Nutritional Approaches to Stress

Paleo Diet

The first nutritional approach is the Paleo diet, which consists mainly of animal protein and vegetables, oils and fats, nuts and some types of fruits. This diet eliminates most dairy, soft drinks, fruit juices, legumes, grains, fatty meats, salty foods, starchy vegetables, and sweets. The diet is based on the idea that eliminating grains rids the body of gliadin peptides, which elicit a pro-inflammatory immune response (de Punder & Pruimboom, 2013). These peptides increase intestinal permeability and the high zonulin levels that have been found in celiac disease, multiple sclerosis, intestinal bowel syndrome, cancer, depression, cardiovascular disease, and schizophrenia patients (de Punder & Pruimboom). A result of intestinal permeability (leaky gut syndrome) is a dysfunctional immune system and a chronic inflammatory response. Although this diet may not directly affect psychological stress, it has the potential to decrease the physiological stress caused by the body's inflammatory response. This may be especially salient for individuals intolerant of grain and grain products (Biesiekierski et al., 2011).

In addition, animal protein is a crucial component in the synthesis of dopamine and norephinephrine, as well as providing the body with tryptophan, which is needed in the body's manufacture of serotonin (Laureate Education, Inc., 2012). Protein sources such as fish and poultry help the body to be resilient against stress (Laureate Education, Inc., 2012). This nutritional approach might be contraindicated for individuals allergic or intolerant of any of the foods advocated on this diet.

Mindful Eating
Mindful eating is another nutritional approach that contributed to weight loss, a decrease in psychological distress, and increased positive eating behaviors in obese women. Biological changes included lowered risk for cardiovascular disease, lowered C-reactive protein, and helped them lose weight.

Hanh & Cheung, L. (2010) believed mindful eating helps individuals eat better and eat less. In addition, they found when mindfulness is implemented in this one aspect of daily living(eating), it begins to affect the rest of the individual's self, and brings the richness of mindfulness into every aspect of life. Mindfulness, in general, is an effective method of coping with stress (Baer, Carmody & Hunsinger, 2012). Kelley (2009) believed successful stress management strategies include getting some exercise, meditation, and a healthy diet. Mindful eating seems a promising component of any successful stress management plan.

The contraindications for mindful eating might be the same as for mindfulness meditation. Caution is advised for individuals with serious psychological affects to practicing mindfulness. As I mentioned in this week's discussion 1, this practice may be contraindicated for individuals with posttraumatic stress disorder, addictions, and individuals with severe depression (Dobkin, Irving, & Amar, 2012).

References

Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly Change in Mindfulness and Perceived Stress in a Mindfulness-Based Stress Reduction Program. Journal Of Clinical Psychology, 68(7), 755-765. doi:10.1002/jclp.21865

Barrett, J., Haines, M., Doecke, J., & ... Gibson, P. (2011). Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. The American Journal Of Gastroenterology, 106(3), 508-514. doi:10.1038/ajg.2010.487

Dalen, J., Smith, B., Shelley, B., Sloan, A., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies In Medicine, 18(6), 260-264. doi:10.1016/j.ctim.2010.09.008

Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated? (Report). Mindfulness, (1). 44. doi: 10.1007/s12671-011-0079-9

Hanh, T., & Cheung, L. (2010). Savor: Mindful eating, mindful life. San Francisco, CA US: HarperOne/HarperCollins.

Kelley, D. (2009). The effects of exercise and diet on stress. Nutritional Perspectives: Journal of the Council on Nutrition, 32(1), 37–39.

Laureate Education, Inc. (2012). Stress and its impact on nutrient processing and absorption. [Handout].

de Punder, K. & Pruimboom, L. (2013). The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients, 5, 771-787. doi :10.3390/nu5030771

