Psychology Today: Can Exercise Prevent Depression?

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In working with patients who are subject to bouts with depression, I usually try to encourage them to make even limited but regular exercise sessions a priority.  Self-care can generally be helpful in fighting depression, and just the discipline of organizing one’s life around an activity that is a break from stress can contribute to a virtuous cycle of healthier living.  The excerpt below (emphases in bold italics are mine) discusses a very large prospective research study that suggests that “even a brief but regular schedule of light activity may lower the chances of developing depression.”  That’s an important precept for all of us, whether we’re currently disposed toward depression or not.

Psychology Today: Can Exercise Prevent Depression?

By Emily Deans M.D.

A long-term study suggests a surprising amount of exercise might help.

Oct 07, 2017

Exercise and fresh air have always been folk prescriptions for a glum mood….But clinical depression is a different story—could regular exercise prevent a full on depressive episode from occurring? Researchers aimed to find out in a study published this week online in the American Journal of Psychiatry.

Here’s the theory of how exercise might help treat or prevent depression or anxiety: We’ve pretty much settled that a lot of clinical depression and anxiety are caused by chronic or severe acute stress, leading to a state of inflammation in the body and brain. When it comes to physiology, this means the sympathetic “fight or flight” nervous system is activated too strongly for too long, and the parasympathetic “rest and digest” nervous system doesn’t come online robustly enough to undo all the stress from the “fight or flight” overactivity. Exercise, via parasympathetic vasovagal activation during the recovery period, can, in real time, strengthen that “rest and digest” action. However, you need quite a bit of exercise to really engage the parasympathetic recovery: To get the famous “endorphin” effect you need quite a bit of high-intensity exercise, like a long and fast run, and for a pharmacologic effect it would need to be fairly frequent. In theory, exercise should work better for anxiety, which is more directly related to stress, than for clinical depression (though the two often come together).

So what did the researchers in the HUNT [Cohort Study] protocol do? They designed a very large prospective study following thousands of participants in Norway for 9-13 years. The subjects were found by inviting the population of an entire county, aged 20 or older, to fill out a basic screening form for depression and anxiety. The happiest 70% were asked to participate in order to get a healthy baseline (and an additional 8,400 or so were excluded for serious physical illness), and of those, nearly 34,000 were included in the study. Other data, such as smoking status, social supports, BMI, resting heart rate, and demographic data were collected at various visits over the years. All in all about 22,500 completed the study….

Once all the numbers were crunched, the researchers ended up with a surprising finding. Those who exercised were, indeed, less likely to develop depression over those 9-13 years than those who didn’t. The weird thing is, it didn’t matter how much exercise as long as you did some deliberate physical activity for at least an hour each week. Yes, that’s right, only one hour total for the entire week. And it also didn’t matter how intense that exercise was…could be a walk in the park or three sessions of intense spinning class or a daily 5K run. This finding belies the “parasympathetic vasovagal reactivity” theory of how exercise might prevent depression by stopping the sympathetic overactivity that characterizes the disease. Also, exercise was not related to lower risk for the development of anxiety disorders—only depression….

…. The researchers postulate that it’s the social benefits of exercise—getting out and about, feeling good about oneself, self care, that sort of thing—that may make the real difference, though the number-crunchers felt that a lot of the mechanism and wherefore and whys remain unexplained. We also know that people who develop a clinical depression have less get up and go, less motivation, less of the frontal lobe’s saying “get out of bed and get to the gym,” so once a depression kicks in, exercise is likely to drop as a matter of course. The same isn’t really true for anxiety.

Also, straight up parasympathetic training and sprint intervals aren’t the likely mechanism for preventing depression or anxiety, but anyone is welcome to do these more intense exercises for other reasons.

….This data suggests that keeping up even a brief but regular schedule of light activity may lower the chances of developing depression in the future…. Twelve percent of depression cases prevented? That’s a significant amount, and you may not have to be a gym rat to make it happen.

 

NYT: How to Build Resilience in Midlife

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This is an excerpt of an article that appeared in The New York Times; the below emphases in bold and italics are mine.  Reframing is an important part of my work with patients: we have a tendency to focus on the negatives in life and to return to these thoughts; this habit can limit our ability to learn from positive experiences, transform them into touchstones of resilience, and use them to support our positive future actions.

By TARA PARKER-POPE

JULY 25, 2017

Well – Mind

How to Build Resilience in Midlife

Much of the scientific research on resilience — our ability to bounce back from adversity — has focused on how to build resilience in children. But what about the grown-ups?

