Intro: You are listening to supporting supporters, a free mental health and wellbeing podcast. This podcast is offered by Allina Health. My name is Tonya Freeman, I'm a licensed psychologist and regional lead psychologist with Allina Health. These podcasts are aimed at the goal of providing quick tangible resources from Allina Health mental health providers. Ranging from topics of day-to-day life of the listener. We invite you to join us in any way you please, whether you sit back and kick your feet up, or as you engage in movement, your daily commute, or as you prepare for your day. However, you choose to join us, we welcome you and honor your time. 

Episode: Hi and thanks for listening today.  My name is David Nathan, and I’m a licensed psychologist.  I work for Allina Health, and I primary work with children, teens, and men on a wide range of issues.  Other than myself, everyone in my family is a teacher, including both of my parents and my twin sister.  Working in the education system is extremely demanding but so crucial.  Thank you for what you do every day.  You are making the world a better place.  I hope this is helpful to you. 

Today I am going to talk about five doable things that can improve our quality of life, both with the body and our minds.  And the good news is that all these things are free.  They are what I would consider the bedrocks of mental health: exercise, a healthy diet, good sleep, self-care, and self-compassion. I know that these concepts are not new, but perhaps I can offer a different approach to prioritizing these core concepts. 

Exercise, eating well, getting good sleep, self-care and engaging in self-compassion are not just nice things to do.  They impact everything about us.  And I recognize that you have probably heard everything or almost everything I am about to say, and that’s ok.  Sometimes we need to hear good messages many times before we act on them. Or perhaps you have been able to make some small changes in the past and are ready to hear possible next steps.  

There is an entire dynamic in psychology called the Transtheoretical Model, or the Stages of Change, which I won’t get into in detail here, but it presents a way of understanding the steps needed for someone to make changes in their life.  I encourage you to google the Transtheoretical Model if you are interested in more information.  According to the model, there are six stages we go through when we make changes to our lives; The first stage takes place when we are not even thinking about making a change.  The second is considering a change that someone might want to do, And so on.  The point is, the transtheoretical model describes what we all know: making big changes in our lives or even the small ones, is not as easy as flipping a switch.   It is a process that takes time and energy, and sometimes it takes a lot of time and energy.  This podcast isn’t about bringing you from step one to step six; sustaining change.  This podcast is about helping someone in stage one or two make incremental improvements to sustain a happier healthier life. You can decide when and how you want to use this information. 

I also want to say that I do not promote one approach over another.  I think these are each part of keeping ourselves mentally and physically healthy.  And there are other approaches too; some people may benefit from medication that reduces symptoms of anxiety and depression, some people may benefit from talk therapy, and other approaches I am not discussing here today.  I like an “all of the above” methods when it comes to mental and physical health concerns.  The more methods we have to take care of ourselves, the better off we are going to be.  

One thing- I did say that making changes in life takes time and energy before, and this is true.  If you have some significant new difficulties going on in your life, a marriage, a divorce, a new child, a new job, moving, the loss of a loved one, etc, this is NOT the time to try to make a change of any kind in your life unless you absolutely need to.  We don’t try to learn how to swim by tying weights around our wrists and ankles.  If you want to think about making bigger changes, do it when your life is as sustainable and comfortable as possible.  

Ok. Let’s discuss exercising.  

First line anxiety and depression medications, selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have been around for decades.  There are lots and lots of studies on them, it is pretty clear that for most people, SSRIs and SNRIs are really helpful with reducing symptoms of anxiety and depression.  

There is one other treatment that pharmaceutical corporations never test their medications against.  Only independent researchers do studies like this.  They compare the effectiveness of medications against exercise.  And I don’t mean one pill a day against hours and hours of exercise a day.  I mean comparing standard doses of medication every day to 30 minutes of exercise 3 to 5 times per week.  

According to mountains and mountains of published research that comes from universities and other independent sources, not pharmaceutical companies, medication is very effective at treating anxiety and depression.  And according to mountains and mountains of other research, exercising 30 minutes a day 3-5 times a week is just as beneficial as the benefits from front line medications.  Like I said before, I am not promoting one approach over another.  And medication does have a clear benefit in treating anxiety and depression symptoms.  But I do like an “all of the above” approach, and it is worth noting that exercise makes a big difference.  We don’t have to do one or the other.  This can be a yes and situation. 

