Oxytocin’s Influence on Immune Function, Pain Modulation & Metabolism

Welcome to this presentation on how oxytocin shapes stress, attachment, mood and health. I'm your host, Dr. Donnelly Snipes. For many people, relationships are not regulating or calming. Closeness actually activates their threat, vigilance, shame or pain responses. So assuming that telling people to develop supportive social networks is going to help them is a huge leap and one that a lot of people are not ready to take early in recovery, telling people to, quote, increase connection can actually biologically worsen stress physiology. I can even see it when I'm sitting in the room with them. If you tell them, you know, it's important for you to try to develop social support systems. You can see them tense up because they're social support systems to date have been inadequate or rejecting, abandoning, or something else. So we don't want to assume. Our clinical task is to educate clients about all of the different ways that oxytocin impacts their life. Oxytocin has its grimy little mitts in just about every system, mainly indirectly through helping regulate the stress response. But we'll get to that. We need to increase people's awareness of how they respond in interpersonal situations, whether they fight, flee, freeze, fawn or flop. And we want to help increase oxytocin supportive experiences that don't require interpersonal vulnerability and enable them to create a sense of safety and connectedness. So we're going to learn what oxytocin actually does and identify ways to increase it, when appropriate, to create safety and connection action without activating relational threat. Oxytocin is both a hormone and a peptide sweet. So it does, you know, kind of double duty. It shifts stress, responding toward relationship based, relationship based survival strategies. Oxytocin, instead of thinking of it as our love and our bonding hormone, oxytocin is our tendon defender hormone, or our mama bear hormone, as I like to call it. Mama bears love their cubs and they want to nurture their cubs and their cubs crawl all over them, and that's wonderful. But if somebody threatens their cubs, oh, and mama bear will do everything to defend her cubs. In both instances, mama bear's oxytocin is high. And I'm not actually sure if that's actually what happens in bears or not, but it's the metaphor. Oxytocin modulates how the brain interprets internal and social signals. So if somebody has been in a social situation before that has been threatening, rejecting, inconsistent, chaotic, then when they get in those social situations, the brain may remember what those things are like. And oxytocin helps the brain assign Meaning basically and interpret what's going on based on prior experiences, not necessarily based on fit cat or the facts in this context at this time. Oxytocin alters social salience. When people have high levels of oxytocin and they're, they're in that defend mode, then they are going to perceive faces, tone, proximity or threat cues a lot more prominently or intensely than if they are in the tend mode, if you will, the bonding mode. They feel safe, in which case they'll look around and the same faces, same tone, same proximity may not feel nearly as threatening. So oxytocin helps modulate how we respond based on our sense of safety. It interacts with the vagus nerve and brain areas involved in social engagement. Remember, vagus nerve helps us downregulate and our sympathetic nervous system helps us activate. And all of those are integral with the hypothalamic pituitary axes. And oxytocin does a lot up there in the hypothalamus. Oxytocin dampens, dampens or intensifies threat appraisal in the amygdala. That's the fear processing area of the brain. The depending on context. So if somebody is in an environment in which they feel safe and supported, but there's a threat, oxytocin may dampen the threat appraisal. If they are in an environment in which they feel completely unsafe and vulnerable, then, and then the threat comes along, then oxytocin will ramp up that threat perception. So think about people who are in residential treatment. They are in basically a group living situation with a whole bunch of people that they've never met. And they may not feel safe around those people. So assuming that they are increasing oxytocin by, you know, playing volleyball and going to group together. No, not necessarily. Not necessarily. If they don't feel safe among those people, then they're going to have potentially higher oxytocin, but they're going to stay in that defend mode. Oxytocin also influences pain perception. Think about that mama bear. When mama bear is trying to defend her cubs, she doesn't notice the pain that she's in, which is wonderful. Likewise, and we'll talk about this in a minute, when people are feeling safe and content, their stress level is down, their stress response and stress hormones are down, serotonin is higher and oxytocin is better able to help suppress pain. So either way, oxytocin is a powerful anti inflammatory and analgesic. So the takeaway is that oxytocin can support co Regulation in a situation in which the person feels safe. Now when we talk about CO regulation, it may be with other people or it may be with an emotional support animal. It doesn't have