Mindfulness Based Stress Reduction

Mindfulness based stress reduction (MBSR) is an effective method of coping with stress (Baer, Carmody & Hunsinger, 2012; Hölzel et al., 2011; Grossman, Niemann, Schmidt, & Walach, 2004). During the last three decades, like many other complementary and alternative strategies for clinical and non-clinical problems, mindfulness strategies for the reduction of stress have gained recognition as a viable means of mitigating stress (Roeser et al., 2013). Mindfulness originated from a Buddhist tradition designed to reduce mental suffering (Carmody, Baer, Lykins & Olendzki, 2009). It is a practice of awareness of experience without judgment (Davis & Hayes, 2011). Practitioners of mindfulness learn to accept their circumstances rather than to engage in negative thinking, deactivating the vicious cycle of stress and worry. MBSR has been successful at reducing stress in a variety of circumstances including teaching, terminal cancer, and for the stressors of daily life (Baer et al., 2012; Nyklíček, Mommersteeg, Van Beugen, Ramakers, & Van Boxtel, 2013; Roeser et al., 2013).

Explaining Efficacy of MBSR

Originally, mindfulness was thought to affect the fight or flight response. When a practitioner of MBSR perceives a threat, they are less likely to engage in the negative thought patterns associated with stress. Instead, they are able to perceive their circumstances without judgment, which reduces the stress experienced from worry and rumination. More recently, MBSR has been shown to affect structural changes in the brain, specifically an increase in gray matter in the hippocampus, and right anterior insula, which are involved in emotional regulation and awareness, respectively (Hölzel et al., 2011). Brain plasticity, specifically plasticity of the neural system is reflected in an increase of gray matter as well as improved functioning in performance associated with the particular brain region. Hölzel et al. (2011) found an increase in gray matter in two brain regions; one associated with the production of norephinephrine, and the other of serotonin. As is commonly known, intervening in the serotonin system has had a powerful affect on depression, anxiety, and a range of psychological issues. The norephinephrine system has been associated with modulating responses to environmental demands (Hölzel et al., 2011).

Contraindications and Cautions for MBSR
There are a few contraindications for MBSR and caution is advised for choosing a capable and legitimate instructor (Dobkin, Irving, & Amar, 2012). Participants should not attend a class if they have a medical issue or serious psychological reaction to the training. This type of training may be contraindicated for individuals with posttraumatic stress disorder and addictions. Further, it may not be suitable for severely depressed individuals (Dobkin, Irving, & Amar, 2012).

References

Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly Change in Mindfulness and Perceived Stress in a Mindfulness-Based Stress Reduction Program. Journal Of Clinical Psychology, 68(7), 755-765. doi:10.1002/jclp.21865

Carmody, J., Baer, R. A., Lykins, E., & Olendzki, N. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal Of Clinical Psychology, 65(6), 613-626. doi:10.1002/jclp.20579

Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated? (Report). Mindfulness, (1). 44. doi: 10.1007/s12671-011-0079-9

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35–43. doi:10.1016/S0022-3999(03)00573-7

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, (1), 36. doi:10.1016/j.pscychresns.2010.08.006

Nyklíček, I., Mommersteeg, P. C., Van Beugen, S., Ramakers, C., & Van Boxtel, G. J. (2013). Mindfulness-based stress reduction and physiological activity during acute stress: A randomized controlled trial. Health Psychology, 32(10), 1110-1113. doi:10.1037/a0032200

Roeser, R. W., Schonert-Reichl, K. A., Jha, A., Cullen, M., Wallace, L., Wilensky, R., & ... Harrison, J. (2013). Mindfulness training and reductions in teacher stress and burnout: Results from two randomized, waitlist-control field trials. Journal Of Educational Psychology, 105(3), 787-804. doi:10.1037/a0032093

Mindfulness and Sleep and Insomnia

Two studies provided some interesting information on mindfulness and insomnia. Ong and Sholtes (2010) found  mindfulness meditation affects stress reduction and some symptoms of insomnia.  Lundh (2005) identified cognitive processes that interfere with natural sleep patterns.  Mindfulness helped the insomniac restructure their perceptions of the maladaptive sleep patterns, in effect, reducing the symptoms of insomnia.  Ong and Sholtes explain the mechanism by which mindfulness helps resolve insomnia:  it helps the insomniac become more aware of the mental processes associated with chronic insomnia, lessening the distress associated with maladaptive sleep patterns (not being able to get to sleep), and changes the prevailing relationship between the individual and insomnia. 

