Therapeutic Lifestyle Changes Offer Many Mental Health Benefits

By Roger Walsh, PhD, M.D.

Lifestyle changes – such as getting more exercise, time in nature, or helping others – can be as effective as drugs or counseling to treat an array of mental illnesses, according to a new paper published by the American Psychological Association.

Multiple mental health conditions, including depression and anxiety, can be treated with certain lifestyle changes as successfully as diseases such as diabetes and obesity, according to Roger Walsh, M.D., PhD. of the University of California, Irvine’s College of Medicine. Walsh reviewed research on the effects of what he calls “therapeutic lifestyle changes,” or TLCs, including exercise, nutrition and diet, relationships, recreation, relaxation and stress management, religious or spiritual involvement, spending time in nature, and service to others. His paper was published in American Psychologist, APA’s flagship journal.

Walsh reviewed research on TLCs’ effectiveness and advantages, as well as the psychological costs of spending too much time in front of the TV or computer screen, not getting outdoors enough, and becoming socially isolated. He concludes that “Lifestyle changes can offer significant therapeutic advantages for patients, therapists, and societies, yet are insufficiently appreciated, taught or utilized,” The paper describes TLCs as effective, inexpensive and often enjoyable, with fewer side effects and complications than medications. “In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical and public health,” Walsh said.

According to research reviewed in the paper, the many often unrecognized TLC benefits include:

  • Exercise not only helps people feel better by reducing anxiety and depression. It can help children do better in school, improve cognitive performance in adults, reduce age-related memory loss in the elderly, and increase new neuron formation in the brain.
  • Diets rich in vegetables, fruits and fish may help school performance in children, maintain cognitive functions in adults, as well as reduce symptoms in affective and schizophrenic disorders.
  • Spending time in nature can promote cognitive functions and overall well-being.
  • Good relationships can reduce health risks ranging from the common cold to strokes as well as multiple mental illnesses, and can enhance psychological well-being dramatically.
  • Recreation and fun can reduce defensiveness and foster social skills.
  • Relaxation and stress management can treat a variety of anxiety, insomnia, and panic disorders.
  • Meditation has many benefits. It can improve empathy, sensitivity and emotional stability, reduce stress and burnout, and enhance cognitive function and even brain size.
  • Religious and spiritual involvement that focuses on love and forgiveness can reduce anxiety, depression and substance abuse, and foster well-being.
  • Contribution and service, or altruism, can enhance joy and generosity by producing a “helper’s high.” Altruism also benefits both physical and mental health, and perhaps even extends lifespan. A major exception the paper notes is “caretaker burnout experienced by overwhelmed family members caring for a demented spouse or parent.”

Difficulties associated with using TLCs are the sustained effort they require, and “a passive expectation that healing comes from an outside authority or a pill,” according to Walsh. He also noted that people today must contend with a daily barrage of psychologically sophisticated advertisements promoting unhealthy lifestyle behaviors such as smoking, drinking alcohol, and eating fast food. “You can never get enough of what you don’t really want, but you can certainly ruin your life and health trying” lamented Walsh.

For therapists, the study recommends learning more about the benefits of TLCs, and devoting more time to foster patients’ TLCs.

The paper recognizes that encouraging widespread adoption of therapeutic lifestyles by the public is likely to require wide-scale measures encompassing educational, mental, and public health systems, as well as political leadership.

Source Medical News Today

Dark Adolescent Romance

By Bella DePaulo

I’ll begin with the bottom line: Romantic involvements during adolescence can be bad for you. They can be bad even for adolescents who stay with the same partner and do not break up. By “bad,” I mean that adolescents who become romantically involved, compared to those who do not, become more depressed. Adolescent females become less happy. Both males and females abuse alcohol more and become more delinquent if they become romantically involved than if they do not. The results are noteworthy because they come from a nationally representative sample and a longitudinal design.

In the next few sections, I’ll wade into the weeds of the study. Then at the end, I’ll re-emerge with some big-picture points.

About the Study

During the 1994-1995 school year, a nationally representative sample of adolescents, ages 12 through 17, were recruited to participate in the National Longitudinal Study of Adolescent Health. The relevant data are from 8,181 males and females who also participated in a follow-up interview about a year later.

