Dr. Sarah Ravin - Psychologist | Eating Disorders |Body Image Issues | Depression | Anxiety | Obsessive-Compulsive Disorders | Self-Injury
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Dr. Sarah Ravin

Welcome to my professional blog. I am a Florida Licensed Psychologist and trained scientist-practitioner. In 2008, I received my Ph.D. in clinical psychology. A major component of my professional identity is staying informed about recent developments in the field so that I may provide my clients with scientifically sound information and evidence-based treatment. There is a plethora of information on the internet about Eating Disorders, Depression, Anxiety, Psychotherapy. Unfortunately, much of this information is unsubstantiated and some of it is patently false. It is my hope that by sharing my thoughts and opinions on psychological issues, with scientific research and clinical experience sprinkled in for good measure, I can help to bridge the gap between research and treatment.


Tag: Evolution

Tuesday, August 25th, 2009

Lifestyles of the Depressed and Anxious

Despite miraculous advances in science, medicine, and technology, the rates of mental illness in the western world are higher than ever before. For instance, the rate of depression in the United States is ten times higher today than it was just two generations ago. Most mental illnesses are biologically-based and genetically-transmitted, but genes don’t change that fast, and we are biologically quite similar to our ancestors. Prior to the 20th century, human beings faced more risk and hardship on a regular basis than most of us will ever know, all without the advantage of modern science and medicine. But somehow, they were more resilient. How can this be?

Research suggests that many features of the modern lifestyle are toxic to our mental health. Most Americans have at least one, if not many, of the following issues:

• Too little sleep (less than 8 hours per night)
• Not enough exercise
• Insufficient exposure to sunlight
• Insufficient time outdoors
• Hectic, overscheduled lifestyles
• Too little “down time” to relax and unwind
• Poor eating habits (dieting, skipping breakfast, overeating, having too few fruits and vegetables, skimping on protein and dairy and carbohydrates and fats, eating too many processed foods, insufficient intake to meet one’s energy demands)
• High levels of stress
• High levels of caffeine consumption (more than 2 caffeinated beverages per day)
• Excess alcohol consumption
• Use of illegal drugs
• Over-reliance on prescription and over-the-counter medications
• Social isolation
• Underutilization of family and community supports
• Intense pressure (self-imposed and socially prescribed) to achieve and perform

Sound familiar?

Any one of these issues has the potential to trigger a mental illness in someone who is biologically vulnerable. The unfortunate reality, however, is that most Americans are dealing with several of these concerns simultaneously. No wonder we are so depressed and anxious!

Hundreds of years ago, our lifestyles were much simpler and much healthier. Our better habits were reflected in our mental health. Consider the Amish, who pride themselves on resisting societal change and maintaining their 18th century lifestyle. The Amish have very low rates of mental illness. I believe this is largely attributable to their lifestyles: they are physically active every day, they get plenty of sleep, they simplify their lives, they have low levels of stress, they eat naturally and nutritiously without dieting, they are deeply spiritual, they have a strong sense of community, and they rely upon their families, neighbors, and churches for social support.

Consider the Kaluli, an aboriginal hunter-gatherer tribe native to the highlands of New Guinea. Relatively untouched by modern society, their lifestyles closely resemble those of our ancestors. They live and work outdoors, they are physically active for most of the day, they eat naturally and bountifully from the land, they get plenty of sleep, and they rely heavily on their families and communities for support. A western anthropologist who studied the Kaluli people for nearly a decade found that clinical depression was virtually nonexistent in their tribe.

I would bet that many Amish and Kaluli people have biological predispositions for mental illnesses, but these genes are less likely to be expressed in an environment that protects and nurtures the body, mind, and spirit. We are less likely to develop body image problems if we grow up in a society without dieting and without a narrowly-defined, media-promoted, unhealthy standard of beauty. We are less likely to develop eating disorders if we live in a society in which everyone eats, effortlessly and without guilt, the types and quantities of foods that their bodies need. We are less likely to suffer from anxiety or depression if we are well-rested, well-nourished, and well-supported by our families and communities. Our children are less likely to show signs of inattention and hyperactivity if they get plenty of fresh air and outdoor exercise and have minimal exposure to television, computers, video games, and cell phones. We may discover that, if we are truly caring for ourselves, we don’t need a cup of coffee to wake up in the morning, we don’t want to go out drinking on the weekends, and most of our aches and pains will diminish without the use of Advil. We may find that we actually enjoy going to bed at 9:00 and rising with the sun, spending more time outdoors, being more physically active, and letting go of excess stress that weighs us down.

Perhaps our minds are not suited for the modern world. The evolution of our brains has not kept up with advances in science, technology, and other aspects of modern life. I am not suggesting that, in a Survivor-like twist of events, we turn back time and return to our ancestral hunter-gatherer environment. Science and technology and modern society are remarkable in many ways, and I feel fortunate to live in the twenty-first century. I am suggesting, however, that we take a critical look at the way we live our lives and examine the effects that our behaviors and lifestyles have on our mental health. We can learn a few lessons from the Kaluli and the Amish. We can place more emphasis on our own self-care and encourage our friends and family to do the same.

When I was working at a university counseling center, a colleague of mine had a client – a college freshman – who met full criteria for major depression and an anxiety disorder. This young man’s case was puzzling initially because his symptoms appeared rather suddenly after starting college and he had no family history of depression or anxiety. After a thorough evaluation, my colleague recommended a few simple behavioral changes such as improving his sleep hygiene, increasing the number of hours he slept each night, decreasing his consumption of alcohol and caffeine, and increasing his physical activity. Within two weeks of changing his habits, his symptoms had disappeared entirely and he was back to his full-functioning, high-energy self.

