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Whole Health in Your PracticeDay 2 Morning

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Whole Health in Your PracticeAdvancing Skills in the Delivery of Personalized, Proactive, and

Patient‐Driven Care

Day 2 Morning• Self‐Care, Part I• Self‐Care, Part II

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Whole Health in Your Practice

Advancing Skills in the Delivery of Personalized, Proactive, and Patient‐Driven Care

Welcome Back!

Pulse Checks

Image: Keepcalm-o-matic.co.uk


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Where We’ve Been

• The Big Picture

• Mission, Aspirations, Purpose

• The Power of You

• Mindful Awareness

• Resilience and Clinician Self‐Care

The Whole Health System

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• Name a part of the circle that is missing

• No peeking in your course materials!

The Circle of Health

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What’s the matter with you?


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What matters to you?

For the rest of the course

• Today: Self‐Care and Professional Care

• Tomorrow: Community and Implementation – for you, your patients, your team, your facility, and beyond

Your Life

Your Practice

Your Team

Your Facility

TheSystem


9. Self‐Care

Part I


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Self‐Care in Context • After you outline MAP and do an assessment, what happens?

• You can go over the Circle and the PHI and decide on an area to work on.

• AND, you set goals with them, but you need to know:

– What are some options for a Personal Health Plan?

– How do we empower and equip the Veteran to achieve their goal?

Image: philadelphia.va.gov

Image: va.gov

Journey to Whole Health Clinical Care

Fundamentals

Map to the MAPMission/Aspiration/Purpose

Equip

Integrate

Whole Health Clinical

Care

Page 19

Page 19


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Self‐Care in Context

• You are part of a team that works on this process!

• Whole Health Coaches are trained to help Veterans outline their MAP, explore the Circle, and set goals

• Whole Health Partners are trained to orient them to Whole Health and various self‐care options

Image: blog.va.gov


On average, how much time do you have to interact with a given patient each year?

A. 0‐1 hour

B. 1‐2 hours

C. 2‐3 hours

D. 3‐6 hours

E. 6+ hours

✓✓✓

Depends on different factors...

• Inpatient/Outpatient

• Primary care or specialty

• Letters after your name

• Type of patients you see

...but the bottom line is, we only have so much time!

Why Self‐Care is Key...


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Personalized, Proactive, Patient‐Driven Self‐Care

Support me with what matters most to me

Tailor my careto me as a person

Help me prevent future problems and prepare for any health problem that comes up

Mentalhealth.va.gov

Lifestyle Practices and Cardiac Risk

Ornish, Lancet Oncol. 2013;14(11):1112‐20.

http://www.scientificamerican.com/article/my-what-long-telomeres-you-have/

Lifestyle and Telomere Length


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Mean change in relative telomere length over 5 years with lifestyle intervention compared with control

Ornish, Lancet Oncol. 2013;14(11):1112‐20.

Four Lifestyle Changes1. Whole foods diet2. Aerobic Exercise3. Stress management (60

mins/day)4. Social Support

Four Lifestyle Changes1. Whole foods diet2. Aerobic Exercise3. Stress management (60

mins/day)4. Social Support

Telomeres, Men With Prostate Cancer

Treat the Person, NOT the Diagnosis“On Being Sane in Insane Places”

8 “sane” people admitted to different psych hospitals in 1973

• 4 Psychologists

• 1 Psychiatrist

• 1 Pediatrician

• 1 Painter

• 1 “Homemaker”

All given the diagnosis of “Schizophrenia in remission”

Average length of stay:

Rosenhan DL, Science, 1973;179 (4070): 250‐8.

Photo: Dimitri.co.uk

“On Being Sane” Conclusions: “Being Sane” Study• “It could be a mistake, and a very unfortunate one, to

consider that what happened to us [as patients] derived from malice or stupidity on the part of the staff.”

• “Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent.”

• “Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves...”

Rosenhan DL, Science, 1973;179 (4070): 250‐8.


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Group Exercise: Getting to Know the Self‐Care Circles1. Count off from 1 to 8

2. Your number will be your self‐care topic assignment

3. Meet with your group (we will show you where in a moment) – take your Passport!

4. As a group, learn all you can about your topic from the Passport for 15 minutes

5. Be ready to share what you learn!Don’t

start yet!Don’t

start yet!


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Your Mission

1. Use the Passport chapters to guide you

2. Pick a spokesperson

3. Be ready to share for <5 minutes

Key Question:

What are some key options related to your topic that could be put into a Personal Health Plan?

You will share when the “Subtopic Circle” slide for your topic comes up.

Don’t start yet!

Don’t start yet!

SurroundingsPhysical & Emotional

Improve Where You

Live

Improve Where You

Live

Get More OrganizedGet More Organized

Improve Where You

Work

Improve Where You

Work

Improve Emotional

Surroundings

Improve Emotional

Surroundings

Create Healing EnvironmentsCreate Healing Environments

Reduce ToxinsReduce Toxins

Spend Time in NatureSpend Time in Nature

Make One Small Change


There is a clinical There is a clinical tool that reviews a few ways to reduce toxins...

There was a study There was a study that showed time in green spaces helps with...

Ways people can improve their work

environments include...

The Passport had this to say about hoarding...

Example: Surroundings

Go to the part of the room with your #

SCREEN

2. Working Your Body (Ch 5)

1. Surroundings

(Ch. 6)

7. Personal

Development(Ch 7)

3.Food & Drink

(Ch 8)

4. Recharge(Ch 9)

6. Spirit & Soul

(Ch 11)

5. Family, Friends & Coworkers

(Ch 10)

8. Power of the

Mind (Ch 12)

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Bac

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Now you can start!

We’ll update you on how much time

is left.

Image: dreamstime.com

Your Mission

1. Use the Passport chapters to guide you

2. Pick a spokesperson

3. Be ready to share for <5 minutes

Key Question to Answer at Your Table:

What are some key options related to your topic that could be put into a Personal Health Plan for a Veteran who wants to set a goal in this area?

1. SurroundingsPhysical and Emotional

Photo: gogrit.com


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How do surroundingsaffect your health?

• Home

• Work

• Neighborhood and community

• Emotional surroundings

• Nature

• Climate/environment

• Healing Spaces

Zeroing in on Options

GROUP 1 –PLEASE REVIEW

THESE FOR THE GROUP

SurroundingsPhysical & Emotional

Improve Where You

Live

Improve Where You

Live

Get More OrganizedGet More Organized

Improve Where You

Work

Improve Where You

Work

Improve Emotional

Surroundings

Improve Emotional

Surroundings

Create Healing EnvironmentsCreate Healing Environments

Reduce ToxinsReduce Toxins

Spend Time in NatureSpend Time in Nature



Surroundings: Why Bother?Our surroundings affect our health

• Sunlight and skin cancer

• Light levels and mood

• Smoking and lung cancer

• Thalidomide and arm growth

• Meditation and genes

• And magnesium and number of eyes... If you are a fish

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Photo: nationalgeographic.com


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Living Space:Ask These Questions

• Is it dry enough?

• Clean?

• Pest‐free?

• Safe? Are there fall risks?

• Unpolluted (smoke, radon)?

• Good air flow?

• Maintained – broken things fixed?