There are costs associated with exercise.  It takes time.  There is no way around that.  Compared with taking a medication in the morning, there is a much higher time commitment. But there are some unique benefits that come from exercise.  If you or someone you know has ever gone on an SSRI or SNRI, you know it takes a long time, sometimes several weeks to see a benefit. And if they want to go off, they need to taper their medication down over several weeks.  If they run out of medication, they are stuck.  With exercise, the mood benefits are much more immediate and accumulate with persistent activity.  Exercise doesn’t just improve anxiety and depression symptoms; it helps sustain our attention longer, think more carefully, and generally feel more confident.  Jogging, biking, skiing , swimming, strength training, they all help.  Dancing, karate classes, dodgeball league; whatever floats your boat.  They all help.  Walking up and down stairs at your house or school also works.  You don’t need to buy anything, and you don’t need to get a membership at a club.  If you don’t have weights, you can use water bottles, milk jugs, or canned beans.  I want to make it clear that I am not against using medication for the treatment of mental health concerns.  I have seen medications change people’s lives.  But exercise can make a huge difference too. 

Next point: sleep.  

I’m sure you know that Americans get far less sleep than they should.  In grad school, we had a lecture on this from a sleep expert from the University of Minnesota.  Someone asked, “how long should someone sleep?” the answer was “when you can wake up without using an alarm.”   I don’t know about you, but I’m not sure I have ever woken up without an alarm on a school or workday since I was in fifth or sixth grade.  So I’m probably guilty of not getting enough sleep as well.  In my defense, I do get about 8 hours of sleep every workday.  

There is a reason we tell people they need to get a good night’s sleep before they take the SATs or ACTs.  I conduct ADHD and ASD assessment routinely, and one of the things I tell my patients and their families is make sure they patient has a full night of sleep before testing.  If someone has not gotten enough sleep, I am going to know it about 90 seconds into the testing session, if not sooner, and I’m going to have them reschedule testing.  If you don’t have enough sleep, your mind operates like you have lost several points off your IQ.  I haven’t seen a specific study on this, but I suspect if someone gets a few hours less sleep than they need, their effective IQ is going down 10-20 points the next day. The less sleep we get, the worse our pre-frontal cortex works.  And the effects of sleep loss are cumulative; if we don’t get enough sleep for several days, we are going to be worse off than if we just have one night of little sleep.  The less sleep we get, the more impressionable we are.  If we lose enough sleep, our inhibitions vanish, not unlike having too much alcohol. We become extremely impulsive.  Our coordination evaporates.  And on top of this, we feel exhausted.   

There are a couple of reasons we don’t get enough sleep.  It could be because we have a new baby in the house.  My wife and I have twins who are now nine, and the first several months were rough. It might be because of our jobs creating unusual sleep schedules or needing to have 2-3 jobs to pay for life expenses.  Or because we are watching screens to wind down.  It could be consuming caffeine too late in the day for your body and mind. Or it could be we are having difficulties with anxiety and instead of falling asleep, the minds spirals during the night creating obstacles to relaxing as needed to fall asleep. Or it could be a combination.  

For sleeping difficulties that are due to anxiety, the best way to deal with this is getting treatment for the anxiety.  Exercise, therapy, self-care, reducing caffeine intake, reducing or eliminating screens, raising medication and other strategies can help with this.   

If the difficulties sleeping are due to our own behavior, such as watching screens before trying to go to sleep then it’s a matter of adjusting our evening routines.  If we are doing jobs so late that we are don’t have time for sleep, it’s worth asking yourself about options available to you.  We are very busy people in 2022. If you have the means, it is okay to see what areas of your life can be “outsourced.”  You do not have to do it all! If you can, ask family members/friends/babysitters to watch your children, hire a house cleaner , perhaps investigate grocery or meal delivery services if that saves you time. Sometimes, there is self-imposed expectation that you should be able to do it all, but in 2022, this is not reasonable.  One thing I see over and over again, is that mothers are the backstops of our society.  When a problem in our culture or community arises and no one else is able to or is interested in taking care of it, the problem tends to fall on mom’s laps.  

