articles & updates
12/15/22
Feeling Disordered – The Season by Olivia Valdez, ND
As the summer months shift to fall and winter, the days become shorter and the nights become longer. The sun moves further away from Earth and the daylight becomes seemingly more elusive. This natural cycle can leave us feeling less motivated and more prone to depression—a combination of biologic and mood disturbances referred to as seasonal affective disorder (SAD) [1]. And though it occurs more commonly at the onset of fall and winter, it may also flare during other times of the year. Community-based studies estimate that the prevalence of SAD is close to 10% in northern latitudes (in Canada & the US combined, for example) and predominates more in women than men (by a ratio of 4:1, respectively) [2].
According to the literature, SAD has multiple factors attributed to its etiology but mainly appears as a result of changes to our natural circadian rhythms. Almost all biological creatures have this rhythm which regulates the physical, mental, and behavioral changes correlating to light and dark over a 24-hour period [3]. Circadian rhythms affect our health by releasing hormones, regulating our eating habits & digestion, and modulating body temperature all in correspondence to the time of day or night we are in. In SAD, a phase delay of our circadian rhythm relative to our sleep/wake cycle is postulated to be at the root of winter depression. This theory is called the Phase Shift Hypothesis (PSH) and is the leading philosophy behind SAD. In order to identify circadian phase position in humans, salivary dim light melatonin onset (DLMO) is utilized as a marker [4]. Melatonin is the hormone secreted from the pineal gland in the brain which modulates sleep-wake cycles (among its other roles). In dimly lit environments, melatonin is actively secreted and in bright-light environments, it is suppressed. So how does this all tie together? In order to correct phase delays which cause SAD, correctly timed low-dose melatonin and exposure to bright light can bring the misalignments back into homeostasis and improve emotional wellbeing. And as it currently stands, light therapy has proven to be one of the most effective treatments for SAD.
SAD can have many overlapping symptoms with major depressive disorder (MDD) and is even classified under the umbrella of MDD. The difference, however, is that SAD is characterized by a seasonal pattern and must outnumber the nonseasonal major depressive episodes that may have occurred over a person’s lifetime [1]. Oversleeping (hypersomnia), overeating (especially carbohydrates), weight gain, and social withdrawal (feeling like you want to hibernate) are all commonplace experiences. The bright side of SAD is recognizing your body has an innate awareness of its position in time – realizing there is an evidence-based cause for the way you feel and knowing there was nothing you did wrong. So how can you support yourself the most during fall and winter? What extra TLC might your mind and body thank you for this month?
Our winter wellness tools are many-fold and at IMHC and we can help you find the right combination of treatments for the most alleviation from SAD. The first therapy to consider is a light lamp. This apparatus mimic’s the rays of the sun and can bring you 10,000 lux of light filtered through an ultraviolet shield. Turning this on and sitting in front of it for 15-30 mins upon waking can help suppress the hormone melatonin and boost feelings of wakefulness and drive [5]. Some lamps have dim settings for evening, as well, which can help balance morning brightness with evening “sunset.” Targeted supplementation can also help balance neurotransmitters and hormones associated with mood. Our favorite nutraceuticals to recommend for SAD include high dose Vitamin D & low dose 5-HTP as well as adaptogenic, naturally uplifting herbs such as Rhodiola rosea and Eleutherococcus senticosus. The latter two are preferentially dosed before 2pm to avoid overstimulation close to bedtime, which is another tip of the hat to a healthy circadian rhythm. With varying mechanisms of action, these compounds work to support your body’s metabolic processes while also stabilizing the mental/emotional state. The other wonderful option for SAD includes homeopathy – this medicine not only helps soothe the nervous system and strengthen resilience in someone with SAD, but improves overall quality of life so they can function efficiently and still tackle their daily activities with minimal interference from fatigue and depression.
Lifestyle can also play an impactful role in SAD. What you eat, when you move, and who you interact with all have a part to play in alleviating feelings of depression and optimizing wellness and vitality, especially during the winter months. Eating cooked foods over raw is preferable, as they are more energetically warming. You can take this further by even cooking your proteins and veggies in warming spices like ginger, turmeric, cinnamon, clove, cumin, & black pepper. Combining this nutrition style with gentle exercise of any kind can keep your body happy and warm through this time. Dancing, online exercise videos, swimming (in a mildly heated pool), biking, walking, and yoga can all support healthy serotonin, dopamine, & endocrine hormone production such as epinephrine & norepinephrine (and these are just a few examples). One of the last (but definitely not least) aspects to consider when treating SAD is maintaining connection and community. Being around others helps combat intrusive and negative thought patterns by providing both a distraction and replacement with positive, external experiences [6]. One of the best medicines for SAD can be feeling valued, comfortable, and safe within an close or intimate social circle. If you gather around a fire with friends, share a warm meal, and remind each other to take your Vitamin D, you will be mirroring how human beings have passed the winter months since the beginning of time. In a moment like this, it is much more difficult to feel disordered.
Our team at IMHC can help you identify if you are being affected by SAD and guide you in finding the tools you need to feel your best during the season. We recognize that each person has a unique constitution and what works for one person may be completely different from what works for another. If any of the above messages have resonated with you, know that you are not alone and that there are many reasons and resources for optimism. Healing is a learning curve and we are here to guide you along it. Stop by our office in Scottsdale for your individualized naturopathic support!
References
Feeling Disordered – The Season by Olivia Valdez, ND
As the summer months shift to fall and winter, the days become shorter and the nights become longer. The sun moves further away from Earth and the daylight becomes seemingly more elusive. This natural cycle can leave us feeling less motivated and more prone to depression—a combination of biologic and mood disturbances referred to as seasonal affective disorder (SAD) [1]. And though it occurs more commonly at the onset of fall and winter, it may also flare during other times of the year. Community-based studies estimate that the prevalence of SAD is close to 10% in northern latitudes (in Canada & the US combined, for example) and predominates more in women than men (by a ratio of 4:1, respectively) [2].
According to the literature, SAD has multiple factors attributed to its etiology but mainly appears as a result of changes to our natural circadian rhythms. Almost all biological creatures have this rhythm which regulates the physical, mental, and behavioral changes correlating to light and dark over a 24-hour period [3]. Circadian rhythms affect our health by releasing hormones, regulating our eating habits & digestion, and modulating body temperature all in correspondence to the time of day or night we are in. In SAD, a phase delay of our circadian rhythm relative to our sleep/wake cycle is postulated to be at the root of winter depression. This theory is called the Phase Shift Hypothesis (PSH) and is the leading philosophy behind SAD. In order to identify circadian phase position in humans, salivary dim light melatonin onset (DLMO) is utilized as a marker [4]. Melatonin is the hormone secreted from the pineal gland in the brain which modulates sleep-wake cycles (among its other roles). In dimly lit environments, melatonin is actively secreted and in bright-light environments, it is suppressed. So how does this all tie together? In order to correct phase delays which cause SAD, correctly timed low-dose melatonin and exposure to bright light can bring the misalignments back into homeostasis and improve emotional wellbeing. And as it currently stands, light therapy has proven to be one of the most effective treatments for SAD.
SAD can have many overlapping symptoms with major depressive disorder (MDD) and is even classified under the umbrella of MDD. The difference, however, is that SAD is characterized by a seasonal pattern and must outnumber the nonseasonal major depressive episodes that may have occurred over a person’s lifetime [1]. Oversleeping (hypersomnia), overeating (especially carbohydrates), weight gain, and social withdrawal (feeling like you want to hibernate) are all commonplace experiences. The bright side of SAD is recognizing your body has an innate awareness of its position in time – realizing there is an evidence-based cause for the way you feel and knowing there was nothing you did wrong. So how can you support yourself the most during fall and winter? What extra TLC might your mind and body thank you for this month?