Photo: Dreamstime.com

Anything you wish to improve?Anything you wish to improve?

Homelessness

• Veterans comprise 11% of the adult homeless population (proportion varies by state).

• There are about 40,000 homeless Veterans

• Number of homeless Veterans down 45% over 2009‐17

Photo credit: mlaudisa via Foter.com / CC BY‐NC‐SA

The 2014 Annual Homeless Assessment Report (AHAR) to Congress. 10/17

Getting Organized

• How cluttered is their living space??

– Tidiness

– Messiness

• Clutter can cause falls

– Hoarding

• 5% of people

• Can be treated

– Squalor

• Accumulation of garbage

• Who could help?

Photo: clutterhoardingcleanup.com

Chater et al. Home Healthc Nurst, 2013;31(3):144‐54.


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Work Surroundings

• Could be about finding a place to work

• Health is better if you have more control at work, and reasonable demands

• Consider vocational rehab

• Ergonomics matters

• Coworker relationships

• Workaholism?

Photo: shareitsfunny.com

Emotional Surroundings

• Violence and abuse are common

• 35% of women, 29% men

• PTSD

• Depression, anxiety

• Information overload

• Sensitivity

– Over 10% people are introverted or highly tuned in

• Is there enough humor? Fun?

Photo: ivfpittsburgh.com

About Detox• Many Veterans have exposures

– Shrapnel, Agent Orange, radiation

• Not a lot of gimmicky detox methods work. These do:– Drink fluids

– Exercise

– Eat healthy – whole foods are best

– Saunas can be good if done safely

– Get sleep

– Avoid exposures, including smoke


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Surroundings and Healing

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Photo: activerain.comPhoto: pinterest.com

What would your rather see from your hospital bed?What would your rather see from your hospital bed?


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What Makes a Space Healing?

Appeals to the senses

• Sights – colors, light levels

• Sounds – quiet, loud noises, white noise

• Smells – fragrances, smoke, fresh air

• Touch – comfortable furniture, temperature, sounds, smells, touch, light

Photo: ucsfbenioffchildrens.org

What Else Makes a Space Healing?

• Art

• Nature

• People

• Choice

• Knowing where you are

• Feels a little like a home

Photo: ucsfbenioffchildrens.org

Mindful Awareness‐Your Healing Place...

• You are welcome to choose to do this or not

• It should feel safe and relaxing

• You will be visualizing a place that is healing for you

• What makes it healing?

• You can stop anytime you wish

Photo: videoblocks.com


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Partner Discussion:What Makes for Good Surroundings?

• Take a few minutes each to talk about the place that came up for you in the activity.

• Why do you like that place?

• What is one thing you could do to make other places where you spend time more like this place?

Photo: thewordofward.co.uk

Surroundings: An Exercise

• Draw a picture of what an optimal healing place would look like for you.

• Trust your instincts, don’t perform, entertain, or overthink.

• You have 3 minutes…..

• SHARE at your table

Photo: 123RF.com

Green Spaces and Mortality

• Systematic review of 12 studies

• Tens of thousands of subjects

• Looked at proximity of their homes to green spaces

• Odds of hospitalization for heart disease and stroke 37% lower for those in the highest tertile versus the lowest

• All‐cause mortality lowered

Gascon et al. Environ Int, 2016;80:60‐7.

Photo: People.com


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Video – Imagine a Pill Like This…

http://www.nature‐rx.org/nature‐rx‐part‐1/

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Surroundings: Why Bother?Living close to green space is good

People who live closer to green spaces live longer and have fewer heart attacks and strokes

Three days in nature, and your brain works better

Photo: snopes.com

Passport to Whole Health, Ch 6

How can you get more nature time?

Photo: worldoftravelphotography


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SurroundingsMake One Small Change

• Appeal to the senses

• Get organized

• Change work

• Improve emotional surroundings

• Create a healing space

• Remove/heal from toxins

• Get nature time

• Plant a tree

• Paint a wall

• Put a plant on your desk

• Take a media break

• Clean up the roadside

• De‐clutter

• Add art

• Get a carbon monoxide detector

Photo: Adam Rindfleisch

2. Moving the BodyEnergy and Flexibility

Photo: npr.org

Ways to Move the Body

• All kinds of activities that help

– Strength

–Endurance

– Flexibility

–Balance

–Posture


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THESE FOR THE GROUP

Moving the Body

Energy & Flexibility



Create a Personalized Activity Plan

Create a Personalized Activity Plan

Mindful Movement Mindful

Movement

Track Your ProgressTrack Your Progress

Take a ClassTake a Class

Work with an ExpertWork with an Expert

Moving the Body

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What if there was one prescription

that could prevent and treat

dozens of diseases, such as diabetes,

hypertension and obesity?

-Robert E. Sallis, M.D., M.P.H., FACSM, Exercise is Medicine™ Task Force Chairman

Health Benefits of Exercise

• Associated with lower all‐cause mortality rates

• Increases life span

• Prevention of cardiovascular disease, cancer (colon, breast), type 2 diabetes, hypertension, obesity

• Mitigates negative effects of aging

• Reduces dementia risk

• Enhances executive function and attention, processing speed, memory

• Decreases symptoms of depression, anxiety

• Improves psychological well‐being

• Promotes brain cell growth

Passport, Chapter 5


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FTO (Obesity) Gene

Rampersaud, Arch Intern Med, 2008;168:1791‐7.

Photo: pinterest.com

Walking: Comparing Amish with Non‐Amish

.Bassett et al. Med Sci Sports Exerc, 2004;36(1):79‐85.

Exercising Your Body Exercises Your Mind

• 162 healthy, middle‐aged, female twin pairs.

• Compared leg power 10 years earlier with changes in brain function.

• Those with sturdiest legs a decade ago had the least fall‐off in cognition.

• Leg power predicts both cognitive aging and global brain structure.

Steves, Gerontology, 2016;62(2):138-49.



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Personal Activity Plans: Be FITT

• FITT: – Frequency ‐How often?

– Intensity ‐ How hard will you work?

– Type ‐What you will do?

– Time – How long?

Frequency – How often?

• Every little bit helps

• Choose an amount you can do – if it seems easy, you’ll do it

• Work toward most days of the week, if that seems right

Intensity – How hard?

• Start gently

• “Can talk, can’t sing”

• More of a low‐key exercise = less of an intense one

Happiness is a state of activity.

-Aristotle

Happiness is a state of activity.

-Aristotle


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Type ‐What activity?

• If you enjoy it, you’ll do it more

• Many options

– A sport

– Walking/wheeling

– Classes (like tai chi or yoga)

– Gardening

– Dancing

– Using the stairs

– Stretching

– Weights

– Etc.... A combination?

Photo: somecards.com

Photo: askideas.com

Time ‐ How Long?

http://www.youtube.com/watch?v=aUaInS6HIGo

• It depends on you and your goals

• Start gently, build up slowly

• Even a little helps

• Don’t just count activity at work

Remember...

• Focus on what really matters

• Every little bit counts

• Start gently and slowly build up

• Do a combination of things

• Be sure it is fun

Photo: Foodandnutrition.com


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Mindful Awareness‐A Body Scan...