And yes, this isn’t true of all mothers, and yes, there are some absolutely fantastic fathers out there. No question.  But I see this every day in my work and the research backs this up.  On average moms do more work than dads or non-moms.  We need to be realistic about what are can and cannot actually accomplish.  If the doers get burned out, our kids, families and coworkers are in big trouble.  

Being overworked and overwhelmed is not an issue unique to mothers.  But it is an issue and it is important that it is acknowledged.  

When we were younger, we had time but no money.  As we get older, we have more money and less time.  It is worth considering spending some money to free up some time so you can have more time to rest and enjoy yourself and each other.   

If none of these options work for you, it may be worth thinking about how many jobs you can really fit in your life.   We have a time and energy budget, just like we have a financial budget.  We are taught from an early age how to be thoughtful about living within our means.  It’s important to live within our time and energy means as well.  I would love to buy and drive a Maserati, but that isn’t in my budget.  If you are doing so many jobs that you aren’t getting enough sleep, it might be worth thinking about whether you have the time and energy budget to do all these jobs.  Some jobs we need to do, but it’s also worth thinking along the lines of “I need to be getting ready for bed by 9.  What jobs do I need to do first to make sure they are done by bedtime?” Jobs that cant be finished before bedtime need to wait.  You and your sleep are more important than the laundry.  

If you are looking at screens, think about substituting reading books or magazines, playing card games, doing crossword puzzles or sudokus or other low intensity non-screen calming activities before bed.  We all know that blue lights make our brain think its daytime and that it’s time for us to be up and at ‘em.   Or maybe you are good at putting the phone down, but then you get the ding of a text and feel like you should answer. It is okay to have an internal policy of no screens after “x” time unless it is an emergency. One option is to keep your cell phone charger far from your bed so you are not tempted to respond to a notification.  

Another culprit is caffeine. Even if you feel like you are not sensitive to caffeine, if you are consuming caffeine after lunch time, try cutting that out for a few days and see how things go.  In my experience, caffeine, and screens account for a lot of difficulty sleeping and tend to be some of the easiest issues to address.   

If you find yourself waking up late at night and can’t fall back asleep in a few minutes, it’s important to get out of bed and do something quiet and relaxing, such as reading a book or pet your dog or cat.  Avoid using screens.  Our bodies can become habituated to not sleeping when we are in bed.  I had a professor at St. Thomas who told us when it comes to beds, they should be used for two things: sleep and sex.  If our body and mind get used to being in bed and not sleeping, it can be harder for us to fall asleep in bed when we really want to.  A good cut off point for when to get out of bed is if you notice you are trying to get to sleep for 10 minutes.  At that point, it’s time to get out of bed and do something calming.  When you are feeling more tired, try going back to bed.  This is hard, especially in winter when our beds are cozy. But sleep is worth it! 

Let’s talk about food.  When we eat, the food we ingest is digested by acids and enzymes in our stomach which make the building blocks  for our body, including our brain.   When we eat proteins, our bodies turn them into amino acids.  Amino Acids are used to fix broken cells in our body and make new ones.   If we don’t have enough protein, it’s harder for us to heal from injuries and fight off illnesses.  Carbohydrates are turned into fast energy in our body. Fats are turned into fatty acids in our body, which are also used to build cells.  They can also help certain vitamins A, D, E and K move through our body.  Fat can provide us with a backup source of energy and can also protect our internal organs from injury.  Fat also makes up 60% of our brain tissue.  Vitamins help keep us sharp.  They strengthen our eyesight, help keep our skin clear and make our nails and hair shinier. Minerals help manage processes in our body, like building strong bones and teeth, turning food into energy and managing the fluids inside and outside the cells of our body. And water is critical; our bodies are about 66% water.   Water helps transport vitamins C, B vitamins, and folic acid around our body.   When we eat a balanced diet, we get a good mix of these nutrients.  When we don’t have that variety or do not ingest nutritious foods, our bodies and minds are going to suffer.  If we don’t get enough veggies and fruit, we are not going to digest food as well, and our stomachs and GI tracts in general aren’t going to be as healthy and we’re going to be at increased risk for all kinds of injuries and sicknesses related to those systems.   If we don’t get enough vitamins and minerals, our minds and bodies are going to be dragging. Another side effect of not having a healthy diet is that we are more likely to feel depressed.  I’m not saying you shouldn’t drink soda or eat cookies.  But it is really important that we get a full range of the foods we need to keep our bodies going.  I work at a clinic with a lot of doctors and nurses, and we eat in a shared break room.  Doctors and nurses tend to have extremely healthy, well-balanced lunches because they know the long term consequences of the opposite.   

