Lifestyle Interventions in Mental Health

I'd like to welcome everybody, today's presentation of lifestyle interventions for mental health. I'm your host, Dr. Donnelly Snipes. In this presentation, it's really going to be hopefully a pretty fun presentation. We will talk about complementary interventions that can be used to enhance mental and physical health. In counseling, when people come to see us, we are really focused on helping them identify what is contributing to their thoughts, helping them process experiences that they've had in the past that may be impacting their thoughts and emotions in the present. And you know that that's great. That's all wonderful. However, it may not do any. Everything we re. You remember that our body impacts everything we do. And I want you to really stick with that metaphor of your body as a factory. When you're. When a factory has all of the raw materials it needs to make the products that it generates, then it is going to function well. You're going to have good output, you're going to have good revenue. You know, everybody's going to be happy and keep their job. If the factory doesn't have the raw materials it needs, or if the equipment in the factory that's used to make the. Whatever you're making with the raw materials isn't kept up, doesn't go through its routine maintenance, then that's also going to cause problems in the factory's functioning. Think of your brain as the CEO, if you will, of the company, and it helps control all of those other actions that are going on. More than 50% of Americans suffer from one or more chronic conditions associated with disturbances of the threat response system, or what we've learned to call the hypothalamic pituitary adrenal axis, the HPA axis. This costs an estimated $3.3 trillion annually because people have issues like major depressive disorder, generalized anxiety, gonadal hormone imbalances. If you were in that class a couple, a few classes ago, a couple weeks ago, you know that when our gonadal hormones, our estrogen, our testosterone, progesterone get out of balance, it causes mood symptoms. It causes imbalances in the availability of neurotransmitters. So people with gonadal hormone imbalances often experience depression and anxiety. We see this too, as people get older, and this is one of those lifestyle factors. I guess as we get older, our body actually does not make as much of our primary gonadal hormones, and that can contribute to mood symptoms in people later in life. The body actually starts decreasing its construction output of those hormones in our mid-20s, and it starts to go down from there. So it is important when you're working with adult clients to consider whether their gonadal hormones might be contributing to some of their mood symptoms. Now, obviously, there's probably cognitions that go along with it and they may have other traumatic experiences. Generally, people's dysphoria, mood issues, behaviors are not caused by just one thing. It is a culmination of a lot of things. People who experience HPA axis disturbances are also at a much greater risk for diabetes. And there is a lot of research that associates diabetes with a significantly increased risk for depression. Autoimmune disorders are another thing that are exacerbated by stress by our lifestyle factors. And it's important to recognize that autoimmune disorders, the lifestyle factors we may be talking about, may not just be emotional stress. It can be physical stress, like eating something like gluten that causes an inflammatory reaction in the body. That is a stressor. When you eat something that your body thinks is toxic, that's a stressor to it. People with autoimmune disorders are at greater risk for depression because as inflammation goes up, we know that the likelihood of depression also goes up. They don't exactly know why that happens, but there's almost. Almost. There's a very strong correlation. Let's just say that we also see increased levels of anxiety in people with autoimmune disorders. There's anxiety about having another flare up. There's anxiety when they do have a flare up that, oh my gosh, maybe this is getting worse. There's anxiety when they have flare up that because they can't do the things or they're not as able to do the things that they want to do. They may fear rejection from the people that they love their support system because they can't do the things that they can do when they're not symptomatic. So there are a lot of issues with autoimmune disorders that can contribute to depression and anxiety, both cognitive, interpersonal and physiological stress. HPA axis dysregulation is also associated with metabolic syndrome. And the key identifying feature of metabolic syndrome in a lot of people is gaining a lot of weight in the midsection, having sort of that, what we used to call a beer belly. When people's cortisol levels go up, interestingly enough, for some unknown reason or a reason, I don't know, the researchers probably do, we tend to store fat in our midriff, not in our legs, not in our arms. When we have high cortisol levels, we tend to store more fat in our belly and our gut area. So one of the signs a metabolic syndrome is often core weight gain. Cardiovascular disease and hypertension also go up as the HPA axis becomes dysregulated. And when your cardiovascular system is not working well, it can contribute to symptoms of anxiety. If you have heart palpitations, it can make anxiety worse. Likewise, if you are not getting enough oxygen because you've got bradycardia or because your arteries are, you know, getting all clogged up with plaque and everything, so you don't have as good a circulation, oxygen's not getting to the brain. That contributes to the development of mood symptoms, mainly depression, but it also contributes to the