Feeling down? Go outside!

In previous discussions, we have explored simple, evidence-based interventions for battling depression including exercise (see Exercise as treatment for depression) and diet (see Dietary changes to decrease depression). This discussion will cover the benefits of spending time outside to help reduce depression.

How can spending time outside improve your mood?

There are three factors related to being outdoors and decreased rates of depression. These are sunlight exposure, increases in physical activity, and exposure to the natural environment (1).

Sunlight exposure. There is a great deal of literature indicating positive benefits of exposure to bright light (i.e., light exposure therapy LET) for depression. The benefits of light therapy as it pertains to mood are more closely linked to helping persons develop appropriate sleep-wake cycles (sleep hygiene will be covered in a future blog post) (2). It can be surmised that exposure to sunlight yields similar benefits to LET. Another benefit in exposure to sunlight is in increasing levels of vitamin D. Low levels of vitamin D is linked to depression (3). Wearing sunscreen will not impact the health benefits of sunlight exposure, so be sure to lather up!

Physical activity. Time spent outdoors is commonly associated with being active (walking, playing sports, etc.). A brief exploration of factors related to depression and exercise are explored in another blog post titled: “Exercise as treatment for depression”

As was addressed in the above-mentioned blog, physical activity is related to decreased depressive symptoms. When compared to indoor exercise, outdoor activity has increased benefits for reducing depressive symptoms (4) .

Exposure to the natural environment. Exposure to the natural environment is associated with decreased rates of depression (5). Another study found that that time spent in nature, especially around water is associated with several positive mental health effects (e.g., improved mood, decreased stress) (6). To achieve improved mental health, the minimum recommended time spent outdoors is 3 hours per week (1)

To summarize: Spending two to three hours per week outside is associated with decreased rates of depression.

So, get outside!
Be well, 😊

1. Beyer, K., Szabo, A., & Nattinger, A. (2016). Time spent outdoors, depressive symptoms, and variation by race and ethnicity. American Journal of Preventive Medicine, 51(3), 281–290.

2. Golden, R., Gaynes, B., Ekstrom, R.D., et al. (2005). The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4) 656-662.

3. Anglin, R., Samaan, Z. Walter, S., & McDonald, S. (2013). Vitamin D deficiency and depression in adults: systematic review and meta-analysis. British Journal of Psychiatry, 202(2) 100-107.

4. Mitchell, R. (2013). Is physical activity in natural environments better for mental health than physical activity in other environments? Social Science & Medicine, 91, 130–134.

5. Beyer, K, Kaltenbach, A., Szabo, A., Bogar, S., Nieto, F., & Malecki, K. (2014). Exposure to neighborhood green space and mental health: evidence from the Survey of the Health of Wisconsin. International Journal Environmental Research on Public Health, 11(3) 3453-3472.

6. Barton, J. & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental Science and Technology, 44(10), 3947-3955.

Food to improve your mood! Dietary changes to decrease depression

Depression, as it is referred to in this series of articles, refers to depressed mood, unexplained feelings of sadness, low energy. Trying the tips in this series of articles may help reduce these symptoms but they are not a substitute for formal treatment of clinical depression (feelings of worthlessness or hopelessness, significant impairment of daily functioning and thoughts of suicide).

For exercise ideas for reducing depressive symptoms, check out my previous post: https://therapistspeaks.com/2021/01/11/exercise-as-treatment-for-depression/

A poor diet is associated with increased rates of depression. Depressive symptoms are common in those whose diet largely consists of fast foods (hamburgers & pizza), processed pastries (doughnuts, muffins), foods high in sugar content, and foods with preservatives (1).

Conversely, addressing your diet and making healthy changes will help decrease your likelihood of depression! This article will explore several dietary changes you might consider to increasing your chances of fighting off depression.

First, a ‘traditional’ diet composed of beef, fish, whole grains, fresh fruits and vegetables is associated with reduced risks of depression (1). Additional considerations should be considered but this diet is a good alternative to fast foods, etc.

