Mind Body Connection: How Health, Thoughts, Feelings and Behaviors Interact

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@Allce.com Counselortoolbox you I'd like to welcome everybody today's presentation on the mind body connection. How your health, thoughts, feelings and behaviors all interact. I am Dr. Donnelly Snipes. One of the things that I want us to really focus on is the fact that a healthy body is essential to health and happiness. What we think and the way we react and our feelings impact our physical body and our physical body impacts how we think and feel and all that kind of stuff. We're going to explore briefly how emotions are created, how physical symptoms including pain and fatigue are created. And we're going to look at some of the similarities between those things and. Between those things and mental health issues. We're going to explore how this is done through the autonomic nervous system, the peripheral nervous system, the HPA axis, circadian rhythms, the gut brain axis and the vagus nerve. And we're also going to keep looking at it through a bi directional relationship. So there's a lot of stuff that we're going to cover. How are emotions created? Well, we're going to simplify this as much as possible. We are born with the capacity for anger to the fight. We are born with the capacity for fear, the flee or freeze or cry in the case of a baby. And we are born with the capacity for depression, which is sort of the, forget about it. We'll use that word to be euphemistic right now. All of those things are innate emotions that we have now. What how we respond to any particular stressor depends in part on whether it's an innate stressor or one that's there from birth, or it's a learned stressor. Our emotional responses are regulated by the autonomic nervous system. The sympathetic nervous system lets us bite or flee. If something happens and it startles us like it startles a baby, then the baby will start to cry. If you take a baby and you know you hopefully don't drop them, but you move them backward quickly, they may try to put their arms out to catch themselves. That is a natural reaction to that stimulus. The parasympathetic nervous system is the rest and relax. And that's the one that kicks in with when the threat of danger, whatever the danger was, is gone, when the system is no longer under stress. If the baby is too hot, then that is a stressor and it's going to trigger that Sympathetic nervous system. When the baby is at a good temperature, then they are going to trigger the parasympathetic nervous system. Now the limbic system helps control the ANS and PSNs and it is comprised of the hippocampus, which is responsible for memory consolidation, learning, attention and olfaction. Why is this important? Well, memory consolidation, when we experience something, whether it's good or bad, we form a memory and that memory gets filed away in those filing cabinets in our head that we call as what we call schemas. Learning. Obviously when we experience, experience something and we have a memory, we've learned from it. We've learned it was a positive thing, we've learned it was a negative thing. We've learned maybe what to do differently. The hippocampus is also responsible for attention. What are we going to pay attention to? What stimuli in the environment are going to catch our attention? If we were, heaven forbid, attacked by a dog at some point, then our hippocampus is going to learn that maybe dogs are dangerous. We're going to have that memory, it's going to get filed away in, in our schema, in the, in our heads, and we are going to be more alert to dogs in the environment. Whereas, you know, other people who haven't had unpleasant experiences with dogs may be a little bit more oblivious to dogs in the environment. The hippocampus, you know, starts helping us preparing and olfaction. The hippocampus is responsible for helping us be able to smell and also connecting smell with memory. And that's really important. The amygdala is part of our brain and that is our fight, flee or survival part of our brain. It's a very primitive part of our brain. And the hypothalamus is responsible for hormone regulation and regulation to a certain extent of the HPA axis, which is the hypothalamic, pituitary, adrenal axis, and finally the prefrontal cortex, which is responsible for our higher order cognition and impulse control. All of these things are in the limbic system. And when we have an experience, it affects, affects all of those things. It affects our memories and our learning and what we pay attention to, which if we have a bad experience can mean that we perceive the environment as more dangerous and we tend to be more hyper vigilant, which is going to keep us under chronic stress. It affects the amygdala, which is going to help us stay protected. And if the amygdala is upset, for lack of a better word, or activated, then we're going to tend to experience more distress. And the hypothalamus regulates the physiological reactions, the hormone regulation. It's going to send out hormones and neurotransmitters that help us fight or flee. It's going to help secrete the norepinephrine and the adrenaline and the cortisol. All of these things are important. It's our thoughts, our, our perceptions and our internal physiological reactions. And yes, the sense of smell is actually one of the strongest triggers of memory, Partly because it's controlled in part by the hippocampus. The good thing is the sense of smell and smell, is it tied to memories, but not just bad memories. It can be tied to really good memories. And that's one of those triggers we can help people add to their environment to increase their sense of calm and relaxation and happiness. Encouraging people to think about what smells really make you happy. When I go outside and I can't tell you exactly what it is, but you go outside and the air is crisp and it smells like fall, I can't put a label on it and it's not pumpkin spice, trust me, but that makes me happy. I smell that smell and just naturally get a smile on my face. When we get down to the slide on allostatic load, sometimes we can't eliminate all of the stressors people experience. Probably can't ever eliminate