How Stress Changes Your Genes: The PIECES Method for Functional Health

Foreign I'd like to welcome everybody to today's presentation on the pieces method an introduction to functional mental health and epigenetics. I'm your host, Dr. Donnelly Snipes. Today we're going to define functional mental health and epigenetics. We'll discuss why a whole person approach is necessary for maximal recovery from anything, whether it's mental health, substance abuse, even physical health issues. And we'll briefly explore the bidirectional interactions between the pieces Dimensions Physical Interpersonal, Emotional, Cognitive, Environmental and spiritual. So I just want to start out with the first couple of slides having you really think about this mind body connection when you're well rested, nourished and healthy. So physically you're chugging along. How does it impact you physically? Well for me when all those things are happening I have more energy, I'm sleeping better which are all good and generally I tend to have less pain. Now that's not necessarily true. If we've got a cold front coming in, my arthritis may flare a little bit. But over overall I tend to have more energy and sleep better. In my relationships I tend to have more energy to spend with people and more patience when I am spending time with them. Because I'm not already stressed out, I'm not already triggering that HPA axis. Emotionally I tend to be happier you when I don't have physiological causes or interpersonal causes of for triggering that stress response I tend to be much more easygoing. Mentally I'm clearer headed if I'm getting better sleep. If I have good energy I tend to be more flexible in problem solving I tend to be more again less brain fog. It's all good. Environmentally when I'm well rested, nourished and healthy I keep my environment cleaner. Let's just just call it what it is. Our outside often reflects our inside. And when I start feeling exhausted, overwhelmed, depressed, anxious, my attention and my energy are going other places not to straightening my environment. So my environment tends to be cleaner when I'm doing well and just the tension the energy levels in my environment tend to feel feel a lot lower when I am and negative energy levels tend to feel a lot lower in my environment and spiritually when I am chugging along on all cylinders I feel connected. I feel like there's meaning to what I'm doing and I've got a purpose again and we're not going to belabor each one of these but I want you to think again about when you're feeling supported and loved. So interpersonally when you when that domain is Going well. Even if physically you're not sleeping too good or you know, you've got a little bit of pain or a lot of bit of pain. But if you're feeling supported and loved, how does that impact you physically? Does that help you relax a little bit? Does that help you sleep better? Does do these people that are supporting you help you get stuff done to free up energy? When you're feeling supported and loved, how does it impact you emotionally? How does it impact you cognitively? Like your attitude about others and the way you view the world. Remember, we have reality, whatever that is, and then we have our perception of what's going on. And when we are in fight or flight, we notice the negative. We view the world through a stress informed lens. When we're feeling supported, safe, loved, and hopefully somewhat energetic, we tend to view the world through a much clearer lens. Environmentally, I like having people around when I'm feeling supported and loved, I like having people around to socialize with. Now I'm an extrovert, so, you know, and spiritually again, I feel more connected to others. When I feel like there are others who are supportive of me even if they don't agree with me, but they're supportive of me and they're like, hey, you know, I see where you're coming from. Don't necessarily, just don't necessarily agree with you, but keep on chugging. You know, I see that you've got a purpose in your life that helps me feel more connected to myself and to the world. When you're optimistic, attentive and mentally flexible. So this is the cognitive domain. How does it impact you physically? Oh my gosh. And I want us all to think about this and I skipped over an emotionally because I didn't want to spend the entire presentation going through these. But when we are optimistic, when we're feeling safe and empowered and we, we actually our fight or flight is not triggered. So we're using our wise mind, we're able to pay attention, we're able to use our executive functioning and be mentally flexible. How does that impact you physically? And you're like, huh? Physically. When you are not mentally stressed, when you are not overburdened cognitively or in this negative mental space, it tends to reduce the stress response. So you don't have that HPA axis kicking off. You don't have all those stress hormones surging through your body. It improves your circadian rhythms. It changes for the better. Your gut microbiome. A lot of people feel a lot more energy. It takes a lot of Energy to be pessimistic, to feel negative. So there are a lot of physical changes that. And benefits to. To paying attention to what's going on with us cognitively. And there was a research study, we'll get to it in a few minutes, that actually showed that people who engaged in 12 weeks of cognitive behavioral therapy and found it beneficial, obviously those that didn't found it, find it beneficial, didn't have the impacts. But those who found it beneficial showed positive epigenetic changes, positive changes in which genes were being expressed and which switches were being turned on. You'll understand more about that later. But I thought it was fascinating that they've actually been able to show that by adjusting or addressing our mental health, it impacts our entire body. And likewise for people who have a lot of physiological stress, by reducing that physical stress, by reducing some of that pain and inflammation, it alters people's mental health. It's a fascinating system. Functional mental health, I guess that's the buzzword that we're calling it now, at its simplest, evaluates how functioning in all pieces of life impact epigenetics, impact which systems in your body are active, if you will, how it impacts health, mental health, and vice versa. So all of these things play a role. Unhealthy behaviors and poor