• Can help you notice more about what is going on with your body

• Should feel safe and relaxing

• Will have you notice different parts of your body, one at a time

• Can be stopped any time, if you need a break

*If you note discomfort, try to simply watch it without getting caught up in it.

Photo: tarabrach.com

Mindful Movement:Yoga and Tai Chi

1. All VA’s will be offering them in some way starting in 2018

2. We know they help your health

– They help prevent heart attacks, improve mood, build balance, and more

3. Can recommend a class – see what your VA has to offer

4. We’ll cover these in the CIH modules this afternoon

Apps and Pedometers

1. Pedometers and wheelchair odometers can tell you how far you go

2. There are many different types of apps –pick ones that work for you.

– General Examples (free, but have ‘in‐app purchases’)

• FIT Star

• MyFitness Pal (tailors workouts by fitness level)

– For specific activities –• Jefit for weight lifters

• Cyclemeter for cyclists


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When Choosing an App, Ask:

• Is it easy to use and to get around in?

• Do you trust the info it gives?

• Does it give you enough info?

• Does it tailor activities to your level of fitness?

• Does it want you to spend a lot on in‐app purchases?

Classes

• Know what is available at your site

• Yoga, tai chi, recreational therapy, dance, Pilates, others

• Some places have agreements with local YMCAs or other groups

• Some VA’s have gyms

• Events – wheelchair games, “walk with a doc”

Professionals

1. Physical therapists (PT’s)

2. Occupational therapists (OT’s)

3. Recreational therapists (RT’s)

4. Fitness class instructors

5. Personal trainers


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Moving the BodyMake One Small Change

All the topics so far can guide you• Personal activity plan

(FITT)

• Mindful movement

• App’s and devices

• Classes

• Professional help

Or set a different small goal• Walk with a buddy 3

times a week

• Park farther away

• Get a standing work station

• Use the stairs as able

Photo: Military.com

Video – Introducing Health for Life

Through One Veteran’s Story

https://www.youtube.com/watch?v=imEROGy6Kmk&list=PL3AQ_JVoBEyzh1RDFeKlW

kiY2z19Qg7yv&index=2

Movement Practice

Photo: Mybestruns.com


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3. Food & DrinkNourishing and Fueling

Photo: modernfarmer.com

Does Anyone Disagree that Food & Drink Affect Your Health?

Let food be thy medicine and

medicine be thy food.

-Hippocrates

Let food be thy medicine and

medicine be thy food.

-Hippocrates



THESE FOR THE GROUP

Food & DrinkNourishing & Fueling

Work with a Dietitian

Work with a Dietitian



Create Your Own Food & Drink Plan

Create Your Own Food & Drink Plan

Learn More About

Preparing Meals

Learn More About

Preparing Meals

Eat Mindfully

Eat Mindfully

Tailor Your Eating to

Your Health Needs

Tailor Your Eating to

Your Health Needs


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Our Body Mechanics: From Parts to the Whole

Photo: CariD.com

Photo: Pathwayz.org

Photo: kia.com

Photo: pixabay.com

You Really Are What You Eat

Everything is broken down into molecules

Those molecules affect how your body works

Those molecules turn into you!

Why Food and Drink Matter

Healthy Eating Also Helps You Feel Good• Blood flow

• Brain function

• Energy level

• Digestion

• Breathing

• Mental health

• Pain

• ...and many more areas of healthhttp://www.who.int/dietphysicalactivity/publications/trs916/summary/en/

Photo: USDA.gov


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Why Food and Drink Matter

Healthy Eating Helps Prevent• Obesity

• Heart disease

• Stroke

• Diabetes

• Cancer

• Mental health

• Pain

• ...and many more health issueshttp://www.who.int/dietphysicalactivity/publications/trs916/summary/en/

Photo: 360yourlife.com

Small Group Exercise:Best....Meal....Ever!

• Form groups of 2 or 3

• Choose someone to go first

• Each person takes a few minutes

• Describe one of your best meals ever

• What made it great?

Large Group Discussion:Best Meal Ever

What came up for you?

– A great meal is made up of good food... and more

– Company

– Conversation

– The setting

– Good memoriesPhoto: artofmanliness.com

Food & Drink connects to the other self-care circles in the

Circle of Health

Food & Drink connects to the other self-care circles in the

Circle of Health


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Food & Drink:Important Reminders

• This can be complex – good to get support (dietitians)

• Pay attention to habits – alcohol, binge eating, eating disorders

• Get your nutrients

• Be cautious if you have health issues, especially things like diabetes, liver or kidney problems, stomach problems

Personal Food & Drink Plans: Some “Food for Thought”

1. Don’t just think in terms of “diet”

2. People don’t follow through if it feels like a punishment

3. Not all calories are created equal

4. Careful about ‘good and bad’ labels

5. Consider your budget and what you have access to

Photo: newkidcenter.com

Personal Food & Drink Plans: More Food for Thought

Different Options

1. Add (increase) something

2. Remove (decrease) something

3. Change a habit

Photo: myprotein.com


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The Food & Drink Plan: Adding

• When you add something, you don’t have to add too many extra calories (unless you need them)

• Examples

–More veggies and fruits

–More fiber

–More water

–More nuts

The Food & Drink Plan: Removing

• Shouldn’t feel like a big sacrifice

• Examples

– Smaller servings

–Cut back desserts each week

–Drink fewer sweetened drinks

–Eat less processed food

–Cut back on sugar

–Eat less animal fat

The Food & Drink Plan: Changes

• Simple changes can make a big impact

• Examples

– Eat out less often, if you tend to eat less healthily when you do

– When you eat, really focus on eating (focus on the food and not the TV, sit down, leave your work space). Talking with others is okay

– Think about when you eat during the day, and how many meals and snacks you have

– Eat the rainbow

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Remember...

• Always go back and ask why healthy eating and drinking matter

• Remember, every little bit counts

• Start gently and slowly build up

• Do a combination of changes, if you like

• Work with other people who can support you –ask for help!

Examples:

“Starting next Monday, I am going to cut back to 1 soda a day and drink water in place of the other sodas.”

“I will go out for fast food only twice a week, instead of four times.”

“I will cut back on my salt intake to under 2,000 mg a day, like my dietitian asked me to do.”

“I will only eat half a bowl of ice cream at night, instead of a full bowl.”

Classes

• Know what is available at your site

• Many sites have Healthy Teaching Kitchens where Veterans can learn cooking skills

• Some dietitians teach classes on how to shop for healthy food, including on a budget

• Online classes can also be an option

Mindful Awareness‐An Eating Meditation...

• Eating slowly and intentionally is not usually part of life in the military!

• This next activity might seem strange, but you might be surprised what you can learn

• You might notice more about what goes on in your mind (or does not) as you eat

• You will tune into your senses and, if you wish, your emotions related to food

Photo: total-yoga.org


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Mindful Eating Experience

• Food is distributed on the tables.

• Don’t eat them just yet!

Photo: farmlandaccess.org

Reflections on Mindful Eating

• What did you notice?

‐Thoughts

‐Sensations

‐Emotions

• How does this compare to the way you normally eat?

• How can you use this experience in your daily life?

• How can you use Mindful Eating with Veterans?

There are many different ways to eat

• Based on general patterns

–High fat, low carb

–High carb, low fat

– Intermittent fasting

–Calorie control

–Vegetarian or Vegan

Note that this isn’t to say you must follow one specific eating

plan or approach!