Our winter wellness tools are many-fold and at IMHC and we can help you find the right combination of treatments for the most alleviation from SAD. The first therapy to consider is a light lamp. This apparatus mimic’s the rays of the sun and can bring you 10,000 lux of light filtered through an ultraviolet shield. Turning this on and sitting in front of it for 15-30 mins upon waking can help suppress the hormone melatonin and boost feelings of wakefulness and drive [5]. Some lamps have dim settings for evening, as well, which can help balance morning brightness with evening “sunset.” Targeted supplementation can also help balance neurotransmitters and hormones associated with mood. Our favorite nutraceuticals to recommend for SAD include high dose Vitamin D & low dose 5-HTP as well as adaptogenic, naturally uplifting herbs such as Rhodiola rosea and Eleutherococcus senticosus. The latter two are preferentially dosed before 2pm to avoid overstimulation close to bedtime, which is another tip of the hat to a healthy circadian rhythm. With varying mechanisms of action, these compounds work to support your body’s metabolic processes while also stabilizing the mental/emotional state. The other wonderful option for SAD includes homeopathy – this medicine not only helps soothe the nervous system and strengthen resilience in someone with SAD, but improves overall quality of life so they can function efficiently and still tackle their daily activities with minimal interference from fatigue and depression.
Lifestyle can also play an impactful role in SAD. What you eat, when you move, and who you interact with all have a part to play in alleviating feelings of depression and optimizing wellness and vitality, especially during the winter months. Eating cooked foods over raw is preferable, as they are more energetically warming. You can take this further by even cooking your proteins and veggies in warming spices like ginger, turmeric, cinnamon, clove, cumin, & black pepper. Combining this nutrition style with gentle exercise of any kind can keep your body happy and warm through this time. Dancing, online exercise videos, swimming (in a mildly heated pool), biking, walking, and yoga can all support healthy serotonin, dopamine, & endocrine hormone production such as epinephrine & norepinephrine (and these are just a few examples). One of the last (but definitely not least) aspects to consider when treating SAD is maintaining connection and community. Being around others helps combat intrusive and negative thought patterns by providing both a distraction and replacement with positive, external experiences [6]. One of the best medicines for SAD can be feeling valued, comfortable, and safe within an close or intimate social circle. If you gather around a fire with friends, share a warm meal, and remind each other to take your Vitamin D, you will be mirroring how human beings have passed the winter months since the beginning of time. In a moment like this, it is much more difficult to feel disordered.
Our team at IMHC can help you identify if you are being affected by SAD and guide you in finding the tools you need to feel your best during the season. We recognize that each person has a unique constitution and what works for one person may be completely different from what works for another. If any of the above messages have resonated with you, know that you are not alone and that there are many reasons and resources for optimism. Healing is a learning curve and we are here to guide you along it. Stop by our office in Scottsdale for your individualized naturopathic support!
References
- https://www.aafp.org/pubs/afp/issues/2012/1201/p1037.html
- https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
- https://nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx
- https://www.researchgate.net/publication/5876179_The_phase_shift_hypothesis_for_the_circadian_component_of_winter_depression
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934317/
- https://www.headtohealth.gov.au/meaningful-life/connectedness/community
8/31/22
Could Your Anxiety Be Related to Progesterone Levels? By Tara Peyman, ND
Anxiety is one of the most common mental health conditions. Feelings of anxiousness are normal for everyone to experience from time to time. However, for some people, anxiety can become severe and interruptive to daily functioning. This is when it is important to seek professional help and look for the underlying cause.
Sometimes anxiety is related to ongoing stress in your current daily life, and sometimes there is a history of trauma that has wired your nervous system to get stuck in a fight or flight state, leading to persistent anxiety even when there is nothing externally wrong in your current life to cause such high levels of anxiety. Stress and trauma tend to respond well to psychological therapy, such as CBT, EMDR, or other counseling modalities. Some people get great relief using natural supplements for stress reduction, such as passionflower, L-theanine, or homeopathic remedies.
Yet sometimes there is another cause. For females with anxiety, there can be a hormonal connection. If you notice that anxiety levels tend to fluctuate throughout the month, or if anxiety has been worse since menopausal changes, hormones may be at play here.
Progesterone can have a tranquilizing effect on the brain and nervous system. It does this primarily by acting on GABA receptors to calm the body and brain.1,2 Interestingly, there is a gut-brain connection with progesterone as well. Progesterone has been found to act as a probiotic in the digestive system, promoting growth of the beneficial bacteria, lactobacillus reuteri.3 This healthy bacteria strain has been shown to diminish anxiety levels and improve mental health.
If progesterone levels are relatively low, the nervous system may feel more stimulated, anxious, and restless. Some females with low progesterone will feel highly irritable as well. Low progesterone may lead to insomnia, which often happens during the luteal phase of a woman’s menstrual cycle, the phase when PMS is most likely to occur.
Progesterone also tends to drop first, before estrogen levels drop, during perimenopause. This means that females in their 40s and early 50s may start to have difficulty with insomnia, irritability, and anxiety, before they develop the classic menopausal symptoms of hot flashes and night sweats, which are more commonly related to a drop in estrogen.
If you are curious about whether progesterone might be a contributing factor in your anxiety, one good first step would be to make some notes about when anxiety occurs. Does there seem to be a cyclical pattern of anxiety or agitation increasing before your menstrual cycle? Has anxiety or insomnia increased or started as you’ve gotten older, possibly related to declining progesterone levels?
Most of the time, there are multiple factors that lead to heightened anxiety, and these factors play off of each other. For example, if your progesterone is lower, and you are not sleeping well and feeling anxious, you may be less productive at work or more irritable with others, and this can lead to increased stress and worry about these issues.
Stress and anxiety also can play a role in reducing progesterone levels, because progesterone is partly produced by the adrenal glands, and when you are under greater stress, your adrenal glands – the primary glands responsible for stress management in the body – will shunt more of their focus to production of cortisol and reduce focus on reproductive hormone production. So, in this way, there can be a cyclical effect of stress and anxiety causing low progesterone, which leads to more anxiety and stress.
How can we intervene to help this problem? Hormone testing is the first key element, to measure your levels of progesterone, estrogen, testosterone, cortisol, DHEA, thyroid hormones, vitamin D, and other markers that your doctor might be interested in testing, to get the whole picture of your internal health status. Once you have test results, your doctor can help determine whether there are imbalances between your hormones, or other issues that need to be addressed, in order to resolve the issues you are facing.
Treatment for progesterone deficiency may include herbal supplements, such as vitex, to promote more progesterone effects in the body. Vitex can also have specific antidepressant and anti-anxiety benefits, in addition to its hormone balancing effects, and was found to be similar in efficacy to fluoxetine in one study.4 If estrogen is relatively high and progesterone is normal or only slightly suboptimal, bringing the ratio into balance is key. This can be done with an estrogen reducing natural supplement, such as DIM (diindolylmethane) or I3C (indole-3-carbanol), both made from vegetable sources. For people with very low progesterone, or women further into perimenopause, progesterone supplementation may be a better option. This can take the form of low dose over-the-counter progesterone creams, or a bioidentical progesterone prescription from a pharmacy.
It is important to be well informed regarding all the risks and benefits of these treatment options, and to discuss them in detail with a doctor who is well versed in holistic hormone treatments. It is also vital to focus on the whole picture, because when it comes to hormonal health, balance is key. What is most important is to have the right ratios of each of the hormones, as well as a healthy diet and lifestyle that includes mindful self-care, to feel at your best.
