Chronic Wounds and Mental Health – An Overlooked Connection? 19 February 2021 Bliss Team No comments Categories: Guest Post When we think about our health, what often comes to mind are physical health issues like cancer, diabetes, and cardiovascular disease. These conditions do deserve significant attention, and certainly do pose a risk to our health. However, along with many of these conditions, there is another complication that does not garner as much attention, although it does significantly affect our health: our mental health. Chronic wounds are those wounds that do not heal in the expected time frame and do not follow the normal healing process. The result is an ongoing battle to overcome the wound and return to an active lifestyle. Coping with a chronic wound can feel like an uphill battle with no end in sight. This is also why chronic wounds can affect our mental health so dramatically – because they seem like injuries that cannot be overcome. What Is Mental Health? Mental health can simply be defined as the absence of mental illness. However, mental health deserves a much broader definition and more widespread recognition than it is given. It can be the difference between functioning at a satisfactory level and truly embracing and enjoying our lives, especially when it comes to chronic wound care The World Health Organization defines mental health as “subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential, among others.” Ultimately, our well-being includes the realization of our abilities, coping with normal stresses of life, productive work, and contribution to our community. Our mental health also affects how we think, how we perceive the world, the actions we take, and how we feel on a day-to-day basis. It can also contribute to how we handle life’s stresses, setbacks and failures, and our relationships. All in all, mental health encompasses just about everything we experience as humans, which is why it’s so important. According to the Centers for Disease Control, nearly one in five U.S. adults live with a mental illness (46.6 million in 2017), with an estimated 11.2 million adults aged 18 or older in the United States with what can be classified as a Serious Mental Illness. This means 4.5% of all U.S. adults cope with some form of mental illness. Many factors contribute to our ability to maintain our own mental health. These include any biological problems we may have, our life experiences, our family history, and any health conditions we are coping with – such as chronic wounds. How Do Chronic Wounds Affect Mental Health? According to the National Institute of Mental Health (NIMH), the presence of chronic conditions can increase the risk for mental illness. For example, conditions like Parkinson’s disease and stroke cause changes in the brain, which may trigger symptoms of depression. Depression is also common in people who have chronic illnesses such as cancer, coronary heart disease, diabetes, Alzheimer’s disease, HIV/AIDS, rheumatoid arthritis, lupus, and epilepsy, among others. Chronic illness can also cause feelings of illness-related anxiety and stress related to coping with wounds. Moreover, when depression and anxiety are present, the symptoms, as well as those of the chronic health condition, tend to be more severe. The NIMH also says people with depression are at higher risk for other medical conditions. As an example, people with depression have an increased risk of cardiovascular disease, diabetes, stroke, Alzheimer’s disease, and osteoporosis. One explanation for this is that mental illness may interfere with the ability to cope with chronic health conditions. For example, with mental illness present, a person may find it more difficult to seek care, take prescribed medication, eat well, and exercise. Lastly, preliminary research suggests that symptoms of depression and anxiety can cause signs of increased inflammation, changes in the control of blood circulation and heart rate, increased stress hormones, and metabolic changes that increase the risk of diabetes – all of which impact our health and our ability to cope with chronic health conditions. How Can Mental Health Be Improved While Coping with Chronic Wounds? The process of wound healing comes in four stages and it’s imperative to maintain mental health throughout each of them. While the most common treatment strategies for mental illness include cognitive behavioural therapy (CBT), medication, such as selective serotonin reuptake inhibitors, (SSRIs), and, in the most severe cases, electroconvulsive therapy (ECT), there are many lifestyle changes that we can incorporate every day to improve our mental health. Psychology Today suggests the following nine, all of which apply especially to chronic wound care patients: Be positive. While it is easy to overlook the automatic thoughts that run through our heads, when combined, they can add up to a negative outlook. When we see life through a negative lens, we tend to focus more on the things that confirm that belief. On the other hand, when we incorporate positive thoughts, these often lead to positive interpretations. For example, rather than saying, “I can’t do anything right,” try saying, “It didn’t work out this time, but I will try again.” Be grateful and write it down. It’s now clear that feelings of gratitude do significantly affect