Whole Body Psychiatry

Personalized Mental Health in New York City

Anxiety

Building A Routine for Mental Health

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Studies have recently been showing that people who stick with and find value in a routine can find more meaning in their lives. This often translates into a more positive perspective in life and outcomes that result in a higher quality of life. It stands to reason that if routine can build a better life, it might be beneficial to use in our mental health goals. 

Find your “peak hours.” Peak hours are when you feel the most focused and most able to get things done. Peak hours shouldn’t be used for routine or mundane tasks that don’t require a significant amount of your brain’s attention. I’ll use myself as an example. My peak hours happen to be quite early in the morning (5:30-7:30am) for 2 reasons. First, it’s extremely quiet at 5:30am. When there isn’t a ton going on, such as emails or phone calls, focus doesn’t get diminished as quickly. Once those emails start, it’s tough to find time for ourselves and by evening, I’ve used a ton of my brain energy capacity. Second, I have created a routine where I enjoy my coffee while doing things like writing podcasts, books, or reading for my continued education. 

Make lists. Don’t just write out everything you need to do in broad strokes. Break it down into manageable items in order to make more traction on it. Let’s look at an example. If you are tasked with writing up a proposal on a product you’ll be pitching to your executive team, writing down “do Project X” will generally result in feeling overwhelmed. You don’t know where to start. Instead try breaking down “Project X” into larger pieces. 1. Outline, 2. Competitive research on current landscape of similar products, 3. The Why of investing in this product, 4. The slide deck. These get broken down even further. What places will you search for research on the landscape. Where will content for visuals come from for your presentation, etc. Doing it in a small bites approach makes it much easier to get started, because you can do one thing and start to build momentum. 

Triage that list. Once you develop your list, you also need to triage it. We use the word triage in medicine a lot. It means figure out what is most urgent and do that first. This is especially true in the emergency room. We have criteria for how we need to triage certain patients and how much time we have to get that done. If we apply this idea to personal life and work, consider what time line you’re looking at and what is actually urgent. For example, do you have a due date for something tomorrow? Then don’t clean the bathroom that you might be able to do another time. You also need to triage what you’re actually capable of doing in the time period you have at any given time. You don’t want to commit to 17 hours of work in a day if that’s not going to happen and then feel like you let yourself down when it wasn’t realistic in the first place. 

Reflect. Reflect on the hard work you’ve put into the work you’ve done over the day, week, month. Reminding yourself about what you’ve accomplished helps to predict your future success and keeps your mind focused on being able to successfully accomplish your goals rather than focusing on the things that don’t go perfectly. 

Everyone uses routines differently, find one that works for you and try to put it into practice for a few weeks to see how it impacts your view on life. 

Work from Home – Revisited

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A woman working from home during 2020

This week, let’s check back in about working from home. You might be hitting your 7-month mark of working from home and many of us are experiencing burnout from the redundancy of working from home. I’m putting together a few tips on ways to stay refreshed while working from home.

How To Deal With Working From Home

Feeling grateful for working from home.

As a physician, I feel very lucky every day to be able to help my patients. I also feel incredibly grateful that I can do this work from the safety of my home without being in the hospital or having to wear PPE every day to protect myself in the hospital. It’s worth taking a moment when you feel burned out to feel grateful about the benefits and safety of working from home. 

Creating the atmosphere that makes you most efficient. 

  1. Define your workspace. Even if you don’t have a desk, pick one or a few spaces where you’ll plan to do the majority of your work. Define them as places where you’ll be at peak focus for especially tough tasks versus 
  2. Not working in relaxing places. Avoid your bed and couch, where you tend to relax if possible. By avoiding these spaces of relaxation we preserve them as places to wind down, which you especially need when you’re working from home.
  3. Take breaks as you would have at work. Snack break, fresh air break, coffee break. Try to keep up with taking some breaks even if that is just stretching or getting a glass of water. At home we’ve lost some sense of that and it’s worth planning that out between your meetings.

Plan your day accordingly. 

It might feel tough to plan out your day especially when random meetings and calls pop up. However, if you at least try to sketch out your day, by the hour or half hour, you can try to schedule things out in a way that helps you feel that you can keep progressing in your day, even if timing gets a little or a lot off track.

Take advantage of healthier habits. 

Do you remember thinking to yourself, I wish I didn’t have to get take out for lunch/dinner all the time? Maybe you wished you could have coffee from a ceramic mug or focus on finally trying to eat a lower inflammation diet (low/no gluten or dairy).

