Calm Link

Blueberries: Superfood & Anxiety Buster

July 27, 2019August 10, 2019

Blueberries have gained notoriety in recent years as a superfood, and while the term superfood is sometimes tossed around loosely, these sapphire snacks truly are deserving of it. Read on to learn how they can reduce your stress and anxiety levels as well as supercharge your health.

Nutritional powerhouses, each blueberry packs a wallop of essential vitamins, minerals, fibre and polyphenols. This makes them beneficial to the entire human organism, strengthening body and mind.

Let’s start by taking a look at what the Vitamin C in blueberries can do for us.

Humans are entirely dependent on getting Vitamin C from their diet, as unlike most animals, we are unable to synthesize our own [1] This vitamin plays a vital role in the maintenance of both our physical and mental well-being. As an essential vitamin, it is vital for a range of bodily functions ranging from supporting immune function and bone maintenance to aiding wound healing and maintaining balanced neurotransmitters levels [2].

Vitamin C supplementation has been shown to reduce subjective and objective measures of stress in double-blind, placebo clinical trials [3.4] Without adequate dietary intake, both body and mind are adversely affected. Consequences range from excess anxiety and weight gain to poor mood and immunity [5]. A single serving of blueberries provides 24% of the recommended daily Vitamin C intake, making them a convenient way to reap the benefits of this crucial nutrient.

Blueberries are also a rich source of Vitamin K, another vitamin critical to mental and physical well-being. Benefits of getting optimal levels of Vitamin K range from preventing heart disease, cancer and osteoarthritis to maintaining brain health and mood [6]. This vitamin allows the body to produce unique fats called sphingolipids which are an important component of all cells, especially those found throughout the nervous system [7].

As such, it’s not surprising that eating a diet rich in Vitamin K is associated with cognitive benefits such as reduced anxiety levels and increased verbal fluency [8, 9]. Conversely, getting inadequate amounts of this essential nutrient is associated with reduced spatial learning, low mood, excess anxiety and even damage to some regions of the brain [7]. With each serving of blueberries packing an impressive 36% of the recommended Vitamin K daily intake, snacking on them is a simple way to reap these impressive benefits.

Finally, what truly elevates blueberries to the upper superfood echelons is their polyphenol content. Polyphenols are the phytonutrients that imbue things such as red wine and green tea with their impressive health benefits. These include reduced risks of cancer, obesity and cardiovascular disease, as well as boosted immunity, cell regeneration and cognition [10].

Blueberries pack these phytonutrients in spades, containing polyphenols of both the flavonoid and stilbene classes [10]. These provide blueberries with their antioxidant and anti-inflammatory properties, making them particularly powerful allies not only in the battle against stress and anxiety, but also against cancer, obesity, cardiovascular disease and age-related degeneration.

In particular, the flavonoid polyphenols in blueberries have been shown to improve symptoms of both anxiety and depression [10]. Anxiety, especially when experienced for prolonged periods, is associated with increased oxidative stress and inflammation in the brain[11]. Additionally, prolonged stress states and anxiety disorders are associated with neurotransmitter imbalances, namely excessive norepinephrine [11].

Through their antioxidant and anti-inflammatory effects, blueberries have been shown to mitigate the oxidative stress and inflammation associated with stress [11]. Further, flavonoids have been shown to interact with enzymes responsible for neurotransmitter synthesis [12]. This, in combination with the antioxidant and anti-inflammatory properties allows blueberries to assist in restoring balanced neurotransmitter levels [11, 12].

While blueberries have something to offer everyone in terms of health benefits, those experiencing excess stress and anxiety may find eating more of them particularly beneficial in achieving a tranquil, serene state of mind. Not only will you feel better in the short term, your health will be improved in the long term, giving you less to worry about down the road.

Drugs or Therapy?

Psychotherapy Superior to Pharmacology for Anxiety

June 22, 2019January 28, 2020

Modern life for many is fast-paced and, at times, seemingly replete with existential threats. As such, it is not surprising that anxiety disorders are the most common mental health disorders in Canada and around the world (Katzman et al., 2014, p.1; Craske & Stein, 2016, p. 3049). The disabling nature of these disorders is particularly troublesome because they are at once highly prevalent and highly untreated (Katzman et al., 2014, p.1; Roberge, Fournier, Duhoux, Nguyen, & Smolders, 2011, p. 321). Consequently, anxiety disorders are associated with staggering direct and indirect costs to the Canadian economy (Stonebridge & Sutherland, 2016, p.2). Optimizing treatment is therefore of concern not only to medical professionals and anxiety sufferers but to society at large. Efforts to treat anxiety disorders have led to the emergence of psychotherapeutic and pharmacological interventions (Craske & Stein, 2016, p. 3048; Cuijpers, et al., 2013, p. 137; Katzman et al., 2014). Although both approaches are currently regarded as similarly effective first-line treatments, recent research suggests that psychotherapy offers some distinct advantages (Swift, Greenberg, Tompkins, & Parkin, 2017; Craske & Stein, 2016, p. 3055; Ophuis et al., 2017, p. 11). Despite this, statistics show that pharmacotherapy is currently the de facto first-line approach in Canada (Public Health Agency of Canada, 2015). While pharmaceuticals can play a role in anxiety disorder treatment, pharmacotherapy should be abandoned as a first-line treatment in favor of psychotherapy. Shifting the focus of first-line treatment towards psychotherapy would improve treatment outcomes and increase treatment rates, easing the burden anxiety disorders place on individual sufferers and society at large.