health are going to alter your epigenetics because as stress increases, it turns on different systems in your body. When your mental health is poor, you're going to see the same thing. You're going to see different. Different things activated, different systems activated in your body than are activated when you are in good mental health, optimistic, feeling safe and empowered and all that stuff. There is a strong emphasis on understanding the bidirectional interaction between stress in any of the pieces of life. Now, remember, physical stress, maybe pain, is going to impact you in other ways physically, like increasing your stress response and increasing inflammation, possibly disrupting circadian rhythms. So problems or good things in any one of the dimensions is going to affect every dimension, including its own dimension. So let's talk about epigenetics. I've said it a couple of times, but some of you are going to. Yeah, might as well be speaking Greek. Epigenetics is the study of how each of the pieces of life, physical, interpersonal, emotional, cognitive, environmental and spiritual, impact our genes without altering our DNA and therefore shape our health and mental health. Through what many people are now starting to call biohacking, we understand how to modify various things in each of the pieces of life to turn on the good genes and turn off, or at least Dim or silent quiet. The bad genes and when we, when I'm talking about bad genes, that's kind of oversimplified. Inflammatory genes when they are turned on for a short period to help you heal from something great system works well. When the inflammation switch gets stuck in the on position and inflammation is just persistent and systemic, that's bad. We have genes that are called oncogenes or cancer genes and those can get flipped on under certain circumstances. So we need to recognize what may be going on in our body. All of us have DNA, we've all heard about DNA and rna, we're focusing on DNA today. That is our bodies main standard operating procedures if you will. Just because you have a gene for something doesn't mean you will develop that trait or problem. So if you have a dream, a gene for schizophrenia, okay you have it. But if it never turns on, then you're never going to develop schizophrenia. Interesting. However, there are ways to adjust things so we can, for some things that turn on, we can quiet them. We may not be able to turn them completely off. We haven't found a way to turn the schizophrenia gene off once somebody has their psychotic break, but we've found a way to quiet it somewhat. Think of your DNA and there's, you have lots of genes, hundreds, thousands of genes. Think of DNA like a control panel and each gene is a switch. Now most everything in our body isn't controlled by just one gene unfortunately. Because that would make it so much easier. No, no, they're controlled by multiple genes and just like the rest of your body they work sort of in a sequence. You have a gene called your MTHFR gene that actually helps control methylation or the process of turning on and off the genes. So if your MTHFR gene is not working well, then your body's going to have trouble turning on and off the system. Maybe that's working well, but then another gene gets activated and we have a lot of genes that work together to either complement or inhibit each other. When you're at optimum health, a certain set of your DNA switches is turned on and you're just buzzing along. When you're under stress, different switches are activated, inflammation may increase and the balance of all things changes. And we've talked so many times in other videos about how uncontrolled stress or persistent stress causes systemic inflammation. And it causes that some of those inflammation switches to get stuck in the on position and some of those anti inflammatory switches to not get turned on at all. Well that sucks. So it's kind Of a double whammy. Think about children with aces. We've seen research over the past 10, 15 years that's shown that children who are exposed to adverse experience experiences in childhood show a much greater propensity for developing mental health as well as physical health problems later in life. And it's almost a proportional thing. The more adverse experiences they had, the worse their physical and mental health tends to be later. And a lot of that can be explained through epigenetics, through genetic changes that occur, switches that get turned on and never turned off. For a lot of people, when you think about adverse childhood experiences, some of that, if not a lot of it, had to do with interpersonal stress and maybe attachment trauma, abandonment trauma, trauma, trauma. But it has to do with what's going on with other people. And a lot of times the child doesn't regain or ever gain a sense of safety and empowerment. So they are constantly under some low level of stress because they're hyper vigilant. They're not able to relax, which means their stress genes stay turned on all the time, and the rest and repair genes don't get turned on as much. For children who experience ACEs, think about how insecurity, attachment, trauma, or abuse lead to inflammation. And think about maslow's hierarchy. You have your biological needs, you have your safety needs, and then you have your love and belonging needs. And for children who experienced ACEs, a lot of times, they didn't have any of those. So the entire foundation of their psychological pyramid, if you will, was not there or, or weak at best. All of this causes stress. And as adults, we may be able to look back and go, oh, you know, it was more stable than I felt like it was. Well, we have to look at the world through that child's eyes. How did that child feel when they were five years old and this was going on? Had to be terrifying. Constantly terrifying. A lot. A lot of the things that are associated with ACEs are associated with chaos and instability and unpredictability. So how do you expect a child to feel safe? In general, a process called methylation is what the body uses to turn these switches on and off. That's where that mthfr gene comes in. Typically, methylation is thought to turn off genes. Inadequate methylation leads to hyperactive genes. So if the methylation is working well and your mthfr genes are doing their job and all of his buddies we'll see in a few minutes are doing their job, then the methylation is available. But