If you are interested learning how to cook healthy inexpensive meals, there are a treasure trove of websites, podcasts and YouTube videos out there to teach you, and they are free to access.   

Eating well makes a difference in how we think and feel.  When we don’t get everything, we need, our body ages faster.  We are more likely to experience injuries and illnesses and we are going to have a harder time recovering from them. Our minds in general are not going to function as well. Our senses will be less astute and we’re more likely to experience mental illness.  When we don’t get what we need, we don’t drop dead immediately, but the experience of being alive becomes a lot less enjoyable.  

We generally have a tremendous amount of control over what we eat.   I’m not saying we can’t eat delicious snacks, but if we make sure we get the fuel we need, our body and mind are going to run and feel much better.   Fast food is cheap and easy, and junk food can be a great short-lasting pick me up when we are feeling down.  But there is a price besides the amount we pay at the register when we fill up on empty calories.  It’s worth including that when working on meal planning.  

Our pen-ultimate topic today is self-care.  Self-care are activities that help us feel better.  I think there are two requirements of what constitutes self-care.  The first is that self-care is something that makes us feel joy.  This is going to be different for each person.  For someone, it’s spending time with certain friends.  For someone else, its gardening.  For someone else, cooking might be it.   This brings us to the second requirement of self-care; it leaves us feeling better than we did before we did it. 

We have a time energy budget, and when we engage in self-care, we are putting money into the energy part of that account.  In some of my previous podcasts, I have discussed how one way to look at the mind is like a cell phone battery.  When we are fully charged, we can handle things pretty well.  But every day, we experience things that take energy.  Boring tasks.  Activities outside of our comfort zone. Dealing with difficult people.  Whatever uses us up. Self-care is the process that helps us recover from those difficult situations.  

This second requirement for self-care, that the activity leads us to feel better when we are finished than when we were when we started, is why various addictive behaviors, such as drug or alcohol use, video games, gambling or other similar activities do not count as self-care, they can be addictions.  Used in moderation, these things may make us feel better.  But if we become addicted to them, they don’t make us feel better.  They may anesthetize when we use them. We use them when we are feeling crummy, and we forget how bad we feel while we are engaged with these activities.  but when we are done with them or when the effect wears off, we are right back where we were when we started.  We may be even worse than we were.  

I have discussed self-care in detail in some of my other podcasts.  If you haven’t heard them and want to learn more about this, I highly recommend either googling the topic or listening to those podcasts.  I think it’s important for everyone to have eight to twelve activities they really enjoy so they can do them when they are feeling down.  Know your preferred activities and have a variety so you have backups if one or a few aren’t available is an extremely helpful life strategy.  

My last topic is self-compassion, and this is actually something I added during my editing process as I was working on the script, because it really deserves to be mentioned.  We are all working very, very hard.  Teachers especially.  It is very easy to feel pretty angry at ourselves when we are burned out.  Becoming upset at oneself is a common human reaction to being overwhelmed. And we can really feel sure that there is something really wrong with us, that were are really not good enough, that we have done something wrong and that the bad things in our life are our proper consequences, or that we are not trying hard enough.  