The first key advantage psychotherapy has over pharmacotherapy is better tolerability with patients, evidenced by lower treatment refusal and premature discontinuation rates (Swift, Greenberg, Tompkins, & Parkin, 2017, p. 48; Payne et al., 2016, p. 397). This means that by comparison, fewer patients refuse to initiate, or prematurely discontinue, psychotherapeutic treatment. Swift, Greenberg, Tompkins, & Parkin’s (2017) meta-analysis of 186 studies demonstrated this, finding that pharmaceutical treatment was associated with treatment refusal rates 1.76 times higher, and premature dropout rates 1.2 times higher, than psychotherapeutic treatment (pp. 51-52). Given the host of side effects associated with pharmacotherapy, which range from nausea and diarrhea to sexual dysfunction and asthenia, these findings are unsurprising (Pittman, 2016). Problematically, these negative treatment outcomes undoubtedly contribute to the high rates of untreated anxiety observed. Research shows that only about one-third, and in some cases fewer than one-fifth, of those impacted by an anxiety disorder, actually receive treatment (Roberge, Fournier, Duhoux, Nguyen, & Smolders, 2011, p. 321; Yuen et al., 2013, p.52). Given that as many as 31% of Canadians are likely to struggle with an anxiety disorder over the course of their lifetime, many millions of Canadians impacted are likely to go untreated. This is substantial because untreated anxiety costs the Canadian economy a staggering $17.3 billion a year in indirect costs associated with things such as absenteeism, reduced work hours and early retirement (Stonebridge & Sutherland, 2016, p.2). By shifting first-line treatment towards psychotherapy, we can expect to lower the rates of untreated anxiety disorders, and therefore lower the immense associated indirect costs. Further, since anxiety disorders are associated with substantially lowered quality of life, improving treatment rates would ease a great deal of human suffering (Oei & Mcalinden, 2014).

Not only is psychotherapy better tolerated than pharmacotherapy, but the benefits it imparts upon patients are more durable and resilient than are those imparted by pharmacotherapy (Craske & Stein, 2016, p. 3055; Payne et al., 2016; Westra, Eastwood, Bouffard, & Gerritsen, 2006, p. 8). While it is true that relapses also occur in patients treated with psychotherapy, rates are generally significantly lower (Craske & Stein, 2016, p. 3055). Since psychotherapy helps patients better understand the sources of their anxiety and equips them with skills to manage their own mental health, the benefits it produces naturally tend to persist longer after treatment cessation (Briers, 2015; Westra, Eastwood, Bouffard, & Gerritsen, 2006, p. 8). Alternatively, pharmacotherapy conditions patients to depend upon a pill to cope with their anxiety, leading to a loss of agency and frequent relapse upon treatment cessation (Westra, Eastwood, Bouffard, & Gerritsen, 2006, p. 8; Craske & Stein, 2016, p. 3055). Because of this, psychotherapy arguably produces not only a better return on investment dollar for dollar than does pharmacotherapy but also yields greater long-term improvements in quality of life for those treated. As such, it should be expected that both direct and indirect costs associated with anxiety disorder treatment would be reduced if more people received psychological rather than pharmacological treatment.

In addition to offering more self-sustaining treatment gains, psychotherapy can be augmented with evidenced-based psychological maintenance approaches. Conversely, despite decades of pharmaceutical research and development, no evidence base for pharmaceutical maintenance strategies exists (Craske & Stein, 2016, p. 3055). Craske & Stein (2016) point out that standard practice when relapse occurs after pharmaceutical treatment cessation is to restart drug treatment, however, this practice is not supported by evidence (p. 3055). Conversely, Craske & Stein point out that simple strategies for maintenance of psychotherapeutic treatment gains do exist and are backed by evidence demonstrating they improve long-term outcomes. These strategies can be as simple as a 20-minute telephone conversation once a month to reinforce skills learned, or a maintenance therapy session once a month for nine months (Craske & Stein, 2016, p. 3055). Ultimately, the existence of evidence-based maintenance strategies which can support psychological treatment gains after treatment completion places psychotherapy at a distinct advantage over pharmacotherapy. This advantage has the potential to offer more anxiety sufferers better long-term outcomes, fewer relapses, and an enhanced quality of life, as well as the potential for reduced direct and indirect costs to society.