when any of those are broken down, then there can be Inadequate methylation which can lead to hyperactive genes. Now they found a lot of children who experience prenatal stress actually have polymorphisms or changes in their MTHFR gene which makes it less effective at methylating the DNA. Over methylation often leads to inadequate gene expression. So sometimes we can silence too much what's going on. For example, inadequate methylation of IL6 and TNF and you don't need to remember these, I'm just kind of giving you examples of different genes. So inadequate methylation of the genes IL6 and TNF increases inflammation. So these are your inflammatory cytokines. TNF actually stands for tumor necrosis factor. Excessive myelation of IL10 and IL37 suppresses. These are both anti inflammatory genes. So when they are over methylated they're not going to turn on to try to combat the TNF and the IL6. So you see it kind of parting the sea if you will. One gets turned on too much and the other one gets sort of suffocated. Think about our nervous system. When the stress response is too active for too long, we develop sympathetic dominance. It becomes too strong. So the parasympathetic nervous system has difficulty counteracting it. Well part of what's going on under the hood is these genes are at work and the genes that are going to help trigger the parasympathetic stuff, they are not able to. To get activated. Certain nutrients are necessary to make the methyl group. A methyl group is added to or removed from genes to alter the expression. So if people have inadequate nutrition, it's a stressor. You've heard me say it before, you're going to hear me say it again, probably from now until the cows come home. But if we're not taking in the basic nutrients that our body needs, then it can't break them down to make what? Hormones and neurotransmitters and methyl groups in order to help regulate that DNA. However, genes like the MTHFR are required to tell the body to convert those nutrients to a methyl group. So if and, and whenever I see it, and forgive me, I, um, When, when I see mthfr it just looks like an abbreviation for a phrase that starts with mother and you know what it ends with. But it's kind of fitting in some ways because if this doesn't, if this system's not working well, the whole system's kind of screwed. So it can be a real pain in the hiney when it's not working well. If the MTHFR functions inadequately, it's like the manager whispering instructions so everybody in the factory, they can't hear them, he's telling them, but nobody can hear. So nobody knows what they're supposed to do. But mthfr, if you're going to start studying epigenetics, this is one of the genes that you need to really remember, which is why I shared that little anecdote with you, because it makes it easier to remember that if this guy ain't doing his job, nobody can do their job. If the methylation system is working well, then it orders the other genes on and off. When the genes are in the on position too long they can get stuck, which causes downstream changes in the nervous system. That's when you start seeing the glucocorticoid resistance. For example, when cortisol is coming out too, too much, too often, that cortisol release gene is turned on. Then the body starts saying okay, you're flooding me, I can't deal with this. So you start seeing the loss or deactivation of cortisol receptors. So even though the body's producing a lot of cortisol, very little of it is actually being used because the body has pruned back the receptors. Generally the genes that get stuck in the on position, unfortunately are those activated by stress. I'd love to say all the relaxation genes can get stuck in the on position. I don't think anybody complain about that. But it is important to understand that the stress genes, when they're stuck in the on position, part of the group of genes that are activated are going to be some of the inflammatory genes. Again you don't need to know each of these genes. I just wanted to give you an introduction to some of the genes that are involved in mental health. And these genes you can see nr3, c1 and fkbp5 and pomc, crh, they're all involved in regulating the HPA axis and in different ways. The interesting thing I want you to note though is under what stressors will alter them, it says general. What does that mean? That means stress. In any piece of life, anything that triggers that HPA axis is going to alter the expression of that gene. Which is why it's so important to not think of people or treat people from the perspective of let me help you change your thinking or let me change help you change how you're feeling about things and everything will be ducky. Well not really because if physiologically they are experiencing stress, interpersonally, environmental toxins, etc. Then the system is going to somewhat stay stuck in that on position and those HPA axis genes are going to be more active. Then you've got three more for serotonin synthesis. Then you've got dopamine and monoamine. That's your neurotransmitters in general. Then more dopamine down here, norepinephrine. So you've got a group of genes that help regulate your dopamine, which is your perseverance as well as partially your reward chemical. When we do things, we persevere to do things and it produces positive results. We get a hit of endorphins, our endogenous opioids, and we go, ooh, I want to do that again. Dopamine also shows up to help us persevere to run away from the hungry lion. So it's not just a reward chemical, it's a keep doing that or I want to do that again neurochemical. It's a motivation chemical. But it's interesting to note that all of these things are interrelated. And remember we've always talked before about your neurotransmitters and how if one's altered, all the rest of them are going to change. It alters the entire buddy group, if you will. But again, all of these genes can be altered. Their expression can be altered by any, any type of stressor, not just cognitive or mental stress. BDNF is another one we're going to talk about in the future, probably ad nauseam. And it's involved in neuroplasticity. It helps us with memory and learning and healing in a lot of ways. OXTR is your oxytocin system. So if this gene is malfunctioning and stuck in the off position, then we have less bonding, we have potentially social withdrawal, we have more inflammation because oxytocin is a really