Mind-Body Connection: Incorporating Lifestyle Habits Into Mental Health Care | The Retreat at Sheppard Pratt

Mind-Body Connection: Incorporating Lifestyle Habits Into Mental Health Care

March 24, 2011 —

Mind-Body Connection:
Incorporating Lifestyle Habits Into Mental Health Care
written by Heidi Waltos, RN, MSN, CNS, Wellness Coordinator for the Retreat

Introduction

Although there is indisputable evidence correlating lifestyle habits with mental health (i.e. nutrition, exercise, body-image, etc), these elements are far too often over-looked. Becoming emotionally healthy and resilient is not simply a matter of attending to our minds and hearts, it is also a matter of how we perceive and care for the physical body we are housed in. Treatment outcomes can be vastly improved when these connections are re-established.

This article emphasizes the necessity of offering a whole systems approach to mental health and then provides an example of a group (Mind-Body Connection) which was developed with these principles in mind. A particular focus of the group has been to assist individuals who are experiencing weight issues with relation to pharmacotherapy.

The Connection of Mental Health Issues with Physical Health Issues


A 2004 World Health Organization study revealed that rates of mental illness are far higher in the U.S. than in any other country in the world. The survey of more than 60,000 adults in 14 countries showed a 27% incidence of mental disorders (depression, anxiety, eating disorders, substance abuse, etc). An even larger estimate of 46% of individuals was sited in the Archives of General Psychiatry (1). Globally, depression is slated to become the second largest contributor to the burden of disease by the year 2020 (2). Perhaps most alarming however, is the increase in mental disorders which is occurring in our children. More than four times as many visits to general practitioners involved a psychiatric diagnosis in 1999 than in 1985 (3,217,000 versus 757,000) (3). A recent report from the Commission on Children at Risk warned that rising rates of mental health issues among our youth signal a crisis for the country. “Conservative estimates say one in every ten children and adolescents now suffers from mental illness severe enough to cause impairment” (4).

We have to ask ourselves what is going on here. Causative factors which are most often identified and investigated include; genetic factors, biological factors, social stressors, traumas (early neglect, abuse, etc), attachment issues, and family systems dysfunction. We have also gotten better at diagnosing. However, these rising rates of mental illness are most likely not solely accounted for by ‘diagnostic creep’ (higher numbers of diagnosis due to an expanded view of what constitutes mental illness). And, if it was purely genetic predisposition, the rise would be following a generational pattern. It does not. So, what else has affected our biology and psyches to such a degree to make us so fragile? One connection we rarely make is the glaring one to how we choose to live our lives. To a large degree it is the same set of lifestyle conditions which affect both our mental and physical health…they are intertwined.

In the United States we are concomitantly seeing a meteoric rise in chronic diseases. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition. These conditions include such issues as arthritis, asthma, cancer, cardiovascular (heart) disease, and diabetes. Since 1980, obesity rates have increased 250 percent, now affecting 71 million Americans. One might wonder whether this is due to our aging population, however… childhood chronic diseases have almost quadrupled over the past four decades.

For the most part, we accept that chronic diseases are caused or exacerbated by poor nutrition, lack of exercise, sedentary habits, lowered exposure to fresh air, higher exposure to multiple toxins (including smoking), interrupted sleep patterns and other lifestyle choices. These behaviors and practices create system-wide inflammation and over-all imbalance (where the system is re-shuffling resources to areas of need). It turns out our brains are not impervious to these toxic consequences. Similarly, our brain function then affects the lifestyle choices we make. There is a feedback loop which requires us to take a holistic approach if we really want to re-establish health.

Re-establishing Connections

In a report written by a group of 33 pediatricians, neuroscientists, and mental health professionals, it was concluded that medications and psychotherapies are not enough in dealing with our growing rates of mental illness. “Programs of individual risk-assessment and treatment seldom encourage us, and can even prevent us, from recognizing as a society the broad environmental conditions that are contributing to growing numbers of suffering individuals” (Kovner Kline, Kathleen, Dartmouth Medical School, 2009). The Commission for Children at Risk specifically identified lack of connectedness – close connections to other people and deep connections to moral and spiritual meaning, as primary causative factors of our current mental health crisis. The findings from neuroscience demonstrate to us that we are basically hard-wired to connect to one another, and that we have an innate desire to connect to a sense of meaning in our lives.

