Resilience: How Do We Get It?

So what is resilience? We all want it, and we want to teach it to our children. But are there only a lucky few who inherit it?

Resilience is the ability to lead a healthy life, both physically and mentally, despite living through horrific circumstances, says Petros Levounis, M.D., M.A., chair of the Department of Psychiatry at Rutgers New Jersey Medical School. While there’s a genetic component, he said the thinking is changing around the idea that only some people are born with the ability to stay mentally strong in the face of war, natural disaster, rape, terrorism, chronic poverty and other traumas.

“Humans are far more resilient in general than we think, than we have assumed in the past,” Levounis said. “People who have been subjected to absolutely traumatic situations very frequently come out on other side and do quite well.”

There are some who may suffer more after a traumatic event -- people with depression or anxiety disorders are at a higher risk of developing posttraumatic stress disorder (PTSD). But PTSD is not the opposite of resilience, Levounis explained. “PTSD doesn’t mean you are weak. We now know that developing PTSD is associated with compassion and imagination and creativity.”

“Staying healthy both physically and mentally is paramount. Not only exercise and nutrition, which pretty much everybody knows, but also sleep hygiene. Sleep is the neglected stepchild of physical health. Keeping your mental health intact, your social life, your sexual life, your intellectual life, and for some your spiritual life—these build resilience,” Levounis said.

He added that parents who impart those healthy lifestyle habits to their kids will be helping their children be resilient, too.

By Mary Brophy Marcus, health writer, APA

Need a New Year’s Resolution? Try Exercise!

By Ahmed Raza Khan, MD, MPH
Follow@AhmedRazaKhanMD
Child and Adolescent Psychiatry Physician at Stanford University School of Medicine

Most people know that exercise is beneficial for cardiac health and is prescribed by physicians for the prevention and alleviation of various medical complications. But what if I told you exercise can also significantly benefit your mental health in more ways than one? Let’s take a look at some of the ways exercise can improve mental health and how to incorporate this into your new year’s resolution list!

Exercise and Depression Prevention:More than 350 million people in the world suffer from depression and it is the leading cause of disability worldwide.  Exercise has often been considered as a supplemental tool in treating depression, but recent evidence points to exercise playing a role in the prevention of future depressive episodes. These recent findings show that even low levels of physical activity (e.g., walking less than 150 minutes a week) can prevent future depression. There has been significant research in the last few years that links cardiovascular health’s role in the origin of depression. This would certainly be a plausible explanation for why exercise may prevent depression.

Alzheimer’s Disease Prevention:Alzheimer’s disease is a chronic, degenerative disease of the brain that affects over 25 million people in the world. This illness leads to a progressive mental decline, steering its victims to dependence on caregivers and, eventually, death. Amyloid plaques are abnormal clusters of protein fragments that are found in the brains of patients with Alzheimer’s disease and are thought to play a major role in its progression. Recent studies have found that people who exercised at or above the levels recommended by the American Heart Association had significantly lower numbers of amyloid plaques than those who exercised less. This was the case for even those who carried the APOE-e4 gene variant, which is an established risk factor for Alzheimer’s disease. When people with the APOE-e4 gene variant were compared, those with higher levels of exercise had lower levels of amyloid plaques.

Improving Cognitive Functioning:Exercise has been shown to increase cognitive functioning in rats. As rats get older, their memory tends to diminish and this appears to be due to a drop of nerve synapses in the hippocampus, the memory center of the brain. But after 12 weeks of voluntary running, both memory and hippocampus nerve synapses were restored in these rats.

Consistency in Exercise:Recent neuroscientific studies have shown that the cognitive benefit of exercise may have a window of time. In fact, rats that improved their cognitive functioning by exercise, had this improvement dissipate in 3-6 weeks of inactivity. This is similar to what is seen with muscle mass or heart rate when exercise is withdrawn. This evidence intimates that exercise is beneficial for the brain and should be performed consistently.

The American Heart Association is a great resource for planning the amount and type of exercise one needs. They recommend at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week for a total of 150 minutes or at least 25 minutes of vigorous aerobic activity 3 days a week for a total of 75 minutes. An easy target to remember: 30 minutes a day, 5 days a week.