Now is the time to try this out. Meal planning even if you’re at home is still worthwhile by making things at the start of the week and putting it into containers can save time and make healthy eating a no-brainer. At the same time, planning your workouts remains incredibly important. It might feel that you don’t need to wake up until right before your first meeting of the day, but if you were a morning workout person, try to get back to that, even if it’s at home.

Could you fit in a 20 min workout at lunchtime now that you don’t have the commute back and forth? Pick a health goal and try to focus on it every time you consider not following through. 

Pick a cut-off time.

Just because you’re working from home, doesn’t mean you need to work from home 24/7. Know when your last meeting is and plan something that causes a cut-off time. Maybe you’ve signed up for an online workout class that you’ve prepaid, or you have a facetime or in-person dinner date with a friend.

Having something that forces you to cut off work is incredibly important to continue not just a physical space difference from work at home, but a mental difference so that you can unwind and relax, preparing yourself mentally and emotionally for the next day.

Follow these ideas and create some of your own. We can breathe life back into working from home and make it our conscious choice rather than something we feel relegated to doing for an unknown amount of time longer. 

If, after reading this, you still feel like you need some help coping with working from home, consider reaching out.

Flight Anxiety. Don’t let it get you down.

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An image of an airplane wing, depicting and symbolizing flight anxiety

While my travels are over, for now, I am excited to keep sharing what I learned while I was away. Travel can be exciting for many people, but others are distressed and at times held back from travel due to their flight anxiety, up to 70% of people, in fact!

While we might not know for sure what makes the difference, when I travel I like to try to troubleshoot for my patients who struggle with flight anxiety. These are a few tricks I find to help decrease flight anxiety.

Target your automatic thoughts of catastrophization. Statistics tell us that flying on a commercial airline is probably the safest way to travel. This is because the level of monitoring done on airplanes far exceeds that of what we monitor about cars and trains.

Another interesting statistic is that if you were in the unfortunate event of being in an airplane accident, it is likely that you would actually survive based on the most likely accidents that occur.

How To Deal with Flight Anxiety

What happens in the air though, even knowing all of these statistics? One issues is the lack of feeling grounded and in control. As humans we like to feel as much control as possible, being on an airplane, you have to give up that control. One idea is to try to take back control of your body with a few different exercises that might help.

  1. Write your name in cursive with your non-dominant hand over and over. 
  2. Utilize progressive muscle contraction to distract your body from the feeling of turbulence or take off. This might be squeezing your hands to make fists, or squeezing your legs and glutes repeatedly.
  3. Make conversation with the person next to you. You’d be amazed at who you meet on airplanes, and if 70% of people statistically have some level of flight anxiety, you are likely to find someone that is interested in being distracted as well.
  4. Listen to music that makes you happy and channel the confidence that artist has while you listen. 

Let me know if you enjoyed it on my Instagram page!

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**

Happiness?

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Hundreds of balloons being released into the sky, symbolizing happiness

Happiness is often thought of as a status that we’ve accomplished something and we have something to be happy about. However, happiness is really more of a mental state that we must practice every day to keep it strong, just like our muscles.

It can be easy to see the things that make us unhappy and often our minds, trained through evolution for survival, make us consider all the bad things around us with more attention than the good things. What if we practiced more positive psychology, how would that affect life? Here are a few easy steps to help train your brain to see the things to be happy about. 

1. Write 3 good things. No matter how big or small, writing and acknowledging that 3 good things (or maybe more when you get on a roll) are happening to you on any given day.

2. Develop a mantra. Whether you want to be happier, calmer, or something else, saying it to yourself over and over again throughout the day starts to ingrain this philosophy in your head. 

3. Be fully present. Instead of being half on your phone and half-aware of the conversation you are in, be fully there and engage. Look into someone’s eyes as they are speaking to you and connect, for happiness and feeling a sense of togetherness. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**

The Pain Mood Connection, Part 2: How to blossom again.

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A blooming flower, symbolizing the connection between pain and mood

Pain and mood are incredibly interconnected.

In part 1 of the pain-mood connection, we discussed a few factors including connected brain pathways that result in pain from physical and mental conditions. Additionally, these pathways appear to light up even more in patients with mental health conditions, like depression, making pain tolerance all the worse. We also briefly looked at inflammation, a difficult-to-appreciate factor of chronic illness that can over time, bring damage to your body and immune system.

Today, what steps are there to take to help with both the physical and mental aspects of pain and mood. 