strong anti inflammatory. Then you have gaba, glutamate, acetylcholine. So you have all of your neurotransmitters and this is not all of the genes by any means, but these are the big ends. Then you have your clock and your PUR genes. I don't know why it's PR1, PR2, purr and cry. But clock gene makes a lot of sense. You can easily remember that, that it's your circadian rhythm, but it's not the only one because you have per one, two and cry, cry one that are all involved in your circadian rhythms. Circadian rhythms are al. AL are altered by general stress. Yes, we know that, but they're also altered by circadian disruption, so more so than other genes. If your circadian rhythm starts to get off, then your clock gene is, its expression is going to be altered. Then MTRR hangs out with MTHFR in the methylation cycle. IL6 and TNF? A are involved in immunity and inflammation, as in, as is NFKB1. Your thyroid system has multiple genes. Here's MTHFR and BHMT. It's another one that's involved in the methylation cycle, specifically in the liver. So people who have liver disease may not have their B H M T gene may not be working as well. We need to recognize as people age, their kidneys and their livers don't work as well. It's just a fact of life. It's not that they've got liver disease or something. It's just a fact of life. The body has more difficulty clearing medications. Just a fact of life. Now people who have a history of substance abuse or hepatitis C, they tend to have more difficulty because their liver is basically injured. And people who have fatty liver Disease and then DNMT 1 and 3A are also involved in methylation and epigenetic regulation, telling, sending the signal out which switches should be turned on and off. And again, you're not, I'm not expecting you to memorize all those, but I want you to get fascinated. That's my goal. I want you to get fascinated about how all of these switches work together to make something happen. Okay, so let's go back and put this all together. Physical aspects and, and epigenetics. What causes stress in one's physical body, physical life that can alter your epigenetic expression? Circadian rhythm disruption. How many of our clients have poor sleep and probably poor circadian rhythms? They don't have that 24 hour cycle. Maybe they're on shift work. Maybe they've got a new baby at home. Maybe they just stay up too playing video games or watching porn or whatever they're doing. But that is going to add stress to the body. We need to spend more time focusing on some of the basics. Now we can't prescribe anything, we can't prescribe a diet. But we do need to educate people. Why 7 to 9 hours of sleep is important at roughly the same time each day. We need to educate them about what their circadian rhythms do. And I know, big surprise, I've got a video on it on circadian rhythms alone on the YouTube channel if you want to learn more about that. But circadian rhythms control everything. Did you know circadian rhythms control when your blood, you, when your body Uses glucose best. Your body is more sensitive to insulin in the morning and early afternoon than at night. Likewise, your body produces more saliva in the morning and early afternoon because saliva helps break down food. So along with everything else it controls, it even controls your saliva. Oh, my gosh. And you know, some of us are glad that controls saliva at night so we're not drooling on our pillow and whatever. But circadian rhythms are really important for regulating hormones, neurotransmitters, stress in the body, circadian. When people get adequate quality sleep and circadian rhythms help the body know when it's time to release melatonin. Because cortisol is low, serotonin is low because melatonin is being made to help us get to sleep. When we're asleep, we rest and repair and clear out the adenosine and clear, clear out the oxidative stress, which if left in place, will cause inflammation, brain fog, confusion, all kinds of stuff the next day. Nutrition, got to give it the right building blocks and hydration. If our body doesn't have water, it's less effective at flushing all this crap out and it's less effective at sending signals through the nervous system. Blood sugar, insulin regulation. If you have, if your blood sugar's all over the place, that's stressful. And I know some of these things, you're going, well, yeah, no, duh. Your gut health. When your microbiome is in bad shape or activated for stress, because we have a certain crew, if you will, that populates our microbiome under stress and a certain crew that populates it when we are not stressed. And if the stress crew stays there for too long, then it starts to proliferate and it's more difficult for the relaxation group to come in and kick them out. So it is important to pay attention to our microbiome. Leaky gut. When we get stressed and when serotonin goes down, especially the mucus coating of the intestines becomes thinner and the junctions between the cells in the intestinal wall become looser. So it's easier for toxins to leak into our system that's inflammatory. You know, you can figure toxins in the system is going to be inflammatory. Oral health, your mouth not too far from your brain. But if you have somebody who has a lot of oral health problems, they may not be chewing their food well enough. They may not be eating a good diet because it's hard to chew. If they've got mouth pain and if they've got open sores, from anything from brushing their teeth to eating Something that's too hot and getting a really bad burn. I don't know. The bacteria from the mouth can migrate into the system and contribute to systemic inflammation. And I just did a presentation that is going to be released in the next couple of weeks. I'm going to gradually trickle those out. It was a six hour workshop on healthy aging but we did an entire section on oral health because it's that important. Autonomic nervous system balance. If your stress response is in overdrive, if it's too strong and your parasympathetic nervous system, your vagus nerve can't balance it out, then you're going to probably stay clicked in the on position most of the time. We can help people learn how to regulate their autonomic nervous system, strengthen their vagal tone. Basic breathing. Box breathing can be helpful. They don't like box breathing. Singing loudly. They don't like singing loudly. Have them blow bubbles. There are a lot of