A Mediterranean diet has been linked to reductions in depression. This diet consists of increased amounts fresh fruit and vegetables, nuts, legumes, fish and poultry (grilled not fried), and decreased amounts of red meat and whole-fat dairy (2).

Mediterranean diet: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

A Ketogenic diet has demonstrated antidepressant and mood stabilizing effects. This diet includes high fat, low to moderate proteins and reduced carbohydrates. Common foods on a Keto diet include meat, fish, butter, eggs, cheese, heavy cream, oils, nuts, and avocados. Foods higher in carbohydrates such as grains, rice, beans, potatoes, sweets, milk, cereals, fruits are reduced or eliminated from the diet (3,4).

Keto diet: https://www.ruled.me/guide-keto-diet/#what-to-eat

The most heavily researched dietary factor associated with reductions in depression is increased intake of omega-3 fatty acids especially those high in eicosapentaenoic acid (EPA). Omega-3 acids are commonly found in fish, nuts, and seeds and fish oil supplements (5,6).

Preliminary findings indicate that adding a variety of vitamins and minerals (e.g., a multivitamin) helps reduce depression (7).

Maintaining healthy gut bacteria is associated increased availability of the most common neurotransmitters associated with decreasing depressive symptoms (serotonin and dopamine) (8).

Interestingly, a study involving adults whose diet consisted of standard potions of meat reported improvement in mood when switching to a vegetarian diet (9).

Though long-term benefits are yet to be determined, Therapeutic fasting, which involves brief periods of fasting (up to 48 hours) with water and gradual reintroduction of foods such as fruit and rice is associated with improvement in mood and sense of well-being (10).

I hope you have found this article helpful! Subscribe to my blog for regular updates.

Be well,

🙂

Jacka F.N., Pasco J.A., Mykletun A, Williams L.J., Hodge A.M., et al. (2010) Association between western and traditional diets and depression and anxiety in women. American Journal of Psychiatry, 167: 305–311.
Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, et al. (2009) Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch General Psychiatry, 66: 1090–1098.
Dsouza, A., Haque, S., & Aggarwal, R. (2019). The influence of ketogenic diets on mood stability in bipolar disorder. Asian Journal of Psychiatry, 41, 86–87.
Brietzke, E., Mansur, R. B., Subramaniapillai, M., Balanzá-Martínez, V., Vinberg, M., González-Pinto, A., Rosenblat, J. D., Ho, R., & McIntyre, R. S. (2018). Ketogenic diet as a metabolic therapy for mood disorders: Evidence and developments. Neuroscience and Biobehavioral Reviews, 94, 11–16.
Lopresti, A. L., Hood, S. D., & Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise. Journal of Affective Disorders, 148(1), 12–27.
Partaka, M. R. (2020). Healing naturally: An integrative health approach to treating anxiety and depression [ProQuest Information & Learning]. In Dissertation Abstracts International: Section B: The Sciences and Engineering, 81(2–B).
Yeum, T.-S., Maggiolo, N. S., Gupta, C. T., Davis, B. J., Nierenberg, A. A., & Sylvia, L. G. (2019). Adjunctive nutrition therapy for depression. Psychiatric Annals, 49(1), 21–25.
Jacka, F. N. (2019). Targeting the gut to achieve improved outcomes in mood disorders. Bipolar Disorders, 21(1), 88–89.
Beezhold B.L. & Johnston C.S. (2012). Restriction of meat, fish, and poultry in omnivores improves mood: a pilot randomized controlled trial. Nutrition Journal, 11:9.
Fond, G., Macgregor, A. ,Leboyer, M., Michalsen, A. (2013). Fasting in mood disorders: neurobiology and effectiveness. A review of the literature, Psychiatry Research, 209(3):253-258.

Exercise as treatment for depression

Given all the events in the world today including social isolation due to COVID-19, tension related to political events, and impact on financial well-being its is to be expected that many of us may struggle with feelings of being depressed. What can I do to help improve my mood and sense of well-being?