development of dementia later in life, because that lack of oxygen does have effects over time. And hypothyroid, if you've worked with people who have hypothyroid, you know, a lot of symptoms of hypothyroid are very similar to symptoms of depression. The low energy, the sluggishness, apathy, a lot of things are associated. We know that when cortisol is high, it prevents the thyroid from being able to convert the T4 to T3. So people can develop hypothyroid if they are exposed to stress for too long. My point being stress, this sort of amorphous thing that we call stress, contributes to the development of mood disorders. But it's not just emotional stress, it's not just thoughts, it's also physical stress, stress on the body factory that keeps it from running effectively. One of those sources of stress is the media, and I use this term kind of broadly. But a lot of what we're talking about here is news media. Regardless of what channel you watch, any news media, they are, what's the word I'm looking for, Funded, supported by advertisers. That means they want people, and advertisers want people to watch them. You know, they want more bang for their buck. Well, are you going to tune in to watch Fluff Pieces, or are you going to tune in because you need to find out what terrifying thing you've got to protect yourself from? Most people are more likely to tune in to what I randomly call fear porn. We are so afraid of missing something that is crucial, that might be dangerous to us, that we tend to stay more hooked on media than if they were just playing Fluff Pieces all the time? According to the social signal transduction theory. That's a mouthful. Perception of social threat by social, symbolic or imagined threats and adversity upregulate the HPA axis. So when we have social symbols or social interactions or symbols or even imagined threats that threaten our society, that threaten our culture, that threaten our person, it upregulates the HPA axis. Now let's just take a minute and I'm not going to, you know, name name names or call things out right now, but think about all the things that they talk about on the news over the past, oh, I don't know, year that has contributed to a perception of threat, a perception of a loss of self, safety, just a perception of disempowerment. Modern news media recasts social, political and cultural events and highlights the presence of terrorism and dystopia 24 hours a day. Back in my day we had the news at, you know, six in the morning, noon and six in the evening, 30 minutes at a shot in the evening, I think it was an hour. Now it's on literally 24, 7, 365. And even if you are aware that what you're seeing is the same thing over and over and over again, if you watch a story at 8 in the morning that triggers you and then you hear it again at 9 in the morning, 10 in the morning, noon, etc. Do you think it's not going to trigger you then? It may not trigger you as much, you may become a little bit habituated to it, but hearing it over and over again, if it triggered you, is likely going to trigger you again. So you're exposing yourself to repeated iterations of that stress response. The persistence of threat messages within a climate of heightened awareness and vigilance about domestic and international terrorism causes chronic HPA axis activation. Our culture right now unfortunately seems to be very focused on, instead of focused on helpfulness and tolerance and patience and, you know, safety. We hear when we tune into the news, when we tune into the media about domestic and international terrorism that, you know, sort of strips people of their perception of safety and their perception of personal power to keep themselves safe. This keeps people on high alert. People feel in many cases right now like they are in a virtual foxhole and they can't go to sleep. I've talked to some clients who literally have difficulty sleeping because they're afraid if they go to sleep or when they go to sleep, somebody's going to break into their house. You know, there are a lot of people who don't feel safe and a lot of people who may used to have felt safe who don't feel safe anymore. And this causes chronic HPA axis activation leading to the release of pro inflammatory molecules in the body. So it creates systemic inflammation, increases levels of cortisol and glutamate in the brain. That creates a neurotoxic environment. So you start burning up brain cells, and all of these things can contribute to the development of depressed mood, fatigue, and just behavioral withdrawal. You just don't. You don't want to do it anymore. You don't care. You don't have the energy. Well, if you're not sleeping well, if you're not getting that deep restorative sleep, yeah, you're going to have a hard time having the energy to want to do things. The ubiquitousness and persistence of these messages can be even more damaging to youth who, depending on their developmental level, may not be able to understand something that's being recast from something that's still occurring or something that's happening 1,000 miles away from something that is like, right in their neighborhood and an imminent threat. So children are especially sensitive to a lot of these things. They may not understand that they are safe because what they're seeing on TV is something that happened, you know, six months ago or something that happened across, across the border, you know, in a whole other country. It is important if children are exposed to this, young children that we explain to them what they're seeing. And young children like 5, 6, elementary school still have difficulty sometimes conceptualizing that. One of the things that we can do if children are exposed to news media and some of the stuff that we're talking about get on things like Google Earth and show them