different things they can do that will slow their breathing and when they do that it slows their heart rate and triggers the relaxation response. But for a lot of people, because they've been stuck in the stress position for so long, they have to learn to manually override that stress response and actively work to bring their heart rate down. High intensity interval training is great. Most people don't want to do that. So that's not something that I regularly recommend. I find it is imperative. Pain is stressful. Pain is generally associated with inflammation. We want to bring it down. Some people can't get rid of their pain. It's not going to completely go away. We realize this. However, helping people live in the and recognize they can live their rich and meaningful life and have some level of pain. Help them develop cognitive tools in addition to physical and environmental tools to manage that pain. Ergonomics is an environmental tool. Physical tools can be massage, ice, heat. Maybe you consider those environmental. I don't know. Working with a physical therapist. Gentle movement under the advice of a physical therapist. There are a lot of non medication things that we can do to help people manage their pain. I have these and I'm not wearing them today. I have these little compression gloves that are a game changer for me. When my arthritis acts up, they keep my hands warm and less painful. You know the exact mechanics of how it works? Not sure but they are a game changer. So helping people find different strategies like that that can help tens units, that's another thing that can be really helpful. Immunity and illness. When we're sick, it's stressful on the body, it's going to add stress, it's going to increase inflammation, it's going to click on some of those stress genes. And we can't realistically expect to be completely healthy 100% of the time. It's just not real practical. Now there are people like Linus Pauling who say they've never haven't been sick in 30 years or something. They're the exception, not the rule. Let's set our goals realistically. But when we are sick, we're going to heal faster, we're going to be able to defeat the illness and, and get well more quickly when we're not under stress or why? Because our body is devoting energy to healing and we're not hyper activating that stress system. We're not increasing inflammation everywhere unnecessarily. And that allows the body to focus on doing what it needs to do, get it done and move on. Hormones go Nadal and thyroid as we. Well, even when you're younger, there are enough things in your environment that are endocrine disruptors that may contribute to hormone imbalances, that when your hormones get imbalanced, it's stressful on the body. It's like trying to drive a car with the wrong kind of oil. I don't know, I, I should never make automotive metaphors, but your gonadal hormones are supposed to be in a particular balance for you. And when they are not in that balance, then things don't move smoothly and the system is under stress. Likewise, thyroid. And remember in other videos we've talked about how chronic stress not only alters the hypothalamic pituitary adrenal axis, but it alters the hypothalamic pituitary, gonadal and hypothalamic pituitary thyroid access. We, we know that chronic stress alters our sex hormone levels as well as our thyroid hormone levels and all of our stress hormone levels which alter the availability of all of our neurotransmitters. When your neurotransmitters are out of whack, that's a stressor. We can't. There is no test. Don't let people tell you there is. There is no test to determine whether you have adequate neurotransmitter activity in your brain for a certain neurotransmitter. Now they can do some brain scans and see parts of the brain light up, but we can't yet figure it out. Dopamine receptors, serotonin receptors, norepinephrine receptors are throughout the body. So if people take a urine test, it will may tell them how much serotonin or dopamine or whatever they've got. Possibly, but it's not telling you. Number one, are the receptors working? Well, that's why people with diabetes, they have high blood sugar. They got plenty of blood sugar in their system, but it's not being used, it's not being taken up by the muscles. Well, the same thing can be true for our neurotransmitters. We may have plenty of circulating dopamine, but if the receptors aren't receptive, it can't do its job. Medications, A lot of times medications are toxins. And while they may be necessary, we need to recognize that they can add stress to the body. And lack of movement and oxygenation is also a stressor. Our body is meant to move. It's not meant to be sedentary. 24, 7, 365, we start to seize up. If you've ever had your arm in a cast and then it's gotten out of the cast, it's, you know, it hasn't had the same range of motion. It's taken a minute to get everything fluid and going again. But when we are poorly oxygenated, partly from not adequately breathing, it reduces our energy, it adds stress to the body. All of these things are going to impact us physically. You know, if you have disruption in your sleep, it's going to alter your blood sugar, it's going to alter your gut microbiome, it's going to. And those alterations, especially high blood sugar, can alter your oral health. So all of these things affect one another. They don't just operate independently. And when physically you're not feeling well, it impacts every other piece of life interpersonally. And we've talked about this before, self esteem. How you feel about yourself is important. If you constantly have that inner critic going on in your head and you don't feel like you're worth anything, then that's stressful. I mean, how unsafe does it feel when your biggest critic is living in your own head? You can't get away from it. How awful. Helping people silence that inner critic. They may not think they're all that in a bag of chips right away, but helping them counter that inner critic can be really helpful or at least challenge the inner critic. This is what you're telling yourself. Do you believe it? Is that accurate? Self confidence, people's self efficacy is important. We can help people focus or turn their attention to not only their failures but also their successes and help reframe things yeah, you've made some mistakes, but look at how much knowledge you've gained. Look how much courage you've shown and