our mental health. When we can find things in our lives to be grateful for, not only do we feel differently, we also act differently – in ways that often lead to additional mental health benefits. One quick way to start is to keep a gratitude journal, or better yet, try practicing three acts of gratitude every day. Focus on what we can control, and be in the moment. Both ruminating about the past and forecasting the future can cause feelings of regret, depression, and anxiety. We can’t do anything about the past or the future. However, what we can do is stop and choose to focus on what we can control – our actions in the present moment. One easy way to do this is to simply pay attention to your routine activities and the thoughts that accompany them. Get active. Exercise is one of the most palpable ways to gain a sense of control. When you exercise, despite what else is happening in your life, you remind yourself that you can do something positive for your mind and body. Further, exercise increases stress relieving and mood lifting hormones, which have both an immediate and ongoing effect. Exercise can be incorporated in 30-minute blocks, or you can simply look for small ways to increase your activity level, like taking the stairs, going for a walk, or playing with your dog. Eat right. What we eat provides our brain with the ingredients to function well and improve our mood. Carbohydrates increase serotonin, which makes you happy, while protein-rich foods increase norepinephrine, dopamine, and tyrosine, which help keep you alert. Fruits and vegetables provide nutrients that feed every cell in the body, including mood-regulating brain chemicals. Lastly, foods with Omega-3 polyunsaturated fatty acids (found in fish, nuts, and flaxseed) can improve both our cognitive function and our mood. Open up. When we bottle emotions up, we don’t give ourselves an opportunity to cope and find creative solutions. We also dampen our ability to recognize our own habits, which may be contributing to how we feel. On the other hand, when we open up to someone else, we can pinpoint the positive aspects in other people (such as feeling valued or experiencing a sense of trust) and overcome our own biases. Do something for someone else. Like acts of gratitude, being helpful to others has a beneficial effect on how we feel about ourselves. Moreover, being helpful helps us feel valued, which contributes to positive self-esteem and helps us find a sense of meaning in our lives. Chill out. Sometimes in moments of high stress what we really need to do is step away. Often by simply slowing down, we can gain a greater perspective on what is going on, and in the process, find a positive solution. You can start with focusing on something that brings you positive feelings, such as a person that you love, an experience you enjoy, or something you are grateful for. You can also talk a walk, spend a moment in nature, or close your eyes and visualize yourself feeling calm and at peace. Get a good night’s rest. Sleep deprivation has a significantly negative effect on our mood, and sadly many of us don’t get enough sleep. Sleep can be improved with a few daily habits such as going to bed at a regular time each night, avoiding caffeinated beverages for a few hours before sleep, shutting off screens before bed, or incorporating relaxing activities before bed. There are many powerful components of mental health, like enjoying our lives, feeling as if we are striving toward something important, utilizing our skills, and seeking to reach our full potential, to name a few. And while chronic health conditions are often an overlooked deterrent to mental health, incorporating daily habits -i.e. replacing automatic negative thoughts with positive ones, performing acts of gratitude, staying in the moment, exercising, eating well, opening up, being helpful, taking time out, getting enough sleep, etc. – we can combat mental illness even amidst difficult chronic health conditions. Written By: Claire Nana Claire Nana, LMFT, is a Licensed Marriage and Family Therapist who specializes in post-traumatic growth, optimal performance, and wellness. She’s written over thirty continuing education courses on a variety of topics from Nutrition and Fitness, Mental Health, Wound Care, Post-Traumatic Growth, Motivation, Stigma.
Busting Stress 6 July 2017 Bliss Team No comments Categories: Guest Post It’s a question I ask during every initial visit: “Tell me about your stress.” Oftentimes, people don’t even recognize their stress as stress. We are so conditioned to think being “go-go-go” all the time is ‘normal’ that we don’t even realize it’s not. More and more, I am convinced that stress is the epidemic of our time. Back to the Basics During hunter-gatherer days when we would see a wild animal our stress would peak, our adrenals would put out adrenaline and cortisol, our bodies would shunt blood from our inner organs to our limbs and muscles, and we would run away. This is fight-or-flight, also known as Sympathetic Mode. The sympathetic nervous system increases heart rate, increases blood flow to extremities, diverts sugar to the blood (increases blood sugar levels), increases blood clotting, increases inflammation. We would get back to the fire and safety, our stress would decrease, our adrenals would relax, our bodies would deliver