I appreciated Ong and Sholtes' perception of mindfulness as self-compassion. If an individual is able to connect to such self-compassion, perhaps this ability would interfere with the negative thought patterns associated with insomnia (Ong & Sholtes, 2010).  It would certainly be worth a try, do you agree?  In addition, mindfulness might help create a new cycle, and the develop of new, more adaptive patterns of  sleep: getting more quality sleep, feeling more rested during the day, increased success at the practice of mindfulness, better sleep, and so on.

In addition, because of your personal experience, you might be interested to check the references in both these articles.  In particular, Harvey has written  an abundance of material on insomnia.

References

Lundh, L. (2005). The Role of Acceptance and Mindfulness in the Treatment of Insomnia. Journal Of Cognitive Psychotherapy, 19(1), 29-39.

Ong, J., & Sholtes, D. (2010). A mindfulness-based approach to the treatment of insomnia. Journal Of Clinical Psychology, 66(11), 1175-1184. doi:10.1002/jclp.20736

The Effect of Hope on Cancer Patient

Hope is a construct that involves targeting a future time or goal or an action that will be undertaken (Berg, Ritschel, Swan, An, & Ahluwalia, 2011). It involves goal-directed thought processes within which individuals assess possibilities and their personal abilities that can be used to facilitate accomplishing the goals (Snyder, 1996; 2002). It can also be defined as a construct that seems to have an important place in an individual's life when the present is difficult to tolerate or accept or when circumstances are suboptimal. Hopes change with knowledge, and although one goal may have to be altered to failure, these losses and alterations may be an inherent part of the goal-directed thought process (Snyder, 1996). For example, when patients are diagnosed with cancer, they may hope for a full recovery. Later, as the individual's condition deteriorates, they may hope for strength and peace as they approach death. Folkman (2010) believed coping fostered hope in the darkest of circumstances, and hope cultivated the lasting effects of coping.

Hope has a constructive place in health and longevity. Hope has been associated with better adaptation and adjustment in disease and injury (Barnum, Snyder, Rapoff, Mani, & Thompson, 1998; Jackson, Taylor, Palmatier, Elliott, & Elliott, 1998) and to increased pain tolerance (Berg, Snyder, & Hamilton, 2008). It is, as described by Elliott and Olver (2009) as essential to the well-being of patients. For this discussion, I have chosen the effects of hope in terminally ill cancer patients.

Helping Patients Generate and Sustain Hope

Hope is essential, and sustaining it provides psychological nourishment for the terminally ill (Elliott & Olver, 2009). However, Elliott and Olver (2009) found a paucity of research on how terminally ill patients relate, perceive, and interact with hope. Beinzein, Norberg, and Saverman (2001) found four distinct hopes in these individuals: for a cure, to live as normally as possible, to have someone with them until the end, and to come to terms with their finality. The first seems unrealistic and false, but fostering the latter three seems realistic. The patient could be encouraged to live as normally as possible in their home with the help of hospice care. If the patient has a companion, the value of that companionship could become a focus of hope, that they could enjoy each other until the end. He or she could be encouraged to actively work on coming to terms with the end of life. Hospice care could help facilitate that process. If the individual participates in a religion, a religious advisor could be helpful in sustaining hope for coming to terms with death.

Herth (1990) found as individuals approached death, having attainable goals, interpersonal connectedness, and spirituality were the most salient categories of hope. Herth suggested fostering hope through loving or caring relationships with the patient and his or her family and actively listening to the patient and expressing optimism and hopefulness when the patient expressed hope generated and sustained those hopes. Encouragement, humor, fostering lightheartedness, and facilitating an environment within which the individual can explore and reflect upon his or her spirituality are essential as well (Herth, 1990).

Hope in Relation to the Stress and Immune Response
Hope is like coping in that it is a transaction, of sorts, between the individual and their environment (Folkman, 2010). Often, the environment is an internal environment generated by self-reflection and thoughtfulness. Whereas coping is a method of managing demands, hope is a means of relieving the stress of a negative outcome. When patients are terminally ill, the future is uncertain, which leaves them feeling out of control, which can lead to a heightened stress response (Carver, 2011). Folkman suggested hope is a reappraisal process that reduces the threat of the disease. It is a component of the cognitive coping process that, along with other coping skills elicits a relaxation response that calms the stress response, which in turn allows the immune system to return to a normal state.

