Integrative Health in Psychotherapy

Integrative Health in PsychotherapyCharles M. Ware, D.H.Ed., M.S., CHES

You are stranded on a deserted island!You …

Are alone for one yearHave access to clean filtered waterCan only have one food

Must pick a food that you think would be best for your overall health.

Objectives of this course Explain the importance of a healthy lifestyle in preventing premature disease

and promoting wellness.

Define each of the four components of psychosocial health.

Identify the basic traits shared by psychosocially healthy people.

Explain how mental health professionals can play a role in preventing specific types of psychosocial health problems.

Define integrative health and medicine.

Identify three integrative health practices to use in psychotherapy.

What is integrative health?

Integrative healthcare is a practice that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing (Academy of Integrative Health & Medicine, 2015).

Definition of Health and WellnessHealth

The ever-changing process of achieving individual potential in the physical, social, emotional, mental, spiritual, and environmental dimensions.

WellnessThe achievement of the highest level possible in

each of several dimensions.

To some, health means the antithesis of sickness, to others it means being in good enough physical shape to resist illness.

Dimensions of health and wellnessPhysical health

Social health

Intellectual health

Environmental heath

Emotional health

Spiritual health

Dimensions of health and wellnessPhysical Includes body functioning, physical fitness, and ability to

perform activities of daily living (ADLs)SocialAbility to have satisfying interpersonal relationships

Intellectual Using “brain power” effectively to meet challengesAbility to think clearly and to reason objectively

Dimensions of health and wellnessEnvironmentalAppreciation of the external environment and one’s role

to preserve, protect, and improve its conditionsEmotionalSelf-esteem, self-confidence, self-efficacy, and

other emotional reactions and responsesSpiritualFeeling as if part of a greater spectrum of existence

Dimensions of health and wellnessSocial Health: Interactions with Others

Aspect of psychosocial health that includes interactions with others, ability to use social supports, and ability to adapt to various situations

Social bondsSocial supportTangible support Intangible support

Dimensions of health and wellness Intellectual Health

“Thinking” or “rational” part of psychosocial healthMentally healthy people tend to respond to life’s

challenges constructively. Irrational thinking may indicate poor mental health.

Dimensions of health and wellnessEmotional Health: The Feeling You

The “feeling” or subjective side of psychosocial health that includes emotional reactions to life

Emotions are intensified feelings and complex patterns:Love, hate, frustration, anxiety, and joy

Dimensions of health and wellness Other important concepts:

Mental healthA broad concept that encompasses dimensions of

emotional, social, spiritual, and intellectual healthThe thinking part of psychosocial health Includes your values, attitudes, and beliefs

Spiritual Health-Holistic approach to healthEmphasizes the integration and balance of mind,

body, and spirit

How does psychosocial health play a role in integrative healthcare?

Psychosocial health encompasses the mental, emotional, social, and spiritual dimensions of what it means to be healthy.

Psychosocial health is the result of complex interaction between a person’s history and his or her thoughts about and interpretations of the past and what the past means to the present.

Maslow’s Hierarchy of Needs

In the 1960s, human theorist Abraham Maslow developed a hierarchy of needs to describe the certain basic needs that a person must have in order to be a socially healthy individual.


According to Maslow’s theory, a person’s needs must be met at each of these levels before that person can ever truly be healthy. Failure to meet one of the levels interferes with the person’s ability to address the other levels.

Base level of needs?

Base level of needs

Sleep time vs. Sleep efficiency Previous research stated we needed at least 60 hours of

cumulative sleep a week.

Dr. William Seiber (2015) states that the goal of sleep should be sleep efficiency and NOT sleep time.

Poor sleep and fatigue leads to overactive amygdala.

Remember that the amygdala is the integrative center for emotions, emotional behavior, and motivation.

Sleep time vs. Sleep efficiency Studies show that those who get less than 6 hours of sleep are

42% more likely to get diabetes. Compared to…those with the most disturbed sleep are 97% more likely to die in the next 20 years.