References:
1. Antonia V. Seligowski, et al., Translational studies of estradiol and progesterone in fear and PTSD. European Journal of Psychotraumatology, Volume 11, Issue 1, 2020.
2. Tapilskaya N.I., et al., Stress-protective effects of micronized progesterone in treatment of anxiety disorders in pregnant women after in vitro fertilization. Gynecology, Vol 23, No 4, 2021.
3. Watcharin N.Sovijit, et al., Ovarian progesterone suppresses depression and anxiety-like behaviors by increasing the Lactobacillus population of gut microbiota in ovariectomized mice. Neuroscience Research, Volume 168, 2021.
4. Mutakabbir Rashid Chowdhury, et al., Vitex peduncularis Boosted Anxiolytic, Antidepressant, and Antioxidant Properties in Albino Mice and In Silico Model. Journal of Herbs, Spices & Medicinal Plants, Volume 27, Issue 1, 2021.
Could Your Anxiety Be Related to Progesterone Levels? By Tara Peyman, ND
Anxiety is one of the most common mental health conditions. Feelings of anxiousness are normal for everyone to experience from time to time. However, for some people, anxiety can become severe and interruptive to daily functioning. This is when it is important to seek professional help and look for the underlying cause.
Sometimes anxiety is related to ongoing stress in your current daily life, and sometimes there is a history of trauma that has wired your nervous system to get stuck in a fight or flight state, leading to persistent anxiety even when there is nothing externally wrong in your current life to cause such high levels of anxiety. Stress and trauma tend to respond well to psychological therapy, such as CBT, EMDR, or other counseling modalities. Some people get great relief using natural supplements for stress reduction, such as passionflower, L-theanine, or homeopathic remedies.
Yet sometimes there is another cause. For females with anxiety, there can be a hormonal connection. If you notice that anxiety levels tend to fluctuate throughout the month, or if anxiety has been worse since menopausal changes, hormones may be at play here.
Progesterone can have a tranquilizing effect on the brain and nervous system. It does this primarily by acting on GABA receptors to calm the body and brain.1,2 Interestingly, there is a gut-brain connection with progesterone as well. Progesterone has been found to act as a probiotic in the digestive system, promoting growth of the beneficial bacteria, lactobacillus reuteri.3 This healthy bacteria strain has been shown to diminish anxiety levels and improve mental health.
If progesterone levels are relatively low, the nervous system may feel more stimulated, anxious, and restless. Some females with low progesterone will feel highly irritable as well. Low progesterone may lead to insomnia, which often happens during the luteal phase of a woman’s menstrual cycle, the phase when PMS is most likely to occur.
Progesterone also tends to drop first, before estrogen levels drop, during perimenopause. This means that females in their 40s and early 50s may start to have difficulty with insomnia, irritability, and anxiety, before they develop the classic menopausal symptoms of hot flashes and night sweats, which are more commonly related to a drop in estrogen.
If you are curious about whether progesterone might be a contributing factor in your anxiety, one good first step would be to make some notes about when anxiety occurs. Does there seem to be a cyclical pattern of anxiety or agitation increasing before your menstrual cycle? Has anxiety or insomnia increased or started as you’ve gotten older, possibly related to declining progesterone levels?
Most of the time, there are multiple factors that lead to heightened anxiety, and these factors play off of each other. For example, if your progesterone is lower, and you are not sleeping well and feeling anxious, you may be less productive at work or more irritable with others, and this can lead to increased stress and worry about these issues.
Stress and anxiety also can play a role in reducing progesterone levels, because progesterone is partly produced by the adrenal glands, and when you are under greater stress, your adrenal glands – the primary glands responsible for stress management in the body – will shunt more of their focus to production of cortisol and reduce focus on reproductive hormone production. So, in this way, there can be a cyclical effect of stress and anxiety causing low progesterone, which leads to more anxiety and stress.
How can we intervene to help this problem? Hormone testing is the first key element, to measure your levels of progesterone, estrogen, testosterone, cortisol, DHEA, thyroid hormones, vitamin D, and other markers that your doctor might be interested in testing, to get the whole picture of your internal health status. Once you have test results, your doctor can help determine whether there are imbalances between your hormones, or other issues that need to be addressed, in order to resolve the issues you are facing.
Treatment for progesterone deficiency may include herbal supplements, such as vitex, to promote more progesterone effects in the body. Vitex can also have specific antidepressant and anti-anxiety benefits, in addition to its hormone balancing effects, and was found to be similar in efficacy to fluoxetine in one study.4 If estrogen is relatively high and progesterone is normal or only slightly suboptimal, bringing the ratio into balance is key. This can be done with an estrogen reducing natural supplement, such as DIM (diindolylmethane) or I3C (indole-3-carbanol), both made from vegetable sources. For people with very low progesterone, or women further into perimenopause, progesterone supplementation may be a better option. This can take the form of low dose over-the-counter progesterone creams, or a bioidentical progesterone prescription from a pharmacy.
It is important to be well informed regarding all the risks and benefits of these treatment options, and to discuss them in detail with a doctor who is well versed in holistic hormone treatments. It is also vital to focus on the whole picture, because when it comes to hormonal health, balance is key. What is most important is to have the right ratios of each of the hormones, as well as a healthy diet and lifestyle that includes mindful self-care, to feel at your best.
References:
1. Antonia V. Seligowski, et al., Translational studies of estradiol and progesterone in fear and PTSD. European Journal of Psychotraumatology, Volume 11, Issue 1, 2020.
2. Tapilskaya N.I., et al., Stress-protective effects of micronized progesterone in treatment of anxiety disorders in pregnant women after in vitro fertilization. Gynecology, Vol 23, No 4, 2021.
3. Watcharin N.Sovijit, et al., Ovarian progesterone suppresses depression and anxiety-like behaviors by increasing the Lactobacillus population of gut microbiota in ovariectomized mice. Neuroscience Research, Volume 168, 2021.
4. Mutakabbir Rashid Chowdhury, et al., Vitex peduncularis Boosted Anxiolytic, Antidepressant, and Antioxidant Properties in Albino Mice and In Silico Model. Journal of Herbs, Spices & Medicinal Plants, Volume 27, Issue 1, 2021.
Image by CHADD.ORG
8/3/2022
ADHD vs. Anxiety in Kids By Hillary Lim N.D.
It’s that time of year again. . . back to school! As your child is entering a new year, or perhaps starting school for the first time, there may be some of you who are concerned about your child’s ability to function optimally at school. Maybe they struggle with sitting still, focusing, or have the tendency to be disruptive or forgetful. You may be thinking, “Does my child have ADHD? Or is he/she just an anxious little human?”. Hopefully this article will help to guide you in identifying what’s going on with your child so you can take some helpful action steps in this new school year!
Let’s start with some data. According to the CDC, 6.1 million children have been diagnosed with ADHD in the U.S., with 1 in 9 children diagnosed with ADHD between the ages of 11 - 14.
But how do you know if you should have your child evaluated for ADHD? The first step is to refer to the diagnostic guidelines for ADHD (please take a moment to scroll down to the end of the article to refer to the diagnostic criteria.)
Come back here to continue reading!
Now that you’ve gone through the diagnostic guidelines, you should have a better idea of whether or not your child may have ADHD. The next question is, if my child does meet the above criteria, do I need to get him/her officially evaluated? If you feel like your child would benefit from accommodations at school, like extra time for testing, a wiggle chair, one-on-one tutoring if provided, etc. then yes! They will need to be evaluated by a provider like a psychiatrist or developmental pediatrician to be officially diagnosed. Then you can take that diagnostic evaluation to the school and set up an Individualized Education Plan (IEP) for your child to help them to be as successful as possible at school!