physic, physically, visually show them, you know, you are here, here's the United States. And then, you know, maybe here's where grandma lives, because they know it takes a long time to get to grandma's house. And then here is where this is going on. So they can see spatially sort of that they don't have to worry about something that may be happening in Syria, for example. So that's important with children to help them make it tangible. Remember, young children can't think abstractly, so they need things very concrete, visual. And if you can help them, you know, give them things to manipulate. But generally with what we're talking about here with the media, maps are where it's at. Caregiver stress from these messages can also contribute to mood and behavioral disorders in children. Children are extraordinarily perceptive little people, and they may not understand why you're angry or why you're upset or distressed, but they can sense it. Even infants can sense distress in their caregivers, and it's overwhelming. They've done studies with infants and when the caregiver was distressed, the infant yawned more and would avert their gaze more frequently because it was just too overwhelming, too overpowering to handle the energies, if you want to put it that way, that the caregiver was giving off. So it's important to recognize that even if the children are not seeing the stressful media, if you are in a state of distress, it is going to impact them. And I think this is really important that we help caregivers become more alert to so they're more aware of the impact of their non verbals on their environment and on the children in the environment. If we think back to adverse childhood experiences, having a caregiver with a mental health issue can contribute to adverse childhood experiences partly because the mental health issue, if it's uncontrolled, may prevent the caregiver from being able to adequately and accurately attach with the child being consistent and responsive, attentive, validating and empathetic. Since all people engage in more detailed processing of negative events because, you know, it's a lot more threatening, it's a lot bigger, bigger of a problem if we miss the snake that's on the ground than if we miss the bunny rabbit. So we are primed to pay more attention and pay more attention to the details of negative events. But since we do tend to process that more thoroughly, exposure to the predominantly negative stories in the news may contribute to increased negative emotional responses which increase HPA axis activation and anxiety related behaviors. One of the activities that I have people do and kind of a stretch to call it an activity, is when they get stressed to notice the difference between what they notice when they're in a, you know, cranky framework versus when they're not. And it's important for them to pay attention for a week to what they're noticing and what their mood is at the time. And they start seeing in most part that when they are angry, when they are anxious, when they're depressed, they tend to miss things, they tend to not notice things that they would notice when they're not feeling that way. And they actually tend to pay more attention to the environment and almost seek out things that are going to self validate their current mood state with the news. I encourage people to spend, you know, a week and when they watch the news, you know, 30 minute news program, do a hashtag or a hash mark list of how many negative stories that the news reports on and then another little hash list, hash mark list of the number of positive stories that they report on and just take a look at that and evaluate their mood before and after they watch the news. I know for my husband, for example, he can be in a decent mood before he starts getting into the news, but as soon as he does, his demeanor changes completely. People who spend more time online, especially on social media, also have some challenges. Now, social media is not in itself all bad. It can be a problem if it contributes to a decline in communication with family members and a reduction of your social circle. Interestingly, they found that a lot of people spend a lot of time on social media, like Facebook, Instagram, those sorts of things, but they spend a lot of time lurking or just perusing things and really don't engage with a lot of people. So where, whereas they may have, you know, 500 connections on Facebook or something, they really don't interact with those people. They really don't socialize with them. Even virtual socialization is minimal. So there is a reduction in their social circle. There's also a reduction in sleep because people tend to spend. They come home from work and they get sucked into the vortex of whatever social media platform that they may be on, and all of a sudden, three hours have passed. So it's important to help them recognize this. And if they want to get on social media, to set a timer that keeps them from getting kind of into that abyss where they lose hours at a time. That way they can get to sleep in a reasonable time frame. Other people lose sleep when they're on social media and kind of jumping ahead, but they get on social media and they start looking at everybody else's profiles, and it looks like everybody else's life is just so perfect. And then they start feeling depressed and isolated and envious and resentful, which increases their HPA axis and gets them all fired up, which makes it harder for them to get to sleep. So if social media causes distress, then obviously it's probably better to avoid it before bed. People who spend a lot of time on social media also have an increased sense or increased fear of missing out. And we really need to talk with people and encourage them to examine that feedback. Fear of missing out. What