- The gut microbiome consists mostly of bacteria and that is largely the portion of the microbiome we are focusing on (fungi and viruses exist but their function is largely unknown)
- Communication pathways exist between the microbiota-gut-and brain.
- Multiple mechanisms exist that allow gut microbiota to signal to the brain and control physiological processes.
- These include release of gut peptides from enteroendocrine cells which activate receptors of the immune system and vagus terminals in the gut.
- Studies indicate that these bacteria can manufacture and secrete essential neurochemicals including serotonin, dopamine, NE, GABA, and acetylcholine
- Depression and anxiety have been linked to a less well diversified gut microbiome.
- What can help diversify the gut microbiome? Diet, processed food, sugar, saturated fats, and red meat. Medication can also alter the gut microbiome, a good example is oral antibiotics used to treat an acute infection, sleep, exercise. Sounds a lot like a healthy lifestyle will get you the microbiome you need for optimal mental health.
- However, if you want a treatment there have been several studies that looked at fecal transplant to treat psychiatric disorders. Fecal transplants are much easier these days and now there is a capsule version that you take orally. There is not enough data to recommend this as a practical treatment and if the patient goes back to eating a poor diet, sleeping poorly, not exercising then the gut microbiome will revert after the transplant.
- What are the practical things you can do? Stop eating processed food, sugar, and red meat. Increase your fiber intake and select a diet like the Mediterranean diet or a plant based whole food diet that will provide those prebiotics. You could supplement with a probiotic but most of what you need can be had from a good diet alone and I think it’s far better to change the diet then to try using supplements to treat a poor diet. Fermented products like kimchi, kombucha and sauerkraut are good sources of live bacteria.
- If you choose to take a probiotic make sure it’s a quality, 3rd party tested product.
- Increase aerobic activity, I think if you goal is overall general health and you have limitted time, I think aerobic activity is a better bang for your buck.
- The way I believe you get and keep a healthy gut microbiome is through lifestyle modification. Improving your diet, exercise, and sleep is a good place to start. If you want to supplement with food products like kimchi or kombucha, go for it. I do not believe there is enough evidence to support a probiotic supplement for psychiatric disorders at this point, but if you want to spend $30 or more per month on a product if it’s a quality one that’s fine. Remember you cannot supplement away a bad diet.
In this video I focus the discussion on the exercise/physical activity portion of lifestyle medicine for psychiatry. Exercise is an underrated and underutilized tool for fighting depression. It can have a profound impact on mood, and helps people learn to be more resilient.
Key Findings Include:
- For resistance training, higher intensity and shorter duration provides improvement in mood symptoms
- For aerobic exercise, durations of 45-60 minutes appear to provide the most improvement in mood symptoms. Longer and shorter durations showed less benefit.
- Keep it simple and just get started. There are a million different programs, and you can easily find yourself worrying to much about getting all the information and not enough time worrying about exercising.
- The simplest way to start is with a daily walking routine. Spend six months consistently walking for 45-60 minutes. That’s it, no special equipment or significant out of pocket expenses required.
- A walking routine will set the foundation for adding additional forms of exercise including resistance training
My clinical experience indicates that most psychiatric disorders would benefit from the use of lifestyle medicine. As a member of the American College of Lifestyle Medicine, I’ve used lifestyle interventions to treat many of my patients. It’s an underutilized and undervalued part of health care in general and these are my thoughts about why that is the case.
Anxiety is something most of us have experienced. This five-step exercise can be helpful during periods of anxiety by helping to ground you in the present moment.
Start the exercise by drawing attention to your breathing. Slow, deep, breaths can help you induce a feeling of relaxation. Once you feel relaxed, go through the following steps to ground yourself:
One: Note ONE thing you can taste
Examples may include: gum, sugar free candy, coffee, sparkling water (anything you can taste in the moment).
Two: Note TWO things you can smell
Examples may include: fresh air, scented candle, flowers, food cooking (anything around you that you can smell)
Three: Note THREE things you can hear
Examples may Include: people talking, cars driving, wind blowing, rain falling (anything in the environment you can hear)
Four: Note FOUR things you can touch
Examples may Include: desk, chair, pen, phone (anything around you that you can touch)
Five: Note FIVE things you can see
Examples may include: door, computer screen, car, tree, house (anything you see around you)
I’ve done a soft rollout of the Shrinks In Sneakers YouTube channel over the past several months. I think I’m finally comfortable introducing it on the blog. I made the decision to start making videos because I can create content at a more rapid rate, and I can connect with the viewer in a more personal and intimate way. Please subscribe to the channel for updates. If you have specific topics you want covered, or have questions about existing content please comment. I will try to answer all questions and continue creating engaging content based on your interests.