While resilience is an essential skill for healthy childhood development, science shows that adults also can take steps to boost resilience in middle age, which is often the time we need it most. Midlife can bring all kinds of stressors, including divorce, the death of a parent, career setbacks and retirement worries, yet many of us don’t build the coping skills we need to meet these challenges.

The good news is that some of the qualities of middle age — a better ability to regulate emotions, perspective gained from life experiences and concern for future generations — may give older people an advantage over the young when it comes to developing resilience, said Adam Grant, a management and psychology professor at the Wharton School of the University of Pennsylvania.

“There is a naturally learnable set of behaviors that contribute to resilience,” said Dr. Grant, who, with Sheryl Sandberg, the chief operating officer of Facebook, wrote the book “Option B: Facing Adversity, Building Resilience and Finding Joy.” “Those are the behaviors that we gravitate to more and more as we age.”

Scientists who study stress and resilience say it’s important to think of resilience as an emotional muscle that can be strengthened at any time. While it’s useful to build up resilience before a big or small crisis hits, there still are active steps you can take during and after a crisis to speed your emotional recovery….

…Here are some of the ways you can build your resilience in middle age.

■ Practice Optimism. Optimism is part genetic, part learned. So if you were born into a family of Eeyores, you can still find your inner Tigger. Optimism doesn’t mean ignoring the reality of a dire situation. After a job loss, for instance, many people may feel defeated and think, “I’ll never recover from this.” An optimist would acknowledge the challenge in a more hopeful way, saying, “This is going to be difficult, but it’s a chance to rethink my life goals and find work that truly makes me happy.”

While it sounds trivial, thinking positive thoughts and surrounding yourself with positive people really does help. Dr. Steven Southwick, a psychiatry professor at Yale Medical School and Dr. Charney’s co-author, notes that optimism, like pessimism, can be infectious. His advice: “Hang out with optimistic people.”

■ Rewrite Your Story. When Dr. Charney was recovering from the shooting, he knew that his life was forever changed, but he reframed the situation, focusing on the opportunity the setback presented. “Once you are a trauma victim it stays with you,” he said. “But I knew I could be a role model. I have thousands of students watching my recovery. This gives me a chance to utilize what I’ve learned.”….

….■ Don’t Personalize It. We have a tendency to blame ourselves for life’s setbacks and to ruminate about what we should have done differently. In the moment, a difficult situation feels as if it will never end. To bolster your resilience, remind yourself that even if you made a mistake, a number of factors most likely contributed to the problem and shift your focus to the next steps you should take….

….■ Remember Your Comebacks. When times are tough, we often remind ourselves that other people — like war refugees or a friend with cancer — have it worse. While that may be true, you will get a bigger resilience boost by reminding yourself of the challenges you personally have overcome.

“It’s easier to relate to your former self than someone in another country,” said Dr. Grant. “Look back and say, ‘I’ve gone through something worse in the past. This is not the most horrible thing I have ever faced or will ever face. I know I can deal with it.’”

■ Support Others. Resilience studies show that people are more resilient when they have strong support networks of friends and family to help them cope with a crisis. But you can get an even bigger resilience boost by giving support.

In a 2017 study of psychological resilience among American military veterans, higher levels of gratitude, altruism and a sense of purpose predicted resiliency.

“Any way you can reach out and help other people is a way of moving outside of yourself, and this is an important way to enhance your own strength,” said Dr. Southwick. “Part of resilience is taking responsibility for your life, and for creating a life that you consider meaningful and purposeful. It doesn’t have to be a big mission — it could be your family. As long as what you’re involved in has meaning to you, that can push you through all sorts of adversity.”

■ Take Stress Breaks. Times of manageable stress present an opportunity to build your resilience. “You have to change the way you look at stress,” said Jack Groppel, co-founder of the Johnson & Johnson Human Performance Institute, which recently began offering a course on resilience. “You have to invite stress into your life. A human being needs stress; the body and the mind want stress.”

The key, Dr. Groppel said, is to recognize that you will never eliminate stress from your life. Instead create regular opportunities for the body to recover from stress — just as you would rest your muscles between weight lifting repetitions. Taking a walk break, spending five minutes to meditate or having lunch with a good friend are ways to give your mind and body a break from stress.

“Stress is the stimulus for growth, and recovery is when the growth occurs,” said Dr. Groppel. “That’s how we build the resilience muscle.”