Each time the adolescents were interviewed, they answered questions about their romantic relationship history (e.g., “In the last 18 months, have you had a special romantic relationship with anyone?”), their drinking (e.g., how often in the past 12 months did they do “something you later regretted because you had been drinking”), and any delinquent behavior (e.g., how often they ran away from home or got into a serious physical fight). They also rated their happiness and filled out a standardized measure of depression. Other questions were also included. For example, during the first interview, they were asked how much they hoped they would be romantically involved during the coming year.

Some Key Findings

For many young people, depression increases over the course of the mid-adolescent years, especially for females. So one key question is: Does depression increase more (from the first year of the study to the second) for those who become romantically involved than for those who have had no romantic involvements?

The answer to that question is yes. Depression increases for those who become romantically involved for the first time. It increases for those who remain involved with the same person during the year or so in question.

Both male and female teens become more depressed if they become romantically involved than if they do not, but the increase in depression is even greater for the females.

Guess who else becomes especially more depressed over the course of the two interviews? Those who said that they very much wished they would be romantically involved in the next year (regardless of whether their wish comes true).

Well, they are young, and the findings I’ve reported so far are for all of the participants, whether they are 12 years old, 17 years old, or anywhere in between. Is romantic involvement less likely to deepen depression for the relatively older adolescents?

No, not for the males. For the guys, age does not matter. What does matter is whether they have had more than one romantic partner in the past 18 months, and whether they’ve experienced a break-up in the past month. If either of those is true, the guys become more depressed.

So what about the females? The relatively older teenage girls who stay involved with the same partner do seem to show less of an increase in depression than the younger romantically-involved girls. But for girls (and boys) at any age, becoming romantically involved for the first time is linked with becoming more depressed.

Happiness is not just the opposite of depression; it is measured separately. For girls, their happiness takes a hit if they become romantically involved. For boys, levels of happiness do not change with romantic involvement.

Some theorists believe that females’ problems show up in levels of depression, whereas males’ issues reveal themselves in higher rates of drinking and delinquency.  In this study, though, both the females and the males who became romantically involved reported more problems with drinking and delinquency than their peers with no romantic involvement.

So why is this happening? Why do teens who become romantically involved also become especially more depressed? The hints that the authors found are different for the girls than for the boys. The girls who become romantically involved report that their relationship with their parents is getting worse. The boys (and the younger girls) are more likely to have grades that are slipping.

The Big Picture

Valentine’s Day is not the only time of year when couples and coupling are romanticized. At this point in history, matrimania is our cultural wallpaper. As adults, we often have the wherewithal to keep it all in perspective – maybe even to mock it. The meta mindset, or big-picture perspective, is more difficult for adolescents to attain. Many of them yearn to be coupled. Maybe that’s what brings them status among their peers.

But it does not bring them happiness. Instead, they become more depressed, report more drinking problems, and engage in more delinquent behaviors than their peers who do not become romantically involved.

When you think about adolescents getting into trouble, what comes to mind? I bet it is not romance. Typically, it is their friends, their peer group, “running with the wrong crowd” that gets the blame. This research reminds us of something different: Romance can be risky for teens.

Source Psychology Today

Behavioral Problems, Such As Depression And Aggression, Linked To Cortisol Levels

By Christopher Fisher, PhD

Cortisol, the so-called stress hormone, seems to behave in contradictory ways in children. Some youngsters with behavioral problems have abnormally high levels of cortisol, while others with identical problems have abnormally low levels. Researchers at Concordia University and the Centre for Research in Human Development may have resolved this cortisol paradox.

In a groundbreaking study published in the journal Hormones and Behavior, they link cortisol levels not simply to behavior problems, but to the length of time individuals have experienced behavior problems.

“We studied the relationship between cortisol levels in young people with problematic behavior, such as aggression or depression, and the length of time since the onset of these behaviors,” explains Paula Ruttle, lead author and PhD candidate at Concordia’s Department of Psychology. “Cortisol levels were abnormally high around the time problem behaviors began, but abnormally low when they had been present for a long time.”

To obtain subjects’ cortisol levels, researchers analyzed saliva samples taken from 96 young people during early adolescence. They then matched cortisol levels to behavioral assessments taken in childhood and again during adolescence. Problem behaviors were classified as either “internalizing” (depression and anxiety) or “externalizing” (aggression, attentional problems).