Link to YouTube Channel
Anxiety is a part of life; we all experience it. The amount of anxiety a person experiences is to some degree related to how important a particular outcome is to that person. It seems like everything these days is high stakes and anxiety provoking. There is a global pandemic that continues to create chaos around the world, economic uncertainty, gender and racial inequality, and now a presidential election.
People are more anxious than ever about this presidential election. According to a recent article by the American Psychological Association 68% of U.S. adults say the 2020 U.S. presidential election is a significant source of stress. This is compared to the 2016 election where 52% of U.S. adults found the election stressful. It might just be a symptom of the times, but it remains a significant concern. If you are having election anxiety here are some simple ways to reduce stress and anxiety during this election cycle.
- Make sure you are getting enough sleep. Set a regular sleep time and wake time. Make sure the room you sleep in is as conducive to sleep as possible (e.g. dark room with no ambient light). Limit the bed to sleep and sex only, do not play games on your phone or read in bed. If you can’t sleep get out of the bed and do a mildly strenuous activity. A good example is a crossword puzzle, then come back to bed when you feel tired. If you are not sleeping well it can cause problems in other areas of life such as mood and cognitive function.
- Get outside or stay inside whichever you prefer, but make sure to move. Exercise is a great way to cope with stress and anxiety. There are countless free guided exercise routines on sites like YouTube that require little or no equipment to perform. If you do not like that option, take a walk in your favorite park, take a bike ride, or go for a hike on your favorite trail.
- Limit your consumption of news throughout the day. Set aside one or two times per day to check the news and see what is going on with the election. Resist the urge to continually check in and get play by play updates. This simple, but difficult to follow advice will save you a lot of stress and anxiety.
- Avoid talking to people in your life about the election who are unable to keep their emotions under control while discussing the topic. You should have a good idea of who these people are in your life. This will save you a lot of stress and anxiety by simply choosing to talk about other topics with those individuals.
- The last thing I recommend for people who want an activity they can perform to reduce stress is a thought journal . This can be as simple as a piece of paper that you record the thoughts on. There are printable versions of this online. I will provide a link to one such example here. This is a common technique used in cognitive behavioral therapy (CBT) all the time.
The other day I had a conversation with a friend, and the topic of Alzheimer’s disease (AD) came up. My friend’s opinion was basically why would I want to know I have a disease that results in steady decline in function, and lacks any disease modifying treatments? This is in large part true, there have been multiple clinical trials of both symptomatic and disease modifying drugs that failed to produce adequate results. However, this is a very limitted view and neglects the benefits of focusing on modifiable risk factors and primary prevention. We know approximately 1/3rd of AD cases are due to modifiable risk factors, and the implementation of lifestyle modification early may prevent or delay the onset of AD.
Modifiable Risk Factors
Common modifiable risk factors for AD include hypertension, hyperlipidemia, diabetes, obesity and smoking. Management of these risk factors as early as possible may offer a preventative approach for AD. Equally important are lifestyle modifications such as physical exercise, diet, mediation/mindfulness, and social activity.
Physical inactivity has a significant influence on the development of AD. Twenty-one percent of AD cases are attributable to physical inactivity. There is a significant number of studies in the literature that indicate physical activity is neuroprotective. We know one of the areas in the brain affected by physical activity is the hippocampus which is involved in memory. Exercise leads to increased neurogenesis and neuroplasticity in the hippocampus. Other benefits of exercise on the brain include increased blood flow, modulation of inflammatory markers, and increased brain-derived neurotrophic factor (BDNF). The exact definition of adequate exercise varies in the literature. Any activity that is sufficient to increase heart rate and can be sustained for 30-60 minutes is my definition. A basic example would be brisk walking for 30-60 minutes. Physical activity two times a week beginning in middle age is associated with reduced risk of AD. Aerobic exercise is associated with additional cognitive benefits including improved processing speed, attention, and memory in adults with mild cognitive impairment. This recommendation is especially important for ApoE4 carriers, as exercise is associated with reduced amyloid deposits.
