What goes well with psychotherapy?
If you’re thinking “psychiatry” or “exercise,” you’re not wrong, but those have been covered ad nauseam. Three other things, one of which may enhance medication efficacy, can nicely complement more traditional mental health care approaches.
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Chiropractors, massage therapists, and nutritionists.
These professionals may not have psychology degrees, but their services can have profound effects on mental health. Here’s how:
Some readers may be familiar with the quasi-chiropractic practice of craniosacral therapy and the claims of attention-deficit/hyperactivity disorder (ADHD) and autism symptom improvement (eg, Amrovabady et al., 2013; Vaughn Kratz et al., 2017), but what about general chiropractic or orthopedic interventions in depressed/anxious people?
Consider that low back pain and depression often co-occur (Harvard, 2013., Mei et al., 2019) and it isn’t always that people get depressed after an injury. As noted by Mei et al. (2019) There is evidence of an association between an unhealthy mental state and low back pain in uninjured people who are leading psychologically stressful lives, for example.
It’s also no secret that people with depression can experience a somatoform disorder with pain symptoms (eg, American Psychiatric Association, 2013). Somatoform disorders are physical symptoms in the absence of any physiological cause, believed to be brought on by subconscious mechanisms symbolically expressing internalized conflicts related to the affective state. However, anyone who has been sufficiently depressed or anxious, or worked with these populations, will be familiar with musculoskeletal discomforts brought on by psychomotor symptoms related to depression and anxiety that exacerbate their dysphoria.
Over the years, I’ve heard physical complaints ranging from upper and lower back and neck discomfort to jaw problems and headaches coinciding with depression and anxiety. Consider that depression can lead to poor posture and irritation, afflicted people hanging their heads or sitting slumped, perhaps even bedridden in positions not kind to the back. You don’t have to be a kinesiologist to know that muscle tension is part of the package of chronic stress/anxiety (eg, American Psychological Association, 2018). This happens especially in the shoulders, which affects the neck; the chain reaction can lead to jaw problems and headaches (eg, Babak, 2004).
Patients who complained of tension in the upper back, neck, and jaw not unusually complained of a chain reaction that ended in headaches. Some mentioned clenching so hard in their sleep they’d awaken to an earache and would feel “stuffy” ears all day. Along with this was sometimes the development of tinnitus, or ringing in the ears, which becomes another noxious stimulus to contend with.
When you’re already down and out, these states are an insult to injury. They can exacerbate insomnia and make it harder to concentrate, try to exercise, and be able to work or go to school, which creates additional stressors, keeping the psychological distress up. In fact, researchers such as Kapfhammer (2006) have noted that when painful physical symptoms accompany depression, it is correlated to more relapse of depression, chronic and severe course of illness, suicidal activity, and early mortality.
A chiropractor or orthopedic specialist could prove helpful in evaluating and correcting such structural complications caused by psychological distress. They could also recommend physical therapy to narrower resumed physical comfort that allows one to sleep better again and move about without the stress-causing pain that exacerbates the psychological distress.
Massage can not only be a pleasurable, tactile treat to the chronically stressed or anxious, but it can also contribute to relaxing the muscle tension that contributes to the aforementioned musculoskeletal discomforts. Furthermore, the effects are deeper than the muscles massaged. Massage seems to reduce cortisol (eg, Field et al., 2005; Rhoades & Hopper, 2017), which is higher in people with psychological distress and contributes to musculoskeletal tension (eg Tosado et al., 2015). It has also been observed to increase serotonin (eg, Field et al., 2005; Rhoades and Hopper, 2017), the well-known neurochemical combatant of anxiety and depression.
Furthermore, massage/”body work” has become a wider area of interest for posttraumatic stress disorder (PTSD) intervention (eg, van der Kolk, 2014; Korn, 2016; Sumpton and Baskwill, 2019). Korn (2016), for example, documented several studies in which massage was correlated with decreased pain, dissociation, anxiety, and depression, and better feelings of safety and interpersonal boundary settings in traumatized individuals.
While many massage therapists are generalists and can provide enjoyable and relieving muscle work, it will be important to have a discussion with them about what specifically is irritating you or if you’d simply like a relaxing massage. If you’re involved in trauma therapy, your provider will likely know of massage therapists educated in working with people with particular kinds of traumas. This is very important to inquire about, as touch can be healing, but also could be triggering if not carefully applied.
As an aside, massages from experienced licensed massage therapists can be expensive and aren’t usually covered by insurance plans. The good news is that many massage schools offer significantly discounted sessions by supervised students.
Everyone knows the phrases “You are what you eat” and “Garbage in, garbage out.” Essentially, what you consume has a big impact on how you feel. Of late, there is momentum toward “medical foods,” or nutraceuticals. A cursory search will present plenty of evidence that dark leafy greens, calciferous vegetables, nuts, and cold-water fish are correlated with improved mental health.
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It’s almost as if, after a near century of psychopharmaceutical popularity, the tide is beginning to shift toward prescription of a healthier dietary lifestyle to aid mental wellness. Nutritional psychiatrist Uma Naidoo (2020) tells us that, prior to the 20th century, doctors were clued into the gut–brain connection, but as medicine became more specialized, a focus on the big picture, or, how systems interact, was reduced to looking at single organs. In this case, it was medication that targeted the brain without regard to how other systems may contribute to psychological distress.
Modern diets are often high in refined sugars and carbohydrates, and there is a correlation between escalated depression and anxiety in people with such eating habits (eg, Sadeghi et al., 2019). Chances are, these foods encourage inflammation, which is thought to be a contributor to psychological distress (eg, Hyman, 2009; Bullmore, 2018).
Aside from helping with a diet that fights psychologically stressing inflammation, nutritionists can also assist in creating diets that are believed to enhance anxiety and depression-fighting neurotransmitters like GABA and serotonin in the body (eg, Briguglio et al., 2018; Srivastava and Kumar , 2021). Regarding serotonin, for example, as noted by Eva Selhub, MD (2020), “Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions.”
Lastly, some more traditional psychiatrists are prescribing nutritional supplements along with pharmacological interventions given there is evidence they may enhance the efficacy of the medication (eg, Buffington, 2015; Schefft et al., 2017; Firth et al., 2019).
Disclaimer: The material provided in this post is for informational purposes only and not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care from an individual’s provider or formal supervision if you’re a practitioner or student. Before embarking on any of the adjunctive therapies in, be sure to investigate with your provider(s) if it is a sound option for you.