Riding the cortisol roller coaster
Youngsters who developed depression-like symptoms or anxiety problems in adolescence had high levels of cortisol. However, those who developed symptoms earlier had abnormally low cortisol levels. The conclusion? Cortisol levels go up when individuals are first stressed by depression or anxiety, but then decline again if they experience stress for an extended period.

“It seems the body adapts to long-term stress, such as depression, by blunting its normal response,” says coauthor Lisa Serbin, a psychology professor who is Ruttle’s PhD supervisor and Concordia University Research Chair in Human Development.

“To take an extreme example, if someone sees a bear in the yard, that person experiences a ‘flight or fight’ reaction,” continues Serbin, a member of the Centre for Research in Human Development. “Stress levels and therefore cortisol levels go up. However, if the same person sees bears in the yard every day for a year, the stress response is blunted. Eventually, cortisol levels become abnormally low.”

Aggressive behavior in early childhood
At first glance, study results from children with aggressive behavior and attentional problems seem to contradict this theory. In this group they found that low levels of cortisol were related to aggressive behavior both during childhood and adolescence. However, the authors contend that since aggressive behavior often begins in the second year of life or earlier, subjects may have been stressed for years before entering the study, resulting in abnormally low cortisol levels.

“This blunted response makes sense from a physiological point of view,” says Ruttle. “In the short term, high levels of cortisol help the body respond to stress. However, in the long term, excessive levels of cortisol are linked to a range of physical and mental health problems. So, to protect itself, the body shuts down the cortisol system – but research shows that’s not good either.”

What, me worry?
Individuals with a blunted response to stress may not respond to things that would – and should – make other people nervous. For example, children with long-term behavior problems perform poorly in school. Because of their blunted stress response, these youngsters may not be worried about exams, so they do not bother to prepare as much as their peers.

The study has many significant implications, according to Serbin. “This research suggests interventions should begin as soon as a behavioral problem appears,” she says. “For children with severe externalizing problems, this may be very early, perhaps even when they are preschoolers or toddlers.

“We now have evidence that behavioural problems in children are linked to mental and physical health. Taking a ‘wait-and-see’ attitude may not be the right approach.”

Source The Behavioral Medicine Report

Recommitting is the Key to Long-Term Recovery from Alcoholism

By Sarah Allen Benton, M.S., L.M.H.C.

Recovery is an ongoing process and those fortunate to have long-term recovery have one thing in common- an ability to recommit themselves. It has been observed that people often get sober and as a result expect that life should go their way-a reward, in a sense, for their “good” behavior. However, that is not generally what happens. In fact, many sober high-functioning alcoholics, in particular, report that their lives often get worse before better. While this may seem unfair, it is actually a blessing in disguise- for it can ensure that the motivation to remain sober becomes internal and not based solely on external rewards. For example, a person gets sober and then receives a new job, a romantic relationship and everything external in their life takes a positive turn. Inevitably a negative situation will arise and the individual may struggle to cope and feel that there is no point to being sober because life is not going their way. In contrast, when a person is staying sober despite difficult circumstances initially, they are able to increase their distress tolerance and to realize that recovery is about slow internal growth and not dramatic external rewards. It does not matter what the conditions are in early sobriety for an individual-positive or negative, for over time difficulties will arise. It is imperative to learn how to deal with the good, bad and indifferent waves that life will inevitably bring forth.

Initially, getting sober may feel exciting, new and fresh-the world suddenly appears different and a person may feel better mentally and physically. However, this “pink cloud”, as many have labeled it, will wear off and “reality” of this lifelong venture will set in. At this time it is crucial to have a social support system in place as well as outside help for co-occurring mental health issues such as anxiety, depression, etc. (i.e., individual therapy and medication management-as needed). Getting through a difficult time while staying sober builds their “muscle” and makes the next challenge feel possible to work through. Recovery itself may start to feel mundane and tedious and it is up to the individual to take a look at all facets of their lives to see what actions they need to take in order to get back on track. This is the process of “re-committing” and it involves acknowledgement of weakness in an area(s) of recovery and then self-correcting.