Physical activity should be a recommendation for all patients without major health concerns preventing physical activity. The earlier in life a patient begins an exercise routine the better. Some of these studies have looked specifically at starting exercise routines in middle age, but there is no reason to wait. The physical and cognitive benefits of exercise are beneficial regardless of age. It’s much easier to begin training when you are young and healthy. If you build healthy lifestyle habits earlier in life, they are likely to last as you age. Guidelines for regular exercise can be found on the American Heart Association or American College of Sports Medicine websites.
Meditation or mindfulness is a topic that is beginning to get more attention in the medical literature. Chronic stress is believed to effect brain structures involved in memory and may contribute to AD. Psychological stress increases oxidative stress and telomere shortening which could contribute to the neuronal loss seen in AD. Meditation has emerged as a possible way to reduce the stress associated with daily life. The techniques of mindfulness involve directing one’s attention to the present moment to reduce the stress associated with constant thinking and worrying. Randomized controlled trials (RCTs) have shown significant improvements in overall well-being and attention. Improved executive function and reduced inflammatory processes implicated in AD. Additional research and larger RCTs are needed to improve the evidence base. Given the data we currently have there is no reason to not begin mindfulness practices. The techniques are relatively simple and can be learned from a variety of sources. If you are looking for low cost options for learning mindfulness, YouTube has a variety of guided mediations available. I personally like Headspace for beginners because it provides a solid foundation, has a variety of meditation courses, and allows you to track your progress. There is a fee for access to all the courses, but the first 10 sessions are free. Whichever route you choose, spending 10-15 minutes per day practicing mindfulness will lead to a happier and healthier brain.
A great deal of research has been conducted over the last several years on the role of diet with respect to cognition. People with high calorie diets, specifically those high in fat are at higher risk for AD. Traditional western diets high in processed carbohydrates, simple sugars, and saturated fatty acids can impact the hippocampus and memory. When Japan transitioned to western diet the incidence of AD increased. Lower calorie diets with lower saturated fat content are linked to lower oxidative stress, decreased Beta amyloid burden, and decreased inflammation. One diet with proven benefits for preventing AD is the Mediterranean diet. This diet is rich in fruits, vegetables, whole grains, olive oil, and fish. There is moderate intake of low-fat dairy products and low intake of red meat, saturated fats, and sugar. Most of the data supporting the reduce risk of AD with this diet comes from epidemiological studies. Studies have shown combining this diet with exercise further reduces the risk of AD. The Mediterranean diet is associated with better cognitive function and reduced cognitive decline. This is one specific example, but the basic principles can be applied without the need to adhere to one specific named diet.
Some specific foods you may want to add to your diet to prevent AD include fresh berries which have the highest amounts of antioxidants among the fruits. They are also low in calories and work well in diets where weight loss is a goal. Green leafy vegetables and tomatoes have the highest nutritional value when it comes to brain health amongst the vegetables. Foods high in omega-3 fatty acids are considered to be helpful in supporting brain function. The omega-3 fatty acid most important in brain function is docosahexaenoic acid (DHA), which is mostly found in fish. The anti-inflammatory and antioxidant properties of DHA are thought to be responsible for its role in preventing AD. Patients with diagnosed AD are known to have low levels of DHA. Omega-3 fatty acids recommendations from the American Heart association for adults is to eat fish rich in omega-3s two or more times per week. If using a supplement 1-3 grams per day is an adequate dose. Over 3 grams per day, you should consult with your doctor before moving above 3 grams per day.
Finally, curcumin which is derived from turmeric has anti-inflammatory, antioxidant, and anti-amyloid properties. There is low bioavailability of the curcumin lead to mixed results in the initial trials. A new more bioavailable form called Theracumin demonstrated positive results in a randomized double-blind placebo-controlled study on memory, attention, and amyloid plaques in older adults without dementia.
While there is no guarantee that lifestyle modification alone will prevent AD, there are some promising studies indicating it plays a role in the development of this disorder. Most of these interventions are things patients can implement in their lives immediately. They will not only improve cognitive function and lower the risk of developing AD, but it will improve and potential reverse other diseases of lifestyle.