References

Barnum, D. D., Snyder, C., Rapoff, M. A., Mani, M. M., & Thompson, R. (1998). Hope and Social Support in Psychological Adjustment of Children Who Have Survived Burn Injuries and Their Matched Controls. Children's Health Care, 27(1), 15-30. doi: 10.1207/s15326888chc2701_2

Benzein, E., Norberg, A., & Saveman, B. I. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117–126

Berg, C. J., Snyder, C., & Hamilton, N. (2008). The Effectiveness of a Hope Intervention in Coping with Cold Pressor Pain. Journal of Health Psychology, 13(6), 804-809. doi: 10.1177/1359105308093864

Berg, C. J., Ritschel, L. A., Swan, D. W., An, L. C., & Ahluwalia, J. S. (2011). The role of hope in engaging in healthy behaviors among college students. American Journal of Health Behavior, 35(4), 402–415.

Carver, C. S. (2011). Effects of stress on immune function: Implications for immunoprotection and immunopathy. In R. J. Contrada, & A. Baum (Eds.), The handbook of stress science (pp. 221-229). New York: Springer Publishing Company.

Eliott, J., & Olver, I. (2009). Hope, life, and death: a qualitative analysis of dying cancer patients' talk about hope. Death Studies, 33(7), 609-638.

Folkman, S. (2010). Stress, coping, and hope. Psycho-Oncology, 19(9), 901–908.

Gallagher, M. W., & Lopez, S. J. (2009). Positive expectancies and mental health: Identifying the unique contributions of hope and optimism. The Journal of Positive Psychology, 4(6), 548–556.

Herth, K. (1990). Fostering hope in terminally-ill people. Journal Of Advanced Nursing, 15(11), 1250-1259. doi:10.1111/j.1365-2648.1990.tb01740.x

Jackson, W. T., Taylor, R. E., Palmatier, A. D., Elliott, T. R., & Elliott, J. L. (1998). Negotiating the reality of visual impairment: Hope, coping, and functional ability. (1998). Journal of Clinical Psychology in Medical Settings, 5(2), 173.

Snyder, C. R. (1996). To hope, to lose, and to hope again. Journal Of Personal & Interpersonal Loss, 1(1), 1. doi:10.1080/15325029608415455

Snyder, C. R. (2002). Hope Theory: Rainbows in the Mind. Psychological Inquiry, (4), 249. doi:10.2307/1448867

The Relationship between Sleep and Stress

The relationship between sleep and stress is complex and not clearly understood although, it is a bidirectional relationship in that each effects the other (Vandekerckhove & Cluydts, 2010). Stress alters an individual's basic sleep patterns as well as sleep's fundamental anatomy and these alterations have a profound influence on health and well-being. For example, in individuals who attempt suicide, increases in rapid eye movement (REM) sleep during the night prior to a suicide attempt have been identified. Further, altered sleep patterns have been identified in people with depression and in alcoholics prior to relapse (Vandekerckhove & Cluydts, 2010).

For general well-being, the impact of sleep is a salient determinant; it is restorative and may soften the blows of daily stressors. Considering Lazarus' (1991) explanation of the role of cognitive appraisal in determining the threatening nature of circumstances, a good night's sleep may help stave negative or threatening cognitive appraisals and may decrease an individual's predisposition to stress. Lack of sleep has neurophysiological implications as well, in its influence on neural activity in the extended limbic system and other brain regions. In short, sleep has a tremendous affect on the brain, which has subsequent far-reaching effects on cognitive processing, mood, and coping (Vandekerckhove & Cluydts, 2010). Further, it regulates emotions, the capacity to manage stress, and behaviors.

Sleep Deprivation and Illness

Sleep deprivation is implicated in several examples of ill health. It has been associated with substance use and abuse with over 45% of patients with sleep problems self-medicating. In older adults, self-medicating with sedative-type drugs is especially problematic since these drugs are harmful for this population (Wells & Vaughan, 2012). Sleep deprivation has been linked to decreased cognitive functioning, lethargy, and emotional instability (Alhola, & Polo-Kantola, 2007; Wells & Vaughan, 2012). In addition, lack of sleep has been associated with an increased risk of stroke, depression, diabetes, heart disease, and obesity and other chronic diseases (Balkin, Rupp, Picchioni, & Wesensten, 2008).

