Part 3 Mind-Body Feedback Cycle: Treatment

Part 3 of 3

Please share your opinion

• I agree with this including my personal health journey
• I agree with this theoretically or as a practitioner
• Interesting, but yet undecided
• I disagree with the ideas in this article

Da Vinci's Vitruvian man was his ideal of perfection based upon ratios, or in other words, balance. In this blog, a metaphor for mind-body balance.

Considering mind-body connection, but the lack of solid science behind the medicine, are there treatment implications? This is tough to say since we are either in the early stages of understanding certain aspects of wellness that are systemic and holistic, or because of the holistic perspective necessary to understand these aspects of wellness, the reductionist scientific method is at least in the current day-and-age ill-equipped to answer this question. This article intends only to be an prologue. Some portions have a scientific basis within the competence of this author, some are personal anecdotes and others are wonders for the future. None of this should be taken as treatment recommendations and any treatment decisions should be made with consultation of your personal care provider.

Medical treatments we do not know enough about

Vagus nerve stimulation

This is another newer technology that is currently in-vogue in the maintstream, but unclear whether there is medical, scientific evidence of it's safety and effectiveness, as well as regulation to ensure safety. The theory behind these devices makes sense and the underlying technology has been broadly used medically and in the mainstream. These devices use electrical stimulation to activate the parasympathetic nervous system via the vagus nerve causing a sense of calm, but also likely over time helping to improve regulation of sympathetic nervous system. Anything that directly effects such a vital nerve should cause caution, and it is unclear why this would be preferable over parasympathetic activation skills, listed below, other than ease of use. As a psychologist, gaining the skill to do this on our own seems significantly more beneficial than relying on an external device that may have risks. However, it is a tool that some may use for calmness and consequently reducing inflammation. Pulsetto is currently the leading device in popularity because of the quality, effectiveness and price point. Others include Hoolest/VeRelief, and Sensate (these link should provide a slight discount as a professional care affiliate).

Low Dose Naltrexone

This is an old medication with a new use. It is an opiate antagonist, meaning it blocks the receptors opiates would attach to, stopping their effects. Consequently, it has been used to reduce cravings for narcotics like heroin and alcohol, and preventing the reinforcing effects if those drugs are used including euphoria. Despite being an opiate antagonist, Naltrexone still increased endorphins including with the newer low-dose regimen, which helps with mood, sleep and pain. LDN also helps with inflammation, but it is early days and not broadly accepted by all providers.

Supplements

If you do any reading from well-regarded sources about supplements, you will find two things that should be yellow-flags (a sign of caution, not necessarily a red flag indicating there is no potential value in supplements). First, none that I have read about were considered to be well enough researched for any use to be listed as a known, evidence-based treatment. Sources always say the research is limited and there needs to be more. There are multiple reasons for this including possible financial limitations, but this leads to my second point - supplements are not well regulated. There are examples in which a supplement is marketed as something, but testing shows it contains none of that substance, or other things that are not on the label. If you consider a supplement, always talk to a prescribing doctor and you can also review whether the product is tested by a well-regarded third party to ensure purity and accuracy of the label. Having said that, there are a few that stood out in my personal health journey.

Coenzyme Q10, or coq10, has anti-inflammatory properties, is often used for cardiovascular health, and cellular energy production. The latter factor makes coq10 a potentially interesting product for individuals experiencing fatigue due to an inflammatory or immune condition. It is available from Thorne, Life Extensions, Now, Nutricost and Doctor's Best.

Ginkgo Biloba had some past attention in the mainstream for cognitive support, but also is considered anti-inflammatory, promotes energy, and has vascular benefits for poor circulation such as Raynaud's. It is available from Life Extensions, Now, Nutricost, and Doctor's Best.

Additionally, my providers have recommended I take a multivitamin, and that most people in the North have a vitamin D deficiency. Likewise, it seems most people can benefit from Omega 3. I have also used digestive enzymes, which make a significant difference in my personal health.