There are many aspects involved in having stable recovery. Some common areas in which sober alcoholics may lose their commitment over time are:
• Attending individual therapy as recommended
• Exercising
• Obtaining proper sleep
• Maintaining balanced nutrition
• Attending regular mutual-help meeting (A.A., SMART Recovery, Women for Sobriety)
• Attending group therapy
• Staying in contact with sober peers
• Not engaging in other addictive behaviors (i.e., shopping, sex, gambling)
• Taking prescribed medication that has been assessed as necessary
• Being honest
• Pursuing spiritual practice
• Following through with daily responsibilities (i.e., work, paying bills, chores)
• Giving back to others
• Involvement in healthy relationships (friendships, family and romantic)

One pattern that can lead to relapse is, for example, not attending mutual-help meetings for a period of time and then feeling discouraged about this pattern, giving up all effort in other areas of recovery and possibly relapsing. Instead of viewing this break from an aspect of recovery as a temporary lull and then recommitting, many individuals use “black and white” thinking to judges themselves in a negative way and as a result may “give up” on sobriety. However, no one is perfect, and everyone with long-term recovery has had a time when they were lacking motivation in one area or another. The key is to observe what aspect of life is out of balance and to work on making adjustments without giving up completely. Sometimes creating small and obtainable daily goals can help a person to get back into their routine. It is important to reach out for help and to talk with others in their support network about these challenges-for no one has to be alone on this path.

Source Psychology Today

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Brain Pacemaker Holds Promise for Untreatable Depression


According to experts, nearly 10 percent of all cases of depression are so severe that patients do not respond to any established treatment method. But stimulating targeted brain areas with a type of “brain pacemaker” has shown promising results.

According to initial studies, half of patients with the most severe depression treated with deep brain stimulation see a significant improvement in mood.

Now, physicians from the University of Bonn in Germany, together with colleagues from the U.S., have suggested a new target structure for this intevention which they hope will achieve an even better success rate with fewer side effects.

In deep brain stimulation, physicians implant electrodes in the brain. Then, using an electrical pacemaker implanted under the patient’s clavicle, physicians can influence the function of certain areas of the brain.

The method was originally developed for treating patients with Parkinson’s disease to treat its typical movement problems.

For several years, the method has also been investigated in the treatment of the most severe cases of depression, with striking and completely unexpected success. In patients who had undergone many years of unsuccessful treatment, the symptoms sometimes significantly resolved.

The most striking aspect: “Depression does not return in patients who responded to the stimulation,” said Professor Dr. Thomas Schläpfer from the Bonn Hospital for Psychiatry and Psychotherapy.

“The method appears to have lasting effects – and this is in the case of the most treatment-resistant patient group described in the literature. This has never before happened.”

Deep brain stimulation has been tested to date in three different areas of the brain: the nucleus accumbens, the internal capsule, and a structure known as cg25.

Surprisingly, the effects are nearly identical – regardless of which of these centers the physicians stimulate. Together with colleagues from Baltimore and Washington, the Bonn researchers have since been able to explain why this is the case. Using a novel tomography method, they were able to make what they call the “cable system” of the three brain centers visible.

“In doing this, we determined that at least two of these three areas – probably even all three – are attached to one and the same cable harness,” said Bonn brain surgeon Professor Dr. Volker Coenen.

This is the so-called medial forebrain bundle, which forms a kind of feedback loop that allows us to anticipate positive experiences. “This circuit motivates us to take action,” said Coenen.

“In patients with depression, it is apparently disrupted. This results in, among other things, an extreme lack of drive – a characteristic symptom of the disease.”

The nucleus accumbens, internal capsule, und cg25 all appear to be connected to the medial forebrain bundle – rather like leaves are connected to the branch from which they arise.

Whoever stimulates one of these regions of the brain simultaneously influences the other components of the motivation circuit to a certain extent.

Coenen, who was the first to anatomically describe the forebrain bundle in humans, now proposes implanting the electrode for deep brain stimulation directly into this structure.

“We would use the electrode to send the current pulses to the base of the network and not to the periphery, as before,” said Schläpfer. “We could thus potentially work with lower currents and yet achieve greater success.”

Observations of patients with Parkinson’s disease appear to support this idea: In this case, a network of brain structures responsible for movements is stimulated.

The more basally (figuratively speaking: near the branch) the electrical stimulation is applied, the greater its effect. At the same time, the risk of adverse side effects is reduced.

By now, more than 80,000 patients with Parkinson’s disease worldwide have a brain pacemaker in their body.

“Experiences to date demonstrate that the brain intervention necessary for this is relatively low-risk,” said Coenen.

“Thus from a medical point of view, there is nothing that argues against also using this method to help people with very severe depression.”

The work is published in the journal Neuroscience and Biobehavioral Reviews.

Source Psych Central