to be another human being, but the person has to feel safe in order for oxytocin to promote CO regulation. Otherwise, if the person doesn't feel safe, oxytocin will intent intensify vigilance. And we see this even more dramatically in what we call trauma primed SIM systems. Those people who've experienced a fair number of adverse childhood experiences or chaos in their, in their past, in their relationships, they are often hyper vigilant. That oxytocin says people ain't safe. You need to stay on the lookout because you never know when you're going to get Jekyll and when you're going to get Hyde. So trauma primed nervous systems tend to be much more reactive than non trauma primed nervous systems. And we see this sometimes in the way emotions come out. We call it emotional dysregulation. I don't like that term. Because what we're seeing is the body's protective response to an on what they what it perceives as an ongoing threat. But anyhow, in terms of our endocrine systems, our hormones, oxytocin regulates stress via the HPA axis, hypothalamic pituitary adrenal axis in socially meaningful contexts. Now, if you are in at work and you're having a difficult time on a problem, maybe you're doing web design and you're stuck on something. Oxytocin isn't going to help you out a lot because that is not a socially meaningful contact context. But when people are under stress in socially meaningful contexts, like when they are at the airport or traveling or at a family's gathering or maybe even watching TV with their family, I don't know. Oxytocin tends to help regulate stress in response to the environment. It looks at the people and the things that the person is connected to in the environment and it says, am I safe in this environment? And if so, then it helps downregulate and if not, it upregulates oxytocin. Plus perceived social support reduces cortisol. Now this is not new information. When we feel like we've got adequate dependable social support, we tend to feel less stressed. And that is in part because oxytocin says, hey, you've got this. You don't have to carry the world on your own shoulders. Repeated relational threat increases cumulative physiological stress, causing increased inflammation, fatigue Brain fog and mood disturbances. And this is what we really need to look at with oxytocin. You know, it learns. And if it learns over and over and over again that people aren't safe, then every stress experience, every time, if it feels like every time I interact with someone it is threatening, devastating, depressing, just unpleasant, then when I encounter people in the future, the brain, the amygdala is going to say, oh no, we've been here before. And it's going to trigger the stress response. And what do we know from the past few weeks? Chronic stress increases inflammation, fatigue, brain fog and dysphoric moods. Attachment injury, whether it was the primary attachment, which is true for a lot of people, or later on attachment, when people have insecure attachment styles, it becomes physically costly over time because they are feeling unsafe in social environments. They're feeling unsafe, unconnected, disconnected and unsupported. Even when overt stressors are absent due to stress, prolonged stress hormone exposure and incomplete recovery from prior instances, it adds up. It adds up and we start seeing that inflammation and sleep problems and everything else take its toll on the body. If I don't feel safe, if I don't feel connected, it's going to be a lot harder for me to relax and rest enough to get into deep sleep, which means I'm going to have sleep impairment. And we've talked so many times about how lack of quality sleep, enough quality sleep, contributes to mood issues, brain fog, inflammation and pain. In terms of the immune system, oxytocin links social safety to immune regulation. When oxytocin is high, we tend to have less inflammation. Now that could be because oxytocin is helping to suppress inflammation during a fight or flight sort of thing, during the defender setup. And when we are in that tend setup, oxytocin actually acts to help as an anti inflammatory and help regulate those immune cells. Oxytocin has shown promise in improving inflammatory regulation across multiple conditions, including autoimmune disorders. But again, it's context dependent. You can't take somebody who has an autoimmune issue and say, hey, let's get you around a whole bunch of people so you can have more oxytocin. No, that ain't going to work. Most of the time. Most of the time that's going to add stress because they perceive the other people as threats instead of supports. Poor health and mental health related to chronic stress and isolation may be mediated by oxytocin. One of the things that they found is wound healing is even slower when oxytocin is low. And they did a bunch of studies after 2021. I won't say why, but I think you can guess. Looking at the impact of isolation and lack of actual human connection on people and they found that, that those people who were still feeling isolated and or still perceiving other people as threatening had much lower levels of salivary oxytocin. Oxytocin also supports pain modulation. Oxytocin helps us relax, downregulate our stress response when we feel safe. Oxytocin is anti inflammatory, that's in and