Given that psychotherapy is associated with better long-term outcomes and fewer relapses, it comes as no surprise that research shows psychotherapy to be a more cost-effective approach compared to pharmacotherapy (Mavranezouli, et al., 2015; Ophuis, 2017). Since mood and anxiety disorder treatment in Canada is associated with more than $4.5 billion in direct healthcare costs, all Canadians benefit from the utilization of cost-effective anxiety disorder treatment approaches (Government of Canada, 2016). In their economic analysis of 28 different psychological and pharmaceutical treatment approaches, Mavranezouli et al. (2015) found the most cost-effective interventions all to be psychological (p. 12). These results are in line with results of a meta-analysis by Ophuis at el. (2017) which also found that psychotherapy was more cost-effective than pharmacotherapy (p. 10). Interestingly, studies investigating the comparative cost-effectiveness of the various psychological approaches suggest that a computerized form of psychotherapy known as Internet-based Cognitive Behavioural Therapy may be the most cost-effective delivery format of all (Kumar, Bell & Juusola, 2018, p. 10). Critically, internet-based psychological approaches offer not only potential savings in direct healthcare costs but may also mitigate indirect costs by overcoming many of the barriers to conventional treatment.

Due to the low treatment rates associated with anxiety disorders, overcoming barriers to treatment is crucial to bring down the associated economic and personal costs. Many obstacles to receiving pharmacological treatment and in-person psychotherapy identified in a Canadian study by Perreault et al. (2013) such as physical distance from service sites, lengthy wait times and trouble getting a hold of clinicians by phone could conceivably be overcome through computerized psychotherapy modalities such as Internet-based Cognitive Behavioural Therapy (para. 3). Multiple studies confirm that Internet-based Cognitive Behavioural Therapy, which was first developed over two decades ago, is effective and in many cases can be as effective as in-person treatment (Andersson, Carlbring, & Furmark, 2012, p. 1; Yuen et al., 2013; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Nordgren et al., 2014). Further, the benefits observed in internet-based psychotherapy appear to enjoy the same excellent resiliency as results garnered from in-person therapy. In a study to evaluate the efficacy of Internet-based Cognitive Behavioural Therapy in subjects with social anxiety disorder by Andersson, Carlbring & Furmark (2012), lasting benefits were observed 5 years after treatment (p.1). This is interesting because social anxiety disorders have one of the lowest treatment rates of all the anxiety disorders, with over 80% of sufferers going untreated (Yuen et al., 2013, p.52). Since a major barrier for these patients is their fear of social interaction, and computerized Cognitive Behavioural Therapy can be delivered with minimal to no human interaction, this is a major advantage psychotherapy has over pharmacotherapy, since treatment via pharmaceuticals requires interaction with a prescribing physician.

Psychiatrists, of course, may want to question whether psychotherapy alone could fully replace pharmacotherapy in the first-line treatment of anxiety disorders. They may point out that psychotherapy relies on patient motivation and typically takes longer to show results (Katzman et al., 2014; Davis, 2004). However, meta-analyses show the two approaches share similar effectiveness (Craske & Stein, 2016, p. 3054; Cuijpers, et al., 2013, p. 145). Critically, despite sharing similar efficacies, research shows that psychotherapy does not share many of the problems associated with pharmacotherapy such as issues with side effects, dependence, abuse, and overdose (Farach et al., 2013; Westra, Eastwood, Bouffard, & Gerritsen, 2006). Further, while it is true that treatment gains produced by psychotherapy can be slower to initially emerge than those produced by pharmaceuticals, treatment duration is typically shorter with psychotherapy and by the end of treatment differences in symptom reduction are typically negligible (Briers, 2015). The combination of shorter treatment times, better treatment durability and fewer side effects is a potent recipe for reduced economic costs and an enhanced quality of life for those treated.

Due to the fact that both psychotherapeutic and pharmaceutical treatments have been proven to be effective in reducing anxiety disorder symptoms, some may intuit that combining the two modalities would produce even greater treatment gains. However, this notion is not supported by research which is mixed at best and does not support regularly combining the two treatment approaches. Some studies, such as Fernández-Arias et al.’s (2013) suggest no additive benefit from combination therapy, only increased direct healthcare costs (p. 313). Other research suggests modest short-term benefits in some cases while noting concern that long-term use of pharmaceuticals may interfere with psychological treatment gains (Schmidt, 2005; Otto, Mchugh & Kantak, 2010, p. 91). Indeed, recent studies such as Nordahl et al.’s (2016) suggest that in the long-term, psychotherapy is superior to either pharmacotherapy alone or combination therapy, and that combination therapy can impair long-term outcomes (p. 353). With this in mind, the most reasonable role for pharmaceuticals in anxiety treatment would seem to be one of temporary adjuncts in those individuals who do not initially respond to psychotherapy. This approach would spare many individuals from experiencing unnecessary side effects from pharmaceutical treatment as well as save the economy direct costs associated with inefficient treatment.