Seemingly reputable supplement brands with 3rd party testing:

• Thorne Labs

• Life Extensions

• Now

• Nutricost

• Doctor's Best

Medical interventions that probably do have an evidence basis

Diet

The literature on this topic is always evolving, and moderation seems a safe route. We can be fairly certain that excess of processed foods, particularly including sugars and nitrates, and fried foods are detrimental to various aspects of health. These have direct health consequences that are well documented (sugar effect on blood sugar, fried food on lipids, and both having metabolic consequences) but also cause inflammation. This inflammation may cause leaky gut in which the intestine becomes more permeable, things that shouldn't pass through the gut do, our immune system reacts to these foreign objects as threats, this can lead to an autoimmune response and inflammation.

A permeable gut combined, especially combined with diminished digestive enzymes can mean we start to have reactions to proteins in more foods. We become sensitive to these foods and have an immune response, possibly leading to autoimmune symptoms and inflammation.

Examination of human skulls shows noticeable differences from 400-years ago when food was only minimally processed, such as grains roughly ground to flour for bread, which would not have been as soft as contemporary breads. Diet consisted of much more rough and course foods resulting in more trophied mandables (larger jaw bones from chewing), which consequently broadened nasal and sinus pathways. This would have made breathing easier, and hypothetically reduced the likelihood of experiencing anxiety as well as physical health problems like sleep apnea. Sleep apnea worsens anxiety by causing sympathetic nervous system dysregulation and inflammation.

Fermented foods tend to be considered helpful for our diets and wellness. The microbiome prevents spoilage from potentially harmful pathogens in food while also contributing to our microbiome when eaten. These microbes produce digestive enzymes that help break down foods and reduce immune response and inflammation, as well as protecting our gut from harmful microbes. Examples of this include yogurt, kombucha and water kefir (see my blog article on making water kefir).

Many foods contain vitamins, minerals and other healthy components like antioxidants and anti-inflammatories. The greater a portion of our diets that an array of these foods make up, the less we fill it with highly processed foods. While grains in the wheat family have been in the hot seat as potentially problematic for wellness, it is arguable this has been generalized to carbohydrates broadly. Various care providers have encouraged me to make sure I get enough complex (not processed) carbohydrates from other sources, such as oats. This is part of a diverse, moderated diet.

Exercise

No one should be surprised that exercise is recommended for health. However, there are caveats. Individuals with inflammatory conditions and overactive immune response such as Chronic Fatigue Syndrome (CFS) or long-COVID actually typically respond poorly to excessive exertion. Their fatigue and muscle weakness worsens, while other individuals feel good due to endorphins and may have an increase in energy and mood. This brings up an important differential diagnosis - while depression and anxiety respond positively to behavior activation including exercise, if the true underlying pathology is something like CFS, prescribing exercise could backfire. Less intense, exertive exercise has, in some literature, been indicated as equally as effective for physical well-being as intensive exercise. Taking a walk, making sure we move around every hour or so while at work.

Psychological and lifestyle interventions

Parasympathetic activation

We can think of our sympathetic and parasympathetic nervous systems like a see-saw. They balance each other, and when one is more active, the other is less so. Physiological arousal is associated with our sympathetic nervous system, and this can include anxiety and stress responses. Too much of this, like chronic stress, results in the system being unable to regulate itself and consequently being too easily activated by small triggers or constantly activated creating a persistent sense of worry or hypervigilance. This has psychological and physical consequences. Psychologically, if our base-level of arousal is raise, we have a smaller window or buffer before we reach anxiety that reduces our functioning or crosses the threshold into a panic attack. Clearly we want a larger buffer and calmer baseline! Chronic dysregulation and activation of the sympathetic system also leads to inflammation.

