As western medicine moves towards a deeper understanding of the body/mind connection, the psychological community is also understanding more the impact of lifestyle factors on our sense of well being. In psychotherapy communities, these are referred to as therapeutic life changes, or “TLC’s.” Not only are these important ways to show ourselves some tender loving care, but in cases of mild to moderate symptoms, they can be used as an alternative to medication

In an article that was published in January, 2011 in the American Psychological Association’s online publication of American Psychologist, Roger Walsh, PhD, MD, of the University of California, Irvine College of Medicine, lists eight major therapeutic life changes that can reduce symptoms of depression and anxiety, increase physical health, and promote a sense of well-being. Many of them are also “neuroprotective,” meaning that they reduce the risk of age related cognitive losses. These eight are:

• Exercise
• Nutrition and Diet
• Time in nature
• Relationships
• Recreation
• Relaxation and stress management
• Religious and spiritual involvement
• Contribution and service to others

Increasingly, our lives have become more hectic. We are less closely connected to friends and family, cut off from nature, and have less time to cook fresh food, exercise, or cultivate our spiritual life through prayer, meditation, or contemplation. We may feel alienated from the religious practices of our childhood. Perhaps we’d like to be of service to others, but we don’t even know where to start in terms of volunteering. All of this has a direct impact on our self-esteem and our sense of well-being. We can end up feeling isolated and lonely in a big city.

These TLC’s are potent. Some of them are as powerful as medication, without the side effects. A study in the UK in 2007 at the University of Essex showed that 71% of participants reported a decrease in symptoms of depression with 30 minutes walks in nature five days a week. Many studies have shown that diets rich in a wide selection of fruits and vegetables (a “rainbow diet”) and rich in fish oils can ameliorate symptoms of depression and anxiety, while at the same time increasing the body’s immune system and protecting from cognitive loss as we age (for recommended nutritional supplements, see below).

Combining these TLC’s may actually potentiate them – for example, a hike in nature with a group of friends not only combines exercise, time in nature, relationships, recreation, and relaxation, but also may be more powerful than exercising alone. A weekend meditation retreat can combine stress management, spiritual involvement, and relationships.

I practice these TLC’s in my own life and stress them in my practice. It’s clear that self-esteem affects our experience in life. It’s now becoming clear that our experience of life affects our self-esteem, and I often check in with my clients about where they are in regard to these TLC’s and what their goals might be. In some cases, implementing TLC’s in ones life may provide relief and on-going support without medication. In other cases, medication may still be necessary and appropriate, but TLC’s can increase their potency and help offset the impact of potential side-effects. I’m happy to discuss challenges that might arise as you work to sustain these and help you develop resources to create healthy habits around them.

Nutritional Supplements

The following supplements are created by the Nutrametrix company specifically for healthcare practitioners with ingredients backed by scientific studies. You can order the products simply by clicking on the image of the product you want below. This will take you directly to the Nutrametrix website which will give you much more information on each product including a list of ingredients, benefits, the science behind the product, and faqs (which include important information on how, when, and when not to use these supplements). After testing the products myself and finding them effective, I have made them available to many of my clients who have found them effective in improving both physical and mental health.

OPC: OPC-3 A potent antioxidant that helps the body's own mechanism counteract the activity of stress hormones.

Omega 3s may be effective for mild symptoms of depression.

Tryptophan: an excellent, all-natural, non-addictive sleep aid that can also alleviate mild symptoms of depression and anxiety.

Bliss Anti-Stress Formula promotes relaxation without drowsiness, helps stabilize mood.

ACTs works specifically to promote healthy adrenal gland function, cortisol levels and thyroid function to help control stress levels and minimize weight gain that is associated with increased stress.

Great blog post sent to me by a friend recently on that feeling of emptiness within. Another example on trusting and working directly even with our most painful symptoms.

Anxiety results from this sense of groundlessness, so it’s important to ground ourselves during times of anxiety – like when you’re in between jobs or looking for a new one. Here are some suggestions on how to do that:

• First of all, recognize that anxiety is a natural part of the process. There is nothing “wrong” with being anxious when you’re looking for work anymore than there is something “wrong” with a performer feeling nervous before going out on stage. Just like actors use nervousness to enhance their performance on stage, we can use anxiety to remind us there is something in our life that needs our attention and to motivate ourselves to act.
• Exercise. Go for walks, bike rides, or runs. Play ball. Dance. Do yoga or martial arts.
• Be in nature as much as you can. Sit in a park, or by a stream, or in your back yard. Awaken your senses – look, smell, listen. Look up at vastness of the sky, and back down at the solidness of earth.
• Take good physical care of yourself: eat good food. Rest. Be cautious about the intake of caffeine and alcohol, since both increase anxiety.
• Be mindful – make lists of things that you need to get done, and keep to a schedule.
• Keep a notebook and pen by your bed. If you wake up in the middle of the night with anxious thoughts, right them down. This helps calm the mind.

If you are job hunting and currently unemployed, here are some further tips for handling anxiety:

• Get to know your public library. It’s free and full of good resources, from mysteries to take your mind off the anxiety to how-to-write-resume books when you’re ready to jump back in.
• Go where the people are – take a break from your home on a regular basis. Take a laptop to a café to search for jobs, work on your resume, or email contacts.
• Spend 15 minutes making a list of things you always said you’d do “if only I had the time.” Do them.
• Volunteer: not only will this give you a sense of purpose, it looks very good to prospective employers.
• Remember that ingesting vast amounts of information INCREASES anxiety – so monitor the time you spend watching tv and reading on the internet.

Great article in Slate about anxiety here in the US (the most anxious country in the world, as it turns out: “people in developing-world countries such as Nigeria are up to five times less likely to show clinically significant anxiety levels than Americans”). The article, written by Taylor Clark, whose upcoming book “Nerve: Poise Under Pressure, Serenity Under Stress, and the Brave New Science of Fear and Cool” will be published in March, posits three reasons for the anxiety that permeates our lives: first, lack of community, second, information overload, and third, a negative attitude towards, well, negative emotions. The good news? With intention (and attention), this is all manageable.

More good news? Washington DC does NOT rank amongst the 10 Most Stressed Out Cities in the US, according to an article in Forbes. Surprised? I was – pleasantly!

It’s official: mindfulness practice is effective at preventing episodes of depression. For those who choose not to use anti-depressant medication to prevent a relapse into depression, mindfulness practice (meditation) offers a viable alternative. This isn’t all that surprising. Meditation on a regular basis helps us work with the ups and downs of our lives; it increases our capacity to bring a sense of kindness to our experience, it helps us become more precise and increases our attention span, and can actually increase confidence in ourselves.

You can read the most recent study here.

In last week’s Washington Post, there’s an important article about job satisfaction in the federal government.   What makes for job satisfaction?  According to the article, “the primary factor in job satisfaction…remains effective leadership from senior agency bosses.”

Effective leadership provides workers with a clear mission, with clear expectations for meeting that mission, and for the necessary resources to meet the expectations.  Take any of those away, and burn out can follow.  This is as true in both the non-profit sector and business world as it is in the government.  It’s also true when you work for yourself – except in that case, you can’t blame your boss (or you can, but it might not work out so well!).

I would add a few other things for true job satisfaction:

• Interest: are you interested in what you do?  Do you share interests in those you work with?
• Personality fit: does your job fit your personality?  If you’re gregarious and out going, do you get enough time with others through out your workday?  If you’re an introvert, does your job provide you with private space necessary to re-energize?
• Values: does your work match your core values?
• Skill set (this one is often overlooked, so pay attention!): does your job enable you to use not just skills that you have, but rather skills that you want to be using?  I can type pretty fast – but I don’t necessarily want a job where fast typing is required.

Here’s the article – if you’re looking for work in the federal workforce, give it a read, then check out bestplacestowork.org, referenced in the article: Best Places to Work Rankings

A friend posted this video on her Facebook page and I really liked it.  Being alone is so hard – hard when you’re young and trying to figure out the whole relationship thing, hard when you’ve just been dumped because you haven’t quite figured out the whole relationship thing, hard when you want a family, aware of the biological clock but with no one on the horizon, and hard when, tragically, a loved one unexpectedly dies.

We spend a lot of time trying hard not to be alone, perhaps not to feel the pain of being alone.  Tanya Davis turns this logic on its head.  She suggests that the path away from the pain of being alone – is by embracing our aloneness.  And when we learn to be comfortable with ourselves, then the world can begin to open up to us.

You are, after all, the most important person for you to be in relationship with.

The cute guy you met Saturday night calls and cancels the date you had set up for the following Saturday. Sighing, you think to yourself “I will never have a boyfriend.”

The promotion your boss told you that you were in line for goes to another colleague. “I will never get anywhere,” you tell yourself.

“I look around and see nothing but happy people,” you say to a friend over coffee. “Why doesn’t anything good ever happen to me?”

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It is one of those paradoxes in life that a key ingredient for change is acceptance.  This can be somewhat frightening: why should we want to accept our depression, our anxiety, our bad relationship, our boring job?  Indeed, the reason most people show up for therapy is in fact to change something, not keep it the same, right?

Many people interpret the word “accept” to mean something that involves loss. There’s a definite sense that to accept inherently implies defeat – that accepting involves giving in to feeling worse.  On the one hand, this is quite reasonable – if one is depressed, even just admitting we are depressed can further open the floodgates of sadness. On the other hand, without acceptance change never happens.  Without acceptance, we’re just expending energy pushing something away, not actually changing it.

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