These are unprecedented times around the world. The situation escalated much quicker than most people predicted. Now, many people in the United States are facing continued statewide stay at home order for all non-essential persons. If you are stuck at home you may be trying to find alternative ways to use your time. Maybe it’s time to clean the garage or work on the yard as the weather in most parts of the country starts to improve. One way I’ve observed many people using their time is walking, running, or doing home workouts to improve their health and wellbeing. Despite the situation we can use this time to focus on lifestyle changes that can continue long after the pandemic ends.
I’ve always believed that lifestyle interventions specifically diet, exercise, sleep, and stress reduction is key to improving both mental health and physical health. I’ve been using lifestyle modification to help improve symptoms of depression and anxiety for the past year in my patients. I’ve been successful in reducing depression ratings on the Hamilton depression inventory (HAM-D), medication dosage, and reducing body weight in several patients with these interventions. There is also a growing body of literature on the topic of lifestyle modification and mental health. I’m going to provide some general tips for getting started with lifestyle modification.
Before starting any diet or exercise program you should consult with your doctor.
- See a primary care provider (might be difficult under the current circumstances): Make an appointment with a primary care physician, and get baseline results including waist circumference, BMI, blood pressure, fasting blood glucose, fasting lipid panel, basic metabolic panel, thyroid stimulating hormone, and complete blood count. There are additional tests that could be relevant on a case by case basis, but these are the basic things we want to see to establish a baseline. At the very least you can get a weight and BMI calculation if you have a scale and a measuring tape at home.
- Nutrition: Schedule a consult with a registered dietician to help create a manageable diet. You can also research diets on your own, but I suggest you have a professional guide you in the process to ensure the information you are getting is accurate and not harmful. The best diets in my opinion are whole food plant-based diet or Mediterranean diet. However, it’s important to remember that dietary recommendations are individualized and should suit the needs and lifestyle of each person. At the very least you want to increase your consumption of fruits and vegetables while limiting the intake of red meat, sugar, processed foods, and alcohol. These are staples in the standard American diet (SAD) which almost everyone agrees is harmful to your health.
- Stress management: The modern life of most Americans is filled with more stress than any previous time in history. Finding ways to reduce stress, and recharge our mental batteries is essential to enhanced performance and overall well-being. The most prevalent method is mindfulness training and there is a verity of ways to incorporate this into a busy daily schedule. I personally prefer meditation applications like Headspace (free for the first few sessions then subscription fee) to help guide patients initially, but this is not essential and there are many free guided meditations available on YouTube free of charge. I will also provide a beginner’s guide to meditation in future posts.
- Exercise: The question of aerobic Vs strength training and which is better to incorporate in your daily life is a common one. I believe both forms of training have value and should be used on a daily basis if possible. Like many things it depends on the individual patients’ goals and needs. Strength training increases lean body mass, protects bone health, improves balance and flexibility among other things. Aerobic training helps with efficiency of respiration, improves blood flow to muscles, improves cardiovascular efficiency among other things. I believe if your goal is improved general or mental health finding ways to use both types of exercise is essential.
- Sleep: Helping people sleep is a large part of a psychiatrist’s job. Sleep plays an essential role in mental health. Many people fail to get enough quality sleep and suffer excess day time sleepiness or poor work performance as a result. The first step from anyone who has trouble sleeping is to keep a sleep log for one month that we can analyze together. You can gain a lot of information from asking specific questions about sleeping patterns, but you still want to see the log because it brings the persons attention specifically to how they are sleeping. I also go over basic sleep hygiene which is a series
I realize that some of these thigs will be difficult to do under the current circumstances. The key with anything in life is to just start. I cannot count how many times my life would have been improved if I made the decision to just start.
The other day, I was working out in my home gym and I started to think about the topic of therapy. Most of my thinking is done in the solitude of the gym. I keep a small pad and pen to write my thoughts down in between sets. On this particular night, I began thinking about what my own therapy looks like.
The things I was thinking about were not necessarily the standard type of talk therapy most people are accustomed to. I absolutely believe in talk therapy. Honestly, every psychiatrist should be in therapy and it’s often recommended to trainees. The work of a psychiatrist is deep emotional work and its good to analyze these experiences with someone. However, it’s not always easy to find a good therapist.
People often wonder outside of formal talk therapy, what activities do psychiatrists use to reduce stress.
My personal form of therapy is physical training. I learned a lot about myself over the years by demanding a lot of my body. I stress to all of my patients the importance of self-care in the form of physical activity. The human body is made to move, and we have slowly grown into lives of inactivity. Much of our work, education, and leisure activates involve no physical movement. I highly recommend incorporating various sports, running, weight training and other fitness actives into your daily life. If you can bring a friend along for the workout even better. This covers both physical and social areas of wellbeing.