■ Go Out of Your Comfort Zone. Resilience doesn’t just come from negative experience. You can build your resilience by putting yourself in challenging situations. Dr. Groppel is planning to climb Mount Kilimanjaro with his son. Take an adventure vacation. Run a triathlon. Share your secret poetry skills with strangers at a poetry slam.

“There is a biology to this,” said Dr. Charney. “Your stress hormone systems will become less responsive to stress so you can handle stress better. Live your life in a way that you get the skills that enable you to handle stress.”

 

New York Magazine: Psychologists Think They Found the Purpose of Depression

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Students of evolution have long wondered which psychological profiles provide an evolutionary advantage to an individual, group, or species, a question whose complexity is compounded in the study of human history by the observation that many of those who have achieved notable successes within societies  — and who have survived to pass along their genetic material — nevertheless evidence major psychological weaknesses and pathologies in their psyches.  In other words, what might be evolutionarily limiting, even fatal, for a species, may seem to be beneficial, at least in the short term, for individuals and families….This line of questioning has lead some psychologists to wonder whether certain psychological pathologies, despite being being exactly that — illnesses to be combated — are nevertheless a form of the human animal trying to help itself become healthier by prompting a self-healing reaction.  The excerpt below summarizes an article which discusses some of research being done in this fascinating area of enquiry, focusing on depression as viewed through this theory: depression as a state in which the body is trying to tell an individual to take therapeutic steps toward healing his or her own life.

Excerpt from:

Psychologists Think They Found the Purpose of Depression

By Drake Baer
New York Magazine
February 9, 2017

Depression is pervasive: In 2015, about 16 million — or 6.7 percent of — American adults had a major depressive episode in the past year. Major depression takes the most years off of American lives and accounts for the most years lived with disability of any mental or behavioral disorder. It is also expensive: From 1999 to 2012, the percentage of Americans on antidepressants rose from an estimated 6.8 to 12 percent. The global depression drug market is slated to be worth over $16 billion by 2020.

The National Institute of Mental Health defines a major depressive episode as “a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.” This falls in line with what Matthew Hutson, in a new feature for Nautilus, describes as the disease model of depression: that depression is “a breakdown, a flaw in the system, something to be remedied and moved past.” In his compelling and challenging piece, Hutson profiles several researchers who advance an argument that depression can serve a possibly positive purpose in the lens of evolution. But rather than deifying evolution and trying to scry out what it meant for us, let’s focus on what’s more immediately useful for lived human lives today: that, in some circumstances, depression may be, in the arc of a life, yielding of insights and personal meaning. All of this is in no way meant to minimize the suffering that depression can cause — but to suggest the uses that it may serve.

At the center of Hutson’s piece is Paul Andrews, an evolutionary psychologist at McMaster University in Canada. Andrews argues that depression may be “an adaptation for analyzing complex problems.” He sees it in the condition’s bouquet of symptoms, which include “anhedonia,” or an inability to feel much pleasure; people who are depressed ruminate frequently, often in spirals; and they get more REM sleep, a phase associated with memory consolidation. This reflects an evolutionary design, the argument goes, one that’s to, as Hutson summarizes, “pull us away from the normal pursuits of life and focus us on understanding or solving the one underlying problem that triggered the depressive episode.” Like, say, a “failed” relationship. The episode, then, is a sort of altered state, one different from the hum of daily life, one that’s supposed to get you to pay attention to whatever wounding led to the upset. For example, 80 percent of subjects in a 61-person study of depression found that they perceived some benefit from rumination, mostly assessing problems and preventing future mistakes….

….This framing of depression as a space for reflection is empowering, and lends a degree of agency to the person being pressed down. Like anxiety, depression might be trying to tell you something. The language of therapeutic traditions is useful: a Jungian analyst would describe depression as katabasis, an Ancient Greek word for descent. Like Orpheus heading to Hades or Luke Skywalker in the swamps of Dagobah, it’s a journey into the underworld, where the adventurer is to “go through the door … immerse himself in the wound, and exit from his old life through it,” like [sic] Robert Bly writes in Iron John. Since it is subjective, the problems and solutions will be personal — of the person and their particular psychological history — and thus demand the individualized understanding of the sufferer of depression, perhaps with the assistance of a skilled therapist. That’s another theme: While disengagement from emotionality characterizes depression and other disorders, engagement with one’s inner world looks to to be the way out. Put more poetically: You exit through the wound.