strength you've developed by all the crap you've gone through. Helping people develop that sense of empowerment is so important. When we don't feel empowered, we feel vulnerable, and vulnerability is stressful. Help them learn how to set and maintain healthy boundaries with others. And I know this is kind of counseling 101. A lot of people have really poor boundaries, whether it's in person, only online, only with only certain people. Maybe I can set great boundaries with people at work, but not so much at home or vice versa. We need to help them learn how to set those boundaries. And in every area, not just physical boundaries, but also emotional boundaries and cognitive boundaries. What I think and how I feel are valid for me. You may not agree, but you don't have the right to try to tell me how to feel or what to think. We need to help people develop an awareness of best first mindfulness and ability to effectively communicate thoughts, wants and needs. And there's so much use of the word narcissist anymore. It just drives me nuts because we've got become so sensitive in many ways. And I know I'm probably triggering some of you by saying that right now, but we've become so sensitive in many ways that if people express differing thoughts, wants and needs, not telling you how to feel, but they just say, I don't agree. I think that's wrong. This is my point of view. People become very defensive, they start feeling very vulnerable. Add to that, and I went on a diatribe about this on Monday, these new chat bots that we've got out there. Oh my gosh. People who are engaging with these friend chatbots, I don't know what they're actually called, not your chat GPTs, but the ones that actually interact with you like a friend, they're developing an AI. In most cases that agrees with them 100% of the time. There is no adversity. So the first time they're interacting with people in real life and somebody says, n, I disagree, they're like, whoa, that's not allowed. My AI doesn't disagree with me. My AI thinks I'm the greatest thing since sliced bread. So that's a whole other issue that we're going to have to face at some point. But. But we do need to increase people's awareness and ability to effectively communicate their thoughts, wants and needs and set those boundaries and say, you don't have to agree with me. But you don't have the right to tell me how I feel. And be okay with that. If somebody gets defensive, be okay with the fact that they feel vulnerable because you're not allowing them to try to control you. And, and help them role play those things and figure out how to accept that in certain circumstances, help them develop healthy social support systems with secure attachment. When we don't have social support, we often feel more stressed. Now, introverts are going to have one or two really close friends. Extroverts are going to have 20 or 50, you know, acquaintances. It doesn't matter what you define, but as your social support system. But it's important for people to feel like they've got somebody they can call. And resolution of interpersonal traumas and social anxiety. Well, you're going to have a hard time developing a social support system if you've got wicked social anxiety, avoidant issues, attachment issues, and interpersonal traumas. All of those things until they're healed, may contribute to you, to people feeling unsafe in relationships, unsupported, unconnected, which means, you know, pretty much no oxytocin unless they've got a house full of cre creatures, dogs, cats, whatever. But it's not a replacement. You know, your, your boxer is not going to be able to do the same thing that another human being can. Emotional aspects that can add stress if not handled, if not working well. People who have low emotional intelligence, they're not sure what they're feeling, why they're feeling it, or how to manage it. They're going to experience a lot of stress. Because emotions are our body's way of communicating with us about what might be getting ready to happen. Doesn't mean it is. Feelings are not facts. Feelings are smoke alarms. Early warning signs that say, this may be good or this may be terrifying. You better devote some energy to figuring out what's going on. So emotional intelligence is the composition or whatever of a person's ability to, to identify each emotion and their purpose. Why do I feel angry? Why do I feel jealous? Why do I feel grief stricken? What are those emotions trying to tell me? Why? Why am I experiencing that right now? To downregulate, we can't think when we're in a stressed state. Our prefrontal cortex actually kind of disengages because it's more important to fight or flee, not ponder. So our prefrontal cortex isn't really engaged until we can downregulate, turn down the cortisol, the glutamate, the adrenaline, and get into our wise Mind where we explore triggers and solutions and then make a choice of what steps to take. We act in choosing the best response that we think will we can do to move us toward our rich and meaningful life. And then assess later, did it work if it didn't work? Okay, let's go back to exploring triggers and solutions again. You know, sort of rapid cycle change right there. But it is important that people start becoming more aware that emotions are there for a purpose, but they are not factual. Curiosity, hope, motivation, anger, anxiety, depression, grief, they all serve a purpose and we want to encourage them. Curiosity and hope are obviously not going to generally trigger the stress response too much. They require energy, but they're not going to be overly stressful. Motivation when people have tends to be it require again, it requires energy, but it doesn't over tax the system. Most of the time when people don't have motivation, they can start to get frustrated and that triggers anger. When they start getting angry, it triggers the stress response, it triggers the inflammation, it alters the gut microbiome, alters the blood sugar. You see how everything's starting to go together. Recognizing we're going to feel angry sometimes and that's okay. Recognizing that anger is there to tell us there might be a threat, there might be a problem. Just like the smoke alarm tells you there might be a fire. And then we're supposed to take that energy and not steep ourselves in anger and anxiety, but take that energy and go figure out if there is a problem. If there is, handle it. If there isn't, move