There are several non-pharmacological interventions that are helpful for treating depression including exericise, socialization, dietary changes, engagement in enjoyable activities (i.e., hobbies) and more.

I will be posting a series of blog entries on non-pharmacological (non-prescribed medications) ways of helping yourself to improve your mood. The first of the interventions to be explored is exercise.

To review my post on dietary changes to help with depression, click here: https://therapistspeaks.com/2021/01/28/dietary-changes-to-decrease-depression-2/

*It is important to note that when treating clinical depression, the interventions explored in this series of posts can be used as an adjunct to prescription treatment by a physician- not a substitute!

Exercise

According to the World Health Organization (WHO) (1) and the National Institute for Health and Care Excellence (NICE) (2), exercise is a valuable intervention for depression. For a detailed description of benefits of exercise as an intervention for depression, see Rethorst, Wipfli, Landers (2009) (3).

Two specific forms of exercise, neuromuscular exercise and endurance training have been found to be especially helpful for treating depression (4). Neuromuscular training focuses on balance, strength, coordination, and proprioception. Examples of this type of exercise are tai chi, yoga, and simple weight training. Endurance training is exercise which requires sustained levels of exertion (a.k.a. aerobic exercise). Examples of this type of exercise are brisk walking/ running, cycling, and playing active sports (e.g., soccer, tennis, and basketball).

For exercise to be effective, the American Heart Association suggests at least 2.5 hours per week (roughly three 45 minutes per week) (5).

Summary: Forty-five minutes of exercise, three times per week (endurance training or neuromuscular exercise) can be helpful for improving your mood.

Happy New Year and here’s to feeling better!

😊

WHO. Mental Health. Physical Activity. (n.d.). Available online at: http://www.who.int/mental_health/mhgap/evidence/depression/q6/en/ (Accessed December 06, 2017).
NICE Depression: The Treatmentand Management of Depressionin Adults. NICE Clinical Guidelhine 90 (2013).
Rethorst, C.D., Wipfli, B.M. & Landers, D.M. The Antidepressive Effects of Exercise. Sports Med 39, 491–511 (2009).
Nebiker, L., Lichtenstein, E., Minghetti, A., Zahner, L., Gerber, M., Faude, O., & Donath, L. (2018). Moderating effects of exercise duration and intensity in neuromuscular vs endurance exercise interventions for the treatment of depression: A meta-analytical review. Frontiers in Psychiatry, 9.
American Heart Association Recommendations for Physical Activity in Adults and Kids | American Heart Association. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

How do I choose a therapist?

A common question is “how do I find the right therapist for me”?

The term “therapist” is a universal term which covers a variety of disciplines including mental health counseling (also known as professional counseling), clinical social work, marriage and family therapy, counseling psychology, and clinical psychology. All disciplines require at least a master’s degree and more than one thousand hours of supervised clinical practice prior to licensure. All licensed mental health professionals are trained in basic competency for all mental health issues. Many therapists will also identify specialties (e.g., trauma, depression, anxiety, etc.). Selecting a therapist who specializes in your issue could help maximize the possible benefits of therapy. A specialist is particularly important for issues which may be either less common or requiring increased sensitivity such as sexual trauma, gender identity, videogame addiction, etc.

How do I select a therapist? If you have health insurance, call your provider to see who the approved in-network providers are in your area. Therapy is an investment into your well-being though can become pricey. Exploring options with the support of your insurance would be a good place to start.

Most insurance cards will have a number for “mental health”, or the like listed on the back of your member card. When you call, they will ask for a brief description of what you may need help with and then offer a list of providers in your area.

Once you obtain a list, you can do some research on each provider. Most therapists advertise on Psychology Today (www.psychologytoday.com) and provide information on their theoretical orientation, rates, services provided, and areas of specialty. Therapist may also have their own sites which contain similar information.

Some things to consider when selecting candidates to be your therapist might be gender, age, and culture/ ethnicity, and religious/ spiritual orientation of the counselor.