If we are to address this disconnectedness it needs to be on all fronts…both within the individual and within the systems that promulgate this sense of separation…our healthcare system being one of them. Medical research tends to look at isolated parts of a system which often translates into ‘part-specific’ interventions. Also, in an effort to keep up with the exponential growth of knowledge we have developed a cadre of specialists and sub-specialists. While this does afford us the possibility of expert, detailed care in specific areas, it has biased our perspective, encouraging us to look at various pieces of an entire system rather than continuously being mindful of the entirety of that system. It is not uncommon to receive the biological approach to mental illness from one practitioner, while receiving the psychological and social approach to the same issue from another practitioner. Sometimes this separation has so permeated our thinking that we are likely to see medication as the primary fix for what ails us, often completely ignoring that fact that much of the ‘fix’ lies within our own natural internal resources. Facilities like The Retreat are able to work effectively with the whole individual.

Individuals also have a responsibility for plugging back into the connections that sustain them. We need to wake up and pay attention to what depletes us and what fortifies us. We cannot expect somebody to do this for us. It will require us to let go of false notions that we have impenetrable boundaries from the external effects of the environment, and that our brains are somehow protected from the things which go on in our body. We’ll need to take the time to carefully listen to the wisdom of our bodies (signaling to us what is nurturing or detrimental to our functioning). We’ll need to recall that the same things which sustain any living organism, sustain us as well…things like fresh air, sunshine, healthy food, exercise, adequate hydration, time for rest, time outdoors in nature, etc. We’ll need to make ‘face to face’ time for others and notice when our spirits are lifted because somehow what we did felt ‘right’ to us in our hearts.

Mind-Body Connections
Mind-Body Connection is an example of a therapy group which offers a whole-systems approach to lifestyle. This particular group has a specific emphasis on preventing the weight gain occasionally associated with certain medications. The prime message it seeks to impart is re-connecting to the wisdom of the body through awareness.

 Sessions 1
The first session of the group has a unique perspective and goal. It is designed to empower individuals through knowledge; inspiring them to reclaim their healthy relationship with food. By revealing some truths about our food and entertainment industries we demonstrate how much we have become disconnected from healthy eating and how we have been lulled into sedentary and stressed lifestyles. We ask the question, “Who is in charge?” Is it us or the industries we unwittingly created which have conditioned us to be mindless consumers? It is our hope that by instilling some consciousness about this, people will be more motivated to reclaim their ability to make informed rather than mindless choices. The group begins by sharing some grim statistics regarding our dangerous and rapid rise in obesity and in diseases of inflammation. For example, it is projected by 2015 that 75% of Americans will be overweight and 25% obese – obesity accounting for 300,000 deaths per year in the U.S.; equal to that of smoking. Our youngsters have been dubbed the XXL generation, with one in five kids having unhealthy lipid levels already. These are primarily societal issues for which the individual has paid dearly. We have a plethora of services and products to address weight reduction on one end and we have an entertainment driven culture on the other end which promotes an unrealistic ideal to which we subconsciously aspire. Advertisers establish brand allegiance with our children by the time they are two years old. (Valkenburg PM. Media and youth consumerism. Journal of Adolescent Health. 2000;27S:52-56). The average 18-21 year old spends 71/2 hours per day connected to some form of technology. The individual sits with the effect of this in isolation, feeling guilty, ashamed and believing erroneously that it is their short-coming which caused them to succumb to the lure of over-consumptive malnutrition and inactivity. The worse a person feels about themselves the more they are apt to turn to outside sources for solace. It becomes a vicious cycle. It is important for us to develop awareness about this, to become conscious consumers and to reclaim our hijacked brains.

We need to become aware of the very real addictive properties of many of our current processed foods – to recognize that whenever something is refined and concentrated, whether it is an experience or a substance, the potential for developing an addiction to this substance is greatly enhanced. For example, in nature: cocoa beans, poppies, tobacco leaves, grains, fruits, potatoes, are not harmful to us but once we refine and concentrate them they respectively become: cocaine, opium, cigarettes, and various types of alcohol.

The same process applies to our food sources.
And just as classic drugs of abuse hijack the brain, accumulating evidence suggests that chronic consumption of refined, highly palatable foods has a similar impact. A new study by Thornley in Australia (2011) reveals eating foods with a high glycemic index may trigger the same area in the brain associated with addiction to cigarettes and drugs. Additionally, when foods are designed to intensify the experience of sweet, salty, fat and colorful they appeal to the limbic structures of our brain which recognize these foods as central to our survival. We have a hard time resisting these combinations. Whole foods, on the other hand, which are not layered, refined, concentrated or processed leave our brain clear and allow it to apply its wisdom.

This same type of response occurs with exposure to intensified experiences offered through our technology. Internet addiction is a very real issue we need to grapple with. It isn’t just the immediate gratification of pushing buttons and getting results but also the potentially damaging issues we are giving our repetitive attention to; such as pornography, gambling, shopping, etc. And to add insult to injury, the time we give away to these pursuits, keeps us from connecting with ourselves, one another and nature. The trade-offs we make filling our bellies with unhealthy foods keeps us from actually getting the vitamins, minerals, proteins, amino acids, etc necessary to create a healthy balance of neurotransmitters, a healthy immune system, muscular-skeletal development, etc. We think we are making fully conscious choices but frequently we are on automatic pilot and we don’t even realize it.