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There are many different ways to eat

Popular diets: • Weight Watchers• Zone• Jenny Craig• Paleo• Atkins• South Beach• Mediterranean

Eating recommendations created by medical groups or individuals• American Diabetes Association diets

• DASH (hypertension) diet

• Glycemic Load• Ornish• Dietary Guidelines for Americans

So, How Do You Decide?

• You have to ask what is sustainable for you• Different approaches to eating work better for

different people- Ask your health care team (dietitian) for help- Consider how your health issues tie in

• Start small – set goals you know you can reach• The eating plans people succeed with are the

ones they keep following!

Some Examples

• Certain foods may trigger headaches in some people

• Certain approaches to eating can help with Crohn’sand colitis

• Type 2 diabetes can improve a lot based on how you eat

• How you eat affects cholesterol and weight

• Healthy eating can help prevent heart disease, stroke some cancers, and other problems

• Certain ways to eat are better for kidney and liver disease

• Ask for a dietitian to help you out!


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Red MeatDairySugar

https://oldwayspt.org/resources/oldways-mediterranean-diet-pyramid

Mediterranean Diet Grows Your Brain

Gu, et al. Neurology, 2015;85:1–8.

52% reduction in diabetes

in those with 3 risk factors.

• 418 subjects in 3 groups (Age: 55‐80)

• No calorie restriction

• No weight loss

• No increase in exercise

• Benefits remain!!

a) Med Diet (Olive Oil)

b) Med Diet (Nuts)

c) Control (Low fat)

Salas‐Salvado et al. Diabetes Care, 2011;34(1):14‐9.

Med Diet and Diabetes Risk


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Add Subtitle

CV Events with Mediterranean Diet

30% Reduction in those at high risk

Estruch et al., NEJM, 2013;368(14):1279‐90.

Nutrition & Food Services (NFS)

Registered Dietitian Nutritionists (RDN) make the connection between science & food choices.

NFS Nutrition Professionals… Experts in Action!

• Pay close attention to the research

• Are an important part of the team

• Follow a specific care process

– Gather info

– Help figure out what is going on

– Come up with nutrition plans• Teaching

• Counseling and support


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All the topics so far can guide you• Personal Food and Drink

Plans

• Meal prep, classes, teaching kitchens

• Mindful eating

• Tailoring your eating to your health needs

• Seeing a dietitian

All kinds of goals are possible• Add or subtract a food

• Change a pattern

• Time meals in new ways

• Only eat when hungry

• Cook with loved ones

• Try a new food

• Go to a farmers’ market

• Other ideas?

Photo: chron.com

4. RechargeSleep & Refresh

Photo: wideopenpets.com

Let’s Discuss: What Does it Mean to Recharge?

If there’s a secret to a good night’s sleep, it’s a good

day’s waking.-Rubin Naiman

If there’s a secret to a good night’s sleep, it’s a good

day’s waking.-Rubin Naiman


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Why Recharging Matters

• Promotes resilience, prevents burnout

• Increases safety (24 hours of no sleep is like a blood alcohol of 100)

• Allows time to reflect

• Gives you time to think about what really matters

• Gives you energy to pursue what really matters, too

Photo: Bearlakecamp.com

Sleeping: Why It Mattters

• Sleeping helps you keep a healthy weight

• You need sleep to lay down new memories

• It allows brain to remove toxins and regenerate helpful chemicals

• Good sleep is tied to fewer suicidal thoughts

Photo: Nationalgeographic.com

Sleeping: Why Bother?7‐8 hours a night versus less than 5:• 40% less obesity

• 40% less diabetes

• 40% less risk of cholesterolproblems

• 60% lower risk of stroke

• 150% lower risk of heart attack

• Fewer mental health problems

People who regularly get a good night’s sleep have a 4 times better survival rate

Photo: babygaga.com

Passport to Whole Health, Chapter 9


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Other Types of Breaks: Why?

• Low physical activity level (sedentary time) is tied to more health concerns

• Workaholism also causes problems

• Vacations can be beneficial

• Taking time for you matters

Photo: thefix.com



THESE FOR THE GROUP

RechargeSleep & Refresh




Sleep BetterSleep Better

Take BreaksTake Breaks

Boost Your Energy

Boost Your Energy

Take Time Just for YouTake Time Just for You

Discussion – How You Recharge Answer these questions, as you wish...

Discuss any or all of these with a partner• How is your sleep?

• What helps you sleep better?

• What gives you energy?

• Do you take breaks? Vacations? Stay‐cations?

• How much spare time do you have in a day, and how do you use that time?


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Tips for Improving Sleep

• Address sleep disorders and other health issues

– Sleep apnea

– Restless legs

– Reflux

– Allergies

– Heart failure

– Thyroid

– Depression and anxiety

– PTSD

– Bladder and prostate

Photo: formerdays.com

Improving Sleep: Other Self‐Care Circles

• Be active during the day

• Exercise• Try yoga

• Watch caffeine• Time meals well• Alcohol stops

helping over time

Use mind‐body approaches• CBT‐I• Meditation• Imagery• Breathing

• Light• Noise• Comfort• No TV in bed

CBT‐I and Mindfulness for Insomnia: Both Seem to Work!

• Garland, et al. Explore (NY), 2015;11(6)445‐54.• Ye, et al. PLoS One, 2015;10(11): e0142258.• Mitchell, et al. BMC Fam Pract, 2012;12:40‐51.


41

Raising Melatonin Levels

• Good Sleep‐Wake cycle– (7‐8 hours of uninterrupted sleep in darkness)

• Remove EMFs around bed

• Maintain ideal weight ( BMI=Melatonin)

• If able, remove drugs that lower melatonin

– Beta‐blockers, Ca channel blockers, antipsychotics, anti‐depressants and anti‐convulsants.

Light Therapy Works –No Matter the Season

Lam, et al. JAMA Psychiatry, 2016 Jan;73(1):56‐63.

Light Therapy Pearls

• The dose is 2,500‐10,000 lux of light for 20‐60 minutes, 2‐3 times a day. Start at 20 minutes twice a day (morning and early afternoon)

• Morning therapy is most effective

• The lightbox should be within three feet and the individual should not look directly into the light

• Encourage exercise outdoors on a sunny day


42

Sleep Tips – Sleep “Hygiene”

• Includes all the good habits that help you sleep better

• Get up and go to sleep at the same times each night

• Don’t watch TV or read in bed

• Consider sleep masks and good curtains

• Use white noise, ear plugs

• Use blue light filters

• Be strategic with naps

Mindful Awareness‐Working with Falling Asleep

• There are many ways to use mindful awareness to help sleep.

• Noticing your thoughts and emotions can help you learn to sleep better.

Photo: yogajournal.com

Not moving is risky

• People who watch 0‐1 hours of TV a week are half as likely to get diabetes or be obese as people who watch >40 hours a week

• Time inactive each day is a risk factor for heart attacks, above and beyond how much you exercise

• Move however you can during the day!

Photo: moneysense.ca

Katzmarzyk, Diabetes, 2010;59:2717-25.