Ultimately, the best way to evaluate a therapist as a potential fit for you is to schedule an appointment and spend a session with them to see if you feel comfortable. Don’t be afraid to ask questions about their approach to therapy or how they may be able to help you specifically with whatever it is you would like to work on. A good working relationship with a therapist is a very valuable tool, so selecting someone who is a good fit for you will pay off in dividends.

I hope you have found this helpful! 😊

Keywords: counseling , counselor, therapy ,therapist, psychotherapy , psychotherapist , selecting a therapist , finding a therapist , mental health treatment.

COVID Thoughts 1

Hello Friend,

SO much has been happening these days and it’s hard to comprehend the scope of what we are living through.

Virtually all aspects of our lives have been impacted by COVID-19: At its worst is the growing number of deaths due to the disease. For those who keep their lives, we are now faced with reconciling the entire infrastructure of our economy and society. What will our lives outside our homes look like once the dust settles? I wonder if the café where I love to sit and write will remained closed forever. This is a very high-class problem but it’s the creature comforts that we miss…

I long for some sense of normalcy to return. I am fortunate to have suffered a severe injury last year which has left me with limited usage of my left hand. Adjusting to life with a disability involves accepting a new “normal.” I continue to grieve the loss of the use of my hand but know that staying in those thoughts for too long brings suffering. Accepting the new normal, including uncertainty of what is next, is our next task.

We humans have been very fortunate for a long time. We are now faced with something which is causing widespread damage and we don’t like it. Fair enough. In many ways, we have been spoiled as we haven’t experienced the suffering, at a very base level, that so many other species in the world have.

I feel this whole experience will be very grounding for humanity. It is giving us an opportunity to reflect upon what is truly important in life (as we have now become increasingly aware of our own mortality).

I am so excited to see (either on social media or riding bikes around my neighborhood) so many families bonding with each other. The degradation of the family unit contributes to much distress and I hope that this time with each other will invigorate bonds with one another.

I encourage- no implore you to take this time as a big “reset” to evaluate your true needs and wants and consider how to implement them in your lives.

I would love to get some audience participation on this post so please offer a reply below.

Be well. 😊

My Experiences With Racism

I am stupid. I am awkward. I am a middle-aged, middle class, straight white man. I have been told I know nothing about prejudice and that I shouldn’t even try to pretend like I do. I have had my nose broken by a black kid while he was pranking me. I have been robbed (twice) by two black men. I have been assaulted by two black men while in basic training in the Navy. I have been called a racist when, in my best estimation, I wasn’t

I have been profiled and rejected. The one time I spoke out for equality of a minority group I was met with intense resistance and hatred from both the minority population and people who fit my demographic. I frequently have felt defeated. In my estimation, there is nothing I can do to overcome the differences between myself and people of color- especially those who have suffered at the hands of people that look like me or their ancestors. I hate the behaviors of people who happen to look like me have cast long shadows over our current daily experiences between people of different skin colors.

During my graduate training, I was encouraged to discuss the racial or ethnic differences between my clients and me. This has not gone well. The first time I attempted it caused the client to angrily state “I’m not afraid of you because you’re white.” I was wrong, once again.

I have had potential clients elect to work with other therapists less experienced than myself solely based upon the color of the counselor’s skin. I feel powerless.

As my car was being broken into and one thousand dollars of contents removed, I contemplated walking out with my pistol and killing the two young black men. When the police arrived, the officer indicated that if I had fired a shot I would go to prison. He said if, however, I had disabled one of them with a baseball bat and detained him that the officer would arrest him and take him without question. When I told this story at work, the radical feminist said that was an example of White Privilege- without even acknowledging the fact that I had been robbed. Again, it’s my fault and I’m stupid and entitled.

I teach a course titled Culture and Psychology in a local university. I teach about racism and the continued experiences of minority persons in America. I have had lived and worked with people of color. I have friends currently who are also people of color. I hear stories that break my heart. And still, I know nothing.

