Whole Body Psychiatry

Personalized Mental Health in New York City

Depression

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.**

Why being your own Valentine is more valuable than a holiday.

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A photo of a flower wreath to symbolize being your own valentine

Being your own valentine is not a bad thing.

These days it seems that Valentine’s Day is more of a Hallmark holiday than anything else, but why does it still have the ability to make us feel so down? Valentine’s Day historically is rooted in both religion and fertility rituals. Knowing this, it’s not too difficult to make the jump to love and partnership and why, at least in the United States, where online dating abounds and finding a partner remains the forefront of society, many people find themselves feeling more down on this day of heart shaped boxes of chocolate. Whether you are in a relationship or not, Valentine’s Day can be rough, but there are ways to think about this day as a target date to commit to being your own beloved year round. 

Expectations, expectations, expectations.

You are responsible for your own expectations and your emotional reactions, and being your own valentine can help you do that. So often we hope that our significant other or the person we’re dating will “make the day special.” The problem with that is, no one can read your mind about what makes you happy, not even someone who you feel the closest to. If you’re single, you are in control of the day, which can be a great gift. What would make you happy? What would help you feel loved? You don’t need someone else to create this for you.

Realizing you can pick and choose how you spend the free time in your day and mentally process this day of love to be self-love can be extremely empowering. It can be equally tough if you are in a relationship and hoping for a loving surprise. Discussing expectations on holidays and thinking about ways you like to be shown you are cared about is important no matter what the day. Be direct and express your needs, whether that’s to yourself or your partner.

Self-care is a lifelong habit. 

Every day can be Valentine’s Day when you are enforcing self-care. Self-care and understanding yourself better are important to daily wellbeing, not just when a holiday comes along. Understanding what you’d like for your life and what makes you happy can be a life long process, but putting in the work to think about yourself rather than why you aren’t in a relationship or on a date is much more productive.

Engaging in psychotherapy and working on cognitive processes and distortions can be extremely productive to figuring out the patterns in your life that might at times steer you wrong. You can work to figure out what kind of relationship is right for you and picking a partner that contributes to your happiness. 

How Being Your Own Valentine Can Have A Positive Impact

1. Work out.

 – Study after study has shown us that exercise releases mood boosting endorphins that can help us feel happy, give us more energy, and allow us to rest more deeply. It’s also a great stress reliever. No matter what level of exercise you go after (taking the stairs, walking around the NYC streets at a jogging pace, or hitting the gym), plan some physical exertion time for yourself. 

2. Eat your favorite food.

 – The connection between our brain and the food we put in our body is becoming more and more clear. But even the healthiest eaters sometimes need a treat. Grabbing something that reminds you of home, friends, or just plain makes you happy is a worthwhile endeavor in moderation. 

3. Make plans with a friend.

 – Just because you don’t have a date, doesn’t mean that you are alone. Humans are tribal beings, we crave community and togetherness. Make sure on days that you know might be tougher, like Valentine’s Day or other special events, you have your support group with you. 

4. Watch a funny movie.

 – “Laughter is the best medicine” is a good prescription on any given day. Laughing at a good movie or sitcom might be one of the best things you can do for your body and brain. The simple human act of laughing or smiling sends a feedback to your body to release endorphins to help you feel good and to decrease stress hormones in your body. Talk about natural medicine!

5. Stay off social media.

 – While the jury is still out on the full impact of social media on our brains and bodies, we do know that seeing someone else’s life appearing “perfect” when we’re upset about our own, doesn’t help. Searching for past loves, or wishing you were a celebrity likely won’t make you feel differently. Instead, staying off social media can decrease your screen time, thus reducing your eye and brain exposure to blue lights that mess up your sleep cycle. Opt for rest, and you’ll likely see social media influencer accounts more clearly. 

Valentine’s is just one day out of the year, but following steps of self-care and monitoring your expectations can lead to a whole new and happier you for the next 365. 

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

The “winter blues” debate

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Black and white photo of a leaf, symbolizing the winter blues

Seasonal affective disorder, or SAD, is often referred to culturally as “winter blues.” People often suggest that they feel more down and less motivation in the colder months of the year. They also seem to feel that they should “shake it off.” Diagnostically, SAD meets the criteria for major depressive disorder but has a seasonal pattern of symptom appearance. What are those criteria? That includes feeling down or depressed more days than not, loss of interest in usual activities, sleep and appetite disruptions, lower energy levels, decreased motivation and focus and decreased sexual desire.

It can also include thoughts about dying. Your primary care doctor or psychiatrist might use rating scales to see how severe these symptoms are for you to better monitor the condition and determine how and when to treat it. As a psychiatrist, I consider it just as significant as someone having major depressive disorder, which should be treated. But the question stands, does feeling down in the winter months mean SAD is rampant in the United States or is something else going on? 

Are you experiencing SAD or the Winter Blues?

It may be that there is a predominance of the winter blues in the United States, as depression rates and suicide rates continue to rise. However, I think it is also true that we are not as mindful about caring for ourselves during the colder months. In the absence of a depressive episode, we may regardless have less motivation to socialize, exercise, or go outside, getting some of the precious midday rays of sunshine and Vitamin D that we need.

It is also less appealing or easy to eat healthy. Coming off the holiday months where eating sweets and richer foods is accepted, it’s difficult to suddenly break that habit in the bleak winter. There is also likely an evolutionary component that we need to ensure that we stay warm during what would have been harsher conditions to our ancestors. Perhaps this also applies to conservation of energy, we huddle on the couch instead of making a trek to the gym. 

What can we do to break this cycle? Figure out a planning style that works for you, consider writing down your goals, often easier to stick to than mentally making note of what you want to do. Writing it down makes it real. And then commit to it. Make it a non-negotiable in your schedule, whether that starting place is seeing your friends for a dinner, working out, or taking a midday break to see the sunshine.

Positive reinforcement can be a help in this as well. If your goal is getting up earlier so that you can work out, make sure you have your coffee ready on a timer, or drop off your laundry to be done instead of using up those hours that could be better used to help you feel better. 

If you feel that this has been a consistent pattern that impacts your life, i.e. you aren’t going to work or relationships are damaged by your behaviors, consider getting assistance with a medical professional like your primary care physician or a psychiatrist. Psychotherapy and medications can be helpful, and taking the first step to understanding what is going on with your mental health is always worth it. 

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