The next question is, what do I do if my child does have ADHD? Most people are familiar with the traditional medication options for ADHD, which include both stimulant and non-stimulant meds. However, many parents would prefer to try more natural ways to address the symptoms before going down the medication road. Every individual is different, but for many children there are ways to improve in areas like focus, restlessness, and working memory without the use of traditional medications. Individualized combinations of various therapies like homeopathic treatment, gut healing protocols, hormone and nutrient balancing, detoxification, Craniosacral therapy, neurofeedback, and nutritional supplements are key to optimizing brain function and focus! It’s also important for kids with ADHD to learn about how special they are, their strengths, and their weaknesses so they can learn skills that they can use throughout their life which will help them to maintain balance as much as possible.
Now, what if your child doesn’t exactly meet enough of the criteria for ADHD above, but there are still prevalent symptoms that are affecting everyday life?
Could it be Anxiety?
Sometimes what presents as ADHD is actually anxiety! Kids don’t always know how to verbalize their stress and worry, so they may exhibit one or more of the following symptoms:
It’s also possible that your child has BOTH ADHD and anxiety. If you’re feeling overwhelmed, just remember that there are action steps to take that don’t involve prescription medications!
The first step is getting a holistic workup done. Ideally, this would involve ordering diagnostic blood/urine tests. This allows us to investigate if there is a physiological reason that the symptoms are there so we can address that physiological imbalance.
Common abnormal lab results in kids with ADHD/anxiety/or both!
Another important part of the workup should be identifying any anxiety symptoms or other physical symptoms that are there. Connecting kids with their own bodies and helping them to identify their emotions and sensations is very important. If they still don’t have the words to describe the emotion or sensation in detail, that’s OK! They will still be able to give us some basic insight. For example, “My tummy hurts when I think about school” or “When I try to go to sleep it feels like there’s ants crawling up and down my legs”. Then we can use that information to help to decrease the prevalence of that symptom, by using things like homeopathy, individualized guided meditations, tapping techniques, etc.
Natural Treatment Options
Again, most people are aware of the medication avenue for ADHD and anxiety. If you are interested in a more holistic approach, there are options out there! I would recommend finding a Naturopathic Doctor (N.D. or N.M.D. depending on the state you live in) to help address the underlying imbalances and tendencies that are contributing to the symptoms that are present. He/she can help you in various ways by recommending one, a few, or all of the following:
At IMHC, all of our doctors are familiar with treating both ADHD and anxiety in kids. We can see individuals locally in AZ, and can act as naturopathic consultants for individuals living out of the state or country. To schedule your free phone consult with IMHC’s medical director, click here.
Resources:
“General Prevalence of ADHD”, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), Accessed August 3, 2022, https://chadd.org/about-adhd/general-prevalence/
“ADHD19 Assessment Table”, American Academy of Family Physicians, Accessed August 3, 2022, https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf
ADHD vs. Anxiety in Kids By Hillary Lim N.D.
It’s that time of year again. . . back to school! As your child is entering a new year, or perhaps starting school for the first time, there may be some of you who are concerned about your child’s ability to function optimally at school. Maybe they struggle with sitting still, focusing, or have the tendency to be disruptive or forgetful. You may be thinking, “Does my child have ADHD? Or is he/she just an anxious little human?”. Hopefully this article will help to guide you in identifying what’s going on with your child so you can take some helpful action steps in this new school year!
Let’s start with some data. According to the CDC, 6.1 million children have been diagnosed with ADHD in the U.S., with 1 in 9 children diagnosed with ADHD between the ages of 11 - 14.
But how do you know if you should have your child evaluated for ADHD? The first step is to refer to the diagnostic guidelines for ADHD (please take a moment to scroll down to the end of the article to refer to the diagnostic criteria.)
Come back here to continue reading!
Now that you’ve gone through the diagnostic guidelines, you should have a better idea of whether or not your child may have ADHD. The next question is, if my child does meet the above criteria, do I need to get him/her officially evaluated? If you feel like your child would benefit from accommodations at school, like extra time for testing, a wiggle chair, one-on-one tutoring if provided, etc. then yes! They will need to be evaluated by a provider like a psychiatrist or developmental pediatrician to be officially diagnosed. Then you can take that diagnostic evaluation to the school and set up an Individualized Education Plan (IEP) for your child to help them to be as successful as possible at school!
The next question is, what do I do if my child does have ADHD? Most people are familiar with the traditional medication options for ADHD, which include both stimulant and non-stimulant meds. However, many parents would prefer to try more natural ways to address the symptoms before going down the medication road. Every individual is different, but for many children there are ways to improve in areas like focus, restlessness, and working memory without the use of traditional medications. Individualized combinations of various therapies like homeopathic treatment, gut healing protocols, hormone and nutrient balancing, detoxification, Craniosacral therapy, neurofeedback, and nutritional supplements are key to optimizing brain function and focus! It’s also important for kids with ADHD to learn about how special they are, their strengths, and their weaknesses so they can learn skills that they can use throughout their life which will help them to maintain balance as much as possible.
Now, what if your child doesn’t exactly meet enough of the criteria for ADHD above, but there are still prevalent symptoms that are affecting everyday life?
Could it be Anxiety?
Sometimes what presents as ADHD is actually anxiety! Kids don’t always know how to verbalize their stress and worry, so they may exhibit one or more of the following symptoms:
- Forgetfulness
- Restlessness
- Excessive worry about school or social situations
- Overly clingy
- Sleep difficulties
- Struggling with focus
- Talking rapidly
- Irritability
- Stomach aches
It’s also possible that your child has BOTH ADHD and anxiety. If you’re feeling overwhelmed, just remember that there are action steps to take that don’t involve prescription medications!
The first step is getting a holistic workup done. Ideally, this would involve ordering diagnostic blood/urine tests. This allows us to investigate if there is a physiological reason that the symptoms are there so we can address that physiological imbalance.
Common abnormal lab results in kids with ADHD/anxiety/or both!
- Anemia (too little iron, B12, folate, or all of the above!)
- Genetic methylation difficulties
- Yeast overgrowth in the gut
- Decreased mitochondrial function
- Lead toxicity
- Vitamin D deficiency
- Thyroid and/or adrenal function disturbance
- Difficulty with processing histamines
Another important part of the workup should be identifying any anxiety symptoms or other physical symptoms that are there. Connecting kids with their own bodies and helping them to identify their emotions and sensations is very important. If they still don’t have the words to describe the emotion or sensation in detail, that’s OK! They will still be able to give us some basic insight. For example, “My tummy hurts when I think about school” or “When I try to go to sleep it feels like there’s ants crawling up and down my legs”. Then we can use that information to help to decrease the prevalence of that symptom, by using things like homeopathy, individualized guided meditations, tapping techniques, etc.
Natural Treatment Options
Again, most people are aware of the medication avenue for ADHD and anxiety. If you are interested in a more holistic approach, there are options out there! I would recommend finding a Naturopathic Doctor (N.D. or N.M.D. depending on the state you live in) to help address the underlying imbalances and tendencies that are contributing to the symptoms that are present. He/she can help you in various ways by recommending one, a few, or all of the following:
- Homeopathic Treatment
- Craniosacral Therapy
- Gut testing and gut healing protocols
- Detoxification Protocols
- Neurofeedback
- Cognitive Behavioral Therapy
- Nutritional Supplementation to address underlying deficiencies
- Genetic testing and support
- Other possible learning disability support
At IMHC, all of our doctors are familiar with treating both ADHD and anxiety in kids. We can see individuals locally in AZ, and can act as naturopathic consultants for individuals living out of the state or country. To schedule your free phone consult with IMHC’s medical director, click here.
