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.
Mindfulness never struck me as something I could see myself doing on a regular basis. For many years, I viewed the practice as something for “enlightened people” with no practical application for the average person. As the years went on and the research continued to pile up in the literature, I decided to try it out.
There are two basic ideas to keep in mind during meditation practice. We are not aware of how our body is feeling, and we are not aware of the constant stream of thoughts occurring all day long. By bringing attention to these two things we can begin to take control of our bodies and our minds.
The process is very simple and can be performed from most locations. Ideally you want a quiet place where you will be undisturbed for 10-15 minutes. I personally like the 10-minute mediation session, and it works well if you have a busy schedule.
To begin the process, find a chair, preferably one you can sit upright in with your feet on the floor and back straight. I like to rest my hands on my legs.
I begin the process with my eyes open, and a few deep breaths in through the nose and out through the mouth. On the 5th breath I close my eyes. I return to my normal rate and rhythm of breathing in through the nose and back out through the nose.
Next I begin the process of performing a body scan. I like to start at the head and work my way down to the toes, noting any discomfort or tension. I will also take note of areas on the body the fell relaxed and tension free. This should take 1-2 minutes.
If at any point thoughts pop into your head, it’s fine let them come but most importantly let them go. Do not dwell on any one particular thought, just allow them pass.
The next step is a series of breathing exercise I learned several years ago. Start with 10 breaths in through the nose and out through the mouth, counting each one. Then perform 10 breaths in through the nose and out through the nose, again counting each one as you go. Finally, take a breath in through the nose, hold it for 5 seconds, and release it slowly through the mouth to a count of 4. This sequence of breathing exercises should be performed two times for a total of 60 breaths. This will take approximately 5-7 minutes.
For the final 1-2 minutes do not count or breath in any particular manner just allow the mind the space to think about anything it wants to. After a minute or two bring the focus back to the body, feel the feet on the floor, and arms on you lap. Open your eyes slowly, and sit for a minute to think about what you are grateful for before starting your day. It’s an excellent way to practice some gratitude.
The more you practice this technique the easier it will be for you. As the days go on you will experience more control over both your body and your mind.
As we navigate through uncharted territory related to COVID-19, it seems like people finally understand the need for social distancing. (If this concept still needs clarification, please check out https://www.cdc.gov/coronavirus/2019-ncov/index.html for clear guidelines and current recommendations.) Responsible humans are engaging in social distancing when possible and hand hygiene is totally in right now. If you are feeling calm and well adjusted during this fretful time in world history, congratulations, you may stop reading now. If you wake up and feel like you might throw up or can’t shut your mind down or if your head hurts every time you think about your sister’s wedding in June or your children’s education, read on.
You are not alone. (Even if you are physically alone. Sitting on your couch in joggers. We see you.)
During conversations with friends and family, I heard some common physical complaints arise after people began to be affected by COVID-19. These include stomachaches, headaches, back pain, neck pain, and racing heart beat among a number of other possible symptoms. While you should discuss any new or concerning medical symptoms with your doctor, these symptoms may be related to anxiety. In psychiatry, we call problems that arise in your body as a result of problems in your mind “somatic symptoms.” They are extremely common in a variety of mental health disorders. Colloquially someone may say “I hold my stress in my neck” which is an example of an anxiety related somatic symptom. If somatic symptoms are plaguing you during this time of COVID-19, see below for some suggestions. All are available in the comfort of your home.
You know, because you should be in your home. Once again, if it wasn’t apparent, please stay home.
Everything on this list has been personally vetted by me, an extremely extroverted resident physician psychiatrist, struggling to socially distance and loaded with somatic complaints.
I know, you’ve heard it before, deep breathing is frequently met with eye rolls in my practice. I’m serious though – I promise you can do a better job breathing. It is the only vital sign you can control (that is serious power.) There are so many methods that you can use and you can use them any time of day, in any location.
Try this: lay on your back on a comfortable flat surface. Put your hand on your belly and make your hand go up and down with each breath. Make your breaths long and slow. Count to 60 breaths; you will probably lose track while you count and your mind may wander. Bring it back to the last number you remember. This always helps.