We can activate the parasympathetic nervous system in many ways, and I frequently combine them in a brief mindful-meditation practice. The first skill to learn is deep breathing. This skill has various names and approaches and the "best" one is what works best for you. However, to begin, I recommend something basic: four seconds breathing in, four seconds breathing out. We count this: in, two, three four, out, two, three, four. The second part of this exercise is breathing from our diaphragm. To practice and learn this, place one hand on your chest, and one hand on your belly. Practice moving your breathing lower and lower so only the hand on your belly is moving in and out with each breath. Think about a baby breathing. Before we internalize all the worries of the world, we / babies breath from their tummy - if you've ever looked over the edge of a crib at a baby sleeping, you can see this. But what about a baby crying? We see the chest moving and they frequently gasp for air, often having irregular breathing for a period of time even after they are no longer upset.

Good, now that you've got deep breathing down, let's consider progressive muscle relaxation (PMR). Just like we learn to breathe from our chest through a life of stress, we learn to carry that stress in our muscles. With PMR, we release that stress while also teaching ourselves a key word to trigger this, like a mantra or the chime that caused Pavlov's dogs to salivate. Consider a word like relax, calm, or safe, and integrate it into deep breathing. As we breathe in, we tighten one muscle group in our body, and as we breathe out, we say our key word and relax the muscle. When doing this, we count: in, two, three, four, relax, two, three, four. Start from top to bottom: forehead, jaw, shoulders, back, arms, wrists, fists, chest, abdomen, thighs, calves, ankles, toes. Imagine looking down on yourself and scanning up and down your body for any leftover tension. With each exhale, let as much go as possible. Relax your entire body, deeper and deeper with each exhale, feeling heavier and heavier in your chair. Eventually with this skill, you can release all of this tension in a single exhale as your say your key word in your mind.

Imagery and Grounding are two more skills that we can add to our toolbox. Grounding was initially developed for dissociative disorders secondary to trauma (posttraumatic stress disorder). Dissociation is escaping psychologically when we cannot escape physically, when can be very effective and a skill therapists sometimes teach, but it can also be overused or debilitating when it happens involuntarily. Daydreaming is thought to be a (typically) mild and normal version of this. Grounding helps us reconnect with the physical world around us, while also distracting from whatever triggered the need to dissociate in the first place. What we do is explore the world around us using our senses and describe something - anything - in as much detail as possible. The color of the wall, what it might be made of, shadows or light on it, texture. Now move onto the carpet, what it feels like to touch, the sound of running your foot over it. How about the way your seat cushion feels when you touch it with your hand? Smooth, rough, hot, cold? The air in the room, clothes on our body, scents and sounds.

With imagery, we can imagine mentally traveling to a safe or favorite place. Many people imagine the beach or playing at grandma's house while she makes dinner or bakes cookies. We want to apply the same grounding skills and describe as many details of the soundings using all of our senses as possible/necessary until we feel calm and safe to return to the outside world around us.

These skills culminate with mindful meditation. Classical meditation has a completely different goal and involves stripping away all the unnecessary things in the world until we find what is left at the core of our self. Mindful meditation is a form of mindfulness in which we are practicing strengthening being mindful, or consciously determining what we attend to. It is strengthening our attention. The trickiest part is not becoming judgemental, self-critical or frustrated when this is hard to do. The goal is not being perfectly mindful, but rather to slowly improve, over time, our ability to hold our attention on one thing at a time in the present movement. I liken this to a weight lifter: they don't just hold the weight up, but continually lift and lower it. As we consciously and intentionally shift our attention to a designated stimuli, we strengthen that muscle. Consequently, any distraction or "failure" to hold our attention is an opportunity to shift it again, so long as aware are aware and non judgemental about losing our attention.

• I recommend starting with deep breathing, and then listening for sounds far away - outside of the building like wind, rain, cars. Hold your attention on this, and if or when distracted, gently shift it back.

• Listen to sounds inside the building, but not the room. Other people moving about the building, maybe an appliance whirring away elsewhere.

• Shift your attention to sounds within the room. Air moving through the ducts or about the room, the whir of lights or other electronics, the sound of your breath or any repositioning you might do.

