Karuna Counseling’s Newsletter Articles

August 3, 2010

Managing Anxiety and Depression Using Diet, Nutritional Supplements and SAM-e

by Darby Christopher, LMSW

Please note: This article should not be taken as advice for how to treat any particular condition. Individuals should always consult with their doctor before making any lifestyle or dietary changes, as some natural substances are harmful to specific medical conditions. Never stop taking any prescription medication without the advice and care of your doctor.

 

Introduction

The decision of whether or not to take prescription medication for anxiety or depression is a personal choice an individual makes based on many factors. This choice is made in conjunction with a doctor and often with the help of a therapist. For many individuals, prescription medication is not only a good fit, but the best fit for their particular constellation of life experiences, genetics and environment.

This article is written for individuals who, with the help and consultation of their doctor and therapist, would like to try to use diet and dietary supplements to manage their issues with anxiety and depression without, or in conjunction with, prescription medication. It is also intended to provide information for individuals to explore more fully on their own and with their doctor and therapist.

There are many factors that can affect a person’s mood and energy level, such as diet, proper rest, psychotherapy, exercise, spiritual practices, environment and relationships. This article will focus on diet and biochemistry, while acknowledging that each of these areas are interconnected and equally important.

Why Nutrition Matters

Our bodies need well functioning neurotransmitters, such as serotonin and dopamine, to experience enjoyment, relaxation, focus and motivation. From a holistic perspective, many factors aside from nutrition can affect how well our bodies are able to produce these chemicals. Yet, inadequate nutrition will result in a diminished ability to produce the chemicals we need to feel good. (Inadequate nutrition may result from a tainted food supply, lack of affordable healthy food, absorption problems in the body, and misinformation or inattention to diet.)

What our Bodies Need Nutritionally to Make Feel Good Chemicals

According to Dr. Charles Gant, author of End Your Addiction Now: The Proven Nutritional Supplement Program That Can Set You Free, there are four primary groups of neurotransmitters that are responsible for feelings of well being, relaxation and focus. They include endorphins and enkaphalins, serotonin, GABA, and dopamine and norepinephrine. (Serotonin also contributes to an ability to sleep well.) What our bodies need is to ingest the nutrients necessary to manufacture these items. So, what are these nutrients?

Let’s start with serotonin. Specific cells in our bodies manufacture serotonin using the amino acid tryptophan, working in conjunction with vitamin b6, vitamin c, folic acid and magnesium. Some foods that contain tryptophan include cheese, soy products, seafood, meat, poultry, whole grains, eggs, beans, peanuts and sunflower seeds. Some foods that contain vitamin b6 include tuna, bananas and a variety of green vegetables.

GABA, a neurotransmitter that promotes relaxation, is produced from the amino acid glutamine, working with vitamin b6, vitamin c and magnesium, among others. Foods that contain glutamine include chicken, fish, eggs, beef, beets, dairy, beans and cabbage. A wide variety of fruits and vegetables contain vitamin c, and magnesium is found in specific beans, seeds, fish and green vegetables.

Tyrosine is an important amino acid that contributes to the production of dopamine. Food sources of tyrosine include fish, chicken, pork, whole grains, dairy, beans, nuts and seeds.

The reader may have already noticed that the common admonition to eat a wide variety of fruits, vegetables, whole grains and proteins applies to managing anxiety and depression. As the intention of this article is to provide a broad overview, the above examples are illustrative. The reader is encouraged to research and explore more of the specific proteins, vitamins and minerals that manufacture the various neurotransmitters and which foods support their production.

The Benefit of Whole Foods

Because many of the nutrients that our bodies need to manufacture neurotransmitters now come for sale in a bottle at our neighborhood stores, a word about eating whole foods is in order. In their book Paradox & Healing, Dr. Michael Greenwood and Dr. Peter Nunn discuss the Chinese Traditional Medicine (CTM) concept of “Qi,” or, energy, that is a part of whole foods. They contend, “ …it is the “whole” herb or food which has the Qi and its strengthening properties, not any isolated extract which is called for. In other words, the difference between taking vitamin C in capsules and eating fruit which contains the vitamin is profound.” Recent research into the benefits of phytonutrients found in whole fruits and vegetables corroborates the concept of Qi.

