Psychology Today: Can Exercise Prevent Depression?

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

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.”….

….■ Dont 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.”

 

Tips to Improve your Well-being in 2016

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.