all of them. But we can counter them by adding strengths and resources and positive feelings. One of the things that we can do there is increase the positive triggers for positive emotions. Emotions can be created, as I mentioned earlier, from unconditioned and conditioned stimuli. Unconditioned emotional responses are reactions to stimuli that didn't need to be learned. They're present from birth. I volunteered this weekend at an animal rescue and there was a mama dog there who had just had puppies, cutest little puppies. But you know, we had to rearrange them a little bit so we could clean up the room that she was in. And I picked up this puppy and you know, it didn't know me from Adam's house cat, probably maybe 4 ounces. Little tiny thing just started to growl. I could feel it growling, its little abdomen just kind of vibrating because it was growling at me. It was going to tell me about it, which was really very cute. That was an unconditioned emotional response. It felt fear, so it started getting angry or attack fighting, if you will. When children go to the doctor, they experience pain, they get a shot. Babies do this. They get a shot, they cry, it hurt. And that is their call. Because they're not big enough to fight for something that is their call for their caregiver to come fight and protect them. That is a natural, innate sort of response to pain, love and contentment. The release of oxytocin is another unconditioned emotional response. People tend to feel more. Calm when they are interacting with other people. And love and contentment. We can see this as an unconditioned response with kangaroo care. When you take infants that have been born prematurely and you hold them, the infants are tend to show lower cortisol levels, lower blood pressure and lower levels of agitation on multiple different levels. That oxytocin is just naturally released when there is that skin to skin contact and that can help them feel calmer or more content. Then there are our conditioned emotional responses. The unconditioned emotional responses are there to promote our survival. And generally we don't want a monkey with those. Those are things that are there for a reason. Conditioned emotional responses aren't necessarily accurately learned. So let's think about some things that people have differing responses to that can cause or reduce stress. Dogs for example, when dogs are present, some people are afraid of dogs and they see a dog and they trigger their stress response and they get panicked and anxiety stricken. Other people, when they see dogs, they're like me and they're just like, oh let me see the little puppy. Doesn't really matter how big or how small the dog is, it just makes us happy. Fire is another thing. Some people who've had bad experiences with fire will, when they're exposed to fire, even in a fireplace or at a bonfire, may have a flashback or a stress related reaction to that sight of fire or to the smell of fire. Others of us who haven't had those negative experiences may have positive experiences with fire, like sitting in front of the fireplace with our families. Depending on people's prior experiences will shape their emotional response. Doesn't mean there is emotional response is bad or good. It just means that it is what it is. Police are the same way. Phone calls. Some of us, or very few of us actually get real phone calls anymore. So when my phone rings, I, I know it's either an emergency or a telemarketer and neither one of them makes me happy. The phone is now a, when it rings is now often a negative stimulus and you know, prompts a unpleasant reaction. There are some things that we learn when we are younger, such as when we're alone. When you're alone and you're a child and you know that can be terrifying. I remember one time my son was in his room and we were in the backyard washing the cars. And I got in the car to move the car out of the backyard, not to leave. But he saw me getting in the car and driving away. And he lost his cookies because he didn't understand that I was just moving the car to the driveway. That was terrifying for him. Children, you know, can get scared by being alone. If that goes unchecked, then they may have fears when they become adults and may have difficulty being alone when they become adults. At a certain point, you know, when you're, when you're younger, you go through this process where, you know, mom and dad may leave you alone for an hour while they go to the grocery store, and then maybe for a few hours while they go to dinner, and then maybe when you get a little bit older for an overnight or something. So you're gradually exposed to experiences that push the envelope but don't make you feel terrified. If you're not exposed to that, then you can grow up and be an adult who is, you know, terrified of being home alone at night. Some of these things. My point is that some of these things that we learn as children, whether it's because of our age or just something that happened when we were children, we may need to check those for their accuracy in the present. Is this still threatening? And we want our clients to really check some of those schema and go, is this schema still accurate? Transference reactions can also prompt a stress reaction. When we're perceiving the environment and we see someone who reminds us, let's stay on a positive note, see someone who reminds us of our first love or somebody who brings back a positive memory, then we may have a positive feeling even though it's not that person, you know, the person that we had that positive experience with, we're seeing someone that reminds us of them. So we're having similar positive feelings. Obviously, the same thing can be negative. How we react to failure, rejection and loss of control also depends on how we've experienced it in the past. If we've failed, for example, and you know, we were helped to see it as a challenge and a growth experience and you know, yada, yada, yada. Then when we experience failure now, it may not be a big deal or as big of a deal when, if somebody experienced failure as in their past and it was a big deal and they were rejected and, you know, they had all kinds of losses associated with it, then when