exactly are you missing out on? You know, maybe they spend look at what they do for a week on social media and ask themselves at the end of every day, if I wouldn't have been on social media today, what would I really have missed? What. What did I see on there that was just so crucial that I had to see it? And most of the time, what, you know, our. Our daily lives, there isn't a lot we just have this fear that, you know, the one time I don't log in, but back in the day, my daughter hates when I say that. Back in the day when we had, you know, home telephones, we didn't. This was before beepers, this was before cell phones, this was before computers. Yeah, I'm that old. You know, there was a lot less FOMO because we weren't inundated with it all the time. And we just knew that, you know, we either heard about whatever was going to go on when we were at school or we didn't. And there's increased feelings of depression and loneliness coupled with the perception that other people's lives are more perfect. Remembering. Most people aren't going to take a picture of themselves on the worst moment of the day and post it on social media and go, hey, life really sucks right now. You know, that's just not what we do. Or they burn dinner and they take a picture of it going, I botched this one. No, they're going to give you pictures of their best moments, of their most beautiful meals that they prepare. And we need to recognize that we're not seeing everything, we're seeing that filtered snapshot. But social media can be a force for health and healing. After I go through all that, I say, yeah, there are some good sides to it. It's important for some people to recognize that they do have the ability, for example, to connect with family members through social media. If they don't live near one another anymore, they can share pictures, they can share stories on social media. So that can be, you know, kind of fun. That actually can promote communication with family members in some ways. I know with my kids, they were a lot more communicative with their grandparents through social media because, you know, they could tag them in, tag them in, posts and whatever so they didn't have to call, you know, four different sets of grandparents. They were able to just tag everybody and put that at whatever they wanted to say out there once, and then people could respond. And it was interactive. And that is the key. If we're going to use social media for social support, then it has to be interactive. You can't just, you know, peruse people's timelines, which also enhances the social circle. If you are interacting, you know, choosing. You can't interact with 500 people with regularity. But choosing your social circle and making sure that you nurture your virtual relationships just like you nurture your in real life relationships, and using social media to connect with others with like, interests or like situations. Depression support groups, health and healing groups, meditation groups, nutrition groups, let's start exercising groups. There are actually a lot of very positive supportive groups on social media. You just need to find it for health and nutrition. For example, it's not necessarily on what you would think of as traditional social media, but the Spark People app has a really active board where people support one another and provide words of encouragement and suggestions and everything. So that is an app that people can download that is very targeted to health and wellness. So social media, when used with care, can actually promote mental health. But we do need to make sure that we don't fall into these habits of being reactive and expecting social media to magically fulfill our needs. We have to interact with others, we have to make a point to nurture those relationships. We have to make a point to recognize that social media is, if you're interacting, is kind of like having friends over. And you need to set some boundaries with time as well, because you set still need to be able to get good sleep. According to the cdc, one in three adults doesn't get enough sleep, though. Deep sleep, that deep restorative sleep downregulates the HPA axis. It helps you relax and it clears out adenosine in the brain, which promotes alertness and cognitive flexibility the next day. When people feel groggy, hungover, tired, you know, we have different words for it that often indicates that they didn't get adequate deep sleep the day before. Sleep disruption or deprivation can lead to changes which further inhibit sleep and inhibit the HPA axis. So when we don't get enough sleep or we don't get good sleep, it actually upregulates the HPA axis which prevents us from getting good sleep. So somewhere in there we've got to break this cycle and say, all right, you know, I have got to do something to help myself relax so I can get better quality sleep. We want to identify ways, help people identify ways that they can reduce their cortisol levels at night. And part of this may be, we'll get to it in a few minutes, low intensity exercise. We want to make sure that they are eating a healthy diet so they have adequate levels of the raw materials they need to make serotonin and eventually melatonin. Now, some people take over the counter melatonin, and you can talk with your doctor about that. It is, for many doctors, it is a preferred supplement for helping with sleep as opposed to, what's the word I'm looking for, Antihistamines. But that's important for people to Talk with their doctor about. When we are trying to enhance sleep hygiene, one of the things we can do is to help have people do an AB test. And I do this with a lot of things. We've talked about it a lot already. When you are getting good sleep on a night, you've gotten good sleep and you've really tried to pay attention