Session 2
Becoming aware is a primary aspect of all healing. Not surprisingly, once the mind is freed from the addictions and distractions and can reconnect to the body, it is turns out to be adept at making nurturing choices. In the second session of Mind-Body Connection we point out and support people’s natural inclination for health. Although we provide information on what foods are most healthy, (specifically as it relates to promoting mental health) and we also give guidance on potential nutrient deficiencies, we find that many people are already familiar with this type of information. For example, it is pretty well known, on an intellectual level, that the Mediterranean diet (with an emphasis on; fish, whole grains, olive oil, fruits, nuts and vegetables) is the healthiest way to eat, yet until people ‘own’ this on a deeper level they will continue to pursue diet and exercise fads which, (as evidenced by our expanding waistlines), have not had any effect on us. Once the ‘spell has been broken’, (that the fix comes from the outside) and the mind can come ‘on-line’ again, we find that people are more apt to resume the natural inclination to eat with balance, variety and moderation. We find that strategies which ask us to pay attention and re-establish the connections we have to the wisdom of our own bodies (the signals of hunger, satiety, emotional needs, etc) are the most effective. We promote this inside-out proposition, encouraging individuals to take charge by being aware of when they are eating on the run, in front of the TV or computer versus eating as a pleasurable, social experience, when their reward centers of the brain are being stimulated artificially versus through ‘good’, authentic behaviors like; being stimulated by activity because it is good for the body to get movement, being stimulated by eating because it is good for our body to get this healthy nourishment, being stimulated by experiencing love because it is good for the survival of the human race, being stimulated when we have achieved something because it is good that people do constructive things or being stimulated because we have touched upon the things which give us sustenance and joy. By noticing these positive connections we essentially expand what’s right with us and consequently devote less of our efforts to ‘defense mode’, trying to correct what’s ‘wrong’ with us.

Session 3
In this session we focus on stopping the cycle of sedentary lives. It begins with awareness as well and paying attention to how we feel on those days where we have been active, versus the days we spent primarily sitting in one place. (Think of the cubicles where workers spend endless hours in front of a terminal).

We provide information on the powerful benefits of activity on mental health. In 2001 the British Medical Journal did a review of the antidepressant effects of exercise treatments. Fourteen randomized controlled trials revealed statistically positive effects of ‘exercise treatment’ for depression. Although there was some debate over the validity of this review since some of the participants may have had sub-clinical mood problems rather than fully diagnosed major depressive disorders, the idea that ‘exercise treatment’ is more effective than no treatment at all is supported by at least two other systematic reviews and most of the systematic reviews find as well that ‘the antidepressant effect size of exercise can be comparable to that of psychotherapy and to that of pharmacotherapy.’(5, 6, 7, 8, 9)
“Some experts argue that it is far too difficult for a severely depressed individual to find the motivation to exercise on a regular basis, but given the promising fairly recent results of even brief high intensity weight lifting on relieving depressive symptoms it might indeed be viable if the duration is considerably short especially as adherence to regularly taking anti-depressant drugs is equally a problem among individuals with depression.” (10).

Results of the effect of exercise on ameliorating anxiety were equally as impressive. In six meta-analyses; (Calfas & Taylor, 1994; Kugler, Seelback, & Krüskemper, 1994; Landers & Petruzzello, 1994; Long & van Stavel, 1995; McDonald & Hodgdon, 1991; Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991) exercise was significantly related to a reduction in anxiety (11, 12, 13, 14, 15, 16). These effects ranged from “small” to “moderate” in size and were consistent for trait, state, and psycho-physiological measures of anxiety. The reduction of anxiety occurred for all types of subjects. The type of exercise that seemed to be most beneficial for anxiety was more along the aerobic lines, where for depression the combination of weight lifting and aerobic was more beneficial. The findings also indicate that the antidepressant effect of exercise begins as early as the first session of exercise and persists beyond the end of the exercise program (Craft, 1997; North et al., 1990) (17). In addition to recovering more quickly from psycho-social stressors, improved physical health, improved sleep (especially REM sleep) and improved self-esteem were ‘side effects’ of the exercise therapy.