on. Depression. And a lot of times people's depression is either associated with anger and anxiety or grief. When you're angry and anxious for too long, eventually your body starts to just kind of shut down. Your brain says, I can't keep doing this, I'm exhausted, I give up. And that is the flop part of the stress response. Fight, flee, freeze, fawn and flop. So if somebody is persistently or has been angry and anxious for a long time, they may be flat a lot of the time. They may feel apathetic, unmotivated, no joy, depressed. When people are grieving, grief is part of the stress response. That or depression is part of the grief response. We need to acknowledge that and not pathologize it. You are feeling hopeless and helpless because you can't change that situation. You can't regain what was lost. And it's a normal reaction. Helping people understand and remember grief is not just the loss of a person or a pet. Grief can be the loss of dreams, the loss of your Understanding of how the world works, it can be the loss of a friendship. There are a lot of things to be grieved. And if we start examining what's causing this right here, we may have a better understanding of how to address it cognitively. It's stressful when you're only paying attention to the negative. But when your stress response is on your body's telling you pay attention to the stressors. You're hiking down the forest, a snake crosses your path. Stress response the next, maybe the rest of your hike, maybe the next hundred yards, I don't know, depends on you. You're probably going to be more hyper vigilant, more attentive to the potential for another snake to come out. You're not listening as much to the birds, you're not paying as much attention to the different flora and fauna. You're hoping that you're not going to have another cottonmouth come out. So we want to help people learn how to stop and notice the wide array of all of the things in their life that they're committed to that are important to them. Some of them are going to be going fine, some of them are going to suck. That is just life. And we want to help them balance those out, but not and help them avoid exclusively paying attention to the negative. We don't want to invalidate the negative. It's there and it sucks. And there are these things over here, this little glimmer of light that we can bathe in for a few minutes. I've suggested before and I've research has shown that spending 20 minutes a day generally I advise during a meal because that's 20 minutes people do every day. Focusing on what's going well. That can be really helpful in helping people notice the good. The other 23 hours and 40 minutes they can focus on all the stressors if they want to. But they've actually shown that that 20 minutes helps strengthen the vagus nerve when concentration is poor. Whether it's because of environmental factors, they didn't get enough sleep, they've, they're worrying about something, whatever, it can add stress and concentrating itself takes energy. It's stressful. We want to recognize that older adults with hearing loss have to focus so hard and concentrate so hard to try to understand what's being said. It increases what the call cognitive load. And they've shown that that persistent increase in cognitive load is exhausting, increases inflammation and is associated with an increased risk of dementia. We want to help people develop mental flexibility in perception and problem solving and awareness and management of thinking errors. Yeah, that's the stuff we were trained to do in graduate school. So let's help them notice some of these things, Help them develop healthy optimism. Not toxic optimism, not oh, everything's going to be fine, but healthy optimism. What is going right? What is not going so well? What do you have the ability to control? And what don't you have the ability to control? We want to help them be aware and manage cognitive load so they don't just get completely brain drained and engage in mental exercise with regularity. That actually helps develop neuroplasticity. And mental exercise is reminiscing. It can be doing sudoku, it can be crosswords, learning a new hobby, whatever. Environmentally light, sound, smell, taste and touch. All of our senses, when they are either over or under stimulated, it's stressful. And what is over or under stimulating for different people is it's very individual. Likewise, especially when it comes to smell and sound. People who have a trauma history may have triggers and, and sites too, to a certain extent have triggers in their environment that add extra stress. So we need to go through the entire array of senses when we're trying to identify stressful triggers that we can eliminate or mitigate. And positive triggers, empowering triggers that we can add. We also want to be aware that toxins, airborne toxins like carbon dioxide and carbon monoxide, endocrine disruptors in food, water, detergents and cosmetics, and microplastics, whenever they are ingested, whether they're inhaled or eaten or whatever, they add stress to the body because it disrupts the, the very precarious balance, the very fragile balance of the hormones and neurotransmitters. And our body recognizes toxins and it goes, whoa, don't want to have that here. So there is a stress response. Spiritually helping people develop values that support their connection and agency in the world can help reduce stress, which reduces the activation of those stress related genes. And developing a sense of meaning and purpose so they know what is important in their rich and meaningful life is essential because that helps them decide. Am I making forward progress? Am I able to move toward what I want to do? Am I empowered to do that? Functional mental health recognizes that frequent or consistent stress in any of the pieces of life contribute to epigenetic changes. Changes in which genes are methylated or activated, nervous system imbalance. And those changes lead to nervous system imbalances, inflammation and imbalances in neurotransmitters and hormones. Well, when those are imbalanced, we got a heck of a mess on our Hands Addressing one area will. Will help. Like if somebody wants to work on getting better sleep. Well, that's great. That's awesome. That will help. But true recovery and the ability to live their most functional life requires reducing unnecessary stress in all pieces of life and to reduce unnecessary inflammation so