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Is It Time For A Timeout? 4 Tips For Managing Your Anger

By Uyen-Khanh Quang-Dang, M.D., M.S., Resident Psychiatrist, UCSF School of Medicine &

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Emory University School of Medicine Follow @VahabzadehMD

When does anger become a problem?

Anger is an emotion that everyone experiences at some point in their life. Anger in and of itself is not a bad thing. Anger becomes a problem when the anger itself, or how we express the anger, causes problems in our lives. For example, anger can be felt too intensely, too frequently, or it can be expressed inappropriately, leading to harm to oneself or to others. Poorly managed anger can result in damage to our mental health, physical well-being, social relationships, and employment.

When we feel angry, the most important consideration is how we manage this emotion. In many cases, we may manage anger in a similar way to people around us. Many children learn how to deal with anger from observing their parents and other family members. The way that we respond to anger may also be as a result of what happens when we become angry; it may help us to get things that we want, thereby reinforcing our behavior. There are many practical strategies which may be adopted to help overcome problems with anger management. Here are four tips on how to deal with anger:

#1 Make a list of events or situations that trigger your anger. It can be a helpful perspective to notice that each of us get triggered by different things – while some of us may get outraged by an inconsiderate roommate who leaves dishes in the sink, others may instead fume while driving in congested traffic. Having a better awareness of triggering events will help you to better manage and possibly prevent your anger.

#2 Take a timeout. Timeouts aren’t just for kids – they are an essential anger management strategy that should be in everyone’s anger management “toolbox”. Basically, timeouts help us think instead of impulsively reacting in the heat of the moment. Timeout strategies can range from taking a few deep breaths and taking note of how your anger is experienced in your body, to leaving the situation that is causing the anger. You can have a pre-arranged agreement where any of the parties involved can call a timeout during an upsetting interaction and return to the conversation at a later point.

#3 Engage in Exercise! We all know that exercise is good for your physical health, but it’s also great for your mental and emotional health as well. Regular exercise can be an effective preventative anger management strategy. In addition to cardiovascular exercise, try yoga – either in live classes or through videos available on iPad apps and YouTube videos if live classes are too expensive.

#4 Use the A-B-C-D Model. The A-B-C-D Model (developed by Albert Ellis) helps us to change our underlying irrational beliefs that perpetuate our anger.

“A” stands for an activating event that triggers our anger.

“B” stands for our beliefs about the activating event. What do you tell yourself in reaction to the triggering event? What are your beliefs and expectations of others? For example, when a friend arrives late, you may tell yourself, “This friend is a bad friend. If he respected me, he wouldn’t be late. I can’t be friends with this person.”

“C” stands for consequences – emotional responses about the triggering event based on your self talk. For example, you may feel sadness or contempt.

“D” stands for dispute, where you examine your beliefs related to the event, identify any irrational beliefs, and dispute them with more rational or realistic ways of reacting to the activating event. The point of this model is to replace maladaptive self-statements that exacerbate anger with adaptive self-statements that reduce anger and help you have a more realistic reaction to the event.

While these tips may be helpful, you may need support from a counselor or mental health professional. Keep in mind that you don’t have to deal with anger all on your own. There are effective anger management therapies available in individual and group settings that can help you learn healthy ways of managing anger. 

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Too Much of a Good Thing: Exercise Addiction

By Claudia L. Reardon, M.D.

We all know it’s possible to have too much of a good thing. But can that apply to exercise too? Many people struggle to exercise even a small amount, so it might be hard to imagine that "exercise addiction" could be a problem. However, research shows that it can be, with one report estimating that 3% of the population could be addicted to exercise.

Some researchers suggest the following symptoms for "exercise addiction." These are some of the same symptoms of other addictions like alcoholism.

·    Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a “buzz”  or sense of accomplishment.

·    Withdrawal: in the absence of exercise, experiencing negative effects such as anxiety, irritability, restlessness, and sleep problems.

·    Lack of control: unsuccessfully attempting to reduce exercise amount or to stop exercising for a certain period of time.

·    Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount.

·    Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise.