Some might argue that one insurmountable obstacle to implementing psychotherapy as the sole first-line approach to treating anxiety is the limited number of psychologists trained to deliver such therapy. Receiving specialized, postgraduate psychological training is a long, arduous process. Therefore, the limited number of professionals available to provide psychotherapy could quickly be overwhelmed with the increased patient load, and new clinicians could not quickly be trained to meet the increased demand. Pharmaceuticals, some might point out, can essentially be manufactured ad infinitum, in ever greater quantities as needed. This objection does not hold water, however, since psychotherapy offers multiple evidence-based solutions to the problem of increased demand. First, group psychotherapy is effective and increases the number of patients a single psychologist can treat (Oei & Mcalinden, 2014). Second, non-expert laypeople with as little as 36 hours of specialized training have been shown to be able to effectively deliver psychological treatments under a psychologist’s supervision (Stanley et al., 2014). This could allow the pool of practitioners to be quickly increased as needed. Third, fully automated internet-delivered psychotherapy approaches have been shown to be capable of producing meaningful symptom reduction (Kallestad, et el., 2018). This means some patients could receive treatment with minimal to no direct clinician involvement. Finally, these aspects have all been effectively combined in internet-based group psychotherapy, guided by inexperienced, non-expert therapists (Andersson, Carlbring, & Furmark, 2012). Clearly, many options exist to meet the increased demand for psychological services that would be expected if psychotherapy were to replace pharmacotherapy as the preferred first-line treatment.

Having come around to the advantageousness and feasibility of psychotherapy as the preferred first-line treatment of anxiety disorders, many might question how best to precipitate this paradigm shift. Since, as Arikian and Gorman (2001) point out, most anxiety disorders are initially treated by primary care physicians, this change could be accomplished by updating the current Canadian treatment guidelines and running education campaigns for both primary care doctors and the public on the advantages of psychotherapy (p. 111). Although current Canadian guidelines give no preference to either psychotherapy or pharmacotherapy for first-line anxiety disorder treatment, statistics reveal that Canadian doctors are currently overwhelmingly suggesting pharmaceuticals to their patients (Katzman et al., 2014, p. 5; Public Health Agency of Canada, 2015, pp. 3-4). It stands to reason that by updating the treatment guidelines clinicians use to guide their decisions and running education campaigns for both doctors and their patients about the advantages of psychotherapy, more anxiety sufferers could reap the advantages of those benefits.

Anxiety disorders have vexed humankind for millennia, evidenced by descriptions of phobias in ancient Greek medical texts dating back to the mid-fifth century BC (Crocq, 2015, p. 320). Modern society is no less susceptible to anxiety now, and it seems likely that for many thousands of years people have borne burdens associated with anxiety disorders. These burdens include substantial personal costs for anxiety sufferers, as well as staggering direct and indirect costs for society (Olatunji, Cisler, & Tolin, 2007, p. 573; Stonebridge & Sutherland, 2016, p.2). Concerningly, research suggests that anxiety disorders are not only highly untreated in Canada but that those cases that are treated are primarily being treated pharmaceutically (Public Health Agency of Canada, 2015, pp. 3-4). Surprisingly, this is the case despite recent research suggesting that psychotherapy is a superior first-line treatment in many ways (Payne et al., 2016, p. 397; Craske & Stein, 2016, p. 3055; Ophuis et al., 2017). The realization of the advantages of psychotherapy at large scale would mean a better quality of life for many Canadians with anxiety disorders and economic benefits for all Canadians from an easing of the burden these disorders place on our society. Direct costs associated with treatment would be reduced freeing up tax dollars for other public expenditures such as education and public infrastructure since, as Ophuis et al. (2017) concluded in their meta-analysis, psychotherapy is more cost-effective than pharmacotherapy (p. 11). Further, the immense indirect costs to the Canadian economy associated with unmet healthcare needs of anxiety sufferers would also be reduced thanks to a more resilient, productive workforce. In this way, adopting psychotherapeutic treatments as the first-line approach of choice for anxiety disorders would benefit all Canadians.

References

Andersson, G., Carlbring, P., & Furmark, T. (2012). Therapist Experience and Knowledge Acquisition in Internet-Delivered CBT for Social Anxiety Disorder: A Randomized Controlled Trial (Internet-Delivered CBT for Social Anxiety Disorder). PLoS ONE, 7(5), e37411.