I understand the argument for White Privilege and do firmly support that it exists, at least on a micro level- that is on an everyday, interpersonal level. I have seen people be discriminated against at restaurants; I have heard people yell racist terms at someone walking down the street; I have heard people compliment a black man on how white he was. These things don’t happen to whites (except in perhaps small enclaves of urban areas). I am frustrated by this and do my best to not only not perpetuate it, but to address it when I see. Still, I am frustrated and saddened.

At the end of it, I am unsure of what to do. I have been encouraged by a close friend (a counselor of color) to not discuss differences of race or ethnicity between the client and I it unless the client brings it up. I can deal with that. I am aware of some different cultural norms and try to incorporate my knowledge into how clients present themselves and how they identify their issues.

I am frustrated by the divide that still exists and wish it didn’t.

I don’t like my deviated septum. I wish I had my stuff back. I wish I hadn’t had to fight two men early in my military career. I wish I hadn’t been openly called a racist when, in my best estimation, I am not. I am tired of being awkward and stupid. I hope that at some point, the differences between us (i.e., members of the majority and minority) will be smaller and less of a deciding factor on how we treat one another.

Until whenever that happens, I’ll just keep doing what I’m doing until something else happens to change my course a little- hopefully for the better.

Born Under a Bad Sign

“Born under a bad sign… I’ve been down since I began to crawl” -Albert King

I have worked with a handful of clients who have concluded that bad things happen to them because of destiny, being unlucky, God hating them, being cursed, paying for transgressions from a previous life, or just simply being bad. They were easily able to provide evidence to support their position including having suffered abuse as children, experiencing premature death of loved ones, and seeming to always be the one getting into trouble (both as a child and an adult). These people were entrenched in their position and seemed to embrace and integrate it into their sense of identity. Their primary relationships were with people who had similar perceptions of themselves.

My interpretation of what they are saying is that, due to some omnipotent force beyond their control, that their life is oriented toward pain, loss, defeat, sadness, failure and ultimately suffering (or at the very least, a lack of peace, happiness, and contentment). They feel rejected by life.

This is a profound belief for a person to have of themselves.

Often, these people have not been treated with the dignity and respect that they, along with all people, deserve and thus I explicitly incorporate it into my treatment plan for them. The effective use of empathy and a consistent application of unconditional positive regard is critical. I see myself as serving as a liaison between them and humanity through offering a corrective experience with someone who cares for them. I listen to their stories and apologize for past hurts they have endured. I identify and celebrate their strengths. I offer them comfort and support. We find commonalities in our lives. We laugh. A lot.

In stark contrast to these individuals’ appraisals of themselves, I find them to be incredibly inspirational. They have endured a great deal of heartache and pain and have somehow survived. Their strength and tenacity are enviable. I am honored to be a part of their recovery/ journey.

My Counseling Philosophy

I believe that the meaning of life for all living things is to grow, thrive and when it is time, to die. All living things naturally engage in this process. For people, this process can become slowed or derailed by issues such as non-integrated trauma, messages received about self (especially during formative years), and an array of possible physiological issues (caused by genetic or environmental influences). This belief is aligned with the humanistic traditions of psychotherapy which suggest that given the appropriate environment, people will have a tendency toward self-actualization. Carl Rogers stated: “The organism has one basic tendency and striving – to actualize, maintain, and enhance the experiencing organism” (Rogers, 1951, p. 487). My beliefs inform my approach to my work with clients.

My general approach to working with clients is to build a therapeutic alliance with them while collaboratively determining what I may be able to help them with. To achieve this, I work to understand the client’s worldview and attempt to develop a sense for what it feels like to be them (or at least understand their experience within the current context of their lives). Through listening and asking questions I work to find factors which are contributing to the individual’s challenges. These factors generally include beliefs about themselves, others, or situations; dysfunctional behaviors they are engaged in (e.g., chronic drug use) or sometimes a general lack of direction (e.g., purpose in life). Very often, the predominant issue in their life is that they have no one with whom they can have honest conversations.