·    Reduction in other activities: as a direct result of exercise, social, occupational, and/or recreational activities occur less often or are stopped.

·    Continuance: continuing to exercise despite knowing that this activity is creating or worsening physical, psychological, and/or relationship problems.

·    Behaviors and conditions that often occur together with "exercise addiction" are eating disorders, excessive use of substances such as caffeine to improve athletic performance, and "work addiction."

It's important to point out that not all people who exercise at an intense level have an addiction. For example, competitive athletes often need to spend significant time and energy to their sports. Also, many people may be highly committed to their exercise routines without experiencing the negative effects that go along with an addiction. 

Usually, exercise is a very healthy and positive behavior, and most people benefit from a regular exercise schedule. However, if you think you or someone close to you may be suffering from "exercise addiction," you should seek help from a doctor. Cognitive behavioral therapy may be used to bring a patient back to a normal exercise schedule.

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Living in the Moment with Mindfulness

By Brandon Cornejo M.D., Ph.D.

I hope your first week of 2012 was a good one! How are those New Year's resolutions going? If your goal is to exercise more, my "Mindfulness" two-part blog post should help you stay motivated. In part-one of my post, I discussed the concept of "mindfulness" or living in the moment.

Now I will share how you can use mindfulness to stay focused on a particular goal like exercising. Since exercise and mindfulness enhance mood, decrease stress, and improve negative thinking, these tips will benefit us all as we enjoy 2012!



Tips for staying in the present moment while exercising:

·         One of the most basic tools that you can use in mindfulness is your breathing. By focusing on the sensation of air traveling in and out of your body (just like you do during meditation), you can be grounded in the present moment.

·         You may also try a mantra to stay in the "now" (for example, runners often count out their footsteps – “1, 2, 3…1, 2, 3” – or a mountain biker or skier may constantly remind themselves to “relax”).

·         Applying either technique will keep you in the moment rather than thinking about negative thoughts and feelings that influence behavior in a non-productive fashion during your exercise.

·         Paying attention to physical feelings of your body and your surroundings as you exercise will prevent you from going into “automatic pilot” (when you act and react without conscious awareness).

·         By learning to stay present, you can accept physical discomfort as a temporary state that will soon pass.

·         As you continue your workout, you can “label” both positive and negative thoughts that occur while exercising. Labeling these thoughts will help you understand which thoughts and feelings are limiting your success and need to be changed.

Try out some of these tips and see how you start removing unwanted negative thoughts to overcome challenges that may have held you back in the past. Mindfulness matters when it comes to achieving that New Year's resolution this year.

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Keeping Your New Year's Resolution with Mindfulness

By Brandon Cornejo M.D., Ph.D.

How many of you are trying to get yourselves back into a regular gym and exercise routine for your New Year's resolution? When it comes to exercise, one of the biggest challenges is staying motivated and consistent. I hope I can help you with this two-part blog post on "Mindfulness."

What is Mindfulness?

• Mindfulness is a nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted.

Mindfulness as a Therapeutic Approach

• Mindfulness based stress reduction means to focus your attention on the "now."

• People practicing mindfulness work on not judging or evaluating the present moment but focus on simply “being” present.

• People in a formal mindfulness class engage in daily meditation along with skill-building homework that ties them to the “here and now.” 

 How Does Mindfulness Work?

• Mindfulness allows a person to pause calmly and reflectively before reacting to things.

• Mindfulness may prevent relapse of clinical depression by allowing a person to have some “space” between who they are and their emotions.

• Mindfulness based cognitive therapy (MBCT), a form of therapy that combines elements of mindfulness with cognitive based approaches to treatment, can be an effective approach for the treatment of anxiety or depressive disorders.

• Mindfulness may enhance mood as well as help eliminate negative thoughts associated with depressive states.

So why is "mindfulness" important to keeping that New Year's resolution of daily exercise? Next week, I will post part two with my tips for staying in the present moment while exercising. Happy New Year's!

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Female Athlete Triad: Sport Gone Bad

By Claudia L. Reardon, M.D.