of itself a good thing. And it helps trigger endorphins. This may explain why pain is often lower when people have perceived support and higher with relational stress or abandonment cues. Now let's just think about how we feel if we're in an environment when we feel interpersonal stress and a, you know, we're fearing abandonment. I don't know about you, but I'm tense and I'm stressed. That tension and that stress in and of itself increases. Cortisol decreases, serotonin increases pain. When the brain perceives that they're. The person is in an environment that not only are they feeling stressed and abandoned, but they've got pain. Oxytocin says, oh, we're vulnerable, we need to defend. So the person often feels more pain if they're not in those situations. When they do have social support, when they don't fear abandonment, when they don't have six other things adding to their stress bucket. Pain is lower, cortisol is lower. We talk about oxytocin a lot as the love hormone or the bonding hormone. And it is involved to some extent in reproduction, attachment and protection. Oxytocin concentrations vary in women during the menstrual cycle and peak during ovulation. Oxytocin and estrogen tend to go together. They're good buddies. And in males and in women with pcos, they don't have enough estrogen. Testosterone is often considered an inhibitor of pro social behavior and antagonizes oxytocin. So testosterone, when your testosterone levels are too high, like we see in pcos in women, they tend to be fighting a battle in, in their body because oxytocin wants to do its thing. Maybe. But testosterone is keeping it down, keeping it suppressed. So we, it's important that we recognize how gonadal hormones directly impact oxytocin and all of its effects, not just the desire to procreate. Adolescents, oh bless their hearts, their hormones are all over the place, which means their oxytocin is all over the place. And I don't know about you, but thinking back to high school, you know, there were a lot of times where people felt, and the other students may have felt more threatening than they were, or there were times, maybe you were in a group, where you actually felt safe and protected. But oxytocin plays a role in this. And if we've got somebody who is chronically bullied or, you know, young people can be mean. They just can. A lot of it is because there's a lot more impulsivity. They don't have as much of a filter, whole different presentation. But suffice it to say, most of us remember high school, and it wasn't wonderful. It wasn't just this great place where we held hands and sang Kumbaya. No, that's not how I remember it. At least. So oxytocin is playing a role here in trying to help the adolescent regulate who's safe, who's not safe. When am I safe? Who knows? Disease. When people have pcos, for example, their oxytocin levels are going to be lower. So if we have a patient who has PCOS or has an autoimmune disease that may be contributing to suppressing oxytocin, we want to recognize that there are times, you know, again, if they feel safe, then promoting oxytocin can be helpful. Menstrual cycles, we already mentioned, is another time that oxytocin is variable, helping people understand the difference in their reactivity in their tendon defend. We have people who have premenstrual dysphoric disorder, and they may start feeling a lot more on the defend side during that. During that period. People who are on artificial birth control, which throws the gonadal hormones out of balance, may have different levels than what they normally would have of oxytocin stress. Cortisol directly, you know, increases the stress response and directly inhibits our desire to form new relationships. We go into tend and defend. And then aging. As we age, our reproductive hormones, our gonadal hormones, naturally go down. So if we know that cortisol, not cortisol, oxytocin, goes up with estradiol, then when we see people who are in menopause, they don't have as nearly as much estradiol. They still have a little bit, but not a lot. How is that affecting their oxytocin levels? How is that affecting their inflammation, their stress levels, their desire to bond with others? In terms of metabolism, oxytocin influences energy, balance and feeding behavior. It modulates appetitive neur neurocircuitry impacting both hunger and emotional eating. Now this is interesting. With emotional eating, it oxytocin has been found to in interact with serotonin and dopamine circuits, which are the same circuits that are activated when we eat comfort food. So when oxytocin goes up, they found that people tend to engage in less emotional eating, less eating, driven by the desire to basically increase serotonin and dopamine. That was interesting. Oxytocin has been shown to improve impulse control, both in eating behaviors as well as in addictive behaviors. They've shown again, what, what do addictive behaviors do? They increase dopamine and generally serotonin and all of its buddies. But when oxytocin levels are higher, it helps stabilize it helps raise the person's baseline so they're not feeling so depleted. And it can actually reduce food intake in humans, which irrespective of emotional eating. They have shown that people who have higher oxytocin levels tend to consume less food. Now, the