Pain And Mood: Simple habits to integrate into your life:

  1. Consider seeing a psychiatrist. Seeking psychiatric evaluation if you are dealing with mood disorders, seems pretty straight forward. But if you have chronic pain, and are unsure if your mood symptoms are interfering, finding a consult liaison psychiatrist (formerly psychosomatic medicine) can really help to better understand this connection and determine if you might be helped with therapy and or medications.
  2. Progressive Muscle Relaxation. Progressive Muscle Relaxation or PMR, has been studied in insomnia and was developed in the 1920s to assist patients who suffered from various illnesses. It was developed by Edmund Jacobson who felt there was a common overlap in patients with chronic illness that they all had muscle tension and pain, worsening whatever else they were dealing with. Utilizing PMR can help create a feedback loop to your brain that you are in a relaxed state, control your anxiety and stress, and decrease tension that worsens pain. It can also help you better understand what it feels like to be in a relaxed state so that you can better intervene when you are stressed. 
  3. Meditation. There is a lot out in pop culture about meditation today, including specific meditation studios in big cities. But, meditation has been around for thousands of years, and has been show to help calm both pain and mood symptoms. There are tons of free apps for meditation, so it can be cost effective as well. 
  4. 4-7-8 breathing. My patients must by now think I’m a broken record, because one of my favorite techniques for stress, anxiety, and tolerating pain is a breathing exercise. In using 4-7-8 breathing, you are inhaling a deep breath into your belly to a count of 4, holding your breath for a count of 7 and exhaling as deeply as you can to a count of 8. It takes some getting used to, and if you have any lung issues, this may not be for you. Again, it can feedback to your brain that you have taken control of your “fight of flight” response and you can regain focus or push through whatever stressful event is going on.
  5. Positive psychology. A quick intervention I like to talk about is the idea of identifying “3 good things” everyday. They don’t have to be profound. It could be that your train came on time or that you enjoyed your coffee this morning. It could be that you got a promotion or that you got outside for 5 minutes of sunshine. Keep up listing these good things to remind your brain that even in the setting of struggling with mental health or physical illness, including pain, there are good things to keep looking out for. 

As always, speak with your doctor before undergoing interventions, but I hope these can be helpful ideas to integrate into your life, no matter what you’re going through. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**

The pain-mood connection, Part 1: Pain, pain, go away.

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A man writhing in pain

Lady Gaga presented us with a wonderful statement at the 2019 Grammy Awards, “If you see somebody that’s hurting, don’t look away, and if you’re hurting, even though it might be hard, try to find that bravery within yourself to dive deep and go tell somebody…”

Her quote speaks to what we often seen used in colloquial language, depression and other mood symptoms can be painful. But then why do we so often associate pain with only the physical? Realizing the profound and reciprocal mental and emotional impact on pain can be freeing and help to decrease the stigma to get treatment for mental health conditions associated with physical illness. 

What happens when the body interprets emotional signals as pain? Mental health diagnoses such as depression, anxiety, somatic symptoms, and PTSD can significantly overlap with pain signaling in the brain and research looking at brain scans have found that in certain diagnoses, areas in the brain associated with pain light up more in patients that also suffer from mood disorders. Thankfully, even without great assessment tools to quantify pain, gone are the days of chalking it up to being “all in your head.” Physical conditions can stand alone without an interference from mental health, but, it doesn’t mean that having an untreated or under-treated mood disorder can’t worsen your physical conditions.

In fact, as a consult liaison psychiatrist, my specialty training is focused on this exact intersection of the physical and mental and how our bodies respond to various stressors, including pain. Although many conditions can be included, some of the most prominent and debilitating include headache disorders, neuropathy, inflammatory bowel disease, fibromyalgia, and chronic fatigue. In working with these patients, under medical care for their diagnosis, we can tackle many aspects of how to decrease pain by utilizing psychotherapy and medications.

The Pain-Mood Connection

Another interesting aspect of the intersection of pain and mental health is the idea of inflammation in the body. Many chronic illnesses, including chronic pain (whether it is isolated or due to another illness) can result in signs of physical inflammation, including elevated cortisol levels, elevated white blood cell counts, and decreased immune functioning. Depression and anxiety can do the same, and make other chronic physical illnesses worse! It is so important to treat these conditions for overall health and wellbeing and to decrease stress on your body. Often patients with mood disorders express feeling shame that they cannot just “deal with it.”

Let’s think of a different example. No one suggests that a patient diagnosed with cancer simply “walk it off”. Mental health conditions that result in inflammation are just as important to treat, to prevent long term damage to our bodies. They deserve to be thought of as chronic illness and as disorders that can get better, with the right treatment. The first step to stopping the hurt is reaching out and better understanding your condition and treatment options, ideally with a psychiatrist that is trained in consult liaison psychiatry to help you understand how your mental and physical conditions are intersecting and what to do next. 

Check out the blog on Thursday for tips to intervene on both mood and pain in your everyday life. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**