Ways to Improve Your Stress Response: and the correlations to chronic illness

I was listening to a podcast a few weeks ago and the guest was talking about the physiology of our fight-flight-freeze response and how it can specifically relate to certain chronic illness. The guest used the following examples: lupus as being the fight response, and CFS/ME as being the freeze response. I had never thought of it this way and it made me interested in this topic. (The podcast is called Therapy Chat if anyone is interested but I can’t remember the specific episode number, sorry!). Fight-flight-freeze is also known as the stress response, which is a product of evolution that kept our species alive for a long time, however, if you ask many people with chronic illnesses (especially autoimmune diseases) you’ll have a lot of people tell you about chronic stress, trauma history, and attachment issues, all of which can dysregulate our stress response. Usually this occurs in childhood, and I can specifically remember 5 years where I had chronic stress (at school only, due to a traumatic friendship).

I’m going to try to explain the stress response in the easiest, most non-technical way possible (because honestly my eyes glaze over when I have to read about brain anatomy, and I’m guessing I’m not alone in that). So there are a few different parts of our autonomic nervous system, most notably the sympathetic nervous system (fight and flight) and our parasympathetic nervous system (freeze). There is also our vagus nerve which is really important in understanding the nervous system but I’ll leave polyvagal theory for another time. Sympathetic activates us to either fight or run away in order to survive, whereas the parasympathetic suppresses everything in order to keep our bodies alive when we can’t fight or flight. The problem is that when our stress response is chronically activated, it can impair our physical and mental health. I want to put a caveat here for the rest of this post, correlation does not mean causation, however, most theories do point to chronic stress as being causation (at least partially – biopsychosocial approach) for a lot of illnesses.

Image from: https://www.youtube.com/watch?v=DPWEhl7gbu4

I think it’s also important to talk about stress-related disorders, because they tend to also be diagnosed in people with autoimmune diseases. Examples include acute stress disorders (same symptoms as PTSD but only lasting between 3-30 days), posttraumatic stress disorder (which most people seem to have a basic understanding of), and adjustment disorders (occurs during major life changes). Attachment disorders can also contribute. One study I looked at found that people with a stress-related disorder were more likely to not only develop an autoimmune disease, but to actually be diagnosed with multiple ones, and had a higher rate of them if they were younger when having the stress-related disorder.

Let’s talk about chronic stress – when our stress response is activated for a long period of time (i.e., daily stress as opposed to one major stressor) – because a lot of research has been done in this area. Here is a bunch of things that chronic stress can do:

  • contribute to high blood pressure
  • contribute to anxiety, depression, OCD, anorexia nervosa, and substance use disorder (and withdrawal)
  • contribute to obesity (increase appetite, leading to weight gain)
  • suppress or dysregulate immune function (leading to inflammatory disorders and hyperactive immune systems such as in RA and lupus)
  • suppress the reproductive system
  • suppress growth in children (lots of studies of children in orphanages)
  • digestive problems
  • switch off disease-fighting white blood cells, increasing risk of cancer
  • worsen symptoms in lupus patients
  • contributes to malnutrition
  • contributes to poorly controlled diabetes
  • contributes to hyperthyroidism
Stress always worsens my UCTD symptoms.

So that’s a lot. I mentioned ME/CFS as the beginning of this post as well, which is associated with the physiological state of freeze, as examined by metabolic changes. Some research indicated that people with ME/CFS are “wired,” meaning a combination of both the fight/flight and freeze responses, leading them to feel wired and tired at once. I hope this gives you some understanding of what is going on with you if you have any of the illnesses mentioned in this post. Understanding is one thing, but what can we do to help ourselves, especially if we are in a chronic stress response? While there is no right answer, there are definitely things we can try (and a bunch have worked for me!)