blood back to our inner organs, and we would rest. This is rest-and-digest, also known as Parasympathetic Mode. The parasympathetic nervous system stimulates digestion (enzyme production, stomach acid production), peristalsis (the movement that moves food the intestines), regulates deep sleep (stage 4), and stimulates sex organs (libido and fertility). Cortisol is known as our stress hormone, and we should have a regular rise and fall in cortisol throughout the day, which is countered with melatonin. In the morning, cortisol peaks while melatonin hits it’s lowest. Then throughout the day cortisol slowly decreases and hits it’s lowest before bed, while melatonin starts to spike which signals sleep. This constant interplay between cortisol and melatonin creates our circadian rhythm. Our ideal cortisol graph would look something like this: After each stressor we are able to return to a relaxed, parasympathetic state, and the stress resolves. However, more and more this rhythm is disrupted with stress. Usually when I am told that, “I’m not stressed, I’m just a busy person. I like it though, I can’t just sit there,” I follow up with, “okay, tell me about your day.” The response usually looks something like this: “Well, I wake up at 6 am, I get the kids up, make them breakfast, pack their lunches, drop them off at school, head over to the office. We are really busy at work so I usually work through the day, sometimes I forget to have lunch or I’ll just have a quick snack at my desk. Then after work I pick up the kids, get them a snack, drop them off at hockey/music/dance/soccer/etc. Then I go to the gym for a bit, then I pick them up, we have a quick dinner, I clean the house, put the kids to bed and I sit down to watch something but often times I fall asleep right away. Then I’ll wake up and go to bed.” (Imagine this said as quickly as possible with few breaths…) That go-go-go is stress. Aging, food, alcohol, coffee, other stimulants, working long hours, and lack of bonding is all stress as well. That is being in sympathetic mode all…day…long. With a graph that tends to look more like this: This means we are rarely getting into parasympathetic mode, and that will take a toll on our body. Stress and the Body It probably comes as no surprise that chronic stress will take a negative effect on the body, but some of the stats and facts might actually surprise you. 79-90% of all visits to primary health care practitioners in North America are due to stress-related illnesses. (Perkins 1994, Saving Money by Reducing Stress. Harvard Business Review 72(6):12) 68% of women say they are chronically stressed, yet only 25% say they are doing anything about it. (Statistics Canada) 11% of Americans age 12 or older report taking antidepressants. (CDC data) Both effects (acute and chronic stress) increase HPA stimulation and result in greater hippocampal and amygdala atrophy, biphasic alterations in structure increasing swings from depression to anxiety in women as compared to men. (Without clinical diagnosis of bipolar). (Bruce McEwen, Glucocorticoids, depression and mood disorders: Structural remodelling in the brain. Metabolism, May 2005, Vol 54, Issue 5, page 20-23). The last fact regarding anxiety and depression may be the most ‘shocking’, but under chronic stress our bodies and adrenal glands get taxed and coping decreases, which includes regulating mood. So, what should you do? It would be awesome if we could all just quit the stress in our lives, move to Mexico, and lay on a beach. But unfortunately that’s not reality, so it’s about finding ways to cope and manage stress. As a Naturopathic Doctor, I will often use nutrition, herbs and nutrients to help support your body and correct depletions. Chronic stress takes a serious toll on the adrenal glands and those don’t bounce back quickly as they won’t ever get a real ‘break’. However, without the tools to mange stress, even supplements are a bandaid and not a solution. My main recommendation for combatting stress is working on getting your cortisol down and into parasympathetic mode. Thankfully, there are a bunch of different ways to do this. Here are my top 5 easy to incorporate ways to manage stress: Yoga: In yoga, physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and oxygen uptake as well as hormone function. In addition, the relaxation induced by meditation helps to stabilize the autonomic nervous system with a tendency towards parasympathetic dominance. (Europe PMC) In one study, researchers evaluated the effects of yoga in females subjects who participated in a 3-month yoga program compared to those on a waitlist and found that those who participated in the yoga program demonstrated pronounced and significant improvements in perceived stress, anxiety, well-being, vigor, fatigue and depression. Physical well-being increased, headaches and back pain decreased and even salivary cortisol decreased significantly after participation in a yoga class (compared to before the class). (com) Guided Meditation/Breathing: This is an easy one to incorporate throughout the day. I will often recommend a quick 2 minute breathing exercise before each meal to help move towards parasympathetic mode and improve digestion. I also love guided imagery. A subscription to Apple Music or Spotify will provide you with a HUGE selection of various guided imageries