Likewise, in his book Food Rules, Michael Pollan says that, “Foods are more than the sum of their nutrient parts, and those nutrients work together in ways that are still only dimly understood.”  Pollan is a reporter who set out to investigate all of the competing dietary claims in the media. He discovered a very simple truth, which is that the Western diet, with all of its processed foods that he calls “edible foodlike substances,” makes people sick, and traditional diets, no matter what whole, natural foods they consist of, promote wellness. Pollan sums up his discovery of what we should eat in what he calls seven simple words: “Eat food. Not too much. Mostly plants.”

Supplements

Having made a case for the benefit of whole foods, our attention will now turn to the possible benefits of nutritional supplements that come in bottles. Just as in some cases prescription medicine is indicated, there are cases also where nutritional supplements, under a doctor’s supervision, are beneficial. These situations might include cases of nutritional deficiency, attempting to overcome an addiction, as advocated by Dr. Gant, or as a personal preference to combat the effects of anxiety and depression.

Many studies have shown and proven the efficacy of treating various conditions with nutritional supplements. Conversely, concern for supplement use may include the body subsequently under producing the item being supplemented, or other imbalances. (Always consult a doctor when considering nutritional supplements, as they can be harmful or even fatal in excess amounts or when combined with certain conditions.)

Of the many supplements on the market today, a few examples will suffice here. If increased serotonin is desired, a product called 5 HTP may be indicated. The amino acid tryptophan turns into 5HTP in the body along the way to making serotonin. GABA can be purchased directly, as can the amino acid tyrosine, which the body uses to make norepenephrine and dopamine. Fish oil aids in overall brain health, and multivitamins enable the chemicals in our body to do their work.

Inositol is another nutrient for sale that contributes to brain health and helps the body metabolize nutrients. Dr. Fred Penzel reports success in his studies with inositol and trichotillomania (hair pulling), to cite one example.

Herbs, such as St. John’s Wort and hormones, such as estrogen, testosterone and thyroid, are also sometimes indicated in the treatment of depression. As with any supplement, careful attention must be paid to combining herbs and hormones with other treatments, and should take place only under a doctor’s supervision.

SAM-e and Methylation

A popular and increasingly well known product on the market today is SAM-e, which is a naturally occurring substance in the body whose function is to act as a catalyst promoting the chemical reactions that allow the body to produce desired substances. These chemical reactions are known as methylation pathways. SAM-e’s benefit is in taking the raw materials available in the body and producing the desired result, including the regulation of neurotransmitters. Many studies have shown the benefit of SAM-e to alleviate depression.

Conclusion

Individuals who are seeking ways to address their anxiety and depression without or in conjunction with prescription medication may find that a well balanced regime of exercise, meditation, proper rest, social support, work with a therapist, and attention to diet may give them the help and relief they are looking for. For the diet portion of this plan, whole foods are essential. Supplements can be added under a doctor’s care and may be beneficial, but do not take the place of whole foods. Informed consultation with a doctor or therapist may help determine an individual’s best course of action, and some trial and error may be expected along the way to discovering what combination of elements will work best.

Bibliography and Recommended Reading:

Food Rules, by Michael Pollan

End Your Addiction Now: The Proven Nutritional Supplement Program That Can Set You Free, by Dr. Charles Gant and Dr. Greg Lewis

Paradox and Healing: Medicine, Mythology & Transformation, by Dr. Michael Greenwood & Dr. Peter Nunn

Web site, The World’s Healthiest Foods, http://www.whfoods.com/

Web site, The Podell Medical Practice: Merging Traditional Medical Practice and Alternative Therapies, http://www.drpodell.org

July 8, 2010

Practicing Yoga Off the Mat

by Dr. Melissa Kulick, Ph.D., RYT

While the physical practices of yoga have enjoyed increased popularity in the west over the past several decades, yoga is, in fact, an ancient philosophy and spiritual approach to being.  The word “yoga” comes from the Sanskrit word yuj, which means “to yoke,” and is often translated as “union.”  Yoga is an interfaith practice, meaning it does not require the practitioner to hold any particular spiritual or religious belief — or any at all.  It simply encourages us to adopt a certain way of being with ourselves, both on and off the mat.

When we practice yoga on the mat we are looking for that place in each asana (pose) where we find our “edge.”  The edge is any physical, mental, or emotional experience that is challenging to us without being overwhelming; a place of effort and engagement but not strain.  It is the challenges we encounter that allow us to stretch and grow.