to your sleep hygiene, how do you feel the next day? And just kind of keeping a log or a journal of that. And then on days where you haven't gotten enough sleep, either you're tossed and turned all night or you let the dog sleep in the bed, or you stayed up way too late, how do you feel the next day? It's important to help drive it home very practically for people, how sleep deprivation impacts them. And then start educating them about sleep hygiene because first they need to buy in to the belief that sleep hygiene is important and not just because we tell them it is. And then we can start educating them about blue light and minimizing blue lights two hours before bed, about making sure that the environment is cool, about attending to anything that's going to wake them up, from their dogs moving around to noise, to even allergens. It's important to evaluate sleep hygiene. And I have several videos on sleep hygiene on the website, so I'm not going to go into, you know, deep detail on that. According to the American Academy of sleep medicine, 26% of adults have sleep apnea. Wow, that's a lot. 26% of adults have sleep apnea, which not only disrupts their sleep, but also the sleep of their partners. If you have a partner who snores, even if they don't have apnea, but if they snore, you know that it probably disrupts your sleep some. Both sleep apnea and sleep deprivation are associated with HPA axis activation and the development of mood symptoms. Because people aren't getting that quality sleep, they're not clearing out the adenosine, their HPA axis is over activated. There's a lot of reasons that it's important. And with apnea, they're not getting enough oxygen to their brain multiple times throughout the night. So what can people do? If people think they have sleep apnea, you know, it's certainly really important for, for them to be evaluated by a doctor. Apnea contributes is directly associated with the development of depression and as I said earlier, also with the development of dementia. So the earlier this is addressed, the better we want to make sure the brain's getting enough oxygen. Apnea can be addressed with CPAP machines. And they found significant decreases in cortisol and increases in mood after somebody starts the positive airway pressure therapies when they sleep. As far as the partners who sleep with somebody who has apnea, it is important for them to be able to address their issues. And that doesn't necessarily stop when the patient, we'll call them, gets the CPAP machine because those CPAP machines are noisy. A lot of times people who have a partner who snores or has sleep apnea may need to consider earplugs or noise canceling headphones or, you know, maybe a white noise machine is enough. I know there are a lot of people who not saying that this is a recommendation, but there are a lot of people who now sleep in separate bedrooms for this very reason. Not because they don't love each other, but because one partner either has apnea, snores or the CPAP machine is, is too loud. So it is important to recognize that now, if they choose the option of sleeping in separate bedrooms, okay, you know, that obviously is going to cut down on the noise. But it will be important to integrate other times throughout the day where they are connecting both emotionally and physically in order to keep that oxytocin level up, in order to, you know, keep that relationship plugging along, so to speak. Because, you know, that is a separation noise. More daytime, more than daytime noise. Nighttime noise exposure causes more frequent awakening, less deep sleep, and increased distress associated with HPA axis activation. When we have noise, even unexpected noise during the day, we're awake, we're alert. So it tends to be less startling, less intense activation of our HPA axis. When it happens, when you are out asleep, you know, especially if you're in a deep sleep and there is a really loud noise that wakes you up, it's going to cause a much stronger startle response. But they've also found that low level noise anytime and any kind of regular exposure to nighttime noise over 42 decibels is associated with a 14% increase in prescriptions for sleep medication and a 17% increase in risk in people's risk of being on antidepressants or anti anxiety medications. Which tells us that this regular exposure to nighttime noise, even if it is consistent, this particular study was done with people who live next to wind farms where they have the wind turbines going all the time. But if you live next in the city where you have a lot of traffic noise all night long, especially if you have to sleep with your windows open and you have that traffic noise that can contribute to it, it's important for people to figure out and just kind of investigate, is there noise at night? And if so, what can they do? White noise machines can be helpful, but they need to keep them low. Obviously, if they're cranking them way up like my daughter does, where they're 42 decibels or more, that's kind of defeating the purpose. Earplugs, again, can work for people who are willing to do that if they don't feel too unsafe by not being able to hear anything. But anything people can do to dampen the noise can be very, very helpful. Other things, you know, as I'm brainstorming, I know when I go to a hotel, you know, when the air conditioner kicks on and off in the, in the old fashioned hotels where they have the room based air conditioners, that would wake me up. So people who have room air conditioners or window air conditioners, that may be something that they don't realize is disrupting their sleep, that actually is, you know, getting creative or getting inquisitive about the different types of noise or different things that might be waking somebody up at night is important. According to the CDC, 20% of Americans are heavy drinkers, defined as drinking 15 more drinks. Fifteen drinks per week or more for men and eight drinks a week for women. So, you know, for women, that's roughly one drink a day. Any more than that is considered heavy drinking. Alcohol stimulates the HPA axis and repeated alcohol exposure leads to that HPA axis dysregulation, that hypocortisolism that we've talked about, the blunted HPA axis response. So when you drink, it doesn't have the same stimulatory effect anymore, which can lead to depressive symptoms, including anhedonia, fatigue, behavioral withdrawal. And we do know alcohol in particular does contribute to widespread inflammation. It's if you've ever had Everclear, you know that, you know, alcohol itself can be kind of powerful stuff. Obviously, a lot of people aren't drinking Everclear, but what they, they are still getting that alcohol in their system, just in a lower intensity, which does cause inflammation of the gut and the soft tissues. Not everybody is willing to give up alcohol. One of the things that I talk with my clients about is the fact that when you drink before bed, it may help you drift off faster, but as the alcohol leaves your body, it actually impairs your sleep. So if you're going to drink, drinking early enough that when you go to bed, your blood alcohol is 0.0 is certainly what you want to Aim for and having people consider how much they actually need the alcohol. Now again, not everybody's willing to give up their wine, their beer, their liquor, whatever that is. A personal choice, but recognizing that if you're going to drink, there may be times that are less harmful to to drink. The stimulant effects of nicotine and caffeine may intensify sleep problems. And both of these things are often used during waking hours to counteract the effects of sleep problems on cognitive functioning. So you use a stimulant. It keeps you from getting good sleep. Then you continue to use the stimulant to counteract the effects of not getting good sleep. Sleep. Eventually that system is going to break down again with nicotine and caffeine, just like we see with other things. The HPA axis is going to start getting blunted in the face of persistent exposure to the stimulants, to the cortisol, to the norepinephrine. They found that as nicotine use and dependence goes up, HPA axis activation actually goes down. The HPA axis just says, you know what, I can't get that excited as much. It starts becoming resistant to the effects of the stimulant. Caffeine is found not only in coffee, but also in soda, chocolate, over the counter migraine, migraine medications, decongestants, and some diet and workout supplements. It can be a very sneaky little thing. And you know, as long as we're on the topic of stimulants, not all stimulants that are in some of our, you know, energy drinks and some of our over the counter stimulant type supplements are necessarily caffeine. So it's really important for people to educate themselves about all of the components of any supplements that they're taking. Then that includes your energy drinks like Monster or Red Bull or whatever they're called. Now to recognize exactly what you're ingesting and how it may be affecting you. When I call these dietary stimulants, any stimulant that you're getting from a pill or a drink or food. When dietary stimulants are paired with stress. So you're already drinking caffeine and smoking cigarettes, and then all of a sudden something happens. A stressor happens. Cortisol and adrenaline levels far exceed the levels seen when caffeine or stressors are encountered independently. So your body may react to caffeine with a 10, it may react to the stressor with a 10. But when you have caffeine in your system and you encounter the stressor it reacts with a 30. So instead of 10 plus 10 is 20, 10 plus 10 is 30. And so it's important that people recognize that this can be the case. One of the things that drives me bonkers, frustrates me. I don't know what the word is I'm looking for is when people tell me, oh, I can drink caffeine right before bed, it doesn't faze me anymore. Well, what does that tell you? That tells you that your receptors have become completely resistant to the effects of caffeine. It's been bombarded so much that you've got HPA axis regulation going on. Which also tells me that there's a likelihood that there are also underlying physiological issues and maybe even mood issues or mood symptoms that the person may be experiencing that they don't even realize, maybe from contributed to by stimulant overuse. Educating people about cortisol resistance, about glucocorticoid resistance, and how the body adapts, develops tolerance to stimulants is really important. Educating them about HPA axis dysregulation and how it contributes to all of those things we talked about on the first slide I find can be helpful. Now, are people going to necessarily give up nicotine and caffeine? No. Again, that's a personal choice, but we can help them recognize the impact it's having so they can make an informed choice about which vices that they are going to choose to maintain. If they decide that they are going, they want to cut back or quit using nicotine, caffeine, alcohol, then we can provide them referrals. There are a lot of really good pharmacological assists for and nicotine replacement therapy. There are a lot of things that can help people quit smoking, vaping, using dip, whatever they're doing, however they're getting the nicotine into their system. And most people that I have talked to who have been dependent on nicotine have said that those things are invaluable to, to stopping nicotine is one of the most addictive substances on the planet. So helping them understand that, helping them embrace that and recognize that using nicotine