that can be downloaded and listened to. This type of mindfulness has been shown to improve mood, decrease stress, boost the immune system, and even improve fertility. Studies are also showing there is huge benefits in children as well. My own daughter has a full playlist on Apple Music of children’s guided imagery that we will use after school, before bed, or any time we need a bit of calm. Adult Colouring: I know it’s all the rage right now, but for good reason. In a recent study, participants had their salivary cortisol measured before and after 45 minutes of adult colouring/art making. The results showed a statistically significant decrease in salivary cortisol levels and participants reported feeling much more relaxed with lower stress. It makes you wonder why we adults ever stopped colouring in the first place! Sleep Hygiene: We can’t look at stress and cortisol without also looking at sleep and melatonin. If cortisol becomes unbalanced/spiking improperly then the interplay between melatonin and cortisol will also become unbalanced, and sleep often gets affected. A good sleep routine helps to keep those circadian rhythms in check and allows your body to know when it should be producing more cortisol and when it should be producing more melatonin. Make sure you are following these basic sleep hygiene practices: Keep a regular sleep and wake time (as much as possible) to keep your circadian rhythm regular. Keep your room completely dark – remove clocks, use black out blinds etc. This helps signal your body that it’s time for sleep and to produce melatonin. Avoid electronics before bed – this plays into the dark point above but even more, electronic screens (tvs, phones, e-readers, etc.) emit blue light, which further disrupts melatonin production. So make sure you are avoiding it before bed. You can also download blue light blocking apps, or on iPhones you can set your screen to “night mode” which removes the blue light. Assemble your team: You’ve heard it before. “It takes a village.” And this rings true for your stress and mental health as well. The majority of our stress these days is kind of unavoidable – we have to get to work (traffic), we have to take care of kids, we have to have jobs, etc. Completely removing stress is unrealistic, but it is important to find people who can help you to manage your stress. Find a counsellor or therapist that you click with. I know there is still some lingering stigma around seeing a therapist when there really shouldn’t be. These are skilled practitioners who are well trained to provide you with an outlet to work through stress, as well as an array of coping mechanisms and tools to help manage or reframe stresses. Get a massage. Multiple studies show the benefits of massage. It has actually been shown that massage can decrease cortisol levels and actually increase dopamine and seratonin levels! Participate in mindfulness. Whether through a yoga class/instructor or finding a mindfulness or meditation coach, working on retraining your body to get into parasympathic mode is a huge step in reducing stress and cortisol. There are even group meditation classes in Uptown Waterloo! Talk to your Naturopathic Doctor. Optimizing diet, nutrients and lifestyle goes a long way in dealing with stress and coping. Herbs and supplements can also help support those adrenal glands and give them the nourishment they need after chronic stress. However, it’s not just finding tools, it’s also allowing yourself to make self care a priority. How many people feel ‘guilty’ sitting down in the afternoon or evening, thinking about all the ‘other’ things they should be doing (dishes, laundry, errands, emails, tasks, etc.)? Many times, these moments of just relaxing are thought of as ‘wasted’ time. Working on shifting that mindset to view those times as important moments of self care will be an important way to allow yourself to truly get into parasympathic mode. Remember, self care is never wasted time. If you are feeling stress or overwhelmed, it is never too late to reach out and start making changes. In Health, Dr. Jessica, Naturopathic Doctor at The Coach House Therapeutic Centre This post originally appeared on The Coach House Blog Disclaimer: The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. This information shouldn’t take the place of seeing a Naturopathic Doctor or your primary care provider for individualized health recommendations. Dr. Jessica Gurske completed her Bachelors of Science at the University of Waterloo. After her third year of studies, she traveled to Central America with International Service Learning Organization where she spent three weeks providing healthcare to under-serviced areas throughout Costa Rica and Nicaragua. It was a life-changing and educational experience. Jessica went on to complete a four year Doctor of Naturopathic Medicine program at the Canadian College of Naturopathic Medicine in Toronto, Ontario. She has successfully completed two national board exams through NABNE (North American Board of Naturopathic Examinations) and provincial licensing through the Board of Directors of Drugless Therapies-Naturopathy (BDDT-N). Jessica also has additional training in facial rejuvenation acupuncture. Jessica is also a mother which has sparked her interest in pregnancy and newborn care, women’s health and paediatrics.