Improving Mental Health With Mindfulness and Lifestyle Changes

While there is definitely a place for medications and drugs to treat many mental health disorders, there also needs to be an understanding that medications do not change the environment contributing to negative thoughts and behaviors. Psychotherapy, mindfulness training, and healthy living behaviors are also key to bringing a person back to mental wellness. 

One popular psychotherapy approach is cognitive behavioral therapy (CBT) - a type of therapy that has been studied in depth in both research and clinical settings and have shown to significantly improve a multitude of mental health disorders. 

CBT bases its treatment on the consideration that those who experience mental health disorders may have thinking behaviors that are unhealthy or unhelpful, that we have learned these patterns of unhelpful behaviors, and that there can be shown methods to better cope with these thoughts, behaviors and patterns to achieve symptom relief. 

CBT sessions are focused on changing a set way of thinking to try to re-position the mind to think differently about the same situation:

- Problem-solving skills to cope with challenging situations

- Understanding realities of situations, and realizing our distortions in thinking about these realities

- Learning and understanding motivations and behaviors of other people

- Developing confidence in oneself

- Learning and practicing mindfulness, calming and relaxation techniques

Additionally, paramount to improving mental health requires a holistic approach - often focus must eventually shift to incorporating a healthy lifestyle with good nutrition, regular physical activity, and routine and sufficient sleep, as well as stress reduction techniques (or changing a particular situation to remove stress if possible). 

There is evidence that nutritionally, fatty/greasy and high sugar content foods can worsen mental health such as depression, whereas foods such as eating more fruits and vegetables is associated with mental well-being. 

There is evidence that regular exercise can help build those endorphins that help you weather stress, mental and physical pain, sadness and despair. Even better is finding a physical activity you find interesting and working towards engaging in that interest - no matter how dark your journey is at the moment, no matter how exhausting, consider it a prescription from the physician to climb out of the deep darkness to somewhere where you can see the sun again - small steps at a time.

Developing a routine of good habits over time and staying consistent with these good habits builds overall confidence and self-esteem, builds a sense of purpose and achievement in life, which then helps shield against negative thinking and despair. It may help us re-wire our brain and balance the levels of neurotransmitters simply by thinking and living differently. 

The neurochemical biology of mental health disorders is very complex, however, and cannot always be improved by therapy or mindfulness alone - please do not vilify or shun the person who does not achieve the results you expected them to achieve with lifestyle changes. Sometimes, medications are needed to bridge over the darkness and this is appropriate in the course of treatment. We should reach for medication with caution, and as physicians, it is our duty to explain what we're prescribing, expected outcomes and potential side effects. Some of these medications have significantly changed the course of lives of many, so it is still beneficial to consider this option as an adjunct to therapy and lifestyle changes. 

Here are some affordable resources to consider to help guide you, especially if you feel you're going through a bout of mental health challenges. Asking your physician for specific recommendations for community CBT resources or therapists is highly recommended, as a dedicated therapist on your team can tailor treatment to you individually and make the most of a therapy session. 

Engage with your physician to work on lifestyle changes - even though this may be one of the most challenging things you do while you battle mental illness; it will help pave the way for long-term mental health healing and stability.

Be Mindful Online - CBT Online Course (Complete At Your Own Pace)

Meditation Short Audios - Guidance

Financial Disclosure: Dr. Kristine Tsai receives no monetary compensation for referral to these websites on this specific post.

Why Is My Cold Not Treated with An Antibiotic Right Away?

Physicians are often put in quite a challenging position when trying to do best by their patients. One of the most difficult pieces is offering an appropriate treatment plan for upper respiratory infections (or common colds and acute bronchitis) - often which just tender loving care, rest, hydration and nutrition will support your body to fight of the infection on its own. We try our best to hold off on antibiotic treatment because there is inherent harm to the patient and the community from over-prescribing. Here is one of the most common disappointments I see on patient surveys:

"I went to see my doctor, and I had this miserable cold! She said I was going to be fine and sent me home! What a waste of my time and money! That doctor was useless!"

Patients: I absolutely hear your frustrations on the above, and hope we can communicate better regarding care plans. In fact, when I was an undergrad in college, I had the same complaint about my own sick visit. I was prescribed some OTC allergy pill, and was so upset I wasted $90 to be told it was nothing when I felt so awful. Did I get better on my own? Yes. Didn't even take the allergy pill. Learned a lesson that year. 