Poor sleep may make you more prone to pre-diabetes, anxiety, and upsetting emotions.

Less sleep also affects appetite and eating.

Leptin is the hormone that lowers our appetite, and ghrelin is the hormone that increases appetite. With sleep deprivation our leptin goes down, and our ghrelin goes up (it also does it with overeating!).

Why water?Water is necessary for:

Electrolyte and pH balance

Transporting cells and molecules (every heard of water soluble vitamins?)

Lack of water

Dehydration can impair short-term memory function and the recall of long-term memory

How much water?Weight in pounds (lbs)Divide by two (2)Answer equals number of ounces (oz) of water per day

Example:230 lbs. /2 = 115 oz.This is equivalent to 7 bottles of 16.9 oz (500ml)

bottles of water.

Studying the Nutrition-Brain-Behavior Connection

The study of how nutrition affects the brain and behavior is relatively new.

Scientists have just begun to understand how changes in particular nutrients alter the brain and how these neural changes then affect intelligence, mood, and the way people act


There is a link between poor nutrition and environmental factors.

Therefore, changes in behavior may not be due to poor nutrition only.

Other factors such as education, social or family problems may affect behavior.


It is difficult to alter only one substance in the human diet.

Therefore, it is difficult to determine if a particular vitamin or mineral has a certain effect on behavior.


People respond to different modifications in different ways.

In other words, there is a large individual variation in the body's response and need for different nutrients.


A change in diet may have a placebo effect.

The placebo effect occurs because a person thinks something will have an effect.

In other words, if a person thinks a change in diet will affect behavior, it may actually affect behavior even if the nutrients are not causing the change.

Nutritional PsychologyPotential impact diet has on the diagnosis and

treatment of mental disorders, including possible misdiagnosis of non-psychiatric conditions created by today's modern dietary lifestyle.

Diet and NeurotransmittersCertain foods contain precursors (starting

materials) for some neurotransmitters. If a diet is deficient in certain precursors, the brain will not be able to produce some neurotransmitters.

Neurological and mental disorders may occur when the balance of neurotransmitters is upset.

Diet and NeurotransmittersAspartic Acid

Used to make aspartate; found in peanuts, potatoes, eggs and grains.

Spinal cord neurotransmitterAlso has pre-synaptic membrane function

Diet and NeurotransmittersCholine

Used to make acetylcholine; found in eggs, liver and soybeans.

Is an excitatory neurotransmitterControls skeletal and smooth musclesHelpful in patients with multiple sclerosis

Diet and NeurotransmittersGlutamic Acid

Used to make glutamate; found in flour and potatoes.

Most common neurotransmitter in the brain.Sodium/Potassium exchange

Diet and NeurotransmittersPhenylalanine

Used to make dopamine; found in beets, soybeans, almonds, eggs, meat and grains.

Dopamine, like epinephrine, produces arousal. Is also in aspartame

Some research suggests that patients with ADHD have lower levels of amino acids such as phenylalanine, so there was hope that providing phenylalanine might treat ADHD.

Diet and NeurotransmittersTryptophan

Used to make serotonin; found in eggs, meat, skim milk, bananas, yogurt, milk, and cheese.

High carbohydrate meals affect glucose levels by increasing insulin secretion.

The drowsiness induced by serotonin is a common effect of a large carbohydrate meal.

High-estrogen contraceptives may have contributed to depression by lowering serotonin levels in the brain

Diet and NeurotransmittersTyrosine

Used to make norepinephrine; found in milk, meat, fish and legumes.

As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled.

Norepinephrine, along with dopamine, has come to be recognized as playing a large role in attention and focus.

Malnutrition and the BrainVitamin and mineral deficiencies can be caused

by:StarvationPoor dietPoor absorption of vitamins and mineralsDamage to the digestive system InfectionAlcoholism

Obtaining Essential NutrientsVitamins Potent, essential, organic compoundsPromote growth and help maintain life and healthTwo types

Fat soluble—absorbed through intestinal tract with the help of fats. A, D, E, and K vitamins are fat soluble.