43

Vacations help some

• Vacations can indeed be relaxing, AND

• Vacations can also be stressful

– Work tries to come with you

• You can come back refreshed, AND

• Benefits go away fast if you return to your daily stress

Photo: Wisebread.com

Katzmarzyk, Diabetes, 2010;59:2717-25.

Taking Breaks: Tips• Build breaks into your daily

schedule– Take 5 minutes for every 30

minutes you work

– Larger break of 15 minutes per half day

– Take lunch/meal breaks

– Go somewhere else for your break – mix it up

• Get a standing workspace

• Have a plan for how you use your break time

• Use vacation time if you have it

Photo: masymejor.com

Another Type of Break: Media Fasts

• Half of all adults in the US report that the news stresses them out

• Take a period of time (days, weeks) to unplug

• No news, no TV, no other electronics

• What do you think? Doable?

Photo: urchinmovement.com


44

Try it out!

An Activity

Where does your energy go?

Example: Joe

What charges you back up?

Example: Joe


45

What did you notice?

Photo: medicaleconomics.com

Why is time for ourselves important?

Photo: mydeal.com.au

What we do during our working hours determines what we have; what we do in our leisure hours determines who we are.

-George Eastman

Taking Time for You – Thoughts?• Many people who serve or care for others don’t have this on their radar

• It’s like oxygen masks on a plane

• Possible options

– Respite care

– Take 20 minutes a day (Less? More?)

– May mean hiding out for a bit

Photo: trueactivist.com


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Recharging: Professional Care

• Sleep psychology• Sleep specialists

• CBT‐I• Other psychotherapies

Acupuncture

Supplements Supplements (melatonin)

Address other health problems

Light therapy

Medications (with care)

Recharge: One Small Change

All the topics we have talked about can guide you

• Improve sleep

• Take breaks

• Take a vacation

• Add what energizes you

• Remove things that tap your energy too much

• Take some “me time”

• Work with a sleep expert

There are many small changes you can make. Examples:

• Take one sleep hygiene step – e.g., ear plugs

• Set aside a few minutes each day to pause

• Set an alarm to remind you to take breaks

• See how exercise and activity affect your energy

Photo: whatsnext.nuance.com


10. Self‐Care

Part II


47

5. Family, Friends & CoworkersRelationships

Photo: https://www.va.gov/vetdata/veteran_population.asp

Let’s Discuss: Connections

Replace “I” with “We” and illness

becomes wellness.-Satchitinanda

Replace “I” with “We” and illness

becomes wellness.-Satchitinanda

The Central Question:

Photo: vahomeloanguru.com


48



THESE FOR THE GROUP

Family, Friends & Coworkers

Relationships



Connect with Loved

Ones

Connect with Loved

Ones

Connect with Other Veterans and Community

Connect with Other Veterans and Community

Improve Communication

Practice CompassionPractice

Compassion


Discussion – Your ConnectionsAnswer these questions, as you wish...

• Who are five of most important people in your life right now?

• Who can you turn to if you need different types of support?

– Affection

– Finances

– Teaching or mentoring

– Help with a project (like home repair)

• Who turns to you?

• Share your answers with a partner

Family, Friends, Coworkers: Connection = Life

• 2015 meta‐analysis of 70 studies – Social isolation = 29% higher likelihood of dying

– Loneliness = 26% higher likelihood

– Living alone = 32%

–Results “…consistent across gender, length of follow‐up, and world region…”

Photo credit: Caro's Lines via Foter.com

Holt‐Lunstad, et al., Perspectives Psychol Sci, 2015;10(2):227‐37.


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Family, Friends, Coworkers: Connection = Life and Health

• 2014 summary: Interviews with 23 Veterans who had attempted suicide

– Two things would have helped most:

• More compassion and empathy from care providers

• Social support Montross, et al. Crisis, 2014;35(3):161‐167.

• Loneliness and poor social connection cause inflammation and chronic disease

Fagundes CP, et al, Soc Personal Psychol Compass,2011;5(11):891‐903.

High Social Integration

Low Social Integration

Tsai, A.C., et al., Ann Intern Med, 2014;161(2):85‐95.

2 x less Suicide!(and lower all-cause mortality)

34,901 Male Health Professionals over 24 years

The Importance of a Loving Partner

• 10,000 men with high heart disease risk:– Saying , “yes, my wife shows me her love” was tied to

• 50% less angina

• 50% fewer ulcers Medalie, JH, American Journal of Medicine, 1976, 60(6): 910‐21.

• 1400 men and women after heart catheterization– If you were not happily married or didn’t have a

confidante,

• Triple the 5 year mortality rate (50% died versus 15%)Williams, RB et al, JAMA 1992, 267(4):520‐24. Photo credit: The Nick Page via Foter.com

Photo: medicaldaily.com


50

Entrainment of Heart Rhythms in Sleep

McCraty, The Energetic Heart: Bioelectromagnetic Interactions Within and Between People. https://www.heartmath.org/resources/downloads/the-energetic-heart/

Animals

• Animal‐assisted therapy has multiple benefits

• Companion animals and pets can be very healing

• Anyone here have pets or other animals in your life?

Photo: bouderquestretreat.org

Photo: Ranker.com

Friends

• Being able to confide in people is linked to your health

• Number of confidantes per person has dropped in recent years

• Technology helps us connect

Photo: bethesdahealth.org

Photo: soldiers.dodlive.mil


51

Social Capital• The value of being connected

• You invest in others, they give back to you

• The balance of favors owed, favors given

• More = longer life

• Twin studies show that twins with more social capital have better mental and physical health

Photo: socialcapitalinc.org

Community is Part of the Circle

Fellow Veterans

• Do they connect with other Veterans?

• How?

• Volunteering

• VFW, DAV and other Veteran groups

• Other groups

• Classes

Photo: mentalhealth.va.gov


52

Giving: Volunteering and More

People who volunteer...

• Get to help others

• Live longer

• Feel a ‘helper’s high’

• Feel more of a sense of accomplishment

• Seem to do better with chronic illnesses

• Find it helps with depression

• Have lower heart disease risk

Photo credit: https://www.blogs.va.gov/VAntage/2224/support‐veterans‐during‐national‐volunteer‐week/

Veterans love working with other Veterans!

Veterans love working with other Veterans!

Even if you can’t volunteer, you can do random acts of

kindness

Even if you can’t volunteer, you can do random acts of

kindness

Healthy Groups: A Discussion

• What groups do you belong to?

• What groups have you considered joining?- Groups at work

- Support groups

- Group medial visits

- Social media

- Community gardens

- Classes

- Church/spiritual community

- Gyms

- Others?

Photo: gscid.co.za

Communication

Tips for Communication

1. Listen well

2. Ask and clarify, restate

3. Get out of fixing mode

4. Don’t focus just on what you will say next

5. I statements

- Use “I” instead of “You”

- “I don’t want to do that” instead of “You shouldn’t do that”


53

Communication‐ More tips

6. Listen as much as you speak

7. If you don’t know them, pause to introduce yourself

8. Ask what you and they want out of the conversation

9. Stay focused – don’t ramble

10. Consider their point of view

11. Body language – yours and theirs

OTHERS?