  • Deep breathing (into the diaphragm) – for many people this lowers stress (it sometimes increases anxiety for me, so I personally find it more effective to do mindful breathing)
  • visualizations and guided imagery – try this one out.
  • Prayer – this is a mindful activity that many people find helpful
  • Yoga and Tai Chi – mindful movement can be very grounding – listen to this podcast episode about it.
  • Walking (and other forms of exercise) – for many people this lowers the stress response, for some people it can increase it due to heart rate increases
  • Journaling – you have to like to write/journal for this one but it can be helpful to get your thoughts out of your head
  • Biofeedback – this is a technique in which you can learn to control some of your bodily functions (i.e., heart rate)
  • Progressive Muscle Relaxation – try this one out.
  • Massage – I personally find massages to be both relaxing and therapeutic
  • Acupuncture – there is research showing it helps with both stress and chronic pain
  • Social Support – from friends, family, colleagues, support groups (in person or online), and pets!
Furry friend social support.

Hopefully that gives you a few ideas for how to lower your stress response. Keep making the most of it!

Your Repression of Emotions Can Affect Your Health

I know this is a bold statement, but honestly it’s not one that I’ve come up with. It’s one that’s been studied, and it came to my knowledge through the form of a book – When the Body Says No by Gabor Mate. Now, I have done a whole post giving my review of that book awhile back, so that might be something you want to check out before or after reading this today.

First things first, I want to reflect on my own life. As an adult I wouldn’t say I repressed my emotions. Well, sometimes, when I was in my 20s, I would repress anger until it boiled over and spilled out like. Then I was accused of having ‘anger problems’ but really, looking back I was just not expressing it as it came about. On the other hand, sadness, joy, etc. all seemed to come out appropriately. Diving further back, I know there was a time between the ages of 8-13 that I repressed emotions – again, usually anger. Through those 5 years I had a group of friends at school, and one girl in particular was good at manipulating the others into not talking to me for periods of time. Like I mean I had no one to hang out with at school when they did this. It started as just being a day, then a few days, then a week, sometimes a month. It was honestly unpredictable of when it would happen and how long it would happen for. I never knew what ‘I was doing wrong’ and was always only told by them, “If you don’t know, then I’m not going to tell you.” I think this was actually a traumatic experience for me. Actually, my therapist told me it was. However, this post isn’t about that trauma, it’s about repressing me emotions. I think the only way I could get through 5 years of elementary and middle years schooling was to repress. Not show any emotion about it at school. I remember crying myself to sleep at night, but certainly not every night. Luckily, I was enrolled in a ton of extracurricular activities which probably helped me too.

I think I was 6 in this photo.

What does repression of emotions have to do with chronic illness? Well, in When the Body Says No, Gabor Mate explains that repression of emotions – particularly anger – has been linked to several illnesses. These include autoimmune diseases, cancer, and ALS. Now, this doesn’t necessarily mean EVERYONE fits the bill, but certainly, in my conversations with others, people readily admit they have difficulty expressing anger in an appropriate and healthy way. Very interesting.

I was first diagnosed with autoimmune in 2016.

Why does repression of anger cause chronic illness? Well, in and of itself, it does not. However, when we look at illnesses from a biopsychosocial standpoint (this is the mostly widely accepted view in the medical community – both Western and holistic), it is a contributing factor stemming from the “psycho” portion. Bio stands for biological – so any genetic or epigenetic (meaning our genes were changed by our environment) – contributions to illness. Psycho stands for psychological contributors, which can also include personality, management of emotions, how we handle stress, and so on. Social usually relates to the environment, which often includes factors like traumatic events.

Biopsychosocial model of illness (physical & mental).
Image from: https://www.physio-pedia.com/Biopsychosocial_Model

What can we do with this knowledge? For me, the best thing I’ve learned to do is appropriate and consistent expression of emotions. This means I don’t ‘boil over’ with rage but rather can notice and accept the feelings of anger, expressing them through words. This is sometimes referred to as emotional regulation, and in my practice it definitely falls under acceptance. There are many ways to learn to do this. The most effective would be going to see a therapist. There’s also the self-help section of the bookstore or library. The practice of mindfulness. Just to name a few. Will doing this help heal our illnesses? Well, not exactly, but it can help lessen the severity and impact of our symptoms on our lives. I think it is a part of the healing process we often neglect, but really shouldn’t. This week’s episode of the podcast talks about acceptance (find it here). If you have questions about it, feel free to DM me on Instagram (@chronically.living_)

Learning to express our full range of emotions – anger, sadness, joy, nervousness, etc. – is important to our overall well-being (just watch the movie Inside Out if you’re not convinced).

Keep making the most of it everyone!

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Book Review: When the Body Says No

If you haven’t heard of this book and you have a chronic illness you need to get in the know. And to be fair, and I hadn’t heard of the book until about a year ago, and I didn’t actually read it until recently. The author I had heard of. Dr. Gabor Mate. He has written several books over the years on topics ranging from chronic illness to substance abuse to ADHD, and he’s quite well-known in both the self-help and medical communities. So, now that I’m done reading this (must-read) book, let me share some thoughts and opinions, and hopefully help encourage you to also give it a read.

It’s available at all major book sellers
(I got mine from Amazon)

First, for those of you unfamiliar with Gabor Mate, he is a Canadian (now retired) doctor who spent his career in family practice, palliative care, and working with people who use substances in Vancouver’s East End. And he’s touted as being an expert in these areas. The book, When the Body Says no is about how “stress” influences chronic illness. Now, stress encompasses a lot of things here, which is why I put it in quotations. It includes life stress, attachment, coping styles, trauma, adverse early childhood experiences, adult relationships, and so on. Basically a lot of stuff, though Dr. Mate posits that it’s our early life stresses that have the greatest impact on us. The book takes a biopsychosocial approach. This means it includes biological, psychological and sociocultural influences on health and illness. This is the approach that science is backing when it comes to both physical health and mental health (literally my first class in grad school was “A Biopsychosocial Approach to Mental Health”). What’s interesting, if you go online to research most illnesses (come on, we’ve all googled our actual illnesses, as well as other potential ones) usually only biological causes are listed. And I will agree with Dr. Mate, that biological causes don’t tell the whole story (and neither to strictly psychological or sociocultural). For example, he writes (based on scientific research) that some people with biological markers for illnesses never actually develop one. Why? If it was strictly biological then everyone with the biological markers would clearly develop it. Again, there is more to the picture.

Like I said, I agree with a lot of the content in the book. I mean, many autoimmune diseases are diagnosed after a person has gone through a stressful experiences. It makes sense that the body would take on what our minds don’t want to – such as a repression of emotions. And clearly trauma can manifest in many, many ways (illness, substance use, psychiatric disorders, etc.). Many people will read the book and find themselves very well represented for whatever illness they have (and he covers a lot of illnesses from cancer to a variety of autoimmune diseases to Alzheimers and so on). My only problem with it is that he asserts that attachment issues (to parents) are the #1 determinant of illness, and that virtually all people with illnesses have more than one of these issues. And this is where I didn’t find myself represented. My attachment style with my parents has always been healthy. My early childhood experiences were really good. In fact, the first trauma I suffered was ongoing between the ages of 8-13 (being bullied at school). At the time, yes, I did probably repress a lot of my emotions, but as I got older, and certainly by the time I was diagnosed with my illnesses, and I was not repressing emotion (at least as often) anymore. Now, that being said, maybe all it took was that experience to account for the psychosocial part of my illness. I can’t say either way, but regardless I don’t feel I perfectly represent the picture Dr. Mate paints in his book, though I can appreciate that a lot of people do.

My brother and I, circa 1988-89.

All of that said, I do highly recommend reading this book if you have a chronic illness OR if you have a loved one with a chronic illness. It gives insight into the causes, which some people find helpful. And if you’d rather live in the here-and-now, rather than try to decipher what caused your illness, the last chapter is called the “Seven A’s of Healing” and it really resonated with me, because for the most part, it is exactly what I work on with clients, and it is strongly evidence-based. So, go read When the Body Says No, it’s definitely worth it.

My podcast episode this week is on Creative Hopelessness, so if you’re finding it difficult to make changes in your life and/or you’ve been feeling hopeless, please check it out. Until next week, keep making the most of it!

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Expressive Writing for Health & Mental Health

I love writing (hello, this is a blog after all) and I’ve always found it to be helpful for me in my own life (and health) journeys (that and music). I came across some research on the mental and PHYSICAL health benefits of expressive writing, so I did a bit more digging and damn, we should all be doing more of it! And hopefully, this post will inspire you to do some. Hearing that there are mental health benefits is probably less shocking than that there are physical health benefits to expressive writing, so we’ll start there, but before we get into that, let’s quickly establish what expressive writing is. Expressive writing is simply writing about our deepest thoughts and feelings about an event or situation, without holding back. When people do this, it is often through journaling, and is often free-writing, without too much thinking about it. It can be done on the computer or by hand, really whatever you prefer. The leading pioneer in this research is Pennebaker (too many articles to site them all), but I’ll site some of the other research on the subject (which also references him) at the end of the post.

Buying a journal (or using an online one) can get you in expressive writing mode.

Okay, so the mental health benefits:

  • reduces stress
  • reduces symptoms of depression
  • reduces post-traumatic symptoms
  • improves mood
  • improves focus and concentration – including in people with ADHD
  • improves working memroy
  • improves emotion regulation (which is our ability to control the quality, frequency, intensity and duration of our emotional responses to situations)
  • and it increases our self-awareness
Improve your mood!

If these aren’t good enough reasons to do some expressive writing, then maybe the physical health benefits will convince you:

  • decreases the number of doctor’s visits you’ll have
  • reduces the number of days spent in the hospital
  • reduces the overall number of hospitalizations – i.e., people with cystic fibrosis
  • reduces blood pressure
  • reduces chronic pain – i.e., cancer and chronic pain conditions
  • reduces the severity of inflammatory conditions – i.e., rheumatoid arthritis, lupus (SLE)
  • improves immune functioning – i.e., cancer, HIV
  • improves lung functioning – asthma
  • improves liver functioning
  • improves and speeds up post-operative recovery
  • improves overall physical well-being

And then, if that’s still not enough for you, there are some other general benefits:

  • reduced number of “sick” days from work plus faster return to work if you were layed off
  • increased GPA in university students
  • improved sporting performance in athletes
Even improve sporting performance! Me and some friends after a curling tournament in 2019.

Okay, so how does this all work? I mean, I understand how it can improve some of the mental health problems we may experience, because we’re writing about our thoughts and feelings. But how does it improve our physical health? Well, actually the two are related. Remember that stress has a HUGE impact on our physical health, and the mind and body are connecting, meaning that anxiety and depression can also feed into (and trauma can cause) physical health problems. The processes of expressive writing are as follows:

  • it allows for cognitive processing and restructuring of painful events and situations – cognitive restructuring changes how we perceive emotional stressors (both internal and external)
  • it allows for repeated exposure – which is controlled re-experiencing of events and situations so that they have less influence over our minds and behaviours

Improving our bodies, improves our minds and vice versa. Here’s the podcast episode on it.

How do we engage in expressive writing? According to the experts we need to write about our deepest thoughts and feelings, without holding back, about situations or events or really anything relevant to us at this moment that are painful. This could be anything from having cancer, to spending time in the hospital to going through a traumatic event. When we sit down to write, it should be for 15-20 minutes at time, without stopping, and be done on 4 consecutive days. Just doing that is enough to lead to all the benefits I listed earlier. It’s possible that more consistent writing could have more improvements, but I honestly didn’t find much on that. So, I’m curious, who’s going to try out some of this expressive writing to see if it helps?

Me! Me! I like health & well-being!

I want to remind everyone that in addition to this blog, if you’re looking for more information to improve your health, I have a podcast: Chronically Living and how to make the most of it, which is available on Apple, Spotify and everywhere else you get podcasts, including this web link. I also have a YouTube channel for those of you looking to incorporate more mindfulness as it has a number of benefits for your physical and mental health as well: Kelsey L Harris Meditations.
Until next week, keep making the most of it!

References:

Baikie, K.A., & Wilhelm, . (2018). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338-346. https://doi.org/10.1192/apt.11.5.338
Lepore, S-J., Greenberg, M.A., Bruno, A., Smyth, J.M. (2002). Expressive writing and health: Self-regulation of emotion-related experience, physiology and behaviour. In S.J. Lepore & J.M. Smyth (Eds), The writing cure: How expressive writing promotes health and emotional well-being (p. 99-117). American Psychological Association. https://doi.org/10.1037/10451-005
Stanton, A.L., Danoff-burg, S., & Huggins, M.E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncology, 11(2), 93-102. https://doi.org/10.1002/pon.574

Trauma and Chronic Illness

Today I want to talk about some of the work of Dr. Gabor Mate, because, well, I find it quite interesting. Dr. Mate is an addictions specialist, who has also worked as a family physician and in palliative care. Much of his work and research has been on that body-mind connection between mental health and chronic illness and substance use. He has a lot to say about stress, trauma, and coping and their relationship to chronic illnesses ranging from autoimmune diseases to neurological conditions to skin disorders to cancer. While I’m not sure that I necessarily agree with everything he says, a lot of it does make sense.

The work of Dr. Mate I had heard of before but never looked much into. At my practicum, the other student at my site brought it up. She was interested in his work as someone who wants to work with people who use substances, and she thought I might also be interested as someone who is specializing in working with people with chronic illness (which is currently 40% of my case load!). She was correct that this would be interesting and helpful for my work as a psychotherapist. So let’s talk about some of this work. Dr. Mate asserts that there is a “pathway from stressful emotions, often unconscious, to physical disease” or to break it down slightly differently, “emotional stress if a major cause of physical illness.” Again, he’s talking about a wide range of illnesses, including autoimmune diseases and cancer. There are two parts of this that I found interesting doing some research (and there’s a lot more I want to do yet – there’s a whole book of his that’s on my to read list).

The first part is emotions themselves. For instance, Dr. Mate connects repressed anger to the development of autoimmune diseases. Basically, if you’re not letting your anger out (in an appropriate way of course) and instead, you’re holding it in, it bursts out, not in a fit of rage, but in a chronic illness such as RA or lupus and so on. Tied into this is emotional repression in general. So if you’re disregarding your emotions, whatever they may be, and holding them in, this can lead to illness as well. On his website Dr. Mate gives the example of Lou Gehrig and ALS (and according to Mate, every patient he has seen with ALS), who often disregarded both emotional and physical pain he was in throughout his life.

The second part is trauma and trauma response. It is pretty well documented that people who endure trauma, especially early in life, will make adaptive changes either physically or psychologically, in order to survive. Childhood abuse is one often cited with this. It is also well documented that childhood trauma has a huge impact on adult physical and mental health. Dr. Mate states that trauma in another cause of the range of chronic conditions I’ve mentioned.

So wait, does this mean that every person with pretty much any chronic conditions has either a history of trauma and/or a history of emotional repression? Not necessarily. I watched an interview with Dr. Mate, where the interviewer asked just that (because it’s a rather big claim). The response was that of course, this doesn’t apply to everyone, but it does apply to a large portion of this population. Interesting. So my thoughts on it are this: I have an autoimmune disease. I did not have any kind of significant childhood trauma (I have maybe what I’d call minor trauma) and I have usually been good at expressing my emotions (though I have gone through periods where I’ve been less likely to, those are usually short-lived). Basically, I’m not sure I fall into this category. I also know many other Spoonies who would not fall into this category. That being said, especially through my work as a therapist, there are many people who this does make sense for.

It’s not necessarily the case for everyone. Circa 1988/89.

My main takeaway from this is that to help heal from chronic illness (and I’m not saying cure), one really has to take care of their emotional health. See a therapist. If there’s trauma in your background, that likely needs to be worked through (also just in general for your mental health). If it’s emotional repression, then you need to start to learn to open up (part of my work as an acceptance and commitment therapist is to get people to allow their emotions to be there). The body and mind are connected so we need to treat them as such.

That’s all for this week. Until next week, keep making the most of it.

References:
https://drgabormate.com/culture-good-health/
https://drgabormate.com/topic/mindbody-health/

Treating Depression

Depression is one of the most common mental health problems (right up there with anxiety). It also commonly co-occurs with chronic illnesses. If you’re feeling depressed, or have been diagnosed with Major Depressive Disorder, it’s really important you are treating it in some form. As a therapist-in-training, I see many clients with depression – some with both depression and anxiety, some with perinatal depression, some with depression and chronic illness – and there are a lot of evidence-based treatments out there. It’s really important to know that you don’t have to suffer alone. So I thought this week, we’d talk about some common treatments, and some up-and-coming ones for depression. I also have an entire podcast episode dedicated to depression and chronic illness this week, which you can access here.

This week’s podcast.

For chronic illness, depression most frequently occurs in people with Alzheimer’s, autoimmune diseases of all sorts, cancer, coronary heart disease, diabetes, epilepsy, HIV/AIDS, hypothyroidism, and Parkinson’s. I got into the criteria for major depressive disorder in the podcast episode, so definitely check that out for more information. When it comes to treating depression, the two most common routes are anti-depressant medications and psychotherapy. Anti-depressants most commonly come in the form of SSRIs (selective serotonin reuptake inhibitors) that alter our brain chemistry because it is implicated in depression (our brains are not the only thing that is implicated though). There is a lot of research that supports anti-depressants in treating depression, though research also shows that it works as well as a placebo. In other words, if you believe it will help it will. Now don’t get me wrong, I fully support someone taking medication (unless you’re pregnant or breast-feeding and can’t – thus why I see many perinatal moms in my practice), however what a lot of people find is that just taking medication isn’t enough to see significant improvements in their symptoms, and many people don’t want to rely on medication forever.

Depression affects about 20% of the population in their lifetime.

That’s where option 2 comes in: psychotherapy. As a student, I see about 10 clients a week plus I co-facilitate a group for 2 hours a week. There is a lot of research that supports the use of psychotherapy. My podcast episode on anxiety, which you can access here, breaks down how much your therapist and you each contribute to your outcomes in therapy, which is important to know. As for what type of therapy, there are many to choose from and they all have good outcomes. CBT (cognitive-behavioural therapy) and it’s third-wave counterparts (DBT, ACT, SFT, etc) are the most common. Typically this involves a combination of talk therapy, where you tell your therapist about your thoughts and feelings, and then the therapist giving you some things to try out in session that you can also practice between sessions (some people call it “homework” but I don’t like that term). Another option for therapy is psychodynamic, which involves talk therapy plus the therapist often makes interpretations. And then there are the therapies that rely mostly on talk, utilizing the therapeutic relationship, such as person-centred, existential, etc. All of these can help and are something I highly recommend. There is also evidence that different lengths of therapy are beneficial as well, from one session of drop-in counselling to short-term (10-20 sessions) of CBT or long-term (more than 20 sessions) of person-centred therapy.

Our thoughts and feelings can be like quicksand. Our natural tendency is to struggle, but that only makes us sink deeper in. The actual way to get out of real quick sand: be a still and flat as possible and let yourself float to the surface.

If you are in immediate crisis because of self-harm, abuse, trauma, and suicidal thoughts/plans, then please contact your local help line. I’ve put some numbers in the show notes for my podcast on depression. A quick Google search can help you find them in your country. If you don’t like talking on the phone, there are some organization that offer texting services. I volunteered for Kids Help Phone in Canada which had switched to primarily a texting hotline since many young people prefer to text. You are strong for reaching out because it is not easy to.

Canada.

In terms of other treatments, a few are available for treatment-resistant and severe depression. Electroconvulsive therapy (ECT), which used to be called “shock therapy” can be helpful for people with severe depression, though there are some potential harmful side effects, and psychiatrists don’t commonly use this unless necessary. Transcranial Magnetic Stimulation (TMS) is another option for treatment-resistant depression where magnetic pulses stimulate the nerves in your brain. Newly approved in Canada (and how I got the idea for this post) is the use of Ketamine for treatment-resistant depression. Ketamine is a dissociative drug that has a lot of research supporting its use for depression. It activates your glutamate, dopamine and serotonin receptors in your brain. It takes effect much quicker than anti-depressants and has shown to decrease suicidal ideation. So far research shows no long-term side-effects, though because it is a psychedelic drug, there is the chance of substance dependency.

Great video for anxiety and depression.

Whether or not you have chronic illness, if you have depression there is hope for recovery, and lots of options available. Talk to your GP, your psychiatrist, a psychotherapist or whomever else is or could be part of your mental health care team. That way, you can keep making the most of it.