• Sensations on your skin. Temperate of the air, movement of the air. Clothes on your skin. The weight of your body on the chair. The feeling of your feet firmly planted on the ground. Your hands on the armrest of the chair - is it cool? Smooth or rough?

• Attend to other bodily sensations on or just below the skin. Your hair. How about just below the skin - are all your muscles calm?

• Imagine looking down onto yourself from above and doing a body-scan: scan from head to toe attending to any muscle tension. With each exhale, let as much of it go as you can. Continue this until you feel calm through your body.

• Breathe through your nose - feel the cool air in your nose as you inhale and the warm air as you exhale. Slow your breathing - in, two, three, four, out, two, three, four. Are you breathing from your chest or diaphragm? Can you move your breathing lower?

• Continue deep breathing, and try to feel your body as a whole, single entity. Relaxed, and getting heavier and heavier in the chair with each exhale. Go deeper and deeper into calm with each breath. [This is a primary step toward self hypnosis]

• Finally, imagine your mind as a factory. It has two floors - you are up above in the manager's office, looking down at the conveyor belt. The conveyor belt carries all of the contents of your mind. First, simply watch them go by. Next, identify each one as a thought, mental image, physical sensation, or emotion. Let each one come and go naturally, like a wave lapping up on the shore and receding back into the sea. Or a leaf slowly dropping from a tree, landing in a creek and floating slowly away. Do you notice yourself clinging to any thoughts, feelings or images, or pushing them away? Non-judgementally try to let the thoughts, feelings and images come and go naturally.

• With a final exhale, come back into the room.

Lastly, there are means of shocking your parasympathetic nervous system into activation during acute stress. Splashing cold water on your face elicits and evolutionary response in which your body calms itself to preserve oxygen in case of being plunged underwater. Squeezing ice cubes or frozen oranges provides a similar response. A warm (or cold) shower or bath is a calming way to escape, and can involve various sensory distractions like soaps, oils, or, if safe, candles.

Lifestyle

A great source for lifestyle best-practice guidelines is Interpersonal Social Rhythm Therapy (IPSRT). Check out the IPSRT Book and Workbook. Having a strong routine, social interaction, good sleep hygiene and consequently efficient sleep are all things that will promote physical and psychological wellness - our mood is strongly correlated to our circadian rhythms. None of this should seem surprising, however, like other health behavior change interventions, I find astoundingly few people (patients, colleagues, friends or family) follow these guidelines. Some are as follows.

The easiest factor in setting our social rhythms is our morning wake up time. For people with poor internally driven circadian rhythms, like someone with bipolar disorder, they should ideally get up every day within 15-minutes of the wakeup time they decide is healthiest for them and their responsibilities (such as occupation). So, if we choose 7am as our wakeup time, we would have a window from 6:45am to 7:15am that would be ideal. Most of us are ok with a 30-minute window. This, in turn, will influence our bedtime. Again with a 15-30 minute window. When going to sleep, we want to practice good sleep hygiene:

• Low lights like a lamp with a warm-color light bulb

• Minimize screen usage and if we do use a screen, dim the brightness and consider a setting that limits blue light wavelengths. Blue wavelength light is activating and prevents melatonin production onset, and consequently delays sleep onset.

• Calm activities like reading a book.

• Bed is only for sleep and sex - nothing anxiety provoking or activating like work, otherwise we are training ourselves to be alert in bed.

• Have an active morning routine.

  • Access to sunlight or a bright-light lamp (light therapy box). Carex Daylight is recommended by CET.org and was the one we utilized in the hospital and research setting. You can use this while eating breakfast, reading our using a tablet/laptop.

  • Most people benefit from exercise in the morning, which gives our body cues to set the internal clock that this is when we start our day. It builds energy for the day.

  • Reasonably early social interaction. Is this with your partner? A first work meeting? Regular social interaction is also important to our wellness, of course in consideration of our temperament, which refers to the introversion-extraversion continuum. While introverts need downtime to recharge their emotional battery, they also need social interaction and may need to be conscious of sprinkling this in each day.