they fail now, they may feel very self conscious, may Feel very anxious or angry. It's all about our learning and those memories that are in the hypothalamus. The HPA axis is our threat response system. And I've talked about this a lot before, but when we're under stress, what happens? We have a thought, we have a physical sensation, we have some sort of experience that causes us pain or discomfort or stress. Our body secretes adrenaline, norepinephrine and corticotropin releasing hormone or crh. Then cortisol is released, our body starts releasing that stress hormone, cortisol. Glutamate is also released and gaba, our relaxation hormone, is inhibited. So any GABA in there, let's just get rid of it for right now. Because we need to release the glutamate. Blood pressure increases. Well, we need to fight or flee, so we need to get that blood pumping. Blood glucose is elevated. We need to fight or flee. So we need energy in order to make that happen. Another interesting thing that happens, we tend to think of serotonin as a single molecule with single receptors, and that's just not the way it is. Some serotonin is excitatory and some serotonin is calming or inhibitory. We do need to kind of recognize that. So when this HPA axis gets kicked off, some serotonin receptors are activated that prompt our motivation and energy and focus. And others are inhibited when the body finally perceives the all clear. GABA and serotonin, the calming serotonin, are released and the system down regulates. When we're talking about neurotransmitters, it's important to remember that for the lion's share of neurotransmitters that are out there, there are multiple types, there are multiple dopamine receptors, there are multiple serotonin receptors, and they all do slightly different things, which is why there's so much confusion in, you know, what causes us to feel anxiety or depression. Well, some people say that too much serotonin causes anxiety and too little serotonin causes depression. We. Well, that's oversimplified because it depends on how much of the different serotonin receptors and which serotonin receptors are activated. Over activated or under activated. Another thing that's affected by these hormones, it's not just our moods, our hormones, our neurotransmitters and our hormones also affect our capacity and desire to attach and connect to other people. Dopamine, norepinephrine, cortisol, interestingly enough, oxytocin and the serotonergic can never say that Word serotonergic system. Modulate attachment. What does that mean? That means when we don't have attachment or when there's a problem, we're going to have increases in cortisol and we're going to have more negative feelings about it. When we have a positive attachment, dopamine is going to be released, which is our perseverance neurochemical, for lack of a better word. Dopamine makes us want to keep going after it. It's our go get it neurochemical. It's our motivation neurochemical. Norepinephrine is also responsible for motivation and action. Norepinephrine and glutamate are our two main excitatory neurochemicals. When we are in, you know, think about that first three months or, you know, if you're really lucky, 30 years of a relationship and when you see that person, you have this feeling of happiness and you want to be with them all the time. That's the dopamine. And you get energized when you're around them. That's the norepinephrine. The oxytocin comes out and it says, let's do more of that. And then your serotonin also modulates it. Interestingly, opioids, not just, you know, heroin, but any opioids, may inhibit oxytocin and reduce feelings of social connection, which is an interesting thing to look at if we've got a client. Not necessarily abusing opioids, but there are a lot of people who are on pain management protocols in which they're taking opioids consistently. How does that affect their relationships? How does that affect their desire to interact with other people? Now when they're not on the opioids and their pain is uncontrolled, how does that affect their relationships? You know, neither one is a win win. But we do want to recognize that opioids do downregulate certain hormones that can cause problems with attachment. So some caveats here. When we're talking about these hormones and neurotransmitters that cause emotions and prompt the fight or flight reaction, the body has to have the resources to make the hormones and neurotransmitters. If it doesn't have the building blocks, it can't make the neurotransmitters. So people are not going to be able to feel those feelings as much. The way we interpret the world or think about it impacts the frequency and intensity of euphoric and dysphoric emotions. If you are somebody who tends to be a negative Nelly and you see everything as a conspiracy or, you know, going, going to crap, or you know that you see a foreshortened future, you perceive doom everywhere you look, then you're going to interpret that negatively, which is going to keep that HPA axis activated. Because your body is going to go. There's a threat. There's a threat. If you interpret the world, the same world, in terms of what you can and cannot control and you're able to identify things that are positive, then you may have more euphoric emotions. It doesn't mean you're going to completely ignore the bad things and you won't have dysphoric emotions, but you're going to. We all have frustrations and anxiety and depression. That happens occasionally. It's about the balance. The way we react to stress, though, impacts the neurobiology of our body. When we are happy, we have, you know, happy chemical soup. And that also impacts our sex hormones, our thyroid hormones, you know, the whole gamut. When we are stressed, when we are angry, when we are depressed, then you've got the negative neurochemical soup which also impacts thyroid hormones, sex hormones, and all of those things impact our life. When you think of it in this cascade or ripple effect, just because I'm in a bad mood or exposed to chronic stress, if that keeps my HPA axis activated and reduces my calming serotonin and reduces my availability of estrogen, and reduces my libido and reduces my desire to interact with others, and