Most episodes of depression end on their own — something known as spontaneous remission,” Vanderbilt psychologist Steven Hollon tells Nautilus, noting that the depression-as-adaptation narrative may explain why. Indeed, “cognitive behavioral and problem-solving therapies may work precisely because they tap into and accelerate — in a matter of weeks — the very processes that have evolved to occur over the space of months,” he added. Katabasis leads to catharsis; not coincidentally, there’s a shared theme in the personal narratives of people who reach midlife with a sense of well-being and generativity toward others: redemption.

Tips to Improve your Well-being in 2016

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Here are some worthwile ideas for practicing better self-care.

Excerpt from PsychCentral.com: 3 Jan 2016

For 2016: Stop Neglecting Yourself by Jonice Webb, Ph.D.

….We almost all neglect ourselves in one way or another, at one time or another. One could argue that the damage we do by neglecting ourselves is far more substantial than whatever neglect we experience from others.

Read through the common areas of self-neglect below, and see if any ring true in your life.

Common Examples of Self-Neglect

  • Not pursuing an activity that you know you would enjoy
  • Settling for a job that’s under-challenging or isn’t stimulating
  • Unhealthy eating
  • Not getting enough sleep or rest
  • Not developing a talent that you know you have
  • Engaging excessively in an activity that harms your body and detracts from your emotional health, like pot-smoking or using other drugs….
  • Generally over-focusing on other people’s needs while leaving your own unmet
  • Not exercising enough
  • Not speaking up for your opinions
  • Over-scheduling yourself so that you don’t have enough free time
  • Settling for too little joy or fun in your life
  • Neglecting to address sources of unhappiness
  • Spending too little time, effort or money on your appearance, a potential source of self-esteem
  • Depriving yourself of the freedom and pleasure brought by spending time in nature

Have you been neglecting yourself in these, or other ways? If so, rest assured that you are in good company, along with much of the human race.

Take a moment and try to imagine treating a child the way you are treating yourself/your body right now. Would you deprive a child of joy? Vegetables and fruits? Fun? Nice clothing? An opinion? Fresh air and exercise? Then why do you treat yourself or your body this way?

Now, at the very start of 2016, is a great time to stop the neglect and start giving yourself the time, attention, and effort that you need and deserve.

Five Steps to Cure Your Self-Neglect in 2016

  • Identify the area or areas in which your self-neglect has arises.
  • Write each one down. Seeing it in writing will make it more vivid and real and will also serve as a record to consult throughout the year.
  • Choose one item (working on one at a time will optimize your success) from your list, and promise yourself to improve on it in 2016.
  • Focus on that goal. Pay attention to when you fail to do what’s best for you or your body.
  • Track your success on paper or using your smartphone.

…The deep roots of self-neglect often spring from a lack of self-worth. Somewhere, somehow, maybe you don’t feel you are worth the effort of self-care…

… You can take charge of your own self-neglect with enough motivation, dedication, and perseverance throughout 2016.

Can You Learn Self-Control?

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NYT.com: OpTalk

Can You Learn Self-Control?

By

October 14, 2014

Walter Mischel conducted one of the most famous experiments in 20th-century psychology. In the late 1960s, he oversaw a test at Stanford University using a group of preschoolers. These studies gave him access to children whom he subsequently tracked for decades, collecting data on each child’s education, health and other factors. Now, more than 40 years later, he’s published a book, “The Marshmallow Test: Mastering Self Control,” about the experiments.

In the marshmallow test, Mr. Mischel asked a preschool child to choose between receiving one small reward now (say, one marshmallow or one cookie) and waiting a short amount of time — about 10 minutes — to receive two rewards (two marshmallows or two cookies)….

…The test was designed to measure a child’s ability to delay gratification. The major problem at the heart of the test is the concept of intertemporal choice; that is, how we compare a larger delayed reward against a smaller immediate one. In study after study it’s been shown that our brains tend to undervalue a bigger payoff in the long-run, no matter what the objective calculation is.

In Mr. Mischel’s view, this is a test of willpower: the ability to use the brain’s executive, rational functions to overcome the immediacy — and emotional potency — of desire. In subsequent studies of his original subjects, Mr. Mischel found that children that were able to withstand temptation and wait for another treat were likely to have higher SAT scores, achieve higher educational degrees, earn more money and have a lower body mass index, an indication of healthy weight.