This biggest barrier to this process is getting started. Patients often say, “I could never do that” to which I say you don’t have to. Start off simple call a friend or two that can serve as workout partners and start with one 20-minute walk per day. It’s low impact and can be accomplished in almost any setting. There is no need to invest in the best pair of running shoes, a gym membership, or personal trainer. It’s about creating a sustainable habit that will continue for a lifetime. All you need to do is literally take that first step.
Feel free to share what helps you stay mentally fit and reduce stress in the comment section below.
Good morning! Happy Monday. Generating content the way I’ve wanted to has been difficult being home with a little one, working, or working while being home with a little one. I have chosen to take my own advice and be kind to myself, realizing these are unique times and congratulating myself for small victories.
So why am I asking you about shampoo?
This morning was a tough Monday after a tough weekend. Feels a little bit groundhog day and the gray weather is definitely affecting my mood. But as I engaged my glutes in some old-school leg lifts while jazzercising on Facebook, I had a moment of clarity. It’s wild how the mind clears with increased blood flow from exercise. I promise I’m getting to the shampoo.
In other areas on the site, you may have read about depression. We work with people with depressive disorders every day and there are some common themes. One of the questions I frequently ask my patients is, “What brings you joy?” Why do I ask this? It can answer many questions. Not least of all, assessing for anhedonia. If nothing brings you joy, you may be experiencing anhedonia and should check out Dr. G’s series on depression.
I’ve been thinking about the things that bring me joy and have come to the conclusion that I am unable to do many of them right now. Among those include spending time with friends and family, enjoying new restaurants, taking live workout classes, and perhaps the most missed activity, traveling. What that means is that I need to fill the joy bank with other things in order to prevent anxiety and depression. Preventive medicine is the best medicine after all.
Finally, the shampoo.
I shampoo my hair probably every other day. That means I’m spending a decent amount of time engaging with my shampoo. Recently, I determined that I don’t really like my shampoo. It was simply shampoo, got the job done, nothing special. Then, one evening at approximately 1AM, I made the bold decision to try to love my shampoo. (Side bar: the mind readers on Facebook advertising may have nudged this decision ever-so-slightly. Thanks omniscient overlords of Facebook.) While it took three tries, and a few dollars from my pocket, I now love my shampoo. I like the smell, how it feels in my hair, and the overall results. Best part? Creating a little bit of joy. A little bit of joy every day as a result of a small change adds up to serious improvements in mood.
Below I will make some suggestions for ways to increase joy in your daily life. Who knows when I will take my next trip to Key West or participate in my next 10k? It is time to create some joy and prevent dips in my mood that might contribute to the development of depression or anxiety.
If you are like me, social distancing might have you realizing how frequently you were eating out. Cooking and eating-in are definitely increased in my household. When we do order out, it requires more thought and intention about how to acquire the food and if it will be worth the effort involved.
Honest moment: I’m still not that into cooking. If you love to cook, yay you! Keep cooking and generate some joy. Just learning? Even better! America’s Test Kitchen is a tried and true resource and they are having some excellent promotions right now.
As for me, the answer is avocados. Prior to life in social distancing, I never purchased avocados. They either taunt me while being completely unripe at the exact moment I crave guacamole or slowly disintegrate into a pile of mush in the corner of my counter. Now, I have the time to commit to avocados. Each week, I splurge on delicious avocados and excitedly anticipate the moment my thumb gently indents the skin of the avocado easily, indicating nature’s mayonnaise is ready for consumption. I’m currently at a pace of half of an avocado per day. Sliced up with salt, pepper, and parsley on top of toast – maybe with some tomatoes? Go wild. Breakfast is elevated and I am happy. Every time I have this breakfast (which is quite frequently now) I am tempted to document my elegant meal.
Are there any foods that bring you joy? (I’m not referring to in-the-moment joy that leaves you feeling tired and unmotivated afterwards – although of course there is a time and place for that.) Just think, if you could be excited by your breakfast, that would add some serious coin to your joy bank.
