• Avoiding danger is what keeps us alive. Humans call this signal anxiety.
• Avoiding this sensation drives much of dysfunctional human behaviour. We know how to stay alive but not necessary thrive.
• Anxiety is a physiological reaction that is about a million times stronger than the conscious brain. It cannot be controlled.
• We can auto-regulate and redirect it. Addressing anxiety at the root physiological cause will solve many mental health problems.

Why is Anxiety Considered a Psychological Diagnosis?

Anxiety is simply a warning signal. Every form of life has a withdrawal/ avoidance response to real or perceived danger. All life forms, from one-celled organisms to humans respond with complex changes to optimize the odds of survival. This unconscious automatic reaction is powerful and has evolved to feel extremely unpleasant in higher life forms. It compels action to lessen the sensations. The species who did not pay attention to these danger signals, simply did not survive.

 Staying alive

When you sense danger, how do you feel – anxious? Although this a basic survival feeling, humans have the capacity to name it. It is the result of stress, threats, and life challenges, not the cause. Avoiding this sensation is the driving force behind much of human behavior, and seeking safety is necessary to store up reserves to fight another day.

What happens in your body that creates this sense of dread? The term is, “threat physiology.”

Threat physiology

Physiology is the term that refers to how your body functions. Your survival reactions are mostly unconscious, and about 40 million bits of information are processed per second. Our conscious brain deals with only about 40 bits per second. Your unconscious brain is a million times stronger than your conscious brain; the responses are hardwired and automatic, and the reason it is not subject to being controlled. However, it can be regulated and reprogrammed.

Examples of physiological actions are heart rate, blood pressure, blinking your eyes, acid-base balance, sweating, breathing, bowel and bladder function, hunger, and the list is almost endless.

These are some of drivers activating threat physiology.

• Stress hormones – adrenaline, noradrenaline, histamines – ready the body for fight and flee
• Cortisol – mobilize fuel (glucose) from tissues throughout your body.
• Glutamate – Neurotransmitters change from calming to excitatory to increase alertness and sensitivity to danger signals.
• Inflammatory cytokines (small molecules that transmit signals between cells) – the many aspects of the immune system kick into action.

Anxiety is a physiological state

This is a small fraction of actually what occurs in fight or flight physiology. Consider how you feel when your body is in this state. Here is a suggested word progression.

• Alert
• Nervous
• Afraid
• Angry
• Paranoid
• Terrorized

They fall under the umbrella of “anxiety” or “fear.” We will do almost anything to avoid this sensation resulting in many bad behaviors. Psychological diagnoses are ALL anxiety driven. The exceptions are in the positive psychology domain.

A paradigm shift

The way we view mental health must change. Here are some suggestions.

• Eliminate the word anxiety from the DSM coding system. It is the driving force and cause of poor mental and physical health.
• Most psychological diagnoses are descriptions of behaviors driven by the sensations created by threat physiology. Descriptions are less pejorative than labels (diagnoses).
• Substitute the word anxiety with the phrase, “activated threat physiology.”
• Anger is “hyperactived threat physiology.”

“Dynamic Healing”

The root cause of our mental health crisis is sustained threat physiology. There are many ways of lowering it and creating “cues of safety.” The model is called “Dynamic Healing” and is at the core of how medicine should be delivered. The portals are:

• The input – you can process your stresses so as to have less impact on your nervous system.
• The nervous system – the resiliency can be increased so it takes more stress to set off the flight or fight response.
• The output – your nervous systems takes in sensory input, summates them, and sends out signals of threat or safety. There are ways to directly dampen the threat response.

None of the approaches are difficult and require few resources. There are many clinicians in all medical fields that understand and are applying these approaches. It is just not happening on a wide enough scale.

There is no question that symptoms and behaviors must also be addressed while people heal. But if the root cause is not dealt with, their suffering will continue. Hence, the nationwide burden and fallout of poor chronic mental health continues to skyrocket.

Let’s do this!!

Our mental health crise reflects a lot of needless suffering as deep science has pointed the way to effective treatments for over 40 years. Most of clinical medicine is not connected to the data or is categorically ignoring it. It is certainly not being widely taught in medical school.

Where will the energy come from to wake us all up? It has to emanate from the public demanding better care because the business of medicine seems to have little interest in true change. It is the responsibility of the medical profession to honor the known data and implement what is already known.

The answers for our mental health crises are right in front of us if we just pay attention. Take your medical care and life back. It is your right.

The post There is an Answer to the Mental Health Crisis first appeared on Back in Control.