2. Heart bench.
I advocate for yoga whenever possible, but if you only have time for one move during the day to address anxiety, heart bench is the one for you. Frequently included in yin practices, heart bench is designed to open the chest in a gentle way. The heart and lungs are both located in the chest and we spend most of our time hunched over or curled up, our body’s natural response to stress. Unless you have backbends in your yoga practice, this move will counterbalance poor posture and anxiety related symptoms you may feel in your chest.
Try this: If you have yoga blocks, set one on its tallest height and one below it on the second highest height in a T shape. To make this pose even more gentle, place a blanket or pillow over the blocks, taking care not to knock them over. Lay back gently, resting the base of your neck on the tallest block and relaxing your spine over the other yoga block. No blocks? No problem. Roll up a towel, yoga mat, or blanket and place a pillow at the top of the roll perpendicularly. Rest gently back on the towel. Keep your feet straight or cross your legs, whichever is more comfortable. If I didn’t mention it before, these techniques are good for your cooped-up children too!
3. Move your body – Beginner’s Edition.
If you have a fancy watch, follow the clear prompts to get up and move. No fancy watch?
Try this: Look at the clock. If the first number is different than the last time you looked at the clock, get up and do something.
4. Move your body – Advanced Edition
Speaking of moving, perhaps now is the time to begin that new workout plan you have been meaning to try. If you are in a safe area where social distancing outside is possible, take walks. Or maybe this is the time to start a couch to 5k plan or to start training for that longer event. Can’t run or walk outside due to crowds? No worries, the online options are endless. The best workout routine is the one that you will actually do. Be honest with yourself.
Try this: Love to dance? Feel like a music video star and sweat your butt off with the Fitness Marshall https://www.youtube.com/user/TheFitnessMarshall. Interested in building muscle with no equipment and have $50 to spend? Try this dummy-proof six week workout regimen https://www.onnit.com/six-bodyweight/. They have some free videos on the website too with good step by step instructions for some of the bodyweight moves if you prefer a free resource.
5. Practice Moderation
Use caution with alcohol and snacks. If you are someone who eats junk or boozes during periods of stress (or boredom!) you may be ramping up your intake without realizing it. I am not telling you to completely skip the IPA or Ben and Jerry’s, but self-awareness is key. Feel like the beer you bought last week went more quickly than usual? There is probably not a sneaky beer elf stealing your goods.
Try this: Write down the alcohol you consume. This will keep you honest. If you aren’t happy with how things are adding up, you can create a plan to make better choices.
6. Monitor Caffeine Intake
While I already suggested practicing moderation, many of us fail to practice moderation with caffeine unless particularly prompted; however, given its importance, caffeine warrants its own discussion. Caffeine contributes to anxiety, can raise your heart rate, and make you feel like you are vibrating. It may be tempting to drink cup after cup of delicious Columbian roast, but caffeine is one of the first things I address when patients bring up symptoms of anxiety.
Try this: There is something seriously soothing about a hot beverage. When it can double as an herbal tea with calming properties, even better. Try sipping on some chamomile or tulsi tea (aka holy basil.) I like Organic India Tulsi Original and Traditional Medicinals Organic Chamomile. Throw in some local honey or agave syrup for a little sweetness.
7. Connect with Friends and Family
Social distancing does not equal social isolation. In the past few days, I’ve spent quality internet and phone time with friends. We’ve had an opportunity to catch up due to this period of slowing down. COVID-19 has taught us to be creative and tech savvy regarding engaging with our friends and family.
Try this: Houseparty, Hangouts, WhatsApp and good old FaceTime. Give them a try, might be more fun than you think.
8. Limit Your Consumption of COVID-19 Media
Finally, limit your time reading about coronavirus. Knowledge is power – unless it isn’t. Stick to evidence based sites and avoid Brad from high school spewing conspiracy theories on Facebook.
Try this: Set a timer on your phone for what you feel is a reasonable amount of time to educate yourself (I suggest 15 minutes). When the timer goes off, put the phone down and go back to step 1!
Hope you found these suggestions helpful. Stay home, have fun, be calm. And keep checking out Shrinks in Sneakers!