/news/to-your-health/wp/2016/03/16/how-schools-are-using-mindful-eating-to-help-prevent-eating-disorders/

Mental Health & Wellness – A Conversation with Dr. Ayesha Mian

 

mind, body, spirit, soul and you

Can you tell us a bit about your clinical practice?

I am an adult psychiatrist and specialize in Addiction Medicine. I have been in practice for over 6 years. My patients are usually in different phases of their mental illness and/ or addiction disease. I help people get off alcohol and other drugs in a hospital and clinic setting. I also work with people who might be in a state of mental decompensation or seeking assistance to improve their mental health and well-being. I work at Fairfax County Community Services Board, Virginia Hospital Center and my private practice in Arlington, VA.

What are some of the most common mental health issues you see in the community?

Some of the most common issues I deal with are depression, anxiety and alcohol dependence. We live in the day and age of high stress, unrealistic expectations, limited social supports, social media frenzy, breakdown of family structure and abundance of reliance on alcohol and drugs. All these factors contribute to depression and anxiety and these are some of the most common issues I see in the community.

What are some early signs of depression, anxiety?

There are several signs to watch out for with depression- problems with sleep, that is sleeping too much or too little; problems with appetite, that is eating too much or too little resulting in weight loss or weight gain; problems with energy, focus and concentration. People might begin to lose interest in the things they normally find pleasure in, they might begin to isolate and may not be as talkative, they may start to call-in sick at work. Some times if the depression has gone on too long, people might start to feel that life is not worth living. Anxiety may or may not present with depression. When people are anxious, often times they complain of physical symptoms- feeling palpitations or a racing heart, shortness or breath, feeling ‘keyed up’ all the time, worrying constantly about mundane things, feeling overwhelmed etc. There is usually a spectrum of severity with these illnesses. You may only feel some of these symptoms and you may only have them at low intensity and they may progressively get worse. It is important to seek help if you or your loved one might be experiencing such symptoms.

We live in a world filled with multiple stressors. How do you counsel patients about dealing with stress?

I tell people that it is normal to have some degree of ups and downs in your mood with the normal ups and downs of life. It is important to keep a healthy life style, which includes nutritious diet and exercise. 30-40 minutes of cardio 5 or more times a week improves anxiety and low grade depressive symptoms. Incorporating yoga, mindfulness and meditation helps decrease levels of stress as well. Other ways of building resilience include reliance on social relationships, positive thinking and self-care. Human beings are social creatures and we should cultivate relationships in our life, spend quality time with family and friends and rely on our networks in times of need. Oftentimes we don’t reach out for help when we should. The power of positive thinking and having hope in the future are also important as coping skills. Self-care – taking the time out to treat ourself, read a good book, travel, any thing that makes one feel good – are important tools to improve one’s mental health. Eliminating negativity from our lives, decreasing use of social media, putting down our phones and having more meaningful conversations and relationships with people one on one are all coping strategies we can incorporate in our day to day lives.

Have you found a role for “mindfulness” and meditation in reducing stress? Can you talk a bit about that?

Definitely. Mindfulness, in short, is practicing being present in the moment and learning to accept without judgment. There are known benefits of meditation and mindfulness on mental health. Research shows evidence that mindfulness changes the brain. Studies show that the part of the brain called the Anterior Cingulate Cortex, which is associated with self-regulation of impulsivity and aggressive behavior, has higher activity in people who meditate. Meditators and people who practice mindfulness have greater self control and are less impulsive.

In addition, people in stress whether it is psychological or physiological, tend to have higher levels of the stress hormone called cortisol. Studies show that people who practice mindfulness or meditation tend to have thicker gray matter in the region of the brain called the hippocampus, which is involved in memory and emotion. This is the same region of the brain that has a lot of cortisol receptors and is found to be damaged in people with PTSD or depression. So, we actually see physiological benefits on the brain with practice of mindfulness and meditation and I absolutely recommend this to my patients.

There is a stigma in our society not only about mental illness, but also about seeking out counseling for issues like stress, family problems, anxiety etc. Many people are afraid they will be labeled as having a “mental problem” and hence shy away from these resources, or have tried it once and felt a disconnect. What would you advise about the importance of professional counseling and therapy?

Over 18% of the people in the US suffer from some form of mental illness each year. This is not a small number of people. It is important to address mental illness because it can very commonly get to a point where the person becomes dysfunctional in their life and / or it severely negatively impacts their relationships. It can also lead to suicidal or homicidal thoughts, which is considered a medical emergency. We see and hear about people completing suicide because they couldn’t tolerate the suffering and pain of their illness. Therapy and medications do help. You might have to see a few different therapists before you find the right fit, and it is definitely worth the time it takes to find the right person for you. It is important to have a therapist who is neutral (not a friend or family) and would be able to help guide you to discover things about you that you might not be able to otherwise.

How do you approach medication initiation for patients suffering from depression or anxiety?

Depending on the severity and effect of depression or anxiety on a person’s level of functioning, I make a decision on whether a medication needs to be started or not. Some times, people come to me after being referred by their therapist or other doctors. I almost always recommend life style changes – including diet, exercise, limited caffeine intake, meditation, yoga, breathing exercises, therapy etc. Often times, by the time someone is referred to me, these recommendations alone are not enough and we may add a medication. But it really is a decision based on each person’s individual history. There is no one-size-fits-all. I have to assess each person’s medical history, family history, trauma history, genetic predispositions, psychological and social factors, etc. before I can make a recommendation regarding medications.

If I notice a friend or loved one having some serious mental health concerns – (e.g. extremely depressed, paranoid thoughts, irrational behavior) but they are unwilling to see a doctor, what resources are there to seek help?

I come across this a lot. Some times but not always, family and friends have leverage and can do an intervention to convince the person to see a doctor. One way to find a therapist is through your insurance company. Another option is http://www.psychologytoday.com where you can search for therapists in your zip code and your insurance carrier. Your primary care physician might also know a therapist or psychiatrist they work closely with. Also, all Virginia counties have Community Health Services Boards with emergency services for their county residents. It is hard to get someone to go to treatment against their will, but if someone is in danger of harming self or others, then call 911 or take the person to the nearest emergency room.

What do you think are the biggest barriers to seeking out mental health services – Stigma? Financial coverage? Education and awareness of resources?

All of the above. There is a long way to go in improving the challenge that we see with stigma associated with mental illness. We as health professionals have to continue to create awareness about mental illness as a way to counter the stigma. I also think people don’t know how to recognize mental illness and when they do want to seek help, they do not know where to go. Another barrier is the scarcity of mental health professionals which makes it hard to get an appointment with a psychiatrist in a reasonable amount of time. The hope is that access and availability improves over time and those who need mental health care receive it.

 

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