explanation for that was a little less clear, however, for our clients that struggle with emotional eating, that struggle with self, soothing oxytocin in the right environment can be beneficial in terms of learning, memory and social conditioning. Oxytocin shapes what the brain learns about people and relationships. It modulates our interpersonal behaviors and remembers socially relevant cues. So it helps us remember that when somebody makes this look, it's dangerous. Or when somebody holds out their arms, they're wanting to give you a hug, that may be dangerous, that may not be dangerous. Depends on your learning experience. But oxytocin helps us remember most things in terms of how it impacted relationships, in terms of how the interaction with another person. Was it safe, was it supportive, or was it rejecting and threatening? Oxytocin exerts neuromodulary effects, neuromodulatory effects relevant to social, spatial and episodic memory. Which basically means that if we're in a threatening social situation or we're in an environment, maybe we're in a really bad relationship, Our brain is going to remember a lot about that situation. So then the next time we are around those cues, even if it's objectively safe, that's not what oxytocin is going to tell the brain to remember. Oxytocin is going to tell the brain, oh, when you're around this type of person or when you're in this sort of situation, it's going to be dangerous. So oxytocin enhances awareness of cues in the environment. Why because it wants to keep us safe. Just like the analogy I usually use about the snake when we're out hiking. If I'm walking down the path and a snake appears, you know, I'm like, ah, my brain's going to remember, hey, when you're on a path in the woods and you hear this sound, it's probably not going to be something that you're really wanting to see. Therefore, in the future, when I'm on that path, I'm in that environment, I'm remembering that episode in the back of my mind. My brain's going, okay, we've been here before. We need to be on guard. We need to be vigilant. And it's going to be looking for those exact same cues again. It's actually seeking out confirmation or seeking out cues that it associates with prior threats in order to kind of give us the advantage. Therapy, however, can focus as a social learning environment. And if people have come to counseling, that's great. They are indicating a willingness to maybe develop a sense of connection and trust with you. Now, assuming that they trust you and feel connected from jump, that's foolhardy. It is important to allow them to establish a sense of safety. Interpersonal trauma profoundly disrupts one's sense of safety and connection. When you've had it with one person, you may start expecting it from everybody else, especially if that one person was your primary caregiver. But that's not the only person. You can have a great primary attachment and then get into some really bad relationships, and then your attachment style becomes somewhat altered. The goal for us is to increase a sense of safety and connection. Have the person increase mindful awareness of different types of connection and what feels safe and unsafe. A lot of people aren't even connected to themselves. You ask them how they're feeling, they don't know. They're numb, they're on autopilot. So mindfulness is a great place to start. If they have a trauma history, don't have them do intense body scanning or body work. Just have them check in with themselves and recognize, you know, what am I? What's my emotion right now? What, what am I thinking? What am I feeling? Where am I at? That can be a huge step at helping them create a sense of safety. Because in the past, they may have been in unsafe situations, but in the present, they are at a different place at a different time. They are a different person than they were six months ago, six years ago, etc. So helping them start getting grounded and being aware of who, when, and where they are is really important. Increase mindful awareness of what feels safe and unsafe in the moment. And I know you're like, well, that has nothing to do with a person. Well, that's true. However, safety is not just person related. So what helps you feel safe? This is what we would ask our clients. What helps you feel safe in your own skin? When you're at home by yourself, when you're in a safe place, what makes that place feel safe? Animals. Thinking about your relationships with them. Now, some people are terrified of dogs. I get it, okay? But when you're in a. In a relationship, your relationship with animals can actually help promote oxytocin, even wild ones. When I feed my birds and I see my little birds come out there, and yes, I'm projecting onto them, assuming they're grateful that I'm giving, giving them all kinds of good food, but it actually increases oxytocin. It increases a sense of connection. So people don't have to necessarily start out with developing connection with other people or necessarily even themselves, especially if they start with something that is important to them, that helps them feel connected to something else. The universe. What feels safe and unsafe in their relationship with the universe. And then finally, what feels safe and unsafe in their relationship with others? And that's a big old Pandora's box that'll take a while to unpack. But recognizing different behaviors, different expressions, different things that make relationships feel safe or unsafe. If they have a trauma history, there may be certain sights, smells, facial expressions, tones of voice that they associate with trouble, with danger. And just becoming aware of that, they can desensitize to it. They can process that past trauma. They can start to learn that, yes, then you were unsafe, now you are safe. Create safety. Have them do things when they are at home, when they're in their car, wherever they are alone, that helps them feel safe not only in their, you know, in the environment, but also in their own head. Because our inner critic can really suck our oxytocin dry. If it's constantly telling us that we are not worthy, we are not lovable, we are not. Fill in the blank. So what can they do to create safety in their own head as well as in their environment? What can they do to create safety with another person? Starting in this relationship with you do, what is it that you know? If I'm a therapist, I'm going to say, what is it that you need me to do that can help you feel safe? And they may not know. A lot of times they don't know some of the ground rules I lay out at the beginning of therapy is this is your journey. You are in control, you set the pace. However, if I think you're starting to go too fast or get ahead of yourself in a way that maybe damaging, I may suggest that we slow it down a little bit. But if we start going too fast and you're not comfortable, you can put on the brakes any old time you want. Letting them know that they're in control, letting them know, I'm going to suggest things sometimes that are interventions if you don't think they're going to work, if you're not going to do them, if they sound stupid to you, that's fine, let me know. You are in the driver's seat. And I say that. That's pretty much the speech that I give all of them at the beginning of therapy. And I regularly start out sessions by saying, you know, what is your comfort level in this session today? Are you feeling safe? And if not, what do we need to do to help you feel safe? And what changed, you know, what happened maybe last session or between sessions that is making you feel unsafe today? So I want to keep bringing it back every session to that safety to help them get used to regularly checking in with themselves and saying, do I feel safe? Use fit cat the facts in this context at this time and you can also use fit cat the facts in that context at that time to examine what has happened in prior relationships that felt unsafe. So in that relationship at that time, what behaviors did somebody do or what happened that led to rejection or abandonment or criticism, boundary violations or flat out harm? Okay, so what happened in that relationship? Those things your amygdala remembers. And when that happens again, or when somebody does something even similar again, your brain may jump into high gear going, okay, I need to protect myself, becoming aware of that. So then they can check it out in the present context and say, all right, get given. You know, I know that in the past similar situations have been threatening the based on the facts in this context at this time, am I safe? Help them develop skills to manage these threats because they're going to happen. Other people will get angry, Other people will raise their voice, their bosses may criticize them, their significant other may criticize them for something. It's going to happen. And we don't want people to feel completely ripped open and raw every time this happens. So when somebody gives you criticism, even if it's not constructive feedback, when somebody provides criticism, what are your, what skills do you need to manage it so you still feel Connected, you still feel lovable. And one of those skills is unhooking, unhooking from criticism. People may disagree with your thoughts. They, people may not feel the same way. People may not like something that you did, but it doesn't mean that they don't like you. Separating your thoughts, behaviors and feelings from who you are is important. I mean, I, my kids are in their 20s now, but during their teen years especially, there were lots of times where they didn't like a lot of what I was thinking, feeling, whatever. Likewise, you know, I disagreed with some of the things that they thought, felt and did, but I still loved them. And that was one of the important things for maintaining that sense of connection. I love you. Examine what is happening in the current relationship that feels safe and ways to enhance that in other relationships. So having the person examine in our interaction, therapist and client, what feels safe that's going on right now and how can you do that more in your friendships, in your other relationships. Boundary setting, for example, open communication. You know, lots of those things that feel very threatening for a lot of people. Have them look at relationships that they do have that they kind of feel safe in, if there are any. And if there are, say, okay, what feels safe in that relationship? How can you nurture that and how can you create that in other relationships? Help them to develop secure attachment with their self. And I alluded to this earlier, but many people, many people with trauma histories have low oxytocin and insecure attachment. Many people with low oxytocin have insecure attachment, period. Hard stop. Helping them develop a sense of secure attachment with themselves is the first step. If you don't feel safe in your own skin, if you don't believe you can keep yourself safe, then the world is a much, much scarier place. Going back to three of my favorite mnemonics cares, have them be consistently mindful and consistently responding to themselves. If something's okay on Monday, it needs to be okay on Thursday, not okay, it's fine one day and not another. They need to be consistent in their how they treat themselves, attentiveness. And yes, I have four asterisks after this because normally it's one. We kind of say this is something when you spend time with someone else, it helps them feel loved and increases their self esteem and everything. This attentiveness is so important because it's the key for oxytocin in when you are attentive to yourself. You spend time with yourself, doing something that you like, taking care of yourself without guilt. Oh My gosh, that's a whole different hurdle. You increase oxytocin going well, you don't even have to go and get a massage. Even giving yourself a massage, getting rid of pain can feel beneficial. Exercise, if you believe it is good for you, can increase oxytocin. Now that's what the research says. I don't know whether I agree, but you know, being responsive and we go to the mnemonic idea. When they feel upset, they're consistently mindful of how they're feeling. When they feel upset, they respond by identifying the feeling and the function of that feeling. Down regulating. Because you ain't going to be able to do very much useful when you're in your stress mind. When you're in your emotional mind, you need to down regulate to get into your wise mind. Examine the triggers, the facts in this context at this time and possible responses and then act. So identify the feeling. Down regulate. Examine the triggers and what you can do and act in the way that best helps you meet, move toward your rich and meaningful life. So that's responsiveness, encouragement. Providing yourself encouragement actually increases oxytocin. Being your own champion, saying you got this actually does help you feel safer in your own skin. And then safety. That's when we're silencing that inner critic. We're unhooking our thoughts, feelings and behaviors from who we are. Because sometimes we think things that we shouldn't, sometimes we do things that we shouldn't. And instead of feeling like we're a bad person, recognizing that we had a bad thought or we made a bad choice is really helpful. But really paying attention to that inner critic and unhooking value as a person and worth as a person from the things that you do sometimes. So the cares mnemonic is for secure attachment, consistency, attentiveness, responsiveness, encouragement and safety. In terms of being responsive to themselves, they need to mindfully pay attention and then identify the feeling when it happens. Down regulate. Examine the triggers and possible responses and act accordingly. Examine their relationships with their self and others to define what the behaviors look like that help them feel safe and what the opposite of those behaviors look like. So what does it look like when a mother safely nurtures her child? What does the opposite of those behaviors look like? Okay, now let's fast forward to adulthood. What does it look like when somebody safely nurtures, healthfully nurtures an adult relationship and what does the opposite look like to them? Address guilt related to self care. Because a lot of people were taught that taking care of yourself, doing Nice things for yourself, getting a massage, taking time out, that's not okay. You should be doing something else. And that's self care is non negotiable. If you drain your battery till it's like completely zero, till your battery's dead, you're not going to be good to anybody. You're not going to be able to help anybody. You have to recharge your battery, have them define their rich and meaningful life and anchor that to connectedness. So what people, things and experiences are important in my rich and meaningful life. And what can I do that connects me to those things? That's important because not everybody's rich and meaningful life is the same. Not everybody you know, will get an oxytocin boost from feeding the birds. I do. It's one of my things. So having people define what's important to them and how they can nurture those connections will help them figure out how to naturally increase their sense of connection to what's important in their world. Touch. Self touch is huge for increasing oxytocin. And most of these interventions we're talking about today don't have to do with other people. Why? Because a lot of people with trauma histories actually feel unsafe around others or if they do get into a relationship, it's very, they're very anxiously attached. So that increases their stress. They're not feeling safe, connected and regular co regulated. So a lot of these things are helping people just naturally start increasing oxytocin in themselves. Self touch, you can give yourself a hug. They found that pressure actually stimulates the receptors that trigger the release of oxytocin. Massage. And it can be self massage if you have, you know, sore muscles after working out or something, or you just slept wrong, massaging that pain away. The brain perceives that as eliminating a problem, as tending a, an issue that's happening and releases oxytocin. Weighted vests or lap pads can be very calming for some people. They can feel extremely oppressive for others. Depends on the person. Not every intervention works for everybody. Animals. And I say on here it varies by relationship style and context. Of course, if they are terrified of dogs, then trying to get them a dog is an emotional support animal. Probably not a good move. Animals that they feel safe and connected to will increase their levels of oxytocin. I had the most amazing rooster for he lived a little over 10 years. His name was born Stellar and he was just the best little guy there was. One time we had another rooster that tried to attack me and started trying to claw my head when I was picking the hoofs on the donkey and Bornsteller came up and told him what for physically and defended his mama's honor. And to this day, it makes me smile and gives me joy when I remember that. That's oxytocin. Yes, it was a freaking chicken, but it was my freaking chicken. And he was just. He was a great addition to our little farm. So animals can vary and it's whatever gives them meaning. My son has a snake. I'm not a huge snake person. I've learned to tolerate them. I don't think I'll ever, you know, want one myself. But people have different connections. So finding animals that they can connect with can be a much less threatening first step than creating connection with other human beings. So, you know, obviously cats and dogs, they can feed the birds. We have a little deer. It was one of twins that was born in our yard. In the spring, Mama and its sibling have left and it's decided to hang around on our. On our farm. And it kind of thinks it's a dog. I mean, it gives us a wide berth. It's still wild, but it's cute to see it and I enjoy seeing it. Right now, its ears are still way too big for its little head. So it's kind of goofy looking, you know, but it's adorable. Massage. Head massage can be really relaxing for some people. You can do it yourself. You don't need to rely on somebody else. And generally, head massage is gentle. You're not pressing, so your hands are going to get tired, just gently massaging your scalp. Foot massage, you can get devices, you can get shiatsu foot massage devices that can help relax the tension in your feet. But it also, that relaxation response also prompts the release of oxytocin. And then they have what they call the third eye in Eastern medicine, and that is this area right between your eyebrows in the middle of your forehead. And they believe that there's a lot of our anxiety maybe held there, for example, and gently rubbing that area can help release feelings of anxiety. Now, some people will do acupressure. You know, that's a whole different, whole different thing. But finding something that works for you, that you can regularly do. Music. Listening to slow tempo, relaxing or happy music is accompanied by an increase in oxytocin level and a decrease in cortisol. So finding music you like, it doesn't have to be instrumental. It can be something that is just slower tempo because your body tends to regulate with the beat. So if it's 165 beats a minute, your body's going, all right, let's go on a run. If it's 75 beats a minute, your body's going, okay, we can coast through this. Physical warmth mimics caregiving conditions and stimulates thermoregulatory centers in the oxytocin linked to oxytocin release, which enhances relaxation. Don't get too warm, you know, that's obviously going to increase stress. But gentle warmth can help, which is why heating pads, you know, if you've, especially if you've got pain, it's a double benefit. The warmth from the heating pad as well as the attending to that pain and getting rid of it helps increase oxytocin. It helps your brain say, hey, I'm safe. I've got this. I can, I can live happy. I can live, you know, safely and maybe not completely pain free, but, you know, I can live. Laughter triggers the vagus nerve, reduces cortisol, enhances interpersonal synchrony, and leads to increased oxytocin and endorphins. One of the best ways I've found is some of those videos on YouTube in which there's a baby laughing hysterically and there's one where the caregiver is tearing paper and the baby just thinks it's the funniest thing in the world. I don't know why, but you almost can't watch it, or I cannot watch it and eventually not start laughing. It's just contagious, if you will, so you don't have to be in a room with other people laughing. When I used to work in residential, I carried around a book of knock knock jokes with me. This was before smartphones and if I had a patient who was, seemed to be kind of off that day, I find a joke because, you know, knock knock jokes and those other kids jokes tend to be cleaner. And I'd find a joke and I would tell them and they'd look at me and they'd be like, what, doc, have you lost your mind? And I'm like, hey, you know, everybody likes a laugh at that time. I could get away with it too, because I had