I believe that much can be gained through honest discourse. Through honest conversations with others, people can learn to develop meaningful relationships. I frequently act as a surrogate for others to practice talking about their inner thoughts, feelings, and desires which they can hopefully transfer to other relationships in their lives.

I try to remind myself that everyone is doing the best they can with the tools they have to work with or within the context within which they exist.

I believe that life is hard. Therefore, I try to offer comfort and support to all my clients. I am direct with my clients with my insights, but I also infuse humor (when appropriate). Laughter is important to me. I believe in laughing often. My personal hardships and experiences allow me to respectfully make light of even the worst situations.

I use self-disclosure when I feel that it could be helpful to the person or to the relationship. I try to show my humanness when I can.

I know my place. If I am meeting with a person who is 25 years old, I ask myself, what in this hour of this person’s life can I realistically expect to accomplish?

If I incorrectly approach a topic with a client, or if my speculations are erroneous, I own my mistakes. I apologize. I admit when I don’t know. This is directly related to the value that I place on relationships. If I acknowledge my mistakes, it models healthy behavior. If I admit when I don’t know, I show that I am ok with not knowing, that I don’t expect myself to know everything, etc. I apologize when I am aware that I may have overstepped a boundary or when I have said something other what is true.

Finally, I seek to inspire. I seek to challenge people’s beliefs about themselves and to consider there may be more possibilities. I want people to find peace and to experience the joys of living. Despite my sometimes-cynical personal nature, professionally, I am an idealist of sorts. I have a (Doctor Who 🙂 )poster in my office which reads: “I am and always will be the optimist. The hoper of far-flung hopes and dreamer of improbable dreams.”

Rogers, C. (1951). Client-centered therapy: Its current practice, implications and theory. London: Constable.

I hope you are well. 🙂

“I’m sorry” versus a true apology

What does it mean to say “I’m sorry” for something? It is a phrase that we are taught to say when we have done something that we have become aware is a transgression against another person. But, aside from social convention, do these words have any real value? Do these words clear the transgression?

Teaching words to a person without emphasizing meaningful change of action, which led to the transgression, is of little value (aside from social convention).

Consider what the words/ sounds “I’m sorry” mean to a dog. Like all sounds to all animals, it means nothing on its own. When pairing it with something that the dog is likely to respond to, it becomes something of value. For example, a dog owner with an anger issue kicks his dog when frustrated. After the owner settles down, he apologizes to the dog and pets it on the head. In his (the owner’s head) he has corrected the transgression and the dog is supposed to acknowledge the apology, forgive the transgression, and forget what has happened.

What might the dog have learned after years of this process? My owner gets angry and kicks me a lot. Then he pets me and says words that seem to make him feel better. I really like when he pets me, but it is only after he kicks me. I have tried to learn all the words he says so I can be a good dog. The words “I’m sorry” seem to mean something to him but to me, they are the words he says when the beatings have stopped for the time being. I must be on the lookout for when he’s angry, so he doesn’t hurt me so much. I try to be a good dog and love him, but he hurts me a lot.

How have we taught those around us what the words “I’m sorry” mean when we say them? Do they mean that we wish we hadn’t done what we did, that we ask for forgiveness, and that we will do everything within our control to ensure it won’t happen again? Or, are we just saying words when we know we messed up?

Words without substance have little value. When you use the words “I’m sorry” do your best to change the behavior to reduce risk of repeating it. If you find you are unable to do it on your own, get help.

-This article is written as a reflection to my work with people with substance use disorders. They frequently apologize for hurting those around them and continue to do the behavior which they are apologizing for. Over time, “I’m sorry” means nothing to the family of an addict. In early recovery, the words “I’m sorry” can still mean little (as it should). The behaviors indicating that a change is taking place (i.e., staying clean) have much more value than idle words.

To the angry dog owner: Stop kicking your dog- this will be a true apology.