The post There is an Answer to the Mental Health Crisis appeared first on Back in Control.

There are two ways of stopping a deadly pandemic. One is through developing immunity, either by exposure to the virus or by inoculation with a vaccine. The other is to prevent people from dying. The key is to prevent the inflammatory response from reaching a level that destroys tissues and its host’s organ systems. The graph below illustrates the issue.

Cytokines

Cytokines are small signaling proteins that transmit higher-level signals and coordinate activities between cells. Consider them as the final off and on switches. They are central to modulating the immune system and inflammatory response. There are two categories of cytokines: pro-inflammatory (Pro-I) and anti-inflammatory (Anti-I). While Pro-I’s protect us by warding off acute perils, Anti-I’s keep us safe by allowing us to regenerate, thrive, and prepare us for battle with environmental enemies.

One term used to describe the excessive elevation of the inflammatory cytokines is “cytokine storm.” It is unclear whether there really is a “storm” or whether the normal rise of already elevated cytokines pushes people over a critical threshold into tissue edema and destruction.

Any real or perceived threat elevates Pro-I’s. That is the desired, normal response and is usually successful in protecting you from harm. However, COVID-19 virus can induce a powerful reaction that can kill you. The goal of treatment, aside from defeating the virus, is to prevent the levels of pro-inflammatory cytokines from crossing that fatal point of no return.

There are two ways to accomplish this goal. One is to arrest the activity of Pro-I’s before the level of inflammation reaches a crisis point. In the graph, the horizontal dotted line represents the level of inflammation where cytokines cause severe damage to body organs. Once that threshold is reached, mortality rate is high. The asterisk (*) represents the point where interventions to halt this “cytokine storm” are being explored. There are definite possibilities.

Graph by D. R. Clawson, MD

The other approach is to ensure that patients begin with a lower cytokine load in the first place so that, should the Pro-I’s rise as expected when faced with COVID-19, the level of elevation does not cross the critical threshold. There are strategies to this end that can be easily pursued by any of us. Presenting these approaches is the goal of this paper. First, it is important to understand the nature of threat. Download pdf for detailed discussion

 Threat

Any mental or physical threat is going to be met with a defensive response from your body. Much of this is mediated through the vagus nerve, at the core of the autonomic nervous system. The response is the well-known fight, flight, or freeze reaction. Dr. Stephen Porges has wonderfully presented the sequencing in his well-known, Polyvagal Theory. (Porges)

We are familiar with the physical manifestations of an increased heart rate, sweating, rapid breathing, muscle tension, elevated blood pressure, etc. But what you may not know is that the immune system also gets fired up and mobilizes many types of cells that fend off predators such as bacteria, viruses, and cancer cells. The result is inflammation where the “warrior cells” exit the blood stream through widened openings in the blood vessels to destroy the invaders (antigens). Cytokines are small proteins that are the “switches”, which activate and deactivate this activity.

Threat always activates pro-inflammatory (Pro-I) cytokines. Physical threats include allergens, parasites, bacteria, viruses, lions, tigers, bears, and people we perceive as dangerous. Less obvious but even more inflammatory are mental threats, because we can’t escape from them. The sustained inflammatory response destroys tissues and is the basis for chronic mental and physical disease. Examples of mental threats are memories, negative thoughts, suppressions, repressions, insecurities (social, financial, health, etc.), cognitive distortions, loss of life perspective, and purpose.

Discovery and acknowledgement of all our threats–whether real, imagined, anticipated, or repressed–is the first step towards addressing them. The second is choosing an adaptive rather than a maladaptive escape to safety, whether the threat be physical or spiritual. We are better at physical escapes to safety than we are at spiritual ones (Fredheim). If you don’t feel safe and peaceful, you are carrying elevated levels of cytokines. If you encounter the additional threat of a COVID-19 infection, you will have less chance of surviving, since you’ll already be closer to the critical threshold.

Lowering your cytokines

I am going to present an overview of the approaches and you can access this booklet that discusses each strategy in more detail. Each one has been document in medical research to lower your pro-inflammatory response (Pro-I’s) and improve your chances of surviving the COVID-19 infection. Using as many of them will increase your odds of surviving. Conversely, ignore them at your own risk. You may have noticed in the news that the people who are dying have “risk factors.” Every one of these causes an elevation of inflammatory markers. Poverty is one of them and there are a multitude of problems connected to living in this environment. But the essence of the problem is that it is a tremendous ongoing stress directly affecting your body’s ability to defend itself.