Psychiatrists encourage nearly everyone to participate in sports and exercise. Sports not only improve physical health but also can greatly improve mental well-being. However, if girls and women take involvement in sports too far, they can suffer a well-described triad of symptoms. The so-called female athlete triad consists of the following three inter-linked health problems:

1. Insufficient caloric intake/disordered eating
2. Menstrual problems
3. Weak bones

Girls and women who participate in “leanness sports” that emphasize thinness (running, ballet, gymnastics, figure skating, and others) are particularly at risk. If they receive the message that being thinner could result in greater athletic success, they may try to cut down on their caloric intake to levels too low to support their levels of physical activity. This can result in full-blown eating disorders, irregular menstrual cycles, and weak bones (including osteoporosis at young ages).

Some common myths about the female athlete triad include the following:

• If an athlete’s performance has not started suffering, then she must not have a problem. FACT:  Even if an athlete’s performance has not started suffering, it eventually will.  Not taking in enough calories to match activity level is not sustainable in the long-run.
• It is normal for female athletes to stop menstruating. FACT:  It is never normal for a female athlete to stop menstruating. There are serious health risks, especially bone loss, to not menstruating. Studies show that after three years of not menstruating, bone loss is likely to be permanent. Loss of future reproductive function could also occur.
• If an athlete is not eating enough to match activity level, she is aware of what she's doing. FACT: Denial is powerful. Athletes will very often feel that they are being as healthy as possible, and that meticulous attention to diet is a sign of dedication to sport. Coaches, parents, and professionals will need to help the athlete see the problems with the behaviors.
• An athlete who eats “healthy," is a top performer on the team, and excels in class is unlikely to have an eating disorder. FACT: Traits that are desirable in an athlete can make them more at risk of developing an eating disorder. Mental toughness, pursuit of excellence, performance despite pain, commitment to training, and being a team player are very similar to excessive exercise, perfectionism, denial of discomfort, and being self-less.

What can you do if someone you know might be suffering from the female athlete triad?

1. Share your concerns with the athlete.
2. Talk with the coach, athletic trainer, or school counselor.
3. Encourage the athlete to see a physician and dietitian. Not all health care professionals are familiar with the details of the female athlete triad; to help them out, you can send along this brochure with the athlete to the appointment.

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Live Longer by Making Mental Wellness Your Mission

By Felicia Wong, M.D.

September is National Recovery Month and SAMHSA's National Wellness Week (Sept. 17-23), a time to remind us why "wellness" is so important to our overall health. Did you know, people with mental and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions?

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. In a past blog post, I identified coping tools for dealing with stress and boosting your overall well-being. Here are "Top 8 Tips for Mental Wellness." I hope you will take another look and share with your loved ones this week. 

1) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

2) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

3) Stay Positive. Positive emotions can boost your ability to bounce back from stress.

4) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

7) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

8) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

Which tips on this list are missing in your life? Today is the perfect time to take action! Your wellness matters. 

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Make Mental Health Your Priority Every Month

By Felicia Wong, M.D

As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority.  Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. 

These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being.  Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .  

1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.

2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.

3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.

7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine.  For more information, go to http://www.liveyourlifewell.org/ . 
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Why Women Must Exercise for Mental Health

By Claudia Reardon, M.D.

Exercise has mental health benefits for men and women of all ages.  However, there are unique factors to consider in thinking about the mental health benefits of exercise for women in particular.  Compared to men, women have a two-fold increased prevalence of major depression throughout their reproductive life cycle.  Exercise can be a very useful treatment for depression in women at any of a number of different times in their lives:   

• During pregnancy and breastfeeding:  Depression is highly prevalent in women of childbearing age.  Medications are often necessary to treat moderate to severe depression.  However, many women wish to avoid treatment with medications during pregnancy and while breastfeeding.  At least one study has shown that women who exercised regularly reported less depression in the first and second trimesters compared with women who did not exercise.  The American College of Obstetricians and Gynecologists has recommended 30 minutes of moderate exercise on most days.

• During the postpartum period:  Exercise can also help to treat and prevent postpartum depression.  One study has shown that postpartum women who exercised three times per week had less depression than postpartum women who did not exercise. 

• During the premenstrual period:  Exercise can be useful to treat physical and emotional premenstrual symptoms.  It is less clear if exercise by itself can treat the most severe of premenstrual syndromes (called “premenstrual dysphoric disorder”), but it is still a first-line treatment strategy that most physicians would recommend. 

• During menopause:  Several studies have shown that aerobic exercise can improve both depression and insomnia occurring during menopause.  Additionally, lower intensity exercise such as yoga has been shown to improve psychological well-being in menopausal women.

Importantly, women may experience barriers to exercise.  Here are some examples of these barriers, and strategies to help address them:

• Childcare issues:  Women are often responsible for childcare, which makes it difficult for them to find opportunities to exercise.  Gyms that offer childcare services can be helpful.  Also, partners can share the workload. 

• Intimidation:  Some women may feel uncomfortable working out in the coed environment of a gym.  Consider taking women-only exercise classes, or walking or doing other exercise with women exercise buddies.

• Self-consciousness about appearance:  If a woman is already uncomfortable about her appearance, then she might worry that she’s drawing even more attention to her body by exercising, especially if wearing skimpy sports clothes.  One strategy is to try walking, which can be done almost anywhere and in almost any type of clothing.

• Guilt:  Women, especially those who are family caretakers, sometimes describe feeling guilty about taking time for themselves to exercise.  Remember, it is not a selfish thing to exercise.  You are taking time to improve your physical and emotional health, which will allow you to more effectively be there for others.  Besides, you deserve to experience the benefits of exercise!   

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Athletes Suffer from Depression Too

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.

Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:

1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.

3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.

4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.

5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.
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"Green Exercise" 5 minutes a day for better mental health!

by Felicia K. Wong, M.D.

Researchers from the University of Essex found that as little as five minutes of a "green activity" can boost mood and self esteem. Jules Pretty and Jo Barton, who led this study, looked at data from 1,252 people of different ages, genders and mental health status taken from 10 existing studies in Britain.

They analyzed "green activities" such as walking, gardening, cycling, fishing, boating, horse-riding and farming. They found that the greatest health changes occurred in the young and the mentally ill, although people of all ages and social groups benefited.

All natural environments were beneficial, including parks in towns or cities, they said, but green areas with water appeared to have a more positive effect.

Dr. Wong enjoying a spring stroll through the Portland Japanese Garden

Portland Japanese Garden

 
 
 


May is Mental Health month and these are all great activities to do during May and throughout the year!

Healthy Eating

by Felicia K. Wong, M.D.

In my previous blog post, I brought up the importance of exercise as an effective treatment for depression. Today, I’d like to focus on another aspect of lifestyle that you can control to improve how you feel about yourself:

Healthy Eating.

Psychiatric medications and mental illness can pose a double threat to maintaining healthy weight. A common challenge faced by people with mental illness is weight gain. Some psychiatric medications can stimulate appetite and lead to overeating. Others cause sedation, decreasing your energy expenditure and calories burned. Mood disorders have been shown to create carbohydrate cravings because carbs increase serotonin, a chemical that makes us feel better. Eating too many carb-rich foods can lead to repetitive episodes of weight gain or failure to succeed on weight loss regimens.

For people with mental illness, proper nutrition is extremely important to overall health. Weight gain is not only detrimental to emotional health, as it can lead to poor self-esteem and worsening depression - it can also be physically dangerous, increasing the risk for many medical problems including diabetes, heart disease, osteoarthritis, hypertension and gallbladder disease.

Here are some basic tips to jumpstart a healthier diet and promote weight loss:

1. Read the food label.

2. Pay attention to portion size.

3. Eat slowly to give the stomach time to signal the brain when it's full.

4. Eat more frequent small meals and snacks to lower insulin levels, reducing the production of body fat.

5. Differentiate between stomach and psychological hunger. Try not to soothe your negative feelings with food.

6. Reduce fast food intake.

7. Minimize soft drinks with sugar and other high calorie beverages.
8. Eat more fruits, whole grain, vegetables, lean meat, fish, and poultry.

9. Prepare food by broiling or baking more often instead of frying.

10. Keep food/activity diaries.

Start the New Year out with a resolution to eat healthier and lose weight!