Resources:
“General Prevalence of ADHD”, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), Accessed August 3, 2022, https://chadd.org/about-adhd/general-prevalence/
“ADHD19 Assessment Table”, American Academy of Family Physicians, Accessed August 3, 2022, https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf
Image by AAFP.ORG
6/28/22
Disparities in Racial/Ethnic Minority Mental Health
By Molly Tately, N.D.
July marks National Minority Mental Health Awareness Month, highlighting the unique challenges encountered by racial and ethnic minorities regarding mental health in the United States. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2020 National Survey on Drug Use and Health, 52.9 million adults in the United States suffer from a mental, behavioral, or emotional disorder. An estimated 49.5% of adolescents aged 13-18 have had a mental disorder at some point in their life.1
Based upon SAMHSA’s survey, racial/ethnic minority groups tend to have fewer mental health disorders than White individuals. This has long been the case and is something that researchers have struggled to explain as American social environments largely seem less than conducive to supporting the mental health of our minority populations. The risk factors for development of mental health disorders are immense. The original CDC-Kaiser Adverse Childhood Experiences (ACE) Study published in 1998 established a strong basis of understanding of this by looking at seven domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, and incarcerated household member.2 (Parental separation/divorce was later added as an eighth domain in subsequent studies.) Frequencies of adverse experiences were calculated by domain and a mean ACE score determined. Exposure to events in these domains showed significant physical health risks, but also strong links to depression, anxiety, severe mood disorders, and suicide with a higher ACE score correlating to higher risk for poor physical and mental health. The 2020 data shows that White individuals had lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals.3 This demonstrates a tremendous amount of stress on these racial/ethnic minorities, putting them at higher risk for mental illness.
Underestimating and under-reporting in minority group mental illness has been suggested as a rationale for the abovementioned minority mental health paradox.4,5 Differences in conceptualization of mental illness has also been postulated. One study offered that “holistic cultures” rooted in Buddhism, Confucianism, Hinduism, and Taoism acted as a protective factor against the development of mental disorders. These cultures were assessed to have lower expectations for ideal levels of happiness, health, and self-esteem and therefore interpret negative experiences in a more neutral manner than individualistic cultures like the United States.4 While possibly explaining a factor involved in prevalence disparities in the Asian minority population, this cultural basis doesn’t appear to apply across all other racial/ethnic minority groups of the United States which also demonstrate lower rates of mental illness.
A recent study out of the University of Pennsylvania took another approach and explored frequently prescribed medications for physical health conditions such as certain analgesics, antihypertensives, corticosteroids, gastrointestinal agents, hormone modifiers, and respiratory agents with depression or suicide as side-effects. Large differences in the use of pharmaceutical medications along racial/ethnic lines were identified according to analysis of data in the Medical Expenditure Panel Survey (MEPS). 37% of adults in the United States currently take at least one medication with these adverse effects and 15% take three or more.5 Of these, White individuals consumed higher levels of medications with side effects of depression or suicide (28%) than individuals in any other ethnic/racial group (no higher than 15%).5 Analysis revealed that taking even a single medication with suicide as a possible side-effect more than doubled the chance of mental/emotional disturbance; taking three or more further compounded this further. Interestingly, it is the decreased utilization of pharmaceutical interventions for physical health conditions that appears to be a potentially protective factor for racial/ethnic minorities against the development of mental disorders. This observation leads to more questions as improved physical health has historically been correlated with improved mental health.
Lower levels of minority service utilization are not limited to just the physical health space. Racial/ethnic minorities diagnosed with mental illness are less likely to receive mental health services to address their conditions. In 2020, 46.2% of adults with any mental illness received mental health services including inpatient treatment, outpatient treatment/counseling, or prescription medication(s).1 Of these, White individuals were most likely to receive treatment (51.8%), whereas only 20.8% of Asian individuals, 35.1% of Hispanic individuals, and 37.1% of Black individuals received care.1 Differences along racial/ethnic lines were also identified in the types of services accessed more frequently. White and American Indian/Alaska Native individuals were more likely to receive outpatient mental health services and take prescription psychiatric medications and Black individuals were more likely to receive inpatient mental health services.6 A study by Hudson et al revealed that White children are about twice as likely as Black or Hispanic children to be treated with stimulant medications for attention deficit/hyperactivity disorder.7 Similarly, White adolescents are about twice as likely as Hispanic adolescents to be treated with antidepressant medications.8
The American Psychiatric Association cites multiple factors for the disparity in mental health service provision and poorer outcomes amongst racial/ethnic minorities. These include inaccessibility of high-quality mental health care services, cultural stigma surrounding mental health care, discrimination, and overall lack of awareness about mental health.9 Language challenges, lack of diversity among mental health care providers, lack of culturally competent providers, and distrust of the healthcare system were also identified as barriers.6 Some evidence suggests apprehension surrounding common interventions targeted at addressing mental disorders is also a factor. For example, Black and Hispanic patients express higher concerns than White patients about side-effects and quality of life effects of pharmaceuticals.7 And finally, higher ACEs may affect attitudes about health and healthcare in general which could reasonably impact service utilization.2
Studies also suggest that incidents of racial discrimination are of profound importance for mental health because they are “experiences of exclusion that trigger feelings of a ‘defilement of self.’ This includes feelings of being over-scrutinized, overlooked, underappreciated, misunderstood, and disrespected.”10 These, like ACEs, can lead to heightened vigilance through both actual exposure or even the threat of exposure to a potentially discriminatory experience. This is an important consideration within the context of mental healthcare where the quality of patient-provider interactions is critical to developing a positive therapeutic relationship.
Here at IMHC we acknowledge the importance of our patients’ lived experiences and focus on each individual holistically. We work collaboratively with our patients in putting together their treatment plans and choosing an array of natural and conventional therapeutic options to address both mental and underlying physical health concerns. We have doctors that speak Spanish and Korean and work with translators as needed to include individuals where language may be a barrier to receiving care.
References
Disparities in Racial/Ethnic Minority Mental Health
By Molly Tately, N.D.
July marks National Minority Mental Health Awareness Month, highlighting the unique challenges encountered by racial and ethnic minorities regarding mental health in the United States. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2020 National Survey on Drug Use and Health, 52.9 million adults in the United States suffer from a mental, behavioral, or emotional disorder. An estimated 49.5% of adolescents aged 13-18 have had a mental disorder at some point in their life.1
Based upon SAMHSA’s survey, racial/ethnic minority groups tend to have fewer mental health disorders than White individuals. This has long been the case and is something that researchers have struggled to explain as American social environments largely seem less than conducive to supporting the mental health of our minority populations. The risk factors for development of mental health disorders are immense. The original CDC-Kaiser Adverse Childhood Experiences (ACE) Study published in 1998 established a strong basis of understanding of this by looking at seven domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, and incarcerated household member.2 (Parental separation/divorce was later added as an eighth domain in subsequent studies.) Frequencies of adverse experiences were calculated by domain and a mean ACE score determined. Exposure to events in these domains showed significant physical health risks, but also strong links to depression, anxiety, severe mood disorders, and suicide with a higher ACE score correlating to higher risk for poor physical and mental health. The 2020 data shows that White individuals had lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals.3 This demonstrates a tremendous amount of stress on these racial/ethnic minorities, putting them at higher risk for mental illness.
Underestimating and under-reporting in minority group mental illness has been suggested as a rationale for the abovementioned minority mental health paradox.4,5 Differences in conceptualization of mental illness has also been postulated. One study offered that “holistic cultures” rooted in Buddhism, Confucianism, Hinduism, and Taoism acted as a protective factor against the development of mental disorders. These cultures were assessed to have lower expectations for ideal levels of happiness, health, and self-esteem and therefore interpret negative experiences in a more neutral manner than individualistic cultures like the United States.4 While possibly explaining a factor involved in prevalence disparities in the Asian minority population, this cultural basis doesn’t appear to apply across all other racial/ethnic minority groups of the United States which also demonstrate lower rates of mental illness.