To help everyone understand, here's the Physician reasoning:

Your current infection is probably caused by a virus.  Antibiotics cannot kill viruses. Viral infections can last about 2-3 weeks, but you will slowly begin to improve on a day-to-day basis, although it may feel like it’s slow and lingering.

Often times, most of your symptoms would have improved after 2-3 weeks, but you may even have a lingering cough that could last 4-8 weeks. This is part of the inflammation healing process, and it is not a type of bronchitis that can be healed by antibiotics.

Anti-viral medications for Influenza and COVID19 are available. These medications are very helpful to prevent severity of these specific viral infections (not other common cold viruses). You must test early for these diseases to make taking the medication effective and worth it --- another reason why we still recommend testing for COVID19 and the flu early in your symptoms as a helpful way of managing these diseases. 

These are the reasons antibiotics can be a problem if it is prescribed too often (or reasons that it should be prescribed with caution):

•  Antibiotics can cause side effects and allergic reactions – some people get nausea/vomiting, others diarrhea, and others end up at the hospital with swelling and rash.

•  Antibiotics can destroy your good gut or intestinal bacteria. These good bacteria help with overall appropriate digestion and movement of your bowels. Good gut bacteria can also prevent deadly overgrowth of bad bacteria. One of the most common dangerous overgrowth is by Clostridium difficile (or C. Diff). This is a very serious condition that can cause inflammation in your bowels and can be very painful or simply very smelly. It also causes a severe diarrhea that would not go away, and this infection would then need more antibiotics for treatment. Antibiotic use can also lead to increased risk for fungal or yeast infections.

•   Antibiotics overuse can lead to resistant bacteria – this may mean that one day, if you were in a situation which requires the use of antibiotics (for instance, in burn patients, transplant patients, cancer patients, and those with deadly infections), the antibiotic had stopped working on the bacteria because it was overused, then it is now a matter of life or death. There are already people in hospitals that struggle with this now. Unfortunately, we don’t have newer antibiotics to fight these infections at this time.

"Doctor, ok.... I understand you don't think it's necessary for antibiotics, but I'm miserable. Why aren't you doing anything for me?!"

Here is where I feel bringing this up with someone who is on your trusted health care team can make the difference (rather than going to a Big Box Store Clinic). You will feel much more comfortable telling a physician you've known for years how awful you feel and that you don't agree with that TLC-rest/hydrate plan (or your physician will notice how miserable you feel because they've seen you on your good days). Bring it up: Say - my cough is bad, can you please prescribe something for it?

This is again, part of the team approach to care. Please openly communicate how miserable you feel and what symptom(s) you need us to address the most right then and there. We might not be able to cure your viral infection right away, but we might be able to help ease the course. 

"So what if my symptoms are getting worse even after a diagnosis of viral infection?"

Physicians don't have a magical scanner in our eyes and cannot predict if your currently benign infection is going to progress to pneumonia or a bacterial infection. We make risk assessments based on progression of a disease. I always say, what is occurring one day can change quickly in the following days. 

We do not recommend antibiotics to “prevent” things getting worse or "getting ahead of the infection" for the above reasons written. However, there is always a chance of your symptoms getting worse and leading to such a complication, although this does not occur very commonly in every infection. Some people tend to have more complications than others. The most appropriate way to handle this situation is to keep your physician in-the-know (another good reason to seek out your primary care team to help, because they follow you all the way). Please understand that sometimes another office visit may be required to evaluate your symptom progression because certain diagnostic tests may need to be ordered or certain antibiotics only work for certain infections such as pneumonia, and we should see you to try to get the right diagnosis to give you the best prescription possible. It may seem inconvenient, but it is the best way for us to take care of you and get you feeling better sooner and stay out of the hospital with the least amount of side effects and harm as possible. 

If it feels very miserable, then find us early so that we can test you for flu and COVID19 and check for pneumonia or other diseases as soon as possible. However, if it feels like a mild common cold and you test negative for COVID19 at home, then you might not need to come see us at the very early part of your cold each time.  Check-in with your physician to see if they want to see you right away.  You may save yourself a co-pay.

Surely if your symptoms are still not improving, and it's been more than 10-14 days or you notice worsening or scary symptoms, come find us - we're here to help rule out the bad diseases, provide treatment/therapies when indicated, and sometimes advise reassurance as well. It also puts you on our radar in case you call back saying... something's not quite right.