Compassion

• Favorably affects brain function

• Alters gene expression too

• Helps us connect

Photo: Skydharma.com

Social Workers and Others can… Experts in Action!• Suggest community resources

• Link people with support groups

• Help with intimate partner

violence

• Assist with benefits and services

• Share couples and family

counseling options (or offer the

counseling themselves)

• Teach communication skills

Photo: socialwork.va.gov


54

Family, Friends & CoworkersMake One Small Change


• Build a relationship

• Make a friend

• Join a group

• Work on communication

• Get expert help

• Practice compassion


• Go to a Veteran event

• Be active in your community –the arts, sporting events, local courses

• Set aside time each week to call/contact someone you haven’t see for a while

• Use social media (wisely)

Photo: herbhand.wordpress.com

6. Spirit & SoulGrowing & Connecting

Photo: cbsnews.com

Ground Rules

• Listen to everyone’s views

• Share your views, too

• Do NOT try to impose your beliefs on others

• Respect that everyone has a unique point of view

The Spectrum of SpiritualityThe Spectrum of Spirituality

I don’t believe

in...

I don’t believe

in...

I do believe

in...

I do believe

in...

I don’t know

for sure

I don’t know

for sure


55

What Do Spirituality, Religion, and Soul Mean?

You can’t have a physical transformation until you have a

spiritual transformation-Cory Booker

You can’t have a physical transformation until you have a

spiritual transformation-Cory Booker

Examples of Definitions

• Religion – a body of beliefs shared by a community

• Spirituality – directly experiencing the sacred

• Soul – what makes something or someone alive

• A person can be spiritual, religious, and soulful at the same time

Spirit and Soul may include:

• Meaning and purpose, what we value

• Seeking well‐being, inner freedom, and inner peace

• Living, flourishing, and being resilient when challenges come

• Connecting with others, or with something beyond us. Belonging

• Being in the present moment (mindful awareness)

Photo: harvestinghappinesstalkradio.com


56

Spirituality and Religion‐Why They Matter

• Attending religious services at least once a week – decreases risk of death by 23%

– Increases lifespan by 7.5 years

– Increases connection

• Coping: Spirituality and religion help people cope better, including with overall stress, cancer, chronic diseases, natural disasters, and the effects of war

Photo: beliefnet.com

Mallin R, Prim Care Clin Office Pract 2008; 35:857‐66.

Religious Gatherings: Benefits

• 2000 meta‐analysis found 22% lower mortality if you attend a religious gathering at least once weekly

• The study was criticized for not showing a “clinically significant change”

• However, the benefit is equivalent to:

– Using statins for primary prevention

– Exercise‐based rehabilitation after an MI

– The opposite of how much harm heavy drinking causes

McCullough ME et al. Health Psychol, 2000;19(3):211-222.

Spirituality and Religion‐More Benefits

• Mental health: Tying them in with mental health care (when patients want to) improves outcomes

• Healthy behavior: People are less likely to smoke, drink, etc.

• Benefits of prayer:

– Prayer activates different parts of the brain

– Seems to help with chronic pain and mood problems



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More Spirituality is Linked to

• Lower systolic and diastolic blood pressures

• Greater adherence when taking medications

• Exercising more

• Eating healthier

• Being able to quit smoking more readily

Mueller, PS et al, Mayo Clinic Proc, 2001;76:1225‐35.

A Summer’s Day, by Mary Oliver

…I don’t know exactly what a prayer is.I do know how to pay attention, how to fall downinto the grass, how to kneel down in the grass,how to be idle and blessed, how to stroll through the fields, which is what I have been doing all day.Tell me, what else should I have done?Doesn’t everything die at last, and too soon?Tell me, what is it you plan to dowith your one wild and precious life?

Mindful Awareness‐Spirit & Soul Writing Exercise

• An important piece of self‐care is connecting with what gives you meaning and purpose

• This is an exercise to help with that

• Note what comes up for you –thoughts, emotions, sensations – as you work through this exercise

• There will be time to discuss as a group when we finish

Photo: emptygatezen.com


58



THESE FOR THE GROUP

Spirit & SoulGrowing & Connecting




ExploreValues,

Meaning and Purpose

ExploreValues,

Meaning and Purpose

Consider if Spiritual

Practices are for you

Consider if Spiritual

Practices are for you

Work with Grief, Moral Injury, and Recovery

Work with Grief, Moral Injury, and Recovery

Explore ForgivenessExplore

Forgiveness

An important part of self‐care is self‐awareness.

What do you...

?

Image: redlinesteel.com

Six Aspects of Spirituality

Religious

Humanistic

Nature

Experiential

Cosmos

Mystery

You might find that

more than one of

these apply to you.

Also, you might be

drawn to others

besides these.

You might find that

more than one of

these apply to you.

Also, you might be

drawn to others

besides these.


59

1. Religious

Closeness and connection to the sacred as described by a specific religion. Sense of closeness to a particular Higher Power

• 83% of US adults belong to a religious group

• 91% believe in God or a universal spirit

Photo credit: Lel4nd via Foter.com

2. Humanistic Spirituality

Closeness and connection to humankind.

May involve feelings of love, reflection, service, and altruism.

Photo: WND.com

3. Nature Spirituality

Closeness and connection to nature or the environment. Like the wonder you feel walking in the woods or watching a sunrise.

An important focus for many traditional healing approaches.

Photo credit: WherezJeff via Foter.com


60

4. Experiential Spirituality

• Shaped by personal life events

• Influenced by our individual stories

• Informed by what we love to do and be

• Experience in war influences Veterans profoundly

Photo: dav.org

Photo: KZTV10.com

Photo: mae.kmi.com

Photo dailymail.co.uk

5. Cosmos Spirituality

• Feeling connected to all of creation.

• Can come up when you think about just how big it all is...

• ...like when you look up at the stars or down at a handful of grains of sand

Photo: Sweetie187 via Foter.com

Photo: flickr.com

6. Mystery

• There is much that we simply cannot know or understand

• Perhaps it is not possible to fully grasp or know, and that is okay.

Photo credit: _Hadock_ via Foter.com


61

Partner Exercise‐Your Spiritual Perspective

Consider the six different aspects of spirituality (and others you may think of):

1) Religious

2) Humanistic

3) Nature

4) Experiential

5) Cosmos

6) Mystery

• Which ones resonate with you the most, and why?

• How might your views influence how you take care of yourself?

What is a Spiritual Practice?

• Something you do that reminds you about what really matters

• An activity that brings peace and ease

• Something that helps you feel a sense of connection to something more

Photo: World Network of Prayer

Photo: KHVN AM.com

Photo: michaelshouse.com

Photo: stripes.com

What is a Spiritual Practice?

• Other Examples– Carrying an “anchor”– Holidays– Pilgrimage– Meditation– Music and Art– Joining a community– Gratitude– Compassion– Forgiveness– 12‐Step Programs

• You decide!