Andrews, G., Cuijpers, P., Craske, M., McEvoy, P., & Titov, N. (2010). Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis. (Research Article). PLoS ONE, 5(10), e13196. https://doi.org/10.1371/journal.pone.0013196

Coplan, J., Aaronson, C., Panthangi, V., & Kim, Y. (2015). Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World Journal of Psychiatry, 5(4), 366–378. https://doi.org/10.5498/wjp.v5.i4.366

Cuijpers, P., Sijbrandij, M., Koole, S., Andersson, G., Beekman, A., & Reynolds, C. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons. World Psychiatry, 12(2), 137–148. https://doi.org/10.1002/wps.20038

Craske, M., & Stein, M. (2016). Anxiety. The Lancet, 388(10063), 3048–3059. https://doi.org/10.1016/S0140-6736(16)30381-6

Crocq, M. (2015). A history of anxiety: from Hippocrates to DSM. Dialogues in Clinical Neuroscience, 17(3), 319–325.

Davis, J. L. (2004, September 07). Drug vs. Talk Therapy for Depression. Retrieved from https://www.webmd.com/depression/news/20040907/drug-vs-talk-therapy-for-depression

Farach, F. J., Pruitt, L. D., Jun, J. J., Jerud, A. B., Zoellner, L. A., & Roy-Byrne, P. P. (2012). Pharmacological treatment of anxiety disorders: Current treatments and future directions. Journal of Anxiety Disorders, 26(8), 833-843. doi:10.1016/j.janxdis.2012.07.009

Government of Canada. (2016) Mood & Anxiety Disorders in Canada. Retrieved from https://infobase.phac-aspc.gc.ca/datalab/mood-anxiety-blog-en.html

Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621-32.

Katzman, M., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(Suppl 1), S1–S1. https://doi.org/10.1186/1471-244X-14-S1-S1

Kumar, S., Bell, M., & Juusola, J. (2018). Mobile and traditional cognitive behavioral therapy programs for generalized anxiety disorder: A cost-effectiveness analysis. PLoS One, 13(1), e0190554. https://doi.org/10.1371/journal.pone.0190554

Nordahl, H. M., Vogel, P. A., Morken, G., Stiles, T. C., Sandvik, P., & Wells, A. (2016). Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial. Psychotherapy and Psychosomatics, 85(6), 346-356. doi:10.1159/000447013

Nordgren, L., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Carlbring, P., (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial. Behaviour Research and Therapy, 59, 1–11. https://doi.org/10.1016/j.brat.2014.05.007

Oei, T., & Mcalinden, N. (2014). Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic. Psychiatry Research, 220(3), 1012–1018. https://doi.org/10.1016/j.psychres.2014.08.036

Olatunji, B., Cisler, J., & Tolin, D. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572–581. https://doi.org/10.1016/j.cpr.2007.01.015

Ophuis, R., Lokkerbol, J., Heemskerk, S., van Balkom, A., Hiligsmann, M., & Evers, S. (2017). Cost-effectiveness of interventions for treating anxiety disorders: A systematic review. Journal of Affective Disorders, 210, 1–13. https://doi.org/10.1016/j.jad.2016.12.005

Perreault, M., Lafortune, D., Laverdure, A., Chartier-Otis, M., Bélanger, C., Marchand, A., … Milton, D. (2013). Barriers to treatment access reported by people with anxiety disorders. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 58(5), 300–305. https://doi.org/10.1177/070674371305800508

Roberge, P., Fournier, L., Duhoux, A., Nguyen, C., & Smolders, M. (2011). Mental health service use and treatment adequacy for anxiety disorders in Canada. Social Psychiatry and Psychiatric Epidemiology, 46(4), 321–330. https://doi.org/10.1007/s00127-010-0186-2

Rozental, A., Castonguay, L., Dimidjian, S., Lambert, M., Shafran, R., Andersson, G., & Carlbring, P. (2018). Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open, 4(4), 307–312. https://doi.org/10.1192/bjo.2018.42

Public Health Agency of Canada. (2015). Mood and anxiety disorders in Canada: Fast facts from the 2014 Survey on Living with Chronic Diseases in Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/mood-anxiety-disorders-canada.html

Payne, L. A., White, K. S., Gallagher, M. W., Woods, S. W., Shear, M. K., Gorman, J. M,…Barlow, D. H. (2016). Second-stage treatments for relative nonresponders to cognitive behavioral therapy (CBT) for panic disorder with or without agoraphobia-continued CBT versus SSRI: A randomized controlled trial. Depression and Anxiety, 33, 392–399. http://dx.doi.org/10.1002/da.22457