Below I have outlined ten areas to address in order to reduce your inflammatory cytokine load. I am going to summarize them, and you can access a more detailed discussion in this pdf.Each strategy will lower your pro-inflammatory response (Pro-I’s) and will improve your chances of surviving the COVID-19 infection.

1. Understand and treat anxiety. Anxiety is simply your body signaling danger. It is the sensation generated by elevations of your stress hormones, activation of the sympathetic nervous system, elevated Pro-I’s, and the inflammatory reaction. It is not a “psychological issue,” although mental threats are more likely to over-stimulate the nervous system than physical ones. With the correct approach, it is solvable.
2. Get adequate sleep. At least seven hours a night of restful sleep lowers your threat response and inflammation.
3. Employ expressive writing. You can’t control your thoughts and emotions but writing them down, tearing them up and discarding the paper separates you from them. The practice has a remarkable impact on both mental and physical symptoms.
4. Practice forgiveness. Anger creates a powerful neurochemical reaction with marked elevations of Pro-I’s and inflammation. There is no shortcut to overcoming anger but it needs to be dealt with quickly. You also must address your deepest wounds. Do you want the person or situation you hate to be what ultimately kills you? Who would win?
5. Follow an anti-inflammatory diet. This can make a remarkable difference in lowering Pro-I cytokines. This is a separate goal than from losing weight.
6. Decrease stimulation of your nervous system.
   1. Limit watching the news.
   2. Avoid watching violent and over-stimulating shows, especially at night. Just witnessing violence will increase Pro-I’s (ref).
   3. Stop negative talk, such as complaining, gossiping, discussing your medical problems or care, giving unasked-for-advice, and criticism.
7. Maintain an exercise regimen.
   1. At least 30 minutes a day
   2. Moderate and enjoyable
8. Stay on top of your medical problems.
   1. Control your diabetes.
   2. Take your blood pressure meds.
   3. Comply with all of your recommended medical treatments.
   4. Stay in touch with your doctor, even about issues you consider minor.
9. Directly address family issues. Families trigger each other, but there are effective ways to create structure that will minimize conflict.
   1. Living in chaos is not only unpleasant; it also has a negative impact on your health.
   2. Your family is usually the source of your biggest triggers.
   3. Be nice! Any member of your family who feels trapped is at higher risk for an illness or chronic disease.
10. Having fun is one of the most powerful ways to stimulate the production of Anti-I’s and relaxation hormones.

 Life is tough

 It is easy to drop into living life in a survival mode. Life is tough, competitive and challenging. For animals without consciousness, it is far more simple. You either learn the skill and cunning to survive–or not. There is also a lot of luck. Humans have the additional characteristics of language, socialization and can deal in the abstract. One of the curses of consciousness, is the only thing we know for sure is that we are not going to live forever. It is the ultimate fear. Yet we spend a lot of time distracting ourselves and trying not to think about it.

The paradox

Here is the paradox. The more anxious and frustrated you are, for any reason, you are adding to your threat load and there is a much higher chance that you will develop a severe disabling disease and die earlier. Additionally, while living in this state, your capacity to enjoy the time you have been given on this earth is compromised. You are living a chaotic and reactionary life and even forget to ask yourself, “where is the endpoint?” There is none. You cannot outrace your mind.

Instead of surviving and hoping to thrive someday, it is necessary to flip the paradigm. Thriving is a learned skill similar to learning a new language. Once you have learned it, your odds of surviving improve, regardless of the circumstances–including COVID-19. Thrive and survive.

Plan A: Thrive and Survive COVID-19 pdf

1. Porges, Stephen. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-regulation. Norton and Co. New York, NY, 2011.

Contributors: Polyvagal Work Group

David R Clawson, MD–Physical Medicine and Rehab, Seattle, WA

Stephen Porges, PhD––“Distinguished University Scientist” Indiana Univ Bloomington

Les Aria, PhD–Lead pain psychologist, Kaiser Northern CA, Sacramento, CA

Steve Overman, MD–Rheumatology, Seattle, WA

Matt Lederman, MD–Internal Medicine, Co-founder of Kinetin.com

Steve Lederman, MD–Cardiology

Ray Bunnage–Database and Visualization Developer, U of WA Medicine, Seattle, WA

Hara Marano–Senior editor-at-large, Psychology Today, New York, NY

James Taylor, MD–Anesthesiologist, Pain physician, Pinehurst, NC

The post Thrive and Survive COVID-19: The Polyvagal Approach first appeared on Back in Control.

The post Thrive and Survive COVID-19: The Polyvagal Approach appeared first on Back in Control.