Photo: innovationmanagement.se


62

Grief

• More than an emotion

• Tied to physical and mental problems

• Complicated grief (7% of the time)

• Veterans were trained to be stoic, and that can cause problems with healing grief

• Important to have support

Photo: griefrecoverymethod.com

Info from the “Grief” Overview and Tools in the Whole Health Ed Website

Moral Injury

• Someone did something, saw something, or couldn’t prevent something that was against their deepest moral beliefs

• This causes them not to trust themselves or others

• Can be tied to medical problems

• Commonly happens during war

Photo: iStockPhoto.com

There are techniques to work through it – care professionals

can help

There are techniques to work through it – care professionals

can help

Recovery

• Healing for addiction

• 12‐Step Programs can be incredibly helpful

• “Process of change through which people improve health and wellness, live self‐directed lives, strive to reach full potential”

Photo: hogg.utexax.edu


63

Forgiveness

• A freely made choice, and a process

• Takes time• Research supports its use for many health problems

• Involves setting yourself free, notsaying a bad thing that happened is okay

• Is another area where it is good to get help from your care team

Photo: lifehack.org

Spirit and Soul: Experts

Chaplains

• Can help people from many religions and traditions

• VA has a strong chaplaincy presence

• They an cover many topics

– Death and dying

– Meaning of illness and suffering: “Why is this happening?”

– Feelings of spiritual anxiety, guilt, anger, loss, and despair

Psychologists, clergy, pastors, ministers, rabbis, etc. can help with grief, forgiveness, recovery, and moral injury too

Ph

oto

: atla

nta

.va.g

ov

Spirit & Soul: One Small Change


• Clarify your beliefs and values

• Decide if you want to start a practice

• Work with grief, moral injury, and/or recovery

• Forgive

• Talk to a chaplain or other professional


• Carry a photo of someone important to you

• Read something inspirational

• Offer gratitude

• Do a random act of kindness each day

Photo: thepet.info


64

7. Personal DevelopmentPersonal Life and Work Life

http://ewddlacity.com/index.php/

What Does “Personal Development”

mean to you??

Life isn’t about finding yourself. It is about creating yourself.

‐George Bernard Shaw

Life isn’t about finding yourself. It is about creating yourself.

‐George Bernard Shaw

Personal DevelopmentHow do you learn/grow/live more fully?

• Abilities - talents and skills

• Gratitude

• Learning and education

• Creativity, hobbies

• Service and volunteering

• Healthy mood, humor

• Hope and optimism

• Balance

• Achieving dreams and goals

• Building resilience

• Wonder and amazement

Photo: d

ailyherald

.com


65

Why This Matters: Examples

• Optimism, reducing hostility, and focusing on what is going well can all increase health

• Feeling good about the work you do improves health and prevents burnout

• Happier people are more healthy, socially connected, and successful

• Laughter and humor decrease anxiety, lower heart attack risk, and improve cholesterol

Why This Matters: Examples

• Volunteering lengthens your life, helps people with depression and heart disease, and builds connections

• Being more financially healthy is (to a point) linked to less stress

• Educational level is one of the strongest predictors of good health we know of

• Personal Development helps with resilience

Maslow and Self‐Actualization

• Abraham Maslow

• “Hierarchy of needs” – need to meet more basic needs so you eventually meet others

• Not to say that people struggling in one area can’t have a lot of successes in other areas

• Goal is to reach “self actualization”

wilgengebroed via Foter.com / CC BY‐NC


66



THESE FOR THE GROUP

Personal Development

Personal Life &Work Life

Build Hope and

Optimism

Build Hope and

Optimism

Find BalanceFind

Balance

Create and Learn

Create and Learn

GiveGiveBe Grateful (Count Your Blessings)

Be Grateful (Count Your Blessings)

Increase HumorIncrease Humor

Be More ResilientBe More Resilient



Positive Psychology

Defined as those “conditions and processes that contribute to the flourishing or optimal functioning of people, groups and institutions.”

It is concerned with positive human experiences, including:

• Gratitude

• Hope and optimism

• Values and meaning

• Forgiveness

• Positive relationships

Duckworth, Ann Rev Clin Psychol, 2005;1:629‐51.

Photo: socialsciencespace.com

Gary: “I learned to focus on the good”

Gary is a 35 year old Navy Veteran• Kept hearing he was ‘too

negative’

• Learned from his VA psychologist that people can learn to be more optimistic

• Started noticing – and shifting ‐ his thinking

• Set goals and plotted out how to reach them

• “It isn’t always perfect, but it is better!”


67

Employment

Photo credit: srqpix via Foter.com / CC BY

Employment associated with:

• Less chronic illness

• Better mental health

• Lower risk of suicide

• Longer life span.

Abby’s Work Life: “I hated my job.”

Abby is a 57 year old Gulf War Veteran

• She struggled with her job

– Limited control

– Negative supervisor

– Took a lot of work home

• Talked with her supervisor, and with human resources

• Asked for more responsibility

• Wrote out a job description

• Practiced saying no to working weekends and evenings

• Found she is less burnt out

• Taking classes to help with promotion

Giving: Volunteering and MorePeople who volunteer...• Get to help others• Live longer• Feel a ‘helper’s high’• Feel more of a sense of

accomplishment• Seem to do better with

chronic illnesses• Find it helps with depression • Have lower heart disease risk

• Even if you can’t volunteer, you can do random acts of kindness

Photo credit: https://www.blogs.va.gov/VAntage/2224/support‐veterans‐during‐national‐volunteer‐week/

What would they like to do? Veterans love to work with

other Veterans!

What would they like to do? Veterans love to work with

other Veterans!


68

Altruism, Relationships & Giving

• Mother Teresa study– Neutral movie or Mother

Teresa helping others– Watching act of compassion

improved immunityMcClelland, Psychol Health, 1988 2:31‐52.

• Tecumseh Study– Followed 3,000 volunteers for

9‐12 years– Volunteers 2 ½ times less

likely to die during study period

House, Science, 1988, 241:540‐45.


Gratitude

• Gratitude comes from the word gratia, which means grace

• Can work with it in many ways. Examples:

1. List three positive things that happened today. Do that every day

2. Express thanks to the people in your life

3. Count your blessings. Write them down if it helps!

Photo:pnw.edu

Laughter and Humor

Answer three questions:

1. How does humor help your health?

2. What makes you laugh?

3. Is there a way for you to laugh more?


69

Burnout and Resilience

Photo: Foter.com


We discussed this in Module 6. Anything that you do to boost your resilience is linked to Personal Development.

We discussed this in Module 6. Anything that you do to boost your resilience is linked to Personal Development.

Personal DevelopmentMake One Small Change

All the topics so far can guide you• Hope and optimism

• Balance

• Create and Learn

• Give and Volunteer

• Be grateful

• Humor

• Resilience

Or set a different small goal• Develop self‐compassion

• Increase happiness

• Work on your finances

• Set a new goal

• List your strengths

• Do a simple kindness for someone

Photo: brandvox.com

8. Power of the MindRelaxing & Healing

Photo: wjcatv.com


70

What Does “Power of the Mind” mean?

We are what we believe we are.

-Anonymous

We are what we believe we are.

-Anonymous



THESE FOR THE GROUP

Power of the Mind

Relaxing & Healing




Relax! Work with Stress

Relax! Work with Stress

Try a Mind‐Body

Approach

Try a Mind‐Body

Approach

Improve Emotional Health

Improve Emotional Health

Work with Habits

Work with Habits

Mind and Body (and Beyond)Why It Matters

• Mind and body are more closely connected than we used to think

• Our thoughts are affect our health

• Our feelings are tied to our health

• Also, our beliefs affect our health

• How we deal with stress matters a lot too

Photo: showtimeshowdown.com


71

A Spectrum of Techniques

• Biofeedback*

• Meditation*

• Guided imagery*

• Clinical hypnosis*

• Psychotherapies

• Art and music therapy

• Breathing exercises

• Eye movement desensitization and reprocessing

• Therapeutic disclosure

• Progressive muscle relaxation

…and many others

Photo credit: grimeshome via Foter.com

The ones with a * are covered by all VA’s in some form. Many

psychotherapies are already covered. Many others are also offered already,

but it depends on which VA.

The ones with a * are covered by all VA’s in some form. Many

psychotherapies are already covered. Many others are also offered already,

but it depends on which VA.

Passport, Chapter 12

Example #1: Placebo

• Placebos are treatments, like a sugar pill, that don’t have a chemical benefit

• A person’s mind makes them work (or not)

• They work about 1/3 as well (or more) as a treatment they are being compared to

• Even when people know they are getting placebo, it can still help. In a study of 97 people with back pain

– People knew they were getting a sugar pill

– They took it for three weeks

– They had their pain drop by 1.5 points on average (scale of 1‐10)

Carvalho, et al. Pain, 2016;16:2766-2772.

Photo: dingtwist.com

Photo: choose-healthy-eating-for-life.com

Example #2: Brain “Plasticity”

• Plasticity = ability to change

• We used to think our brains never changed after adulthood (except with aging and a little with learning/memory)

• Now we know better

• Mind‐body approaches change them. For example:– Chronic pain causes loss of brain

mass

– Psychotherapy (CBT) can help brain mass increase

Photo: braintalks.wordpress.com

Our brains function differently when we do mind-

body exercises

Our brains function differently when we do mind-

body exercises


72

Pause to ponder for a moment:

• How can the Power of the Mind support me with what matters most in my life?

• What makes me happy?

• What helps me relax?

• What helps me think clearly?

• Who in my life is good for my mental health?

It’s fine if you are still looking for these answers and don’t have them all yet.

Working With Stress

• In short bursts, stress helps us stay alive

• Chronic stress – being in “fight, flight, or freeze” all the time – is hard on us

– Inflammation

– Mood changes

– Blood pressure

– Emotions/mental health

• And, there are things we can do about it

Photo: 123RF.com

Relaxation Response:A Common Denominator• Term coined by Herbert Benson,

MD, a cardiologist

• The autonomic nervous system has 2 branches

1. Sympathetic (fight/flight)

2. Parasympathetic (rest/digest)

*Most mind‐body exercises have the parasympathetic activation and other physiological changes as a common endpoint

The key is, which approach will best fit any given individual?

Photo: jurist.org


73

Mindful Awareness‐Dropping In

• Can help you notice more about what is going on with your mind‐body connection

• Dropping in focuses you on what is happening right now – pulls you out of worries about the future or the past

Photo: psychologytoday.com

Mindful Awareness‐A Breathing Practice...

• Can change heart rate variability

• Can help you notice more about what is going on with your body

• Changes your state of mind and body away from fight or flight

• Can be stopped any time, if you need a break

*If you note discomfort, try to simply watch it without getting caught up in it. Use caution if you have breathing problems

Photo: tgo-4-health.com

Your Turn: Teaching a

Mind-Body SkillI really need to settle my mind!

I really I really need to calm my body!

Image: culturalgutter.com


74

1:2 ratio breath6 breaths per minute

In3-4

counts

Out6-8

counts

Now, Practice Teaching Your Partner

• Introduce a breathing exercise

• 1:2 ratio breath

• Centering Breath with hand on heart/belly

• Model it for them

• Get centered and grounded

• Guide them through it

• Ask for feedback from your partner

• Switch

What We’ve Covered Also Applies to Emotional Health

• Relaxing calms both thoughts and emotions

• The mind‐body approaches we have covered help with emotions too

• Finding the balance between head and heart is part of Power of the Mind

• And it isn’t about turning off feelings...

Photo: theatlantic.com


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Power of the Mind – and Power of the Heart

• People who are happy live longer and have fewer health problems

• Optimism correlates with lower cardiovascular even risk and all‐cause mortality

• Less anger and hostility means lower risk of heart attack

• People who laugh more easily have less heart disease

• Reducing anxiety reduces unnecessary visits and tests

Photo: symphony of love via Foter.com

Rozanski, JAMA Network Open, 2019;2(9):31912200 Clark A, et al. Int J Cardiol, 2001;80(1):87‐8.

HOSTILITYCARDIA Study• 374 18‐30 year‐olds

• Hostility index measured at baseline

• CT scans of carotids in 10 years later

• Those with more than the median hostility score had twice the risk of coronary calcifications

• ….and nine times the risk of those who scored below the mean

Image: Theophilos via Foter.com

Iribarren et al., JAMA, 2000; 283:2546‐2551.

Emotions and Heart Rhythm

McCraty R. Bioelectromagnetic Interactions Within and Between People. HeartMath Research Center.

Changes in heart rate from beat to beat are good, but only if there is a pattern...

Changes in heart rate from beat to beat are good, but only if there is a pattern...


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Habits

• Habits can be a positive or negative aspect of Power of the Mind

• Pause to reflect (no need to share out loud):

– What are your healthy habits?

– What are your unhealthy ones?

• VA has numerous resources

– Substance abuse (drugs, alcohol)

– Eating disorders

– Tobacco

– Hoarding, gambling, others...

Habits

• Another area you can focus on in your Personal Health Plan

• Many of the mind‐body practices can help

– Building good habits (optimism, gratitude, taking a different point of view)

– Working with challenges (harmful behaviors, hostility, addictions)

– Becoming more aware of triggers and how you react to them

Mental Health Professionals… Experts in Action!• Many different experts

– Psychologists

– Psychiatrists

– Social workers who do counseling

– Substance use specialists

– Suicide prevention

– Mental Health Treatment Coordinators

– PTSD experts

– Military Sexual Trauma Counselors

– ...many more

• Encourage people to work with any biases they have about mental health and talk with their clinical team

Photo: Mentalhealth.va.gov


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Power of the MindMake One Small Change

All the topics we’ve covered so far can guide you

• Focus on a way to relax

• Do a mind‐body exercise– Breathing– Meditation– Biofeedback– Imagery– Hypnosis– Others

• Work on emotions

• Work on habits

• Seek professional help


• Take a meditation class

• Practice counting to 3 before reacting to a challenging situation

• Remove something stressful

• Schedule in time to relax each day

• Talk to someone

• Do something that makes you happier

• Decrease _____ (smoking, gambling, etc.)

Imag

e: r

iven

gear

.com

Self‐Care: Putting it All Together

Video ‐ Arthur’s Amazing Transformationhttps://www.youtube.com/watch?v=qX9FSZJu448

Discussing Self‐Care: Demo

Image: moddb.com


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• Find a partner

• Ask them about the green circles

– Areas of strength?

– Areas where they want to improve something

• Practice asking some of the questions on page 17 of your workbook.

• No need to set goals or anything like that yet – we will practice that tomorrow.

Your Turn: Assessing Self‐Care

Image: P

sychologycareercenter.org

whyp day2am with hidden slides - whole health library · whole health in your practice day 2...

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