Stonebridge, C. & Sutherland, G. (2016) Unmet Mental Health Care Needs Costing Canadian Economy Billions. (2016, September 1). Targeted News Service. Retrieved from http://search.proquest.com/docview/1815929141/

Swift, J., Greenberg, R., Tompkins, K., & Parkin, S., (2017) Patients More Likely to Refuse Drug Therapy Than Psychotherapy for Mental Health. (2017, March 6). Targeted News Service. Retrieved from http://search.proquest.com/docview/1874703998/

Swift, J., Greenberg, R., Tompkins, K., & Parkin, S. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy (Chicago, Ill.), 54(1), 47–57. https://doi.org/10.1037/pst0000104

Westra, H. A., Eastwood, J. D., Bouffard, B. B., & Gerritsen, C. J. (2006). Psychology’s pursuit of prescriptive authority: Would it meet the goals of canadian health care reform? Canadian Psychology, 47(2), 77-95. Retrieved from http://search.proquest.com.libezproxy.nait.ca/docview/220791689?accountid=12654

Yuen, E., Herbert, J., Forman, E., Goetter, E., Comer, R., & Bradley, J. (2013). Treatment of Social Anxiety Disorder Using Online Virtual Environments in Second Life. Behavior Therapy, 44(1), 51–61. https://doi.org/10.1016/j.beth.2012.06.001

Benefits of Meditation

Benefits of Meditation for Stress and Anxiety: 101

September 28, 2018June 22, 2019

Meditation is a powerful tool for managing anxious feelings and coping with high levels of stress. In fact, meditation of one form or another is arguably the key to gaining full control over one’s anxiety.

Meditation is not an esoteric practice, reserved only for yogis and monks on remote mountain tops. Many these days are reaping the benefits of this age-old practice.

The emotions we experience are very often a function of our conscious attention. When our attention is on of happy thoughts we feel happiness; When our attention is on sad thoughts we feel sad feelings, and so on.

Most of us have an internal running narrative with ourselves that we have surprisingly little control, or even awareness of. To directly experience this lack of control, try the following:

Sit comfortably somewhere free of distractions
Take a few deep breaths, and focus your awareness on your breathing
Clear your mind of any stray thoughts and focus entirely on your breathing
Count your breaths until a stray thought pops into your mind

Most will not get past 3 or 4 before a stray thought emerges into their consciousness. Indeed, it can take much practice to make it to 10. This exercise is useful for increasing awareness of your internal dialog – that ongoing conversation taking place between your ego and itself. This inner narrative both influences your perception of your life experiences, and plays a crucial role in how you derive meaning from those experiences.

When this inner chatter focuses too much on anxious thought patterns, we suffer excessive anxiety. It follows that since this dialog plays such a significant role in generating the anxious feelings we wish to control, if we could control it then we could conquer our anxiety.

Well, we are in luck! It just so happens this inner dialog can be brought under control, and meditation is the vehicle for achieving it. In our next meditation article, we will explore mindfulness meditation. Look for Mindfulness Meditation 101 to learn more about what this form of meditation entails, and what role it can play in conquering your anxiety.

All About Anxiety

Ashwagandha – Herbal Anxiety & Stress Fighter

June 14, 2018June 22, 2019

Ashwagandha is an herbal adaptogen with potent anti-stress and anti-anxiety properties. It has been used traditionally for thousands of years, and its benefits have been demonstrated in double-blind, placebo-controlled studies (1). Read on to learn more about what ashwagandha is, and how it can help combat stress and anxiety.

A small evergreen shrub native to India, Ashwagandha has been used medicinally for millennia (2). Traditional use has come down to us from Ayurveda, a healing tradition which originated in India more than 3,000 years ago. In Aryurveda, ashwagandha is known as a rasayana (powerful rejuvenator), thought to impart the strength and stamina of a stallion. As an adaptogen, it helps the body cope with the psychological and physiological effects of stress.

Personal Note:

Ashwagandha (specifically the KSM-66 extract), is the most effective herbal adaptogen I have come across for dealing with anxiety and stress.

As someone who has struggled with anxiety for years, ashwagandha is now a valued staple in my daily supplement stack.

While this article focuses on the anti-anxiety and anti-stress benefits of ashwagandha, the herb possesses many other benefits as well. Ashwagandha has demonstrated anti-microbial, anti-inflammatory, anti-tumor, neuroprotective, cardioprotective, and anti-diabetic properties.

In terms of combating stress and anxiety, ashwagandha exerts its benefits through two main mechanisms:

Enhancing GABA signalling
Reducing cortisol levels

This combination of GABA-enhancing and cortisol-reducing activity is what allows ashwagandha to treat both the mental and physical symptoms of stress.

GABA is our main inhibitory neurotransmitter, which binds to and activates the GABA receptors. Enhancing GABA activity is associated with anti-anxiety, relaxing effects (3) (4).

Ashwagandha acts on GABA receptors to exert many of its anti-anxiety benefits (5). In fact, ashwagandha has been shown in studies to be as effective as some benzodiazepine drugs at reducing anxiety (6). Due to this GABA activity, ashwagandha also increases the effects of other GABAergic drugs, such as alcohol.

A broad range of conditions can be benefited from enhancing GABA activity, including insomnia, anxiety, seizures and muscle spasms (7). Importantly, ashwagandha is able to exert its benefits without the side-effects, tolerance and addiction issues associated with other GABAergics such as benzodiazepines and alcohol (8).

Whereas ashwagandha enhances GABA to help rid the mind of stress and anxiety, it reduces cortisol activity to ease stress on the body.

Cortisol is a hormone produced by the body in response to stress, and chronic stress can lead to chronically elevated cortisol levels. While some cortisol is necessary for normal function, elevated levels over time cause a range of damaging effects from increasing fat and decreasing muscle mass to damaging brain cells and suppressing immune function (9)(10).

Ashwagandha has been shown to reliably and significantly reduce serum cortisol levels (10). This allows the parasympathetic nervous system to activate, enabling your body to repair and ‘rejuvenate’. This aligns with ashwagandha’s traditional use in Ayurvedic medicine. In fact, ashwagandha is such an effective rejuvenator it has been shown to reduce body fat, while increasing lean body (muscle) mass and physical strength (11).

Three main options are available for ashwagandha supplementation:

Raw Ashwagandha powder
KSM-66 extract
Sensoril extract

In order to ensure potency and simplify dosing, extracts of ashwagandha are generally preferred. Both KSM-66 and Sensoril are standardized, proprietary extracts with extensive research behind them. Each contains a set quantity and ratio of withanolides, the active constituents of the herb.

KSM-66 is the preferred option for daily use in healthy people. Made from only ashwagandha roots, it remains true to Ayurvedic tradition in which leaves are excluded from ingestion. Standardized to contain less than 0.1% Withaferin A, a cytotoxic but cancer-fighting withanolide, it is virtually non-toxic (12). Typical dosage for KSM-66 is 300mg twice a day, for a total of 600mg per day (1).

Sensoril ashwagandha extract differs from KSM-66 primarily in that withanolides are extracted from both the leaves and roots to produce it. This strays from tradition, however it does yield a higher percentage of total withanolides and Withaferin A. This makes Sensoril the more potent option with greater anti-tumor properties, but also gives it a greater potential for toxicity (11). Those experiencing extreme stress, and those fighting cancer may find Sensoril to be the best short-term option. Typical dosage for Sensoril is 125mg twice a day, for a total of 250mg per day (13).

References

Chandrasekhar K, Kapoor J, Anishetty S. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum X. Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian Journal of Psychological Medicine. 2012;34(3):255-262. doi:10.4103/0253-7176.106022.
Pratte MA, Nanavati KB, Young V, Morley CP. An Alternative Treatment for Anxiety: A Systematic Review of Human Trial Results Reported for the Ayurvedic Herb Ashwagandha (Withania somnifera). Journal of Alternative and Complementary Medicine. 2014;20(12):901-908. doi:10.1089/acm.2014.0177.
Griebel G, Holmes A. 50 years of hurdles and hope in anxiolytic drug discovery. Nature reviews Drug discovery. 2013;12(9):667-687. doi:10.1038/nrd4075.
Foster AC, Kemp JA. “Glutamate- and GABA-based CNS therapeutics”. Curr Opin Pharmacol. 2006;6 (1): 7–17. doi:1016/j.coph.2005.11.005. PMID16
Kumar A, Kalonia H. Effect of Withania somnifera on Sleep-Wake Cycle in Sleep-Disturbed Rats: Possible GABAergic Mechanism. Indian Journal of Pharmaceutical Sciences. 2008;70(6):806-810. doi:10.4103/0250-474X.49130.
Savage K, Firth J, Stough C, Sarris J. GABA-modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence. Phytotherapy Research. 2017;32(1):3-18. doi:10.1002/ptr.5940.
Candelario M, Cuellar E, Reyes-Ruiz JM, et al. Direct evidence for GABAergic activity of Withania somnifera on mammalian ionotropic GABAA and GABAρ receptors. Journal of Ethnopharmacology. 2015;171(1):264-272. doi:10.1016/j.jep.2015.05.058.
Raut AA, Rege NN, Tadvi FM, et al. Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteers. Journal of Ayurveda and Integrative Medicine. 2012;3(3):111-114. doi:10.4103/0975-9476.100168.
McAuley MT, Kenny RA, Kirkwood TB, Wilkinson DJ, Jones JJ, Miller VM. A mathematical model of aging-related and cortisol induced hippocampal dysfunction. BMC Neuroscience. 2009;10:26. doi:10.1186/1471-2202-10-26.
Choudhary D, Bhattacharyya S, Joshi K. Body Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled Trial. Journal of Evidence-based Complementary & Alternative Medicine. 2017;22(1):96-106. doi:10.1177/2156587216641830.
Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. Journal of the International Society of Sports Nutrition. 2015;12:43. doi:10.1186/s12970-015-0104-9.
Wadhwa R, Singh R, Gao R, et al. Water Extract of Ashwagandha Leaves Has Anticancer Activity: Identification of an Active Component and Its Mechanism of Action. El-Shemy HA, ed. PLoS ONE. 2013;8(10):e77189. doi:10.1371/journal.pone.0077189.
Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: a double-blind, randomized, placebo-controlled study. J Am Neutraceut Assoc 2008;11:50–56