A recent study out of the University of Pennsylvania took another approach and explored frequently prescribed medications for physical health conditions such as certain analgesics, antihypertensives, corticosteroids, gastrointestinal agents, hormone modifiers, and respiratory agents with depression or suicide as side-effects. Large differences in the use of pharmaceutical medications along racial/ethnic lines were identified according to analysis of data in the Medical Expenditure Panel Survey (MEPS). 37% of adults in the United States currently take at least one medication with these adverse effects and 15% take three or more.5 Of these, White individuals consumed higher levels of medications with side effects of depression or suicide (28%) than individuals in any other ethnic/racial group (no higher than 15%).5 Analysis revealed that taking even a single medication with suicide as a possible side-effect more than doubled the chance of mental/emotional disturbance; taking three or more further compounded this further. Interestingly, it is the decreased utilization of pharmaceutical interventions for physical health conditions that appears to be a potentially protective factor for racial/ethnic minorities against the development of mental disorders. This observation leads to more questions as improved physical health has historically been correlated with improved mental health.
Lower levels of minority service utilization are not limited to just the physical health space. Racial/ethnic minorities diagnosed with mental illness are less likely to receive mental health services to address their conditions. In 2020, 46.2% of adults with any mental illness received mental health services including inpatient treatment, outpatient treatment/counseling, or prescription medication(s).1 Of these, White individuals were most likely to receive treatment (51.8%), whereas only 20.8% of Asian individuals, 35.1% of Hispanic individuals, and 37.1% of Black individuals received care.1 Differences along racial/ethnic lines were also identified in the types of services accessed more frequently. White and American Indian/Alaska Native individuals were more likely to receive outpatient mental health services and take prescription psychiatric medications and Black individuals were more likely to receive inpatient mental health services.6 A study by Hudson et al revealed that White children are about twice as likely as Black or Hispanic children to be treated with stimulant medications for attention deficit/hyperactivity disorder.7 Similarly, White adolescents are about twice as likely as Hispanic adolescents to be treated with antidepressant medications.8
The American Psychiatric Association cites multiple factors for the disparity in mental health service provision and poorer outcomes amongst racial/ethnic minorities. These include inaccessibility of high-quality mental health care services, cultural stigma surrounding mental health care, discrimination, and overall lack of awareness about mental health.9 Language challenges, lack of diversity among mental health care providers, lack of culturally competent providers, and distrust of the healthcare system were also identified as barriers.6 Some evidence suggests apprehension surrounding common interventions targeted at addressing mental disorders is also a factor. For example, Black and Hispanic patients express higher concerns than White patients about side-effects and quality of life effects of pharmaceuticals.7 And finally, higher ACEs may affect attitudes about health and healthcare in general which could reasonably impact service utilization.2
Studies also suggest that incidents of racial discrimination are of profound importance for mental health because they are “experiences of exclusion that trigger feelings of a ‘defilement of self.’ This includes feelings of being over-scrutinized, overlooked, underappreciated, misunderstood, and disrespected.”10 These, like ACEs, can lead to heightened vigilance through both actual exposure or even the threat of exposure to a potentially discriminatory experience. This is an important consideration within the context of mental healthcare where the quality of patient-provider interactions is critical to developing a positive therapeutic relationship.
Here at IMHC we acknowledge the importance of our patients’ lived experiences and focus on each individual holistically. We work collaboratively with our patients in putting together their treatment plans and choosing an array of natural and conventional therapeutic options to address both mental and underlying physical health concerns. We have doctors that speak Spanish and Korean and work with translators as needed to include individuals where language may be a barrier to receiving care.
References
- Mental illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness. Accessed June 23, 2022.
- Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258. doi:10.1016/s0749-3797(98)00017-8
- Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020;20(1):1327. Published 2020 Sep 10. doi:10.1186/s12889-020-09411-z
- Alvarez K, Fillbrunn M, Green JG, et al. Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults. Soc Psychiatry Psychiatr Epidemiol. 2019;54(5):553-565. doi:10.1007/s00127-018-1644-5
- Schnittker J, Do D. Pharmaceutical Side Effects and Mental Health Paradoxes among Racial-Ethnic Minorities. J Health Soc Behav. 2020;61(1):4-23. doi:10.1177/0022146519899115
- Mental health disparities: Diverse populations. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Diverse-Populations.pdf. Accessed June 20, 2022.
- Hudson JL, Miller GE, Kirby JB. Explaining racial and ethnic differences in children's use of stimulant medications. Med Care. 2007;45(11):1068-1075. doi:10.1097/MLR.0b013e31806728fa
- Mental health disparities: Hispanics and Latinos. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Hispanic-Latino.pdf. Accessed June 27, 2022.
- Mental health disparities: Diverse populations. Psychiatry.org - Mental Health Disparities: Diverse Populations. https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts. Accessed June 20, 2022.
- Williams DR. Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors. J Health Soc Behav. 2018;59(4):466-485. doi:10.1177/0022146518814251
5/30/2022
Can PTSD be "Simple" or "Complex"?
By Dr. Olivia Valdez, ND
When most people think of post-traumatic stress disorder (PTSD), they may imagine a war veteran, a tsunami survivor, or a car accident victim -- someone who can trace their symptoms back to a single traumatic event or period in their lives. This is the classic form of PTSD as defined in the DSM-5, also known as "typical" or "simple" PTSD (SPTSD) [1, 2]. But did you know there is another category of PTSD emerging in contemporary literature? Though not yet officially included in the DSM-5, it is a cousin of the SPTSD we may be more familiar with. And though they share certain roots, they also have branches that stretch in entirely different directions. It is our hope that one day this is acknowledged by the leading institutions of psychology, but for now, here are the highlights.
In contrast with SPTSD, "complex" PTSD (or CPTSD) occurs after prolonged trauma over a period of months to years and can be more enduring than that seen with SPTSD. [3] Dr. Judith Herman, MD, introduced this term in the 1990s when she researched the trends of prolonged trauma that women experience versus men (10% versus 5%, respectively). This type of chronic trauma can stem from various forms of repetitive exposure: childhood physical and sexual abuse, chronic spousal abuse, human trafficking, prolonged combat trauma, or any extended period of extreme instability with chronic lack of safety. CPTSD is characterized especially by somatization (experiencing medical symptoms without organic causes), dissociation (disconnecting from thoughts, memories, actions, or surroundings), and affect dysregulation (reacting excessively to negative emotional stimuli). [4] The survivor's sense of self can be damaged leading to personality disorders, their sense of purpose and meaning in life can be blunted, and interpersonal relationships become difficult.
SPTSD lacks these kinds of chronic personality changes and manifests more commonly with forms of intrusive symptoms of which the survivor is aware: nightmares, flashbacks, and unwanted memories [5]. These intrusive symptoms produce active maneuvers of avoidance (such as evading certain environments, people, or online content) and changes in mood and reactivity. But these mood changes are less personally identifying and deep-seated than in CPTSD. Both forms pose intense challenges for the survivor, and at Integrative Mental Health Center (IMHC), we recognize the unique roads to recovery for all. No mental health condition is defining, and there are many therapeutic modalities we can use as naturopathic physicians to facilitate your healing journey.