Finding our edge in a given moment or situation allows us to feel safe and remain open — to be present exactly where we are — as we encounter life’s challenges.  For someone faced with a huge task that leaves them feeling stuck in avoidance and procrastination, finding their edge may mean breaking the task down into small, manageable pieces, or allowing them to set time limits for themselves on each work session.  For someone confronting an addiction, it might be asking a trusted friend to accompany them to a first twelve-step meeting.  Staying mindful of our edge in a given moment is crucial in creating an optimal working environment in psychotherapy — where the safety exists that allows for deep transformational work to occur at pace where one stretches and grows without feeling overwhelmed.

On the mat, it is said that we are not ‘practicing yoga’ if we are attempting to force a pose – to push our body beyond our edge. If we are experiencing pain (as opposed to the sensations of a tight muscle experiencing a stretch, or feeling a pose in a joint) or if we are not able to maintain steady breath in our posture, then we are likely forcing our bodies beyond a state of wellness and balance.

Learning – encouraging and training ourselves – to recognize when in our lives we are attempting to force something to happen, is a valuable tool. A great deal of tension and unhappiness is caused when we try to control outcomes (by some form of ‘scheme’ or manipulation) or ignore obstacles and resistances that are telling us that the direction in which we are trying to move is not in our best or highest interest. Yoga teaches us to turn to and within ourselves, and become better attention-payers to the messages available to us – to our breath and body, and to the more obvious and subtler voices of our intuition.

Mindfulness is a central component in the practice of yoga, often referred to as developing the witness mind.  The witness mind simply observes the thoughts that fill and move through our head, as well as the sensations in, and movements of, our bodies.   As witness, we are taking note of — compassionately.  What we are not doing is judging or comparing, though we may well notice that the thoughts running through our mind in that moment are doing just that (e.g., “She’s so much more flexible than me.  I stink at this.”)  You might also notice that your thoughts have jumped right out of the current moment, for instance to what you are going to eat for dinner that night.  When our witness mind observes that we have engaged in judgment or left the present moment, it simply names the experience “judging” or “not present” and returns to focus on the pose and on the breath — with compassion and without judging where we’d just been.

The physical practice of yoga on the mat can literally be ‘practice’ for living that same way of relating to ourselves off the mat.  After experiencing our witness mind on the mat, we may find ourselves having difficulty completing a task at work and notice we have begun to berate ourselves inside our head. Once we have noticed and acknowledged the thought, we can simply take a breath and let it go, returning to the task at hand. Or we may be engaged in a conversation with a good friend who is telling us about some fabulous trip she has planned, and we hear some petty or jealous thought line begin.  Again, once we are aware of the thoughts, we can choose to simply acknowledge their presence and let them go, without further indulging them or putting ourselves down for having them.

When we practice yoga on the mat we experience poses, and our bodies in poses, differently from day to day.  I have heard it said that we bring a different body to the mat every day.  Yoga teaches us to be unattached to — and not defined by — the body we brought to the mat yesterday or might bring tomorrow. “Beginner’s mind” is a term often used to refer to this coming to the mat without any assumptions, needs or expectations of what we will encounter or experience there. We use our witness mind or our beginner’s mind in the course of our daily lives when we similarly notice the stream of thoughts running through our heads and the movements and sensations of the body, and choose not to identify with, buy into or react to them.  We are not our thoughts, any more than we are the bodies we bring to the yoga mat or elsewhere.

The Breath

One of the primary things that set yoga apart from other forms of physical exercise is its focus on breath awareness.  Movements are linked with inhalation and exhalation, and the release of exhalation is often used to help us more deeply open into a pose.

The breath is a most powerful tool for helping us stay in the present moment.  My guru (yoga is historically an oral tradition passed from guru to chela, or student to teacher) teaches that, “If you can control your breath, you can control your mind. If you can control your mind, you can control your life.” By practicing breath awareness both on and off the mat, we gain the ability to practice another yogic tool, hesitation.  It is hesitation that allows us the moment to choose non-reactivity, non-judgment and compassion.

When you bring awareness to the breath, it becomes prana. Prana is life force energy.  There are many practices in yoga, called pranayama, which means “control of the life force”, that allow us to effect the flow of pranic energy within us.

One great way we can take our yoga practice off the mat is by practicing pranayama, or breathwork, wherever we need it.  Here are some basic techniques you can try when needed:

Ida Breath and Pingala Breath

Our nasal flow can have a lot to do with our energy.  There are three main energy channels that run along our spine.  The sushumna is the central channel and correlates with our spine.  The ida is the path of the left nostril.  Its energy is associated with the moon, and is gentle, cooling, and inward.  The pingala is the energy of the right nostril.  It is associated with the sun, and is more, fiery, outward, and strong.  Our typical breath is such that one nostril is dominant for a little less than two hours at a time, and then it is switched to the other side.