Most people I know bathe every day. (This is a judgment free zone, and you may not have left the house in several days, so please continue to do you. Unless the people around you complain. In that case, please take a shower.) For this article, let’s assume you bathe every day for about ten minutes. Why not make those 70 minutes per week joyful? What type of soap do you use? Do you love it? (I love my soap, check out Little Egg Harbor soaps online, loving Citrus Twist right now.) I already addressed the shampoo situation. What about a loofah or new set of plush washcloths? Doesn’t have to be expensive, I am very happy with my set of purple Amazon Basics washcloths. Take the time to assess your shower routine. Are there any ways you can make it better, specifically in a way that increases your happiness?
This category will be different for everyone depending on how you are most comfortable. Are you someone who loves getting dressed up for work every day and now you never change out of sweatpants? That probably isn’t going to add any joy to your life. I’ve spoken to some friends who feel much happier putting on jeans and a cute top, and this simple action of putting on clothes that make you feel good can improve your self esteem and help prevent problems with your mental health.
As for me… if one more person on social media suggests putting on pants with buttons to keep myself in check, I might yell at the computer. Why on earth would I put on pants with a button if that is unnecessary at this time? What an absurd notion. So how has clothing brought me joy? Glorious sweatpants and leggings. Soft flowy tops. Buttery wire-free sports bras.
I have two pairs of sweatpants that I love. One pair has dinosaurs on them and the other I purchased at a brewery a few months back. I also treated myself to a pair of overpriced camo print leggings. Every time I slide them on, I take a moment to deep squat and stretch it all out and bask in the sensation of unrestricted leg movement.
Good sleep is integral to your mental health and I would like to devote a post in the future exclusively to sleep. For the purpose of this post, I’m suggesting improvements to your sleep routine that might make you smile. Do you sleep with an eye mask? These can be wonderful, especially for city living. What about aromatherapy? A touch of lavender on your pillow prior to bed time might trick your senses into thinking you are at an upscale spa hotel. Some other suggestions: update your pajamas, sheets, or pillows.
5. Self Care
Self care means different things to different people. For me, one of the things I think of is makeup. I love makeup, but my relationship with makeup has evolved over the years. In the past, I loved a full face. Bring on the bronzer! When I started my residency training, I wore full makeup (and heels… what was I thinking?) every day. I think it was almost like wearing armor. As I’ve grown more comfortable over the past few years in my role as a resident physician, I feel perfectly comfortable going to work with no makeup.
For me, playing with a new eye palette in preparation for an upcoming wedding or watching a YouTube tutorial on liquid eyeliner or DIY lashes is fun and makes me happy while applying makeup daily does not. I treasure the extra fifteen minutes in the morning to eat my fancy avocado toast with my family (see above.)
I also no longer feel like I need makeup to be attractive. I have my daughter to thank for that… I see her tiny face sprinkled with my features and I never want her to feel anything less than beautiful. If I think I need makeup and her face looks like mine, that would suggest her perfect face needs makeup too – which it most certainly does not.
I’ve also become comfortable with the mascara and lip only makeup which takes exactly one minute. You’ll find me wearing that makeup look in the photo above posing with shampoo. This applies to hair, waxing, nails, and skin care. As much or as little as makes you happy. Does being home and not needing to do your hair feel amazing? Time to harness that and include it as added happiness to your day. Have you perfected the at-home gel manicure? Color me impressed by both your artistic ability and commitment to nail care. It might even save you money in the future.
6. Sexual health
Sexual health is part of your health. This might mean a celibate hiatus due to a lack of interest at this time. Prefer the Netflix portion of Netflix and chill? That’s just fine. Despite what the internet might have you believe, global pandemics and social distancing aren’t an absolute aphrodisiac for most people.
If the mood does strike you, this might present an opportunity to get to know your needs more, with or without assistance from a device or adult entertainment. Or maybe now is the time to revisit your sexual health needs with your partner.
Pro-tip: Continue to use contraception while engaging in partnered sexual activity if you do not wish to grow your family.
I’m sure there are other ways to add joy into your day. We would love to hear suggestions in the comments! Whatever you choose, take time to assess your piggy bank of joy. Don’t let the balance get too low or you may risk experiencing depressed moods or feelings of anxiety.
One further comment on this subject, and I alluded to it above: you don’t actually NEED to do anything. We are in an uncharted time of global pandemic. If you are alive and keeping any persons that depend on you alive, you are doing a fabulous job! This post seeks to protect the integrity of your mental health by way of experiencing happiness in your daily life.