All these kinds of thoughts are garbage.  Absolutely not true and not worth buying into.   These are common symptoms the human mind experiences when faced with loss and disappointment and overwhelm, or other forms of pain.  A much better, healthier and more accurate way of looking at things is that these are symptoms of the bad experience. Is what we are doing the best we can, that we are worthy, and giving ourselves forgiveness.  In the context of psychology, this approach is called self-compassion.  My wife is a family practice doctor, and she calls it grace.  In the evening when my wife and I discuss our days, she often tells me how she told her patients that day, to give themselves grace.  To be kind and forgiving to themselves just as we would be kind and forgiving to others.  This is a very healthy, important frame of mind and state of being to hold.   

When the thoughts come that we are bad, that we are less than, when we are feeling negatively toward ourselves, whatever thoughts or behaviors these thoughts lead us to, are going to make the situation worse.  I saw a clever meme recently that said, “if beating myself made me better, I should be pretty amazing by now.”  Beating ourselves up is something some people’s minds do when we feel down.  It isn’t helpful.  It’s like allergies, our bodies really overreact to something that is pretty unimportant.  Those negative thoughts and feelings are just bad reactions.  It’s important to know that. 

Self-compassion, grace leads us to healing.  It may take time.  But it leads in a positive, healing direction.  If we can’t get everything done, it's because we are mortal and have limited energy.  If we make a mistake, it's because we thought we were doing it the right way at the time.  If we knew how it was going to turn out, we would have made a different choice.  We can’t hold ourselves to a higher standard than we hold other people to. If your good friend made the same mistake, how would you treat them?  What would you say to them?  I suspect you would be kind and supportive. You deserve to treat yourself the same way that you would treat a friend.  Those words and actions that you would take with your friend, you deserve to talk to yourself that way too.  Sometimes negative thoughts come to us, and they are automatic.  They are just the way our minds respond to painful situations.  But just because we have negative thoughts and feelings of self-blame does not make those ideas and feelings accurate ways to understand the situation.  Self-compassion, grace, is a healthy way to respond to when those unhelpful feelings and thoughts show up.  You, me all of us, deserve it.   

So that is my spiel on nutrition, exercise, sleep self-care and self-compassion. I bet every few weeks, I have a new patient who is a teenage guy whose diet consists of frozen pizza and mountain dew and who plays video games until three in the morning on school nights.  The patient and his parents tell me his is depressed, isn’t doing well in school, feels tired all the time but can’t sleep, and he feels gross.  Often, these patients are caught in a vicious cycle.  Something or many things are happening in their lives that make them feel bad. They start Engaging activities in hopes of feeling better, but those activities actually leave them feeling worse than they were to begin with.  The first thing we discuss is how we are going to address the four fundamentals needs we talked about today. I may spend the first few sessions discussing ways to adjust behavior and complementing progress the patient is making in these cases.  Only after we have some sort of foundation established do we begin addressing other mental health concerns.  There have absolutely been cases when after a few weeks of foundation adjustments, the patient and their family report significant improvement in all of these areas and decide that they don’t have any other concerns to be addressed at the time.   

Nutrition, sleep, exercise and self-care/ self-compassion are absolutely huge.  If we can manage those, we can actually enter into a virtuous cycle where we make choices that lead us to feel better and make more choices that help us feel even better than that.  When we have a healthy amount of sleep, exercise, self-care and a healthy diet, we improve our physical and mental health and reduce risk of things going badly.  And we rebound faster when life goes awry. If we are lucky, we get to live for a long time and probably have decades left of life.  Managing these fundamentals help us be our best selves and live our best lives.  Just remember, if you want to make changes in any of these areas of your life, remember that change is slow, and you need to have patience.  And don’t try making changes in your life when things are already extremely demanding. Remember there is a time and energy budget, if you can't do it now you can do it later.  

This is David Nathan, Licensed Psychologist with Allina Health.  Thanks very much for listening today.  

Outro: On behalf of Allina Health and Change to Chill, we thank you for taking the time to listen to our podcast. We do hope you enjoyed this episode, and we hope that you join us in other episodes covering even more interesting topics with mental health providers. As always, you can find the show notes and any accompanying research and tools at the change to chill website at www.changetochill.org. In health and wellness, take care and see you next time!