Ida Breath

Because the ida channel is gentle, cool and soothing, this breath can be used in situations where we are feeling anxious, overheated, or needing to calm or steady the mind.  It is also helpful for insomnia.

Technique:

Sit in a comfortable position with the spine upright and long.  Using the right hand, keeping the palm flat and fingers together, raise it up and use the thumb to block the right nostril.  Take long, deep breaths through the left nostril only.  You may want to begin with practicing this for 3 minutes and build up to 11 minutes.  If you start to feel your energy getting out of balance, you can restore balance with a right nostril breath.

Pingala Breath

Because the pingala channel is powerful, hot and dynamic, this breath can be used when we need to stimulate or increase our physical or mental energy.

Technique:

Sit in a comfortable position with the spine upright and long.  Using the left hand, keeping the palm flat and fingers together, raise it up and use the thumb to block the left nostril.  Take long, deep breaths through the right nostril only.  You may want to begin with practicing this for 3 minutes and build up to 11 minutes.  If you start to feel your energy getting out of balance, you can restore balance with a left nostril breath.

Ujayii Breath

Translated as the “victorious breath,” the ujayii breath is a breath commonly encouraged of practitioners to maintain throughout their asana practices. Also referred to as “the ocean-sounding breath” for the sound created in its practice, this breath is considered the most effective yogic breath for reducing stress and anxiety.  The sound, itself, can be incredibly soothing.

Technique:

The breath is like sighing with your mouth closed. Begin by inhaling through your mouth making a sighing sound and, while still inhaling, close your mouth. See if you can still hear the sound. You’re essentially drawing breath across the back of your throat, over the glottis. As you exhale, begin again with your mouth open making a sighing sound, then continue the breath as you close your mouth. Once you feel comfortable with it and can hear the sound on both the inhale and exhale continue the breath with your mouth closed only. This breath can be done as a regular practice for a set amount of time (e.g., 3 or 11 minutes) or can be done at any time during your day when you are feeling a need to bring greater calmness to your being.

Karma Yoga

Here’s one final note on another fabulous way to practice yoga off the mat.  As mentioned earlier, yoga is a thousands-year-old philosophy of being.  One path of yoga, karma yoga (karma literally translates as “action”) focuses on the performance of seva, selfless service, as a path to enlightenment and liberation.  Even if enlightenment and liberation are not what you are after, I honestly know of no better way to pull myself out of a crappy mood than step outside myself and give to/help/serve someone else. To quote a swami I know, it’ll help you “get over your cheap self.”  You can do this in a large way by volunteering your time to feed or serve the poor or ill, but you can also do this by making the effort to hold the door for the person coming out of the store as you’re going in, or by making a point of smiling, making eye contact with, and saying hello to people you pass on the street — without being attached to the response.  It costs us nothing.  And since, as another yogic teaching tells us, “energy follows thought,” holding that openness of thought and heart toward others will create an open flow of energy within our own being.

On or off the mat, you need to be nothing but the truth of who you are in this – and every –  moment.

Namaste.

Recommended Reading

Bringing Yoga to Life by Donna Farhi

Yoga and the Quest for the True Self by Stephen Cope

In addition to her psychotherapy practice, Melissa, who is a certified teacher of Classical Yoga and Kali Natha Yoga, is also developing yoga sets specifically designed to address various mental health issues.

November 10, 2007

Emotional Eating During The Holiday Season

By Andrea Schrage, MA, LAPC,CMT and Molly Keeton, Ph.D.

The holidays are an emotional time and often a time of overeating. As family and friends come together, food is often the focus of celebrations. Below are some tips to think about during holiday dining. Allowing yourself to enjoy food during the holiday season is a great option when it is a conscious choice.

Ask yourself if you are hungry.

Take a breath before reaching for food.

Ask yourself how you feel in that moment.

Imagine tasting the food in front of you and decide

if it is really what you want.

When allowing yourself to indulge, plan some limits ahead of time.

Drink plenty of water.

Don’t skip meals to make up for too many sweets.

Be compassionate with yourself and your choices.

Eat regular meals and healthy snacks to avoid being over-hungry.

Prepare a list of alternatives to eating.

Make healthier versions of favorite recipes.

Make room for emotional support.

Read this list before going to events.