So what are these tools? The very first idea we integrate is working within your "Window of Tolerance" (WoT) [6]. Being inside your window means you can function healthfully: you are oriented to self, place, and time and can feel present and mindful without experiencing traumatic triggers. Being outside your window manifests with any level and/or combination of traumatic-stress responses. These could include anything from mild anxiety and a fast heart rate to emotional numbing, panic attacks, and dissociation (among others). As we help you create and develop tools to stabilize traumatic stress responses, an initially small WoT will expand. With time and patience, physical and emotional resilience increases and traumatic stress triggers become less intrusive. Though CPTSD has a more difficult WoT to identify than SPTSD, this concept can be applied for both forms.
Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can both be used to grow the WoT. CBT focuses on the relationship between thoughts, feelings, and behaviors and how any one domain can affect the other two. In PTSD treatment, CBT can help identify and reframe unhelpful thought and emotion patterns (called "distortions") [7]. Stress management and crisis planning also fall under the skill-building of CBT. DBT, which may be especially helpful for CPTSD, brings practitioner and patient together under the concept of "integration of opposites." This can be very helpful for management of suicidal or self-harming impulses, coping with severe anxiety, and shifting out of persistent depressive thought spirals. With DBT, both the practitioner and the patient practice collaboration and compassion to facilitate the goals of the patient productively. DBT also strives to balance complete acceptance of the patient as they currently are while also facilitating growth and change [8].
The last therapeutic modality discussed here is called eye movement desensitization and reprocessing (EMDR) therapy. A mouthful indeed, but EMDR also boasts a powerful therapeutic effect. By combining bilateral eye movements with a brief focus on the traumatic event or repetitive exposure, trauma-related emotions and vividness reduce [8]. The wonderful thing about EMDR is that it was initially developed specifically for PTSD and helps patients fully process memories that would otherwise go unseen. Processing a specific memory uses an 8-phase approach beginning with a thorough history-taking and ending with a practical evaluation of treatment results.
Any of the therapies discussed here are great ways to initiate healing and we regularly refer to trusted counselors who offer EMDR, DBT, and CBT, to complement the naturopathic therapies that we offer for PTSD. We can work collaboratively with your therapist or psychiatrist for a team approach that will yield faster and better results. Here at IMHC, we provide further naturopathic options that can be used adjunctively with those discussed above.
In our experience, homeopathy, acupuncture, and targeted nutritional or herbal supplementation can all contribute to a well-rounded treatment plan for those with S/CPTSD. We have seen empowering and positive results from even simply prescribing the right homeopathic remedy. Homeopathy can not only help soothe the nervous system and strengthen resilience in a trauma patient, but improve overall quality of life so the patient can function more efficiently and still tackle their daily activities with less interference from triggers. This modality can also act adjunctively with CBT, EMDR, DBT, or other counseling techniques, by creating a healthier foundation for the treatments to build upon. Acupuncture has also proved helpful with protocols which calm the mind and body, downregulate organ systems which are hyperactive, and tonify organ systems which are deficient from the trauma. Certain acupuncture points like Anmian and Heart 7 can even help with insomnia, which is a common problem in S/CPTSD. Supplements and nutrients which target the endocrine and nervous systems often have a powerfully supportive effect. In a fight-or-flight scenario, acute or chronic, cortisol pathways are the first to become imbalanced. This is why cortisol-modulating and supporting herbs and nutrients such as Withania somnifera, Glycyrrhiza glabra, L-theanine, B vitamins, Vitamin C, and certain trace minerals are so crucial to include. We can also utilize prescription medications if needed, to act as additional support for mood, sleep, or other symptoms, while your nervous system heals.
At Integrative Mental Health Center, we recognize and respect each and every patient's story. We honor the strength and struggle that exists in every trauma patient, and though the DSM-5 has not put a label on CPTSD as it has with typical PTSD, this does not make your experience any less real. We treat many with symptoms under the vast umbrella that is trauma and want you to know that you are not alone. There are a number of arrows in the quiver of healing, and we are here to guide you on how to use them. If you or someone you know is experiencing symptoms of simple or complex trauma, do not hesitate to reach out. And if you've made it all the way to the end of this article, we are proud of you -- awareness is the first step towards recovery.
References:
Can PTSD be "Simple" or "Complex"?
By Dr. Olivia Valdez, ND
When most people think of post-traumatic stress disorder (PTSD), they may imagine a war veteran, a tsunami survivor, or a car accident victim -- someone who can trace their symptoms back to a single traumatic event or period in their lives. This is the classic form of PTSD as defined in the DSM-5, also known as "typical" or "simple" PTSD (SPTSD) [1, 2]. But did you know there is another category of PTSD emerging in contemporary literature? Though not yet officially included in the DSM-5, it is a cousin of the SPTSD we may be more familiar with. And though they share certain roots, they also have branches that stretch in entirely different directions. It is our hope that one day this is acknowledged by the leading institutions of psychology, but for now, here are the highlights.
In contrast with SPTSD, "complex" PTSD (or CPTSD) occurs after prolonged trauma over a period of months to years and can be more enduring than that seen with SPTSD. [3] Dr. Judith Herman, MD, introduced this term in the 1990s when she researched the trends of prolonged trauma that women experience versus men (10% versus 5%, respectively). This type of chronic trauma can stem from various forms of repetitive exposure: childhood physical and sexual abuse, chronic spousal abuse, human trafficking, prolonged combat trauma, or any extended period of extreme instability with chronic lack of safety. CPTSD is characterized especially by somatization (experiencing medical symptoms without organic causes), dissociation (disconnecting from thoughts, memories, actions, or surroundings), and affect dysregulation (reacting excessively to negative emotional stimuli). [4] The survivor's sense of self can be damaged leading to personality disorders, their sense of purpose and meaning in life can be blunted, and interpersonal relationships become difficult.
SPTSD lacks these kinds of chronic personality changes and manifests more commonly with forms of intrusive symptoms of which the survivor is aware: nightmares, flashbacks, and unwanted memories [5]. These intrusive symptoms produce active maneuvers of avoidance (such as evading certain environments, people, or online content) and changes in mood and reactivity. But these mood changes are less personally identifying and deep-seated than in CPTSD. Both forms pose intense challenges for the survivor, and at Integrative Mental Health Center (IMHC), we recognize the unique roads to recovery for all. No mental health condition is defining, and there are many therapeutic modalities we can use as naturopathic physicians to facilitate your healing journey.
So what are these tools? The very first idea we integrate is working within your "Window of Tolerance" (WoT) [6]. Being inside your window means you can function healthfully: you are oriented to self, place, and time and can feel present and mindful without experiencing traumatic triggers. Being outside your window manifests with any level and/or combination of traumatic-stress responses. These could include anything from mild anxiety and a fast heart rate to emotional numbing, panic attacks, and dissociation (among others). As we help you create and develop tools to stabilize traumatic stress responses, an initially small WoT will expand. With time and patience, physical and emotional resilience increases and traumatic stress triggers become less intrusive. Though CPTSD has a more difficult WoT to identify than SPTSD, this concept can be applied for both forms.
Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can both be used to grow the WoT. CBT focuses on the relationship between thoughts, feelings, and behaviors and how any one domain can affect the other two. In PTSD treatment, CBT can help identify and reframe unhelpful thought and emotion patterns (called "distortions") [7]. Stress management and crisis planning also fall under the skill-building of CBT. DBT, which may be especially helpful for CPTSD, brings practitioner and patient together under the concept of "integration of opposites." This can be very helpful for management of suicidal or self-harming impulses, coping with severe anxiety, and shifting out of persistent depressive thought spirals. With DBT, both the practitioner and the patient practice collaboration and compassion to facilitate the goals of the patient productively. DBT also strives to balance complete acceptance of the patient as they currently are while also facilitating growth and change [8].