replacement therapy to help them move towards cessation is not a, it's not a weakness, it's not a crutch. It's actually probably going to help them be more successful. Caffeine. When people stop using caffeine, a lot of times they want to wean off of it. So getting the half and half, half caffeinated, half decaf for a month and then going to 3/4 decaf and 1/4 caf for a month, et cetera, until they weaned down completely off the caffeine. Danielle asks if there is there any research about the effects of vaping in regards to similar effects? Well, it depends on what they're vaping, but if they are vaping a nicotine based product, then it's going to have similar effects, dose response effects as smoking cigarettes. Unfortunately with vaping, a lot of people actually ingest a lot more nicotine than they do from a single cigarette. If they are vaping marijuana, then they are going to be experiencing the same effects that you would see from marijuana ingestion. So yeah, vaping doesn't have the, some of the toxins that they think that are associated with tobacco burning tobacco leaves. But nicotine is, nicotine is nicotine, it's a drug and when you ingest it, it's going to have pretty much the same effects on you no matter whether you get it orally or through vaping or smoking. Another factor impacting sleep is working in buildings with a lack of access to natural light shift work and which prevent overnight regulation of the 24 hour circadian rhythm. Our body doesn't naturally keep its 24 hour circadian rhythm. It actually is about 26 hours, I believe. So we use light, we use behaviors, we use a variety of different things to help set and maintain our circadian rhythms on a 24 hour cycle. But if you work in one of those offices like this one that has zero windows, the day can come and go and you may not even notice it. If you get to work when it's dark, you stay inside, don't see sunlight, leave when it's dark, your brain's going, did I miss something here? So it is helpful to encourage people to go out and get natural light. They did some studies with nurses and found that if, even if they worked in an ICU or NICU where the lights tend to be kept very dim, if they went outside for five to 10 minutes, two to three times a day, and that includes when they walked in in the morning and when they left at night. If it was daylight during those times, it helped them keep their circadian rhythms in sync. When people work shift work, it's important for them to try to maintain, and this is so hard if you've got a family, sometimes try to maintain their same schedule on their days off as on their work days. The body takes about 24 hours to adjust to a time zone change. And I know a couple of you in here can, you know, attest to the Challenges of time zone changes. It takes about a month to adjust. So if you are working for three days and then you are off for two days and you try to switch your schedule and then you try to switch back. When you have to go back to work, you are in a perpetual state of jet lag and your circadian rhythms and your hormone balances and everything are completely out of whack. It is really important to try to maintain circadian rhythms because they control. They are involved in just about every system of your body. Nearly 20% of Americans are at risk for graveyard shift work disorder, which is characterized by insomnia and daytime drowsiness. People who work night shift, really, if they can get home and get into bed before it's daylight, that is super beneficial. But again, even if they can't, if they maintain the same schedule on their off days as their on days, it helps them a lot. Insomnia at night causes people to experience frustration and increases stress because the person was drowsy all day and desperately wants to sleep but cannot. So if they come home from a midnight shift, they get home at 7am and they're like, well, I'll just stay up and I'll go to bed with the family. Then they're drowsy all day long. But when it's time for them to go to work on their work days, they tend to get their second wind and now they can't get to sleep. And that causes a lot of frustration and consternation. Daytime drowsiness also causes people to use those dagum stimulants again to wake up or get energy throughout the day, which increases HPA axis activation, anxiety, and the potential to develop the glucocorticoid resistance and depression. Helping people learn about their circadian rhythms is important. Advocating with businesses, with work groups for developing shift work that is most supportive of people's circadian rhythms. I worked with law enforcement for many years and one of my battle cries with every department I worked with was do not switch people's shifts every 30 days, please. And if you're going to switch shifts, you know, maybe once a year, switch forward. So instead of going, instead of going backwards, where somebody who was working midnight shift is now working at 7 in the morning, go forward. So the person who was working, you know, 8am to 4pm is now working 4pm to 12pm so that bumps up their schedule eight hours and just keep moving forward like that. Research has found that that is less detrimental. Up to 95% of some neurotransmitters are Made in the gut. Remember we talked about how the gut brain axis links emotional and cognitive centers of the brain with your digestive tract through the vagus nerve. So think of, you know, your gut as one of the departments in your body factory. And if it is, if the machinery is not working, or if it doesn't have the materials it needs to do its job, it's going to communicate to the brain that there's a problem. And one of the raw materials it needs to do its job is nutrition, as well as hydration. So when we are malnourished or dehydrated, the gut tells the brain that there's a