Remember that most often finding a balance in life is a healthy goal to obtain.

February 9, 2006

7 Ways To Nurture Yourself

1. Make the choice to be generous and treat yourself to something you’ve been longing for. Spend time with friends, cuddle up with a favorite book or give yourself permission to just do nothing.

2. Forgive yourself for one act of self-sabotage. When we learn from our past we are able to receive it as a blessing. This opens the door to compassion and forgiveness.

3. Focus on one aspect of yourself that you love and acknowledge it for the way it has contributed to your life. This could be a physical characteristic like your eyes or your heart or it could be a positive quality like your decisiveness or sensitivity.

4. Close your eyes and acknowledge yourself for 10 positive choices that you made today – even for the simple things like getting out of bed or returning a phone call.

5. Make the choice to embrace one aspect of yourself that you dislike. Every quality comes bearing gifts – search and find a powerful interpretation of this aspect of you.

6. Allow others to love you up! Call two friends and ask them to share with you three things they love and admire about you.

7. Commit to having an extraordinary life. Take one bold action today: Find a [therapist], take a course you’ve been thinking about, or join a sacred community dedicated to conscious living.

 

These tips are from Debbie Ford’s newsletter.  In addition to “inspiring humanity to lead fully integrating lives,” Debbie Ford (www.debbieford.com) presents workshops and publishes books such as The Dark Side of the Light Chasers, Spiritual Divorce, Why Good People Do Bad Things, and The Right Questions. If you would like more information about the application of integrative shadow work principals in psychotherapy and personal growth, you can reach Metta Sweet Johnson, LCSW, MAT at (404) 221-3238.

February 19, 2005

Yoga to Soothe the Mind

Adaptedfrom www.yogajournal.com

Uttanasana
(Standing Forward Bend )

Despite its name, which means “intense stretch” pose, Uttanasana will wake up your hamstrings and soothe your mind.

(OOT-tan-AHS-ahna)
ut = intense
tan = to stretch or extend

Benefits

  • Calms the brain and helps relieve stress and mild depression
  • Stimulates the liver and kidneys
  • Stretches the hamstrings, calves, and hips
  • Strengthens the thighs and knees
  • Improves digestion
  • Helps relieve the symptoms of menopause
  • Reduces fatigue and anxiety
  • Relieves headache and insomnia
  • Therapeutic for asthma, high blood pressure, infertility,
    osteoporosis, and sinusitis

Contraindications/Cautions

Back injury: Do this pose with bent knees, or perform Ardha Uttanasana (pronounced ARE-dah, ardha = half), with your hands on the wall, legs perpendicular to your torso, and arms parallel to the floor.

Step by Step

•Stand in Tadasana, hands on hips. Exhale and bend forward from the hip joints, not from the waist. As you descend draw the front torso out of the groins and open the space between the pubis and top sternum. As in all the forward bends, the emphasis is on lengthening the front torso as you move more fully into the position.

• If possible, with your knees straight, bring your palms or finger tips to the floor slightly in front of or beside your feet, or bring your palms to the backs of your ankles. If this isn’t possible, cross your forearms and hold your elbows. Press the heels firmly into the floor and lift the sitting bones toward the ceiling. Turn the top thighs
slightly inward.

• With each inhalation in the pose, lift and lengthen the front torso just slightly; with each exhalation release a little more fully into the forward bend.  In this way the torso oscillates almost imperceptibly
with the breath.  Let your head hang from the root of the neck, which is deep in the upper back, between the shoulder blades.

• Uttanasana can be used as a resting position between the standing poses. Stay in the pose for 30 seconds to 1 minute. It can also be practiced as a pose in itself.

• Don’t roll the spine to come up. Instead bring your hands back onto your hips and reaffirm the length of the front torso. Then press your tailbone down and into the pelvis and come up on an inhalation
with a long front torso.

Modifications & Props

To increase the stretch on the backs of the legs, stand in the forward bend with the balls of your feet elevated an inch or more off the floor on a sand bag or thick book.

Variation

Padangusthasana (not to be confused with Supta
Padangusthasana
).

After bending forward, slide the index and middle finger of each hand in between the big toe and second toe of each foot. Then curl the fingers under the bottom and around the big toe and wrap your
thumb around your fingers. With an inhalation straighten your arms and lift your front torso away from your thighs, making your back as concave as possible. Hold for a few breaths, then exhale and lengthen down and forward, bending your elbows out to the sides.

Preparatory Poses

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