As Pamela Druckerman revealed in an Op-Ed for The New York Times last month, many parents (Ms. Druckerman included) subject their own children to the test, hoping to ascertain some glimpse of their child’s future. Mr. Mischel explains to her, however, that the results of the test are not destiny. On the contrary, self-control can be taught, and not only in childhood.

Mr. Mischel tells Ms. Druckerman that adults can learn from the children’s spontaneous attempts to resist temptation. Children were most successful when they tried to occupy their attention with something else — make up a song, say, or turn their back on the marshmallow — or transformed the object of desire in their mind, perhaps by imagining it as a piece of cotton or pretending it was smelly or dirty.

…Likewise, adults are better at avoiding temptation when they employ methods of distraction or distancing….

…Those habits can help us achieve what Mr. Mischel calls “a burning goal”: a long-term objective that requires consistent and often arduous work and attention….

…The key, all of these writers say, is to counter something that is emotionally “hot” — desire, temptation, emotion — with something “cool” — the brain’s executive function….

David DeSteno, a professor of psychology at Northeastern University, however, sees it differently. He argues in a detailed, fascinating piece in Pacific Standard that learning to deal with impulses isn’t so much about building up self-control as it is training yourself to appeal to certain emotions — that is, not countering “hot” with “cool” so much as tapping into the correct “hot” response. Mr. DeSteno argues that emotions that have a moral valence and prize a greater social good — responses like gratitude, compassion, pride — can also help us control our behavior in favor of a delayed payoff. These qualities have been selected for historically because they are more likely to benefit a larger social structure.

In fact, an emotional response might be more effective and less draining in helping us resist temptation, especially over the long term. John Tierney wrote in 2011 in The New York Times Magazine that making decisions is depleting and that we each have only a finite amount of energy for making choices in a given time period. Mr. DeSteno refers to similar research, writing that even small decisions like whether to wear a blue or a white shirt wear down our willpower. And our executive function can be used to twist any decision to our advantage…For that reason, “any strategy based solely on forcing adherence to a set of virtues through a bunch of cool-headed, cognitive strategies and a list of ‘thou shall nots’ is a fragile one….”

 

 

 

Ten Things I Learned From My Father

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Ten Things I Learned From My Father

By Ian Anderson, From Squalor to Baller

 

1. You’re not defined by the things you own.

2. There’s no hurry to make up your mind.

My dad didn’t start his career until his mid-forties. Before that, he dabbled in many professions – forest firefighter, mailman, writer, carpenter, engineer, and more. Each of these experiences has added to his complex character and has played a role in preparing him for the next step. As a kid, I assumed this was normal; it wasn’t until later that I realized most people are more direct when it comes to careers. These days, there is a lot of pressure on kids to get into a good college, pick a major, and then get a job; I was lucky to learn early on that less linear career paths were just as viable. 

3. Read and write every day.

… I’ve still come to appreciate the importance of reading and writing on a regular basis. It’s good for your brain and for your vocabulary (and it’s one of the reasons I started this blog).

4. Don’t let the sun catch you sleeping. 

… I have long since discovered that time for yourself in the early morning will do wonders for your mood, productivity, and well-being.

5. Be Handy.

…I spent a lot of time in college reading and writing about how things work in the world, but I’ve slowly come to realize that although being book smart is good, being life-smart is better.

6. Go Outside.

I was lucky enough to grow up in in the beautiful Pacific Northwest, where there are endless opportunities for outdoor adventures. For a mountain man like my dad, getting out of town and exploring the wilderness was not an optional activity for our family. Because of this, I spent much of my youth running down trails, rafting rivers, and summiting mountains. Looking back, I’ve come to appreciate the huge effect it had on my childhood and on the adult I became. Nature is a beautiful thing – go experience it. Go backpacking, rafting, biking, or whatever it takes to spend some time away from the mayhem of your daily life. 

7. Eat your Vegetables.

… Learning to cook for myself and understanding the core concepts of nutrition was one of the best things I learned as a kid. It only took a few months of greasy college dining halls to show me that a good diet and active lifestyle really are the foundation for a strong body and sharp mind.

8. Travel while you’re young.

9. Always have a hobby.

It should come as no surprise that I come from a long line of tinkerers, dabblers, and otherwise curious minds that put great value in breadth of knowledge…. I …always try to balance my life with a variety of activities that keep me well-rounded.

10. Smile. 

Nobody likes a grouch. Add some happiness to the world.