The moral of this story is that poor self-care not only triggers or exacerbates mental illness in those who are biologically vulnerable, but it can actually create a syndrome that appears identical to a mental illness in those without a predisposition.

Very few people fully appreciate the value of self-care. Children are taught to excel in school and sports and music and arts and various other extracurricular activities. They are taught to follow the Ten Commandments and keep their rooms clean and mind their manners and look pretty. As they grow older, they are taught to stay away from drugs and have safe sex and watch their waistlines. But who will teach them good mental hygiene? Self-care is either glossed over or ignored completely in school. Many well-intentioned parents don’t model good self-care – they are overworked, overscheduled, overtired, overmedicated, over-caffeinated, and undernourished. These parents may encourage good grades and good behavior, but they are unlikely to instill good self-care habits in their children. Most physicians overlook the role of lifestyle factors in triggering or exacerbating mental illnesses, and they use medication as the first line of treatment, even if the patient’s problem could be addressed more effectively with behavioral interventions. Many therapists do not teach their clients the importance of self-care in preventing and reducing the impact of mental illness, instead choosing to target cognitive distortions or family relations or interpersonal skills. Don’t get me wrong – these issues are important as well – but without the baseline of good nutrition, plenty of sleep and exercise, stress management, and other healthy habits, the client is likely to continue to struggle with some level of depression or anxiety.

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Friday, August 21st, 2009

Fear Factor

Regardless of their diagnosis or primary presenting problem, most of the clients I see are struggling with some sort of anxiety. From an epidemiological perspective, this is not surprising. Anxiety disorders affect more than 40 million American adults in any given year and are more prevalent than any other type of psychiatric disorder.

Why are we so anxious? I would attribute it, in large part, to evolution. Anxiety is a universal emotional reaction experienced by all humans and most non-human species as well. Anxiety is a useful trait that has been shaped by natural selection.

Human beings are wired to respond to threat in a self-preserving way. When our body or brain detects danger, our sympathetic nervous system releases adrenaline and prepares the body to defend itself using one of three types of responses: fight, flight, or freeze. In response to threat, our heartbeat becomes stronger and more rapid and our breathing becomes faster and deeper in order to deliver more oxygen to muscle tissues in preparation for fighting or fleeing. Our pupils dilate to let in more light, which increases the sensitivity of our vision and helps us scan the environment for sources of danger. Digestion slows down or stops so as to conserve energy, and our mouth may become dry. Muscle tension increases in preparation for fight, flight, or freeze. All of these bodily reactions were vital in our ancestral environment. They allowed us to fight off predators to defend ourselves and our families. They facilitated us as we fled from all kinds of danger, from wild animals to brushfires to hostile natives. They made us freeze, like a deer in headlights, to aid in scanning the environment for danger, concealing ourselves, and inhibiting predators’ attack reflexes.

For tens of thousands of years, our ancestral environment was brutal. We faced life-or-death situations on a daily basis. Those of us with well-tuned fight or flight responses survived to adulthood and reproduced, passing their genes along to the next generation. Those of us with insufficient fear were less protected and tended to die sooner.

Fast forward to the 21st century. The fight-or-flight reflex is alive and well. If a car speeds towards us as we are crossing the street, we instinctually dart out of the way in a split second. When a masked stranger attacks us from behind, we make a quick jab to his stomach followed by a swift kick to his gonads, then run as fast as we can. These situations, though, are few and far between.

Advances in science, technology, and medicine have obliterated most of the threats our ancestors faced. Compared to people in previous eras, we face far fewer life-threatening encounters. And yet, we are more anxious now than ever before. Our ancestors feared storms, wooly mammoths, tidal waves, plagues, famines, droughts, and vengeful gods. What are we worried about? Our grades in school, our performance at work, our weight and physical appearance, our daughter’s loser boyfriend, public speaking, keeping up with the Jones, conflicts with our friends and partners, the rising costs of gas, swine flu, socialized medicine and Obama’s so-called “death panels.” Even more “legitimate” fears, like global warming, terrorist attacks, bankruptcy, and breast cancer, are probably less likely, less immediate, and less deadly than all our worrying makes them seem.

We do have an evolutionary excuse for this: the sympathetic nervous system tends to be all-or-nothing. It is not always modulated for varying degrees of danger. From a purely physiological standpoint, our bodies may respond the same way whether we are giving an oral presentation in school or being chased by a hungry lion.

Having some degree of anxiety is still advantageous in many ways. A bit of anxiety engenders caution, preparedness, and motivation. Mild to moderate levels of anxiety are associated with better school performance and higher occupational achievement. Anxiety protects us from engaging in dangerous activities, contracting deadly diseases, and acting in ways that may lead to social alienation. Anxiety, like most emotions and characteristics, can be positive when it is understood fully and managed mindfully.

However, the enormous number of Americans suffering from anxiety disorders suggests that something has gone awry with this natural, universal, ordinarily adaptive reflex. The problem, I think, is that in order to be adaptive, emotional responses must fit changing circumstances and challenges. In other words, anxiety is only beneficial insofar as it increases our fitness as a species in the modern world, allowing us to survive and thrive. We’ve been slow to adapt to certain evolutionarily recent threats. Our fears of ghosts, monsters, spiders, and snakes are perhaps a bit excessive. On the other hand, we could probably benefit from more fear of driving fast, cigarettes, and unprotected sex.

We are not slaves to our biology, and evolution is not destiny. The problem with biological determinism is not the biology; it’s the determinism. A number of psychological and behavioral treatments have been shown to reduce problematic anxiety. Through cognitive and behavioral techniques, we can gain insight into the workings of our bodies and minds, develop new ways of thinking, challenge our fears, acquire coping skills, and learn to live mindful, joyful, fulfilling lives that are not limited by anxiety.

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