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.

• 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.

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!

You can read the most recent study here.

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

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 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?”

Its not just the telling ourselves that nothing good ever happens to us, but often these types of events bring up strong, uncomfortable feelings of real loss. We don’t just roll our eyes and say to ourselves “Oh I will NEVER get a date…,” we actually, genuinely, feel that way. The logic is incontrovertible: we have yet to have a relationship, this guy is ignoring us, we’re getting older, therefore…we are most likely headed to a life of loneliness. All the work we have done on ourselves (or for our career, whatever…) is futile. FEELS futile. From every possible angle of looking at it, actually IS futile.

I call this particular pattern of thinking and the accompanying feelings of hurt and loss “jumping to the loss.” We take one look at a disappointing situation, and the next thing we do is jump down into an uncomfortable pit with steep sides and quite likely something smelly at the bottom. Rationally, we know we’re not in a pit – but unfortunately, that doesn’t seem to help. The felt body/mind experience is in fact that of REALLY being in a deep, dark pit.

Jumping to the loss really can interfere with genuine progress. Jumping to the loss after not getting that job promotion could very well lead to not recognizing the next opportunity that rolls around. Giving up on that boy who didn’t call you back sets you up for not being open to his legitimate excuse (ok, if there is one!).

So what to do? During experiences of jumping to the loss, the traditional therapy dictum of “getting in touch with your feelings” doesn’t really help. The feelings are TOO real. At this point, you need to get out of them. Here are some techniques for getting out of that exaggerated sense of loss:

~ Remind yourself of past times when you have felt this way, and then ALSO remind yourself of the times that you have felt better. For example, it really is good to remember the painful nights of not sleeping after that guy dumped you – and then, just as importantly, remember the month after when you couldn’t remember his name.

~ Get out of your head. So often, jumping to the loss is a result of getting caught up in our head with our own story lines. “I should NEVER have done this. I was so stupid to get my hopes up. What the hell was I thinking?” Don’t go there – it’s not worth it. Drop out of your head and check in with your body – what does it feel? How is your chest? Your neck and shoulders? Your tummy?

~ Do something generative. Call a friend, update your profile on Match.com, or re-do your resume. Knit something. Cook a meal. Take a hike. These simple generative acts often sooth those strong feelings that nothing good will ever happen.

~ Finally, recognize this for the pattern that it is. It has a beginning, a middle, and an end. It will go away on its own naturally if we don’t hold on to the negative feelings. Really. It will go away.

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.

Acceptance does not mean giving up.  It is much more dynamic than that.  It involves precision, clarity, courage – the willingness to look honestly at what is.  Acceptance is active, and in that sense, provides momentum for change to happen. The precision, clarity, and courage of acceptance, actually empowers us to make change happen, but first we have to do the work necessary to accept our current reality exactly as it is—without denial, exaggeration or hesitation.

Let me give an example.  If you wanted to cross a busy street (and stay alive), you first would stand on the sidewalk, watching, waiting, and seeing what the traffic patterns are, where the crosswalk is, and what the signals say.  When the traffic has cleared or come to a stop, then you cross safely to the other side.

Acceptance is that first piece – waiting, looking, seeing what the traffic patterns are, putting together a strategy to get to the other side of the street without getting hit by a taxi cab or a hockey mom.  Acceptance is NOT going out into the middle of the road, lying down and saying, “Go ahead, traffic.  You might as well run over me.”  That’s something very different from acceptance.  Nor is acceptance refusing to stop at the curb, rushing blindly out into the road, praying to your Higher Power to keep you safe while you madly dodge the oncoming cars and truck and busses.

Acceptance may appear to involve some sense of loss: “I want to cross the street right now but I have to wait until the traffic stops,” or, “I want to get over this failed relationship but to do so I have to admit that I’m alone again.”  Pushing away the alone-ness doesn’t actually help.  Looking at the alone-ness, accepting the alone-ness, provides the very ground whereupon change can take place.  It focuses our energy on the one spot where change can really begin to effect change—the present moment and our life as it truly is right now.

Pema Chodron puts this very well in her book The Places that Scare You (Shambhala Classics, 2002):

“Does not trying to change mean we have to remain angry and addicted until the day we die?  This is a reasonable question.  Trying to change ourselves doesn’t work in the long run because we’re resisting our own energy.  Self-improvement can have temporary results, but lasting transformation occurs only when we honor ourselves as the source of wisdom and compassion.  Right here in what we’d like to throw away, in what we find repulsive and frightening, we discover the warmth and clarity of awakened heart.”   p. 24, The Places that Scare You, by Pema Chodron

One of the most interesting things that I’ve noticed in the years I’ve been doing therapy is how each of us has a tendency to recreate that which we are trying to avoid altogether. In trying to avoid what we fear, we back into it, and find our actions have somehow recreated the very scenario we were trying to avoid. Like a bad dream, we see our fear up ahead on the road, and start backing away from it, only to back right into it:

• People with addictions are sometimes so terrified of being thought of as an addict that they won’t seek treatment – and the addiction grows
• Someone who is unhappily employed may be afraid of not being able to find a satisfying job – so they stay in their current position, dissatisfied.
• A person afraid of their angry feelings vows to be peaceful at any cost, and ends up seething with resentment.

Backing away from fear doesn’t seem to work. Standing still doesn’t seem to work either. Fear grows in proportion to how much energy we put into ignoring it. The more we side step our fear, the more it grows, and as it grows, so does our desire to ignore it until – wham! – we back right into it, and can no longer avoid it.

Counseling is an opportunity to slowly move towards the fear, to explore it, to develop a healthy curiosity about it. Just as ignoring fear somehow gives the fear energy, moving towards the fear eventually leads to a lessening of its power over us, and confidence – fearlessness – begins to grow. Not only does the fear dissipate, we may actually discover that underneath it there is wisdom.