Although these studies focus on exercise as a routine, if we move our bodies physically in ways which increase our heart rate and which also encourage us to build muscle (through heavier lifting), these activities confer the same results. In the group we discuss all kinds of activities; from dancing to yard work. Having a mindset that one has to make time to get to a gym can sometimes interfere with implementation. The Recreational Therapist works with individuals to develop a routine or activity selections which the individual is happy with and which will be challenging enough to be beneficial. Like those findings noted by Blumental, et al in 2007 (19), we have seen that a considerable portion of what is beneficial is determined by the individual’s expectations for what they can achieve, by ongoing daily monitoring and attention placed on this area. We also found similar responses with regard to the best exercise for anxiety and depression being on the vigorous side, the largest gains being seen by those with the highest degree of emotional discomfort, and the more often and longer it is carried out the more the behavior becomes habitual and enjoyable.

Interestingly when Blumental continued to follow the same people for six additional months they found that those who exercised but did not receive an anti-depressant did better than either of the other two groups. The other thing that they identified was that the group that received the anti-depressant plus the exercise was more likely to again become depressed than the group who only exercised. Both of these findings are very much worth exploring more. Blumenthal and colleagues speculated, “It is conceivable that the concurrent use of medication may have undermined the psychological benefits of exercise by prioritizing an alternative, less self-confirming attribution for one’s improved condition. The patients might have incorporated the belief, “I took an antidepressant and got better” instead of incorporating the belief, “I was dedicated and worked hard with the exercise program; it wasn’t easy, but I beat this depression.” Here again, we see the importance of connection to one’s inner resources.

Session 4
This group is run by the Art Therapist. It is an activity where the individual does a life size body tracing which is then placed on the wall – ample time is given for each person to use various materials and pictures to fill in the tracing as they wish. Following this, there is discussion from the artist about their creation (what they sought to communicate and any insights they received), other group members are then invited to give feedback as well. Working with these visual images appears to access emotional content on a consistently deeper level. It serves to re-establish connections to material which may have been repressed. This is a powerful experience that really seems to get to the heart of the matter. It is pivotal is raising awareness to the degree where tangible changes begin to take hold.

Session 5
In this last group we go shopping together and practice healthy food selection. Often we visit grocery stores which cater to the conscious consumer (stocking lots of healthy foods with the understanding that healthy does not need to be expensive or labor intensive). Because stress and time is a factor in our lives we have typically relied on ‘fast foods’. Historically, these types of foods have been laden with unhealthy fats, sugar and salt in order to create a repeat business but fortunately this is beginning to change as our society becomes more informed. We like to support those businesses which help create societal change in this regard. We also include trips to the local farmer’s markets when time allows, pointing out that there is an entire movement entitled “Green Medicine” which re-establishes the connections our health has to the health of the planet.

It is important to note that although the Mind-Body group is a single group run by specific staff, that integrating lifestyle practices is something which permeates all aspects of treatment at The Retreat. For example, in addition to providing direct, intensive psychotherapy the same psychiatrists also prescribe medications when indicated. They are very diligent about working with each individual to carefully monitor any potential weight issues. There is full recognition that compliance with medications, no matter how therapeutic can be lowered in people are uncomfortable with either gaining or loosing too many pounds. A Movement Therapist works with individuals on a hands on basis so they can become reacquainted with the wisdom of their bodies and put this knowledge to use in every day living. A Yoga Therapist teaches yoga, breathing and meditation. An acupuncturist addresses the unseen but very real energy meridians (channels) of the body to insure clearer connections. A Wellness Coordinator offers a Live AWESOMELY group which focuses on the same types of issues as Green Medicine (what makes us well makes the planet well and vice versa). Along with psychological, social, biological interventions, educated guidance is provided regarding natural approaches to mental health. Social Workers assist in re-establishing healthy connections to family systems, Dialectical Behavioral Therapy is offered to help clarify and bring to our awareness the subconscious (and often false) dialogues which occupy our thoughts and affect our behavioral choices, Activity Therapy connects people with meaningful work, play and social outlets. Additionally, all the members of the team regularly meet with one another and the resident to develop an integrative plan of care.

This type of approach is the ideal to which we should all aspire as healthcare providers. Not that every treatment facility will have the luxury to have the resources of The Retreat but each time an intervention is developed with the whole of the patient in mind we improve the entire system. Each time we seek to re-establish an individual’s connection to mankind, to their deeper meaning, to their own resources for healing and to the planet which sustains us we have made a move away from separation and toward health.

References:

(1) Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry, 62,: 593–602.
(2) Lopez A.D.& Murray C.C. (1988). The global burden of disease, 1990-2020. Nat Med.
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(13) Landers, D.M., & Petruzzello, S.J. (1994). Physical activity, fitness, and anxiety. In C. Bouchard, R.J. Shephard, & T. Stevens (Eds.), Physical activity, fitness, and health. Champaign, IL: Human Kinetics Publishers.
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(17) Craft, L.L. (1997). The effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis. Unpublished master’s thesis, Arizona State University, Tempe.
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