The last therapeutic modality discussed here is called eye movement desensitization and reprocessing (EMDR) therapy. A mouthful indeed, but EMDR also boasts a powerful therapeutic effect. By combining bilateral eye movements with a brief focus on the traumatic event or repetitive exposure, trauma-related emotions and vividness reduce [8]. The wonderful thing about EMDR is that it was initially developed specifically for PTSD and helps patients fully process memories that would otherwise go unseen. Processing a specific memory uses an 8-phase approach beginning with a thorough history-taking and ending with a practical evaluation of treatment results.
Any of the therapies discussed here are great ways to initiate healing and we regularly refer to trusted counselors who offer EMDR, DBT, and CBT, to complement the naturopathic therapies that we offer for PTSD. We can work collaboratively with your therapist or psychiatrist for a team approach that will yield faster and better results. Here at IMHC, we provide further naturopathic options that can be used adjunctively with those discussed above.
In our experience, homeopathy, acupuncture, and targeted nutritional or herbal supplementation can all contribute to a well-rounded treatment plan for those with S/CPTSD. We have seen empowering and positive results from even simply prescribing the right homeopathic remedy. Homeopathy can not only help soothe the nervous system and strengthen resilience in a trauma patient, but improve overall quality of life so the patient can function more efficiently and still tackle their daily activities with less interference from triggers. This modality can also act adjunctively with CBT, EMDR, DBT, or other counseling techniques, by creating a healthier foundation for the treatments to build upon. Acupuncture has also proved helpful with protocols which calm the mind and body, downregulate organ systems which are hyperactive, and tonify organ systems which are deficient from the trauma. Certain acupuncture points like Anmian and Heart 7 can even help with insomnia, which is a common problem in S/CPTSD. Supplements and nutrients which target the endocrine and nervous systems often have a powerfully supportive effect. In a fight-or-flight scenario, acute or chronic, cortisol pathways are the first to become imbalanced. This is why cortisol-modulating and supporting herbs and nutrients such as Withania somnifera, Glycyrrhiza glabra, L-theanine, B vitamins, Vitamin C, and certain trace minerals are so crucial to include. We can also utilize prescription medications if needed, to act as additional support for mood, sleep, or other symptoms, while your nervous system heals.
At Integrative Mental Health Center, we recognize and respect each and every patient's story. We honor the strength and struggle that exists in every trauma patient, and though the DSM-5 has not put a label on CPTSD as it has with typical PTSD, this does not make your experience any less real. We treat many with symptoms under the vast umbrella that is trauma and want you to know that you are not alone. There are a number of arrows in the quiver of healing, and we are here to guide you on how to use them. If you or someone you know is experiencing symptoms of simple or complex trauma, do not hesitate to reach out. And if you've made it all the way to the end of this article, we are proud of you -- awareness is the first step towards recovery.
References:
- https://www.medicalnewstoday.com/articles/322886
- https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.45.23.psychnews_45_23_040
- https://www-sciencedirect-com.libproxy.chapman.edu/science/article/pii/S0887618505000630?via%3Dihub#bib10
- https://www.nami.org/Blogs/NAMI-Blog/October-2020/7-Tools-for-Managing-Traumatic-Stress
- https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy
- https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/
- https://www.brainline.org/article/dsm-5-criteria-ptsd
- https://pubmed.ncbi.nlm.nih.gov/15979838/
4/5/2022
Craniosacral Q & A with Dr. Hillary Lim, N.D.
How long have you been practicing Craniosacral Therapy?
I have been a Craniosacral Therapist for close to 10 years. I have performed CST at least 4,500 times and have loved every minute of it!
What led you to become a Craniosacral Therapist?
I first chose to learn this modality from the Upledger Institute as I was looking for a gentle way to work on babies and small children that was different from the high velocity manipulations that we learned in medical school. I didn’t fully understand the vast benefits that Craniosacral can provide when I first started. We were of course introduced to the many conditions that benefit from this type of work, but it wasn’t until I started the work in my own practice that I fully understood the changes that Craniosacral Therapy can bring about.
What are your favorite conditions to treat?
That’s a hard one! I love treating common physical ailments like migraines, TMJ, vertigo, back pain, and constipation. But I also love working on the nervous system in individuals with anxiety, insomnia and PTSD.
What should people expect at their first session?
This varies based on the condition and age of the patient, but generally people feel very relaxed during and after their session. Some people may feel more emotional that day as the body is clearing things, some people feel tired and want to take a nap, and others feel lighter and more energized. This can also vary from session to session, based on what happened on my treatment table that day! I always encourage people to drink extra water after the session to help to clear any toxins (physical and emotional!) that may have been released that day.
Can you share a recent success story?
Of course! I’ll tell you two that just came to mind! One was in regards to an infant who was waking every 2 hours at night and crying (mom and dad were VERY tired!). He was also only having a BM once every 7-10 days! Poor guy. He started having more frequent BM’s even after the first treatment and now is sleeping well, is having BM’s 1-3 times daily, and is an overall happier little guy (and mom and dad are finally getting some rest!)
Another story is in regards to a young woman who suffers from PTSD. While we were doing Craniosacral Therapy she had some old trauma come to the surface and she was able to release some of the fear and anger that she had been storing inside of her. After the session she felt lighter and more relaxed and left my office with a big sigh of relief.
Click here for more information about Craniosacral Therapy
Craniosacral Q & A with Dr. Hillary Lim, N.D.
How long have you been practicing Craniosacral Therapy?
I have been a Craniosacral Therapist for close to 10 years. I have performed CST at least 4,500 times and have loved every minute of it!
What led you to become a Craniosacral Therapist?
I first chose to learn this modality from the Upledger Institute as I was looking for a gentle way to work on babies and small children that was different from the high velocity manipulations that we learned in medical school. I didn’t fully understand the vast benefits that Craniosacral can provide when I first started. We were of course introduced to the many conditions that benefit from this type of work, but it wasn’t until I started the work in my own practice that I fully understood the changes that Craniosacral Therapy can bring about.
What are your favorite conditions to treat?
That’s a hard one! I love treating common physical ailments like migraines, TMJ, vertigo, back pain, and constipation. But I also love working on the nervous system in individuals with anxiety, insomnia and PTSD.
What should people expect at their first session?
This varies based on the condition and age of the patient, but generally people feel very relaxed during and after their session. Some people may feel more emotional that day as the body is clearing things, some people feel tired and want to take a nap, and others feel lighter and more energized. This can also vary from session to session, based on what happened on my treatment table that day! I always encourage people to drink extra water after the session to help to clear any toxins (physical and emotional!) that may have been released that day.
Can you share a recent success story?
Of course! I’ll tell you two that just came to mind! One was in regards to an infant who was waking every 2 hours at night and crying (mom and dad were VERY tired!). He was also only having a BM once every 7-10 days! Poor guy. He started having more frequent BM’s even after the first treatment and now is sleeping well, is having BM’s 1-3 times daily, and is an overall happier little guy (and mom and dad are finally getting some rest!)
Another story is in regards to a young woman who suffers from PTSD. While we were doing Craniosacral Therapy she had some old trauma come to the surface and she was able to release some of the fear and anger that she had been storing inside of her. After the session she felt lighter and more relaxed and left my office with a big sigh of relief.
Click here for more information about Craniosacral Therapy
Dr. Tara Peyman, our Clinical Director and go-to expert for schizophrenia and bipolar disorder, discusses using homeopathy for mental illness below:
Dr. Vanessa Ruiz, passionate about treating trauma, anxiety, and depression, discusses stress management below:
Our owner and expert in autism and mood disorders, Dr. Hillary Lim, discusses how to naturally increase beneficial neurotransmitters below: