The Self-Healing Mind, page 20
“I don’t like to go out much anymore,” he told me. “I’m just so afraid I’ll run into my ex. I don’t have the bandwidth to deal with it.”
Because of that fear, Lewis spent the majority of his free time lying in bed, watching movies, and fielding those contentious phone calls from his old girlfriend. He said he was waiting for something to change, but he wasn’t sure what type of change would make the biggest difference. He explained to me that he had even stopped going to the gym over the past few months.
“I haven’t felt up to it,” he said. “I have a bum hip from football. I hurt it way back in high school. When it acts up, I know I need to stay out of the gym. I don’t want to make it worse.”
As we talked more, it became clear that Lewis wasn’t just taking a break from working out. Rather, he wasn’t moving much at all. Each day, Lewis went from his apartment to his car to work to his car and then back to his apartment again. According to his phone, if he cleared three thousand steps in a twenty-four-hour period, it was an active day for him. As a person who had been accustomed to moving his body, this was a precipitous drop in Lewis’s regular physical activity. That was one of the things that stood out as a big red flag for me the first time we spoke in my office.
Since Lewis told me his medication wasn’t doing anything for him, I initially prescribed a new antidepressant to see if that might help with improving his energy and calming his racing thoughts. A few weeks later, during our appointment, Lewis said that, like the previous prescription, the new one wasn’t working, either. He was still living the same kind of Groundhog Day–type of life. By this point, he wondered if he even had the capacity to feel better than he already did. After discussing the five pillars of self-care for mental health during one of our visits, Lewis decided that focusing on movement was a good place for him to start.
A few visits later, he came to see me and reported feeling much better. The effect was so dramatic that it initially caught both of us off guard. As we talked, he told me that he had intentionally gone to the gym for some light workouts. After a workout, he noticed dramatic improvements in his mood. He felt more motivated and a sense of calm, even to the extent that he felt in better control of his emotions during tense telephone conversations with his ex. After the next few trips to the gym, he realized he was continuing to feel better, and he allowed himself the space to acknowledge that moving his body was directly improving his mental health. After resuming his gym routine, he was feeling the best he had in a long time.
“I still don’t always want to go to the gym,” he told me. “But I feel really good when I’m done with my workout—and that feeling lasts. I keep that in mind when I start thinking about skipping.”
I could relate to what Lewis was saying. I noticed the same sort of mood-boosting buzz after a yoga class when I was living with depression. Yoga, of course, has the added benefits of intentional breath and a spiritual component to help bolster mental health. But it also is a form of movement—and movement, in any form, is a powerful tool that can help improve your mood as well as your overall sense of well-being.
Moving into Health
Even before I discovered yoga, I recognized that moving my body has the power to make me feel good. When I lived in New York City, I’d spend hours walking from Lincoln Center to Times Square, up to Columbia University, and then back down to Juilliard. I would slip on my headphones, lost in the rhythm of my favorite music, and sometimes walk for hours. I found that those walks did an incredible job of clearing my mind, relaxing my body, and leveling my mood, even on the most stressful days. Since then, I’ve known, intrinsically, that movement plays an important role in maintaining my mental health. I feel better after going on a quick run, walking my dog, or practicing an hour of yoga. Moving makes me feel good.
You’ve probably heard a lot of people talk about how “cardiovascular exercise” or “working out” are mental health boosters. Certainly, that’s true—and the scientific evidence backs up these claims. What you may not know is that you don’t have to run a marathon, engage in high-intensity interval training (HIIT), or dead press 250 pounds to enjoy those mental health effects. All you need is to move your body. It really doesn’t take all that much. While Lewis is a fan of quick sprints on the treadmill, and I now gravitate toward my yoga mat, there is also a benefit in taking a short walk around the neighborhood, a quick dance break in the kitchen while making dinner, or working in your garden on a sunny afternoon. What is most important to your mental health is that you find ways to move your body that you actually enjoy, and that you’ll stick with, even when you aren’t feeling your best. Many people struggle with the idea of adding more movement to their lives but, when you come to understand that movement is actually medicine, like antidepressant medications, it can become an integral part of treatment.
Joseph Firth, PhD, a researcher at the University of Manchester in the United Kingdom, has spent his career looking at the benefits of physical activity on mental health. He is one of an emerging group of scientists who are observing strong evidence that regular movement can not only help prevent and manage physical health problems like cardiovascular disease, type 2 diabetes, and cancer; it can also support strong mental health. In addition to that, it works for everyone. Firth’s own research studies have demonstrated that regular movement not only works to prevent mental illness if you’re healthy, but it also helps alleviate debilitating symptoms in those diagnosed with more severe mental illnesses, like schizophrenia and bipolar disorder.
“Based on the evidence we’re seeing, we’re really emphasizing the importance of reducing sedentary behavior,” said Firth. “Even the World Health Organization (WHO) has now updated its physical activity guidelines to say that every move counts; acknowledging that doing something is better than nothing. We’ve got such sedentary lifestyles nowadays that we’re not doing what our bodies need to just function normally.”
That includes our brains—and when we don’t move regularly, our mental health suffers as a result.
An Evolutionary Explanation
In order to understand why movement is critically important for mental health, consider what everyday life was like for our ancestors centuries ago. Long before the advent of supermarkets and kitchen appliances, human beings lived the hunter-gatherer life. To support basic survival, they had to constantly be on the move so they could find ample sources of food and water. They also needed to remain on high alert for any potential predators. That kind of vigilant activity takes a fair amount of brain power. Given the fact that the human brain needs so much energy to work its best—the brain calls dibs on about 20 percent of the body’s total energy stores—many evolutionary biologists believe that our brains naturally evolved to work best when our bodies are on the move. Movement enhances the flow of oxygen-rich blood to the brain as well as promotes neural connectivity. When you think about it, it makes a lot of sense.
“As a hunter-gatherer species, you have to move through the environment to survive,” said Firth. “When you are active and moving is also when your brain needs to be the most active and switched on. That’s because you are hunting, you are looking for berries and other foods. You want to make sure you’re not covering the same ground. You are finding new sources of food and you’re keeping an eye out for threats.”
According to Firth, there’s evidence that exercise results in our muscles releasing brain-derived neurotrophic factor (BDNF). Remember that BDNF is that brain molecule that helps keep our brains fit and nimble, so we can better adapt to the world around us, but it also helps to protect our brains from stress. You can imagine that our forebears, as they were traipsing around the savanna looking for food, would benefit from that extra brain “fertilizer.” It would keep them sharper, allowing them to be more creative about how they went about finding and acquiring different foods. It would also allow them to watch out for predators without being totally done in by the stress of the endeavor. That extra BDNF could help them keep ahead of any environmental hazards and threats—ensuring their safety and well-being. Not to mention, it would also help motivate them to continue on, even when food, perhaps, had been scarce for some time.
“[The release of BDNF] is an evolved consequence; our bodies were designed so that the brain and body are active together,” said Firth. “When we take away that physical activity, you end up taking away that boost for the brain as well.”
Today, of course, we don’t need to look any further than the local market or convenience store to gather our food. We don’t even have to go ourselves—a few taps on a smartphone app means you can have your favorites delivered to your door within the hour. We also, for the most part, don’t have to worry as much about predators or environmental hazards. The end result is that the vast majority of us spend our lives seated and sluggish, our bodies doing the bare minimum to stay upright. This can have a profound negative effect on both our physical and our mental health.
“We are doing nowhere near the levels of physical activity that our bodies were designed to do just to function normally,” said Firth. “That’s why everyone has diabetes, high blood pressure, and other health problems. And, as part of that, we’ve got no BDNF. We don’t have that brain power anymore. That’s fundamentally why we need a healthy, moving body to have a healthy mind.”
The human body wasn’t designed to be sedentary. It needs to move in order to thrive. This doesn’t mean you have to emulate the hunter-gatherer lifestyle, said Firth—you probably couldn’t if you tried. It doesn’t even mean that you have to be a super-athlete of some sort. Leave the marathons and endurance swims for the people who actually enjoy them. Rather, it’s all about finding ways to sit less and move more. Doing so not only may prevent physical health problems from emerging but also will help your brain work its best, and that means improved mental health.
Exercise versus Anxiety
Think about the way your body feels when you are nervous or stressed out. You can go back to the grizzly bear approaching the campsite example we discussed in Chapter 6, if you’d like. Or maybe you can conjure how you felt before a public speaking event, a big sports competition, or even those moments just before you asked your partner out for the first time. As you likely recall, in these moments, your sympathetic nervous system kicks in. Your breath quickens, your heart rate accelerates, and your blood pressure starts to rise. Blood rushes to your brain as well as to your arm and leg muscles. Your body, thanks to its sympathetic nervous system response, is ready for you to think fast, move fast, and deal with the situation at hand in the best way possible.
Now, consider how your body responds to physical exertion. Do you notice the similarities? There is quite a bit of overlap between how the body responds to physical exertion and how it responds to anxiety. Shorter, shallower breaths? Check. Elevated heart rate? Indeed. Increased blood pressure? Also, yes. You probably also have sweaty palms and dry mouth. The two states are nearly identical.
I mention the similarities of physiological symptoms here because (a) they help to illustrate how exercise ties together the body and mind through the sympathetic nervous system response, as Firth explained, and (b) exercise offers an opportunity for you to learn how to manage these symptoms in a controlled environment before you go into full sympathetic overdrive.
Let me explain. Another patient of mine, Jess, was a star volleyball player for her college team. Although she played throughout high school without much of an issue, by the time she reached college, NCAA-level competition resulted in her experiencing horrible pre-match anxiety. When she came to see me, she said she’d been spending an hour before each game vomiting in the bathroom.
Antianxiety medications helped calm her down, but they interfered with her performance on the volleyball court. She told me they made her feel tired and decreased her reaction time.
“I’m no longer puking, which is definitely a plus,” she told me. “But I’m so much less alert when I get out there. I just feel like I’m in a fog when I need to be at the top of my game.”
Her story reminded me of my pre-performance jitters when I was a student at Juilliard. I should tell you that playing live at Avery Fisher Hall in New York City has a way of ratcheting up your nerves. It got to the point where I started doing one hundred jumping jacks or taking a quick run-in-place before I practiced at home, because I wanted to simulate the feeling I’d experience onstage. By using aerobic exercise to engage my sympathetic nervous system, I became more aware of what would likely happen in my body in response to the emotional stress of an audition or a live performance. That helped me to learn, over time, how to acknowledge that physiological response and perform despite my nerves. For example, I learned that if I intentionally activated my sympathetic nervous system by running in place, after I stopped running I could always inactivate my sympathetic response by taking slow, coherent breaths. It took some practice, but eventually I learned that I still had some control over my body’s natural response to anxiety. Ultimately, the time I spent practicing how to manage my sympathetic nervous system made a huge difference for those big performances.
When I suggested that Jess try something similar, she was skeptical. She didn’t think jumping jacks would do it for her (and let’s face it, they might not have; she was in much, much better physical shape than I was as a student). But as we talked more about strategies to help her manage her anxiety, she told me about how, at one volleyball summer camp, the locker room showers had only cold water.
“I hated it so much,” she said. “I’d just have worked out for the day, but I’d feel my heart beating out of my chest just anticipating that freezing water. I got out of there as soon as I possibly could.”
That physical response to cold water was something she could use to help her simulate her own sympathetic nervous system response. To help better manage her pre-game anxiety, Jess started taking an icy, cold shower before volleyball practice. This mimicked her nervous state and gave her the opportunity to find ways to manage those feelings outside of the high-stakes situation of a college game. Jess also found breath work useful in curbing her stage fright, especially 4-7-8 breathing, and started using the technique before joining her team on the court.
While the shower and breath work combination didn’t immediately or completely relieve Jess’s anxiety, it had a cumulative effect. Within a few weeks, although she still felt nervous before playing, she managed to perform without losing her lunch before each match. She could use these self-care techniques to help her better manage anxiety so she could concentrate on playing her best game.
The Many Benefits of Movement
As Lewis and I talked more about exercise during our sessions, he told me he enjoyed high-intensity running intervals on the treadmill, where you intersperse bursts of all-out sprints with lower-intensity jogging.
“You do these intervals, and I can sometimes catch a runner’s high,” he said. “Even if I don’t, though, I still end up feeling nice and relaxed for the rest of the day.”
Many elite athletes talk about achieving a runner’s high during intense physical activity that’s accompanied by feelings of euphoria, relaxation, and decreased sensitivity to pain. As we discussed before, the sympathetic nervous system is activated in response to physical movement (including going for a run). The sympathetic nervous system makes the heart pump faster, working hard to get oxygenated blood to where it’s most needed. Endorphins (chemicals in the body that may reduce perception of physical pain) are released as well as endocannabinoids (chemicals that regulate emotional stress and mood). Although there’s some controversy about the role endorphins play in directly affecting mood in response to physical activity, endocannabinoid levels have been found to be elevated in the blood in response to exercise, and that elevation has direct associations with a boost in mood. In essence, when you move your body, feel-good endocannabinoids are released into the bloodstream. From there, they can move directly into the brain. Endocannabinoids have been found to work almost like an antidepressant as well as to reduce our body’s physiological response to stress.
It probably doesn’t surprise you to learn, given just how interwoven movement and brain health are, that exercise also promotes the release of BDNF as well as neurotransmitters like dopamine, norepinephrine, and serotonin. We already talked about the benefits of increased BDNF. These particular neurotransmitters are linked to not only mood regulation, but also enhanced learning and memory. After all, your hunter-gatherer ancestors didn’t just need to be calm and motivated. They also needed to be sure they were at the top of their mental game so they could find food and water sources as quickly as possible.
“Exercise can lead to overall improved mood,” said Firth. “It can improve the workings of the threat detection areas of the brain, and how it processes threats and anxiety. In doing so, it can help you modulate your emotions. But it also helps with cognitive deficits.”
Many mental illnesses produce cognitive deficits that make it harder to concentrate or work through complex tasks, and may create short-term and long-term memory problems. Experiencing a cognitive deficit as a result of mental illnesses like depression or dementia can impact almost every aspect of your life.
“This makes it much harder to understand social situations and complex social interactions fully,” said Firth. “Obviously, cognitive deficits are an annoyance, but they also impact a person’s ability to keep a job, keep a friend, or keep a relationship. It has that knock-on effect that makes it harder for people to just get on in day-to-day life. And when you can’t get on in day-to-day life, it becomes a vicious cycle, making it even harder to overcome your mental health condition.”
That’s another reason why regular exercise is so important for mental health. Firth’s own research has shown that patients struggling with schizophrenia demonstrate improved cognition after exercise interventions.
