Archive for May, 2010


Mindfulness meditation is a term that is used to describe the cultivation of “non-judgemental, moment-to-moment awareness” of events in our daily life.  Through the purposeful exercise of bringing our awareness to the present moment, we can learn to be “more present” in our day to day lives and less distracted by ruminations of the past or anxieties about the future.  Such a practice can lead to a greater richness and fullness in relationships with spouses & children, help with problems with over-eating, as well as help coping with chronic stress, pain, or illness.  While it is based in Buddhist mediative discipline, Mindfulness Mediation is not a religious meditation; although, being “mindful” and “present” is emphasized by most religious and spiritual traditions.  Mindfulness meditation is not for the purpose of relaxation, although you may feel more relaxed, but rather an exercise in bringing our awareness to the present moment, “the only moment in which we are really alive”.  Most any activity can be done “mindfully” by experiencing the activity with all of our senses.

Mindful breathing is foundational to many mindfulness exercises and is a great place from which to begin a mindful meditation practice.  Mindful breathing does not require a large commitment of time, any special equipment, or location.  Our “breath” intersects both the voluntary and involuntary nervous systems.  Because of this, mindful breathing offers a wonderful opportunity to experience mind-body connectedness.  You may have noticed that when you are very upset or agitated, your breath becomes shallow and rapid.  This shallow breathing further exacerbates feelings of anxiety and creates a negative feedback loop.  Conversely, when we focus our attention on the breath and allow it to “be” without forcing it to be any particular way, our breathing calms down and with it, our mind calms down as well.  Our mind receives the message, “Everything is okay, no need to worry”, which helps us to feel at ease.

Here is a brief, introductory mindful breathing exercise:

Assume a comfortable position, either seated or lying down.  Allow your awareness to center on one area of the breath: such as the flow of air at the nostrils or rise and fall of the abdomen, but away from the mind and “thinking”.  Allow your body to breathe in and out exactly as it wants to.  You may notice the flow of the air in and out, the onset of the breath, the inflection point just before you begin to exhale, and the length of the pause before your next breath begins. Be aware that with every breath you are nourishing every cell in your body. Continue to follow the breath in and out of our body.  When your thinking pulls you away, as it will certainly do, notice the thoughts without judgement and gently bring your focus back to your breath.  Continue your practice for a comfortable period of time; perhaps starting with five to ten minutes.

Guided mindful mediations are a great way to experience Mindfulness Meditation and are readily available from various sources.  I have enjoyed the CD “Mindfulness for Beginners” by Jon Kabat-Zinn (available on iTunes or through Amazon.com).  I also highly recommend “A Mindfulness-Based Stress Reduction Workbook” by Bob Stahl, PhD and Elisha Goldstein, PhD. for more complete instruction in the art of mindfulness meditation.

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May is Mental Health Month. Established by Congress in 1949, this designation was made to help illustrate the importance of mental health issues to the overall health and well-being of American citizens.  While mental health care has changed dramatically since 1949, one thing still remains: the perceived stigma regarding mental health conditions.

Despite the availability of relatively safe and efficacious treatments for these disorders, many individuals fail to seek treatment for their mental health conditions.  Inadequate treatment of mental health conditions remain a significant public health concern: costing millions of dollars in lost productivity, absenteeism, and health care costs.   Existing barriers to receiving adequate mental health treatment include the availability of appropriately trained mental health providers, affordable treatment options, and perceived stigma.  Perceived stigma is the belief that people will devalue and discriminate against individuals who use mental health services and/or have a mental illness.

Perceived stigma can cause a variety of problems for individuals experiencing mental health conditions, including:

  • a delay or failure to seek appropriate treatment
  • premature discontinuation of treatment
  • rejection or ridicule by family and friends
  • discrimination at work, school, or church
  • inadequate health insurance coverage of mental health conditions
  • feelings of anger, frustration, shame, or low self-esteem
  • encountering harassment or violence

Mental illness was commonly thought of as a personal character weakness; we now know that mental health disorders have a biological basis and can be treated like any other medical condition.  Yet as recently as 2008, an APA survey revealed that more than 50% of Americans saw stigma and potential negative perceptions as barriers that would prevent them from seeking treatment.  While an estimated 75 millions Americans experience a mental health disorder in any given year, only one in four will receive treatment. Current lifetime prevalence rates for any mental disorder (including substance abuse) indicate that 57.4 percent of all Americans will personally experience mental illness at some time in their life.

Historically, the traditional medical model has separated mental and physical health; only recently is science “catching up” and revealing the multitude of “mind and body” connections.  We now know that our physical health is directly impacted by our emotional health; and that suffering from a mental condition can be a devastating and debilitating as any physical condition can be.

Despite the progress that has been made in correcting and removing many of the misconceptions surrounding mental health conditions, we still have a long way to go to defeat many of the biases, fears, and misinformation that people continue to have about mental health and the subsequent stigma these attitudes can create. By talking about mental health, we can raise awareness and dispel the stereotypes that exist about individuals with mental health conditions.

What can you do to fight the stigma?

  • Seek treatment– If you suffer from a mental health condition, don’t let fear keep you from getting relief by seeking appropriate diagnosis and treatment.  Safe and effective treatments are available.
  • Don’t define yourself by your disorder–  You are not “Depressed”, you are a person with depression.
  • Utilize available resources– seek out support and assistance groups such as Celebrate Recovery and NAMI. If you can not afford your medications, inquire about patient assistance programs.
  • Speak out and speak up– Your story may encourage someone else to seek the treatment they have needed but didn’t have the courage to ask for.
  • Don’t allow your mental health condition to cause you to feel shame or self-doubt– Mental health conditions are real medical conditions; they are not character-weaknesses or punishments.  By coming to terms with your own illness, you show others that their judgements are based on a lack of understanding rather than reality.  If you are having problems with negative self-esteem or shame, seek appropriate counseling to come to terms with these feelings.

Here is an expanded, integrative approach to sleep hygiene, which is not meant to be applied mechanically, but implemented as a part of a personalized, soothing evening ritual.

  • Be mindful of the basic rhythm of daily life by establishing a regular bed and rising time, obtaining exposure to early morning light and evening dim light, and maintaining regular times for meals and exercise. You should avoid napping if you have insomnia.
  • Manage caffeine, nicotine, alcohol and other drugs. Caffeinated foods and drinks can affect some people up to 12 hours later. Even if you do not think caffeine affects you, it may be interfering with the quality of your sleep.
  • Although regular and adequate cardiovascular exercise promotes healthy sleep, it should be avoided at least 3–4 hours prior to bed because it raises your core body temperature, which can interfere with sleep.
  • Avoid high glycemic and harder to digest foods as bedtime snacks. As an alternative, consider complex carbohydrates (e.g., whole grains, lentils, beans) that may help transport tryptophan, a precursor to melatonin, across the blood-brain barrier.
  • Create a healthy sleep environment by keeping the bedroom cool (about 68° F), completely dark, quiet, and psychologically safe.
  • Avoid clock watching at night since it draws you back to waking consciousness. Ideally, position the clock away from the bed or use a non-illuminated battery operated clock to avoid light and subtle EMF radiation.
  • Manage hyper-arousal and anxiety with cognitive behavioral therapy (CBT) and body-mind techniques. CBT, which is more effective than hypnotics over the long term, addresses sleep-related dysfunctional thoughts and beliefs that trigger arousal. For some, self-help workbooks may prove helpful. CBT is best coupled with body-mind techniques such as mindfulness meditation, progressive muscular relaxation, breathing exercises and guided imagery.
  • Manage bed and bedroom stimulation, which can condition these areas for wakefulness, by using the bed only for sleep and sex. Minimize wakeful time spent there by going to bed only when sleepy and getting out of bed with extended period (15–20 minutes or more) of nighttime wakefulness until becoming sleepy again.
  • Ask your clinician about using a botanical supplement, such as valerian or hops, for sleep for a short term. Melatonin is useful when there is advancing age and/or circadian irregularities. Always use supplements with other sleep hygiene recommendations. Be aware that botanicals are drugs and may have drug-drug interactions with other medications.  Please consult with your physician before starting any supplements.
  • Understand that letting go and surrender are key in sleep onset. In the end, we cannot finagle sleep. We can set the stage and be receptive to it, but we cannot intentionally “go to sleep”.  Efforts to do so typically backfire.

Tips courtesy of the Arizona Center for Integrative Medicine

No! Saliva tests to measure the levels of Serotonin, estrogen, progesterone, melatonin, testosterone, or DHEA are almost never legitimate, are expensive, and do not provide any clinically meaningful information to health care practitioners.  These tests are usually marketed with various supplements to control imbalances of these hormones; a serious conflict of interest.  Some well-intentioned patients have purchased and completed such tests thinking that it might provide their healthcare provider with “important information.”

Saliva testing is not a reliable method of assessing levels of any hormone except Cortisol (which must be done under very specific conditions and only for certain conditions). There is no physiologic reason to measure most salivary hormone levels and no generally published ranges of normal levels of hormones measured in saliva. Hormones are typically measured in blood, which makes physiologic sense; some hormones and their metabolites can usefully be measured in urine, but are not currently a part of any protocol for evaluation or diagnosis of any mental health condition.  Moreover, even if the test results are technically accurate, I’m aware of no science that links salivary hormone assays to non-optimal levels of hormones or neurotransmitters. Nor, even if the tests were entirely legitimate, is there any evidence that the proposed treatments will “optimize” neurotransmitter or hormone levels.

If you are concerned that you may have a mood disorder such as depression or anxiety, concerned about reasons for insomnia, or concerned that you may be approaching menopause, please contact your doctor and have that discussion with him or her. Depression, Anxiety, Insomnia, and all other psychiatric conditions are diagnosed through a “Psychiatric Diagnostic Interview” based on standardized guidelines as put forth by the American Psychiatric Association in the DSM-IV TR (Diagnostic Statistical Manual, 4th Edition, Text Revision).  While certain blood tests may be useful in evaluating for medical conditions that may play a part in certain mental health conditions, such as thyroid conditions, saliva test are not.  Your resources would be better spent investing in yourself through health eating and exercise; you already have all the “important information” any clinician might need: your story.