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All About Anxiety

Physical Symptoms of Stress: Chest Pain

April 4, 2018June 22, 2019

In this series of articles, we shed light on the many (sometimes surprising) physical symptoms of stress and anxiety.

Stress and anxiety can lead to a host of physical symptoms, many of which are easily mistaken for serious illnesses. This in turn can lead to additional stress and anxiety, potentially worsening physical symptoms in a vicious self-reinforcing cycle.

Chest Pain

Of all the possible physical symptoms of stress and anxiety, chest pain is one of the most troubling due to its association with heart attacks. Understanding your chest pain will help you find symptom relief, as well as recognize non-cardiac (i.e. anxiety-induced) from cardiac chest pain.

Symptoms of Anxiety-Induced Chest Pain

Symptoms can vary a great deal from person to person, and from occurrence to occurrence. They may occur in one spot persistently, or they may migrate. Sometimes they are accompanied by other anxiety sensations, and sometimes not. The pain is often described as a:

stabbing pressure
tightness
dull ache
numbness
burning sensation
shooting pain
sharp pain

Anxiety-Induced or Heart Condition/Heart Attack?

Here are the key differences between anxiety chest pain and pain due to heart conditions and heart attack:

Anxiety chest pain typically occurs while resting, whereas cardiac chest pain typically occurs while or is exacerbated by being active.
Anxiety chest pain often appears quickly and then fades rapidly (3 – 10 min), whereas cardiac chest pain often starts slowly and builds in intensity.
Anxiety chest pain is often described as being sharp/stabbing, whereas cardiac chest pain is often described as a heavy pressure (e.g. elephant sitting on your chest).
Anxiety chest pain typically stays within the chest, whereas cardiac chest pain often moves to other areas such as arm, shoulder or jaw.

If you are experiencing frequent chest pain and it is causing you concern, the most important first step is to visit your doctor and rule out any heart conditions. You must be confident that your heart is healthy to overcome non-cardiac chest pin. Any uncertainty as to the source of your chest pain will only become an additional source of anxiety, likely worsening your symptoms.

After learning from your doctor that your heart is healthy, symptoms should begin to recede gradually. It can take days, weeks and sometimes even months for recurring episodes to subside . The key at this stage is to disengage from thoughts about chest pain – the less attention you pay, the faster they will go away.

Further steps can be taken to reduce levels of stress and anxiety, helping bring your symptoms under control and preventing recurrence.

Exercise (particularly aerobic exercise) has been shown repeatedly in studies to reduce levels of stress and anxiety.
Meditation is a reliable and effective means to reduce stress levels and promote relaxation. Mindfulness meditation can help to increase awareness and control over thought patterns, allowing one to overcome anxiety at the root of the issue.
Medication may be helpful for some individuals in the sort-term, however it is generally a poor long-term solution due to side effects and risk of dependency, tolerance and withdrawal upon cessation.

Finally, if you are experiencing non-cardiac chest pain know that you are not alone. In one study out of Northern Ireland, 58.7% of all chest pain presentations at an emergency department resulted in a non-cardiac diagnosis. This is extremely common, having affected even the author of this article. Understanding the nature of this type of chest pain will help ease your mind when experiencing it. In time, you may find you rarely if ever experience these sensations anymore.

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March 15, 2011

Really cool to read through and find so much awesomeness added to WordPress 3.6 while I was gone. I should take three weeks off more often.

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October 5, 2010

All children, except one, grow up. They soon know that they will grow up, and the way Wendy knew was this. One day when she was two years old she was playing in a garden, and she plucked another flower and ran with it to her mother. I suppose she must have looked rather delightful, for Mrs. Darling put her hand to her heart and cried, “Oh, why can’t you remain like this for ever!” This was all that passed between them on the subject, but henceforth Wendy knew that she must grow up. You always know after you are two. Two is the beginning of the end.

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September 10, 2010

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