the body can restore its own genetic balance. It can get the right switches turned on on that switchboard. If you want to do a medium dive into epigenetics, these two articles I think are a great place to start. Van Gool, Epigenetics and the Development of Mental Health Disorders and Missoni, Epigenetic and Mental Diseases the Role of Psychotherapy. Missoni is the one that talks about how psychotherapy actually produces positive EP epigenetic changes, which I thought was absolutely fascinating in your classroom. I have uploaded or I will upload if I forgot to. I'll check as soon as class is over. A bibliography and it's a long one, but it give. If you want to do do your own deep dive on epigenetics. It helps you find the articles that I used just to start creating this presentation. And there's a ton more out there. Are there questions? Thank you, James. I'm glad that the work is helpful for you. Hi Shyman. Adriana is actually out today. Her son is sick and they are at the doctor. I'm glad to see you are here and I hope the baby's doing well. Robbie Gibson. Yes, Progressive muscular relaxation can be super helpful for helping the body relax. Noticing the difference between tense and relaxed. But also when you do that, you can actually almost feel the body pushing the stress. If you start here and move outwards, you can almost feel the body pushing the stress out your fingertips, which is what I love. Um, I used to do that activity with my students when I taught at uf and about halfway through, about half of them were asleep, but hey, they got relaxed enough to get to sleep. So I guess that was good. But progressive muscular relaxation can be super helpful. You are quite welcome, Lisa. And you're welcome, Christina and Jenna. Tyrone, I will see you next time. Happy Halloween. You are quite welcome, Alana. I try to make getting our live CEU's as easy as possible. I know here in Tennessee I have to get live CEUs too. So, you know, do what we can to help each other out. How do you approach a subject with pcp? With a PCP to get necessary blood work. It can be helpful. I mean, we want to educate the patient, the person about how all of these things work. We want to educate them and in General, it's not necessary for them to get any sort of genetic testing unless they're doing what they call a PGX test or a pharmacogenetic test to. Because they've been on multiple antidepressants that haven't worked and they're trying to figure out what's going to work. Okay, so that's one. But in general, see, seeing how their, their hormones are doing and all that stuff, educating the person about how thyroid hormones are impacting their mood, how their changes in their gonadal hormones may be impacting their mood, can be helpful and encouraging them to talk with their doctor about, you know, do you think that this might be going on and are you willing to test for it? The doctor is going to make their own decision. But for example, for thyroid, a lot of times Doctors will test TSH and free T4, but nothing else. We want to look to find out. And that misses a lot of hypothyroid. We want to test TSH, free T4, free T3 and reverse T3, because reverse T3 is the enzyme that breaks down T3, but when you're stressed, reverse T3 actually increases and breaks down the T3 before it can do its job. So we need to look at all of those to figure out if there's a breakdown in the system somewhere. There are a lot of people who have hypothyroid symptoms, for example, that have perfectly normal levels of TSH and free T4, but they feel like crap. So encouraging them to advocate for themselves with their doctor. We can't prescribe it. We can't tell the doctor what to do, but we can provide potential and informed opinion about why we think they may be struggling with hypothyroid or something. To date, I've never had a doctor go, oh, heck no, I'm not doing any of that. The bigger challenge has been getting the patient to go to the doctor and get the blood work run. The nice thing now, and, and I hesitate to mention this, but I think most people are aware of it. Now, a lot of the places like LabCorp and LabQuest or no Quest Diagnostics people can actually. You don't need a doctor's order to get certain tests run. You can go in and request the entire thyroid panel. Now, insurance isn't going to cover it, but you, if you want something done theoretically, you can do that. The other question is, once the results come back, are you going to be able to interpret them? Which again is why having the doctor do it is so important. Tennessee is quite different I grew up in Florida. I really, for the most part, generally enjoy Tennessee, except for those two weeks every year that we get a half an inch of snow and the entire city shuts down. Down. But other than that, it's pretty awesome. Is digging back into trauma over and over again in therapy helpful? If the goal is to ultimately reduce stress and inflammation and stuff, well, there's. That's a loaded question there. Until the person dealing with the trauma feels safe and empowered, then that trauma is going to continue to add stress to their life. However, if you've dug into it once and it didn't do much good, you dig into it again. Doesn't do much good, then digging into it's probably not going to be helpful for whatever reason. So we may need to look at other strategies to help the person address it. The first thing I would look at is before you started digging in, did the person have the skills and tools they needed to feel safe enough to go there? Or were they just opening Pandora's box and hoping it for the best? Because if that's the case, then digging into the trauma may have actually re traumatized them. For some people, talk therapy as it pertains to trauma doesn't really do everything it needs to do. And things like EMDR and transcranial magnetic stimulation have shown more beneficial effects. There are some other more fringe experimental treatments that are coming out now, but EMDR is always my. Sometimes it's my first line. I am not EMDR certified, so I will refer people out, come here, bud. But if I think that that would be the most appropriate course of action for. But if we tried to work on it together in talk therapy and it wasn't effective or not effective enough, then I would certainly refer to refer out for emdr, which has a lot of effects besides just cognitive processing, and it really can help start to reprogram the nervous system.