problem, and it activates the HPA axis. Since many of the hormones and neurotransmitters in the body are constructed from amino acids, with the help of carbohydrates, vitamins, and minerals, a healthy body can help regulate the balance between our different neurotransmitters, positively impacting our neurological, emotional, and behavioral self. Easy tips for nutrition. Eat colorfully. Three colors on every plate can really help up the ante for antioxidants. And antioxidants help reduce inflammation by helping to clear out some of the oxidative stress. The more colorful, the more antioxidants. Three colors on every plate. Carry a water bottle with you so you are getting better hydrated. Generally, when people start making those two changes, they start experiencing really positive effects on, on, you know, on their energy, on their sleep, on their mood. There are a lot more changes they can make. They can download an app like Spark People. No, I'm not paid by them. I just happen to like their app and keep a nutrition log every day. And at the end of the day, they can look and they can see which nutrients they got plenty of and which ones they were a little deficient in. And they may be able to alter their eating that way. When I used to work in a group setting, we would share recipes and I would encourage people when we talked about nutrition to. To share some of their favorite foods. And then we might talk about, you know, healthier ways to make some things sedentary. Ness is another problem. As Americans, you know the old saying or not the old saying? I guess it's a new saying. Sitting is the new smoking. As stress levels increase, we tend to feel more exhausted, so we tend to be less active outside of working hours. We tend to come home and just want to sit on the couch and veg. It's important to find ways to reduce inflammation that's related to stress and reduce oxidative stress from that HPA axis activation, they found that moderate exercise, low to moderate exercise, has been shown to help reduce both inflammatory cytokines to reduce inflammation and as well as reduce oxidative stress and keep your joints more mobile, reduce some some types of chronic pain. So low intensity exercise actually can be really helpful. What they define as low intensity exercise is 40% of your VO2 max. That's too technical for most people. They need to be able to exercise, but they also need to be able to carry on a conversation. If they're having a hard time carrying on speaking in full multiple sentences at a time, they're probably working at a moderate level or above. If they can carry on a conversation easily, that's where we want to be. So this low intensity exercise has been shown to reduce cortisol levels and increase serotonin, contributing to the relaxation response. Going to the gym after work is not super high on my priority list. I don't really love doing it, but after a really hard day, it can be very helpful to go and just easily walk on the treadmill, watch one of my favorite shows on my tablet, and kind of let the cares of the day disappear. It's not my intense workout of the day, but it does, it actually does reduce cortisol and helps get me ready to start winding down for bed. And finally, happiness. People forget to recharge with the positives. We have this box full of things that we want to get rid of, full of memories, full of resentments, full of guilt, full of this, full of that. But if you remove all of those things, you've just got an empty box, and that's not a rich and meaningful life. What we want to do is as we take things out, we also want to be adding happiness activities and positive activities into our box. So encourage people to remember to recharge with the positives. Start finding hobbies that they're interested in or books that they want to read, things that they can do to bring contentment to their lives because that in and of itself will increase serotonin and gaba. And if they're doing things with other people, doing nice things for other people may even up that oxytocin. Counseling typically addresses people's thoughts and prior experiences that directly impact their perceptions of events and emotional and behavioral reactions. We need to provide information about other factors that can also contribute to neurotransmitter imbalances and help our clients identify possible solutions. Environmental changes like getting blue light filters on our mobile devices and addressing noise and allergens and deciding to kick the dogs out of the bedroom, all of those things. You can decide what you're going to do and make some of those sweeping changes all at once. But behavioral changes like changing how you eat or going to the gym should focus on one change at a time. That is in order to allow the person to assess the impact. You know, is this really helping me and adjust to their new normal? So I usually just a general rule, one behavioral change per month, letting people really get established. And Veronica, I totally agree with you. Including in your assessment a recommendation that people get a full physical from their primary care physician, including blood work, to assess gonadal hormones, to assess thyroid hormones, to assess their vitamin D levels. There are a lot of things that a very simple blood test can tell that are very often out of whack and contributing to people's mood issues. So that is a, you know, really, really wise suggestion. Alrighty everybody. I told you we'd get out a little early. I guess I fibbed on that one, but I appreciate you being here. It is now past noontime on Thursday, so we are well into almost to the weekend. I hope you have a fabulous weekend and I will see y' all on Tuesday. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allce.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.