Sleep deprivation has been associated with increased blood pressure and stress hormones, which have the potential to interfere with cognitive functioning and memory (Joo, Yoon, Koo, & Hong, 2013). Stress events (such as sleep deprivation) cause an endocrinological response to stress via alterations in the balance of hormones, such as increased cortisol and thyroid hormone (Maggio et al., 2013) and biological markers for inflammation (Yoo et al., 2013). Sleep loss causes a stress response that provokes inflammatory proteins that play a central role in loss of immunity and disease progression (Frick et al., 2009).

Sleep Hygiene Education

One concept in the practice of good sleep hygiene includes developing a relaxing bedtime routine (Wells & Vaughan, 2012) that does not include watching television in the bedroom (National Sleep Foundation (NSF), 2012). Watching television in the bedroom decreases the quality of sleep. Especially violence, whether news related or fictional, can cause disturbing sleep (NSF, 2012). Caffeine should be avoided. For some, that means no caffeine in the afternoon if it has long-term stimulating effects.

Alhola, P., & Polo-Kantola, P. 2007. Sleep deprivation: Impact on cognitive performance. Journal of Neuropsychiatric Disease and Treatment, 3 (5), 553–67.

Balkin, T., Rupp, T., Picchioni, D., & Wesensten, N. (2008). Sleep loss and sleepiness: current issues. Chest, 134(3), 653-660.

Benham, G. (2010). Sleep: An important factor in stress-health models. Stress and Health: Journal of the International Society for the Investigation of Stress, 26(3), 204–214.

Bonnet, M. H., & Arand, D. L. (2011). How much sleep do adults need? Retrieved from http://www.sleepfoundation.org/article/white-papers/how-much-sleep-do-adults-need

Frick, L. R., Rapanelli, M., Bussmann, U. A., Klecha, A. J., Barreiro Arcos, M. L., Genaro, A. M., & Cremaschi, G. A. (2009). Involvement of thyroid hormones in the alterations of T-cell immunity and tumor progression induced by chronic stress. Biological Psychiatry, 65(11), 935–942.

Joo, E., Yoon, C., Koo, D., Kim, D., & Hong, S. (n.d). Adverse Effects of 24 Hours of Sleep Deprivation on Cognition and Stress Hormones. Journal Of Clinical Neurology, 8(2), 146-150.

Kwon, J. A., Lee, M., Yoo, K., & Park, E. (2013). Does the Duration and Time of Sleep Increase the Risk of Allergic Rhinitis? Results of the 6-Year Nationwide Korea Youth Risk Behavior Web-Based Survey. Plos ONE, 8(8), 1-7. doi:10.1371/journal.pone.0072507

Maggio, M., Colizzi, E., Fisichella, A., Valenti, G., Ceresini, G., Dall'Aglio, E., & ... Ceda, G. (n.d). Stress hormones, sleep deprivation and cognition in older adults. Maturitas, 76(1), 22-44.

National Institute on Aging. (2011). A good night’s sleep. Retrieved from http://www.nia.nih.gov/health/publication/good-nights-sleep

National Sleep Foundation. (2012). Myths and Facts. Sleep Myths & Sleep Facts. Retrieved October 25, 2013, from http://www.sleepfoundation.org/sleep-facts-information/myths-and-facts

Vandekerckhove, M., & Cluydts, R. (2010). The emotional brain and sleep: An intimate relationship.(Report). Sleep Medicine Reviews, (4), 219. doi:10.1016/j.smrv.2010.01.002

Wells, M., & Vaughn, B. (2012). Poor sleep challenging the health of a Nation. The Neurodiagnostic Journal, 52(3), 233-249.

Wong, M., Lau, E., Wan, J., Cheung, S., Hui, C., & Mok, D. (2013). The interplay between sleep and mood in predicting academic functioning, physical health and psychological health: a longitudinal study. Journal Of Psychosomatic Research, 74(4), 271-277. doi:10.1016/j.jpsychores.2012.08.014