Water soluble—dissolve in water. B-complex vitamins and vitamin C are water soluble.

Few Americans suffer from vitamin deficiencies.Overusing them can lead to a toxic condition known as

hypervitaminosis.

Obtaining Essential Nutrients Antioxidants

Most common are vitamin C, vitamin E, and beta-carotene Free radicals damage or kill healthy cells. Antioxidants scavenge free radicals, slow their formation, and

repair oxidative stress damage. Carotenoids

Lycopene (in tomatoes, papaya, pink grapefruit, and guava) reduces the risk of cancer.

Lutein (in green leafy vegetables, spinach, broccoli, kale, and brussels sprouts) protects the eyes.

Obtaining Essential NutrientsMinerals

Inorganic, indestructible elements that aid the bodyVitamins cannot be absorbed without minerals

Macrominerals are needed in large amounts.Sodium, calcium, phosphorus, magnesium,

potassium, sulfur, and chlorideTrace minerals are needed in small amounts

Iron, zinc, manganese, copper, and iodineExcesses or deficiencies of trace minerals can cause

serious problems.

Obtaining Essential NutrientsSodium

Necessary for regulation of blood and body fluids, transmission of nerve impulses, heart activity, and certain metabolic functions.

Recommended consumption less than 1 teaspoon of table salt per day

Pickles, snack foods, processed cheeses, canned soups, frozen dinners, breads, smoked meats, and sausages contain large amounts.

Obtaining Essential NutrientsCalcium

Plays a vital role in building strong bones and teeth, muscle contraction, blood clotting, nerve impulse transmission, regulating heartbeat, and fluid balance within cell

Recommended amount 1,000 to 1,200 mg/dayMilk, calcium-fortified orange juice, soy milk, broccoli,

cauliflower, peas, beans, nuts, and molasses are good sources.

Obtaining Essential NutrientsIron

The most common nutrient deficiency globallyWomen aged 19 to 50 need about 18 mg per day, and

men aged 19 to 50 need about 10 mg. Iron-deficiency anemia—body cells receive less

oxygen, and carbon dioxide wastes are removed less efficiently

Iron toxicity—ingesting too many iron containing supplements

Men who consume excess iron have a higher risk of gallstones.

A Guide to Water-Soluble Vitamins

A Guide to Fat-Soluble Vitamins

A Guide to Major Minerals

Continued

A Guide to Major Minerals

A Guide to Trace Minerals

Using Integrative Health in PsychotherapyEmotional, physical, and nutritional needs must

be addressed when developing a wholistic (holistic) therapeutic plan.

Psychosocially healthy people are emotionally, mentally, socially, intellectually, and spiritually resilient.

Develop integrative plan where…Healthy people…

Feel good about themselvesFeel comfortableControl tension and anxietyMeet demands of lifeCurb hate and guiltMaintain a positive outlookValue diversityAppreciate and respect natureEnrich the lives of others

Is laughter the best medicine?

When psychosocial health deteriorates…so do other dimensions

Any disorder that disrupts thinking, feeling, moods, and/or behaviors and causes a varying degree of impaired functioning in daily life is defined as…?

THOUGHTS become WORDSWORDS become BEHAVIORSBEHAVIORS become HABITS

HABITS become VALUESVALUES become YOU

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Prentice Hall, Inc. Coleman, M. & Gillberg, C. (1996). The Schizophrenias. A biological approach to the schizophrenia

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Treatment.3(a). Gordon, A.M. (2014). The psychology of nutrition: Are you stereotyping food? Retrieved from

https://www.psychologytoday.com/blog/between-you-and-me/201403/the-psychology-nutrition Grosvenor, M.B., & Smolin, L.A. (2014). Visualizing nutrition: everyday choices (3rd ed.). Hoboken, NJ:

John Wiley & Sons, Inc. Mahan, L.K. & Escott-Stump, S. (1996). Krause's food, nutrition, and diet therapy. Philadelphia: W.B.

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Integrative Health in Psychotherapy

Education

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