toddlers and preschoolers at home, so I had a little bit of an excuse, but it kind of would jar them out of the zone they were in. And if they were laughing at the joke or laughing at me, I didn't really care they were laughing. Creative collaboration and shared problem solving also increases mutual trust and stimulates oxytocin release in safe conditions. Playing games and this is a great thing. If a person doesn't have great relationships with their family. Playing games can be one of those things they may be able to do peacefully. It can be a great way to develop trust and a sense of connection. In residential treatment, playing games can eventually lead to a sense of safety and connection. Having people do projects, teamwork type of things can also increase a sense of connection. Forest bathing Shinrin yoku is exposure to natural stimuli, including the associated volatile oils and terpenes. And it's been shown to reduce sympathetic activity, our stress response, and elevate oxytocin and endorphin levels. They measure the salivary oxytocin of people who went on a walk in the city versus people who went on the walk, went on a walk in a park. Doesn't have to be the forest, it just has to not be the middle of Nashville or New York City or something. And they found that the people that were in nature had significantly higher levels of oxytocin and lower levels of cortisol. Acts of altruistic kindness can also increase oxytocin. Doing something nice for someone or something. You may call this feeding the birds. You may call this picking up trash to improve the universe. You may call this taking donations out to the homeless encampment. Whatever it is that you're doing, doing something n nice for others without expecting and sometimes without even wanting something in return. If you're still having difficulty feeling safe around others. Doing something nice for others has been shown to increase oxytocin. What can they do? Even writing letters to soldiers or, you know, somebody can be good. Finding a pen pal, I don't know if that's even a thing anymore, but having a pen pal. Assisted living facilities love people who are in ALFs, love having visitors, love getting mail. Connecting with a higher power or meaning can be beneficial if somebody believes in it. If they don't, then okay, not going to work for them. But a lot of people feel a sense of connection with when they read their scripture, when they spend time praying or communicating with their higher power. Group singing or chanting also increases oxytocin. Whether you're singing at a rock concert or you're singing in church, it actually increases oxytocin. No inter interpersonal interaction required. Which is another thing that's beneficial for a lot of people because they start getting used to being around others and going, okay, hey, this, this may not be so bad. And finally, sleep indirectly improves oxytocin signaling. Sleep reduces stress, particularly cortisol, limits inflammation, and maintains receptor sensitivity and circadian rhythms. When sleep is disrupted Stress increases and oxytocin regulation becomes impaired. So let's think about it. You know, just that's a lot of sciency stuff. But think about you. On days when you wake up and you're already stressed, how connected and happy and safe do you feel in your relationships versus all of these people are getting on my very last nerve. So when we are stressed, we are already primed, we are already in a threat state, if you will. And that tells oxytocin, hey, we need to defend right now. So we're going to tend to have more difficulty with calming oxytocin signaling. Stress does not necessarily. Stress management is important. Stress means the person doesn't feel safe. Reducing underlying stress helps people feel less primed or on edge, allowing their activities to feel safer. And finally, finally, nutrition. Vitamin D, vitamin C and your colorful fruits and vegetables, your anti inflammatory foods are necessary for supporting the oxytocin system. Additionally, probiotics, particularly a strain of Lactobacillus called Lactobacillus routeri has been shown to improve oxytocin signaling. Now, before just adding some random probiotic to your diet or your nutrition, check with your doctor first because you don't want to throw your gut microbiome out of whack. Lactobacillus bacilli strains are prominent in almost every type of fermented food. So generally most providers will recommend just starting out with something, a whole food like yogurt, kimchi, kefir, something like that that can help boost the good bacteria in your gut. Oxytocin's job is to pro promote survival of the individual and the species to tend and defend. The oxytocin system is integral in social stress signaling and learning, reproduction, feeding, pain management and more. Helping people improve the functioning of their oxytocin system can help reduce stress and inflammation as well as improve mood. And I'll say it one more time, we don't have to engage in interpersonal relationships at first to increase oxytocin. Is that probably an end goal? I would like to think so. But that may not be an end goal for every client. So helping them figure out how they can increase their senses of safety and connection in a way that's meaningful to them is what's most important.