because of the reduced serotonin, I have reduced sleep quality, then that's gonna all create additional stress, which is going to continue to trigger keep the HPA axis activated. What we do, including exercise, laughter, happy thoughts, doing things that make you happy, and engaging with positive social supports, among other things, can all reduce cortisol, increase positive endorphins, and possibly increase serotonin and dopamine levels. All those things are good. What we do, including sedentary ness, shallow breathing, sleep deprivation, ineffectively communicating so we don't get our needs met, and then we get irritable about it and exposing ourselves to stressful situations or noxious stimuli can increase HPA axis activation. Some of these things we can't avoid. If you work in a stressful environment, if you work in an emergency room, you're going to be exposed to some stressful situations and that's going to increase your HPA axis activation when you. Which means we need to balance it out. We can't necessarily make it go away, nor would we want to, but we need to be Cognizant of how much time people are spending in their fight or flight state versus their rest or relaxed state. Certain physical conditions, like polycystic ovarian syndrome, menopause, autoimmune disorders, and other things may be caused by or may cause chronic HPA axis activation. With menopause, when the hormones start to become unbalanced, the body desperately tries to rebalance it, which it interprets this imbalance as a stress and can activate that HPA axis, which will in turn further suppress the estrogen. And it's this whole downward negative feeling feedback loop. Autoimmune disorders. When somebody has an autoimmune disorder, they have typically inflammation somewhere in their system or systemically, which is perceived by the body as a stressor. When the body perceives a stressor, it activates the HPA axis, which sends out that cascade of chemicals which inadvertently increases inflammation. So the autoimmune disorder is actually triggering the HPA axis, which is actually making the autoimmune disorder worse. We can help people break these cycles, but they have to understand the. We don't live in a vacuum. You can't just address one little thing. We've got to figure out what are all the things that might be contributing to imbalances in your system. Our bodies want to maintain homeostasis. If we lived in the ideal conditions in this utopia and we had, you know, beautiful, adequate nutrition and all that kind of stuff, you know, that's wonderful. And our body would naturally balance out its neurotransmitters for the most part. There are some people who have some genetic predispositions to, you know, low serotonin or whatever, but for the most part, most people would be able to balance that out. In therapy. We can help people identify ways that they can optimize their body, can optimize their, you know, body system to be able to most effectively serve them. Neurotransmitters, pain and fatigue, serotonin involved. And let me see if I can pull this up real quick while I'm talking. Whoops. Now, that's not what I want you to do. I encourage you, if you are at all interested in neurotransmitters, to go look at this chart later. We don't have near enough time to go over it, but this one talks about the 14 known serotonin receptors. So 14 different types of serotonin with 14 different, slightly different duties, if you will. But serotonin is responsible for everything from mood to appetite to blood pressure, cardiovascular function, memory, mood, nausea, pain perception, penile erection, Respiration, sexual behavior, and the list goes on. And you have all of these different ones. And the neat thing about this chart is it talks about medications that are agonists that will increase that. That receptor activity and antagonists or medications that will decrease that receptor activity. So you can look at the medications that your patients are on and figure out, you know, what might be going on here. If they are taking, you know, an atypical antipsychotic, how is that impacting their mood? If they start to become depressed when they're on the atypical antipsychotic, why might that be? Like I said, that's a whole different class. Just looking at those neurotransmitter receptors, the key takeaway point is there are a lot of different types of serotonin receptors out there. The 5ht2a receptor produces anxiety, pain, and insomnia. That's your excitatory neurotransmitter. It doesn't necessarily always produce anxiety, but it is a stimulatory receptor for serotonin. Your 5 HT1A, which is typically the target of your SSRIs, works to reduce anxiety, pain, and insomnia. It does that. Your medications do regulate serotonin. But interestingly, when serotonin is affected, changed, increased, decreased, whatever you want to say, that also affects the availability of dopamine. Oh, now remember that in schizophrenia, for example, there is a dopamine imbalance, and a lot of your atypical antipsychotics and your antipsychotics reduce dopamine levels. How does that affect serotonin? GABA may decrease the perception of pain, and GABA also affects the availability of the other neurotransmitters. Dopamine helps relieve pain and increases energy and desire, motivation, you know, your go get it sort of attitude. And norepinephrine is activated during pain, both emotional and physical pain, because it's one of those first chemicals that the HPA axis sends out and causes decreased sensitivity to painful stimuli and pain relief. So it can cause some physical pain relief. A lot of times when people are really upset, you know, they may not be feeling as much pain. And this is physical pain. And this is partly because of the norepinephrine. Norepinephrine also mobilizes the brain and the body for action. It's that energetic part of fight or flee. Up to 95% of neurotransmitters are made in the gut. Okay, so we already talked about our perceptions and how we want to look at the environment and assess the environment. For positive triggers and for stressors. We already started talking about the fact that we need to have a healthy body because disruptions for whatever reason, and it can be just age related or anything else, disruptions in our hormones, whether it's our sex hormones or our thyroid hormones or whatever, can cause neurotransmitter imbalances. But our gut is also super important and we're just now really starting to learn more, more about this over the past five, 10 years. The gut communicates with the brain through the vagus nerve and the enteric nervous system they found with mice and obviously they can't do this in humans. But when the vagus nerve was cut, the gut could not communicate with the brain. When the vagus nerve was intact and mice were fed, certain bacteria affected their depressive symptoms. The similar mice who were fed the Lactobacillus bacteria who had their vagus nerve cut still exhibited depression. So they determined through some of these studies that the vagus nerve communicates with the brain. Lactobacillus, which is your yogurt bacteria, produces acetylcholine. Now for those of you who don't really remember what acetylcholine does, acetylcholine controls voluntary movement, memory, learning and sleeping patterns. Too much acetylcholine can cause depression, whereas deficiencies in acetylcholine can cause dementia. And there are the cholinesterase inhibitors that are out there that will affect the level of acetylcholine. Looking again at what medications our patients are taking, not just for psychiatric reasons, but for their blood pressure, for their gastric reflux and all those other things, Candida, which has gotten a bad rap, Streptococcus, which none of us really want to have, E. Coli and enterococcus are all in our gut and they need to be there in order to produce serotonin 5ht. And that's for all of the, all of the receptors. We need to have a certain amount of those in our gut. You don't want to eradicate them completely. Serratia is another gram negative bacteria and it's responsible for a lot of hospital infections, you know, not mrsa, but infections that you typically only get through after surgery and those sorts of things that is also in our gut and it produces dopamine, lactobacillus, bifidobacterium, Candida and streptococcus also secrete GABA and regulate endocannabinoid expression. Alright, so we know basically the take home from that is there's a bunch of bacteria in our Gut and they are responsible for producing at least a portion of our gaba, dopamine, serotonin, acetylcholine, and, and the endocannabinoid system, that's the one that is basically our natural marijuana, if you will. The cannabinoid receptors are also regulated by those bacteria. Who knew? A healthy gut microbiome can decrease depression and anxiety, regulate sleep, appetite and improve cognition. But there are over thousand species of bacteria in a healthy gut microbiome. You're not going to go out and get a pill that's going to give you every single one of those. They flourish under proper nutrition, go figure. And they will naturally balance themselves out. An unhealthy gut microbiome contributes to an exaggerated HPA axis response. And you know, there wasn't a whole lot of definition about how unhealthy the gut microbiome had to be. The basic take home message is we want to ensure that people are feeding those bacteria with the food that they need in so they can produce the neurotransmitters that we need to feel happy. And other things are made in the gut too, not just those, not just neurotransmitters. The effect of acute stress, now this is interesting, is limited due the microbiota's long time relative stable state. But chronic stress can disturb this balance. When you get sick, when you get the flu, when you have a really bad day at work or, you know, maybe there's a death in your family or something that is even an extreme chronic or an extreme acute stressor. Yes, it's going to alter the gut function a little bit for a short period of time. But the microbiome bounces back really quickly because there's enough stragglers left around that it can replenish itself as soon as the stressor is gone. Under chronic stress, the microbiome may change indefinitely. When we, when the HPA axis is activated, one of the things it does is speed up our digestion and excretion of stuff because you know, we don't need to be digesting right now. We need to be using energy to fight or flee that. Also, if under chronic stress, if we keep that going, our system may be going a little bit faster. But that also means that there's less time for nutrient absorption, which means that basically the bacteria in our gut are going to starve and we don't want the little suckers to starve. The structural of intestinal, intestinal microbiota is strongly influenced by diet, you know, and environmental stressors. When we are under Stress. When that HPA axis is activated, it's going to influence the microbiome corticotrophin releasing factor. Remember that one of those chemicals that's released at the beginning of the HPA axis activation plays an important role in changing intestinal permeability. Now you can go back and watch the video on leaky gut, or you can look up leaky gut and learn more about intestinal permeability. But basically, when our intestines become more permeable, then more of those inflammatory cytokines and chemicals can disperse into the body, which causes systemic inflammation. Research suggests that gut brain axis dysfunction may be involved in the development of mood disorders, schizophrenia, addiction, neurodevelopment and neurodegenerative diseases, as well as age related cognitive decline. This is interesting to take a look at. There is a whole field of nutritional psychology that is becoming much more prominent now as they realize how important it is, you know, what we actually eat. The treatment of these conditions, our mood conditions, may adversely affect the composition of the intestinal microbiome because antipsychotics and antidepressants are also, interestingly enough, antibacterial agents. So when we take psychotropic medications, it actually alters the function of the microbiome. Now that might be helpful. Maybe we do need a little less of some bacteria in order to feel a certain way. But we're now starting to realize that maybe the psychotropic medications we're taking are having are affecting our mood by altering the balance of the bacteria in the microbiome, maybe in addition to, you know, causing changes in reception of certain neurotransmitters. But it's kind of an interesting thing to ponder. As I said before, the endocannabinoid system, this is your cannabis receptors, basically. Clinical studies revealed that altered endocannabinoid signaling exists in patients with both chronic depression and chronic pain. We know that the endocannabinoid system somehow is involved. We're not exactly sure how, but we do know dysregulation is associated with schizophrenia and depression. Your CB1, your endocannabinoid receptor, plays a crucial role in preventing neurotoxicity caused by activation of glutamate and methyl diasporate receptors. The short version, HPA axis is activated. Norepinephrine and glutamate, glutamine or glutamate are secreted. Those are our two main excitatory neurotransmitters. When we have too much glutamate, it can be too stimulating, too exciting, and it becomes neurotoxic so the CB1 receptors in there, in our cannabinoid system help protect us from too much stimulation. If those receptors are not working well, then it can become neurotoxic and we can start to develop symptoms. Inadequate endocannabinoid control may produce excess or insufficient dampening of NMDIR activity, thus promoting dopamine signaling, such as in schizophrenia. So there's too much dopamine or diminishing serotonergic activity as observed in depression, so it can alter. Our endocannabinoid system affects both dopamine and serotonin levels. Our endocannabinoid system has been associated with helping with or in the case of dysfunction, causing problems in neurotransmission, neuroendocrine function, inflammatory processes. So if we can't transmit the messages to begin with, well, that's a problem. If we have problems in our neuroendocrine system, our hormones, that's going to affect the level of neurotransmitters. And if there's inflammation, we know it's going to keep the HPA axis activated as well as contribute to the formation of symptoms associated with depression. As A side note, Omega 3s have shown a neuroprotective function and can help modulate activity in the endocannabinoid system, which points to why nutrition can be important. It's not going to do everything. But most Americans diets are sorely deficient in omega 3s and they found pretty impressive results from simply altering omega 3 levels in some individuals. Cortisol helps regulate our circadian rhythms. It's not just a bad thing. Cortisol gives us the motivation to get out of bed in the morning right before we wake up. Our cortisol levels go way up. That's our body going, hey, get out of bed, it's time for another day. So cortisol isn't all bad. It's just too much cortisol for too long, that can be a problem. Our circadian rhythms also regulate our cortisol levels. If your circadian rhythms are out of whack, then your body doesn't know when it's supposed to have that get up surge and when it's supposed to decline like it does throughout the day so you can go to sleep. Cortisol peaks and then drops throughout the day, reaching its lowest levels when it's time to go to sleep. If your body doesn't know when it's time to sleep, then it doesn't know when it's time to pull back the cortisol and increase the melatonin. Just simple disruption of these circadian rhythms is also a stressor. It throws off circadian rhythms. Disruption not only throws off cortisol levels, but it also throws off ghrelin and leptin levels, which are our hunger and satiation hormones. Hence the reason that that we start seeing changes in eating behaviors in people with depression. So what causes stress? Physical pain from injury, inflammation, intense exercise and over training can all increase stress, increase inflammation, increase cortisol levels. Physical illness or dysregulation. And this can be because of hormone issues that can include, not that pregnancy is an illness, but that can include pregnancy. That's a stressor on the body. Brain health. If there's a traumatic brain injury or the person, you know, develops Korsakoff syndrome or just sickness, just general having a bad cold can cause stress on the body. The body has to exert more energy to do something the amygdala recognizes. When we're sick or we're in pain, we're basically the weak link in the pride. So the rest of our group can go on, and we're probably going to be the one that gets eaten by the hungry lion, because we don't. We're more vulnerable when we are in pain or we're sick. Nutrient availability causes stress. If you don't have enough of all the right nutrients, then your body may be struggling to get along, which is why iodine was actually added to table salt, because people weren't getting enough iodine and it was causing physical problems. Medications can also cause stress. There are a lot of side effects from medications, and we are only beginning to understand the whole impact of medications on our body. Not just, you know, relieving pain, but how does it affect the microbiome and how does it interact with hormones and everything else. Gut health or ill health can also cause stress. If you get, you know, some sort of bug, if you will, a tummy bug, it's going to upset your microbiome. If you have ulcers or gastric reflux disease, it's going to upset your microbiome. If your stomach is too acidic, you see where we go. Nutrition deficiencies due to lack of nutrient consumption is one part or malabsorption. When that HPA axis is activated a lot, you've got food and nutrients flowing through that body, but they may be flowing out before they have a chance to get absorbed. Or in the case of people who've had bariatric surgery or who are anorexic or bulimic, you also have malabsorption and nutrient deficiency problems. Hypo or hypoglycemia and insulin resistance all impact the body's ability to react to stressors. When cortisol is released, blood sugar is dumped. If there's no blood sugar or not enough blood sugar, we're going to have hypoglycemia, which has been linked to the development of dementia. If it gets dumped but our body doesn't know how to handle it and it can't get back into the cells, then we may have hyperglycemia, which can also be neurotoxic in its own way. Lack of sleep causes stress. Prior learning experiences. This is one area we can help with too. Those prior learning from schemas, from ptsd. If somebody has developed an idea and generalized their stressful stimuli so it appears that they are constantly in danger, then they are going to be under stress a lot more. We want to help them address those prior learning experiences and identify, using cognitive tools or whatever you want to do to identify the accuracy of those current learning. Prior learning experiences in their current situation. What was threatening when they were six may not be a big deal now that they're 26, but we don't know until we take a look at it. The physical environment can cause stress if it's too hot. You know, think about if you get really well. When I get really hot, I get really cranky. I don't do hot very well. I can do cold better than hot. Some people are just the opposite. When my son was young and he would get hot, oh, he would scream and we just start taking off clothes as quick as possible to help him cool down, and he would, he would calm right down. Noise in our physical environment, whether it's dogs that are barking constantly or, you know, neighbors that are constantly fighting or playing their radio too loud or doing something else, or train that goes by every 15 minutes, any of that can be a stimuli. You also want to think about your physical environment at work. You know, what does it smell like, what does it look like, what does it sound like? And what's the, for lack of a better word, aura at your, where you work? Do you walk in there and is the stress palpable? If it is, that's your physical environment and that is having a, would have a negative effect on you. If you walk into your workplace and it is a positive, warm, exciting environment, you're thrilled to be there, then that's going to have a totally different reaction or interaction with your stress response system and your social environment. If you're Involved with people who are positive, then it will typically help you buffer that stress. If you're involved with people who are negative, it will typically increase rumination and increase focus on the negative things. In a state of chronic stress, the body does everything it can to survive, leading to two situations. Hypercortisolism, too much cortisol, where the negative feedback mechanism doesn't kick in to protect against the ever present danger. The negative feedback mechanism is the one that says, okay, all's clear, well, that's gone. So the person is constantly on edge, constantly hyper vigilant. They are in the fight, flight or freeze state, you know, trying to protect themselves. Think about what a bunny rabbit does when it is threatened. You know, sometimes it fights, especially if it's, you know, with another bunny rabbit. Most of the time it flees, but if it hears a hawk, it may freeze. And that is a survival mechanism that results from being hypervigilant. Hypocortisolism, too little cortisol is when the body is just basically low on cortisol and cortisol levels are lower. The body's decided, I can't win this, I can't fight this, I can't throw any more cortisol at it. I need to reserve, hold on to my energy reserves for when there's really a true threat. And this is when we see depression or the forget about it sort of state where people may perceive something as a problem. Normally they get upset about it, but now they just ain't got the energy and they look at it and go, whatever. It's just one more thing on the pile. Interestingly, our base, our flatline cortisol levels are reduced after exposure to chronic uncontrollable stressors, which supports the notion that our body just quits throwing cortisol at it and lowers our cortisol levels and says, you know what? No, we don't have the energy to be stressed right now. You need to conserve energy. Chronic stress causes inflammatory cytokines to be released which interfere with hypothalamic and pituitary function. Those inflammatory cytokines are released during the HPA axis process. The hypothalamus and the pituitary gland are responsible for producing precursors to the thyroid hormones. So if they are dysfunctioning, then you're probably going to end up with somebody who has hypothyroid chronic stress. And the inflammatory cytokines can also suppress the sensitivity of thyroid hormone receptors to the thyroid hormones. So even people with normal T3 and T4 levels, they go to the doctor, they get it measured. Nothing. You know, they're in normal range. They may still be symptomatic. This is, you know, when I look at blood levels, I ask the person, you know, how they feel, and if they are at the low end of normal, you know, that may clue in that their hormone receptors may not be as active. Is there much we can do about it? No, not really. Right now, we need to help them reduce the inflammation. Most doctors are not going to prescribe any sort of thyroid medication if their levels are normal. So we need to look at why are you still having these symptoms if your levels are. If your levels are normal? The emotional impact of a stressor is determined by our allostatic load. And I talked about that earlier. This is the sum total of all of our stressors, plus all of our strengths and resources. If somebody's resources and strengths completely balance out their stressors, you know, they have, you know, a few days off and a few days of stress, and it kind of balances out, Then they're what I call a sum total of zero. When they have more resources and strengths than stressors, you know, they're. They're doing really good. They've had a great year. Nothing major has gone wrong. They built up some reserves. So their sum total of their allostatic load is going to. To be positive, and so will their mood. When they have more stressors, which is generally where people are when they come into counseling. When they have more stressors than their resources and strengths, then they're getting overwhelmed, and their sum total of their allostatic load is negative. What does that mean? Well, when our allostatic load is 0 and a stressor happens, you know, it's a bugger and a half, but we can deal with it. When our allostatic load is positive and something happens, we may not like it, but we've got the reserves. We're like, all right, you know, let's just put our head down. We can get through this. If the allostatic load is negative and something bad happens, it tends to feel more catastrophic because the person is already exhausted and worn down. Consequences of HPA axis activation, irritability, both physiological and behavioral and emotional perseveration. When our HPA axis is activated, we are going to constantly be scanning and hypervigilant for threats. But we're also then going to tend to perseverate on whatever caused this current crisis because we want to make it go away, and we're going to be stuck on that. Sometimes we can't fix it, and that's when people start having challenges. If they get stuck on something that and they're perseverating on something that they may have no control over. Sleep disruption. You're not going to sleep well if your HPA axis thinks that there's a threat. Increased pain in the long term because our dopamine and our serotonin levels have been suppressed. We also have muscle tension, increased GI motility from those excitatory neurotransmitters, changes in the gut microbiome, reduced libido, hypothyroid because the hypothalamus and pituitary gland start to dysfunction. So the thyroid hormones are not going to be made as effectively social withdrawal, eating changes because of alterations in ghrelin and our circadian rhythms, inflammation and increased sense of helplessness and reduced motivation. When people are exposed to chronic stress, when something else happens, they tend to more quickly give up and just be like, I don't have it in me. And they also tend to. It takes them longer to get motivated to get going again. Every time they get knocked down, it takes them longer to get back up. Basically, the mind helps the body interpret signals based on the stimuli in the current environment. You know, we're going to look around and prior learning, you know, if we see things in the current environment are good, then we're going to feel happy. If we see things in the current environment that we associate with threat or trauma or danger, then it's going to trigger that stress response. The body sends out messages in the form of hormones and neurochemicals which produce physiological reactions that we label with emotional words. When we are riding a roller coaster, you know that HPA axis is going to be kicked off and there's going to be a stress response. We're going to have glutamate, norepinephrine. But if the person labels it as excitement, then they're going to have more dopamine. If they label it as terror, then they're going to have more of the stress response or the dysphoric stress response. Positive emotions promote HPA axis downregulation which improves attachment and sleep, reduces cortisol, increases the antidepressant serotonin GABA dopamine and reduces pain. The mind body system is bidirectional and complex. Therefore it's essential to explore all the causes of symptoms and enhance factors that promote positive changes. I have two minutes here to go back to bidirectional real quickly. When we're irritable, then we're going to tend to perceive more unpleasantness in the environment, which is going to keep that HPA axis activated. When, which is going to make us irritable when we are hyper vigilant. Same way when we have sleep disruption. Maybe you've got a crying baby and you know, a new baby at home, you're not sleeping well, it disrupts your sleep. That is going to trigger that HPA axis, you're going to be more stressed, which is going to make it harder to get good sleep, which is going to increase your sleep disruption. So it's bi directional. These things can cause HPA axis activation and HPA axis activation can cause these things. The good news is we can start just plucking away at these things and say, okay, which ones of these can we normalize and start helping people improve their allostatic load? Now there were a couple of questions. Oh yes, fibromyalgia and pretty much any autoimmune condition is usually activated and exacerbated by stress, intense acute stress and chronic stress. And activation of the autoimmune conditions increases inflammation, which triggers the HPA axis, which increases stress, which is going to make the autoimmune condition even worse. So you again, you want to look at that bi directional relationship and say, okay, where is it that we can start, you know, pulling the plug and breaking this cycle? Hypo and hypercortisolism can be tested for and treated specifically. Although a lot of times doctors, there's such a wide range for, quote, normal cortisol that most doctors are not going to medicate for it unless they are specifically trained in identifying hypocortisol dysfunction, basically. But yes, it can be treated by a blood test and it can be tested for by a blood test and treated. Unfortunately, the typical treatment for hypocortisolism is to give the person prednisone, which is a steroid and that has all kinds of negative side effects with it. If the person can figure out lifestyle changes and cognitive changes that can help improve their situation and reduce their HPA axis, it's possible that their cortisol levels will restabilize. There's a lot of research out there about people with how people with PTSD often have hypocortisolism and by addressing the PTSD symptoms, their cortisol levels tend to rise more over time. It's not something that happens in a month. Like I said, this is a really in depth topic and I couldn't begin to touch on everything I wanted to. Today the biggest take home is I want you guys to recognize the fact that we are really doing people a disservice if we are not helping them recognize that it's not just how they think that's impacting their emotions. And you know, I'm cognitive behavioral at heart, but it's also what they eat and what they do and how they treat their body and and the environment that they place themselves in that are that all contribute to their mood and their happiness. Alrighty everybody, thank you for being here today and I'll see you on Thursday when we talk about it was a request from y' all from one of you. 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